NCLEX Neuro Review Questions And Answers With Rationale

NCLEX Neuro Review Questions And Answers With Rationale Which statement is true for a patient who has pathology in Wernicke's area of the cerebrum? A. Receptive speech is affected. B. The parietal lobe is involved. C. Sight processing is abnormal. D. An abnormal Romberg test is present. A The temporal, not parietal, lobe contains the Wernicke area, which is responsible for receptive speech and integration of somatic, visual, and auditory data. Sight processing occurs in the occipital lobe. The Romberg test is used to assess the position sense of the lower extremities. After a major head trauma, the patient's respiratory and cardiac functions are affected. Which area of the brain is damaged? A. Temporal lobe of the cerebrum B. Brainstem C. Cerebellum D. Spinal nerves B The brainstem includes the midbrain, pons, and medulla. The vital centers concerned with respiratory, vasomotor, and cardiac function are located in the medulla. Integration of somatic, visual, and auditory data occurs in the temporal lobe. The cerebellum coordinates voluntary movement, trunk stability, and equilibrium. Motor and spinal nerves serve particular areas of the body. What is the purpose of the blood-brain barrier? A. To protect the brain by cushioning B. To inhibit damage from external trauma C. To keep harmful agents away from brain tissue D. To provide the blood supply to brain tissue C The blood-brain barrier is a physiologic barrier between capillaries and brain tissue. The structure of the brain's capillaries is different from others, and substances that are harmful are not allowed to enter brain tissue. Lipid-soluble compounds enter the brain easily, but water-soluble and ionized drugs enter slowly. The spinal fluid and meninges help cushion the brain. The skull protects from external trauma. Blood is supplied to the brain from the internal carotid arteries and the vertebral arteries. In a patient with a disease that affects the myelin sheath of nerves, such as multiple sclerosis, which glial cells are affected? D Types of glial cells include oligodendrocytes, astrocytes, ependymal cells, and microglia, and each has specific functions. Oligodendrocytes are specialized cells that produce the myelin sheath of nerve fibers, and they are primarily found in the white matter of the central nervous system. Drugs or diseases that impair the function of the extrapyramidal system may cause loss of A. sensations of pain and temperature. B. regulation of the autonomic nervous system. C. integration of somatic and special sensory inputs. D. automatic movements associated with skeletal muscle activity. D A group of descending motor tracts carries impulses from the extrapyramidal system, which includes all motor systems (except the pyramidal system) concerned with voluntary movement. It includes descending pathways originating in the brainstem, basal ganglia, and cerebellum. The motor output exits the spinal cord through the ventral roots of the spinal nerves An obstruction of the anterior cerebral arteries affects A. visual imaging. B. balance and coordination. C. judgment, insight, and reasoning. D. visual and auditory integration for language comprehension. C The anterior cerebral artery feeds the medial and anterior portions of the frontal lobes. The anterior portion of the frontal lobe controls higher-order processes such as judgment and reasoning. Paralysis of lateral gaze indicates a lesion of cranial nerve A. II. B. III. C. IV. D. VI. D Cranial nerves III (oculomotor), IV (trochlear), and VI (abducens) are responsible for eye movement. The lateral rectus eye muscle is innervated by cranial nerve VI and is the primary muscle that is responsible for lateral eye movement Results of stimulation of the parasympathetic nervous system are (select all that apply) A. constriction of the bronchi. B. dilation of skin blood vessels. C. increased secretion of insulin. D. increased blood glucose levels. E. relaxation of the urinary sphincters A, B, C, D Parasympathetic nervous system stimulation results in constriction of the bronchi, dilation of blood vessels to the skin, increased secretion of insulin, and relaxation of the urinary sphincter. Sympathetic nervous system stimulation results in increased blood glucose levels. Why is it difficult to compare the assessment of muscle strength of older adults with that of younger adults? A. Stroke is more common in older adults. B. Nutritional status is better in young adults. C. Most young people exercise more than older people. D. Muscle bulk and strength decrease with age. D Changes associated with aging include decreases in muscle strength and agility related to a decrease in muscle bulk. A patient who has a neurologic disease that affects the pyramidal tract is likely to manifest which signs? A. Impaired muscle movement B. Decreased deep tendon reflexes C. Decreased level of consciousness D. Impaired sensation of touch, pain and temperature A Among the most important descending tracts are the corticobulbar and corticospinal tracts, collectively called the pyramidal tract. These tracts carry volitional (voluntary) impulses from the cortex to the cranial and peripheral nerves. Dysfunction of the pyramidal tract is likely to manifest as impaired movement. Diseases affecting the pyramidal tract do not result in changes in the level of consciousness, impaired reflexes, or decreased sensation. What is important when obtaining a history of a patient with a neurologic problem? A. Have patient agree or disagree with suggested symptoms to obtain a thorough history. B. Mode of onset and course of illness are essential aspects. C. Check out neurologic problems caused by nutrition by asking about sodium. D. Assess for dementia using the Confusion Assessment Method (CAM). B The mode of onset and the course of the illness are especially important aspects of the history. The nature of a neurologic disease process often can be described by these facts alone. Avoid suggesting certain symptoms or using leading questions. Nutritional deficits of B vitamins are most likely to cause neurologic problems. CAM is used to assess for delirium. What is the most common visual field change resulting from a brain lesion? A. Diplopia B. Blurred vision C. Presbyopia D. Hemianopsia D Visual field changes resulting from brain lesions are usually diagnosed as hemianopsia (one half of the visual field) or quadrantanopsia (one fourth of the visual field) or monocular vision. Which statement is the proper nursing action when testing visual acuity? A. Record the lowest line the patient reads with 50% accuracy. B. Have the patient remove glasses before reading the Snellen test. C. Have the patient point to the readable line if the patient is aphasic. D. Have the patient tell the number of fingers held up if a Snellen test not available. A The Snellen chart is read from 20 feet away, and the number on the lowest line that the patient can read with 50% accuracy is recorded. If the patient wears glasses normally, he or she should wear them during the test. Acuity may not be testable by these means if the patient does not read English or is aphasic. If a Snellen test is not available, the patient is asked to read newsprint for gross assessment of acuity, and the distance from the patient to the newsprint should be recorded. Using the number of fingers held up tests only gross visual ability. You trace the number 8 on the patient's palm, and ask the patient to identify the number. What is this diagnostic test indicating? A. Function of cranial nerves XI and XII B. Stereognosis C. Cortical integration in the parietal lobe D. Spinocerebellar tracts C Graphesthesia, the ability to feel writing on skin, is a test of cortical integration of sensory perceptions (which occurs in the parietal lobes). Cranial nerve XI (accessory) is tested by shrugging the shoulders and turning the head to the side, and cranial nerve XII (hypoglossal) is tested by protruding the tongue. Stereognosis is the ability to perceive the form and nature of objects. Spinocerebellar tracts carry information about muscle tension and body position to the cerebellum. When assessing a patient with a traumatic brain injury, you notice uncoordinated movement of the extremities. How would you document this? A. Ataxia B. Apraxia C. Anisocoria D. Anosognosia A Ataxia is a lack of coordination of movement, possibly caused by lesions of sensory or motor pathways, cerebellar disorders, or certain medications. How do you assess the accessory nerve? A. Assess the gag reflex by stroking the posterior pharynx. B. Ask the patient to shrug the shoulders against resistance. C. Ask the patient to push the tongue to either side against resistance. D. Have the patient say "ah" while visualizing elevation of the soft palate B The spinal accessory nerve is tested by asking the patient to shrug the shoulders against resistance and to turn the head to either side against resistance. The other options are used to test the glossopharyngeal and vagus nerves. When assessing motor function of a patient admitted with a stroke, you notice mild weakness of the arm demonstrated by downward drifting of the extremity. How would you accurately document this finding? A. Athetosis B. Hypotonia C. Hemiparesis D. Pronator drift D Downward drifting of the arm or pronation of the palm is identified as pronator drift. Hemiparesis is weakness of one side of the body, hypotonia describes flaccid muscle tone, and athetosis is a slow, writhing, involuntary movement of the extremities A patient's sudden onset of hemiplegia has necessitated a computed tomography (CT) of her head. Which assessment should you complete before this diagnostic study? A. Assess the patient's immunization history. B. Screen the patient for any metal parts or a pacemaker. C. Assess the patient for allergies to shellfish, iodine, or dyes. D. Assess the patient's need for tranquilizers or antiseizure medications. C Allergies to shellfish, iodine, or dyes contraindicate the use of contrast media for CT. The patient's immunization history is not a central consideration, and the presence of metal in the body does not preclude the use of CT as a diagnostic tool. The need to assess for allergies supersedes the need for tranquilizers or antiseizure medications in most patients. How should you most accurately assess the position sense of a patient with a recent traumatic brain injury? A. Ask the patient to close his or her eyes and slowly bring the tips of the index fingers together. B. Ask the patient to maintain balance while standing with his or her feet together and eyes closed. C. Ask the patient to close his or her eyes and identify the presence of a common object on the forearm. D. Place the two points of a calibrated compass on the tips of the fingers and toes, and ask the patient to discriminate the points. B The Romberg test is an assessment of position sense in which the patient stands with the feet together and then closes his or her eyes while attempting to maintain balance. The other tests of neurologic function do not directly assess position sense. Why are the data regarding mobility, strength, coordination, and activity tolerance important for you to obtain? A. Many neurologic diseases affect one or more of these areas. B. Patients are less able to identify other neurologic impairments. C. These are the first functions to be affected by neurologic disease. D. Aspects of movement are the most important function of the nervous system. A Many neurologic disorders can cause problems in the patient's mobility, strength, and coordination. These problems can result in changes in the patient's usual activity and exercise patterns. During neurologic testing, the patient is able to perceive pain elicited by a pinprick. Based on this finding, which assessment may be omitted? A. Position sense B. Patellar reflexes