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Exam (elaborations)

NCLEX RN TEST

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hich assessment finding would the nurse anticipate identifying in a patient Wdiagnosed with an upper motor neuron (UMN) lesion? - Areflexia - Hyperreflexia - Denervation atrophy - Decreased muscle tone - Hyperreflexia After reviewing the MRI reports of four patients, which patient would the nurse integrate interventions related to paralysis into the plan of care? - Left cerebral cortex lesion - Cerebral cortex lesion - Lower motor neuron lesion - Right parietal cortex lesion Lower motor neuron lesion - The cell bodies of lower motor neurons send axons to innervate the skeletal muscles of the legs, arms, and trunk, and therefore control the body movements. - A lower motor neuron lesion is likely to result in paralysis Left cerebral cortex lesion causes dysphasia and speech difficulties Cerebral cortex lesion causes apraxia - pt is unable to perform learned movements despite of having the physical ability to perform them Right parietal cortex lesion causes anosognosia - an inability to recognize a bodily defect or disease Which functions would the nurse be able to assess when performing a pupillary assessment on an unconscious patient? Select all that apply. - Size - Shape - Reactivity - Convergence - Accommodation - Size - Shape - Reactivity Pupil convergence and accommodation require the patient to focus on the examiner's finger as it moves toward the patient's nose. Which neurotransmitter, released by the preganglionic and postganglionic fibers, would the nurse associate with a patient's parasympathetic response? - Dopamine - Epinephrine - Acetylcholine - Norepinephrine Acetylcholine Which component of the neurologic system is responsible for BP changes in an older adult patient? - Motor reflexes - Central nervous system - Autonomic nervous system - Peripheral nervous system Autonomic nervous system Identify the functions associated with the area depicted in the figure. (Cerebellum) Select all that apply. Regulates the endocrine system Coordinates voluntary movement Maintains trunk stability and equilibrium Regulates arousal and sleep-wake transitions controls coughing, hiccupping, and sneezing response - Coordinates voluntary movement - Maintains trunk stability and equilibrium The area depicted in the figure performs which function? (nodes of Ranvier) - Secretes cerebrospinal fluid - Performs phagocytic action - Enables saltatory conduction - Provides protection to neurons Enables saltatory conduction = gaps in the myelin sheath - action potentials travel quickly along the nodes because they do not traverse the insulated membrane but hop from node to node through saltatory conduction Which nervous system abnormality would the nurse associate with an extensor plantar response? - Brainstem lesions - Lower motor neuron lesions - Upper motor neuron lesions - Lesions in the sensory cortex Upper motor neuron lesions Extensor plantar response The toes point up with plantar stimulation Which function do spinocerebellar tracts perform? - To carry volitional impulses - To carry information about muscle tension - To carry pain and temperature sensations - To carry impulses concerned with deep pressure To carry information about muscle tension - to coordinate movement A patient with a lesion in the central nervous system has developed spasticity with hyperreflexia, weakness, paralysis in the lower extremities, and disuse atrophy. Which potential lesion location would the nurse associate with the patient's clinical manifestations? - Reflex arcs - Upper motor neurons - Lower motor neurons - Ventral roots of the spinal nerves. Upper motor neurons Which glial cells would the nurse associate with a patient's increased intracranial pressures after sustaining a head injury? - Microglia - Astrocytes - Schwann cells - Ependymal cells Ependymal cells - aid in the secretion of CSF - increased secretion of CSF increases ICP, resulting in herniation syndrome. Which situation warrants an assessment of the patient's ability to sense temperature? - When the patient's skin temperature feels very warm - Assess temperature sensations if the patient's pain reflex is absent - Determine the patient's temperature with the e

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