A
The nurse caring for an 80-year-old client knows that the client has a preexisting history of dulled tactile sensation. The nurse should first consider what possible cause for this client's diminished tactile sensation?
A. Damage to cranial nerve VIII
B. Adverse medication effects
C. Age-related neurologic changes
D. An undiagnosed cerebrovascular disease in early adulthood
ANS: C
Rationale: Tactile sensation is dulled in the older adult client due to a decrease in the number of sensory receptors. While thorough assessment is necessary, it is possible that this change is unrelated to pathophysiologic processes.
A 72-year-old man has been brought to his primary care provider by the client’s daughter, who claims that the client has been experiencing uncharacteristic lapses in memory. What principle should underlie the nurse's assessment and management of this client?
A. Loss of short-term memory is normal in older adults, but loss of long-term memory is pathologic.
B. Lapses in memory in older adults are considered benign unless they have negative consequences.
C. Gradual increases in confusion accompany the aging process.
D. Thorough assessment is necessary because changes in cognition are always considered to be pathologic.
ANS: D
Rationale: Although mental processing time decreases with age, memory, language, and judgment capacities remain intact. Change in mental status should never be assumed to be a normal part of aging.
A gerontologic nurse educator is providing practice guidelines to unlicensed care providers. Because reaction to painful stimuli is sometimes blunted in older adults, what must be used with caution?
A. Hot or cold packs
B. Analgesics
C. Anti-inflammatory medications
D. Whirlpool baths
ANS: A
Rationale: Reaction to painful stimuli may be decreased with age. Because pain is an important warning signal, caution must be used when hot or cold packs are used. The older client may be burned or suffer frostbite before being aware of any discomfort. Any medication is used with caution in older adults, but not because of the decreased sense of heat or cold. Whirlpool baths are generally not a routine treatment prescribed for older adults.
A trauma client in the ICU has been declared brain dead. What diagnostic test is used in making the best determination that the brain’s electrical activity has ceased?
A. Magnetic resonance imaging (MRI)
B. Electroencephalography (EEG)
C. Electromyography (EMG)
D. Computed tomography (CT)
ANS: B
Rationale: The EEG can be used to determine that brain activity has ceased.. MRI and CT scans have been used to declare brain death by showing an absence of blood flow, but this is not the best way to determine that brain activity has ceased. EMG is not normally used to determine brain death.
A client is scheduled for CT scanning of the head because of a recent onset of neurologic deficits. What should the nurse tell the client in preparation for this test?
A. "No metal objects can enter the procedure room."
B. "You need to fast for 8 hours prior to the test."
C. "You will need to lie still throughout the procedure."
D. "There will be a lot of noise during the test."
ANS: C
Rationale: Preparation for CT scanning includes teaching the client about the need to lie quietly throughout the procedure. If the client were having an MRI, metal and noise would be appropriate teaching topics. There is no need to fast prior to a CT scan of the brain.
A client for whom the nurse is caring has positron emission tomography (PET) scheduled. In preparation, what should the nurse explain to the client?
A. “The test will temporarily limit blood flow through the brain.”
B. “An allergy to iodine precludes getting the radio-opaque dye.”
C. “The client will need to endure loud noises during the test.”
D. “The test may result in dizziness or lightheadedness.”
ANS: D
Rationale: Key nursing interventions for PET scan include explaining the test and teaching the client about inhalation techniques and the sensations (e.g., dizziness, lightheadedness, and headache) that may occur. A PET scan does not impede blood flow through the brain. An allergy to iodine precludes the dye for an MRI, and loud noise is heard in an MRI.
A client is scheduled for a myelogram, and the nurse explains to the client that this is an invasive procedure, which assesses for any lesions in the spinal cord. The nurse should explain that the preparation is similar to which of the following neurologic tests?
A. Lumbar puncture
B. MRI
C. Cerebral angiography
D. EEG
ANS: A
Rationale: A myelogram is an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Client preparation for a myelogram would be similar to that for lumbar puncture. The other listed diagnostic tests do not involve lumbar puncture.
The health care provider has prescribed a somatosensory evoked responses (SERs) test for a client for whom the nurse is caring. The nurse is justified in suspecting that this client may have a history of what type of neurologic disorder?
A. Hypothalamic disorder
B. Demyelinating disease
C. Brainstem deficit
D. Diabetic neuropathy
ANS: B
Rationale: SERs are used to detect deficits in the spinal cord or peripheral nerve conduction and to monitor spinal cord function during surgical procedures. The test is also useful in the diagnosis of demyelinating diseases, such as multiple sclerosis and polyneuropathies, where nerve conduction is slowed. The test is not done to diagnose hypothalamic disorders, brainstem deficits, or diabetic neuropathies.
A client had a lumbar puncture performed at the outpatient clinic and the nurse phoned the client and family that evening. What does this phone call enable the nurse to determine? Select all that apply.
A. What the client's and family's expectations of the test are.
B. Whether the client's family had any questions about why the test was necessary.
C. Whether the client has had any complications from the test.
D. Whether the client understood accurately why the test was done.
E. The necessary steps for the client and family to take should complications arise.
ANS: C, E
Rationale: Contacting the client and family after diagnostic testing enables the nurse to determine whether they have any questions about the procedure, whether the client had any untoward results, and what to do should complications arise. Since the test was done as an outpatient; monitoring and care are being provided by the family. The health of the client becomes a team effort so any communication by the nurse should include both parties. The other listed information should have been elicited from the client and family prior to the test.
A client is currently being stimulated by the parasympathetic nervous system. What effect will this nervous stimulation have on the client's bladder?
A. Urinary retention
B. Bladder spasms
C. Urge incontinence
D. Bladder contract
ANS: D
Rationale: The parasympathetic division of the nervous system causes contraction (stimulation) of the urinary bladder muscles whereas the sympathetic division produces relaxation (inhibition) of the urinary bladder.
The nurse is performing a neurologic assessment of a client whose injuries have rendered the client unable to follow verbal commands. How should the nurse proceed with assessing the client's level of consciousness (LOC)?
A. Assess the client's vital signs and correlate these with the client's baselines.
B. Assess the client's eye opening and response to stimuli.
C. Document that the client currently lacks a level of consciousness.
D. Facilitate diagnostic testing in an effort to obtain objective data.
ANS: B
Rationale: If the client is not alert or able to follow commands, the examiner observes for eye opening; verbal response and motor response to stimuli, if any; and the type of stimuli needed to obtain a response. Vital signs and diagnostic testing are appropriate, but neither will allow the nurse to gauge the client's LOC. Inability to follow commands does not necessarily denote an absolute lack of consciousness.
In the course of a focused neurologic assessment, the nurse is palpating the client's major muscle groups at rest and during passive movement. Data gleaned from this assessment will allow the nurse to describe which of the following aspects of neurologic function?
A. Muscle dexterity
B. Muscle tone
C. Motor symmetry
D. Deep tendon reflexes
ANS: B
Rationale: Muscle tone (the tension present in a muscle at rest) is evaluated by palpating various muscle groups at rest and during passive movement. Data from this assessment do not allow the nurse to ascertain the client's dexterity, reflexes, or motor symmetry.
The neurologic nurse is testing the function of a client's cerebellum and basal ganglia. What action will most accurately test these structures?
A. Have the client identify the location of a cotton swab on his or her skin with the eyes closed.
B. Elicit the client's response to a hypothetical problem.
C. Ask the client to close his or her eyes and discern between hot and cold stimuli.
D. Guide the client through the performance of rapid, alternating movements.
ANS: D
Rationale: Cerebellar and basal ganglia influence on the motor system is reflected in balance control and coordination. Coordination in the hands and upper extremities is tested by having the client perform rapid, alternating movements and point-to-point testing. The cerebellum and basal ganglia do not mediate cutaneous sensation or judgment.
During the performance of the Romberg test, the nurse observes that the client sways slightly. What is the nurse's most appropriate action?
A. Facilitate a referral to a neurologist.
B. Reposition the client supine to ensure safety.
C. Document successful completion of the assessment.
D. Follow up by having the client perform the Rinne test.
ANS: C
Rationale: Slight swaying during the Romberg test is normal, but a loss of balance is abnormal and is considered a positive Romberg test. Slight swaying is not a significant threat to the client's safety. The Rinne test assesses hearing, not balance.
The nurse is providing information to a client about neurological disorders associated with genetic defects. The nurse knows which disease is considered an autosomal dominant disorder?
A. Duchenne muscular dystrophy
B. Parkinson disease
C. Huntington disease
D. Fragile X syndrome
ANS: C
Rationale: Several neurologic disorders are associated with genetic abnormalities. These diseases can have distinct inheritance patterns including: autosomal dominant, Autosomal recessive, or X-linked. Autosomal dominant diseases include: familial Alzheimer disease, myotonic dystrophies, Von Hippel-Lindau syndrome, Huntington disease, neurofibromatosis, and cerebral arteriopathy. Duchenne muscular dystrophy and fragile X syndrome are X-linked disorders. Parkinson disease does not have a distinct inheritance pattern.