NEURO

A/P

100

Which area of the brain regulates endocrine and autonomic nervous system (ANS) function? a.Basal ganglia b.Temporal bone c. Hypothalamus d. Reticular activating system

Ans. C Rationale Endocrine and the autonomic nervous system function is regulated by the hypothalamus. The basal ganglia function includes initiation, execution, and completion of voluntary movements, learning, emotional response, and autonomic movement associated with skeletal muscle activity. The temporal lobe integrates somatic, visual, and auditory data that contains Wernicke’s sleep-wake transitions with communication among the brainstem. The reticular activating system regulates arousal and sleep awake transitions with communications among the brainstem, formation in the brainstem, and the cerebral cortex.

200

Which type of macroglial cells myelinate peripheral nerve fibers? a. Neurons b. Astrocytes c. Schwann Cells d. Ependymal Cells

Ans. C Rationale Schwann cells are the microglial cells that myelinate peripheral nerve fibers. Astrocytes provide structural support to neurons and form the blood brain barrier with the endothelium of blood vessels. Ependymal cells line the brain ventricles and aid in the secretion of CSF. Neurons are not glial cells.

300

What is the function of the dendrite? a. A gap in the peripheral nerve axon. b. Carrier impulses to the nerve cells body c. Carries impulses from the nerve cell body d. May occur with damage to peripheral axon

Ans. B Rationale The dendrite carries impulses to the nerve cell body. The gap in the peripheral nerve axon is the node of Ranvier that allows an action potential to travel faster by jumping from node to node without trans versing the insulate membrane segments. The axon carrier impulses from the nerve cell body. Regeneration may occur with damage to peripheral axon.

400

The patient is admitted to the emergency department having difficulty with respiratory, vasomotor, and cardiac function. Which portion of the brain is affected to cause these manifestations. a. Medulla b. Cerebellum c. Parietal Lobe d. Wernicke’s Area

Ans. A Rationale The medulla contains the vital centers concerned with respiratory, vasomotor, and cardiac function. The cerebellum maintains trunk stability and equilibrium but is not related to respiratory or cardiac function. The parietal lobe interprets spatial information and controls the sensory cortex. Wernicke’s area is responsible for language comprehension.

500

What function s does the thalamus have? a. Registers auditory input b. Integrates past experience c. Relays sensory and motor input to and from the cerebrum d. Controls and facilitates learned and automatic movements

Ans. C Rationale The thalamus relays sensory and motor input to and from the cerebrum. Auditory input is registered by the superior temporal gyrus. Past experience are integrated by the anterior temporal gyrus. Past experiences are integrated by the anterior temporal lobe. The basal ganglia controls and facilitates learn and automatic movements.

DISORDERS

100

This is a rare disorder that is characterized by loss of motor neurons and is particularly devastating to the patient because they remain cognitively intact while the rest of their body wastes away. a. Multiple sclerosis b. Amytrophic lateral sclerosis (ALS) c. Parkinson’s disease d. Bell’s Palsy

b. Amytrophic lateral sclerosis (ALS); Lou Gehrig’s disease -“For unknown reasons, in ALS motor neurons in the brainstem and the spinal cord gradually degenerate. Dead motor neurons cannot produce or transport signals to muscles. Consequently electrical and chemical messages originating in the brain do not reach the muscles to activate them.”

200

An autoimmune disease of the neuromuscular junction. It is characterized by the fluctuating weakness of certain skeletal muscle groups (such as the eyes, mouth and throat). Muscle weakness becomes more prominent toward the end of the day after the muscles become exhausted because they are the most commonly used. a. Myasthenia gravis b. tetanus c. epilepsy d. Huntington’s disease

a. Myasthenia gravis -“MG is caused by an autoimmune process in which antibodies attack Ach receptors, resulting in a decreased number of Ach receptor sites at the neuromuscular junction. This prevents Ach molecules from attaching and stimulating muscle contraction”

300

This chronic, progressive, degenerative disorder of the CNS is characterized by disseminated demyelination of nerve fibers of the brain and spinal cord and may be caused by interplay between a person’s geography, ethnicity, and other factors. a. restless leg syndrome b. Guillain-Barre syndrome c. migraine headache d. multiple sclerosis (MS)

d.Multiple sclerosis (MS) -“Researchers believe the disease develops in a genetically susceptible person as a result of environmental exposure, like an infection. Possible precipitating factors include infection, smoking, physical injury, emotional stress, excessive fatigue, pregnancy, and a poor state of health.”

400

Acute peripheral facial paresis caused by inflammation of cranial nerve VII on one side of the face without the presence of any other disease. a. stroke b. Bell’s palsy c. trigeminal neuralgia d. botulism

b. Bell’s palsy -“Although the exact etiology is not known, it is believed tat a viral infection such as viral meningitis or activation of herpes simples 1 (HSV1) may trigger Bell’s palsy. The viral infection causes inflammation, edema, ischemia, and eventual demyelination of the nerve, creating pain and alterations in motor and sensory function. It is considered benign, with a full recovery in 3 to 6 months, but a small group of people have long-term facial paralysis.”

500

An acute form of polyneuritis that progresses rapidly and can be fatal. It affects males and females equally and can be characterized by ascending, symmetric paralysis, which usually affects cranial nerves as well as the peripheral nervous system. a. Brown-Sequard syndrome b. sepsis c. Guillain-Barre syndrome d. neurosyphillis

c. Guillain-Barre syndrome -“The etiology of this disorder is unknown. Both cellular and humoral immune mechanisms play a role in the immune reaction directed at the nerves. The result is a loss of myelin and edema and inflammation of the affected nerves. As demyelination occurs, the transmission of nerve impulses is stopped or slowed down. The muscles innervated by the damaged peripheral nerves undergo denervation and atrophy. In the recovery phase, remyelination occurs slowly, and neurologic function returns in a proximal-to-distal pattern.

MEDS

100

The client asks what can be expected from drug therapy for treatment of Parkinsonism. The best response by the nurse would be: A. that a cure can be expected within six months B. that symptoms can be reduced, and ability to perform ADLs can be improved C. that disease progression will be stopped D. that EPS will be prevented

ANS: B RATIONALE: pharmacotherapy does not cure the disease, but does improve the client’s ability to perform normal activities, such as eating, bathing, and walking. The symptoms are often reversed if medications are taken long term.

200

Nurses who administer Sinemet as prescribed for the elderly should incorporate timing of the administration of Sinemet into the patient’s care plan and: A. give sinemet 30 minutes after meals B. give sinemet 30 minutes before meals C. give sinemet one hour before meals D. give sinemet with meals, followed by a glass of water

ANS: C RATIONALE: Sinemet should be taken on an empty stomach. The nurse should incorporate timing of the administration of Sinemet into the patient’s plan of care. Both the patient and the caregiver should be taught that Sinemet should be taken one hour before or two hours after a meal.

300

The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is: A. pyridostigmine (neostigmine) B. atropine (atropine sulfate) C. didronel (etidronate) D. tensilon (edrophonium)

ANS: A RATIONALE: pyridostigmine is used to treat clients with myasthenia gravis

400

Which of the following medications delays progression of ALS? A. riluzole (Rilutek) B. interferon beta 1b (Betaseron) C. interferon beta 1a (Avonex) D. levodopa (Larodopa)

ANS: A RATIONALE: Rilutek is used to treat patients with ALS to prolong survival and/or delay the need for surgery to help breathing

500

A client with myasthenia gravis is experiencing prolonged periods of weakness, and the physician orders an edrophonium (Tensilon) test. A test dose is administered and the client becomes weaker. The nurse interprets tis test result as: A. normal B. positive C. myasthenic crisis D. cholinergic crisis

ANS: D RATIONALE: Worsening of the symptoms after the test dose of medication is administered indicates a cholinergic crisis

DIAGNOSTICS

100

A nurse is developing a plan of care for a client who is scheduled for a cerebral angiogram with contrast dye. Which of the following statements by the client should the nurse report to the provider? (Select all that apply) A.) “I think I may be pregnant” B.) “I take Coumadin” C.) “I take hypertensive medications” D.) “I am allergic to shrimp” E.) “I am allergic to latex”

Rationale: A.) Correct, the contrast dye may put the fetus at risk B.) Correct, potential for bleeding following the angiogram C.) Incorrect, no contraindication r/t contrast dye and a client taking hypertensive medications D.) Correct, being allergic to shrimp, which is shellfish, should be reported to the provider due to potential allergic reaction. E.) Incorrect, no contraindication r/t to contrast dye for a client who has an allergy to latex

200

A nurse is providing education to a client who is to undergo an electroencephalogram (EEG) the next day. Which of the following information should the nurse include in the teaching? A.) Do not wash your hair the morning of the procedure B.) Try to stay awake most of the night prior to the procedure C.) The procedure will take 15 minutes D.) You will need to lie flat for 4 hours after the procedure

A.) Incorrect, patient should wash hair on the morning of the procedure to remove oils, gels, and sprays which may affect the EEG. B.) Correct, the client should remain awake most of the night to provide cranial stress and increase the possibility of abnormal electrical activity. C.) Incorrect, the procedure will take approximately an hour D.) Incorrect, normal activity can resume immediately following the procedure.

300

3.) What are the three components of the Glasgow Coma Scale? A.) Pain, Eyes, Motor B.) Eyes, Motor, Memory C.) Eyes, Verbal, Motor D.) Pain, Memory, Eyes

Rationale: C, Glasgow Coma Scale assesses the neurological function and is useful to determine the level of consciousness and monitor response to treatment. The three components are eye opening, verbal response, and motor response.

400

A noninvasive procedure assesses the electrical activity of the brain that is used to determine if there are abnormalities in the brain wave patterns? A). EEG B). GCS C). CT scan D). ICP

Answer is A Rationale: identify and detetmine seizure activity, and are useful for detecting sleep disorders and behavior changes.

500

For the intraprocedure of a CT and MRI scan, the client must? A). Resting in a chair or lying in a bed B). Lie supine with the head stabilized during the procedure C). Positioned lying on one side or by having the client stretch over an overbed table if sitting D). Remain still during the procedure

Answer is B

MISC

100

Which of the following statements about neurons is true? A – Neurons are 2ndary functional unit of the nervous system, behind dendrites B – Neurons are nonmitotic C – Neurons can be myelinated as well as unmyelinated D – Neurons receive impulses from the dendrites

ANS: C Rationale: Axons can be myelinated as well as unmyelinated. Since axons are part of neurons, this also means that neurons can be myelinated or unmyelinated

200

Which of the following statements made by the older adult client is not true regarding the effects of aging on the nervous system? A – The client receives a phone call and tells the nurse that it is from her dad. The nurse informs the client that her father passed away 2 months ago. The client states: “But who was phone?” B – “The dishes my daughter makes are too salty for my tastes, even when she only adds like 3.50ng of NaCl in it” C – “I don’t even lift nowadays” D – “When my cat caught fire, I was unable to react in time because it took me a while to smell the scent of burnt fur”

ANS: B Rationale: Sense of taste decreases in older adults, not increasing

300

Which of the following vitamins are essential for the maintenance and health of the brain? A – Pyridoxine, cobalamin B - Thiamine, beta-carotene, niacin C – Creatine, riboflavin, celltech D – Vitamin D

ANS: A Vit B group is essential for the maintenance and health of the brain. Pyridoxine and cobalamin are part of the vit B group

400

Which statement made by the client suggests that learning has occurred and was not in vain? A – “My cerebral lesions will affect the orgasmic phase of my excitement phase” B – “My sexual desire for my concubine is influenced by the hormones released in the amygdala” C – “Sildenafil can greatly help my sexual dysfunction, especially in conjunction with Nitrate for my spinal cord injury” D – “I can achieve satisfying expression of intimacy even with my neurological changes. This is nothing but a scratch!”

ANS: D Rationale: Despite neurological related changes in sexual function, many persons can achieve satisfying expression of intimacy and affection (Lewis p. 1346)

500

Which of the following scenarios will require the nurse to intervene 1st? A – ALOC patient is snoring B – Patient post-rectal surgery complains of 5/10 pain level C – 50 years old patient is trying to perform the Valsalva maneuver D – Patient is bleeding scant amount 3.5hrs post-surgery

ANS: A Snoring sounds indicate obstruction and require immediate intervention. ABC. Airway comes 1st