Neuro 1
The brain consists of three parts. Select all that apply.
A. Cerebrum
B. Frontal lobe
C. Cerebellum
D. Brain stem
What are the cerebrum, cerebellum, and brain stem?
Correct answer: A, C, D
The cerebrum, cerebellum, and brain stem are the three parts of the brain. The frontal lobe is a lobe within the cerebrum.
When assessing your client’s gait, you notice that the client has an inability to walk on toes. What is this an indication of?
A. Ataxia
B. Plantar flexion weakness
C. Dorsiflexion weakness
D. Hypotonia
What is Plantar Flexion Weakness?
Correct Answer: B
Plantar flexion weakness is the inability to walk on toes.
The nurse is assessing the patient with a diagnosis of myasthenia gravis. Which assessment findings should the nurse expect? Select all that apply.
A. Muscle fatigue
B. Slurred speech
C. Drooping eyelid
D. Spastic movements
E. Short-term memory loss
What are Muscle Fatigue, Slurred Speech, and Drooping eyelid?
Correct Answers: A, B, C
A. This is correct. Muscle fatigue is a symptom of myasthenia gravis.
B. This is correct. Slurred speech is a symptom of myasthenia gravis.
C. This is correct. Drooping eyelid is a symptom of myasthenia gravis.
D. This is incorrect. Spastic movements are a sign of Parkinson’s disease, not myasthenia gravis.
E. This is incorrect. Short-term memory loss is not a normal sign of myasthenia gravis.
Patient presents to the emergency room with the following assessment: awake, disoriented but converses, obeys commands by moving all extremities. What is the Glasgow Coma Score?
A. 15
B. 10
C. 14
D. 12
What is 14?
Correct answer: C
•Eye response is 4.
•Verbal response is 4.
•Motor response is 6.
GCS total score = 14
A patient comes to urgent care c/o numbness on the right side of her face. You assess cranial nerve VII. What will you instruct the patient to do? Select all that apply.
A. Smile
B. Clench her teeth
C. Frown
D. Puff out her cheeks
What are Smile, Frown, and Puff out her cheeks?
Correct answer: A, C, D
Cranial nerve VII is the facial nerve. You will ask the patient to perform the following movements.
•Smile
•Frown
•Puff out her cheeks
•Clenching teeth assesses CN V.
When the nurse is assessing mental status, he or she should assess which of the following? Select all that apply.
A. Orientation
B. Level of consciousness
C. Ability to move all four extremities
D. Short- and long-term memory
E. Gait
What are Orientation, Level of consciousness, and short- and long-term memory?
Correct Answers: A, B, D
A. This is correct. Orientation is the second part of the mental status assessment.
B. This is correct. Level of consciousness is the first part of the mental status assessment.
C. This is incorrect. Ability to move all four extremities is not part of the mental status assessment.
D. This is correct. Short- and long-term memory are assessed in the mental health assessment.
E. This is incorrect. Gait is not part of the mental status assessment.
What cranial nerve are you assessing if you ask the client to identify various smells, such as coffee beans?
A. Cranial Nerve I Olfactory
B. Cranial Nerve III Oculomotor
C. Cranial Nerve V Trigeminal
D. Cranial Nerve VII Facial Nerve
What is Cranial Nerve I Olfactory?
Correct Answer: A
The olfactory nerve identifies smells.
A patient is c/o of feeling dizzy and having difficulty walking. You perform the Romberg test. What does this test assess in a patient? Select all that apply.
A. Coordination
B. Position sense
C. Cerebellar function
D. Balance
What are all of them?
Correct answer: A, B, C, D
The Romberg test assesses position sense, cerebellar function, balance, and coordination.
The nursing student is reviewing sleep habits with the patient. The patient states he always “feels sleepy” during the day and he sleeps 4 to 5 hours per night. The student nurse should educate the patient by making which of the following statements?
A. “Sleep deprivation can affect your cerebral function.”
B. “Sleep deprivation can result in increased intracranial pressure.”
C. “Sleep deprivation puts you at risk for a stroke.”
D. “Four to five hours of sleep per night is adequate for an adult.”
What is “Sleep deprivation can affect your cerebral function.”
Correct Answer: A
After performing a neurological assessment, the nurse documents, “Client is lethargic.” The student recalls this level of consciousness to mean that the patient is:
A. Disoriented.
B. Drowsy.
C. Difficult to arouse.
D. Unconscious.
What is Drowsy?
Correct Answer: B
A. This is incorrect. A patient can be disoriented to time, person, and place. This does not define lethargy.
B. This is correct. This is the definition of lethargy. A patient is drowsy.
C. This is incorrect. Somnolent is the term used to describe a patient who is difficult to arouse.
D. This is incorrect. Coma is the term used to describe a patient who is unconscious.
Identify the normal findings of the finger-to-nose test. Select all that apply.
A. Patient is able to put the cap on the pen accurately and smoothly.
B. Patient is able to touch the nurse’s finger and nose accurately.
C. Patient is unable to touch the stationary finger with eyes closed.
D. Patient exhibits dysmetria.
E. Patient has spasticity when performing the examination.
What are Patient is able to put the cap on the pen accurately and smoothly, and Patient is able to touch the nurse’s finger and nose accurately.
Correct Answers: A, B
A. This is correct. This is assessed in the finger-to-nose test. Patient is able to put the cap on the pen accurately and smoothly.
B. This is correct. This is assessed in the finger-to-nose test. Patient touches the nurse’s finger and nose accurately and smoothly in all locations.
C. This is incorrect. This is not a normal finding of the finger-to-nose assessment. Patient touches the nurse’s finger accurately and smoothly in one location with eyes closed.
D. This is incorrect. Dysmetria is the inability to perform point-to-point movements.
E. This is incorrect. Assessing spasticity is not assessed in the finger-to-nose test.
The nurse is educating the patient on foods to avoid that may trigger headaches. The nurse knows the patient needs further education by which of the following statements?
A. “I will avoid chocolate.”
B. “I will limit my trips to the local coffee shop.”
C. “It will be okay. I can still use soy sauce in my cooking but not every day.”
D. “I will eliminate fruit and brown rice from my diet.”
What is “I will eliminate fruit and brown rice from my diet.”?
Correct Answer: D
A. This is incorrect. Chocolate is a trigger food for headaches because it contains the amino acid tyramine, so the patient does not need further education based on their statement.
B. This is incorrect. Coffee should be limited because increased caffeine is a trigger for headaches, so this patient does not need further education based on their statement.
C. This is incorrect. Soy sauce often contains monosodium glutamate (MSG), which is a trigger additive for headaches, so this patient does not need further education based on their statement.
D. This is the correct. Fruits and whole grains have not been identified as triggers for headaches and do not contain preservatives, so this patient needs further education.
The nurse is assessing graphesthesia. This technique assesses:
A. The sensation of touch or tactile stimulation.
B. The sensation of position and balance.
C. The indication of loss in sensory nerves.
D. The sensation of proprioception
What is The sensation of touch or tactile stimulation?
Correct Answer: A
A. This is correct. Graphesthesia assesses the sensation of touch or tactile stimulation.
B. This is incorrect. The Romberg test assesses position and balance.
C. This is incorrect. Neuropathy is the loss in sensation of sensory nerves.
D. This is incorrect. Pronator drift assesses for proprioception.
You are a nurse working in the emergency room. The patient is a 21-year-old male who was in a serious motor vehicle accident. You are assessing the patient’s mental status using the Glasgow coma scale. The Glasgow coma scale evaluates the following three responses: ____________________, ____________________, and ____________________.
What are eye; motor; verbal?
Feedback: The Glasgow coma scale (GCS) is an evidence-based assessment of mental status. This scale is widely used and recognized among all interdisciplinary professionals. The scale is based on a score of 3 to 15. This is a more objective way to assess the patient’s level of consciousness. The scale evaluates eye response, motor response, and verbal response, and assesses by checking, observing, and stimulating.