Ch11 The Neurological System Test Bank + Answers

CHAPTER 11: ADVANCED HEALTH ASSESSMENT OF THE NEUROLOGICAL SYSTEM

1. The clinician is assessing a patient whose chief complaint (CC) is a severe headache with loss of vision. The clinician first action would be to:

a. Initiate appropriate interventions for this medical emergency

b. Question the patient about the use of over-the-counter pain medication

c. Reassure the patient that this is a typical tension headache

d. Document the findings in the patient’s medical record

2. A patient presents with complaints of hearing and balance issues. The clinician should focus the physical assessment on which of the following neurological structures?

a. Cranial nerve X

b. The left frontal lobe

c. The vagus nerve

d. Cranial nerve VIII

Rational: Cranial nerve (CN) VIII, the auditory or vestibular nerve, transmits sounds to the brain. In addition, this nerve sends information from the organs of balance to the brain. CN X is also called the vagus nerve. The vagus nerve transmits the sensations of smell and taste to the brain and extends into the abdominal cavity. The left side of the brain controls functions of the right side. The frontal lobe controls voluntary movement, speech, and intellectual and behavioral functions.

3. A clinician is educating a patient with a diagnosis of cardiac failure about self-care. The clinician counsels the patient to avoid activities that stimulate which of the following nerves?

a. Abducens

b. Vagus

c. Trigeminal

d. Accessary

4. A patient is manifesting symptoms of dementia. Specific assessment and care for this condition should include: (Select all that apply.)

a. Administration of the Mini-Mental State Examination

b. Asking the patient to frown and smile

c. Assessing the patient for the presence of hallucinations and delusions

d. Having the patient identify a familiar smell such as peppermint or bananas

e. Referring the patient to a social worker

5. Upon assessment of the patient, the clinician identifies a bilateral steppage gait. The clinician would be most concerned that the patient was exhibiting:

a. An L4 nerve root injury

b. Amyotrophic lateral sclerosis

c. A brachial plexus nerve injury

d. Trigeminal neuralgia

6. To assess cranial nerve (CN) XII, the hypoglossal nerve, the clinician:

a. Instructs the patient to rapidly smile and frown

b. Assesses pupillary response

c. Asks the patient to stick out her tongue

d. Performs a Weber test

7. When performing reflex testing on a patient, the clinician discovers clonus with dorsiflexion of the feet. The clinician should:

a. Document this in the patient’s medical record as a normal finding

b. Explain to the patient that this was an expected response to the reflex testing

c. Recognize this as an expected complication of vascular dementia

d. Assess the patient carefully for further neurological manifestations

8. The clinician is evaluating a geriatric patient who is suspected to have a slow-developing subdural hematoma. To help confirm this, the clinician assesses the patient for: (Select all that apply.)

a. Unilateral rhinorrhea

b. Refusal of usual food preferences

c. Personality change

d. Decreased level of consciousness

e. Increasing irritability

9. A patient is admitted to the ED with a severe headache. To help determine the type and possible cause of the headache, the clinical should assess: (Select all that apply.)

a. Onset in relation to sleep

b. The patient’s food diary

c. Bowel habits and stool quality

d. Response of headache to light

e. Presence of an aura

10. The clinician is assessing a patient presenting with progressive muscle weakness that began in the feet and legs. The weakness has moved upward over the last 48 hours. The clinician determines that the patient is manifesting signs of:

a. Parkinson’s disease

b. Multiple sclerosis

c. Amyotrophic lateral sclerosis

d. Guillain–Barre syndrome

11. The clinician is performing a history with a patient who has been diagnosed with amyotrophic lateral sclerosis (ALS). The patient seems anxious and depressed. To help reduce the patient’s anxiety, the clinician states:

a. “Please listen carefully. Answer my questions completely.”

b. “When did your symptoms first begin?”

c. “Please explain. Why do you seem so anxious?”

d. “You seem worried. Let’s talk about your concerns.”

12. The clinician is assessing a patient with numbness and tingling in the bilateral hands and feet. When making the differential diagnosis, the clinician determines that the patient is manifesting:

a. Hypothyroidism

b. B12 deficiency

c. Supranuclear palsy

d. Tardive Dyskinesia

13. A patient has presented with progressive generalized weakness, paresthesia, and motor problems. In evaluating her gait, the clinician notes a spastic gait with foot dragging. The patient also complains of pain with eye movement and blurred vision. What would the differential diagnosis be for this patient? Briefly describe what lead you to that conclusion.

14. The clinician has diagnosed a patient with Parkinson’s disorder. When evaluating for this condition, it is important for the clinician to review the patient’s medication history. Explain the rationale for the importance of a complete review of all medications.

15. The clinician discovers that the pupils of a comatose patient are excessively dilated and do not respond to light. What are the implications of this finding in relation to the recovery of the patient?

16. A patient has a family history of Huntington’s disease. Describe the expected manifestations of this disorder.

17. After completing the neurological exam, the clinician is attempting to determine a differential diagnosis in a patient with a severe headache. The patient complains of pain over the temporal area and scalp that increases with touch. The patient’s jaw frequently clenches uncontrollably. Identify the probable disorder and the implications of this diagnosis.

18. A passenger in a motor vehicular accident (MVA) is presenting to the ED. Discuss the components of physical assessment that would help the clinician rule out lower spinal cord injury.

19. The clinician is evaluating a patient for a possible intracranial tumor. Discuss what assessments should be performed on this patient.

20. A patient presents to the ED with suspected transient ischemic attacks (TIA). What are the typical manifestations of TIA? Discuss how a TIA relates to stroke.