Ch 35, 36, 37

Question 1

Special somatic afferent neurons

Answer 1

Sense position and movement in the body

Question 2

Discriminative touch

Answer 2

Identifies the size and shape of objects and their movement across the skin; temperature sensation; sense of movement of the limbs and joints of the body; and nociception, or pain

Question 3

A neurologic assessment of the somatosensory function of the body is often necessary for diagnostic information. How is this assessment done?

a. Testing the integrity of spinal segmental nerves
b. Testing the integrity of cranial nerves
c. Testing the integrity of peripheral nerves
d. Testing the integrity of the CNS

Answer 3

a. Testing the integrity of spinal segmental nerves

Clinically, neurologic assessment of the somatosensory function can be done by testing the integrity of spinal segmental nerves. The other answers are incorrect.

Question 4

When testing nociceptive stimuli to elicit a withdrawal reflex in the body, what stimuli are commonly used?

a. Weak electrical current
b. Pressure from a sharp object
c. Skin temperature damp cotton ball
d. Water heated to 5C above skin temperature

Answer 4

b. Pressure from a sharp object

Stimuli used include pressure from a sharp object, strong electric current to the skin, or application of heat or cold of approximately 10C above or below normal skin temperature. The other answers are incorrect.

Question 5

One of the neurotransmitters between the nociceptive neurons and the dorsal horn neurons is a major excitatory neurotransmitter. What is this neurotransmitter?

a. Norepinephrine
b. Substance P
c. Glutamate
d. Dopamine

Answer 5

c. Glutamate

The amino acid glutamate is a major excitatory neurotransmitter released from the central nerve endings of the nociceptive neurons. The other answers are incorrect.

Question 6

Which tract in the spinal cord conducts the diffuse, dull, aching sensations that are associated with chronic and visceral pain?

a. Multisynaptic tract
b. Neospinothalamic tract
c. Anterolateral tract
d. Paleospinothalamic tract

Answer 6

d. Paleospinothalamic tract

The paleospinothalamic tract is a slower-conducting, multisynaptic tract concerned with the diffuse, dull, aching, and unpleasant sensations that commonly are associated with chronic and visceral pain. The other answers are incorrect.

Question 7

Deep somatic pain

Answer 7

Type of pain experienced from a sprained ankle

Question 8

Cutaneous pain

Answer 8

A sharp pain with a burning quality and may be abrupt or slow in onset

Question 9

Visceral pain

Answer 9

Diffuse and poorly localized nature with a tendency to be referred to other locations

Question 10

Referred pain

Answer 10

Perceived at a site different from its point of origin but innervated by the same spinal segment

Question 11

Guarding

Answer 11

A protective reflex rigidity; its purpose is to protect the affected body parts

Question 12

Acute pain

Answer 12

The pain’s location, radiation, intensity, and duration, as well as those factors that aggravate or relieve it, provide essential diagnostic clues

Question 13

Chronic pain

Answer 13

Extends for long periods of time and generally represents low levels of underlying pathology that does not explain the presence and/or extent of the pain

Question 14

It is often necessary to assess a client’s pain. What factors would you assess when assessing pain? (Mark all that apply.)

a. Nature and severity of pain
b. Severity and spinal reflex involvement of pain
c. Location and radiation of pain
d. Spinal reflex involvement and nature of pain
e. Spinal tract involvement and radiation of pain

Answer 14

a, c (Nature and severity of pain, location and radiation of pain)

Assessment includes such things as the nature, severity, location, and radiation of the pain. Spinal reflex involvement and spinal tract involvement are not assessed when assessing pain.

Question 15

When giving pain medicine for acute pain, health care workers are reluctant to provide much needed opioid pain medicine. What is the major concern of health care workers when providing opioid pain relief?

a. Fear of addiction
b. Fear of depressed respirations
c. Fear of oversedation
d. Fear of adverse reactions

Answer 15

a. Fear of addiction

Part of the reluctance of health care workers to provide adequate relief for acute pain has been fear of addiction. However, addiction to opioid medications is thought to be virtually nonexistent when these drugs are prescribed for acute pain. The other answers are not major concern.

Question 16

Chronic pain is difficult to treat. Cancer, a common cause of chronic pain, has been especially addressed by the World Health Organization (WHO). What has WHO created to assist clinicians in choosing appropriate analgesics?

a. An opioid ladder for pain control.
b. An analgesic ladder for pain control
c. Stepping stones for pain control
d. A list of nonpharmacologic ways to control pain

Answer 16

b. An analgesic ladder for pain control

The World Health Organization has created an analgesic ladder for cancer pain that assists clinicians in choosing the appropriate analgesic. The other answers are incorrect.

Question 17

In describing the ideal analgesic, what factors would be included? (Mark all that apply.)

a. Inexpensive
b. Have minimal adverse effects
c. Effective
d. Addictive
e. Decrease the level of consciousness

Answer 17

a, b, c (Inexpensive, have minimal adverse effects, effective)

The ideal analgesic would be effective, nonaddictive, and inexpensive. In addition, it would be produce minimal adverse effects and not affect the person’s level of consciousness.

Question 18

Using surgery to relieve severe, intractable pain has been successful to a degree. What can surgery be used for when a person is in pain?

a. Relief of severe peripheral contractures
b. Cure inoperable cancer
c. Block transmission of phantom limb pain
d. Cure severe myalgia

Answer 18

c. Block transmission of phantom limb pain

Surgery for severe, intractable pain of peripheral or central origin has met with some success. It can be used to remove the cause or block the transmission of intractable pain from phantom limb pain, severe neuralgia, inoperable cancer of certain types, and causalgia. The other answers are incorrect.

Question 19

When a peripheral nerve is irritated enough, it becomes hypersensitive to the noxious stimuli, which results in increased painfulness or hyperalgesia. Health care professionals recognize both primary and secondary forms of hyperalgesia. What is primary hyperalgesia?

a. Pain that occurs in the tissue surrounding an injury
b. Pain sensitivity that lasts longer than a week
c. Pain sensitivity that occurs in the viscera
d. Pain sensitivity that occurs directly in damaged tissues

Answer 19

d. Pain sensitivity that occurs directly in damaged tissues

Primary hyperalgesia describes pain sensitivity that occurs directly in damaged tissues. The other answers are incorrect.

Question 20

Neuropathic pain

Answer 20

Widespread pain that is not otherwise explainable, burning pain, and attacks of pain that occur without seeming provocation.

Question 21

Neuralgia

Answer 21

Characterized by severe, brief, often repetitive attacks of lightning-like or throbbing pain.

Question 22

Tic douloureux

Answer 22

Manifested by facial tics or spasms characterized by paroxysmal attacks of stabbing pain that usually are limited to the unilateral sensory distribution of one or more branches of the trigeminal nerve, most often the maxillary or mandibular divisions.

Question 23

Postherpetic neuralgia

Answer 23

Affected sensory ganglia and the peripheral nerve to the skin of the corresponding dermatomes cause a unilateral localized vesicular eruption and hyperpathia (i.e., abnormally exaggerated subjective response to pain).

Question 24

Phantom limb pain is a little understood pain that develops after an amputation. Because it is little understood, it is difficult to treat, even though the client is experiencing severe pain. What are the treatments for phantom limb pain?

a. Sympathetic blocks and hypnosis
b. Relaxation training and transcutaneous electrical nerve stimulation on the efferents in the area
c. Narcotic analgesics and relaxation training
d. Biofeedback and nonsteroidal anti-inflammatory drugs

Answer 24

a. Sympathetic blocks and hypnosis

Treatment of phantom limb pain has been accomplished by the use of sympathetic blocks, transcutaneous electrical nerve stimulation of the large myelinated afferents innervating the area, hypnosis, and relaxation training.

Question 25

Migraine headaches affect millions of people worldwide. What are first-line agents for the treatment of migraine headaches?

a. Ondansetron and morphine
b. Naproxen sodium and metoclopramide
c. Sumatriptan and tramadol
d. Caffeine and syrup of ipecac

Answer 25

b. Naproxen sodium and metroclopramide

Based on clinical trials, first-line agents include acetylsalicylic acid, combinations of acetominophen, acetylsalicylic acid, and caffeine and nonsteroidal anti-inflammatory drug analgesics (e.g. naproxen sodium, ibuprofen), serotonin (5-HT1) receptor agonists (e.g. sumatriptan, naratriptan, rizatriptan, zolmitriptan), ergotamine derivatives (e.g., dihydroergotamine), and antiemetic medications (e.g., ondansetron, metoclopramide). Morphine, tramadol, and syrup of ipecac are not first-line drugs in the treatment of migraine.

Question 26

A severe type of headache that occurs more frequently in men than women and is described as having unrelenting, unilateral pain located most frequently in the orbit is called what?

a. Migraine headache
b. Tension headache
c. Cluster headache
d. Chronic daily headache

Answer 26

c. Cluster headache

Cluster headache is a type of primary neurovascular headache that typically includes severe, unrelenting, unilateral pain located, in order of decreasing frequency, in the orbital, retroorbital, temporal, supraorbital, and infraorbital region. The other answers are not correct.

Question 27

When assessing pain in children, it is important to use the correct pain rating scale. What would be the appropriate pain rating scale with children from the 3- to 8-year-old range?

a. COMFORT pain scale
b. FLACC pain scale
c. CRIES pain scale
d. FACES pain scale

Answer 27

d. FACES pain scale

With children 3 to 8 years old, scales with faces of actual children or cartoon faces can be used to obtain a report of pain. The other pain rating scales are inappropriate in this age group.

Question 28

Children feel pain just as much as adults do. What is the major principle in pain management in the pediatric population?

a. Treat on individual basis and match analgesic agent with cause and level of pain.
b. Always use nonpharmacologic pain management before using pharmacologic pain management.
c. Base treatment of pain on gender and age group.
d. Treat pediatric pain the way the parents want you to.

Answer 28

a. Treat on individual basis and match analgesic agent with cause and level of pain.

The overriding principle in all pediatric pain management is to treat each child’s pain on an individual basis and to match the analgesic agent with the cause and the level of pain. The other answers are incorrect.

Question 29

The spinal cord contains the basic factors necessary to coordinate function when a movement is planned. It is the lowest level of function. What is the highest level of function in planning movement?

a. Frontal cortex
b. Cerebral cortex
c. Pons
d. Cerebellum

Answer 29

a. Frontal cortex

The highest level of function, which occurs at the level of the frontal cortex, is concerned with the purpose and planning of the motor movement. The other answers are incorrect.

Question 30

Motor neurons

Answer 30

Control motor function

Question 31

Motor unit

Answer 31

Motor neuron and the group of muscle fibers it innervates in a muscle

Question 32

Lower motor neurons

Answer 32

The motor neurons supplying a motor unit are located in the ventral horn of the spinal cord

Question 33

Upper motor neurons

Answer 33

Project from the motor strip in the cerebral cortex to the ventral horn and are fully contained within the CNS

Question 34

Reflexes are basically “hard-wired” into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron that causes muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons?

a. Neurotransmitter
b. Interneuron
c. Intersegmental effectors
d. Suprasegmental effectors

Answer 34

b. Interneuron

The anatomic basis of a reflex consists of an afferent neuron, which synapses either directly with an effector neuron that innervates a muscle or with an interneuron that synapses with an effector neuron.

Question 35

The signs and symptoms produced by disorders of the motor system are useful in finding the disorder. What signs and symptoms would you assess when looking for a disorder of the motor system? (Mark all that apply.)

a. Spinal reflex activity
b. Bulk
c. Motor coordination
d. Muscle innervation
e. Tone

Answer 35

a, b, c, e (Spinal reflex activity, bulk, motor coordination, tone)

These signs and symptoms include changes in muscle characteristics (strength, bulk, and tone), spinal reflex activity, and motor coordination. Muscle innervation is incorrect.

Question 36

Duchenne muscular dystrophy usually does not produce any signs or symptoms until between the ages of 2 and 3. What muscles are usually first to be affected in Duchenne muscular dystrophy?

a. Muscles of the upper arms
b. Large muscles of the legs
c. Postural muscles of hip and shoulder
d. Spinal and neck muscles

Answer 36

c. Postural muscles of hip and shoulder

The postural muscles of hip and shoulder are usually the first to be affected. The other answers are incorrect.

Question 37

Antibiotics such as gentamicin can produce a disturbance in the body that is similar to botulism by preventing the release of acetylcholine from nerve endings. In persons with pre-existing neuromuscular transmission disturbances these drugs can be dangerous. What disease falls into this category?

a. Multiple sclerosis
b. Duchenne muscular dystrophy
c. Becker muscular dystrophy
d. Myasthenia gravis

Answer 37

d. Myasthenia gravis

The aminoglycoside antibiotics (e.g., gentamicin) may produce a clinical disturbance similar to botulism by preventing the release of acetylcholine from nerve endings. These drugs are particularly dangerous in persons with pre-existing disturbances of neuromuscular transmission, such as myasthenia gravis. The other answers are incorrect.

Question 38

In myasthenia gravis, periods of stress can produce myasthenia crisis. When does myasthenia crisis occur?

a. When muscle weakness becomes severe enough to compromise ventilation
b. When the client is too weak to hold the head up
c. When the client is so weak he or she cannot lift the arms
d. When the client can no longer walk

Answer 38

a. When muscle weakness becomes severe enough to compromise ventilation

Myasthenia crisis occurs when muscle weakness becomes severe enough to compromise ventilation to the extent that ventilatory support and airway protection are needed. The others are incorrect.

Question 39

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?

a. Guillan-Barre syndrome
b. Carpal tunnel syndrome
c. Myasthenia gravis
d. Phalen syndrome

Answer 39

b. Carpal tunnel syndrome

Carpal tunnel syndrome is an example of a compression-type mononeuropathy that is relatively common. The other answers are not mononeuropathies.

Question 40

Herniated disks occur when the nucleus pulposus is compressed enough that it protrudes through the annulus fibrosus, putting pressure on the nerve root. This type of injury occurs most often in the cervical and lumbar region of the spine. What is an important diagnostic test for a herniated disk in the lumbar region?

a. Hip flexion test
b. CT scan
c. Straight-leg test
d. Electromyelography

Answer 40

c. Straight-leg test

The straight-leg test is an important diagnostic maneuver for a herniated disk in the lumbar area. The other answers are incorrect.

Question 41

Vestibulocerebellar pathway

Answer 41

Maintains equilibrium and posture

Question 42

Spinocerebellar pathway

Answer 42

Provides the circuitry for coordinating the movements of the distal portions of the limbs

Question 43

Cerebrocerebellar pathway

Answer 43

Coordinates sequential body and limb movements

Question 44

The basal ganglia play a role in coordinated movements. Part of the basal ganglia system is the striatum, which involves local cholinergic interneurons. What disease is thought to be related to the destruction of cholinergic interneurons?

a. Parkinson syndrome
b. Guillain-Barre syndrome
c. Myasthenia gravis
d. Huntington disease

Answer 44

d. Huntington disease

The function of the striatum also involves local cholinergic interneurons and their destruction is thought to be related to the choreiform movements of Huntington disease, another basal ganglia-related syndrome. The other answers do not involve the cholinergic interneurons of the striatum.

Question 45

What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?

a. Parkinson disease
b. Huntington disease
c. Guillain-Barre syndrome
d. Myasthenia gravis

Answer 45

a. Parkinson disease

In Parkinson disease, also known as idiopathic parkinsonism, dopamine depletion results from degeneration of the dopamine nigrostriatal system. The other answers are incorrect.

Question 46

Amyotrophic lateral sclerosis is considered a disease of the upper motor neurons. What is the most common clinical presentation of amyotrophic lateral sclerosis?

a. Rapidly progressive weakness and atrophy in distal muscles of both upper extremities
b. Slowly progressive weakness and atrophy in distal muscles of one upper extremity
c. Rapidly progressive weakness and atrophy in distal muscles of both lower extremities
d. Slowly progressive weakness and atrophy in distal muscles of one lower extremity

Answer 46

b. Slowly progressive weakness and atrophy in distal muscles of one upper extremity

The most common clinical presentation is slowly progressive weakness and atrophy in distal muscles of one upper extremity. The other answers do not describe the clinical presentation of amyotrophic lateral sclerosis.

Question 47

While there is no laboratory test that is diagnostic for multiple sclerosis, some patients have alterations in their cerebrospinal fluid (CSF) that can be seen when a portion of the CSF is removed during a spinal tap. What finding in CSF is suggestive of multiple sclerosis?

a. Decreased immunoglobulin G levels
b. Decreased total protein levels
c. Oligoclonal patterns
d. Decreased lymphocytes

Answer 47

c. Oligoclonal patterns

A large percentage of patients with multiple sclerosis have elevated immunoglobin G (IgG) levels, and some have oligoclonal patterns (i.e., discrete electrophoretic bands) even with normal IgG levels.

Question 48

At what level of the cervical spine would an injury allow finger flexion?

a. C5
b. C6
c. C7
d. C8

Answer 48

d. C8

A functional C7 injury allows full elbow flexion and extension, wrist plantar flexion, and some finger control. At the C8 level, finger flexion is added. The other answers are incorrect.

Question 49

A 14-year-old girl has been thrown from the back of a pick-up truck. MRI shows broken vertebrae at the C2 level. What is the main significance of injury at this level of the spinal column?

a. Cannot breathe on own, needs ventilator assistance
b. Partial or full diaphragmatic function; ventilation is diminished because of the loss of intercostal muscle function, resulting in shallow breaths and a weak cough
c. Intercostal and abdominal musculature is affected; the ability to take a deep breath and cough is less impaired
d. Needs maintenance therapy to strengthen existing muscles for endurance and mobilization of secretions

Answer 49

a. Cannot breathe on own, needs ventilator assistance

Cord injuries involving C1 to C3 result in a lack of respiratory effort, and affected patients require assisted ventilation. The other answers involve injuries further down the spinal column.

Question 50

Approximately 6 months after a spinal cord injury, a 29-year-old man has an episode of autonomic dysreflexia. What are the characteristics of autonomic dysreflexia? (Mark all that apply.)

a. Hypertension
b. Fever
c. Skin pallor
d. Vasoconstriction
e. Piloerector response

Answer 50

a, c, e (hypertension, skin pallor, piloerector response)

Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild (20 mm Hg above baseline) to severe (as high as 240/120 mm Hg or higher), skin pallor, and gooseflesh associated with the piloerector response. Fever and vasoconstriction are not manifestations of autonomic dysreflexia.

Question 51

Bowel dysfunction is one of the most difficult problems to deal with after a spinal cord injury. After a spinal cord injury, most people experience constipation. Why does this occur?

a. Innervation of the bowel is absence
b. Defecation reflex is lost
c. Internal anal sphincter will not relax
d. Peristaltic movements are not strong enough to move stool through the colon

Answer 51

b. Defecation reflex is lost

Even though the enteric nervous system innervation of the bowel remains intact, without the defecation reflex, peristaltic movements are ineffective in evacuating stool. The other answers are incorrect.

Question 52

There are several types of brain injury that can occur. What are the primary (or direct) brain injuries? (Mark all that apply.)

a. Focal lesions of laceration
b. Contusion
c. Hypoxic
d. Diffuse axonal
e. Hemorrhage

Answer 52

a, b, d, e (focal lesions of laceration, contusion, diffuse axonal, hemorrhage)

Question 53

Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?

a. Altered level of consciousness
b. Change in behavior
c. Respiratory instability
d. Loss of eye movement reflexes

Answer 53

a. Altered level of consciousness

Question 54

You are the nurse caring for a 31-year-old trauma victim is admitted to the neurologic intensive care unit. While doing your initial assessment you find that the client is flexing the arms, wrists, and fingers. There is abduction of the upper extremities with internal rotation and plantar flexion of the lower extremities. How would you describe this in your nursing notes?

a. Decerebrate posturing
b. Decorticate posturing
c. Extensor posturing
d. Diencephalon posturing

Answer 54

b. Decorticate posturing

Question 55

Brain death is the term that is used when the loss of function of the entire brain is irreversible. A clinical examination must be done and repeated at least 6 hours later with the same findings for brain death to be declared. What is not assessed in the clinical examination for brain death?

a. Blink reflex
b. Responsiveness
c. Electrocardiogram
d. Respiratory effort

Answer 55

c. Electrocardiogram

Question 56

Much like brain death, there are criteria for the diagnosis of a persistent vegetative state, and the criteria have to have lasted for more than 1 month. What are the criteria for the diagnosis of persistent vegetative state? (Mark all that apply.)

a. Bowel and bladder incontinence
b. Ability to open the eyes
c. Lack of language comprehension
d. Lack of enough hypothalamic function to maintain life
e. Variable preserved cranial nerve reflexes

Answer 56

a, c, e (bowel and bladder incontinence, lack of language comprehension, variable preserved cranial nerve reflexes)

Question 57

The regulation of cerebral blood flow is accomplished through both autoregulation and local regulation. This allows for the brain to meet its metabolic needs. What is the low parameter for blood pressure before cerebral blood flow becomes severely compromised?

a. 30 mm Hg
b. 40 mm Hg
c. 50 mm Hg
d. 60 mm Hg

Answer 57

d. 60 mm Hg

Question 58

Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made?

a. Lumbar puncture
b. MRI
c. Loss of cranial nerve reflexes
d. Venography

Answer 58

a. Lumbar puncture

Question 59

When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining of meningeal irritation is present?

a. Kernig sign and Chadwick sign
b. Brudzinski sign and Kernig sign
c. Brudzinski sign and Chadwick sign
d. Chvostek’s sign and Guedel sign

Answer 59

b. Brudzinski sign and Kernig sign

Question 60

Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors?

a. Tumor infiltration and increased blood pressure
b. Brain compression and decreased ICP
c. Brain edema and disturbances in blood flow
d. Tumor infiltration and decreased ICP

Answer 60

c. Brain edema and disturbances in blood flow

Question 61

For seizure disorders that do not respond to anticonvulsant medications, the option for surgical treatment exists. What is removed in the most common surgery for seizure disorders?

a. Temporal neocortex
b. Hippocampus
c. Entorhinal cortex
d. Amygdala

Answer 61

d. Amygdala

Question 62

Generalized convulsive status epilepticus is a medical emergency caused by a tonic-clonic seizure that does not spontaneously end, or recurs in succession without recovery. What is the first-line drug of choice to treat status epilepticus?

a. Intravenous diazepam
b. Intramuscular lorazepam
c. Intravenous cyclobenzaprine
d. Intramuscular cyproheptadine

Answer 62

a. Intravenous diazepam