Chapter 23: Neurologic System

Question 1

The autonomic nervous system coordinates which of the following?
a. High-level cognitive function
b. Balance and affect
c. Internal organs of the body
d. Balance and equilibrium

Answer 1

ANS: C
The autonomic nervous system coordinates the internal environment of the body by the
sympathetic and parasympathetic nervous systems. The other options are associated with the
cerebral cortex; its function consists of determining intelligence, personality, and motor
function

Question 2

The major function of the sympathetic nervous system is to
a. orchestrate the stress response.
b. coordinate fine motor movement.
c. determine proprioception.
d. perceive stereognosis.

Answer 2

ANS: A
Stimulation of the sympathetic branch of the autonomic nervous system prepares the body for
emergencies for fight or flight (stress response). The cerebellum plays a key role in the
coordination of fine motor movements. Recognition of body parts and awareness of body
position (proprioception) are dependent on the parietal lobe. Stereognosis is the ability to
perceive the weight and form of solid objects by touch and is not under sympathetic control.

Question 3

The parasympathetic nervous system maintains the day-to-day function of
a. digestion.
b. response to stress.
c. lymphatic supply to the brain.
d. lymphatic drainage of the brain.

Answer 3

ANS: A
The parasympathetic division functions in a complementary and counterbalancing manner to
conserve body resources and maintain day-to-day body functions, such as digestion and
elimination.

Question 4

Cerebrospinal fluid serves as a
a. nerve impulse transmitter.
b. red blood cell conveyer.
c. shock absorber.
d. mediator of voluntary skeletal movement.

Answer 4

ANS: C
Cerebrospinal fluid circulates between an interconnecting system of ventricles in the brain and around the brain and spinal cord, serving as a shock absorber.

Question 5

Diabetic peripheral neuropathy will likely produce
a. hyperactive ankle reflexes.
b. diminished pain sensation.
c. exaggerated vibratory sense.
d. hypersensitive temperature perception.

Answer 5

ANS: B
Peripheral neuropathy is a disorder of the peripheral nervous system that results in motor and
sensory loss in the distribution of one or more nerves, usually in the hands and feet. Patients
may have sensations of numbness, tingling, burning, and cramping. In moderate to severe
diabetic neuropathy, there is wasting of the foot muscles, absent ankle and knee reflexes,
decreased or no vibratory sensation below the knees, and/or loss of pain or sharp touch
sensation to the midcalf level.

Question 6

The thalamus is the major integration center for the perception of
a. speech.
b. olfaction.
c. pain.
d. thoughts.

Answer 6

ANS: C
The thalamus is the major integrating center for the perception of various sensations such as
pain and temperature, serving as the relay center between the basal ganglia and cerebellum.
The reception of speech and interpretation of speech are located in the Wernicke area. The
olfactory sense is processed in the parietal lobe. The cerebrum holds memories, allows you to
plan, and enables you to imagine and think.

Question 7

The awareness of body position is known as
a. proprioception.
b. graphesthesia.
c. stereognosis.
d. two-point discrimination.

Answer 7

ANS: A
Recognition of body parts and awareness of body position are known as proprioception. This
is dependent on the parietal lobe. The other options are assessment techniques that test for
sensory impairment.

Question 8

Which area of the brain maintains temperature control?
a. Epithalamus
b. Thalamus
c. Abducens
d. Hypothalamus

Answer 8

ANS: D
The hypothalamus is the major processing center of internal stimuli for the autonomic nervous
system. It maintains temperature control, water metabolism, body fluid osmolarity, feeding
behavior, and neuroendocrine activity. The epithalamus houses the pineal body and is
responsible for sexual development and behavior. The thalamus conveys all sensory impulses,
except olfaction, to and from the cerebrum before their distribution to appropriate associative
sensory areas. The abducens is the sixth cranial nerve with motor function responsible for
lateral eye movement.

Question 9

If a patient cannot shrug his or her shoulders against resistance, which cranial nerve (CN)
requires further evaluation?
a. CN I, olfactory
b. CN V, trigeminal
c. CN IX, glossopharyngeal
d. CN XI, spinal accessory

Answer 9

ANS: D
CN XI is responsible for the motor ability to shrug the shoulders. CN I is associated with
smell reception and interpretation. CN V is associated with opening of the jaw, chewing, and
sensation of the cornea, iris, conjunctiva, eyelids, forehead, nose, teeth, tongue, ear, and facial
skin. CN IX is associated with swallowing function, sensation of the nasopharynx, gag reflex,
taste, secretion of salivary glands, carotid reflex, and swallowing.

Question 10

Motor maturation proceeds in an orderly progression from
a. peripheral to central.
b. head to toe.
c. lateral to medial.
d. pedal to cephalic.

Answer 10

ANS: B
Motor maturation proceeds in a cephalocaudal direction. Motor control of the head and neck
develops first, followed by the trunk and extremities. The other choices are incorrect because
they relate the maturation sequence inappropriately, from outward to central.

Question 11

Normal changes of the aging brain include
a. increased velocity of nerve conduction.
b. diminished perception of touch.
c. increased total number of neurons.
d. diminished intelligence quotient.

Answer 11

ANS: B
Sensory perceptions of touch and pain are diminished by aging. The velocity of nerve impulse
conduction declines, so responses to stimuli take longer. The number of cerebral neurons is
thought to decrease by 1% a year, beginning at 50 years of age; however, the vast number of
reserve cells inhibits the appearance of clinical signs.

Question 12

The area of body surface innervated by a particular spinal nerve is called a
a. dermatome.
b. nerve pathway.
c. spinal accessory area.
d. cutaneous zone.

Answer 12

ANS: A
The sensory and motor fibers of each spinal nerve supply and receive information to a
segment of skin known as a dermatome. Nerve pathway and spinal accessory area refer to
nerve routes. Cutaneous zone refers to a skin area that transmits fine mechanical information
and normal exogenous thermal information at the same time.

Question 13

A neurologic past medical history should include data about
a. allergies.
b. circulatory problems.
c. educational level.
d. immunizations.

Answer 13

ANS: B
The neurologic past medical history should include data concerning neurovascular problems
such as stroke, aneurysm, and brain surgery. The other answers are not pertinent medical
information for the neurologic past medical history.

Question 14

Which is the technique most often used for evaluating the neurologic system?
a. Auscultation
b. Inspection
c. Palpation
d. Percussion

Answer 14

ANS: B
The evaluation tool of inspection is used most often. Inspection of gait and response to
questions can provide data concerning neurologic system function.

Question 15

When assessing superficial pain, touch, vibration, and position perceptions, you are testing
a. cerebellar function.
b. emotional status.
c. sensory function.
d. tendon reflexes.

Answer 15

ANS: C
Superficial pain, touch, vibration, and position perceptions are sensory functions.

Question 16

You are initially evaluating the equilibrium of Ms. Q. You ask her to stand, with her feet
together and arms at her sides. She loses her balance. Ms. Q has a positive
a. Kernig sign.
b. Homan sign.
c. McMurray test.
d. Romberg sign.

Answer 16

ANS: D
The Romberg test has the patient stand with the eyes closed, feet together, and arms at the
sides. A slight swaying movement of the body is expected, but not to the extent of falling.
Loss of balance results in a positive Romberg test. The Kernig sign indicates meningeal
irritation, the Homan sign indicates venous thrombosis, and the McMurray test is a rotation
test for demonstrating a torn meniscus.

Question 17

The finger to nose test allows assessment of
a. coordination and fine motor function.
b. point location.
c. sensory function.
d. stereognosis.

Answer 17

ANS: A
To perform the finger to nose test, the patient closes both eyes and touches his or her nose
with the index finger, alternating hands while gradually increasing the speed. This tests
coordination and fine motor skills. All the other choices test sensory function without motor
function.

Question 18

You are performing a two-point discrimination test as part of a well physical examination.
The area with the ability to discern two points in the shortest distance is the
a. back.
b. palms
c. fingertips.
d. upper arms.

Answer 18

ANS: C
The fingertips can discern two points with a minimal distance of 2 to 8 mm, the back, 40 to 70
mm, the palms, 8 to 12 mm, and the upper arms, 75 mm.

Question 19

As Mr. B enters the room, you observe that his gait is wide-based and he staggers from side to
side while swaying his trunk. You would document Mr. B’s pattern as
a. dystonic ataxia.
b. cerebellar ataxia.
c. steppage gait.
d. tabetic stamping.

Answer 19

ANS: B
A cerebellar gait (cerebellar ataxia) occurs when the patient’s feet are wide-based, with a staggering gait, lurching from side to side, often accompanied by swaying of the trunk.
Dystonic ataxia is jerky dancing movements that appear nondirectional. Steppage gait is noted when the hip and knee are elevated excessively high to lift the plantar-flexed foot off the
ground. The foot is brought down with a slap and the patient is unable to walk on the heels.
Tabetic stamping occurs when the legs are positioned far apart, lifted high, and forcibly brought down with each step; in this case, the heel stamps on the ground.

Question 20

Deep pressure tests are used mostly for patients who are experiencing
a. absent superficial pain sensation.
b. gait and stepping disturbances.
c. lordosis, osteoporosis, or arthritis.
d. tonic neck or torso spasms.

Answer 20

ANS: A
Deep pressure sensation is tested by squeezing the trapezius, calf, or biceps muscle, thus
causing discomfort. When superficial pain sensation is not intact, further assessments of
temperature and deep pressure sensation are performed

Question 21

Vibratory sensory testing should be routinely done for the patient with
a. Parkinson disease.
b. diabetes.
c. cerebral palsy.
d. Guillain-Barré syndrome.

Answer 21

ANS: B
Diabetic neuropathy must be routinely assessed in all diabetic patients. In moderate to severe
cases, decreased or absent vibratory sensation occurs below the knees, which should be
assessed with a tuning fork. The other choices do not result in sensation deficits

Question 22

To assess a cremasteric reflex, the nurse strokes the
a. sole of the foot and observes whether the toes fan down and out.
b. abdomen and observes whether the umbilicus moves away from the stimulus.
c. inner thigh and observes whether the testicle and scrotum rise on the stroked side.
d. palm and observes whether the fingers attempt to grasp.

Answer 22

ANS: C
Stroking the inner thigh of a male patient (proximal to distal) will elicit the cremasteric reflex.
The testicle and scrotum rise on the stroked side. Stroking the sole of the foot elicits a
Babinski sign. Stroking the abdomen elicits an abdominal reflex. Stroking the palm elicits a
palmar grasp.

Question 23

When you ask a patient to close his or her eyes and identify an object placed in the hand, you
are evaluating
a. stereognosis.
b. graphesthesia.
c. vibratory sensation.
d. extinction phenomenon.

Answer 23

ANS: A
Stereognosis is the ability to recognize an object through touch and manipulation. Tactile
agnosia, an inability to recognize objects by touch, suggests a parietal lobe lesion.
Graphesthesia tests the patient’s ability to identify the figure being drawn on the palm. The
vibratory sense uses a tuning fork placed on a bony prominence, and the extinction
phenomenon tests sensation by simultaneously touching bilateral sides of the body with a
sterile needle.

Question 24

The ability to recognize a number traced on the skin is called
a. stereognosis.
b. graphesthesia.
c. an extinction phenomenon.
d. two-point discrimination.

Answer 24

ANS: B
The ability to recognize a number traced on the skin is called graphesthesia. Stereognosis is
the ability to recognize an object through touch and manipulation. The extinction phenomenon
test and two-point discrimination assess a person’s ability to discern the number of pinpoints
and their location.

Question 25

Which condition is consistent with Brown-Séquard syndrome?
a. Central sensory loss that is generalized
b. Motor paralysis on the lesion side of the body
c. Multiple peripheral neuropathy of the joints
d. Spinal root paralysis below the umbilicus

Answer 25

ANS: B
Parietal spinal sensory syndrome (Brown-Séquard syndrome) is noted when pain and
temperature sensation occur one to two dermatomes below the lesion on the opposite side of
the body from the lesion. Proprioceptive loss and motor paralysis occur on the lesion side of
the body

Question 26

To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested?
a. Triceps
b. Patellar
c. Biceps
d. Achilles

Answer 26

ANS: B
To assess spinal levels L2 to L4, the patellar reflex should be tested. The patellar tendon is the
only deep tendon that assesses the lumbar spinal level. The triceps and biceps tendon are
tested to assess the cervical spine, whereas the Achilles tendon is tested to assess the sacral
spine

Question 27

When using a monofilament to assess sensory function, the nurse
a. uses two simultaneous monofilaments on similar bilateral points and then
compares results.
b. applies both a monofilament and a pin on similar bilateral points and then
compares results.
c. applies pressure to the monofilament until the filament bends.
d. strokes the monofilament along the skin from proximal to distal areas.

Answer 27

ANS: C
The monofilament is placed on several smooth spots of the patient’s plantar foot for seconds.
Adequate pressure applied by the monofilament is measured by the bend of the monofilament.

Question 28

Visible or palpable extension of the elbow is caused by reflex contraction of which muscle?
a. Achilles
b. Biceps
c. Patellar
d. Triceps

Answer 28

ANS: D
The triceps tendon, when directly hit with the reflex hammer just above the elbow, will cause
contraction of the triceps muscle and extension of the elbow.

Question 29

It is especially important to test for ankle clonus if
a. deep tendon reflexes are hyperactive.
b. deep tendon reflexes are hypoactive.
c. the Romberg sign is positive.
d. the patient has peripheral neuropathy.

Answer 29

ANS: A
Test the ankle clonus when reflexes are hyperactive. Support the patient’s knee in a flexed
position and briskly dorsiflex the foot with your other hand. If clonus is present, there is
recurrent ankle plantar flexion movement as long as the examiner retains the foot in
dorsiflexion. Sustained clonus signifies the hypertonia of an upper motor neuron lesion.

Question 30

On a scale of 1+ to 4+, which deep tendon reflex score is appropriate for a finding of clonus in
a patient?
a. 1+
b. 2+
c. 3+
d. 4+

Answer 30

ANS: D
1+ indicates a sluggish or diminished reflex. 2+ indicates an active or expected response. 3+
indicates more brisk than expected, slightly hyperactive. 4+ indicates brisk, hyperactive, with
intermittent or transient clonus.

Question 31

Which sign is associated with meningitis and intracranial hemorrhage?
a. Babinski sign
b. Asymmetric tonic neck reflex
c. Doll’s eye movement
d. Nuchal rigidity

Answer 31

ANS: D
A stiff neck or nuchal rigidity is a sign associated with meningitis and intracranial
hemorrhage. Test this by lifting the head of the patient to touch the chin while the patient lies
in a supine position. Pain and resistance to neck motion are associated with nuchal rigidity

Question 32

Cranial nerve XII may be assessed in an infant by
a. watching the infant’s facial expressions when crying.
b. observing the infant suck and swallow.
c. clapping hands and watching the infant blink.
d. observing the infant’s rooting reflex.

Answer 32

ANS: B
Cranial nerve (CN) XII may be assessed in an infant by observing the infant suck and
swallow, by pinching the nose, and then observing for the mouth to open and the tip of the
tongue to rise in a midline position. Watching the infant’s facial expressions when crying
assesses CN VII. Clapping hands and watching the infant blink tests CN VIII. Observing the
rooting reflex assesses CN V.

Question 33

You are most concerned for the infant who has a
a. weak palmar grasp at 3 months.
b. strong stepping reflex at 2 months.
c. weak plantar reflex at 9 months.
d. strong tonic neck at 6 months.

Answer 33

ANS: D
The tonic neck reflex must disappear before the infant can roll over or bring his or her hands
to their face; it should disappear by 6 months. The other choices are within expected ranges.

Question 34

At what age should the infant begin to transfer objects from hand to hand?
a. 2 months
b. 4 months
c. 7 months
d. 10 months

Answer 34

ANS: C
Transferring objects hand to hand begins at 7 months. Purposeful release of objects is noted as
a normal finding by 10 months. Purposeful movements, such as reaching and grasping for
objects, begin at about 2 months of age. The progress of taking objects with one hand begins
at 6 months. There should be no tremors or constant overshooting of movements

Question 35

An acute polyneuropathy that commonly follows a nonspecific infection occurring 10 to 14
days earlier and that primarily affects the motor and autonomic peripheral nerves in an
ascending pattern is
a. cerebral palsy.
b. HIV encephalopathy.
c. Guillain-Barré syndrome.
d. Rett syndrome.

Answer 35

ANS: C
Guillain-Barré syndrome—acute idiopathic polyneuritis—is an acute polyradiculoneuropathy
that commonly follows a nonspecific infection that occurred 10 to 14 days earlier. It is
characterized by ascending symmetric weakness with sensation preserved. An increase in
severity occurs over days or weeks. A decrease in or absent strength and sensory loss may
result, along with motor paralysis and respiratory muscle failure.

Question 36

Which is a concern, rather than an expected finding, in older adults?
a. Reduced ability to differentiate colors
b. Bilateral pillrolling of the fingers
c. Absent plantar reflex
d. Reduction in upward gaze

Answer 36

ANS: B
Bilateral pillrolling is indicative of Parkinson disease; the other choices are expected findings
with aging.

Question 37

Which condition is potentially life-threatening if not treated expeditiously with antibiotics?
a. HIV encephalopathy
b. Dementia
c. Parkinson disease
d. Bacterial meningitis

Answer 37

ANS: D
Meningitis is an inflammatory process in the meninges. Bacterial meningitis is a
life-threatening illness if not rapidly treated with appropriate antibiotics. All the other diseases
are neurologic disorders not treatable by antibiotics.

Question 38

Ipsilateral Horner syndrome indicates a cerebrovascular accident (CVA) occurring in the
a. anterior portion of the pons.
b. internal or middle cerebral artery.
c. posterior inferior cerebellar artery.
d. vertebral or basilar arteries.

Answer 38

ANS: C
The posterior inferior cerebellar artery supplies the lateral and posterior portion of the
medulla. A CVA involving this artery can produce a neurologic sign of ipsilateral Horner
syndrome in the eye.

Question 39

The immune system attacks the synaptic junction between the nerve and muscle fibers,
blocking acetylcholine receptor sites in
a. myasthenia gravis.
b. encephalitis.
c. multiple sclerosis.
d. cerebral palsy.

Answer 39

ANS: A

Myasthenia gravis is a chronic autoimmune neuromuscular disease involving the lower motor
neurons and muscle fibers. The immune system of infected individuals produces antibodies
that destroy acetylcholine receptor sites at the neuromuscular junction. This blocks the nerve
impulse from reaching the muscle and produces muscle fatigue. Encephalitis is acute
inflammation of the brain and spinal cord involving the meninges. It is often caused by a
virus, such as the herpes simplex virus. Multiple sclerosis is a progressive autoimmune
disorder characterized by a combination of inflammation and degeneration of the myelin in
the brain’s white matter, leading to obstructed transmission of nerve impulses and decreased
brain mass. Cerebral palsy is a permanent disorder of movement and posture development
associated with nonprogressive (static) disturbances that occurred in the developing fetal or
infant brain.

Question 40

Persons with Parkinson disease have an altered gait characterized by
a. short shuffling steps.
b. the trunk in a backward position.
c. exaggerated swinging of the arms.
d. lifting the legs in a high-stepping fashion.

Answer 40

ANS: A
The altered gait of Parkinson disease has short shuffling steps, the posture is stooped forward,
and the arms have limited swing.

Question 41

The tests for cortical sensory function include which of the following? (Select all that apply.)
a. Two-point discrimination
b. Extinction phenomenon
c. Superficial pain
d. Stereognosis
e. Touch

Answer 41

ANS: A, B, D
The following tests are tests for cortical sensory function—stereognosis, two-point
discrimination, extinction phenomenon, graphesthesia, and point location.