Quiz #4 - Chapter 22, 23, 24, 25 and 26 Flashcards
A patient is being assessed for range of joint movement. The nurse asks him to move his arm in toward the center of his body. This movement is called?
Moving a limb toward the midline of the body is called adduction; abduction is moving a limb away from the midline of the body.
A patient tells the nurse that she is having a hard time bringing her hand to her mouth when she eats or tries to brush her teeth. The nurse knows that for her to move her hand to her mouth, she must perform the following movement?
Flexion, or bending a limb at a joint, would be required to move your hand to your mouth.
Hematopoiesis takes place where in the body?
The musculoskeletal system functions to encase and protect inner vital organs, support the body, produce red blood cells in the bone marrow, and store minerals.
The nurse notices that a woman in an exercise class is unable to jump rope. The nurse knows that to jump rope, one’s shoulder has to be capable of?
Circumduction is defined as moving the arm in a circle around the shoulder.
To palpate the temporomandibular joint, the nurse’s fingers should be placed in the depression where?
The temporomandibular joint can be felt in the depression anterior to the tragus of the ear.
Of the 33 vertebrae in the spinal column, there are how many in each section?
7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 3 - 4 Coccygeal
The nurse is checking the range of motion in a patient’s knee and knows that the knee is capable of what movements?
The knee is a hinge joint, permitting flexion and extension of the lower leg on a single plane.
A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain.
The nurse tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. This shift in posture is known as what?
Lordosis compensates for the enlarging fetus, which would shift the center of balance forward. This shift in balance in turn creates strain on the low back muscles, felt as low back pain during late pregnancy by some women.
The nurse knows that the incidence of osteoporosis is greatest in which group?
The incidence of osteoporosis is lowest in black men and highest in white women.
A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for awhile, and then gets worse again if he sits for long periods of time. The nurse suspects that he may have what?
Rheumatoid arthritis is worse in the morning when arising. Movement increases most joint pain, except in rheumatoid arthritis, in which movement decreases pain.
A patient states, “I can hear a crunching or grating sound when I kneel.” She also states “it is very difficult to get out of bed in the morning because of stiffness and pain in my joints.” The nurse suspects that the sound she hears is what?
Crepitation is an audible and palpable crunching or grating that accompanies movement and occurs when articular surfaces in the joints are roughened, as with rheumatoid arthritis.
An 80-year-old woman is visiting the clinic for a checkup. The nurse is observing for motor dysfunction in her hip and would have her do what?
Limitation of abduction of the hip while supine is the most common motion dysfunction found in hip disease.
During an examination, the nurse asks a patient to bend forward from the waist and notes that the patient has lateral tilting. When his leg is raised straight up, he complains of a pain going down his buttock into his leg. The nurse suspects what condition?
Lateral tilting and sciatic pain with straight leg raising are findings that occur with a herniated nucleus pulposus.
The nurse is examining a 3-month-old infant. While holding the thumbs on the infant’s inner mid thighs and the fingers outside on the hips, touching the greater trochanter, the nurse adducts the legs until the nurse’s thumbs touch and then abducts the legs until the infant’s knees touch the table. The nurse does not note any “clunking” sounds and is confident to record what?
Normally this maneuver feels smooth and has no sound. With a positive Ortolani sign, you will feel and hear a “clunk” as the head of the femur pops back into place.
A 40-year-old man has come into the clinic with complaints of “extreme tenderness in my toes.” The nurse notes that his toes are slightly swollen, reddened, and warm to the touch. His complaints would suggest what condition?
Acute gout occurs primarily in men over 40 years of age. Clinical findings consist of redness, swelling, heat, and extreme tenderness. Gout is a metabolic disorder of disturbed purine metabolism, associated with elevated serum uric acid.
A 68-year-old woman has come in for an assessment of her rheumatoid arthritis, and the nurse notes raised, firm, nontender nodules at the olecranon bursa and along the ulna. These nodules are most commonly diagnosed as what?
Subcutaneous nodules that are raised, firm, and nontender occur with rheumatoid arthritis in the olecranon bursa and along the extensor surface of the ulna.
A woman who has had rheumatoid arthritis for years is starting to notice that her fingers are drifting to the side. The nurse knows that this condition is commonly referred to as what?
Fingers drift to the ulnar side because of stretching of the articular capsule and muscle imbalance caused by chronic rheumatoid arthritis.
A patient’s annual physical examination reveals a lateral curvature of the thoracic and lumbar segments of his spine; however, this curvature disappears with forward bending. The nurse knows that this abnormality of the spine would be called what?
Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending.
When assessing muscle strength, the nurse observes that a patient has complete range of motion against gravity with full resistance. What should the nurse record using a 0 to 5+ scale?
Complete range of motion against gravity is normal muscle strength and is recorded as 5+ muscle strength.
When performing a musculoskeletal assessment, the nurse knows that the correct approach for the examination should be in what order?
The musculoskeletal assessment should be done in an orderly approach, head to toe, proximal to distal.
The nurse is assessing the joints of a woman who has stated, “I have a long family history of arthritis, and my joints hurt.” The nurse suspects that she has osteoarthritis, what are the symptoms of this condition?
In osteoarthritis, asymmetric joint involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. Affected joints have stiffness, swelling with hard bony protuberances, pain with motion, and limitation of motion.
The two parts of the nervous system are what?
The nervous system can be divided into two parts—central and peripheral.
The central nervous system includes the brain and spinal cord.
The peripheral nervous system includes the 12 pairs of cranial nerves (CNs), the 31 pairs of spinal nerves, and all of their branches.
The wife of a 65-year-old man tells the nurse that she is concerned because she has noticed a change in her husband’s personality and ability to understand. He also cries very easily and becomes angry. The nurse recalls that the cerebral lobe responsible for these behaviors is the __________ lobe.
Its the Frontal lobe here is why:
The frontal lobe has areas responsible for personality, behavior, emotions, and intellectual function.
The parietal lobe has areas responsible for sensation; the occipital lobe is responsible for visual reception.
The temporal lobe is responsible for hearing, taste,
and smell.
The hypothalamus is responsible for what?
The hypothalamus is a vital area with many important functions: body temperature controller, sleep center, anterior and posterior pituitary gland regulator, and coordinator of autonomic nervous system activity and emotional status.
The cerebellum is responsible for what?
The cerebellum controls motor coordination, equilibrium, and balance.
The basal ganglia is responsible for what?
The basal ganglia control autonomic movements
of the body.
Where do the various motor pathways synapse?
The motor pathways of the spinal cord synapse in various areas of the spinal cord, not in the thalamus.
The area of the nervous system that is responsible for mediating reflexes is where?
The spinal cord is the main highway for ascending and descending fiber tracts that connect the brain to the spinal nerves; it is responsible for mediating reflexes.
To interpret the sensation of being pricked or poked which areas of your nervous system must be intact?
The spinothalamic tract contains sensory fibers that transmit the sensations of pain, temperature, and crude or light touch.
Fibers carrying pain and temperature sensations
ascend the lateral spinothalamic tract, whereas the sensations of crude touch form the anterior spinothalamic tract.
At the thalamus, the fibers synapse with another sensory neuron, which carries the message to the sensory cortex for full interpretation.
A patient with a lack of oxygen to his heart will have pain in his chest and possibly in the shoulder, arms, or jaw. The nurse knows that the best explanation why this occurs is which one of these statements?
The sensory cortex is arranged in a specific pattern, forming a corresponding map of the body. Pain in the right hand is perceived at a specific spot on the map.
Some organs, such as the heart, liver, and spleen, are absent from the brain map. Pain originating in these organs is referred because no felt image exists in which to have pain. Pain is felt by proxy, that is, by another body part that does have a felt image.
The ability that humans have to perform very skilled movements such as writing is controlled by what tract?
A. Basal ganglia.
B. Corticospinal tract.
C. Spinothalamic tract.
D. Extrapyramidal tract.
Answer is B, Corticospinal Tract,
Corticospinal fibers mediate voluntary movement, particularly very skilled, discrete, and purposeful movements, such as writing.
The corticospinal tract, also known as the pyramidal tract, is a newer, “higher” motor system that humans have that permits very skilled and purposeful movements.
A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in maintaining her balance. Which area of the brain that is related to these
findings would concern the nurse?
A. Thalamus
B. Brainstem
C. Cerebellum
D. Extrapyramidal tract
Answer: C, Cerebellum
The cerebellar system coordinates movement, maintains equilibrium, and helps maintain posture.
The thalamus is the primary relay station where sensory pathways of the spinal cord, cerebellum, and brainstem form synapses on their way to the cerebral cortex.
The brainstem consists of the midbrain, pons, and medulla and has various functions, especially concerning autonomic centers.
The extrapyramidal tract maintains muscle tone
for gross automatic movements, such as walking.
Which of these statements about the peripheral nervous system is correct?
A. The CNs enter the brain through the spinal cord.
B. Efferent fibers carry sensory input to the central
nervous system through the spinal cord.
C. The peripheral nerves are inside the central nervous
system and carry impulses through their motor
fibers.
D. The peripheral nerves carry input to the central
nervous system by afferent fibers and away from the
central nervous system by efferent fibers.
Answer, D
A nerve is a bundle of fibers outside of the central nervous system.
The peripheral nerves carry input to the central nervous system by their sensory afferent fibers and deliver output from the central nervous system by their efferent fibers.
The other responses are not related to the peripheral nervous system.
A patient has a severed spinal nerve as a result of trauma. Which statement is TRUE in this situation?
A. Because there are 31 pairs of spinal nerves, no effect
results if only one nerve is severed.
B. The dermatome served by this nerve will no longer
experience any sensation.
C. The adjacent spinal nerves will continue to carry
sensations for the dermatome served by the
severed nerve.
D. A severed spinal nerve will only affect motor
function of the patient because spinal nerves have
no sensory component.
Answer, C
A dermatome is a circumscribed skin area that is primarily supplied from one spinal cord segment through a particular spinal nerve. The dermatomes overlap, which is a form of biologic insurance; that is, if one nerve is severed, then most of the sensations can be
transmitted by the spinal nerve above and the spinal nerve below the severed nerve.
A 21-year-old patient has a head injury resulting from trauma and is unconscious. There are NO OTHER injuries. During the assessment what would the nurse expect to find when testing the patient’s deep tendon reflexes?
A. Reflexes will be normal.
B. Reflexes cannot be elicited.
C. All reflexes will be diminished but present.
D. Some reflexes will be present, depending on the
area of injury.
Answer, A
A reflex is a defense mechanism of the nervous system. It operates below the level of conscious control and permits a quick reaction to potentially painful or damaging situations.
A mother of a 1-month-old infant asks the nurse why it takes so long for infants to learn to roll over. The nurse knows that the reason for this is:
A. A demyelinating process must be occurring with her
infant.
B. Myelin is needed to conduct the impulses, and the
neurons of a newborn are not yet myelinated.
C. The cerebral cortex is not fully developed; therefore,
control over motor function gradually occurs.
D. The spinal cord is controlling the movement
because the cerebellum is not yet fully developed.
Answer, B
The infant’s sensory and motor development proceeds along with the gradual acquisition of myelin, which is needed to conduct most impulses.
Very little cortical control exists, and the neurons are not yet myelinated. Making the other responses are not correct.
During an assessment of an 80-year-old patient, the nurse notices the following: an inability to identify vibrations at her ankle and to identify the position of her big toe, a slower and more deliberate gait, and a slightly impaired tactile sensation. All other neurologic findings are normal. The nurse should interpret that these findings indicate:
A. CN dysfunction.
B. Lesion in the cerebral cortex.
C. Normal changes attributable to aging.
D. Demyelination of nerves attributable to a lesion.
Answer, C
Some aging adults show a slower response to requests, especially for those calling for coordination of movements.
The findings listed are normal in the absence of other significant abnormal findings. The other responses are incorrect.
A 70-year-old woman tells the nurse that every time she gets up in the morning or after she’s been sitting, she gets “really dizzy” and feels like she is going to fall over.
The nurse’s best response would be to tell her what?
Aging is accompanied by a progressive decrease in cerebral blood flow. In some people, this decrease causes dizziness and a loss of balance with a position change. These individuals need to be taught to get up slowly.
During the taking of the health history, a patient tells the nurse that “it feels like the room is spinning around me.” The nurse would document this finding as what?
A. Vertigo.
B. Syncope.
C. Dizziness.
D. Seizure activity.
Answer, A
True vertigo is rotational spinning caused by a neurologic dysfunction or a problem in the
vestibular apparatus or the vestibular nuclei in the brainstem.
Syncope is a sudden loss of strength or a temporary loss of consciousness.
Dizziness is a lightheaded, swimming sensation.
Seizure activity is characterized by altered or loss of consciousness, involuntary muscle movements, and sensory disturbances.
When taking the health history on a patient with a seizure disorder, the nurse assesses whether the patient has an aura. This is what type of data?
Aura is a subjective sensation that precedes a seizure; it could be auditory, visual, or motor.
In obtaining a health history on a 74-year-old patient, the nurse notes that he drinks alcohol daily and that he has noticed a tremor in his hands that affects his ability to hold things. The alcohol does not relieve the tremors, the nurse should suspect what?
Senile tremor is relieved by alcohol, although not a recommended treatment. The nurse should assess whether the person is abusing alcohol in an effort to relieve the tremor.
A 50-year-old woman is in the clinic for weakness in her left arm and leg that she has noticed for the past week. The nurse should perform which type of neurologic
examination?
A Glasgow Coma Scale
B. Neurologic recheck examination
C. Screening neurologic examination
D. Complete neurologic examination
Answer, D
The nurse should perform a complete neurologic examination on an individual who has neurologic concerns (e.g., headache, weakness, loss of coordination) or who is showing signs of neurologic dysfunction.
The Glasgow Coma Scale is used to define a person’s
level of consciousness.
The neurologic recheck examination is appropriate for those who are demonstrating neurologic deficits.
The screening neurologic examination is performed on seemingly well individuals who have no significant subjective findings from the health history.
During an assessment of the CNs, the nurse finds the following: asymmetry when the patient smiles or frowns, uneven lifting of the eyebrows, sagging of the lower eyelids, and escape of air when the nurse presses against the right puffed cheek. This would indicate
dysfunction of which of these CNs?
A. Motor component of CN IV
B. Motor component of CN VII
C. Motor and sensory components
D. Motor component of CN X and sensory component
of CN VII
Answer, B
The findings listed reflect a dysfunction of the motor component of the facial nerve (CN VII).
The nurse is testing the function of CN XI. Which statement best describes the response the nurse should expect if this nerve is intact? The patient:
A. Demonstrates the ability to hear normal conversation.
B. Sticks out the tongue midline without tremors or
deviation.
C. Follows an object with his or her eyes without
nystagmus or strabismus.
D. Moves the head and shoulders against resistance
with equal strength.
Answer, D
The following normal findings are expected when testing the spinal accessory nerve (CN XI): The patient’s sternomastoid and trapezius muscles are equal in size; the person can forcibly rotate the head both ways against resistance applied to the side of the chin with
equal strength; and the patient can shrug the shoulders against resistance with equal strength on both sides.
Checking the patient’s ability to hear normal conversation checks the function of CN VIII.
Having the patient stick out the tongue checks the function of CN XII.
Testing the eyes for nystagmus or strabismus is performed to check CNs III, IV, and VI.
When the nurse asks a 68-year-old patient to stand with his feet together and arms at his side with his eyes closed, he starts to sway and moves his feet farther apart. The nurse would document this finding as:
A. Ataxia.
B. Lack of coordination.
C. Negative Homans sign.
D. Positive Romberg sign.
Answer, D
Abnormal findings for the Romberg test include swaying, falling, and a widening base of the feet to avoid falling.
A positive Romberg sign is a loss of balance that is increased by the closing of the eyes.
Ataxia is an uncoordinated or unsteady gait.
Homans sign is used to test the legs for deep-vein thrombosis.
The nurse is performing an assessment on a 29-year-old woman who visits the clinic complaining of “always dropping things and falling down.” While testing rapid
alternating movements, the nurse notices that the woman is unable to pat both of her knees. Her response is extremely slow and she frequently misses. What should the nurse suspect?
A. Vestibular disease
B. Lesion of CN IX
C. Dysfunction of the cerebellum
D. Inability to understand directions
Answer, C
When a person tries to perform rapid, alternating movements, responses that are slow, clumsy, and sloppy are indicative of cerebellar disease.
The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception, the nurse decides to complete the test as quickly as possible. When the nurse applies the sharp point of the pin on his arm several times, he is only able to
identify these as one “very sharp prick.” What would be the most accurate explanation for this?
This is most likely the summation affect, at least 2 seconds should be allowed to elapse between each stimulus to avoid summation. With summation, frequent consecutive stimuli are perceived as one strong
stimulus.
The nurse is performing a neurologic assessment on a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork, the nurse notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patellae. Given this information, what would the nurse suspect?
Loss of vibration sense occurs with peripheral neuropathy (e.g., diabetes and alcoholism). Peripheral neuropathy is worse at the feet and gradually improves as the examiner moves up the leg, as opposed to a specific nerve lesion, which has a clear zone of deficit for its dermatome.
The nurse places a key in the hand of a patient and he incorrectly identifies it as a penny. What term would the nurse use to describe this finding?
It would be documented as Asterognosis.
Stereognosis is the person’s ability to recognize objects by feeling their forms, sizes, and weights. Whereas astereognosis is an inability to identify objects correctly, and it occurs in sensory cortex lesions.
In assessing a 70-year-old patient who has had a recent cerebrovascular accident, the nurse notices right-sided weakness. What might the nurse expect to find when testing his reflexes on the right side?
A. Lack of reflexes
B. Normal reflexes
C. Diminished reflexes
D. Hyperactive reflexes
Answer, D
Hyperreflexia is the exaggerated reflex observed when the monosynaptic reflex arc is released from the influence of higher cortical levels. This response occurs with upper motor neuron lesions (e.g., a cerebrovascular accident).
The nurse is testing superficial reflexes on an adult patient. When stroking up the lateral side of the sole and across the ball of the foot, the nurse notices the plantar flexion of the toes. How should the nurse document this finding?
A. Positive Babinski sign
B. Plantar reflex abnormal
C. Plantar reflex present
D. Plantar reflex 2+ on a scale from “0 to 4+”
Answer, C
With the same instrument, the nurse should draw a light stroke up the lateral side of the sole of the foot and across the ball of the foot, similar to an upside-down J.
The normal response is plantar flexion of the toes and sometimes of the entire foot.
A positive Babinski sign is abnormal and occurs with the response of dorsiflexion of the big toe and
fanning of all toes.
The plantar reflex is not graded on a 0 to 4+ scale.
Which of these tests would the nurse use to check the motor coordination of an 11-month-old infant?
A. Denver II
B. Stereognosis
C. Deep tendon reflexes
D. Rapid alternating movements
Answer, A
To screen gross and fine motor coordination, the nurse should use the Denver II with its age-specific developmental milestones.
Stereognosis tests a person’s ability to recognize
objects by feeling them and is not appropriate for an 11-month-old infant.
Testing the deep tendon reflexes is not appropriate for checking motor coordination.
Testing rapid alternating movements is appropriate for testing coordination in adults.
