UNIT 5: Ch 15 (Porth's 5th Ed) Disorders of Motor Function

Question 1

During a late night study session, a pathophysiology student reaches out to turn the page
of her textbook. Which of the following components of her nervous system contains the
highest level of control of her arm and hand action?
A) Cerebellum
B) Thalamus
C) Basal ganglia
D) Frontal lobe

Answer 1

Ans: D
Feedback:
While intentional movement involves input from various components of the nervous
system including the cerebellum, thalamus, and basal ganglia, primary control and
coordination are controlled by the motor cortex in the frontal lobe.

Question 2

A patient is asked to stand with feet together, eyes open, and hands by the sides. Then
the patient is asked to close his eyes while the nurse observes for a full minute. What
assessment is the nurse performing?
A) Segmental reflex
B) Posture
C) Proprioception
D) Crossed-extensor reflex

Answer 2

Ans: C
Feedback:
Information from the sensory afferent is relayed to the cerebellum and cerebral cortex
and is experienced as proprioception or the sense of body movement and position
independent of vision. The knee-jerk reflex is a form of stretch reflex. The
crossed-extensor reflex serves to integrate motor movements, so they function in a
coordinated manner.

Question 3

A clinician is conducting an assessment of a male client suspected of having a disorder
of motor function. Which of the following assessment findings would suggest a possible
upper motor neuron (UMN) lesion?
A) The client has decreased deep tendon reflexes.
B) The client displays increased muscle tone.
C) The client’s muscles appear atrophied.
D) The client displays weakness in the distal portions of his limbs.

Answer 3

Ans: B
Feedback:
UMNs typically produce increased muscle tone, while hyporeflexia, muscle atrophy,
and weakness in the distal portion of limbs are more commonly indicative of LMN
lesions

Question 4

The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the
boy’s late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a
diagnosis of Duchenne muscular dystrophy. Which of the following teaching points
should the physician include when explaining the child’s diagnosis to his parents?
A) “Your son’s muscular dystrophy is a result of faulty connections between muscles
and the nerves that normally control them.”
B) “He’ll require intensive physical therapy as he grows up, and there’s a good
chance that he will outgrow this problem as he develops.”
C) “Your son will be prone to heart problems and decreased lung function because of
this.”
D) “His muscles will weaken and will visibly decrease in size relative to his body
size throughout his childhood.”

Answer 4

Ans: C
Feedback:
Muscular dystrophy is associated with cardiac and respiratory complications. It does not
involve the nervous system, and the problem will not dissipate with time. While muscles
become weakened, pseudohypertrophy means that their size does not decrease.

Question 5

The unique clinical presentation of a 3-month-old infant in the emergency department
leads the care team to suspect botulism. Which of the following assessment questions
posed to the parents is likely to be most useful in the differential diagnosis?
A) “Have you ever given your child any honey or honey-containing products?”
B) “Is there any family history of neuromuscular diseases?”
C) “Has your baby ever been directly exposed to any chemical cleaning products?”
D) “Is there any mold in your home that you know of?”

Answer 5

Ans: A
Feedback:
Botulism in infants is frequently attributable to honey. Family history is not a relevant
consideration given the bacterial etiology, and mold and chemical cleaning products are
not known to predispose to botulism toxicity.

Question 6

The unique clinical presentation of a 3-month-old infant in the emergency department
leads the care team to suspect botulism. Which of the following assessment questions
posed to the parents is likely to be most useful in the differential diagnosis?
A) “Have you ever given your child any honey or honey-containing products?”
B) “Is there any family history of neuromuscular diseases?”
C) “Has your baby ever been directly exposed to any chemical cleaning products?”
D) “Is there any mold in your home that you know of?”

Answer 6

Ans: A
Feedback:
Botulism in infants is frequently attributable to honey. Family history is not a relevant
consideration given the bacterial etiology, and mold and chemical cleaning products are
not known to predispose to botulism toxicity.

Question 7

22-year-old female college student is shocked to receive a diagnosis of myasthenia
gravis. What are the etiology and most likely treatment for her health problem?
A) Autoimmune destruction of skeletal muscle cells; treatment with intensive
physical therapy and anabolic steroids
B) A decline in functioning acetylcholine receptors; treatment with corticosteroids
and intravenous immunoglobulins
C) Cerebellar lesions; surgical and immunosuppressive treatment
D) Excess acetylcholinesterase production; treatment with thymectomy

Answer 7

Ans: B
Feedback:
The etiology of myasthenia gravis involves a deficiency of acetylcholine receptors at
neuromuscular junctions. Treatment can include corticosteroid therapy and intravenous
immunoglobulins. Destruction of skeletal muscle cells, cerebellar lesions, and excess
acetylcholinesterase are not noted to underlie the disease.

Question 8

A toddler is displaying signs and symptoms of weakness and muscle atrophy. The
pediatric neurologist suspects it may be a lower motor neuron disease called spinal
muscular atrophy (SMA). The patient’s family asks how he got this. The nurse will
respond
A) “This could result from playing in soil and then ingesting bacteria that are now
attacking his motor neurons.”
B) “No one really knows how this disease is formed. We just know that in time, he
may grow out of it.”
C) “This is a degenerative disorder that tends to be inherited as an autosomal
recessive trait.”
D) “This is a segmental demyelination disorder that affects all nerve roots and
eventually all muscle groups as well.”

Answer 8

Ans: C
Feedback:
SMA is a distinctive group of degenerative disorders involving LMNs that begins in childhood.
Answer choice A relates to botulism. It is known which gene is involved in SMA. Answer
choice D does not describe SMA.

Question 9

Which of the following individuals is likely to have the best prognosis for recovery from
his or her insult to the peripheral nervous system? An adult
A) who developed rhabdomyolysis and ischemic injury after a tourniquet application.
B) who suffered a bone-depth laceration to the shoulder during a knife attack.
C) who had his forearm partially crushed by gears during an industrial accident.
D) who had nerves transected during surgery to remove a tumor from the mandible.

Answer 9

Ans: C
Feedback:
Crushing-type injuries carry a higher possibility of nerve function recovery than do
lacerations and insults resulting from ischemia.

Question 10

A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a
patient having problems in his hand/wrist. In order to test Tinel sign, the nurse should
give the patient which of the following directions?
A) “Stand tall, arms at your side, shut your eyes; place the tip of your index finger to
your nose.”
B) “Hold your wrist in complete flexion; keep it in this position for 60 seconds; how
does your hand feel after placing it in a neutral position?”
C) “I’m going to tap (percuss) over the median nerve in your wrist; tell me what
sensation you feel while I am doing this. Does the sensation stay in the wrist or go
anywhere else?”
D) “I’m going to tap this tuning fork and place it on the side of your thumb; then tell
me what you are feeling in your hand and wrist.”

Answer 10

Ans: C
Feedback:
A positive Tinel sign will help diagnose carpal tunnel syndrome. The patient will have a
tingling sensation radiating into the palm of the hand when lightly percussed over the
median nerve at the wrist. Answer choice B relates to Phalen sign, which is also a test to
help diagnose carpel tunnel syndrome. Answer choice D is not the medical test for
carpal tunnel syndrome.

Question 11

During a flu shot clinic, one of the questions the student nurse asks relates to whether
the patient has had Guillain-Barré syndrome in his medical history. The patient asks,
“What is that?” How should the nursing student reply?
A) “A type of paralysis that affects movement on both sides of the body that may
even involve the respiratory muscles”
B) “Swelling of your arm where you got your flu shot, and maybe your eyes and lips
had some swelling as well”
C) “A degenerative disease where you have trouble walking without the help of a
cane or walker”
D) “Influenza-like illness where you had fever and chills for 2 to 3 days after your
last flu shot”

Answer 11

Ans: A
Feedback:
Guillain-Barré syndrome is an acute immune-mediated polyneuropathy. The majority of
people report having had an acute, influenza-like illness before the onset of symptoms.
It progresses along the ascending muscle weakness of the limbs, producing a symmetric
flaccid paralysis. The rate of disease progression varies, and there may be
disproportionate involvement of the upper or lower extremities. Option B is anaphylaxis
following the flu shot. It is not a degenerative disease

Question 12

60-year-old male office worker presents to a clinic complaining of new onset of lower
back pain that has been worsening over the last 6 weeks. The nurse knows which of the
following components of his physical assessment and history is most indicative of a
serious pathological process (like aortic aneurysm or cancer)?
A) His pain is relieved by extended bed rest.
B) When supine, passive rising of his leg to 90 degrees results in hamstring pain.
C) He has needed regular nonsteroidal anti-inflammatory drugs to control the pain in
recent weeks.
D) His onset of pain has been gradual, and he has no prior history of lower back
problems.

Answer 12

Ans: D
Feedback:
The gradual onset of back pain unrelated to injury and initial presentation after age 50
are considered red flags for more serious pathologies such as aortic aneurysm,
malignancy, or compression fracture. Pain that is aggravated by lying down is a red flag
for malignancy or infection. The onset of hamstring pain at 90 degrees of hip flexion is
a normal finding. The need for and use of NSAIDs for lower back pain relief are not
indicative of a serious pathology in and of itself

Question 13

A middle-aged woman is brought to the emergency room after a minor auto accident.
Her gait is staggering and unsteady; her speech is slurred; and she displays slight
nystagmus. The police officer who brought her in says she has not been drinking. Her
blood pressure is very high. Which of the following health problems most likely
underlies her present state?
A) Multiple sclerosis
B) Guillain-Barré syndrome
C) Myasthenia crisis
D) Cerebellar damage caused by a cerebrovascular accident

Answer 13

Ans: D
Feedback:
Cerebellar damage can resemble the effects of alcohol, because alcohol affects the
cerebellum. This woman has not been drinking, but her high blood pressure puts her at risk for cerebrovascular accident.

Question 14

A 70-year-old male has been diagnosed with a stroke that resulted in an infarct to his
cerebellum. Which of the following clinical findings would be most closely associated
with cerebellar insult?
A) Flaccid loss of muscle tone
B) Difficulty in starting movement, stopping movement, and maintaining rhythmic
movements.
C) Tremor, rigidity, and bradykinesia
D) Unsteady gait and difficulty in speaking and swallowing

Answer 14

Ans: D
Feedback:
An unsteady gait characterizes cerebellar ataxia, and both swallowing and speaking are
partly the domain of the cerebellum. Flaccid loss of muscle tone is not noted to
accompany cerebellar insult, and difficulties with starting movement, stopping
movement, and maintaining rhythmic movements are indicative of basal ganglia
disorders. Tremor, rigidity, and bradykinesia are associated with Parkinson disease.

Question 15

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson
disease has recently changed the client’s medication regimen. What is the most likely
focus of the pharmacologic treatment of the man’s health problem?
A) Maximizing acetylcholine release from synaptic vesicles at neuromuscular
junctions
B) Preventing demyelination of the efferent cerebellar pathways
C) Increasing the functional ability of the underactive dopaminergic system
D) Preventing axonal degradation of motor neurons

Answer 15

Ans: C
Feedback:
Antiparkinson drugs act by increasing the functional ability of the underactive
dopaminergic system. The cerebellar pathways, acetylcholine levels, and axonal
degradation are not components of the etiology of Parkinson disease

Question 16

A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and
has experienced a progressive onset and severity of complications. She has been
admitted to a palliative care unit due to her poor prognosis? What assessments and
interventions should the nursing staff of the unit prioritize in their care?
A) Assessment and documentation of cognitive changes, including confusion and
restlessness
B) Regular pain assessment and administration of opioid analgesics as needed
C) Assessment of swallowing ability and respiratory status
D) Cardiac monitoring and administration of inotropic medications

Answer 16

Ans: C
Feedback:
The late stages of ALS normally involve deterioration in swallowing and speech and in
the respiratory musculature. Cognitive changes are not common complications, and pain
and cardiac complications are not noted to be paramount in the course of ALS.

Question 17

A 41-year-old woman was diagnosed with multiple sclerosis (MS) 7 years ago and is
sharing her story with members of an MS support group, many of whom have been
diagnosed recently. Which of the following aspects of her health problem should the
woman warn others to expect at some point in the progression of the disease? Select all
that apply.
A) Debilitating fatigue
B) Progressive loss of visual acuity
C) Gradual development of a resting tremor
D) Loss of mental acuity
E) Shuffling gait

Answer 17

Ans: A, B, D
Feedback:
Fatigue, visual deficits, and cognitive disturbances are all noted manifestations of MS,
while respiratory function and GI function are not normally affected. Shuffling gait is
usually associated with Parkinson disease.

Question 18

The nurse should anticipate she will need to teach the newly diagnosed multiple
sclerosis patient how to give injections if he is prescribed which medication to modify
the course of the disease by reducing exacerbations?
A) Corticosteroids
B) Plasmapheresis
C) Interferon beta
D) Mitoxantrone

Answer 18

Ans: C
Feedback:
Interferon beta helps modify the course of treatment of MS. It may also reduce
exacerbations in persons with relapsing–remitting MS. It is a cytokine that acts as an
immune enhancer. It is administered by injection. The other medications are prescribed
for MS but not given by injection.

Question 19

After being thrown off the back of a bull, the bull rider can move his arms but has loss
of motor function in the lumbar and sacral segments of the spinal cord. This is usually
referred to as
A) tetraplegia.
B) quadriplegia.
C) paraplegia.
D) anterior cord syndrome

Answer 19

Ans: C
Feedback:
Tetraplegia and quadriplegia are loss of motor or sensory function after damage to
neural structures in the cervical segments of the spinal cord. Paraplegia refers to loss of
motor or sensory function in thoracic, lumbar, or sacral segments. The arms function as
normal. Anterior cord syndrome includes loss of motor function provided by the
corticospinal tracts and loss of pain and temperature sensation from damage to the
lateral spinothalamic tracts.

Question 20

Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a
snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel
and bladder and the inability to obtain an erection. While sensation has been completely
preserved in his legs and feet, his motor function is significantly impaired. What type of
incomplete spinal cord injury has the man most likely experienced?
A) Anterior cord syndrome
B) Brown-Séquard syndrome
C) Central cord syndrome
D) Conus medullaris syndrome

Answer 20

Ans: D
Feedback:
Functional deficits resulting from conus medullaris syndrome usually result in flaccid
bowel and bladder and altered sexual function. Sacral segments occasionally show
preserved reflexes if only the conus is affected. Motor function in the legs and feet may
be impaired without significant sensory impairment. Anterior cord syndrome and
Brown-Séquard syndrome include a loss of pain and temperature sensation, while
central cord syndrome manifests in spastic paralysis and is more common among older
adults.

Question 21

If the nurse suspects a spinal cord injury, the patient has developed autonomic
dysreflexia. Which of the following assessments would confirm this complication?
Select all that apply.
A) BP 180/98
B) Skin covered with macular rash
C) Pulse rate 49
D) Complains of a pounding headache
E) Cold, cyanotic lower legs

Answer 21

Ans: A, C, D
Feedback:
Autonomic dysreflexia represents an acute episode of exaggerated sympathetic reflex
responses that occur in people with injuries at T6 and above, in which CNS control of
spinal reflexes is lost. It is characterized by hypertension (BP 180/98), skin pallor, vagal
slowing of the heart rate (pulse 49), and headache ranging from dull to severe and
pounding.