Question 1. A clinician is conducting an assessment of a male patient suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? (Points : 0.4)
The patient has decreased deep tendon reflexes.
The patient displays increased muscle tone.
The patient's muscles appear atrophied.
The patient displays weakness in the distal portions of his limbs.
Question 2. A 51-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the patient's history would not be considered to have contributed to his stroke? (Points : 0.4)
He was diagnosed with type 2 diabetes eight years ago
Blood pressure that is normally 120/80
The patient is an African American Male
History of sickle cell anemia
Question 3. Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? (Points : 0.4)
The inner layer (archilayer)
The middle layer (paleolayer)
The outer layer (neolayer)
The reticular formation
Question 4. A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman's diagnosis? (Points : 0.4)
Decreased brain activity in the pons and brain stem
Reduced activity and gray matter volume in the prefrontal cortex
Atrophy and decreased blood flow in the amygdala
Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes
Question 5. Which of the following phenomena constitutes a component of axonal transport? (Points : 0.4)
Anterograde and retrograde axonal transport allow for the communication of nerve impulses between a neuron and the central nervous system (CNS).
Materials can be transported to the nerve terminal by either fast or slow components.
The unidirectional nature of the axonal transport system protects the CNS against potential pathogens.
Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials.
Question 6. A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood–brain barrier and been transferred from the vascular space into the patient's interstitial space. Which of the following diagnoses best captures this pathophysiology? (Points : 0.4)
Question 7. A nurse practitioner is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. Which of the following pharmacologic therapies is most likely to benefit the woman? (Points : 0.4)
A drug that influences gamma-aminobutyric acid (GABA) levels
A selective serotonin reuptake inhibitor (SSRI)
An antipsychotic medication that blocks dopamine receptors
An epinephrine and norepinephrine supplement
Question 8. A 60-year-old male patient with a long history of back pain has had little success with a variety of analgesic regimens that his nurse practitioner has prescribed. He has recently been diagnosed formally with a chronic pain disorder. Which of the following teaching points about chronic pain would his nurse practitioner most likely emphasize to the patient? (Points : 0.4)
“If your pain comes and goes, then we won't characterize it as chronic, and it will require different treatment.”
“You need to remind yourself that this is a purely physical phenomenon that requires physical treatment.”
“Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about.”
“These pain signals your body is sending likely serve no real, useful, or protective function.”
Question 9. A 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? (Points : 0.4)
Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids
A shortage or decline of acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins
Cerebellar lesions; surgical and immunosuppressive treatment
Excess acetylcholinesterase production; treatment with thymectomy
Question 10. A student is feeling inside her backpack to find her mobile phone, which has fallen to the bottom, and there are a number of items in the bag in addition to the phone. Which of the following components of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items? (Points : 0.4)
The primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron
A slow-conducting pathway that projects into the intralaminar nuclei of the thalamus
The opposite anterolateral pathway that travels to the reticular activating system
A bilateral, multisynaptic, slow-conducting tract
Question 11. A patient on an acute medicine unit of a hospital, with a diagnosis of small bowel obstruction, is complaining of intense, diffuse pain in her abdomen. Which of the following physiologic phenomena is most likely contributing to her complaint? (Points : 0.4)
Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS.
First-order neurons are inappropriately signaling pain to the dorsal root ganglion.
The patient is experiencing neuropathic pain.
The patient's C fibers are conducting pain in the absence of damaged Ad fibers.
Question 12. Which of the following factors is most responsible for the fact that prefrontal lobotomy is no longer a common treatment for mental illness? (Points : 0.4)
Individuals treated by lobotomy have difficulty interpreting somatic, visual, and auditory information.
Lobotomy inhibits the individual's ability to add perception and meaning to sensory information.
Severing connections between the brain and its prefrontal areas inhibits problem solving and results in a loss of ambition.
Loss of communication to and from the prefrontal cortex changes, but ultimately exacerbates, symptoms of mental illness.
Question 13. The unique clinical presentation of a three-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? (Points : 0.4)
“Have you ever given your child any honey or honey-containing products?”
“Is there any family history of neuromuscular diseases?”
“Has your baby ever been directly exposed to any chemical cleaning products?”
“Is there any mold in your home that you know of?”
Question 14. A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? (Points : 0.4)
She repeatedly moves her large toe, ankle, and knee during sleep.
She complains of a powerful urge to move her legs when in bed at night.
She has frequently awakened unable to move or speak.
She believes that she experiences auditory hallucinations when she awakens.
Her sleep latency is normally around 1 hour.
Question 15. A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? (Points : 0.4)
“Does your son have a family history of migraines?”
“When your son has a headache, does he ever have nausea and vomiting as well?”
“Does your son have any food allergies that have been identified?”
“Is your son generally pain free during the intervals between headaches?”
Question 16. Following a motor vehicle accident three months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? (Points : 0.4)
“Your daughter has lost all her cognitive functions as well as all her basic reflexes.”
“Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”
“If you or the care team notice any spontaneous eye opening, then we will change our treatment plan.”
“Your daughter's condition is an unfortunate combination of total loss of consciousness with continuation of all other normal brain functions.”
Question 17. A male newborn infant has been diagnosed with spina bifida occulta. Which of the following pathophysiologic processes has most likely contributed to the infant's health problem? (Points : 0.4)
The vertebral arches around his neural tube have failed to completely close. OR The neural groove failed to fuse and completely close across the top of the neural plate.
The infant's spinal cord and meninges protrude through his skin.
The child's central and peripheral nervous systems have insufficiently differentiated during embryonic development.
The infant's soma and viscera are underdeveloped.
Question 18. A nurse practitioner and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family? (Points : 0.4)
Modest reversal of brain plaque formation and improved symptomatology through cholinesterase inhibitors
Surgical treatment of the ischemic changes that underlie the manifestations of the man's disease
The use of medications such as donepezil and rivastigmine to slow the progression of the disease
Cognitive and behavioral therapy to counteract the agitation, depression, and suspiciousness associated with Alzheimer disease.
Question 19. Which of the following individuals would be most likely to experience global ischemia to his or her brain? (Points : 0.4)
A male patient who has just had an ischemic stroke confirmed by CT of his head
A woman who has been admitted to the emergency department with a suspected intracranial bleed
A man who has entered cardiogenic shock following a severe myocardial infarction
A woman who is being brought to the hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater
Question 20. 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 has the highest level of control over her arm and hand action? (Points : 0.4)
Question 21. Which of the following diagnostic findings is likely to result in the most serious brain insult? (Points : 0.4)
Mean arterial blood pressure (MABP) that equals intracranial pressure (ICP)
Moderate increase in brain tissue volume secondary to a brain tumor
Increased ICP accompanied by hyperventilation
High intracellular concentration of glutamate
Question 22. A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman's ability? (Points : 0.4)
Ruffini end organs
Free nerve endings
Question 23. A patient with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep? (Points : 0.4)
“Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake.”
“While you're obviously less aware of stimuli when you're asleep, your brain is actually more active when you're asleep than when you're awake.”
“There are four types of brain activity, and actually all of them occur at different stages of sleep.”
“Your brain alternates between periods of activity and periods of inactivity when you're asleep, and these correspond to your eye movement.”
Question 24. A 48-year-old male has a new diagnosis of Guillain-Barré syndrome. Which of the following processes underlies the deficits that accompany the degeneration of myelin in his peripheral nervous system (PNS)? (Points : 0.4)
The destruction of myelin causes fewer Schwann cells to be produced in the patient's PNS.
The axonal transport system is compromised by the lack of myelin surrounding nerve cells.
Nerve cells lack insulation and impulse conduction is compromised by the destruction of myelin.
A deficit of myelin predisposes the patient to infection by potential pathogens.
Question 25. 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? (Points : 0.4)
Flaccid loss of muscle tone
Difficulty starting movement, stopping movement, and maintaining rhythmic movement
Tremor, rigidity, and bradykinesia
Unsteady gait and difficulty speaking and swallowing
Question 26. When reviewing the purpose/action of neurotransmitters as they interact with different receptors, the nursing instructor gives an example using acetylcholine. When acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is:
Question 27. 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:
This could result from playing in soil and then ingesting bacteria that are now attacking his motor neurons.
No one really knows how this disease is formed. We just know that in time, he may grow out of it.
This is a degenerative disorder that tends to be inherited as an autosomal recessive trait.
This is a segmental demyelination disorder that affects all nerve roots and eventually all muscle groups as well.
Question 28. A child is experiencing difficulty with chewing and swallowing. The nurse knows that which of the following cells may be innervating specialized gut-related receptors that provide taste and smell?
Special somatic afferent fibers
General somatic afferents
Special visceral afferent cells
General visceral afferent neurons
Question 29. While assessing a critically ill patient in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat that develops into ventricular tachycardia (VT).Immediately, the patient became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is:
metabolic acidosis that occurs spontaneously following any dysrhythmias.
interruption of the blood/oxygen supply to the brain.
massive cerebrovascular accident (CVA) resulting from increased perfusion.
a blood clot coming from the heart and occluding the carotid arteries.
Question 30. 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?
Your son's muscular dystrophy is a result of faulty connections between muscles and the nerves that normally control them.
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.
Your son will be prone to heart problems and decreased lung function because of this.
His muscles will weaken and will visibly decrease in size relative to his body size throughout his childhood.
Question 31. Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply.
A) Clouding of consciousness
B) Decorticate posturing with painful stimulation
C) Pupils fixed at approximately 5 mm in diameter
D) Respiration rate of 40 breaths/minute
E) Decerebrate posturing following painful stimulation of the sternum
Question 32. A patient with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in her chemical synapses?
Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.
Communication between a neuron and the single neuron it is connected with will be facilitated.
The neurotransmitter will cross gap junctions more readily.
More serotonin molecules will cross the synaptic cleft and bond with postsynaptic receptors.
Question 33. Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep?
The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping–waking cycles.
The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep.
The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep–wake cycle.
Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm.
Rationale: The sleep-wake cycle is rooted anatomically in the reticular formation and the interaction between the thalamus and cerebral cortex. Melatonin is produced by the pineal gland, and the hypothalamus and cerebellum are not central contributors to the sleep-wake cycle.
Question 34. After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures?
The man's occipital lobe
The patient's temporal lobe in general and Wernicke area in particular
The man's parietal lobe
The components of the patient's limbic system
Question 35. A nurse practitioner is providing care for a 40-year-old male who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The man is requesting a prescription for “sleeping pills” to help him through this time. Which of the following statements forms a valid basis for the nurse practitioner's plan for treatment?
Sedative and hypnotic drugs will not provide safe relief of the man's health problem.
The man is suffering from primary insomnia.
Melatonin supplements will be the safest and most effective long-term pharmacological treatment.
Behavioral therapies, counseling, and education may be of some use to the patient.
Question 36. The parents of a 15-year-old boy are frustrated by his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have in rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy's sleep disorder?
Delayed sleep phase syndrome (DSPS)
Non–24-hour sleep–wake syndrome
Advanced sleep phase syndrome (ASPS)
Question 37. Which of the following characteristics describe stage 2 non-REM sleep? Select all that apply.
It occurs at the onset of sleep and lasts approximately 7 minutes.
During this stage, theta waves are primarily seen on EEG.
This stage is known as deep sleep where heart rate and BP are decreased.
This stage has interruptions of spindle activity that helps with integration of new memories.
Muscles of the body are relaxed.
Question 38. Which of the following observations of a female client in a sleep lab would indicate the clinicians that she is in REM sleep?
Rolling eye movements are observed, and she has moderate muscle activity.
Her motor movements are suppressed, and muscle tone is flaccid.
Delta waves are evident on her EEG, and the heart and respiration rates are slowed.
She has a low level of cerebral activity, and her EEG indicates low voltage and mixed frequencies.
Rationale: REM sleep is accompanied by low levels of muscle movement and loss of muscle tone. Rolling eye movements, delta waves, and low levels of cerebral activity are associated with stages 1 through 4 of sleep.
Question 39. The nurse knows that which of the following observations of a client during a sleep study would be most likely considered a pathological finding?
The client experiences periods of apnea of 5 to 15 seconds in duration.
The client's intrinsic clock involves a sleep–wake cycle that is consistently 2 hours longer than the actual length of a day.
The client's PCO2 level is increased, and his PO2 level decreased during deep sleep.
The client spends the majority of his sleeping hours in deep REM sleep.
Question 40. Which of the following statements about over-the-counter (OTC) melatonin is accurate?
It has received the FDA approval for effectiveness as a sleep aid.
Long-term studies of melatonin conclude that it is non-addicting.
It produces phase-shifting changes in the circadian rhythm.
Under strict clinical testing, potency and purity of melatonin have been shown to be consistent.
Question 41. When explaining an upcoming test, a polysomnography, the nurse should include which of the following education related to equipment placements the patient will have placed on his or her person during the sleep study? Select all that apply.
An ECG with lots of chest leads will monitor heart rate and rhythm.
A pulse oximeter placed on a finger is used to determine arterial oxygen saturation.
An EOG will be placed on the skin near the eye to record eye movements.
An EMG patch will be placed under the chin to record muscle movement.
An actigraph device will be placed on the wrists and ankles to measure body motion.
Question 42. A business traveler has just arrived in Japan from the United States. During a meeting with his customer, he begins to experience yawning and stretching with an inability to stay focused on the meeting. He also has some eye irritation and has developed a headache. Based on these clinical manifestations, what diagnosis would most likely be causing these symptoms?
Advanced sleep phase syndrome
Delayed sleep phase syndrome
Free-running sleep disorder
Time zone change syndrome
Question 43. Nurses regularly rotate between day shift hours and overnight work hours. Following an overnight shift, nurses frequently exhibit which of the following manifestations? Select all that apply.
Unable to sleep for a long period of time during the day
Falling asleep while sitting in front of a computer charting during the night
Finding it difficult to sleep when they have a night off
Heightened alertness and reflexes on their drive home after work
Increased hunger and thirst in the middle of the night
Question 44. While working for a neurologist who is assessing a patient experiencing restless legs syndrome (RLS), the nurse should be prepared to answer the question about why the patient needs to have his iron level drawn? The nurse response should include,
“Many of the drugs we give for RLS can cause drastic decreases in your iron level.”
“Many patients with RLS also have an iron deficiency anemia as well.”
“You just look a little pale, and so we want to make sure you have normal blood levels.”
“People with low iron levels do not have enough oxygen circulating to their legs.”
Question 45. A 57-year-old female has presented to a clinic exasperated by the effect that restless legs syndrome is having on her sleep.The clinician has performed client teaching prior to choosing a treatment plan.Which of the following responses by the client demonstrates a sound understanding of her condition?
“Increasing my calcium intake is something simple that might help.”
“Transcutaneous electrical nerve stimulation might be a treatment that can help me avoid needing drugs for this.”
“This could be something that I'm simply prone to genetically.”
“I'll try to get more exercise, since there aren't really any effective medications for restless legs syndrome.”
Question 46. Which of the following individuals would be expected to have the highest risk of developing sleep apnea?
A woman with restless legs syndrome and chronic obstructive pulmonary disease
A male client with a diagnosis of unstable angina and peripheral arterial disease
A man with poorly controlled diabetes and hypertension
A female with chronic insomnia and atrial fibrillation that is treated with warfarin
Question 47. Which of the following motor disorders of sleep can be life-threatening?
Periodic limb movement disorder
Restless legs syndrome
Question 48. A 77-year-old woman is concerned because she has occasionally found her husband sleepwalking in the last several weeks. What is her care provider's most appropriate response to her concerns?
“This is not an uncommon event that often accompanies older age.”
“I'll likely prescribe a benzodiazepine for this when I next see your husband.”
“This is understandably upsetting for you, but as long as the environment is safe, it's likely not significant.”
“There may be something else going on with your husband such as delirium or a problem with his medications.”
Question 49. The nurse is educating the new mother about the sleep patterns of a newborn. Which of the following statements should she include in her education?
“Newborns usually sleep approximately 16 to 20 hours/day.”
“Newborns generally sleep 6 to 8 hours/day and then are awake for 2 to 4 hours.”
“Don't worry about them sleeping too long; they will wake up when they are hungry.”
“Most newborns will have their days and nights mixed up.”
Question 50. A 5-year-old boy has started sitting up in bed displaying signs of extreme anxiety. In the morning, when the parents ask the boy about this, he has no recollection. What should the nurse convey to the parents if this happens again?
Assist the boy in settling down without awakening him after an episode.
Watch him closely to see if he has any twitching or thrashing about.
Bring him back to the clinic if this keeps happening, so we can prescribe some sleep medicine.
Shake him to wake him up, and then comfort him and put him back in bed.
Question 51. A geriatrician is assessing an 84-year-old male recently admitted to a subacute medical unit of a hospital for rehabilitation following a recent fall resulting in a hip contusion. Which of the following aspects of the client's sleep history would the physician want to follow up with education? Select all that apply.
“I make sure that I take a long nap each afternoon to compensate for my frequent waking at night.”
“I've got a bottle of diazepam at home, but I only take them once or twice a month.”
“I try my best to get out for a walk after breakfast or after supper.”
“I make it a rule not to drink any alcohol in the evening.”
“Once my head hits the pillow, I am fast asleep.”
- This solution has not purchased yet.
- Submitted On 02 Aug, 2018 03:50:14