Chapter 60 Assessment of Neurologic Function

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Chapter 60  Assessment of Neurologic Function

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

Multiple Choice

1. A client is brought to the emergency room following a motor vehicle accident in which he sustained head trauma. The patient is complaining of blindness in the left eye. The nurse would be correct in documenting this abnormal finding as corresponding to which of the following cerebral lobes?

A) Temporal B) Occipital C) Parietal D) Frontal

Ans: B
Chapter: 60
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Page and Header: 1832, Anatomic and Physiologic Overview

Feedback: The posterior lobe of the cerebral hemisphere is responsible for visual interpretation. The temporal lobe contains the auditory receptive areas. The parietal lobe contains the primary

sensory cortex, and is essential to an individual’s awareness of the body in space, as well as orientation in space and spatial relations. The frontal lobe functions in concentration, abstract thought, information storage or memory, and motor function.

2. A patient scheduled for a Magnetic Resonance Imaging (MRI) has arrived at the radiology department. The nurse who prepares the patient for the MRI would be sure to include what? A) Withholding stimulants 24 to 48 hours prior to exam.
B) Removing all metal-containing objects.

C) Instructing patient to void prior to exam.
D) Initiating an intravenous line for administration of contrast.

Ans: B
Chapter: 60
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process Objective: 6
Page and Header: 1851, Diagnostic Evaluation

Feedback: Patient preparation for an MRI consists of removing all metal-containing objects prior to the exam. Withholding stimulants would not affect an MRI, this relates to an electroencephalography (EEG). Instructing the patient to void is patient preparation for a lumbar puncture. Initiating an intravenous line for administration of contrast would be done if the patient was having a CT scan with contrast.

3. A nursing instructor is talking with her nursing students about aging and neurological changes. What would the instructor tell the students is a normal neurological change in the aging process?
A) Hyperactive deep tendon reflexes
B) Reduction in cerebral blood flow (CBF)
C) Increased cerebral metabolism
D) Hypersensitivity to painful stimuli

Ans: B
Chapter: 60
Client Needs: B
Cognitive Level: Application Difficulty: Moderate
Integrated Process: Nursing Process

Objective: 5
Page and Header: 1849, Assessment of the Nervous System

Feedback: Reduction in cerebral blood flow (CBF) is a change that occurs in the normal aging process. Deep tendon reflexes can be decreased or in some cases absent. Cerebral metabolism decreases as the patient advances in age. Reaction to painful stimuli may be decreased with age. Because pain is an important warning signal, caution must be used when hot or cold packs are used.

4. The nurse has admitted a new patient to the unit. One of the patient’s admitting orders is for an adrenergic medication. The nurse knows that this medication will have what effect on the circulatory system?
A) Thin, watery saliva

B) Increased heart rate
C) Decreased blood pressure D) Constricted bronchioles

Ans: B
Chapter: 60
Client Needs: D-2
Cognitive Level: Knowledge
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Page and Header: 1837, Anatomic and Physiologic Overview

Feedback: The term “adrenergic” refers to the sympathetic nervous system. Sympathetic effects include an increased rate and force of the heartbeat. Cholinergic effects, which correspond to the parasympathetic division of the autonomic nervous system, include thin, watery saliva, decreased rate and force of heartbeat, and decreased blood pressure. Refer to Table 60-03.

5. A nurse is assessing reflexes in a patient with hyperactive reflexes. When the patient’s foot is abruptly dorsiflexed, it continues to “beat” two to three times before setting into a resting position. How would the nurse document this finding?
A) Rigidity

B) Flaccidity C) Clonus D) Ataxia

Ans: C

Chapter: 60
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Page and Header: 1848, Assessment of the Nervous System

Feedback: When reflexes are very hyperactive, a phenomenon called clonus may be elicited. If the foot is abruptly dorsiflexed, it may continue to “beat” two to three times before it settles into a position of rest. Rigidity is an increase in muscle tone at rest characterized by increased resistance to passive stretch. Flaccidity is lack of muscle tone. Ataxia is the inability to coordinate muscle movements, resulting in difficulty walking, talking, and performing self-care activities.

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