Chapter 47 MS

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Questions and Answers

Which neuroglial cell type is responsible for the myelination of axons in the central nervous system?

  • Microglia
  • Oligodendrocytes (correct)
  • Astrocytes
  • Ependyma

In a spinal reflex arc, what is the role of an interneuron?

  • To connect afferent and efferent neurons. (correct)
  • To transmit sensory information directly to the brain.
  • To detect external stimuli.
  • To directly stimulate a muscle contraction.

Which of the following best describes the sequence of events in a nerve impulse?

  • Repolarization, polarization, depolarization, refractory period
  • Refractory period, polarization, depolarization, repolarization
  • Polarization, depolarization, repolarization, refractory period (correct)
  • Depolarization, repolarization, refractory period, polarization

What is the primary function of the corpus callosum?

<p>To connect the right and left cerebral hemispheres. (D)</p> Signup and view all the answers

Which cranial nerve is responsible for the sense of smell?

<p>Olfactory nerve (I) (D)</p> Signup and view all the answers

In the autonomic nervous system, which neurotransmitter is released by preganglionic neurons in both the sympathetic and parasympathetic divisions?

<p>Acetylcholine (C)</p> Signup and view all the answers

Which of the following responses is characteristic of the parasympathetic nervous system?

<p>Increased digestion (C)</p> Signup and view all the answers

What is the primary concern related to mobility for a patient with sensory loss?

<p>Preventing pressure injuries. (C)</p> Signup and view all the answers

A patient has damage to the cerebellum. Which of the following symptoms would you expect to observe?

<p>Difficulty with coordination and balance (B)</p> Signup and view all the answers

Which of the following assessment findings would be most indicative of increased intracranial pressure?

<p>Bradycardia, increasing systolic blood pressure with widening pulse pressure, and irregular respirations (B)</p> Signup and view all the answers

What is the primary purpose of the Glasgow Coma Scale (GCS)?

<p>To assess level of consciousness. (B)</p> Signup and view all the answers

A patient presents with arms flexed at the elbow, hands raised toward the chest, and legs extended. This posture is known as:

<p>Decorticate posturing (A)</p> Signup and view all the answers

Which of the following is a key criterion used in the Confusion Assessment Method (CAM) to diagnose delirium?

<p>Disorganized thinking. (B)</p> Signup and view all the answers

Unequal pupil size (anisocoria) that develops acutely in a patient with previously equal pupils should be:

<p>Reported to the health-care provider immediately (C)</p> Signup and view all the answers

What does a positive Romberg test indicate?

<p>Cerebellar dysfunction (A)</p> Signup and view all the answers

Which of the following cranial nerves is assessed by asking the patient to shrug their shoulders against resistance?

<p>Spinal accessory nerve (XI) (D)</p> Signup and view all the answers

Which laboratory test result might indicate a possible infection contributing to neurologic symptoms?

<p>Elevated white blood cell (WBC) count (A)</p> Signup and view all the answers

During a CT scan with contrast, a patient reports feeling warmth and having the sensation of urinary incontinence. What is the appropriate nursing action?

<p>Document the finding as an expected side effect. (D)</p> Signup and view all the answers

Why is it important to assess for a history of kidney disease, diabetes, and certain medications prior to a CT scan with contrast?

<p>To evaluate the patient's risk for contrast-induced nephropathy. (A)</p> Signup and view all the answers

What is the rationale for keeping the trunk, extremities, hands, and feet in usable positions for patients with paresis, paralysis, or paresthesia?

<p>To maintain the body in functional positions. (B)</p> Signup and view all the answers

Which intervention is most appropriate for preventing foot drop in a patient with a neurologic disorder?

<p>Using high-top tennis shoes and splints. (C)</p> Signup and view all the answers

A patient who has difficulty speaking due to dysfunction of the lips, tongue, or jaw is experiencing:

<p>Dysarthria (D)</p> Signup and view all the answers

A stroke patient states, “I want a…” but is unable to complete the sentence. This is an example of:

<p>Expressive aphasia with word-finding difficulty (D)</p> Signup and view all the answers

What is the initial nursing action when caring for a patient with dysphagia?

<p>Performing a swallowing evaluation. (D)</p> Signup and view all the answers

The medulla oblongata regulates which of the following functions?

<p>Vital life functions (C)</p> Signup and view all the answers

Which nursing intervention is most important when caring for a patient with receptive aphasia?

<p>Providing simple, pantomimed instructions. (B)</p> Signup and view all the answers

What is a priority nursing action for a patient found lying flat in bed and choking on saliva?

<p>Suction the patient's airway. (D)</p> Signup and view all the answers

Subtracting 7 serially from 100 is a method to quickly assess which mental status parameter?

<p>Intellectual Function (D)</p> Signup and view all the answers

Following a spinal cord injury, what somatic spinal cord reflex arc may be triggered in response to a painful stimulus?

<p>Flexor reflex (B)</p> Signup and view all the answers

What physical assessment findings are the components of the Cushing triad?

<p>Bradycardia, increasing systolic blood pressure, and irregular respirations (D)</p> Signup and view all the answers

What is the priority nursing intervention for patients with an altered mental status or LOC?

<p>Ensuring the safety of the patient (D)</p> Signup and view all the answers

A patient reports that they are not able to sense touch or pain in their lower extremities. What are they experiencing?

<p>Paresthesia (D)</p> Signup and view all the answers

Following a recent stroke, a patient has difficulty swallowing. What is this condition called?

<p>Dysphagia (D)</p> Signup and view all the answers

Which activity is NOT an example of actions regulated by the autonomic nervous system?

<p>Skeletal muscle contraction (D)</p> Signup and view all the answers

Which of the following is an example of negative feedback, resulting in an alteration to data collecting for the neurological system?

<p>A decreased LOC coupled with a decreased oxygen saturation on pulse oximetry points to hypoxia as a cause (C)</p> Signup and view all the answers

You are unable to palpate any muscular function for a patient, when testing muscle strength what score should be given?

<p>0 (B)</p> Signup and view all the answers

For the neurological system, what data may be used for correlation to the physical examination findings?

<p>Vital signs (B)</p> Signup and view all the answers

For care of the neurological system, what care should be done in tandem with family members?

<p>Communication with the family regarding patient improvements and information about the illness (B)</p> Signup and view all the answers

A common acronym to note that pupils are equal, round, and reactive to light and accommodation is:

<p>PERRLA (B)</p> Signup and view all the answers

What is the role of astrocytes in nerve tissue?

<p>Contributing to the formation of the blood-brain barrier. (A)</p> Signup and view all the answers

How does myelination affect the transmission of nerve impulses?

<p>It increases the speed of transmission. (C)</p> Signup and view all the answers

Which of the following accurately describes the function of a synapse?

<p>It is the location where neurotransmitters facilitate impulse transmission between neurons. (C)</p> Signup and view all the answers

What is the primary function of the spinal cord?

<p>To transmit impulses to and from the brain and act as an integrating center for reflexes. (D)</p> Signup and view all the answers

Which statement accurately describes spinal nerves?

<p>They are named according to their corresponding vertebrae. (C)</p> Signup and view all the answers

How does the somatic spinal cord reflex arc function?

<p>Sensory input triggers a motor output without involving the brain directly. (B)</p> Signup and view all the answers

What is the primary role of the midbrain?

<p>Serving as a reflex center for visual and auditory reflexes. (B)</p> Signup and view all the answers

What is the function of the thalamus?

<p>Filtering sensory input to the cerebral cortex and enabling concentration. (A)</p> Signup and view all the answers

What is the role of the basal nuclei (ganglia) within the cerebrum?

<p>Regulating subconscious aspects of voluntary movement such as muscle tone and tremor inhibition. (D)</p> Signup and view all the answers

How do the sympathetic and parasympathetic divisions of the autonomic nervous system interact?

<p>They function in opposition to one another, with their activity integrated by the hypothalamus. (B)</p> Signup and view all the answers

What are the functions of the sympathetic nervous system during stressful situations?

<p>Increased heart rate, vasodilation in skeletal muscles, and conversion of glycogen to glucose. (D)</p> Signup and view all the answers

What is the function of the parasympathetic nervous system during relaxed states?

<p>Promoting normal digestion, defecation, and urination while decreasing heart rate. (A)</p> Signup and view all the answers

Why is it important to establish baseline neurological data on every patient admission?

<p>To detect changes in the patient's neurologic system and plan safe care. (C)</p> Signup and view all the answers

What is the rationale for asking a patient to perform serial 7s (subtracting 7 from 100 repeatedly) when collecting data related to mental status?

<p>To assess the patient's intellectual function, attention, and calculation abilities. (C)</p> Signup and view all the answers

What does the Glasgow Coma Scale (GCS) assess?

<p>Level of consciousness by evaluating eye opening, verbal response, and motor response. (B)</p> Signup and view all the answers

What does decerebrate posturing indicate?

<p>Damage in the brainstem area. (B)</p> Signup and view all the answers

What is a major benefit of using the FOUR Score Coma Scale compared to the Glasgow Coma Scale?

<p>It does not require evaluation of verbal response, which is useful for intubated patients. (B)</p> Signup and view all the answers

What does 'oriented times three' typically refer to?

<p>The patient's orientation to person, place, and time. (D)</p> Signup and view all the answers

What does a consensual response during pupillary assessment indicate?

<p>Both pupils constrict when one pupil is exposed to light. (C)</p> Signup and view all the answers

What does the acronym PERRLA stand for in the context of eye examination?

<p>Pupils equal, round, reactive to light and accommodation. (D)</p> Signup and view all the answers

What does a score of 3 indicate when documenting muscle strength on a 5-point scale?

<p>The patient can move the extremity against gravity but not against resistance. (D)</p> Signup and view all the answers

What does the presence of arm drift indicate when evaluating muscle function?

<p>Impairment of the opposite side of the brain as the drifting arm. (D)</p> Signup and view all the answers

In adults, what does it indicate if the great toe extends and other toes fan out during the Babinski reflex test?

<p>Neurologic dysfunction. (C)</p> Signup and view all the answers

What does the Cushing triad indicate?

<p>Increasing intracranial pressure. (B)</p> Signup and view all the answers

An elevated erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count might indicate which condition?

<p>Meningitis. (D)</p> Signup and view all the answers

Why might a CT scan be preferred over an MRI in emergency situations?

<p>CT scans can be done more quickly, which is important for unstable patients. (D)</p> Signup and view all the answers

What nursing action is most appropriate if a patient reports feeling warmth and having the sensation of urinary incontinence during a CT scan with contrast?

<p>Reassure the patient that these sensations are normal, and continue to monitor them. (B)</p> Signup and view all the answers

What is the purpose of a myelogram?

<p>To examine the spinal canal and detect compression of nerve roots or herniation of intervertebral discs. (A)</p> Signup and view all the answers

What is the rationale for splinting hands to keep the thumb and fingers opposed for patients with paresis, paralysis or paresthesia?

<p>To prevent contractures and maintain functional hand position. (A)</p> Signup and view all the answers

What causes contractures?

<p>Permanent muscle contractions with fibrosis of connective tissue due to lack of use. (D)</p> Signup and view all the answers

What is the most important consideration when providing care to a patient with dysarthria?

<p>Realizing the patient knows what they want to say, but the words are difficult to understand. (B)</p> Signup and view all the answers

A patient with expressive aphasia may:

<p>Speak fluently but use inappropriate or substituted words. (A)</p> Signup and view all the answers

If a patient has receptive aphasia, which nursing intervention is MOST important?

<p>Assuming they cannot understand safety instructions. (C)</p> Signup and view all the answers

When should a swallowing evaluation be performed?

<p>If there is a question of the patient's ability to swallow safely. (B)</p> Signup and view all the answers

What is the advantage of using a gastrostomy tube for long-term enteral feedings?

<p>It reduces the risks of aspiration and eliminates nasal skin breakdown. (D)</p> Signup and view all the answers

When caring for a patient with a neurologic deficit, what is the importance of including the family?

<p>The family will need support, education, and inclusion in care and rehabilitation. (D)</p> Signup and view all the answers

If a patient has difficulty swallowing (dysphagia), what consistency of liquids is typically easier for them to manage?

<p>Thick liquids. (A)</p> Signup and view all the answers

What is the primary role of somatic sensory neurons?

<p>To detect external or internal changes from receptors in the skin, skeletal muscles, and joints. (B)</p> Signup and view all the answers

How does the transmission of a nerve impulse change at a chemical synapse?

<p>The electrical impulse is converted to a chemical signal via neurotransmitters. (D)</p> Signup and view all the answers

Which of the following describes the arrangement of the spinal cord's internal structure?

<p>An H-shaped mass of gray matter surrounded by white matter. (B)</p> Signup and view all the answers

What is the significance of the absence of the patellar reflex upon clinical testing?

<p>It suggests a potential issue in the quadriceps femoris muscle, the femoral nerve, or the spinal cord. (D)</p> Signup and view all the answers

How does the thalamus influence sensory information?

<p>It filters sensory input, allowing the cerebrum to focus on important sensations. (D)</p> Signup and view all the answers

What is the primary function of the basal nuclei (ganglia) within the cerebrum?

<p>Regulation of muscle tone and accessory movements. (A)</p> Signup and view all the answers

How do the sympathetic and parasympathetic divisions of the autonomic nervous system maintain homeostasis?

<p>They function in opposition to one another, providing dual innervation to effectors. (D)</p> Signup and view all the answers

Which of the following physiological responses is primarily associated with the sympathetic nervous system during stressful situations?

<p>Increased heart rate, vasodilation in skeletal muscles, and liver conversion of glycogen to glucose. (C)</p> Signup and view all the answers

How does the parasympathetic nervous system promote normal body functioning during relaxed states?

<p>By promoting digestion, defecation, urination, and a normal resting heart rate. (B)</p> Signup and view all the answers

What is the significance of establishing baseline neurological data upon a patient's admission?

<p>To provide a basis for comparison, enabling the detection of changes in the patient’s neurologic function. (B)</p> Signup and view all the answers

Why is it important to ask a patient to perform serial 7s (subtracting 7 from 100 repeatedly) when collecting data related to mental status?

<p>To evaluate the patient’s attention span and ability to concentrate. (D)</p> Signup and view all the answers

What does decorticate posturing suggest about the location of brain damage?

<p>Significant impairment of cerebral functioning. (C)</p> Signup and view all the answers

In the context of eye examination, what does the presence of a consensual response during pupillary assessment indicate?

<p>One pupil constricts when the other pupil is exposed to direct light. (C)</p> Signup and view all the answers

What does the presence of arm drift during evaluation of muscle function typically suggest?

<p>Impairment of the opposite side of the brain as the drifting arm. (B)</p> Signup and view all the answers

What is the primary purpose of a myelogram?

<p>To examine the spinal canal and its contents after injecting contrast material. (C)</p> Signup and view all the answers

If a patient has receptive aphasia, which intervention is MOST effective?

<p>Using pantomime to demonstrate desired actions. (D)</p> Signup and view all the answers

When caring for a patient with a neurologic deficit, why is it essential to include the family in the care and rehabilitation process?

<p>To ensure the family has accurate information and feels supported, leading to better patient outcomes. (D)</p> Signup and view all the answers

Flashcards

Anisocoria

Unequal pupil size.

Aphasia

Inability to use or understand speech.

Contractures

Permanent muscle shortening due to spasm or paralysis.

Decerebrate

Arms and legs extended and rotated internally; signifies brainstem damage.

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Decorticate

Arms flexed at elbows/chest, legs extended; indicates impaired cerebral function.

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Dysarthria

Difficult, poorly articulated speech due to impaired motor control.

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Dysphagia

Difficulty swallowing.

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Electroencephalogram (EEG)

Records the brain's electrical activity via scalp electrodes.

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Myelogram

X-ray of spinal canal after contrast injection.

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Nystagmus

Involuntary, rhythmic eye movements.

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Paresis

Partial or incomplete paralysis.

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Paresthesia

Abnormal skin sensations (tingling, burning, numbness).

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Subarachnoid

Space below the arachnoid membrane of the brain or spinal cord.

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Cognition

Mental processes of knowing, awareness, and judgment.

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Neurologic regulation

Nervous system control to maintain homeostasis.

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Central Nervous System (CNS)

Brain and spinal cord division.

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Peripheral Nervous System (PNS)

Nerves outside the brain and spinal cord.

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Autonomic Nervous System (ANS)

Automatic division controlling involuntary functions.

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Neurons

Nerve cells that transmit electrical impulses.

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Neuroglia

Support cells in nerve tissue.

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Sensory Neuron (Afferent)

Neuron that transmits signals toward the CNS.

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Motor Neuron (Efferent)

Neuron that transmits signals away from the CNS.

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Interneuron

Neuron between sensory and motor neurons.

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Action Potential

Change in a neuron's electrical signal.

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Synapse

Gap between two neurons where signals cross.

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Neurotransmitter

Chemical messenger that transmits signals across a synapse.

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Nerve

Collection of axons in the PNS.

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Nerve Tract

Bundle of myelinated axons in the CNS.

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Reflex

Fast, involuntary response to a stimulus.

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Reflex arc

Neural circuit controlling reflexes.

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Meninges

Dura mater, arachnoid mater, pia mater.

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Ventricles

Cavities within the brain filled with CSF.

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Cerebrospinal Fluid (CSF)

Fluid in the brain and spinal cord.

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Brainstem

Midbrain, pons, and medulla oblongata.

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Thalamus

Gateway for sensations traveling to the cerebral cortex.

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Hypothalamus

Regulates body temperature, hunger, and hormones.

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Cerebrum

Two hemispheres connected by the corpus callosum.

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Corpus Callosum

Band of nerve fibers connecting the cerebral hemispheres.

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Autonomic Nervous System (ANS)

Motor output provides dual innervation to smooth & cardiac muscle.

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Sympathetic Nervous System

Dominant in stressful situations; fight or flight.

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Parasympathetic Nervous System

Dominates during relaxed situations; rest and digest.

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Glasgow Coma Scale (GCS)

International tool to assess level of consciousness.

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FOUR Score Coma Scale

Tool that avoids verbal evaluations, useful if intubated.

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Mini-Mental State Examination (MMSE)

Assessment tool for cognitive impairment.

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Confusion Assessment Method (CAM)

Method to diagnose delirium.

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Anisocoria Emergency

Unequal pupils without a correlating diagnosis.

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Nystagmus

Involuntary eye movement.

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Cushing Triad

Late indications of increasing intracranial pressure.

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