Exam 25: Neurological System

While assessing a 7-month-old infant, the nurse makes a loud noise and notices the following response: abduction and flexion of the arms and legs; fanning of the fingers, and curling of the index finger and thumb in a "C" position, followed by the infant bringing in the arms and legs to the body.What does the nurse know about this response?

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 that the toes curl down and away from the shin.How should the nurse document this finding?

A patient with lack of oxygen to his heart will have pain in his chest and possibly in the shoulder, arms, or jaw.Which of these statements indicates that the nurse knows the best explanation for why this occurs?

When taking the health history on a patient with a seizure disorder, the nurse is trying to determine whether the patient has an aura.Which of these would be the best question for obtaining this information?

During the assessment of DTRs, the nurse finds that a patient's responses are bilaterally normal.What number is used to indicate normal DTRs when the documenting this finding? __________+

Which statement concerning the areas of the brain is true?

A man who was found wandering in a park at 2 AM has been brought to the emergency department for an examination; he said he fell and hit his head.During the examination, the nurse asks him to use his index finger to touch the nurse's finger, then his own nose, and then the nurse's finger again (which has been moved to a different location).The patient is clumsy, unable to follow the instructions, and overshoots the mark, missing the finger.The nurse should suspect which of the following?

The two parts of the nervous system are the:

During an assessment of a 22-year-old woman who sustained a head injury from a motor vehicle accident 4 hours earlier, the nurse notices the following changes: pupils were equal, but now the right pupil is fully dilated and nonreactive; and the left pupil is 4 mm and reacts to light.What do these findings suggest?

During an assessment of an 80-year-old patient, the nurse notices the following: the patient's 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:

During an assessment of a 32-year-old patient with a recent head injury, the nurse notices that the patient responds to pain by extending, adducting, and internally rotating his arms.His palms pronate, and his lower extremities extend with plantar flexion.Which statement concerning these findings is most accurate? This patient's response:

During an assessment of the cranial nerves, 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 cranial nerves?

In the assessment of a 1-month-old infant, the nurse notices lack of response to noise or stimulation.The mother reports that in the past week he has been sleeping all the time, and when he is awake all he does is cry.The nurse hears that the infant's cries are very high pitched and shrill.What should be the nurse's appropriate response to these findings?

The nurse is working at a blood pressure clinic with a multicultural community.The nurse ensures to provide health education resources on stroke, especially to certain individuals who are from the following ethnocultural backgrounds and have a greater risk for stroke: (Select all that apply.)

While gathering equipment after an injection, a nurse accidentally received a prick from an improperly capped needle.To interpret this sensation, which of these areas must be intact?

A 59-year-old patient has a herniated intervertebral disc.Which of the following findings should the nurse expect to see on physical assessment of this individual?

The nurse places a key in the hand of a patient, and he identifies it as a penny.What term would the nurse use to describe this finding?

A 32-year-old woman tells the nurse that she has noticed "very sudden, jerky movements" mainly in her hands and arms.She says, "They seem to come and go, primarily when I am trying to do something.I haven't noticed them when I'm sleeping." This description suggests: