Deck 20: Mental Status And Neurological Techniques

Question 1

The center for reflexes such as sneezing,coughing,and vomiting,as well as the center for regulating the respiratory and cardiovascular systems,is located in the

A) cerebellum.
B) frontal lobe.
C) medulla oblongata.
D) diencephalon.

Answer 1

medulla oblongata.

Question 2

Which of the following best describes a blunted affect?

A) slumped posture, slowed movements, poor eye contact
B) euphoric, irrational, elated
C) restlessness, tenseness, pacing
D) flat and unresponsive

Answer 2

slumped posture, slowed movements, poor eye contact

Question 3

Your assessment of a patient reveals pupils sluggish to light,a response only to vigorous,continuous stimuli,and intact reflexes.This level of consciousness is referred to as

A) confusion.
B) lethargy.
C) stupor.
D) coma.

Answer 3

stupor.

Question 4

The nurse is assessing a patient's cognitive abilities.She tells the patient a list of three items to repeat after 5 minutes pass.What cognitive ability is the nurse assessing?

A) abstract reasoning
B) memory
C) judgment
D) thought process and content

Question 5

In an assessment of the level of consciousness of a patient who does not respond to environmental stimuli such as noise,the proper sequence to follow is to next assess the patient's response to

A) light touch, verbal stimuli, and then painful stimuli.
B) verbal stimuli, light touch, and then painful stimuli.
C) pressure to a nail bed of each extremity, pinching the trapezius muscle, and pressure applied to the supraorbital ridge or manubrium.
D) gentle shaking, shining a light in the patient's eyes, and then painful stimuli.

Question 6

Information obtained during a health history usually is sufficient to assess a patient's mental status.A more specific mental assessment is indicated in a patient with

A) head trauma.
B) a lack of formal schooling.
C) an abnormal gait.
D) hypertension.

Question 7

Your patient has suffered a cerebrovascular accident (CVA)in the anterior cerebral artery.Which part of his brain would you expect to be damaged?

A) frontal and parietal lobes
B) temporal and occipital lobes
C) temporal lobe and midbrain
D) midbrain and medulla

Question 8

Conscious behavior requires arousal,or wakefulness,which is controlled by the

A) cerebral cortex.
B) hypothalamus.
C) reticular activating system (RAS).
D) limbic system.

Question 9

Which responses would you expect to see in sympathetic nervous system stimulation?

A) pupils normal size, decreased heart rate, bronchial constriction
B) pupils dilated, decreased heart rate, increased respiratory rate
C) pupils normal size, increased blood pressure, bronchial constriction
D) pupils dilated, increased heart rate, increased respiratory rate

Question 10

Which neurological condition develops most frequently in females 20 to 40 years of age?

A) cluster headaches
B) Parkinson's disease
C) multiple sclerosis
D) Huntington's chorea

Question 11

You would ask a patient to describe his response to a hypothetical situation,such as seeing a house on fire,when assessing the patient's

A) insight.
B) judgment.
C) spatial perception.
D) mood.

Question 12

While assessing a patient,who has Broca's aphasia,you are most likely to observe

A) impaired auditory comprehension and speech content.
B) intact comprehension and inability to recall names of objects or places.
C) slow, hesitant speech with difficulty in selecting and organizing words.
D) substitution of incorrect sounds for another sound, and difficulty repeating words.

Question 13

An assessment of the cognitive function of attention is typically conducted by asking the patient to

A) repeat a list of numbers, starting with two numbers (e.g., 3, 5) and progressing to five or six (e.g., 1, 5, 4, 9, 0).
B) repeat a series of numbers with seven digits backward and forward.
C) recite her home telephone number backward.
D) recite a personal identification number such as her social security number.

Question 14

The Glasgow Coma Scale (GCS)is used to grade neurological responses to which three parameters?

A) eye opening, verbal response, motor response
B) verbal response, pain response, reflexes
C) pupil response, motor response, reflexes
D) motor movement and strength, reflexes, pupillary size and reaction

Question 15

Your patient has a lesion on cranial nerve X,resulting in difficulty making laryngeal sounds.This condition is known as

A) dysarthria.
B) dysphonia.
C) aphonia.
D) apraxia.

Question 16

A patient is considered to be in a coma if he has a Glasgow Coma Scale score below

A) 12.
B) 10.
C) 6.
D) 3.

Question 17

Long-term memory is assessed by asking the patient to repeat

A) the foods he ate for breakfast that morning.
B) his mother's maiden name.
C) the three items shown to the patient 5 minutes previously.
D) one of the headline stories from the morning newspaper or television newscast.

Question 18

Assessment findings of pinpoint pupils,varied response to painful stimuli,and absent reflexes most likely indicate

A) permanent vegetative state.
B) locked-in syndrome.
C) coma.
D) brain death.

Question 19

The nurse is assigned to a 28-year-old patient,whose chief complaint is headaches and lightheadedness.The patient reports that at times he has sensations that he is moving in space,and occasionally it feels as if objects in the room are moving around him.The nurse recognizes that the patient is describing

A) syncope.
B) vertigo.
C) paresthesia.
D) an epileptic aura.

Question 20

Your patient reported each of the following facts when questioned about his family's health history.Which fact prompts you to question him further to determine if he might have a familial neurological disease?

A) His father was paralyzed at age 45 from a spinal cord tumor.
B) His older brother has a seizure disorder.
C) His grandfather died of complications related to diabetes.
D) His grandmother had hypertension and died of complications resulting from a cerebrovascular accident.

Question 21

A patient is unable to recognize or name familiar objects during her assessment.You would record this response as

A) agnosia.
B) apraxia.
C) constructional apraxia.
D) visual amnesia.

Question 22

A patient's graphanesthesia,or inability to recognize a number or letter you have drawn on the palm of his hand,is most likely the result of a dysfunction of the

A) peripheral nerves.
B) spinal cord.
C) parietal lobe.
D) thalamus.

Question 23

A patient's inability to identify a key placed in his hand with his eyes closed is called

A) dysesthesia.
B) stereognosis.
C) anesthesia.
D) astereognosis.

Question 24

Your 64-year-old patient complains of difficulty concentrating and remembering the names of friends.She states that she feels sad and has little energy.You question her further to determine if she meets the criteria for a major depressive disorder,which is the presence of

A) five key symptoms for more than 2 weeks.
B) three key symptoms for more than 3 weeks.
C) five key symptoms for more than 3 weeks.
D) seven key symptoms for more than 2 weeks.

Question 25

Your patient has a chief complaint of right-sided facial pain,which is exacerbated by shaving and chewing.Your assessment reveals that the patient has normal motor function of his facial muscles and increased sensitivity to light touch and superficial pain stimuli.You conclude that he most likely has

A) Bell's palsy.
B) trigeminal neuralgia.
C) neoplasm of the trigeminal nerve root.
D) supranuclear facial palsy.

Question 26

Which substance should not be used in assessing the olfactory nerve because its odor can also stimulate the trigeminal nerve endings in the nasal mucus?

A) cloves
B) coffee
C) camphor
D) chocolate

Question 27

A patient has difficulty explaining the meaning of the phrase "a stitch in time saves nine." the patient most likely has difficulties with

A) thought processes.
B) abstract reasoning.
C) judgment.
D) comprehension.

Question 28

When testing your patient for two-point discrimination,you should

A) first touch one fingertip with a sharp object and then a second fingertip, and assess if she can accurately report the sequence.
B) simultaneously touch two points of one of her fingers with sharp objects, and assess if she can distinguish the two points.
C) simultaneously touch a finger on her right hand and the corresponding finger on her left hand with two sharp objects, and assess if she can distinguish the two points.
D) simultaneously touch a fingertip with two sharp objects, remove one stimulus, and then assess if she can detect that one point has been removed.

Question 29

A glove-and-stocking pattern of anesthesia most likely is caused by

A) polyneuritis.
B) spinal cord lesion.
C) brain lesion.
D) hysteria.

Question 30

During your assessment of a patient for doll's eyes phenomenon,you observe that the patient's eyes remain fixed.This response most likely indicates

A) a normal finding.
B) damage to the lower brainstem.
C) injury to cranial nerves III, IV, and VI.
D) hematoma formation behind his eyes.

Question 31

An abnormal emotional state characterized by feelings of sadness,despair,and discouragement describes

A) dementia.
B) depression.
C) delirium.
D) acute confusion.

Question 32

Unilateral anosmia is most likely caused by

A) a cold.
B) sinusitis.
C) meningioma of the sphenoid ridge.
D) heavy smoking.

Question 33

You are caring for a patient with diabetes who complains of aching in the legs.Using a wisp of cotton as a stimulus to assess the patient for light touch,you should start with the

A) abdomen, followed by the proximal areas of the extremities, moving distally.
B) hands, followed by the feet, then arms and legs.
C) distal areas of the limbs and then move proximally.
D) right arm, followed by the right leg, left arm, and left leg.

Question 34

In a sensory assessment,which of the following should be tested first?

A) sense of motion and position
B) stereognosis
C) vibratory sensation
D) light touch and pain

Question 35

Diminished or absent vibratory sensation can be the result of a(n)

A) spinal cord lesion involving the posterior columns.
B) lesion of the thalamus.
C) immature nervous system in infants.
D) lesion in the parietal lobe.

Question 36

An assessment for proprioceptive sensation is typically conducted by having the patient close the eyes and then state "up," "down," or "I can't tell" as you raise or lower

A) the patient's arms and legs one at a time.
B) the head of the bed and then the foot of the bed.
C) the index finger of each hand and great toe of each foot one at a time.
D) each finger of both hands and the great toes one at a time.

Question 37

Which of the following suggests depression?

A) impaired attention and judgment
B) impaired abstract reasoning
C) decreased concentration with intact memory
D) impaired spatial perception

Question 38

During your assessment of a patient,you observe on several occasions the abnormal thought process of blocking,which is

A) changing subjects within a sentence.
B) making up answers unrelated to the facts.
C) repeating words or phrases that another person has spoken.
D) pausing in the middle of a sentence, then continuing on an unrelated topic.

Question 39

After completing the assessment of a patient for light touch and pain,you record your findings of bilateral lower-extremity hypesthesia and hypalgesia,which indicate

A) absence of touch sensation and absence of sensation to pain.
B) diminished sense of touch and pain sensitivity.
C) increased sensitivity to touch and pain.
D) tingling and burning sensations.

Question 40

You test a patient for temperature sensation.Why is this test included?

A) It is part of the routine sensory assessment.
B) Abnormal findings in superficial pain sensation were found.
C) It is recommended for all patients over the age of 40.
D) This test is more discriminating in patients with diabetes than the tests for touch and pain.

Question 41

Equilibratory coordination refers to

A) smooth, precise, and harmonious muscular activity.
B) small movements of the extremities.
C) performing rapid, alternating movements.
D) maintaining an upright stance.

Question 42

The tandem walk is tested by instructing the patient to walk

A) first on tiptoe and then on the heels.
B) with the arms swinging opposite the movement of the legs.
C) hopping first on one foot and then on the other.
D) in a straight line, touching the heel to the toe of the other foot.

Question 43

Observing for elevation of the soft palate on phonation,the presence of a gag reflex,and the ability to swallow water are included in an assessment of which of the following?

A) vagus and hypoglossal nerves
B) facial and glossopharyngeal nerves
C) glossopharyngeal and vagus nerves
D) cerebellar function

Question 44

In deep coma,deep tendon reflexes are

A) diminished or absent.
B) normal.
C) hyperactive.
D) delayed, but full strength.

Question 45

Patients with Ménière's disease typically report vertigo that can last for hours.They may also experience

A) pressure behind the eyes.
B) progressive hearing loss.
C) facial palsy.
D) increased incidence of otitis media.

Question 46

Tapping the Achilles tendon just above its insertion in the heel normally results in contraction of the gastrocnemius,soleus,and plantaris muscles and

A) extension of the leg.
B) flexion of the leg.
C) plantar flexion of the foot.
D) dorsiflexion of the foot.

Question 47

Which of the following describes a positive Romberg sign?

A) downward drift of right arm
B) inability to run heel down
C) unsteady after 10 seconds with eyes closed
D) inability to walk in a straight line, touching heel to toe

Question 48

The upper abdominal reflex is innervated by nerves through segments

A) T7-T9.
B) T11-T12.
C) T2-L1.
D) S1-S2.

Question 49

To assess a patient's ability to identify the taste of a sweet substance,you would apply the flavor-soaked cotton swab

A) to the tip of the tongue.
B) to the back of the tongue and the soft palate.
C) along the borders of the tongue.
D) on the top of the hard palate.

Question 50

Your patient has difficulty closing her left eye and the left side of her mouth,and her left eyebrow is drooping because of damage to her facial nerve.Additional findings may include

A) pain in the anterior two-thirds of the tongue.
B) loss of the sensation of taste in the anterior two-thirds of the tongue.
C) loss of the sensation of pain on the left side of the tongue.
D) weakness of the left side of the tongue.

Question 51

To test the patellar reflex,instruct the patient to sit on the edge of the examination table.Place your hand over the quadriceps femoris muscle while tapping just

A) below the patella with the blunt end of the reflex hammer.
B) above the patella with the blunt end of the reflex hammer.
C) below the patella with the narrow end of the reflex hammer.
D) above the patella with the narrow end of the reflex hammer.

Question 52

When testing reflexes,you should hold the reflex hammer

A) loosely between the thumb and index finger, striking the tendon with a brisk wrist motion.
B) securely in your hand, striking the tendon slowly and firmly.
C) tightly with all your fingers, striking the tendon with a quick wrist motion.
D) firmly between the thumb and index finger, striking the tendon with a light tap.

Question 53

Decorticate rigidity is characterized by hyperflexion and adduction of the arms and

A) flexion of the legs and plantar flexion of the feet.
B) hyperextension, internal rotation, and plantar flexion of the legs.
C) extension and external rotation of the legs.
D) hyperflexion and adduction of the legs.

Question 54

Which finding is normal when assessing the spinal accessory nerve?

A) ability to turn the head side to side and shrug shoulders against resistance
B) ability to rapidly alternate touching finger to nose and moving finger from nose to examiner's finger in a coordinated manner
C) ability to flex arms against resistance
D) ability to elevate arms against resistance

Question 55

To perform the Romberg test,you should ask the patient to stand erect with the feet

A) together, and arms at the sides, first with the eyes open and then closed.
B) slightly apart, arms straight out in front, and eyes closed.
C) wide apart, arms at the sides, and eyes closed.
D) together, arms elevated over the head, and eyes open.

Question 56

To assess for pronator drift,you would ask the patient to extend her arms in front of her body with palms up and observe for

A) downward drifting of an arm.
B) upward drifting of an arm.
C) medially rotating one hand.
D) gradually leaning to one side.

Question 57

Extrapyramidal rigidity is characterized by

A) sustained contraction of extensor muscles with extension of legs, arched neck, and clenched teeth.
B) sustained contraction of flexor muscles, with hyperflexion of the arms and legs.
C) sustained spasticity and rhythmic oscillation of involuntary muscle contraction.
D) resistance to passive movement of flexor and extensor muscles in all directions.

Question 58

To test the biceps reflex,you should support the patient's forearm,which is

A) not flexed.
B) extended.
C) flexed between a 45° and a 90° angle.
D) flexed at a 20° to 30° angle.

Question 59

When instructed to touch his nose and then touch your index finger positioned about 18 inches away,Mr.M misjudges the distance and overshoots.This response is referred to as

A) dyssynergy.
B) dysmetria.
C) dysdiadochokinesia.
D) apraxia.

Question 60

A normal lower abdominal reflex is characterized by contraction of the lower abdominal muscles and contraction of the umbilicus

A) downward.
B) toward the stimulus.
C) upward.
D) away from the stimulus.

Question 61

Severe pain,spasms,and resistance occur when you gently flex Ms.N's neck,indicating that

A) the meningeal infection has spread to the neck muscles.
B) death is imminent.
C) there is a spinal cord tumor in the cervical region.
D) the meningeal irritation has caused nuchal rigidity.

Question 62

The subdural space is located below the ____________________.

Question 63

Your patient has suffered a cerebrovascular accident and is presenting with erratic respirations and heart rate.The portion of the brain most likely affected is the _________________________.

Question 64

The glabellar reflex is characterized by

A) puckering of the lips.
B) a hyperactive blinking response.
C) a chewing, sucking, or swallowing response.
D) flexion of the fingers.

Question 65

To assess for the plantar reflex,you should stroke the sole of the foot on the

A) outer aspect from the heel upward to the little toe.
B) inner aspect from the heel across the ball of the foot to just below the little toe.
C) outer aspect from the heel across the ball of the foot to just below the great toe.
D) inner aspect from the heel upward to the great toe.

Question 66

When a patient makes eight errors within 1.5 minutes while performing serial 7s,the nurse concludes that the patient has which of the following?

A) normal calculation ability
B) confabulation
C) dyscalculia
D) constructional apraxia

Question 67

To test the corneal reflex of a patient's right eye,you would ask him to open his eyes and look away from you,and then

A) lightly brush the conjunctiva with a cotton-tipped applicator.
B) place one drop of warmed sterile saline into his eye.
C) shine a bright light onto the cornea from the side.
D) lightly stroke the cornea with a slightly moistened cotton wisp.

Question 68

A positive Babinski's reflex is characterized by

A) extension and fanning of all toes.
B) plantar flexion of the foot.
C) adduction of the toes with plantar flexion of the great toe.
D) abduction of the toes with dorsiflexion of the great toe.

Question 69

Which structures are included in the cerebral hemispheres? Select all that apply.

A) Distal lobes
B) Frontal lobes
C) Cerebral cortex
D) Parietal lobes
E) Temporal lobes
F) Occipital lobes

Question 70

Which of the following characterize decerebration,a result of bilateral diencephalic injury? Select all that apply.

A) Arm extension
B) Arm flexion
C) Back and neck arching
D) Plantar flexion of feet
E) Teeth clenching
F) Dorsiflexion of feet

Question 71

Your are conducting a mental status examination on a patient admitted with a diagnosis of depression.Your examination would most likely reveal which of the following? Select all that apply.

A) Normal sleep pattern
B) Increase or decrease in appetite
C) Depressed mood
D) Positive self-esteem
E) Suicidal ideations
F) Difficulty concentrating

Question 72

Which of the following are commonly associated with suicidal ideation? Select all that apply.

A) Confusion
B) Depression
C) Dementia
D) Substance abuse
E) Schizophrenia
F) Personality disorders

Question 73

When you apply sharp and dull stimuli to assess your patient' sensation of superficial pain,the patient reports impaired sensation on the lower left leg.You attempt to define the area of diminished sensation by applying stimuli to that extremity from the

A) area of normal sensation to the area of impaired sensation.
B) groin toward his foot.
C) knee toward his foot.
D) area of impaired sensation to the normal area.

Question 74

Your patient has a chief complaint of right-sided facial pain,which is exacerbated by shaving and chewing.While testing you patient's corneal reflex,you observe a normal response,which is the

A) blinking of his right eye.
B) constriction of his right pupil.
C) bilateral blinking of his eyes.
D) tearing of his right eye.

Question 75

A 21-year-old has been diagnosed with hallucinogen drug ingestion.Which of the following neurological findings support this diagnosis? Select all that apply.

A) Dilated pupils
B) Pinpoint pupils
C) Dulled sensorium
D) Clear sensorium
E) Hyperactive deep tendon reflexes
F) Dorsiflexion of feet

Question 76

Your patient is in a recumbent position when you lift his leg and flex the knee at a right angle.As you attempt to extend his knee by pushing down,there is a resistance and he complains of pain.This response

A) is normal in nonathletes.
B) indicates he is prone to leg spasms.
C) indicates meningeal irritation.
D) indicates sciatic nerve irritation.

Question 77

Sensory messages are sent to and from the spinal nerve via ____________________.

Question 78

Ms.N has an elevated temperature and complains of a severe headache,nausea,and vomiting.Suspecting meningitis,you decide to assess for other signs of meningeal irritation,which include

A) Lasègue's and Hoffman's signs.
B) Chaddock's reflex and Tromner's sign.
C) Kernig's and Brudzinski's signs.
D) Oppenheim's sign and Gordon's reflex.

Question 79

Your patient is undergoing a neurological assessment after experiencing head trauma during a vehicular accident.You would assess for doll's eyes phenomenon by holding the patient's eyelids open and assessing the movement of his eyes after

A) rotating his head from the center to one side and then to the opposite side.
B) turning him onto one side and then to the opposite side.
C) raising the head of the bed and then lowering it until it is level.
D) light stimulus followed by painful stimulus.

Question 80

Memory storage and recall are associated with the _____________________.