Question 1

How much of a size difference between the two pupils is still considered normal?
A) 1 mm
B) 1.5 mm
C) 2 mm
D) 2.5 mm

Accepted Answer

Pupil size should be documented in millimeters with the use of a pupil gauge to reduce the subjectivity of description.Most people have pupils of equal size, between 2 and 5 mm.A discrepancy up to 1 mm between the two pupils is normal.

Question 2

Which of the following statements best describes assessment of arousal?
A) It measures content of consciousness and is a higher level function.
B) It is an evaluation of the reticular activating system and its connection with the thalamus and the cerebral cortex.
C) It becomes a valid parameter when the patient is able to respond to verbal stimuli, such as squeezing the hands on command.
D) Noxious stimuli are not to be used as an assessment parameter.

Accepted Answer

Assessment of the arousal component of consciousness is an evaluation of the reticular activating system and its connection with the thalamus and the cerebral cortex.Arousal is the lowest level of consciousness, and observation centers on the patient's ability to respond to verbal or noxious stimuli in an appropriate manner.

Question 3

A score of 6 on the Glasgow Coma Scale (GCS)indicates
A) a vegetative state.
B) paraplegia.
C) coma.
D) obtundation.

Accepted Answer

The best possible score on the Glasgow Coma Scale (GCS)is 15, and the lowest score is 3.Generally, a score of 7 or less on the GCS indicates coma.Originally, the scoring system was developed to assist in general communication concerning the severity of neurologic injury.

Question 4

The oculovestibular reflex, or cold caloric test,
A) should not be performed on an unconscious patient because of the risk of aspiration.
B) has an abnormal response of rapid nystagmus-like deviation to the side of the body that is tested.
C) is a routine test of the nursing neurologic examination.
D) is one of the final clinical assessments of brainstem function.

Accepted Answer

The oculovestibular reflex is one of the final clinical assessments of brainstem function.After confirmation that the tympanic membrane is intact, the head is raised to a 30-degree angle.Then 20 to 100 mL of ice water is injected into the external auditory canal.In a normal response, eye movement is in the direction of the injection site.An abnormal response is dysconjugate eye movement, which indicates a brainstem lesion, or no response, which indicates little to no brainstem function.

Question 5

Testing of extraocular eye movements assesses
A) pupillary response to light.
B) function of the three cranial nerves of the eye.
C) the ability of the eyes to accommodate to a closer moving object.
D) the oculocephalic reflex.

Accepted Answer

Control of eye movements occurs with interaction of three cranial nerves: oculomotor (III), trochlear (IV), and abducens (VI).

Question 6

While starting an intravenous line on the right hand of an unconscious patient, the patient reaches over with his left hand and tries to remove the noxious stimuli.This response is called
A) decorticate posturing.
B) decerebrate posturing.
C) withdrawal.
D) localization.

Accepted Answer

Localization occurs when the extremity opposite to the extremity receiving pain crosses the midline of the body in an attempt to remove the noxious stimulus from the affected limb.

Question 7

A critically injured patient can be aroused only by vigorous and continuous external stimuli.The patient's level of consciousness is considered
A) lethargic.
B) obtunded.
C) stuporous.
D) comatose.

Accepted Answer

Stuporous means the patient can be aroused only by vigorous and continuous external stimuli.Motor response is often withdrawal or localizing to stimulus.Obtunded means the patient displays dull indifference to external stimuli, and response is minimally maintained.Questions are answered with a minimal response.Lethargic means the patient displays a state of drowsiness or inaction in which the patient needs an increased stimulus to be awakened.Comatose means vigorous stimulation fails to produce any voluntary neural response in the patient.

Question 8

The respiratory pattern with rhythmic increase and decrease of rate and depth of respiration, then brief periods of apnea, is known as
A) central neurogenic hyperventilation.
B) apneustic breathing.
C) ataxic respirations.
D) Cheyne-Stokes respirations.

Accepted Answer

Cheyne-Stokes respirations have a rhythmic crescendo and decrescendo of rate and depth of respiration, including brief periods of apnea.These respirations are usually seen with bilateral deep cerebral lesions or some cerebellar lesions.Central neurogenic hyperventilations are very deep, very rapid respirations with no apneic periods.They are usually seen with lesions of the midbrain and upper pons.Apneustic breathing includes clusters of irregular, gasping respirations separated by long periods of apnea.They are usually seen in lesions of the lower pons or upper medulla.Ataxic respirations are irregular, random patterns of deep and shallow respirations with irregular apneic periods.They are usually seen in lesions of the medulla.

Question 9

The GCS is an invalid measure for the patient with
A) hemiplegia.
B) Parkinson disease.
C) mental retardation.
D) intoxication.

Accepted Answer

Several points should be kept in mind when the Glasgow Coma Scale is used for serial assessment.It provides data about level of consciousness only, and it should never be considered a complete neurologic examination.Additionally, it is not a sensitive tool for evaluation of an altered sensorium, and it does not account for possible aphasia or mechanical intubation.It is also a poor indicator of lateralization of neurologic deterioration

Question 10

Before performing the doll's eye or oculocephalic reflex, the nurse must verify
A) the absence of cervical injury.
B) the depth and rate of respiration.
C) a physician's order to perform the maneuver.
D) the patient's ability to follow a verbal command.

Accepted Answer

In an unconscious patient, assessment of ocular function and innervation of the medial longitudinal fasciculus (MLF)is performed by eliciting the doll's eyes reflex.If the patient is unconscious as a result of trauma, the nurse must ascertain the absence of cervical injury before performing this examination.

Question 11

Decerebrate posturing (abnormal extension)indicates dysfunction in which area of the central nervous system?
A) Cerebral cortex
B) Thalamus
C) Cerebellum
D) Brainstem

Accepted Answer

Abnormal flexion occurs with lesions above the midbrain in the region of the thalamus or cerebral hemispheres.Abnormal extension occurs with lesions in the area of the brainstem.

Question 12

The initial history for the neurologically impaired patient needs to be
A) limited to the chief complaint.
B) comprehensive, including events preceding hospitalization.
C) directed to level of consciousness and pupillary reaction.
D) information that only the patient can provide.

Accepted Answer

The one factor common to all neurologic assessment is the need to obtain a comprehensive history of events preceding hospitalization.

Question 13

The clinical manifestations of the Cushing reflex are
A) bradycardia, systolic hypertension, and widening pulse pressure.
B) tachycardia, systolic hypotension, and tachypnea.
C) headache, nuchal rigidity, and hyperthermia.
D) bradycardia, aphasia, and visual field disturbances.

Accepted Answer

The Cushing reflex is a set of three clinical manifestations (bradycardia, systolic hypertension, and widening pulse pressure)related to pressure on the medullary area of the brainstem.

Question 14

Which of the following choices is an acceptable and recommended method of noxious stimulation?
A) Nipple pinch
B) Nail bed pressure
C) Supraorbital pressure
D) Sternal rub

Accepted Answer

Nail bed pressure and trapezius pinch are acceptable methods of noxious stimulation.Nail bed pressure allows evaluation of individual extremity function.Trapezius pinch is difficult to perform on large or obese adults.Repeated sternal rub can cause the sternum to become excoriated, open, and infected.Supraorbital pressure must be avoided in patients with head injuries, frontal craniotomies, or facial surgery.Nipple and testicle pinching are inappropriate and unnecessary.

Question 15

Which of the following denotes the most serious prognosis?
A) Decorticate posturing
B) Decerebrate posturing
C) Absence of Babinski reflex
D) GCS score of 14

Accepted Answer

Outcome studies indicate that abnormal flexion or decorticate posturing has a less serious prognosis than does extension, or decerebrate posturing.Onset of posturing or a change from abnormal flexion to abnormal extension requires immediate physician notification.The Babinski reflex is a pathologic finding; absence of this reflex is a normal neurologic finding in adults.The range of scores for the Glasgow Coma Scale is 3 to 15.A score of 14 denotes a minimal deficit.

Question 16

An oval pupil is indicative of
A) cortical dysfunction.
B) intracranial hypertension.
C) hydrocephalus.
D) metabolic coma.

Accepted Answer

Pupil shape is also noted in the assessment of pupils.Although the pupil is normally round, an irregularly shaped or oval pupil may be noted in patients with eye surgery.Initial stages of cranial nerve III compression from elevated intracranial pressure can also cause the pupil to have an oval shape.

Question 17

With an intact oculocephalic reflex, the
A) patient's eyes move in the same direction the head is turned.
B) patient's eyes move in the opposite direction to the movement of the patient's head.
C) patient's eyes remain midline.
D) doll's eye reflex is absent.

Accepted Answer

To assess the oculocephalic reflex, the nurse holds the patient's eyelids open and briskly turns the head to one side while observing the eye movements and then briskly turns the head to the other side and observes.If the eyes deviate to the opposite direction in which the head is turned, doll's eyes are present, and the oculocephalic reflex arc is intact.If the oculocephalic reflex arc is not intact, the reflex is absent.

Question 18

A patient is admitted to the critical care unit with a subdural hematoma.The GCS is used to assess his level of consciousness.Which statement is true concerning the GCS?
A) It provides data about level of consciousness only.
B) It is considered equivalent to a complete neurologic examination.
C) It is a sensitive tool for evaluation of an altered sensorium.
D) It is the most critical assessment parameter to account for possible aphasia.

Accepted Answer

Several points should be kept in mind when the Glasgow Coma Scale is used for serial assessment.It provides data about level of consciousness only, and it should never be considered a complete neurologic examination.Additionally, it is not a sensitive tool for evaluation of an altered sensorium, and it does not account for possible aphasia or mechanical intubation.It is also a poor indicator of lateralization of neurologic deterioration.

Question 19

The most important aspect of the neurologic examination is
A) medical history.
B) physical examination.
C) level of consciousness.
D) pupillary responses.

Accepted Answer

Assessment of the level of consciousness is the most important aspect of the neurologic examination.

Question 20

Symptoms of late stages of intracranial hypertension include
A) decreased perfusion of cerebral tissue.
B) widening pulse pressure values.
C) increased perfusion pressure across the blood-brain barrier.
D) decreased intracranial pressure.

Accepted Answer

Attention must also be paid to the pulse pressure because widening of this value may occur in the late stages of intracranial hypertension.With the loss of autoregulation as blood pressure increases, cerebral blood flow (CBF)and cerebral blood volume increase and intracranial pressure (ICP)therefore increases.The mean arterial pressure must be maintained at a level sufficient to produce adequate CBF in the presence of elevated ICP.

Quiz 17: Neurologic Clinical Assessment and Diagnostic Procedures

How much of a size difference between the two pupils is still considered normal?

Which of the following statements best describes assessment of arousal?

A score of 6 on the Glasgow Coma Scale (GCS) indicates

The oculovestibular reflex, or cold caloric test,

Testing of extraocular eye movements assesses

While starting an intravenous line on the right hand of an unconscious patient, the patient reaches over with his left hand and tries to remove the noxious stimuli.This response is called

A critically injured patient can be aroused only by vigorous and continuous external stimuli.The patient's level of consciousness is considered

The respiratory pattern with rhythmic increase and decrease of rate and depth of respiration, then brief periods of apnea, is known as

The GCS is an invalid measure for the patient with

Before performing the doll's eye or oculocephalic reflex, the nurse must verify

Decerebrate posturing (abnormal extension) indicates dysfunction in which area of the central nervous system?

The initial history for the neurologically impaired patient needs to be

The clinical manifestations of the Cushing reflex are

Which of the following choices is an acceptable and recommended method of noxious stimulation?

Which of the following denotes the most serious prognosis?

An oval pupil is indicative of

With an intact oculocephalic reflex, the

A patient is admitted to the critical care unit with a subdural hematoma.The GCS is used to assess his level of consciousness.Which statement is true concerning the GCS?

The most important aspect of the neurologic examination is

Symptoms of late stages of intracranial hypertension include