NCLEX-PN › Symptoms and Tests for Neural Conditions
Swaying or inability to maintain balance while standing with the eyes closed is considered a positive finding in what test?
Romberg's test
Gait test
Rapidly alternating movement test
Test for ataxia
Romberg's test is an evaluation of both proprioception and vestibular function. The patient is asked to stand with eyes open, then to close their eyes and remain still. Any tilting or loss of balance is considered to be a sign of either proprioceptive or vestibular impairment, and should be evaluated further.
Gait test assesses for gait abnormalities. Rapidly alternating movement test is done with the patient seated with their hands on their thighs. They are asked to rapidly turn their hands over, then return them palms down to their thighs 10 times. This test is evaluating for dysdiadochokinesis, or inability to perform rapidly alternating movements. Ataxia, or the loss of control of bodily movements, is not a specific test, but rather a clinical finding.
A 46-year-old patient presents with dysdiadochokinesis (an inability to perform rapidly alternating movements). What condition is the most common cause of dysdiadochokinesis in adults?
Multiple sclerosis
Parkinson's disease
Cerebellar lesion
Lesion in the pons
In adults, the most common cause of dysdiadochokinesia is multiple sclerosis.
Cerebellar lesion is the most common cause of this finding in children. This symptom is not a normal finding in Parkinson's disease, or in pontine gliomas (tumors of the pons), though neurological impairment or ataxia itself may make rapidly alternating movements difficult.
A 26-year-old woman presents to urgent care after a bike accident in which she got "a bad bump on the head." She was not wearing a helmet. She must now be assessed for increased intracranial pressure. All of the following are signs of increased intracranial pressure except __________.
migraine aura that persists after headache has resolved
effort-related or positional headache
altered consciousness
one or both pupils are dilated and unresponsive to light
Increased intracranial pressure can be chronic or acute. The nurse must assess for pupilary response, level of consciousness, and quality of headache if present, in addition to motor response.
Migraine aura that persists after headache has resolved should be evaluated for stroke, transient ischemic attack, or arteriovenous malformation.
Hank is a schizophrenic 46 year old male. He experiences a persistent belief that a particular television commercial actor is addressing him directly, and that the commercial was created specifically to communicate with him. What type of delusion is Hank experiencing?
Delusion of reference
Erotomania
Delusion of control
Cotard delusion
The belief that general or innocuous events exist specifically for or relate specifically to an individual is called a delusion of reference. Examples include belief that a billboard or television commercial is attempting to communicate directly to an individual, the ascribing of significance to random coincidences, or the observation of coded signals or signs in the general environment.
Charlotte is a 19 year old female with new onset of paranoia and auditory hallucinations. She has a positive family history for schizophrenia. Recently she admitted to her nurse that she can “hear” what other people are thinking. As she describes it, this does not come in the form of sound, but is communicated directly to her brain. Charlotte is likely experiencing which of the following?
Thought broadcasting
Telepathy
Auditory hallucination
Delusions of persecution
The belief that other people can hear one's thoughts is described by the term thought broadcasting. This is a common symptom in schizophrenia. It is differentiated from telepathy in that thought broadcasting, there is a delusion that thoughts can be heard by anyone, while telepathy is generally non-verbal communication between specific individuals, and may be receptive as well as projective. Auditory hallucinations are false perceptions of sounds (or internal thought perceived at emanating from another source), while delusions of persecution can take many forms but generally include a degree of paranoia or feeling of being targeted for harm or attack.
Which of the following conditions can decrease sensitivity to sweet and bitter tastes?
Depression
Psoriasis
ADHD
Rheumatoid arthritis
Depression has been linked with alterations in taste sensation, including decreased sensitivity to sweetness. This may contribute in some part to the high consumption of sweet foods in certain individuals experiencing a depressive episode. None of the other conditions listed have been correlated with alterations in taste receptor function.
Which of the following terms denotes neurological impairment of the ability to speak or understand language?
Aphasia
Ataxia
Apraxia
Dysmetria
Aphasia is the term for neurological impairment of a person's ability to speak or understand language.
The other terms listed all denote various deficiencies:
An unconscious patient exhibits stiffly extended arms that are also adducted with the wrists hyperpronated. The nurse recognizes this presentation to be __________.
decerebrate positioning
decorticate positioning
Babinski reflex
crossed extensor reflex
vestibulospinal reflex
Decerebrate positioning is an involuntary response of abduction, extension, and hyperpronation of the upper extremities due to noxious stimuli. There also is hyperextension of the lower extremities and the feet are plantarflexed. Decorticate positioning involves "mummy baby" posture - elbows, wrists, and fingers flexed, and legs extended and rotated medially. The Babinski reflex involves the extension of the big toe following stimulation of the sole of the foot. The crossed extensor reflex is also known as the withdrawal reflex, which involves the differential flexion and relaxation of muscles in the withdrawal of a limb. Vestibulospinal reflexes involve the use of vestibular organs and skeletal muscle to maintain balance, posture, and coordination.
A client admitted to the neuro intensive care unit is having his level of responsiveness assessed by the nurse on duty. Her findings include eyes opening to verbal command, is disoriented but can converse, and obeys commands.
What is this client's Glasgow Coma Scale score?
The score of this client includes: eye open response is a , best verbal response is
and best motor response is
.
Which of the following is a term for an abnormal surge or excess of electrical activity in the brain?
Seizure
Spasm
Twitch
Dyskinesia
A seizure is defined as an abnormal surge or excess of electrical activity in the brain. This can result in partial or total loss of consciousness, and may cause muscular spasms, twitches, or other types of dyskinesia (disorders of movement). Spasms, twitches, and dyskinesias are not always caused by seizure disorders, however - they may be caused by a wide range of neuromuscular dysfunctions.