Symptoms and Tests for Neural Conditions

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NCLEX-PN › Symptoms and Tests for Neural Conditions

Questions 1 - 10
1

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

Explanation

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.

2

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

Explanation

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.

3

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

Explanation

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.

4

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

Explanation

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.

5

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

Explanation

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.

6

Which of the following conditions can decrease sensitivity to sweet and bitter tastes?

Depression

Psoriasis

ADHD

Rheumatoid arthritis

Explanation

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.

7

Which of the following terms denotes neurological impairment of the ability to speak or understand language?

Aphasia

Ataxia

Apraxia

Dysmetria

Explanation

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:

  • Ataxia is a loss or lack of coordinated motor function.
  • Apraxia describes a lack of motor planning or inability to execute a specific intentional movement.
  • Dysmetria is an inability to judge distance when attempting movements such as grasping at a nearby object
8

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

Explanation

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.

9

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?

Explanation

The score of this client includes: eye open response is a , best verbal response is and best motor response is .

10

Which of the following is a term for an abnormal surge or excess of electrical activity in the brain?

Seizure

Spasm

Twitch

Dyskinesia

Explanation

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.

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