MULTIPLE CHOICE
1. Which of the following is not an important factor in determining the needed frequency of the neurologic assessment?
a.
Patient’s diagnosis
b.
Acuity of the condition
c.
How rapidly changes are occurring or are expected to occur
d.
Shift change
ANS: D
Once a thorough evaluation is done on admission or at the beginning of each shift, subsequent assessments should be tailored to the patient’s condition. The frequency of these later assessments will depend on the patient’s diagnosis, the acuity of the condition, and how rapidly changes are occurring or are expected to occur.
REF: pg. 103 OBJ: 1
2. Which of the following is not part of the brain?
a.
Cerebrum
b.
Cranial nerves
c.
Brainstem
d.
Cerebellum
ANS: B
The brain consists of three parts: the cerebrum, which contains two hemispheres; the brainstem (midbrain, pons, and medulla); and the cerebellum.
REF: pg. 103 OBJ: 2
3. Where in the nervous system is breathing regulated?
a.
Brain cortex
b.
Medulla
c.
Cerebellum
d.
Brainstem
ANS: D
Many neurologic functions of particular importance to the respiratory therapist (RT), such as regulation of heart rate, blood pressure, and breathing, are located in the brainstem.
REF: pg. 104 OBJ: 4
4. Which of the following is the most common cause of a nerve root pathologic condition due to compression?
a.
Herniated vertebral disc
b.
Spinal tumor
c.
Spinal cord injury
d.
Infection
ANS: A
A herniated vertebral disc is the most common nerve root pathologic condition that results in compression on the nerve roots.
REF: pg. 106 OBJ: 4
5. Which of the following diseases may be suggested by the involvement of multiple nerve roots?
a.
Myasthenia gravis
b.
Guillain-Barré syndrome
c.
Brain tumor
d.
Intracranial hypertension
ANS: B
The involvement of multiple nerve roots suggests the presence of inflammatory processes (Guillain-Barré syndrome, amyloidosis, vasculitis), neoplastic processes (carcinomatous meningitis), or infectious processes (syphilis, Lyme disease).
REF: pg. 122 OBJ: 4
6. Injury to the cervical spine roots C3 to C5 is associated with which of the following abnormalities?
a.
Absence of deep tendon reflexes
b.
Babinski sign
c.
Paralysis of the diaphragm
d.
Doll’s-eye maneuver
ANS: C
The phrenic nerves arise from the cervical spine roots of C3 to C5. Damage to this portion of the spinal cord or to both phrenic nerves can result in complete paralysis of the diaphragm and can make the patient dependent on a ventilator for life.
REF: pg. 107 OBJ: 8
7. Which of the following is the most important part of the neurologic examination?
a.
Sensory examination
b.
Motor examination
c.
Level of consciousness
d.
Gait examination
ANS: C
Evaluation of the level of consciousness (LOC) and documentation are the most important parts of the neurologic examination.
REF: pg. 108 OBJ: 7
8. What instrument is used most widely to quantify neurologic impairment?
a.
Merck gait evaluation
b.
Glasgow coma scale
c.
APACHE
d.
Mini-Mental State Examination
ANS: B
The Glasgow coma scale (GCS) was published in 1974 by Graham Teasdale and Bryan J. Bennett to assess the LOC after head injury. It is the most widely used instrument for quantifying neurologic impairment.
REF: pg. 110 OBJ: 6
9. Which Glasgow coma scale score is typically an indication for endotracheal intubation?
a.
<9
b.
<10
c.
<12
d.
<14
ANS: A
Patients with GCS scores less than 9 are in a severe coma and typically require endotracheal intubation.
REF: pg. 110 OBJ: 6
10. Which of the following cranial nerves are evaluated with the gag reflex?
a.
II and III
b.
V and VII
c.
I and II
d.
IX and X
ANS: D
Other functions such as the pupillary response (CN II and III), the corneal reflex (CN V and VII), and the gag reflex (CN IX and X) are dependent on more than one cranial nerve.
REF: pgs. 111-112 OBJ: 8
11. Which of the following diseases is characterized by abnormal deep tendon reflexes due to abnormalities of the neuromuscular junction?
a.
Syphilis
b.
Myasthenia gravis
c.
Cerebritis
d.
Multiple sclerosis
ANS: B
Myasthenia gravis and botulism are diseases that are characterized by abnormal deep tendon reflexes due to abnormalities of the neuromuscular junction that impair normal impulse transmission.
REF: pg. 114 OBJ: 9
12. The presence of dorsiflexion of the great toe with fanning of the remaining toes during testing of the plantar reflex is known as the:
a.
Babinski sign.
b.
“Jerk” reflex.
c.
Patellar reflex.
d.
Quadriceps reflex.
ANS: A
Dorsiflexion of the great toe with fanning of the remaining toes—the Babinski sign—is abnormal, except in children up to 12 to 18 months of age.
REF: pg. 115 | pg. 117 OBJ: 9
13. Which of the following cranial nerves is intact if cough is present while the airway is suctioned?
a.
I
b.
IX
c.
X
d.
XII
ANS: C
The ability to cough with suctioning can be tested in an intubated patient and implies an intact CN X.
REF: pg. 116 OBJ: 10
14. Which of the following does not describe the acronym PERRLA?
a.
Positioned
b.
Accommodation
c.
Round
d.
Reactive
ANS: A
The acronym PERRLA is used very commonly to refer to normal pupils that are equal, round, and reactive to light and accommodation (movement).
REF: pg. 116 OBJ: 11
15. Which of the following anatomic areas is compromised when the patient has dysmetria?
a.
Cerebrum
b.
Pons
c.
Cerebellum
d.
Brainstem
ANS: C
Cerebellar dysfunction results in decomposition of movement and undershooting and overshooting of goal-directed movement (dysmetria).
REF: pg. 117 OBJ: 4
16. Which of the following respiratory patterns consists of phases of hyperpnea that regularly alternate with episodes of apnea?
a.
Biot breathing
b.
Ataxic breathing
c.
Apneustic breathing
d.
Cheyne-Stokes respiration
ANS: D
The most common abnormal respiratory pattern seen in patients with neurologic disorders is Cheyne-Stokes respiration, which consists of phases of hyperpnea that regularly alternate with episodes of apnea.
REF: pg. 120 OBJ: 10
17. Which of the following is the most critical parameter to keep in mind when managing a patient with intracranial hypertension?
a.
Mean arterial pressure
b.
Cerebral perfusion pressure
c.
Intracranial pressure
d.
Pulse pressure
ANS: B
It is extremely important for the RT to remember that although hyperventilation is associated with lower intracranial pressure (ICP) values caused by vasoconstriction of brain blood vessels associated with hypocapnia, cerebral perfusion pressure (CPP) is the most critical element to monitor.
REF: pg. 123 OBJ: 12
18. Hyperventilation would be observed in a patient who has damaged which portion of the brainstem?
a.
High-midbrain
b.
Medulla
c.
Mid-midbrain
d.
Pons
ANS: D
Sequence of Loss of Brainstem Function
Highest Level of Brainstem Function
Breathing
Oculocephalic Reflex
Pupils
Pain Response
High midbrain
Normal
Normal
Normal
Withdrawal
Mid-midbrain
Cheyne-Stokes
Present
Small but reactive
Decorticate
Pons
Hyperventilation
Minimal
Mid-fixed
Decerebrate
Medulla
Ataxic
None
Mid-fixed
None
REF: Table 6-8, pg. 123 OBJ: 3
19. The main goal of assessing mental status is to determine which of the following?
a.
Consciousness
b.
Awareness
c.
Thinking
d.
CNS dysfunction
ANS: A
The initial goals of the examination of a patient with altered mental status are to determine whether the patient is conscious and then to determine awareness.
REF: pg. 109 OBJ: 5
20. A patient who is alert and oriented times three would know all of the following things correctly except?
a.
First and last name
b.
Today’s date
c.
City in which he or she lives
d.
President or head of state’s name
ANS: D
The patient will often be asked to state his or her name, the current date, and the present location. A fully conscious patient will be expected to answer those questions in detail, for example, first and last name, month, day, and year, and the ward and name of the hospital. Such patients can be described as alert and oriented times three (one score for each name, date, and location).
REF: pg. 109 OBJ: 5
21. The brain death determination test involving disconnecting a patient from the ventilator, providing 100% oxygen, and monitoring closely for spontaneous breathing is the __________________.
a.
apnea test.
b.
metabolic test.
c.
tendon reflex test.
d.
deep pain test.
ANS: A
After documentation of normal or near-normal PaO2 and PaCO2, the patient is disconnected from the ventilator, and 100% oxygen is administered through an endotracheal tube. The patient is closely monitored during the apnea test, with the emphasis on spontaneous breathing, oxygenation, and cardiovascular status.
REF: pg. 123 OBJ: 13
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