ATI LPN
Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
Chapter 65 : Assessment of Neurologic Function Questions
Question 1 of 5
The nurse is caring for a patient with an upper motor neuron lesion. What clinical manifestations should the nurse anticipate when planning the patients neurologic assessment?
Correct Answer: C
Rationale: Upper motor neuron lesions cause spasticity and loss of voluntary movement control due to disrupted corticospinal signals. Decreased tone, flaccid paralysis, and slow reflexes are typical of lower motor neuron lesions.
Question 2 of 5
The nurse is admitting a patient to the unit who is diagnosed with a lower motor neuron lesion. What entry in the patients electronic record is most consistent with this diagnosis?
Correct Answer: D
Rationale: Lower motor neuron lesions result in flaccid paralysis, muscle atrophy, and absent deep tendon reflexes due to disrupted nerve supply to muscles. Increased tone and hyperactive reflexes indicate upper motor neuron issues.
Question 3 of 5
An elderly patient is being discharged home. The patient lives alone and has atrophy of his olfactory organs. The nurse tells the patients family that it is essential that the patient have what installed in the home?
Correct Answer: D
Rationale: Olfactory atrophy impairs smell, increasing the risk of missing smoke or gas. A smoke detector is critical for safety. Grab bars and mats address mobility, and heaters are unrelated to olfactory deficits.
Question 4 of 5
The patient in the ED has just had a diagnostic lumbar puncture. To reduce the incidence of a postlumbar puncture headache, what is the nurses most appropriate action?
Correct Answer: A
Rationale: Prone positioning after lumbar puncture minimizes cerebrospinal fluid leakage, reducing headache risk. Supine or side-lying positions are less effective, and acetaminophen is not a preventive measure.
Question 5 of 5
The nurse is conducting a focused neurologic assessment. When assessing the patients cranial nerve function, the nurse would include which of the following assessments?
Correct Answer: D
Rationale: The gag reflex assesses cranial nerves IX and X. Hand grip and arm drift evaluate motor function, while orientation assesses mental status, not cranial nerves.