ATI LPN
Neurological Disorders in Medical Surgical Nursing Questions
Question 1 of 5
A 38-year-old female presents with muscle fatigue that is worse by the end of the day. She reports to have myalgias in the back of her neck, and at times her head 'drops.' She also states to sees 'double' when watching television, or reading for a prolonged period of time. On physical examination, ptosis is produced when asking the patient to look at the ceiling without blinking. Pupillary function is intact. Appropriate serologic testing is obtained. On repetitive nerve stimulation, the amplitude of the compound muscle action potential progressively declines. Which of the following is most likely the diagnosis?
Correct Answer: D
Rationale: Fatiguable weakness, ptosis, diplopia, and declining CMAP amplitude on repetitive stimulation are classic for myasthenia gravis, a postsynaptic neuromuscular junction disorder. Botulism involves descending paralysis, Lambert-Eaton improves with repetition, AIDP (Guillain-Barre) is acute with areflexia, and MS involves CNS demyelination.
Question 2 of 5
A 65-year-old male presents with constant falls and fatigue. His symptoms have progressively worsened throughout the years. He reports feeling unstable when standing, and has fallen 4 times in the past year. It takes him longer to perform certain activities of daily living, and describes himself as feeling weak. The patient denies any illicit drug or alcohol use. He smokes 2 packs of cigarettes daily for the past 25 years. He denies night sweats, or fever, but has lost 5 pounds over the course of 8 months. Medical history is significant for type 2 diabetes mellitus, hypertension, and recently diagnosed depression. The patient appears apathetic, with mild patchy scaling on the eyebrows. A mild right hand tremor is present at rest and tempered with voluntary movement. On gait testing, the patient has a stooped posture, and takes shorter steps as he moves forward. When firmly pulling the patient by the shoulders, he falls back. Which of following best explains this patient's clinical presentation?
Correct Answer: B
Rationale: Rest tremor, bradykinesia, stooped posture, and postural instability (retropulsion) suggest Parkinson’s disease, caused by alpha-synuclein deposition in nigrostriatal neurons. Cerebellar atrophy causes ataxia, not rest tremor.
Question 3 of 5
A 66-year-old man presents with progressively worsening headache that is most severe with sneezing and picking up heavy objects. The headache began approximately 3 months ago, is diffuse, non-pulsating, and associated with nausea and 2 episodes of vomiting. Medical history is unremarkable. A gadolinium-enhanced magnetic resonance imaging (MRI) of the brain shows a hyperintense serpentine irregularity of the margins. Pathology shows a hypercellular gliotic tumor with necrosis and high mitotic count. Preparations are made for radiation therapy with adjuvant chemotherapy. Which of the following is most likely the adjuvant chemotherapeutic agent used?
Correct Answer: B
Rationale: High-grade glioma (e.g., glioblastoma) with necrosis and mitotic activity is treated with radiation and temozolomide, an alkylating agent improving survival. Bevacizumab is for recurrence.
Question 4 of 5
The part of the brain responsible for coordinating all your movements is the:
Correct Answer: B
Rationale: The cerebellum coordinates voluntary movements, balance, and posture, fine-tuning motor actions.
Question 5 of 5
Action potentials normally travel along an axon
Correct Answer: B
Rationale: Action potentials propagate unidirectionally from the axon hillock (near the cell body) toward the axon terminals, away from the soma.