ATI LPN
Medical Surgical Neurology Questions
Question 1 of 5
The first central synapse for neurons transmitting the sweet taste sensation is in which structure?
Correct Answer: B
Rationale: Taste fibers synapse in the nucleus of the solitary tract. TMP13 pp. 687-688
Question 2 of 5
The nurse is caring for a patient who has been experiencing stroke symptoms for 60 minutes. Which action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?
Correct Answer: C
Rationale: Administration of subcutaneous medications is included in LPN/LVN education and scope of practice. The other actions require more education and scope of practice and should be done by the registered nurse (RN).
Question 3 of 5
A previously healthy 68-year-old male presents with progressive muscle weakness in his right hand, swallowing difficulty and difficulty with walking. He believes these symptoms occurred 'out of the blue' and have worsened over the last 2-3 months. His temperature is 98.6 deg F (37 deg C), blood pressure 145/86 mmHg, pulse is 80/min, and respirations are 17/min. Neurologic examination is significant for mild dysarthria. He has atrophy of the thenar muscles of the right hand and forearm, and 2/5 strength on wrist extension and flexion, as well as 3/5 power in intrinsic hand muscles on right. He has some fasciculations in his right thigh, and mild (4+/5) weakness of hip flexors bilaterally. Tone is increased in both legs. Sensory examination is intact. 3+ patellar reflexes are noted on the left lower extremity. On gait testing, the patient has poor balance, and spastic gait. Which of the following is the most likely diagnosis?
Correct Answer: B
Rationale: Progressive weakness, atrophy, fasciculations, spasticity, and hyperreflexia suggest a mixed upper (spasticity, hyperreflexia) and lower (atrophy, fasciculations) motor neuron disease, characteristic of ALS. Guillain-Barre is acute with areflexia, myasthenia gravis involves fatiguable weakness, multiple sclerosis affects sensory and motor tracts, and dermatomyositis includes rash and proximal weakness.
Question 4 of 5
A 65-year-old female is brought to the emergency department by her husband due to abnormal speech. She does not appear to be aware of her deficit. She was last normal 2 hours ago. Past medical history is significant for hypertension, coronary artery disease, and hypercholesterolemia. On exam, her blood pressure is 181/94, her speech is fluent, but empty, with paraphasic errors. Comprehension and repetition is impaired. There appears to be a visual deficit in the right upper quadrant. Non-contrast head CT is shown. Which of the following is the best next step in management?
Correct Answer: C
Rationale: Wernicke’s aphasia and right visual field deficit within 2 hours suggest ischemic stroke. If CT (assumed negative for bleed) confirms no hemorrhage, tPA is the best step within the 4.5-hour window to restore perfusion. Thrombectomy is for large vessel occlusion, labetalol manages BP post-tPA.
Question 5 of 5
A 42-year-old man presents with generalized tonic-clonic convulsions on day 2 of his hospitalization for the management of acute pancreatitis. Prior to the convulsive event, the patient felt anxious, tremulous, and agitated. Medical history is significant for alcohol-use disorder, with multiple hospitalizations for alcohol intoxication and acute pancreatitis. On physical examination, the patient is diaphoretic and convulsing. There is no evidence of stigmata of liver disease. The patient does not appear malnourished. Appropriate laboratory tests are obtained. Which of the following is the best initial treatment?
Correct Answer: D
Rationale: Seizures on day 2 of hospitalization in an alcohol-use disorder patient suggest alcohol withdrawal. Chlordiazepoxide (a benzodiazepine) is the initial treatment to manage withdrawal and prevent further seizures.