ATI LPN
Neurological Disorders in Medical Surgical Nursing Questions
Question 1 of 5
The intraocular fluid of the eye flows from the canal of Schlemm into which location?
Correct Answer: B
Rationale: Aqueous humor flows from the canal of Schlemm into aqueous veins. TMP13 p. 645
Question 2 of 5
A patient has had a cerebral hemorrhage and is unconscious. Which of the following is the priority intervention?
Correct Answer: C
Rationale: In an unconscious patient with cerebral hemorrhage, airway protection is the priority. Suctioning saliva prevents aspiration, which could worsen the condition. Passive ROM, electrolyte monitoring, and documentation are secondary to maintaining a patent airway.
Question 3 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 4 of 5
A 69-year-old male presents with abnormal speech and right-sided weakness. While eating lunch with his wife, he suddenly could not move his right arm or leg, and was unable to speak. They arrived to the emergency department within minutes. His wife currently reports improvement from when the symptoms first began, and he is almost back to normal when examined 1 hour later. Past medical history is significant for hypertension and type 2 diabetes mellitus. He has smoked 1 pack of cigarettes daily for 45 years. Non-contrast head CT is shown. Diffusion-weighted image MRI shows no sign of infarction. CT angiogram of the neck shows 72% stenosis of the left internal carotid artery. Which of the following is most likely etiology of his transient ischemic attack?
Correct Answer: A
Rationale: Transient symptoms resolving within 1 hour with significant carotid stenosis (72%) suggest TIA from artery-to-artery embolization. Cardioembolism requires atrial fibrillation, small vessel disease causes lacunar syndromes, and hypoperfusion lacks focal deficits.
Question 5 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.