The nurse is performing a neurologic assessment on a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork, the nurse notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patellae. Given this information, what would the nurse suspect?

Correct Answer: C

Rationale: The correct answer is C: Peripheral neuropathy. In this case, the patient's inability to feel vibrations on the great toe or ankle bilaterally but being able to feel vibrations on both patellae indicates a sensory nerve dysfunction affecting distal lower extremities. This pattern of sensory loss is consistent with peripheral neuropathy, a common complication of diabetes leading to nerve damage. Hyperalgesia (choice A) is increased sensitivity to pain, which is not reflective of the patient's symptoms. Hyperesthesia (choice B) is increased sensitivity to touch, which is also not consistent with the patient's findings. Lesion of the sensory cortex (choice D) would typically present with more widespread sensory deficits rather than the specific pattern described in the question.

Correct Answer: D

Rationale: The correct answer is D. These decerebrate posturing responses are indicative of dysfunction in the brainstem. Specifically, the abnormal posturing seen in the patient suggests damage to the midbrain or pons. This type of response is considered a more severe sign compared to decorticate posturing, which typically indicates damage to the cerebral cortex. Decerebrate posturing is associated with a poorer prognosis and can be a sign of significant neurological injury. The other choices are incorrect: A: Indicates a lesion of the cerebral cortex - This is incorrect because the patient's response is indicative of brainstem, not cortical, dysfunction. B: Indicates a completely nonfunctional brainstem - This is an extreme and inaccurate statement. The patient is exhibiting specific posturing responses, indicating some brainstem function. C: Is normal and will go away in 24 to 48 hours - This is incorrect as the described response is a pathological sign, not a normal one, and requires medical attention.

Correct Answer: A

Rationale: The correct answer is A (6) because a Glasgow Coma Scale (GCS) score of 6 indicates severe brain injury and coma. The GCS assesses a patient's level of consciousness based on eye opening, verbal response, and motor response, with a total score ranging from 3 to 15. A score of 6 means the patient is in a deep coma with minimal to no responsiveness. Choice B (12) and C (15) indicate normal consciousness levels, while D (24) is not a possible GCS score.

Correct Answer: B

Rationale: The correct answer is B because it provides a clear and accurate definition of neurotransmitters as chemicals that pass messages between brain cells. This response addresses the patient's question directly and in a simple, understandable manner. The other choices are incorrect because: A: This choice assumes the patient's emotional state without addressing the question about neurotransmitters. C: This choice deflects the question back to the doctor without providing any useful information to the patient. D: This choice provides incorrect information about neurotransmitters, as they are not substances we eat daily but rather chemicals in the brain.

Correct Answer: A

Rationale: The correct answer is A: parasympathetic nervous system. Anticholinergic medications block acetylcholine, affecting the parasympathetic nervous system which controls rest and digest functions. Other choices are incorrect because anticholinergics do not directly affect sympathetic nervous system (B), reticular activating system (C), or medulla oblongata (D).