ATI LPN
Medical-Surgical Nursing Neurological System Questions
Question 1 of 5
Which structure functions to ensure that each of the three sets of extraocular muscles is reciprocally innervated so that one muscle of the pair relaxes while the other contracts?
Correct Answer: B
Rationale: The medial longitudinal fasciculus coordinates reciprocal extraocular muscle innervation. TMP13 p. 666
Question 2 of 5
The nurse is caring for a patient who has just returned after having left carotid artery angioplasty and stenting. Which assessment information is of most concern to the nurse?
Correct Answer: B
Rationale: Small emboli can occur during carotid artery angioplasty and stenting, and the aphasia indicates a possible stroke during the procedure. Slightly elevated pulse rate and blood pressure are not unusual because of anxiety associated with the procedure. Fine crackles at the lung bases may indicate atelectasis caused by immobility during the procedure. The nurse should have the patient take some deep breaths.
Question 3 of 5
A 33-year-old female presents with drooping of her eyelid that seem to occur while reading or watching television. This appears to get worse later in the day. She also reports that at times she sees 'double.' A few weeks ago, she was prescribed an antibiotic medication for a urinary tract infection. She does not recall the name of the antibiotic. On physical exam, bilateral ptosis, with the left affected more than the right is seen. Pupillary function intact. A glove is filled with ice, and subsequently applied to the patient's eyelid. After two minutes, the patient's ptosis has improved. Which of the following is most likely to yield rapid symptom improvement?
Correct Answer: C
Rationale: Fatiguable ptosis and diplopia worsening later in the day, with improvement after ice application (reducing acetylcholine breakdown), suggest myasthenia gravis. Acetylcholinesterase inhibitors (e.g., pyridostigmine) provide rapid symptomatic relief by increasing acetylcholine availability at the neuromuscular junction.
Question 4 of 5
A 70-year-old male presents with numbness of the left upper and lower extremity, as well as the right side of his face. He also reports dizziness and difficulty with swallowing. He was last seen normal approximately 6 hours ago. Two weeks ago he experienced acute head trauma due to a fall while jogging. No intracranial bleed was noted in the head CT performed at the time. Past medical history is significant for hypertension and hypercholesterolemia. His temperature is 100.4 deg F (38 deg C), blood pressure 180/102 mmHg, pulse is 97/min, and respirations are 16/min. Blood glucose level is 312 mg/dL. Physical exam is significant for ptosis and miosis (Horner's syndrome) on the right side. Nystagmus on rightward gaze. Uvula is displaced towards the left, and there is paralysis of the right-sided vocal cord. Right-sided hemisensory loss is noted in the trunk and extremities. There is also sensory loss on the right-sided face. Non-contrast CT shows no intracranial bleed. Which of the following is the best next step in management?
Correct Answer: C
Rationale: Lateral medullary syndrome (Wallenberg) with hyperglycemia (312 mg/dL) suggests stroke. Correcting glucose with insulin is critical as hyperglycemia worsens outcomes; alteplase is past the window (6 hours), and labetalol is secondary.
Question 5 of 5
A 31-year-old woman is brought to the emergency department by her partner due to a convulsive episode after an argument. Her partner described the convulsive episode as being abrupt in onset, with asynchronous limb movements, and pelvic thrusting. The patient's eyes were closed throughout the episode and was unresponsive. The event lasted approximately 10-15 minutes, and would consist of bursts of movement followed by pauses, occurring in a stopping-and-starting fashion. The convulsive episode ended abruptly, with complete recovery. The patient said that during the event, she could sometimes hear what people were saying, but was unable to respond. She says she has seizures 2-3 times per week. Physical examination is unremarkable. On videoelectroencephalogram (video-EEG), one of her typical events is recorded, without any abnormality on scalp EEG. What is the most appropriate treatment for this disorder?
Correct Answer: C
Rationale: Prolonged, asynchronous movements with awareness and normal EEG suggest psychogenic non-epileptic seizures (PNES), often stress-related. Cognitive-behavioral therapy addresses underlying psychological triggers.