NIU NURS304 Quiz #5
Question 1
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The nurse is assessing the neurologic status of a patient
who has a late-stage brain tumor. With the reflex hammer, the nurse draws a
light stroke up the lateral side of the sole of the foot and inward, across the
ball of the foot. In response, the patient’s toes fan out, and the big toe
shows dorsiflexion. The nurse interprets this result as:
a negative Babinski sign, which is normal for adults.
a positive Babinski’s sign, which is abnormal for adults.
clonus which is a hyperactive response.
the Achille’s reflex, which is an expected response.
Question 2
A 78-year-old man has a history of a cerebrovascular
accident. The nurse notes that when he walks his left arm is immobile against
the body with flexion of the shoulder, elbow, wrist, and fingers and adduction
of the shoulder. His left leg is stiff and extended and circumducts with each
step. What type of gait disturbance is this individual experiencing?
scissors gait.
cerebellar ataxia.
parkinsonian gait.
spastic hemiparesis.
Question 3
The nurse places a key in the hand of the patient and he
identifies it as a penny. What term
would the nurse use to describe this finding?
extinction.
astereognosis.
stereognosis.
graphethesia.
uestion 4
The nurse is providing instructions to newly hired graduates
about the Mini-Mental State Examination. Which statement best describes this
examination?
Scores
below 30 indicate cognitive impairment.
It is a
good tool to evaluate mood and thought processes.
It is a
good tool to detect delirium and dementia to differentiate these from
psychiatric mental illness.
It is
useful for an initial evaluation of mental status. Additional tools are needed to evaluate
cognition changes over time.
Question 5
The nurse is doing an assessment on a 29-year-old woman who
visits the clinic complaining of “always dropping things and falling down.”
While testing rapid alternating movements, the nurse notices that the woman is
unable to pat both her knees. Her response is very slow and she misses
frequently. What should the nurse suspect?
vestibular
disease.
lesion
of cranial nerve IX.
dysfunction
of the cerebellum.
inability
to understand directions.
Question 6
Cranial nerve IV is known as:
Oculomotor
Trigeminal
Hypoglossal
Trochlear
Question 7
The nurse suspects that a patient has appendicitis. Which of these procedures are appropriate for
use when assessing for appendicitis or a perforated appendix? Select all that apply.
Test
for Murphy’s sign.
Test
for Blumberg’s sign.
Test
for shifting dullness.
Perform
Iliopsoas muscle test.
Test
for fluid wave.
Question 8
In order to document that bowel sounds are absent, the nurse must listen for [ ] minutes. ( Use the number and not the
text word)
Answer
5
Question 9
A patient has had a cerebrovascular accident, or stroke. He
is trying very hard to communicate. He seems driven to speak and says, “I buy
obie get spirding and take my train.” What is the best description of this
patient’s problem?
Global aphasia
Broca’s aphasia
Echolalia
Wernicke’s aphasia
Question 10
A 45-year-old man is in the clinic for a physical
examination. During the abdominal
assessment, the nurse percusses the abdomen and notices and area of dullness
above the right costal margin of about 10cm.
The nurse should:
document the presence of hepatomegaly.
ask additional history questions regarding alcohol intake.
describe this as an enlarged liver and refer him to a
specialist.
consider this a normal finding and proceed with the
examination.
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