Chapter 24, Neurologic System: Findings for the Neurologic System—Sherpath

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Question 1 of 21

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Which findings are considered normal on assessment of the oculomotor, trochlear, and abducens cranial nerves?

  • Correct
    • Palpebral fissures are symmetric.Symmetric palpebral fissures are a normal finding on assessment of the oculomotor, trochlear, and abducens cranial nerves.
  • Correct
    • Both pupils constrict with accommodation.Constriction of both pupils with accommodation is a normal finding on assessment of the oculomotor, trochlear, and abducens cranial nerves.
    • Bilateral peripheral vision is intact.Peripheral vision is not evaluated during assessment of the oculomotor, trochlear, and abducens cranial nerves. Peripheral vision is assessed during examination of the optic nerve.
    • Optic disc has well-defined margins on ophthalmologic examination.The margins of the optic disc are not evaluated during assessment of the oculomotor, trochlear, and abducens cranial nerves. The optic disc is assessed during examination of the optic nerve.
  • Correct
    • Both pupils constrict in response to light directly and consensually.Direct and consensual constriction of both pupils is a normal finding during assessment of the oculomotor, trochlear, and abducens cranial nerves.

Question 2 of 21

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Which facial movements are expected on assessment of the facial nerve (CN VII)?

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    • SmileAbility to smile is expected on assessment of the facial nerve.
  • Correct
    • Show teethAbility to show teeth is expected on assessment of the facial nerve.
    • Stick out tongueAbility to stick out tongue is not expected on assessment of the facial nerve. Tongue thrust is assessed on examination of the hypoglossal nerve (CN XII).
  • Correct
    • Puff out cheeksAbility to puff out cheeks is expected on assessment of the facial nerve.
  • Correct
    • Raise eyebrowsAbility to raise eyebrows is expected on assessment of the facial nerve.

Question 3 of 21

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Which findings are considered normal on assessment of the acoustic nerve (CN VIII)?

    • Sound from tuning fork lateralizes to the right ear.It is not normal for sound to lateralize to one ear when the acoustic nerve is assessed.
  • Correct
    • Sound from tuning fork is heard equally in both ears.The ability of both ears to hear sound equally is a normal finding when the acoustic nerve is assessed with the Weber test.
  • Correct
    • Air conduction of sound is greater than bone conduction of sound.It is normal to find that air conduction of sound is greater than bone conduction of sound when the acoustic nerve is assessed with the Rinne test.
    • Bone conduction of sound is greater than air conduction of sound.It is not normal to find that bone conduction of sound is greater than air conduction of sound when the acoustic nerve is assessed.
  • Correct
    • Individual is able to correctly repeat words whispered in both ears.The ability of the individual to correctly repeat words whispered in both ears is a normal finding when the acoustic nerve is assessed with the whisper test.

Question 4 of 21

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The patient is found to have active, expected deep tendon reflexes. Which score represents the expected deep tendon reflex finding?

    • 0A score of 0 does not represent active, expected deep tendon reflexes.
    • 1+A score of 1+ does not represent active, expected deep tendon reflexes.
  • Correct
    • 2+A score of 2+ represents active, expected deep tendon reflexes.
    • 3+A score of 3+ does not represent active, expected deep tendon reflexes.

Question 5 of 21

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Which finding is considered normal on evaluation of the cremasteric reflex?

    • Testicle and scrotum rise on the unstroked side.When the cremasteric reflex is evaluated, it is not normal to see the testicle and scrotum rise on the unstroked side.
  • Correct
    • Testicle and scrotum rise on the stroked side.When the cremasteric reflex is evaluated, it is normal to see the testicle and scrotum rise on the stroked side.
    • Both testicles and scrotum remain stationary when stroked on either side.When the cremasteric reflex is evaluated, it is not normal to see both testicles and scrotum remain stationary when stroked on either side.
    • Both testicles and scrotum tense when stroked on either side.When the cremasteric reflex is evaluated, it is not normal to see both testicles and scrotum tense when stroked on either side.

Question 6 of 21

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Which movement of the foot is expected when the Achilles reflex is evaluated?

    • Supination of the footSupination of the foot is not an expected movement during evaluation of the Achilles reflex.
    • Pronation of the footPronation of the foot is not an expected movement during evaluation of the Achilles reflex.
  • Correct
    • Plantar flexion of the footPlantar flexion of the foot is the expected movement during evaluation of the Achilles reflex.
    • Plantar extension of the footPlantar extension of the foot is not an expected movement during evaluation of the Achilles reflex.

Question 7 of 21

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During the heel-to-shin neurologic test, which findings suggest intact proprioception?

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    • Absence of tremors with movementThe absence of tremors, tics, and fasciculations suggests intact proprioception with the heel-to-shin test.
    • Presence of occasional tremors with movementThe presence of occasional tremors with movement does not suggest intact proprioception with the heel-to-shin test.
    • Ability to move heel along shin quicklyQuick movement of the heel up and down the shin does not suggest intact proprioception with the heel-to-shin test.
  • Correct
    • Ability to maintain contact of heel with shinThe ability to maintain contact of the heel with the shin as it moves up and down the shin suggests intact proprioception with the heel-to-shin test.
  • Correct
    • Ability to move heel along shin in straight pathThe ability to move the heel along the shin in a straight path suggests intact proprioception with the heel-to-shin test.

Question 8 of 21

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Which finding suggests normal balance while the patient is hopping on one foot with eyes open?

    • Ability to hop for 60 seconds with good balanceNormal balance is not suggested by the ability to hop on one foot for 60 seconds with good balance and eyes open.
    • Ability to hop for 45 seconds with good balanceNormal balance is not suggested by the ability to hop on one foot for 45 seconds with good balance and eyes open.
    • Ability to hop for 30 seconds with good balanceNormal balance is not suggested by the ability to hop on one foot for 30 seconds with good balance and eyes open.
  • Correct
    • Ability to hop for 5 seconds with good balanceNormal balance is demonstrated by the ability to hop on one foot for 5 seconds with good balance and eyes open.

Question 9 of 21

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When a patient’s normal gait is being evaluated, which findings are expected and considered normal?

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    • Gait is smooth and rhythmic.Normal gait is smooth and rhythmic, as well as symmetric. Step after step, a continuous sequencing of stance and swing is expected.
  • Correct
    • Arm swing is smooth and symmetric.With normal gait, arms swing smoothly and symmetrically.
  • Correct
    • Trunk posture sways with gait.With normal gait, trunk posture sways with gait.
    • Trunk posture stays stationary.With normal gait, trunk posture does not stay stationary.
    • Arms stay stationary at sides.With normal gait, arms do not stay stationary at sides.

Question 10 of 21

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The nurse uses the rounded portion of a tongue blade on the toe to test a patient’s sense of superficial pain. Which patient response indicates a normal finding?

    • “I can feel the sensation more on the right foot than on the left.”It is expected that there will be minimal bilateral differences in pain sensation. An indication by the patient that the sensation is felt more in one foot is an unexpected finding.
  • Correct
    • “That feels dull and is not painful.”The patient would be expected to correctly describe the pain sensation. Dull with little pain would be an expected finding when testing with the rounded, or dull, end of a tongue blade.
    • “That feels sharp and is painful.”The patient would be expected to correctly identify the pain sensation. The rounded end of a tongue blade would not be expected to cause a sharp and painful sensation.
    • “I can feel the sensation on the heel of my foot.”The patient should be able to recognize the location of the sensation. Identification of the sensation on the heel would be an unexpected finding when testing the toe.

Question 11 of 21

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The patient has an intact sense of graphesthesia as evidenced by which finding?

    • Can identify where touched on armThe ability to identify where touched on the arm is not evidence of intact graphesthesia. It suggests intact sense of point location.
  • Correct
    • Can identify figure drawn on palmThe ability to identify a figure drawn on the palm is evidence of intact graphesthesia.
    • Can identify object placed in palmThe ability to identify an object placed in the palm is not evidence of intact graphesthesia. It suggests intact of stereognosis.
    • Can identify being touched on the arm in one point or two pointsThe ability to identify one point versus two points touching the skin is not evidence of intact graphesthesia. It suggests intact sense of two-point discrimination.

Question 12 of 21

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During the neurologic test for vibratory sensation, which normal finding is expected?

    • Ability to feel a vibration in the muscleThe neurologic test for vibratory sensation does not test for vibration in the muscle.
    • Ability to feel a vibration on the skinThe neurologic test for vibratory sensation does not test for vibration on the skin.
  • Correct
    • Ability to feel a vibration in the jointVibration in the joint is a normal finding expected during the test for vibratory sensation.
    • Ability to feel a vibration radiating through the limbA vibration radiating through the limb is not a normal finding during the test for vibratory sensation.

Question 13 of 21

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During a neurologic examination of a 3-month-old infant, which findings are related to the presence of primitive reflexes?

    • Withdraws all limbs from pain stimulusAn infant who withdraws all limbs from a pain stimulus is not demonstrating the presence of primitive reflexes. This condition is a normal variation in the infant neurologic system.
  • Correct
    • Alternates flexion and extension of legsAn infant who demonstrates alternate flexion and extension of the legs is demonstrating the presence of the primitive stepping reflex. It is present from birth to 8 weeks and simulates walking.
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    • Grasps object strongly when placed in palmAn infant who strongly grasps an object placed in the palm is demonstrating the presence of the primitive Palmar grasp reflex. It is present from birth to 2 months old and starts disappearing at 3 months old.
  • Correct
    • Moves head and opens mouth to external mouth stimulation when hungryAn infant who moves the head and opens mouth to external mouth stimulation when hungry is demonstrating the primitive rooting reflex. It is present from birth to 3 to 4 months old.
    • Turns eyes in direction of rotation and in opposite direction when rotation stopsAn infant who turns the eyes in the direction of rotation and in the opposite direction when rotation stops is not demonstrating the presence of primitive reflexes. This is the expected response when testing CNVIII using the Doll’s eye maneuver.

Question 14 of 21

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Which statement describes the gait of an older child as compared with the gait of a newly walking child?

    • Feet far apartA stance with the feet far apart does not describe the gait of an older child as compared with the gait of a newly walking child.
  • Correct
    • Feet close togetherA stance with the feet close together describes the gait of an older child as compared with the gait of a newly walking child.
    • Shuffling of feetA gait with shuffling of feet does not describe the gait of an older child as compared with the gait of a newly walking child. Shuffling is often seen in the gait of the older adult.
    • Shorter stepsA gait with shorter steps does not describe the gait of an older child as compared with the gait of a newly walking child. Shorter steps with less lifting of feet are often seen in the gait of the older adult.

Question 15 of 21

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Which cranial nerve senses may be diminished in the older adult?

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    • Sense of sightSense of sight is a cranial nerve sense that may be diminished in the older adult.
    • Sense of touchSense of touch is not a component of cranial nerve sensation; it is a component of peripheral and cortical sensory function.
  • Correct
    • Sense of smellSense of smell is a cranial nerve sense that may be diminished in the older adult.
  • Correct
    • Sense of hearingSense of hearing is a cranial nerve sense that may be diminished in the older adult.

Question 16 of 21

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Match the abnormal adult neurologic disorder with the abnormal finding.

  • Hyperactive deep tendon reflexes
  • Hypoactive deep tendon reflexes
  • Ptosis
  • Nuchal rigidity

Question 17 of 21

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The pregnant patient is in her third trimester and has been diagnosed with intrapartum maternal lumbosacral plexopathy as evidenced by which subjective symptom?

    • Unilateral foot dropUnilateral foot drop is not a symptom; it is a sign of intrapartum maternal lumbosacral plexopathy. Therefore, it is objective data.
    • Uterine crampingUterine cramping is a subjective symptom of pregnancy, but not a subjective symptom of intrapartum maternal lumbosacral plexopathy.
    • Abdominal gasAbdominal gas is not a subjective symptom of intrapartum maternal lumbosacral plexopathy. It is a subjective symptom of gastrointestinal discomfort.
  • Correct
    • Pain radiating from buttock to the legThe patient’s report of pain is subjective data because it is reported by the patient. Pain radiating from buttock to the leg is a subjective symptom of intrapartum maternal lumbosacral plexopathy.

Question 18 of 21

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Which objective data suggest a child has cerebral palsy?

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    • Cognitive impairmentsCognitive impairments are objective data suggestive of cerebral palsy.
    • Exposed meningeal sacAn exposed meningeal sac does not suggest cerebral palsy; it is objective data suggestive of spina bifida.
  • Correct
    • Persistent primitive reflexesPersistent primitive reflexes are objective data suggestive of cerebral palsy.
  • Correct
    • Exaggerated deep tendon reflexesExaggerated deep tendon reflexes are objective data suggestive of cerebral palsy.
    • Rapidly increasing head circumferenceA rapidly increasing head circumference does not suggest cerebral palsy; it is objective data suggestive of hydrocephalus.

Question 19 of 21

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The older adult is newly diagnosed with Parkinson disease and demonstrates which objective signs?

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    • TremorsTremors are an objective sign of Parkinson disease.
    • Numbness of legsNumbness is not an objective sign of Parkinson disease; it is a subjective symptom of Parkinson disease.
  • Correct
    • Muscular rigidityMuscular rigidity is an objective sign of Parkinson disease.
    • Muscle sorenessMuscle soreness is not an objective sign of Parkinson disease; it is a subjective symptom of Parkinson disease.
  • Correct
    • Short, shuffling stepsShort, shuffling steps are an objective sign of Parkinson disease.

Question 20 of 21

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The adult patient has had a stroke as evidenced by which objective signs?

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    • AphasiaAphasia is an objective sign of a stroke.
    • Numbness of left legNumbness of the left leg is not an objective sign of a stroke; it is a subjective symptom of a stroke.
  • Correct
    • Altered level of consciousnessAn altered level of consciousness is an objective sign of a stroke.
    • Trouble seeing in both eyesTrouble seeing in both eyes is not an objective sign of a stroke; it is a subjective symptom of a stroke.
  • Correct
    • Difficulty managing secretionsDifficulty managing secretions is an objective sign of a stroke.

Question 21 of 21

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Match the abnormal pediatric neurologic disorder with the abnormal finding.

  • Persistent primitive reflexes
  • Loss of bowel control
  • Retinal hemorrhages