Any of the following cranial nerves has the parasympathetic nucleus EXCEPT:
- A. vagal
- B. oculomotor
- C. glossopharyngeal
- D. olfactory
Correct Answer: D
Rationale: Olfactory nerve is the correct answer because it is a sensory nerve responsible for the sense of smell and does not have a parasympathetic nucleus. In contrast, the vagus, oculomotor, and glossopharyngeal nerves all have parasympathetic components that regulate functions such as heart rate, pupil constriction, and salivation.
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A nurse assesses a patient diagnosed with functional neurological (conversion) disorder. Which comment is most likely from this patient?
- A. Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion.
- B. I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry and I think I'm getting seriously dehydrated.
- C. Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage.
- D. I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus.
Correct Answer: A
Rationale: Step-by-step rationale:
1. The correct answer is A because the patient's symptoms (shortness of breath and left arm pains) do not have a clear medical explanation, indicating a functional neurological disorder.
2. The patient attributing symptoms to indigestion suggests a psychological rather than physical origin.
3. Choices B, C, and D describe physical symptoms with potential organic causes, not typically associated with conversion disorder.
4. B is more indicative of gastrointestinal issues, C of sexual dysfunction, and D of possible esophageal pathology, making them less likely in a conversion disorder context.
While Susan's medication is being adjusted, which of the following aspects of nursing assessment would be most important to document?
- A. Muscular strength following medication administration
- B. Elimination patterns
- C. Emotional response to her diagnosis
- D. State of consciousness
Correct Answer: A
Rationale: Muscle strength is directly affected by myasthenia gravis and its treatment.
The presence of ataxia suggests damage to any of the following EXCEPT:
- A. cerebellar
- B. thalamus
- C. vestibular nucleus
- D. vagal nerve
Correct Answer: D
Rationale: Vagal nerve is the correct answer because ataxia, which is a lack of coordination, is typically associated with damage to the cerebellum, thalamus, or vestibular system. The vagal nerve, however, is primarily involved in autonomic functions and does not play a direct role in motor coordination.
A 35 year-old reporter presents to your office for evaluation of back pain and weakness in his left leg. He was play-wrestling with his nephew and hurt his back 2 weeks ago. He states that he has noticed tingling in his left leg as well. He has not noticed incontinence of bowel or bladder function. You perform a physical examination and confirm that he is dragging his left foot when he walks and that his Achilles reflex is diminished. The diagnosis is a herniated disc. Which nerve root are you testing with the Achilles reflex?
- A. C5, C6
- B. L2, L3, L4
- C. S1, S2
- D. L4, L5
Correct Answer: C
Rationale: The Achilles reflex tests the S1 and S2 nerve roots. A diminished Achilles reflex may indicate a herniated disc compressing these nerve roots. C5, C6, L2, L3, L4, and L4, L5 are tested by other reflexes, such as the biceps, patellar, and brachioradialis reflexes.
Which of the following is not a typical clinical manifestation of multiple sclerosis (MS)?
- A. Double vision
- B. Sudden bursts of energy
- C. Weakness in the extremities
- D. Muscle tremors
Correct Answer: B
Rationale: Sudden bursts of energy are not associated with MS. Fatigue, weakness, and muscle tremors are common symptoms.