Nokea
In evolutionary terms, which is the oldest part of the brain?
- A. the limbic system
- B. the cortex
- C. the right hemisphere
- D. the brain stem
Correct Answer: D
Rationale: The brainstem is the oldest part of the brain in evolutionary terms, as it is responsible for basic life-sustaining functions such as breathing, heart rate, and blood pressure. It includes structures like the medulla oblongata, pons, and midbrain. The brainstem has been conserved throughout evolution and is present in all vertebrates, making it a fundamental component of the central nervous system. In contrast, the cortex and limbic system evolved later and are more developed in higher mammals.
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When the patient has a rapidly growing brain tumor, what slows expansion of cerebral brain tissue into the adjacent hemisphere?
- A. Ventricles
- B. Falx cerebri
- C. Arachnoid layer
- D. Tentorium cerebella
Correct Answer: B
Rationale: The falx cerebri limits the expansion of brain tissue into adjacent hemispheres.
When obtaining information about the patient's use of medications, the nurse recognizes that both bone and muscle function may be impaired when the patient reports taking what type of drug?
- A. Corticosteroids
- B. Oral hypoglycemic agents
- C. Potassium-depleting diuretics
- D. Nonsteroidal antiinflammatory drugs (NSAIDs)
Correct Answer: A
Rationale: Corticosteroids weaken bones and muscles.
The nurse is assisting as a neurosurgeon examines a patient who has a positive Babinski reflex. What assessment finding should the nurse expect to observe?
- A. The leg flexes when the patellar tendon is struck.
- B. The leg extends when the patellar tendon is struck.
- C. The big toe extends when the sole of the foot is stroked.
- D. Toes curl downward when the sole of the foot is stroked.
Correct Answer: C
Rationale: A positive Babinski reflex, indicative of neurological dysfunction, involves extension of the big toe and fanning of the other toes when the sole of the foot is stroked. Flexion or extension of the leg is associated with other reflexes. Recognizing a positive Babinski reflex is important for assessing upper motor neuron lesions.
A 38-year-old female presents with muscle fatigue that is worse by the end of the day. She reports to have myalgias in the back of her neck, and at times her head "drops." She also states to sees "double" when watching television, or reading for a prolonged period of time. On physical examination, ptosis is produced when asking the patient to look at the ceiling without blinking. Pupillary function is intact. Appropriate serologic testing is obtained. On repetitive nerve stimulation, the amplitude of the compound muscle action potential progressively declines. Which of the following is most likely the diagnosis?
- A. Botulism
- B. Lambert-Eaton myasthenic syndrome
- C. Acute inflammatory demyelinating polyradiculopathy
- D. Myasthenia gravis
Correct Answer: D
Rationale: The patient's symptoms of fatigable weakness, ptosis, and diplopia, along with the decremental response on repetitive nerve stimulation, are classic for myasthenia gravis. This autoimmune disorder is caused by antibodies against acetylcholine receptors at the neuromuscular junction, leading to impaired muscle contraction. Botulism and Lambert-Eaton syndrome also cause weakness but have different clinical and electrophysiological features. Multiple sclerosis and acute inflammatory demyelinating polyradiculopathy do not typically present with fatigable weakness.
Which of the following would indicate side effects of the gold therapy?
- A. Symptoms of gastric irritation
- B. Generalized edema
- C. Elevated blood pressure
- D. Symptoms of visual disturbance
Correct Answer: A
Rationale: Gastric irritation is a common side effect of gold therapy.