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KL is a 34-year-old male admitted to the hospital (large trauma center) after suffering a traumatic brain injury (TBI) secondary to a serious motor vehicle accident. He was in excellent health prior to the accident. HT: 6'2" WT: 190 pounds (86 kg) What is likely the best way to feed KL while he is in the hospital?
- A. nasogastric tube
- B. nasoenteric tube
- C. parenteral nutrients
- D. baby food orally
Correct Answer: B
Rationale: A nasoenteric tube is often the preferred method for feeding patients with traumatic brain injury (TBI) who cannot safely swallow. It allows for enteral nutrition delivery directly into the small intestine, reducing the risk of aspiration compared to a nasogastric tube.
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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.
The ophthalmic division of the trigeminal nerve
- A. Enters the face via the inferior orbital fissure
- B. Supplies sympathetic fibres to constrictor papillae muscles
- C. Supplies sensation to the forehead and upper eyelid, excluding the orbit
- D. Gives five branches, two of which contain sympathetic as well as sensory fibres
Correct Answer: D
Rationale: The ophthalmic division (V1) of the trigeminal nerve gives five branches, including the lacrimal and frontal nerves, which supply sensation to the forehead and upper eyelid. It does not control eye movement.
Certain metabolic diseases can affect the nervous system. For instance, people with diabetes can develop a nervous system problem called diabetic neuropathy. What are the symptoms of diabetic neuropathy?
- A. Constipation or diarrhea
- B. Rapid heart beat
- C. Pain in feet
- D. All of the above
Correct Answer: D
Rationale: Diabetic neuropathy can cause a wide range of symptoms, including gastrointestinal issues like constipation or diarrhea, cardiovascular symptoms like rapid heart rate, and sensory symptoms like pain in the feet. This condition results from nerve damage due to high blood sugar levels. Recognizing these symptoms is essential for managing diabetes-related complications.
When performing a neurologic assessment, the nurse should prioritize:
- A. Observing for any sudden changes in mental status or physical function.
- B. Measuring the patient's body temperature.
- C. Checking the patient's blood pressure.
- D. Assessing the patient's respiratory rate.
Correct Answer: A
Rationale: Sudden changes in mental status or physical function are critical in neurologic assessments. Temperature, blood pressure, and respiratory rate are secondary considerations.
The production of incoherent, jumbled speech is known as
- A. Nonfluent aphasia
- B. Disruptive aphasia
- C. Fluent aphasia
- D. Anomic aphasia
Correct Answer: C
Rationale: Fluent aphasia, also known as Wernicke's aphasia, is characterized by the production of speech that is grammatically correct but often nonsensical or incoherent. Individuals with this condition may speak in long, complex sentences that lack meaning or include made-up words. This occurs due to damage in Wernicke's area, a region in the brain responsible for language comprehension and the formation of meaningful speech.