NR 603 WEEK 1 TEST BANK 300
+ QUESTIONS CORRECT
ANSWERS WITH RATIONALES
LATEST UPDATE 2025/2026
ALREADY GRADED A+ .
,1. A 75-year-old man is involved in a motor vehicle accident and strikes his forehead on the windshield. He
complains of neck pain and severe burning in his shoulders and arms. His physical examination reveals
weakness of his upper extremities. What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome ANS ✓✓ correct
answer B ✓✓ correct answer Central Cord
Syndrome
the central cord syndrome involves loss of motor function that is more severe in the upper extremities than in the lower extremities, and is more severe in the hands. There is typically
hyperesthesia over the shoulders and arms. Anterior cord syndrome presents with paraplegia or quadriplegia, loss of lateral spinothalamic function with preservation of posterior
column function. Brown-Séquard syndrome consists of weakness and loss of posterior column function on one side of the body distal to the lesion with contralateral loss of
lateral spinothalamic function one to two levels below the lesion. Complete cord transection would attect motor and sensory function distal to the lesion. Cauda equina syndrome
typically presents as low back pain with radiculopathy.
2. A 37-year-old man fell from a ladder as he finished hanging the Christmas lights on his house. The right side of
his head hit the alley cement, and he lost consciousness for about 1 minute; he woke up with a headache, but he
had no other complaints. A few hours later, the patient is brought to the emergency room by his neighbor because
of an intense headache, confusion, and left hand hemiparesis. On examination, the patient has a bruise located over
the right temporal region, mydriasis, and right deviation of the right eye, papilledema, and left extensor plantar
response. An emergency CT scan of the head without contrast reveals a lens-shaped hyper-density under the right
temporal bone with mass effect and edema. What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
,2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis ANS ✓✓
correct answer 1 ✓✓ correct answer
Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the middle meningeal artery. Although a lucid interval ranging from minutes to hours followed by altered mental
status and focal deficits is typical for epidural hematoma, this clinical picture is only encountered in up to 1/3 of the patients. The collection of blood between the skull and dura
mater causes an evident mass ettect with ophthalmic nerve palsy and the contralateral hemiparesis. Surgical evacuation of the clot via burr holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging veins that connect the cerebrum to the venous sinuses within the dura. This venous hemorrhage will result in
gradual increase of the hematoma, with a progressive clinical picture over days or weeks. The CT scan will show a concave, crescent-shaped hyper-density compared to the conve
lens-shaped hyper-density in epidural hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most common is the congenital berry aneurysm. The clinical picture is of a sudden, severe headache with
meningeal irritation. A CT scan will show blood in the subarachnoid space, and a lumbar puncture will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by hypertension complicated with Charcot-Bouchard aneurysms. The blood accumulates into the brain substance an
most commonly involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal irritation dominate the clinical picture. Lumbar puncture, indicated if there are no focal neurological
signs on clinical examination, will be the diagnostic procedure. The CT scan of the patient presented in this case is characteristic for epidural hematoma, and there is no indication
a lumbar punctu
3. A 31-year-old woman presents with a purpural rash covering her arms, legs,
and abdomen. She also has fever, chills, nausea, abdominal tenderness, tachy- cardia, and generalized myalgias.
Prior to the development of the rash, the patient noted that she had a headache, cough, and sore throat. Laboratory
, studies were positive for Gram-negative diplococci in the blood, along with thrombocytopenia and an elevation in
PMNs. Urinalysis showed blood, protein, and casts. Vital signs are as follows ✓✓ correct answer PB 92/66, P 96,
RR 14, T 39. The patient denies any foreign travel and does not have any sick contacts. However, she does work part
time as a nurse in a local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to the hospital and placed in respiratory isolation.
What major course of therapy should this patient receive?
Answer Choices
1 Steroids
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici ✓✓ correct answer Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The preferred drug for active infection is penicillin G. For those allergic to penicillin, chloramphenicol and
cephalosporins (ie, cefotaxime, cefuroxime) may be used as alternatives.
Patients will also receive supportive care, but antibiotic therapy must be initiated quickly if the patient is to survive. Intensive care placement may be necessary if organ failure is
imminent. Ventilatory support, inotropic support, and IV fluids are necessary in some. If adrenal insuflciency occurs, corticosteroid replacement may be considered. A
central venous line helps to provide large amounts of volume expanders and inotropic medications for adequate tissue perfusion.
Steroids have not been shown to play a major role in the treatment of meningococcemia. However, they have been used in addition to antibiotic therapy. In the case of adrena
insuflciency, for example, steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the patient sutters from a devastating coagulopathy,
+ QUESTIONS CORRECT
ANSWERS WITH RATIONALES
LATEST UPDATE 2025/2026
ALREADY GRADED A+ .
,1. A 75-year-old man is involved in a motor vehicle accident and strikes his forehead on the windshield. He
complains of neck pain and severe burning in his shoulders and arms. His physical examination reveals
weakness of his upper extremities. What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome ANS ✓✓ correct
answer B ✓✓ correct answer Central Cord
Syndrome
the central cord syndrome involves loss of motor function that is more severe in the upper extremities than in the lower extremities, and is more severe in the hands. There is typically
hyperesthesia over the shoulders and arms. Anterior cord syndrome presents with paraplegia or quadriplegia, loss of lateral spinothalamic function with preservation of posterior
column function. Brown-Séquard syndrome consists of weakness and loss of posterior column function on one side of the body distal to the lesion with contralateral loss of
lateral spinothalamic function one to two levels below the lesion. Complete cord transection would attect motor and sensory function distal to the lesion. Cauda equina syndrome
typically presents as low back pain with radiculopathy.
2. A 37-year-old man fell from a ladder as he finished hanging the Christmas lights on his house. The right side of
his head hit the alley cement, and he lost consciousness for about 1 minute; he woke up with a headache, but he
had no other complaints. A few hours later, the patient is brought to the emergency room by his neighbor because
of an intense headache, confusion, and left hand hemiparesis. On examination, the patient has a bruise located over
the right temporal region, mydriasis, and right deviation of the right eye, papilledema, and left extensor plantar
response. An emergency CT scan of the head without contrast reveals a lens-shaped hyper-density under the right
temporal bone with mass effect and edema. What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
,2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis ANS ✓✓
correct answer 1 ✓✓ correct answer
Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the middle meningeal artery. Although a lucid interval ranging from minutes to hours followed by altered mental
status and focal deficits is typical for epidural hematoma, this clinical picture is only encountered in up to 1/3 of the patients. The collection of blood between the skull and dura
mater causes an evident mass ettect with ophthalmic nerve palsy and the contralateral hemiparesis. Surgical evacuation of the clot via burr holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging veins that connect the cerebrum to the venous sinuses within the dura. This venous hemorrhage will result in
gradual increase of the hematoma, with a progressive clinical picture over days or weeks. The CT scan will show a concave, crescent-shaped hyper-density compared to the conve
lens-shaped hyper-density in epidural hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most common is the congenital berry aneurysm. The clinical picture is of a sudden, severe headache with
meningeal irritation. A CT scan will show blood in the subarachnoid space, and a lumbar puncture will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by hypertension complicated with Charcot-Bouchard aneurysms. The blood accumulates into the brain substance an
most commonly involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal irritation dominate the clinical picture. Lumbar puncture, indicated if there are no focal neurological
signs on clinical examination, will be the diagnostic procedure. The CT scan of the patient presented in this case is characteristic for epidural hematoma, and there is no indication
a lumbar punctu
3. A 31-year-old woman presents with a purpural rash covering her arms, legs,
and abdomen. She also has fever, chills, nausea, abdominal tenderness, tachy- cardia, and generalized myalgias.
Prior to the development of the rash, the patient noted that she had a headache, cough, and sore throat. Laboratory
, studies were positive for Gram-negative diplococci in the blood, along with thrombocytopenia and an elevation in
PMNs. Urinalysis showed blood, protein, and casts. Vital signs are as follows ✓✓ correct answer PB 92/66, P 96,
RR 14, T 39. The patient denies any foreign travel and does not have any sick contacts. However, she does work part
time as a nurse in a local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to the hospital and placed in respiratory isolation.
What major course of therapy should this patient receive?
Answer Choices
1 Steroids
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici ✓✓ correct answer Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The preferred drug for active infection is penicillin G. For those allergic to penicillin, chloramphenicol and
cephalosporins (ie, cefotaxime, cefuroxime) may be used as alternatives.
Patients will also receive supportive care, but antibiotic therapy must be initiated quickly if the patient is to survive. Intensive care placement may be necessary if organ failure is
imminent. Ventilatory support, inotropic support, and IV fluids are necessary in some. If adrenal insuflciency occurs, corticosteroid replacement may be considered. A
central venous line helps to provide large amounts of volume expanders and inotropic medications for adequate tissue perfusion.
Steroids have not been shown to play a major role in the treatment of meningococcemia. However, they have been used in addition to antibiotic therapy. In the case of adrena
insuflciency, for example, steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the patient sutters from a devastating coagulopathy,
