The nurse is performing a neurologic assessment on a 41-year-old ...

[nummyann]

The nurse is performing a neurologic assessment on a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork, the nurse notices that the patient is unable to feel vibrations on the great toe or ankle
 
  bilaterally, but she is able to feel vibrations on both patellae. Given this information, what would the nurse suspect?
  a.
  Hyperalgesia
  b.
  Hyperesthesia
  c.
  Peripheral neuropathy
  d.
  Lesion of sensory cortex

Question 2

The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception, the nurse decides to complete the test as quickly as possible. When the nurse applies the sharp point of the pin on his arm several times,
 
  he is only able to identify these as one very sharp prick. What would be the most accurate explanation for this?
  a.
  The patient has hyperesthesia as a result of the aging process.
  b.
  This response is most likely the result of the summation effect.
  c.
  The nurse was probably not poking hard enough with the pin in the other areas.
  d.
  The patient most likely has analgesia in some areas of arm and hyperalgesia in others.

[Anton]

Answer to Question 1

ANS: C
Loss of vibration sense occurs with peripheral neuropathy (e.g., diabetes and alcoholism). Peripheral neuropathy is worse at the feet and gradually improves as the examiner moves up the leg, as opposed to a specific nerve lesion, which has a clear zone of deficit for its dermatome. The other responses are incorrect.

Answer to Question 2

ANS: B
At least 2 seconds should be allowed to elapse between each stimulus to avoid summation. With summation, frequent consecutive stimuli are perceived as one strong stimulus. The other responses are incorrect.

[nummyann]

TYSM

[LVPMS]

Excellent