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Understanding Pathophysiology 6th Edition Huether Test Bank

Chapter 15: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function Huether & McCance: Understanding Pathophysiology, 6th Edition MULTIPLE CHOICE 1. A neurologist explains that arousal is mediated by the: a. cerebral cortex. b. medulla oblongata. c. reticular activating system. d. cingulate gyrus. ANS: C

Arousal is mediated by the reticular activating system, which regulates aspects of attention and information processing and maintains consciousness. The cerebral cortex affects movement. The medulla oblongata controls things such as hiccups and vomiting. The cingulate gyrus plays other roles in response. REF: p. 359 2. A 20-year-old experiences a severe closed head injury as a result of a motor vehicle accident.

Which of the following structures is most likely keeping the patient in a vegetative state (VS) 1 month after the accident? a. Cerebral cortex b. Brainstem c. Spinal cord d. Cerebellum ANS: B

When a person loses cerebral function, the reticular activating system and brainstem can maintain a crude waking state known as a VS. Cognitive cerebral functions, however, cannot occur without a functioning reticular activating system. A VS is not associated with the cerebral cortex, spinal cord, or cerebellum. REF: p. 364 3. A 16-year-old’s level of arousal was altered after taking a recreational drug. Physical exam

revealed a negative Babinski sign, equal and reactive pupils, and roving eye movements. Which of the following diagnoses will the nurse most likely see on the chart? a. Psychogenic arousal alteration b. Metabolically induced coma c. Structurally induced coma d. Structural arousal alteration ANS: B

Persons with metabolically induced coma generally retain ocular reflexes even when other signs of brainstem damage are present. Psychogenic arousal activation demonstrates a general psychiatric disorder. Structurally induced coma is manifested by asymmetric responses. Structural arousal alteration does not have drug use as its etiology.

Understanding Pathophysiology 6th Edition Huether Test Bank REF: p. 360, Table 15-2 4. The breathing pattern that reflects respirations based primarily on carbon dioxide (CO2) levels

in the blood is: a. Cheyne-Stokes. b. ataxic. c. central neurogenic. d. normal. ANS: A

Cheyne-Stokes respirations occur as a result of CO2 levels in the blood. Ataxic breathing occurs as a result of dysfunction of the medullary neurons. Central neurogenic patterns occur as a result of uncal herniation. Normal respirations are based on the levels of oxygen (O2) in the blood. REF: p. 361 5. A teenager sustains a severe closed head injury following an all-terrain vehicle (ATV)

accident and is in a state of deep sleep that requires vigorous stimulation to elicit eye opening. How should the nurse document this in the chart? a. Confusion b. Coma c. Obtundation d. Stupor ANS: D

Stupor is a condition of deep sleep or unresponsiveness from which a person may be aroused or caused to open his or her eyes only by vigorous and repeated stimulation. Confusion is the loss of the ability to think rapidly and clearly and is characterized by impaired judgment and decision making. Coma is a condition in which there is no verbal response to the external environment or to any stimuli; noxious stimuli such as deep pain or suctioning do not yield motor movement. Obtundation is a mild-to-moderate reduction in arousal (awakeness) with limited response to the environment. REF: p. 361, Table 15-3 6. A patient experiences a severe head injury hitting a tree while riding a motorcycle. Breathing

becomes deep and rapid but with normal pattern. What term should the nurse use for this condition? a. Gasping b. Ataxic breathing c. Apneusis d. Central neurogenic hyperventilation ANS: D

Central neurogenic hyperventilation is a sustained, deep, rapid, but regular, pattern (hyperpnea) of breathing. Gasping is a pattern of deep “all-or-none” breaths accompanied by a slow respiratory rate. Ataxic breathing is completely irregular breathing that occurs with random shallow and deep breaths and irregular pauses. Apneusis is manifested by a prolonged inspiratory pause alternating with an end-expiratory pause.

Understanding Pathophysiology 6th Edition Huether Test Bank REF: p. 362, Table 15-4 7. A patient presents to the emergency room (ER) reporting excessive vomiting. A CT scan of

the brain reveals a mass in the: a. skull fractures. b. thalamus. c. medulla oblongata. d. frontal lobe. ANS: C

Vomiting is due to disruptions in the medulla oblongata. Skull fractures can result in vomiting but would not be related to the mass. The thalamus controls other things such as temperature. The frontal lobe deals with emotions. REF: p. 363 8. For legal purposes, brain death is defined as: a. cessation of entire brain function. b. lack of cortical function. c. a consistent vegetative state (VS). d. death of the brainstem. ANS: A

Brain death occurs when there is cessation of function of the entire brain, including the brainstem and cerebellum. Lack of cortical function or brainstem death is not enough to define brain death. A VS is complete unawareness of the self or surrounding environment and complete loss of cognitive function. REF: p. 364 9. When thought content and arousal level are intact but a patient cannot communicate and is

immobile, the patient is experiencing: a. cerebral death. b. locked-in syndrome. c. dysphagia. d. cerebellar motor syndrome. ANS: B

Locked-in syndrome occurs when the individual cannot communicate through speech or body movement but is fully conscious, with intact cognitive function. In cerebral death, the person is in a coma with eyes closed. Dysphagia is difficulty speaking. Cerebellar motor syndrome is characterized by problems with coordinated movement. REF: p. 365 10. What term is used to describe an explosive, disorderly discharge of cortical neurons? a. Reflex b. Seizure c. Inattentiveness d. Brain death ANS: B

Understanding Pathophysiology 6th Edition Huether Test Bank An explosive, disorderly discharge of cortical neurons is a seizure. A reflex is an expected response. Inattentiveness is a form of neglect. Brain death is a cessation of function. REF: p. 372 11. A patient has memory loss of events that occurred before a head injury. What cognitive

disorder does the nurse suspect the patient is experiencing? a. Selective memory deficit b. Anterograde amnesia c. Retrograde amnesia d. Executive memory deficit ANS: C

Retrograde amnesia is manifested by loss of past personal history memories or past factual memories. In selective memory deficit, the person reports inability to focus attention and has failure to perceive objects and other stimuli. Anterograde amnesia is a loss of the ability to form new memories. Executive memory deficit involves the failure to stay alert and oriented to stimuli. REF: p. 365 12. A 65-year-old patient who recently suffered a cerebral vascular accident is now unable to

recognize and identify objects by touch because of injury to the sensory cortex. How should the nurse document this finding? a. Hypomimesis b. Agnosia c. Dysphasia d. Echolalia ANS: B

Agnosia is the failure to recognize the form and nature of objects. Hypomimesis is a disorder of communication. Dysphasia is an impairment of comprehension of language. Echolalia is the ability to repeat. REF: p. 367 13. A patient experiences a stroke and now has difficulty writing and producing language. This

condition is most likely caused by occlusion of the: a. anterior communicating artery. b. posterior communicating artery. c. circle of Willis. d. middle cerebral artery. ANS: D

Occlusion of the left middle cerebral artery leads to the inability to find words and difficulty with writing. The inability to find words and difficulty with writing are not associated with occlusions of the anterior or posterior communicating arteries or the circle of Willis. REF: p. 367

Understanding Pathophysiology 6th Edition Huether Test Bank 14. A patient with an addiction to alcohol checked into a rehabilitation center as a result of

experiencing delirium, inability to concentrate, and being easily distracted. What term would be used to document this state? a. Acute confusional state b. Echolalia c. Dementia d. Dysphagia ANS: A

Delirium and the inability to concentrate are characteristics of acute confusional state. Echolalia is the repeating of words and phrases. Dementia is characterized by loss of recent and remote memory. Dysphagia is difficulty speaking. REF: p. 367, Box 15-3 15. The patient is experiencing an increase in intracranial pressure. This increase results in: a. brain tissue hypoxia. b. intracranial hypotension. c. ventricular swelling. d. expansion of the cranial vault. ANS: A

Brain tissue hypoxia occurs as a result of increased intracranial pressure as it places pressure on the brain. Increased intracranial pressure leads to intracranial hypertension. Ventricular swelling may lead to increased intracranial pressure, but increased pressure does not lead to either ventricular swelling or the expansion of the cranial vault. REF: p. 374 16. A compensatory alteration in the diameter of cerebral blood vessels in response to increased

intracranial pressure is called: herniation. vasodilation. autoregulation. amyotrophy.

a. b. c. d.

ANS: C

Autoregulation is the compensatory alteration in the diameter of the intracranial blood vessels designed to maintain a constant blood flow during changes in cerebral perfusion pressure. Herniation is the downward protrusion of the brainstem. Vasodilation is an enlargement in vessel diameter and a part of autoregulation, but the vessels should not dilate in the presence of increased intracranial pressure. Amyotrophy is involved with the anterior horn cells of the spinal cord and not related to autoregulation. REF: p. 374 17. A patient is admitted to the neurological critical care unit with a severe closed head injury.

When an intraventricular catheter is inserted, the intracranial pressure (ICP) is recorded at 24 mm Hg. How should the nurse interpret this reading? a. Higher than normal b. Lower than normal

Understanding Pathophysiology 6th Edition Huether Test Bank c. Normal d. Borderline ANS: A

Normal ICP is 1-15 mm Hg; at 24 mm Hg, the patient’s ICP is higher than normal. REF: p. 374, Box, 15-4 18. A 70-year-old patient is being closely monitored in the neurological critical care unit for a

severe closed head injury. After 48 hours, signs of deterioration occur: pupils are small and sluggish, pulse pressure is widening, and heart rate is bradycardic. These clinical findings are evidence of what stage of intracranial hypertension? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 ANS: C

Stage 3 is characterized by decreasing levels of arousal or central neurogenic hyperventilation, widened pulse pressure, bradycardia, and pupils that become small and sluggish. Stage 1 is characterized by an ICP that may not change because of the effective compensatory mechanisms, and there may be few symptoms. Stage 2 is characterized by subtle and transient symptoms, including episodes of confusion, restlessness, drowsiness, and slight pupillary and breathing changes. Stage 4 is characterized by cessation of cerebral blood flow. REF: p. 374 19. The primary care provider states that the patient is experiencing vasogenic edema. The nurse

realizes vasogenic edema is clinically important because: it usually has an infectious cause. the blood-brain barrier is disrupted. ICP is excessively high. it always causes herniation.

a. b. c. d.

ANS: B

Vasogenic edema is clinically important because the blood-brain barrier (selective permeability of brain capillaries) is disrupted, and plasma proteins leak into the extracellular spaces. Vasogenic edema does not have an infectious cause. ICP is increased, but not more so than other forms of edema. Vasogenic edema does not always cause herniation. REF: p. 375 20. The progress notes read: the cerebellar tonsil has shifted through the foramen magnum due to

increased pressure within the posterior fossa. The nurse would identify this note as a description of _____ herniation. a. supratentorial b. central c. cingulated gyrus d. infratentorial ANS: D

Understanding Pathophysiology 6th Edition Huether Test Bank In infratentorial herniation, the cerebellar tonsil shifts through the foramen magnum because of increased pressure within the posterior fossa. Supratentorial herniation involves temporal lobe and hippocampal gyrus shifting from the middle fossa to posterior fossa. Central herniation is a type of supratentorial herniation and is the straight downward shift of the diencephalon through the tentorial notch. Gyrus herniation occurs when the cingulate gyrus shifts under the falx cerebri. Little is known about its clinical manifestations. REF: p. 375, Box 15-5 21. An infant is diagnosed with noncommunicating hydrocephalus. What is an immediate priority

concern for this patient? a. Metabolic edema b. Interstitial edema c. Vasogenic edema d. Ischemic edema ANS: B

An immediate concern for the infant with noncommunicating hydrocephalus is interstitial edema. Neither metabolic, vasogenic, nor ischemic edema is observed as a result of noncommunicating hydrocephalus. REF: p. 376 22. An adult is diagnosed with communicating hydrocephalus. The form of hydrocephalus in

adults is most often caused by: a. overproduction of CSF. b. intercellular edema. c. elevated arterial blood pressure. d. defective CSF reabsorption. ANS: D

Communicating hydrocephalus occurs because of defective reabsorption of the fluid. Hydrocephalus can occur because of overproduction of CSF, but in adults it occurs most often because of defective reabsorption of the fluid. Hydrocephalus is not due to either intercellular edema or elevated arterial blood pressure. REF: p. 376 23. A 16-year-old male fell off the bed of a pickup truck and hit his forehead on the road. He now

has resistance to passive movement that varies proportionally with the force applied. He is most likely suffering from: a. spasticity. b. paratonia. c. rigidity. d. dystonia. ANS: B

Understanding Pathophysiology 6th Edition Huether Test Bank Paratonia is manifested by resistance to passive movement that varies in direct proportion to force applied. Spasticity is manifested by a gradual increase in tone causing increased resistance until tone suddenly reduces. Rigidity is manifested by muscle resistance to passive movement of a rigid limb that is uniform in both flexion and extension throughout the motion. Dystonia is manifested by sustained involuntary twisting movement. REF: p. 377, Table 15-16 24. A patient reports tiring easily, having difficulty rising from a sitting position, and the inability

to stand on toes. The nurse would expect a diagnosis of: a. Parkinson disease. b. hypotonia. c. Huntington disease. d. paresis. ANS: B

Individuals with hypotonia tire easily (asthenia) or are weak. They may have difficulty rising from a sitting position, sitting down without using arm support, and walking up and down stairs, as well as an inability to stand on their toes. Individuals with Parkinson disease have rigidity and stiffness. Symptoms of Huntington disease include irregular, uncontrolled, and excessive movement. Paresis, or weakness, is partial paralysis with incomplete loss of muscle power. REF: pp. 376-377 25. A patient has paralysis of both legs. What type of paralysis does the patient have? a. Paraplegia b. Quadriplegia c. Infraparaplegia d. Paresthesia ANS: A

Paraplegia is the paralysis of both legs. Quadriplegia is the paralysis of all four extremities. Infraparaplegia is not a description of paralysis. Paresthesia is a loss of sensation, not paralysis. REF: p. 382, Box 15-6 26. Spinal shock is characterized by: a. loss of voluntary motor function with preservation of reflexes. b. cessation of spinal cord function below the lesion. c. loss of spinal cord function at the level of the lesion only. d. temporary loss of spinal cord function above the lesion. ANS: B

Spinal shock is the complete cessation of spinal cord function below the lesion. The reflexes are not preserved in spinal shock. Spinal shock is the complete cessation of spinal cord function below the lesion, not at the lesion only. REF: p. 382 27. A patient has excessive movement. What disorder will the nurse see documented on the chart?

Understanding Pathophysiology 6th Edition Huether Test Bank a. b. c. d.

Hypokinesia Akinesia Hyperkinesia Dyskinesia

ANS: C

Excessive movement is the definition of hyperkinesia. Hypokinesia is decreased movement. Akinesia is loss of movement. Dyskinesia is abnormal movement. REF: p. 378 28. A 40-year-old male complains of uncontrolled excessive movement and progressive

dysfunction of intellectual and thought processes. He is experiencing movement problems that begin in the face and arms and eventually affect the entire body. The most likely diagnosis is: a. tardive dyskinesia. b. Huntington disease. c. hypokinesia. d. Alzheimer disease. ANS: B

Huntington disease is manifested by chorea, abnormal movement that begins in the face and arms and eventually affects the entire body. There is progressive dysfunction of intellectual and thought processes. Tardive dyskinesia is manifested by rapid, repetitive, and stereotypic movements. Most characteristic is continual chewing with intermittent protrusions of the tongue, lip smacking, and facial grimacing. Hypokinesia is a loss of voluntary movement despite preserved consciousness and normal peripheral nerve and muscle function. Alzheimer disease is manifested by cognitive deficits and not movement problems; motor impairments will occur in the later stages. REF: p. 378 | p. 380 29. A nurse notes that a patient walks with the leg extended and held stiff, causing a scraping over

the floor surface. What type of gait is the patient experiencing? Spastic gait Cerebellar gait Basal ganglion gait Scissors gait

a. b. c. d.

ANS: A

An individual who walks with the leg extended and held stiff, causing a scraping over the floor surface, is experiencing a spastic gait. A cerebellar gait is wide based with the feet apart and often turned outward or inward for greater stability. A basal ganglion gait occurs when the person walks with small steps and a decreased arm swing. A scissors gait is associated with bilateral injury and spasticity. The legs are abducted so they touch each other. REF: p. 385 30. A patient is admitted to the neurological critical care unit with a severe closed head injury. All

four extremities are in rigid extension, the forearms are hyperpronated, and the legs are in plantar extension. How should the nurse chart this condition? a. Decorticate posturing

Understanding Pathophysiology 6th Edition Huether Test Bank b. Decerebrate posturing c. Dystonic posturing d. Basal ganglion posturing ANS: B

The description is of a patient in decerebrate posturing. The description provided is not associated with decorticate, dystonic, or basal ganglion posturing. REF: p. 385 MULTIPLE RESPONSE 1. A nurse recalls that neural systems basic to cognitive functions include _____ systems. (select

all that apply) attentional memory and language affective sensory and motor tactile

a. b. c. d. e.

ANS: A, B, C

The neural systems that are essential to cognitive function are: (i) attentional systems that provide arousal and maintenance of attention over time; (ii) memory and language systems by which information is communicated; an...