Chapter 14: Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 14: Alterations in Cognitive Systems, Cerebral Hemodynamics and Motor Function

Test Bank

MULTIPLE CHOICE

1. A neurologists 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.

Arousal is mediated by the reticular activating system; the cerebral cortex affects movement.

Arousal is mediated by the reticular activating system; the medulla oblongata controls things such as hiccups and vomiting.

Arousal is mediated by the reticular activating system; the cingulate gyrus plays other roles in response.

REF: p. 347

2. A 20-year-old male suffers a severe closed head injury in a motor vehicle accident. He remains in a vegetative state (VS) 1 month after the accident. Which of the following structures is most likely keeping him in a vegetative state?

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 associated with the brainstem, not the cerebral cortex.

A VS is associated with the brainstem, not the spinal cord.

A VS is associated with the brainstem, not the cerebellum.

REF: p. 347

3. A 16-year-old male took a recreational drug that altered his level of arousal. Physical exam revealed a negative Babinski sign, equal and reactive pupils, and roving eye movements. Which of the following diagnosis 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.

REF: p. 348

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. 349

5. A 45-year-old female 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.

Vomiting is due to disruptions in the medulla oblongata. Skull fractures can result in vomiting, but would not be related to the mass.

Vomiting is due to disruptions in the medulla oblongata, not the thalamus, which controls other things such as temperature.

Vomiting is due to disruption in the medulla oblongata, not the frontal lobe. The frontal lobe deals with emotions.

REF: p. 351

6. A teenage boy sustains a severe closed head injury following an all-terrain vehicle (ATV) accident. He 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 the person may be aroused or caused to open 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. 349

7. A 50-year-old male suffers a severe head injury when his motorcycle hits a tree. His 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.

REF: p. 350

8. When a student asks what can cause dilated, fixed pupils, what is the nurses best response? Dilated fixed pupils can be caused by:

a.

Brainstem hypoxia

b.

Cerebral contusions

c.

Compression of the hypothalamus

d.

Spinal shock

ANS: A

Dilated fixed pupils are caused by brainstem hypoxia.

Dilated fixed pupils are caused by brainstem hypoxia, not cerebral contusions.

Dilated fixed pupils are caused by brainstem hypoxia, not compression of the hypothalamus.

Dilated fixed pupils are caused by brainstem hypoxia, not spinal shock.

REF: p. 362

9. An attorney spoke to the nurses regarding brain death. Which statement indicates the nurses understood brain death? For legal purposes, brain death is defined as:

a.

Cessation of brain function

b.

Lack of cortical function

c.

A 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.

Brain death occurs when there is cessation of function of the entire brain; lack of cortical function is not enough to define brain death.

A VS is complete unawareness of the self or surrounding environment and complete loss of cognitive function.

Brain death occurs when there is cessation of function of the entire brain, including the brainstem and cerebellum, not just the brainstem.

REF: p. 352

10. When thought content and arousal level are intact but a patient cannot communicate, the patient has:

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.

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. 353

11. A 10-year-old female was brought to the ER following a sudden onset of convulsions. The primary care provider thinks that she experienced an explosive, disorderly discharge of cerebral neurons referred to as:

a.

Reflex

b.

Seizure

c.

Inattentiveness

d.

Brain death

ANS: B

An explosive disorderly discharge of 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. 354

12. A 30-year-old female had a seizure that started with her fingers and progressive1y spread up her arm and then extended to her leg, with no loss of consciousness. How should the nurse chart this?

a.

Myoclonic seizure

b.

Tonic-clonic seizure

c.

Focal motor seizure

d.

Atonic seizure

ANS: C

A focal motor seizure involves the extremities and the patient does not experience loss of consciousness.

A myoclonic seizure involves symmetrical movements of selected extremities.

A tonic-clonic seizure involves all body parts and loss of consciousness.

An atonic seizure is without muscle tone.

REF: p. 356

13. A 20-year-old male was at the supermarket when he fell to the ground. Bystanders reported that he lost consciousness and his body tensed up then relaxed, then tensed and relaxed several times. He most likely was experiencing a(n):

a.

Partial seizure

b.

Absence seizure

c.

Myoclonic seizure

d.

Tonic-clonic seizure

ANS: D

A tonic-clonic seizure involves repeated contraction and relaxation.

A partial seizure involves only one body part.

An absence seizure is without movement.

A myoclonic seizure is a simple seizure with minimal jerking present.

REF: p. 356

14. When a patient has a peculiar sensation that immediately precedes a seizure, what term should the nurse use to describe this sensation?

a.

Prodroma

b.

Agnosia

c.

Spasm

d.

Aura

ANS: D

An aura is a peculiar sensation that immediately precedes a seizure.

A prodroma is a manifestation that occurs hours preceding a seizure.

Agnosia is an inability to recognize objects.

A spasm is a jerking action.

REF: p. 356

15. 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 memory 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. 353

16. A 65-year-old male recently suffered a cerebral vascular accident. He 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. 356

17. A 75-year-old female suffers a stroke and now has difficulty writing and production of 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 writing.

Occlusion of the left middle cerebral artery, not the anterior communicating artery, leads to the inability to find words and difficulty writing.

Occlusion of the left middle cerebral artery, not the posterior communicating artery, leads to the inability to find words and difficulty writing.

Occlusion of the left middle cerebral artery, not the circle of Willis, leads to the inability to find words and difficulty writing.

REF: p. 357

18. A patient with an addiction to alcohol checked into a rehabilitation center. He experiences delirium, inability to concentrate, and is easily distracted. From which of the following is he most likely suffering?

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. 357

19. A nurse thinks a patient may be experiencing dementia. Which assessment finding will most help support this diagnosis?

a.

Violent behavior

b.

Hyperactivity

c.

Depression

d.

Loss of recent and remote memory

ANS: D

Dementia is characterized by loss of recent and remote memory.

Dementia is characterized by loss of memory. Patients with dementia may demonstrate aggressive behavior, but this is not its manifestation.

Dementia is characterized by loss of memory, not hyperactivity.

Dementia is characterized by loss of memory, not depression.

REF: p. 357

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

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. 363

21. 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 ventricular swelling.

Expansion of the cranial vault may lead to increased intracranial pressure, but increased pressure does not lead to expansion of the vault.

REF: p. 361

22. A compensatory alteration in the diameter of cerebral blood vessels in response to increased intracranial pressure is called:

a.

Herniation

b.

Vasodilation

c.

Autoregulation

d.

Amyotrophy

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. 361

23. The primary care provider states that the patient has vasogenic edema. The nurse realizes vasogenic edema is clinically important because:

a.

It usually has an infectious cause.

b.

The blood-brain barrier is disrupted.

c.

Increased intracranial pressure (ICP) is excessively high.

d.

It always causes herniation.

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 does not have an infectious cause.

ICP is increased, but not more so than other forms of edema.

Vasogenic edema disrupts the blood-brain barrier, but it does not always cause herniation.

REF: p. 362

24. A 51-year-old male is admitted to the neurological critical care unit with a severe closed head injury. All four extremities are in rigid extension, his forearm is hyperpronated, and his legs are in plantar extension. How should the nurse chart this condition?

a.

Decorticate posturing

b.

Decerebrate posturing

c.

Caloric posturing

d.

Excitation posturing

ANS: B

The description is of a patient in decerebrate posturing.

The patient is in decerebrate posturing, not decorticate.

The patient is in decerebrate posturing, not caloric.

The patient is in decerebrate posturing, not excitation.

REF: p. 372

25. A 20-year-old male is admitted to the neurological critical care unit with a severe closed head injury. When an intraventricular catheter is inserted, the ICP is recorded at 24 mm Hg. How should the nurse interpret this reading? This reading is:

a.

Higher than normal

b.

Lower than normal

c.

Normal

d.

Borderline

ANS: A

Normal ICP is 5 to 15 mm Hg; at 24 mm Hg, the patients is higher than normal.

Normal ICP is 5 to 15 mm Hg; at 24 mm Hg, the patients is higher than normal, not lower.

Normal ICP is 5 to 15 mm Hg; the patients is higher than normal.

Normal ICP is 5 to 15 mm Hg; at 24 mm Hg, the patients is higher than normal, not borderline.

REF: p. 361

26. A 70-year-old female is being closely monitored in the neurological critical care unit for a severe closed head injury. After 48 hours, her condition begins to deteriorate. Her pupils are small and sluggish, pulse pressure is widening, and she 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. 362

27. 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.

Interstitial edema, not metabolic edema, is seen most often with noncommunicating hydrocephalus.

Interstitial edema, not vasogenic edema, is seen most often with noncommunicating hydrocephalus.

Interstitial edema, not ischemic edema, is seen most often with noncommunicating hydrocephalus.

REF: p. 363

28. An adult has hydrocephalus. When the patient asks the nurse what caused this, how should the nurse respond? 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

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 intercellular edema.

Hydrocephalus does not occur due to elevated arterial blood pressure.

REF: p. 363

29. 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.

Gegenhalten

c.

Rigidity

d.

Dystonia

ANS: B

Gegenhalten 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. 364

30. 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. 366

31. A patient has excessive movement. What disorder will the nurse see documented on the chart?

a.

Hypokinesia

b.

Akinesia

c.

Hyperkinesia

d.

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. 369

32. Which principle should the nurse remember while planning care for a patient with spinal shock? 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.

Spinal shock is the complete cessation of spinal cord function below the lesion.

REF: p. 366

33. 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 that 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, eventually affecting the entire body. There is progressive dysfunction of intellectual and thought processes.

Tardive dyskinesia is manifested by rapid, repetitive, stereotypic movements. Most characteristic is continual chewing with intermittent protrusions of the tongue, lip smacking, and facial grimacing.

Hypokinesia is 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. 369

34. 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?

a.

Spastic gait

b.

Cerebellar gait

c.

Basal ganglion gait

d.

Scissors gait

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. 372

35. A male patient complains of tiring easily, has difficulty rising from a sitting position, and cannot stand on his 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: p. 364

MULTIPLE RESPONSE

1. A nurse recalls neural systems basic to cognitive functions include _____ systems. (Select all that apply.)

a.

Attentional

b.

Memory and language

c.

Affective

d.

Sensory and motor

e.

Tactile

ANS: A, B, C

The neural systems that are essential to cognitive function are: (A) attentional systems that provide arousal and maintenance of attention over time; (B) memory and language systems by which information is communicated; and (C) affective or emotive systems that mediate mood, emotion, and intention. The sensory, motor, and somatic systems are not involved. The tactile system is not involved in cognitive functioning.

REF: p. 353

2. The nurse is explaining clinical manifestations of alterations in the extrapyramidal system. The nurse would correctly include (select all that apply):

a.

Little or no paralysis of voluntary movement

b.

Normal or slightly increased tendon reflexes

c.

Positive (present) Babinski

d.

Presence of tremor

e.

Rigidity in muscle tone

ANS: A, B, D, E

The patient will experience little or no paralysis of voluntary movement. The patient will experience normal or slightly increased deep tendon reflexes. Babinski will be negative (absent). Tremor will be present. Rigidity of muscle tone occurs intermittently.

REF: p. 373

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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