Patho Exam 4 Chapter 37 Mastery Quiz

A client has developed hydrocephalus and asks the nurse what may have caused this to occur. The best response would be: a. Overproduction of cerebrospinal fluid b. Deficient cerebrospinal fluid c. Excessive CSF flow in the ventricular system d. Increased reabsorption of cerebrospinal fluid

Correct response: A. Overproduction of cerebrospinal fluid Explanation: Hydrocephalus represents a progressive enlargement of the ventricular system due to an abnormal increase in CSF volume. It can result because of overproduction of CSF, impaired reabsorption of CSF, or obstruction of CSF flow in the ventricular system.

Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury? a. Altered level of consciousness b. Change in behavior c. Respiratory instability d. Loss of eye movement reflexes

Correct response: a. Altered level of consciousness Explanation: In contrast to focal injury, which causes focal neurologic deficits without altered consciousness, global injury nearly always results in altered levels of consciousness ranging from inattention to stupor or coma. The other answers are manifestations of different types of brain injury, not a global injury.

A soccer player has been diagnosed with a brain contusion after being injured in a game. The best explanation of the injury by the nurse would be: a. Bruising on the surface of the brain occurred. b. Tearing of brain tissue occurred. c. Transient neurogenic dysfunction caused by mechanical force to the brain occurred. d. Hypoxia to the brain occurred.

Correct response: a. Bruising on the surface of the brain occurred. Explanation: Contusions represent bruising on the surface of the brain, and lacerations are a tearing of brain tissue. A cerebral concussion is a transient neurogenic dysfunction caused by mechanical force to the brain. Hypoxia usually is seen in conditions such as exposure to reduced atmospheric pressure, carbon monoxide poisoning, severe anemia, and failure of the lungs to oxygenate the blood.

A client has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which of the following pathophysiologic conditions has contributed to this client's diagnosis? a. Weakness in the muscular wall of an artery b. Impaired synthesis of clotting factors c. Deficits in the autonomic control of blood pressure d. Increased levels of cerebrospinal fluid

Correct response: a. Weakness in the muscular wall of an artery Explanation: Aneurysms are direct manifestations of a weakness that exists in the muscular wall of an arterial vessel. Hypertension is a significant risk factor, but autonomic contributions are not common. Levels of cerebrospinal fluid (CSF) and hypo- or hypercoagulability are not implicated in the pathogenesis of aneurysms.

The most common cause of ischemic stroke is: a. thrombosis. b. arterial vasculitis. c. vasospasms. d. cryptogenesis.

Correct response: a. thrombosis. Explanation: Ischemic stroke includes those caused by large artery thrombosis (20%), small artery thrombosis (25%), cardiogenic embolism (20%) and cryptogenic (undetermined cause)(30%), making thrombosis the most common cause (45%).

The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following? a. Hypoxia denotes an interruption in blood flow. b. Hypoxia produces a generalized depressive effect on the brain. c. Ischemia denotes a deprivation of oxygen with maintained perfusion. d. Ischemia does not interfere with delivery of glucose.

Correct response: b. Hypoxia produces a generalized depressive effect on the brain. Explanation: Hypoxia denotes a deprivation of oxygen with maintained blood flow (perfusion), whereas ischemia is a situation of greatly reduced or interrupted blood flow. Hypoxia produces a generalized depressant effect on the brain. Ischemia interferes with delivery of oxygen and glucose as well as the removal of metabolic wastes.

Hypoxic injury will result in which of the following effects on the brain? a. Can be focal or global with only one part of the brain being underperfused or all of the brain being compromised b. Neuronal cell injury and death c. Clouding of consciousness, bilaterally small pupils (approximately 2 mm in diameter) with a full range of constriction, and motor responses to pain that are purposeful or semipurposeful (localizing) and often asymmetric d. Depends on the brain's compensatory mechanisms and the extent of the swelling

Correct response: b. Neuronal cell injury and death Explanation: Neuronal cell injury and death is directly caused by hypoxic injury. The others are specific to several other brain injury types.

What term is used to describe a level of consciousness that sees a client responding only to vigorous and repeated stimuli and has minimal or no spontaneous movement? a. Obtundation b. Stupor c. Coma d. Lethergy

Correct response: b. Stupor Explanation: Stupor is unresponsive except to vigorous and repeated stimuli; responds appropriately to painful stimuli; lies quietly with minimal spontaneous movement; may have incomprehensible sounds and/or eye opening. Stupor is the only option that accurately includes the description presented by the question.

A late indicator of increased intracranial pressure is: a. Tachycardia b. Right-sided heart failure c. Narrow pulse pressure d. High mean arterial pressure

Correct response: d. High mean arterial pressure Explanation: The cerebral perfusion pressure (CPP), which represents the difference between the mean arterial blood pressure (MABP) and the ICP (CPP = MABP ? ICP), is the pressure perfusing the brain. CPP (normally 70 to 100 mm Hg) is determined by the pressure gradient between the internal carotid artery and the subarachnoid veins. The MABP and ICP are monitored frequently in persons with brain conditions that increase ICP and impair brain perfusion. When the pressure in the cranial cavity approaches or exceeds the MABP, tissue perfusion becomes inadequate, cellular hypoxia results, and neuronal death may occur. Elevated MABP, wide pulse pressure and reflex, and slowing of the heart rate are important but late indicators of increased ICP. Heart failure, not a part of the reflex, occurs with compression or herniation of the brain stem.

A nurse is monitoring the intracranial pressure (ICP) of a client. The nurse would consider the client to have a normal reading when the results identify: a. 0 to 15 mm Hg b. 30 to 45 mm Hg c. 15 to 30 mm Hg d. 45 to 60 mm Hg

Correct response: a. 0 to 15 mm Hg Explanation: The cranial cavity contains blood, CSF, and brain tissue. Each of these three volumes contributes to ICP, which is normally maintained within a range of 0 to 15 mm Hg when measured in the lateral ventricles.

A client has developed global ischemia of the brain. The nurse determines this is: a. Inadequate to meet the metabolic needs of the entire brain b. Inadequate perfusion of the nondominant side of the brain c. Inadequate perfusion of the right side of the brain d. Inadequate perfusion to the dominant side of the brain

Correct response: a. Inadequate to meet the metabolic needs of the entire brain Explanation: Global ischemia occurs when blood flow is inadequate to meet the metabolic needs of the entire brain. The result is a spectrum of neurologic disorders reflecting diffuse brain dysfunction.

The nurse is explaining how vasogenic brain edema occurs to a client's family. The most appropriate information for the nurse to provide would be: a. The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. b. There is an increase in the production of cerebral spinal fluid volume. c. Normal physiologic circumstances result in decreased adsorption of CSF. d. There is a decrease in the amount of fluid volume in the brain.

Correct response: a. The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Explanation: Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space. Increased production of CSF and decreased absorption result in hydrocephalus. It occurs in conditions such as hemorrhage, brain injury, and infectious processes.

Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors? a. Tumor infiltration and increased blood pressure b. Brain compression and decreased ICP c. Brain edema and disturbances in blood flow d. Tumor infiltration and decreased ICP

Correct response: c. Brain edema and disturbances in blood flow Explanation: Intracranial tumors give rise to focal disturbances in brain function and increased ICP. Focal disturbances occur because of brain compression, tumor infiltration, disturbances in blood flow, and brain edema. Blood pressure, either increased or decreased, is not a manifestation of a brain tumor.

The intracranial volume that is most capable of compensating for increasing intracranial pressure is the: a. Brain cell tissue b. Intravascular blood c. Surface sulci fluid d. Cerebrospinal fluid

Correct response: d. Cerebrospinal fluid Explanation: Initial increases in intracranial pressure (ICP) are largely buffered by a translocation of cerebrospinal fluid (CSF) to the spinal subarachnoid space and increased reabsorption of CSF. Of the intracranial volumes, the tissue volume is least capable of undergoing change. Surface sulcus fluid is negligible and not a factor in increased ICP. The compensatory ability of the intravascular blood compartment is also limited by the small amount of blood that is in the cerebral circulation. As the volume-buffering capacity of this compartment becomes exhausted, venous pressure increases and cerebral blood volume and ICP rise.