Unit 4 Chapter 10-Pathophysiology

A client with a diagnosis of epilepsy has required surgical removal of part of her prefrontal cortex. Which effect should her family and care team anticipate?

Changes in behavior and judgment

Which role do supporting cells of the nervous system—such as Schwann cells, satellite cells, and types of glial cells—provide in functioning to protect neurons?

Local Protection

The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:

Lumbar Puncture or spinal tap

Restoration of the integrity of myelin sheaths would likely result in a slowing or stopping of the progression of:

Multiple Sclerosis (MS)

The nurse is caring for a client with a longstanding diagnosis of hypocalcemia secondary to kidney disease. The nurse observes which clinical manifestations in this client?

Muscular spasms and reports of tingling in hands/feet

A 60-year-old woman has been recently diagnosed with multiple sclerosis, a disease in which the oligodendrocytes of the client's central nervous system (CNS) are progressively destroyed. Which physiologic process within the neurologic system is most likely to be affected by this disease process?

Nerve Conduction

Which peripheral nerve injury will likely result in cellular death with little chance of regeneration?

Nerve fibers destroyed close to the neuronal cell body

During embryonic development, which structure develops into the central nervous system (CNS)?

Neural Tube

Disorders of the pyramidal tracts, such as a stroke, are characterized by which physical finding?

Paralysis

A newly diagnosed paraplegic client maintains control of bladder emptying. The health care provider explains to the client/family stating which portion of the nervous system allows the motor component of the neural reflex to assist with bladder emptying?

Parasympathetic division of the ANS.

The basis for assessing the function of any peripheral nerve lies in which principle?

Peripheral nerves contain processes of more than one of the four afferent and three efferent cell columns.

A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which treatment measure is most likely to resolve this health problem?

Placement of a shunt

A client who suffered cardiac arrest had cardiopulmonary resuscitation (CPR) performed for 20 minutes. The client is sedated and on mechanical ventilation. A family member asks if there will be brain damage when the client wakes up. Which factor is most important when determining the risk for neurologic impairment?

how effectively CPR maintained cerebral perfusion

A client has developed global ischemia of the brain. The nurse determines this is:

inadequate to meet the metabolic needs of the entire brain.

The nurse is assessing a client for early manifestations of hyponatremia. The nurse would assess the client for:

muscle weakness

Which chemical does blood-brain and CSF-brain barrier control with easy entrance?

oxygen

A client with a diagnosis of liver cirrhosis secondary to alcohol abuse has a distended abdomen as a result of fluid accumulation in his peritoneal cavity (ascites). Which pathophysiologic process contributes to this third spacing?

Abnormal increase in transcellular fluid volume

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a "coup" injury. How will the nurse explain this to the family so they can understand?

"Your son has a contusion of the brain at the site where the bat hit his head."

The nurse is caring for a client who requires measurement of intracranial pressure (ICP). Which action(s) will the nurse include? Select all that apply. -Monitor for signs of infection -Average the ICP readings over a minimum of 30 mins -Restrict Duration of monitoring to less than 24 hours -Report any readings under 15 mm Hg immediately -Monitor Clients blood pressure frequently

- Monitor for signs of infection - Average the ICP readings over a minimum of 30 mins -Monitor Clients Blood Pressure frequently

The nurse is caring for a client who has just arrived at the emergency department with an acute spinal cord injury. Which intervention(s) will the nurse perform? Select all that apply. - Apply immobilizers to prevent spinal movement. -Perform a neurologic assessment. -Obtain Intravenous access -Perform passive range of motion to all joints -Encourage oral fluids

-Apply immobilizers to prevent spinal movement -Perform Neurologic assessment - Obtain Intravenous access

Neurons are characterized by the ability to communicate with other neurons and body cells through pulsed electrical impulses, or:

Action potentials

A nurse is reviewing electrolyte transport in the body. Which statement is correct regarding electrolyte transport?

Anions and cations combine based on the ionic charge in the plasma.

A client with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her:

Arms

A teenager has been in a car accident and experienced an acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?

Brain contusions and Hematomas

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 that:

Bruising on the surface of the brain occurred

Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors?

Brain edema and disturbances in blood flow

A 14-year-old girl has been thrown from the back of a pick-up truck. MRI shows complete cord injury at the level of C2. What is the main significance of an injury at this level of the spinal column?

Cannot breathe on own, needs ventilator assistance

A client is experiencing pain, tingling, and numbness of the thumb and first, second, third, and half of the fourth digits of the hand. She states that she has pain in the wrist and hand, which worsens at night, and she has noticed that they have become clumsy. The nurse recognizes these manifestations as:

Carpal Tunnel Syndrome

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?

Carpal Tunnel Syndrome

An older adult has had a recent decrease in coordination, with gait being described as wide-based, unsteady, and lacking in fluidity, although the client's muscle tone appears normal. This client requires further assessment for which condition that is involved with coordination of movement?

Cerebellar Disorder

Severe head trauma from a coup-contrecoup injury may result in which type of brain injury?

Cerebral Hematoma

The cerebellum, separated from the cerebral hemispheres by the tentorium cerebelli, lies in the posterior fossa of the cranium. What is one of the functions of the cerebellum?

Coordinates smooth and accurate movements of the body

The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:

Decreased levels of oxygen

The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis (MS) is the result of which pathophysiologic event?

Decreased oligodendrocytes

Which statement best describes the pathophysiology of Parkinson disease?

Degeneration of the nigrostriatal dopamine system

The client presents with a traumatic complete spinal cord transection at the C5 level. Based on this injury, the health care worker can expect the client to have control of which body function/part?

Diaphragm

Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia have which effect on motor ability?

Disrupt movement without causing paralysis

A client's recent diagnosis of Parkinson disease has prompted the care provider to promptly begin pharmacologic therapy. The drugs prescribed will likely influence the client's levels of which substance?

Dopamine

Which of the meninges provides the major protection for the brain and spinal cord?

Dura Mater

The underlying causative problem in Parkinsonism is:

Failure of dopamine release

A client with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. After stopping this repetitive action, the client appears confused—he is oriented to person and place but not time. What type of seizure did this client most likely experience?

Focal seizure with impairment to consciousness

A high school student sustained a concussion during a football game. The school nurse will educate the family about postconcussion syndrome and ask them to watch for and report which manifestations of its presence?

Headaches and Poor concentration

A family brings a client to the emergency department with increasing lethargy and disorientation. They think the client had a seizure on the drive over to the hospital. The client has been sick with a "cold virus" for the last few days. On admission, the client's temperature is 102°F (38.9°C). Which other clinical manifestations may lead to the diagnosis of encephalitis?

Impaired neck flexion resulting from muscle spasm

Which pathophysiologic process occurs in cases of bacterial meningitis?

Inflammation allows pathogens to cross into the cerebrospinal fluid.

Reflexes are basically "hard-wired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron to cause muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons?

Interneuron

Neurons that connect sensory and motor neurons are known as which of the following?

Interneurons

Neurotransmitters exert their actions through specific proteins that are known as:

Receptors

A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client?

Respiratory ventilation assessment and prevention of aspiration pneumonia

A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait?

Slow to start walking and has difficulty when asked to "stop" suddenly

Through what specific component do neurotransmitters exert their action?

Specific Proteins

Neurons communicate with each other through which structure?

Synapses

Which lobe of the brain performs functions of perception, long-term memory, and recognition of auditory stimuli?

Temporal lobe

The nurse is explaining to a client's family how vasogenic brain edema occurs. The most appropriate information for the nurse to provide would be:

The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.

A client asks the nurse if the brain is always receiving oxygen. The best response would be:

The brain receives 15% of the body's resting cardiac output and consumes 20% of its oxygen.

During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description?

The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction

Limbic system

The region of the brain involved in emotional experience and control of emotional behavior

A client comes to the emergency department stating she is having severe pain on the left side of her face. The client states that the pain started after being outdoors in the cold. The nurse observes lacrimation of the right eye. Which nerve does the nurse recognize is affected?

Trigeminal

A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on which region of the brain?

Upper and Lower motor neurons

College students were given various amounts of alcohol within a specified time frame and then asked to drive an obstacle course. The rationale for poor performance in driving as the amount of alcohol intake increased includes, "The blood-brain barrier:

allows alcohol, a very lipid-soluble molecule, to rapidly enter the brain."

A client has developed shock and the physician has instructed the nurse to begin the administration of intravenous dopamine. The nurse anticipates that the medication will:

cause vasodilatation of the coronary blood vessels.

Drugs like diazepam, a benzodiazepine, exert their action on ion channels. These drugs do not open the GABA-operated ion channel, but they:

change the effect that GABA has when it binds to the channel at the same time as the drug.

A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is:

characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing.

The nurse is caring for a client with head trauma. The client is flexing the arms, wrists, and fingers. There is adduction of the upper extremities with internal rotation and plantar flexion of the lower extremities. How would the nurse describe this in the notes?

decorticate posturing

Overstimulation of glutamate receptors is the cause of which type of brain injury?

excitotoxic

A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. What is the most accurate description? This drug:

produces paralysis of the larynx muscles by blocking acetylcholine release.

When caring for the client with hyperkalemia, the nurse recognizes the body should respond in which of these ways?

secrete potassium in the distal tubules for excretion

When providing discharge teaching related to some newly prescribed medications, the client who received a head injury on the left temporal lobe area will need for the health care provider to:

sit on the right side and speak slowly and clearly during the education.

A client has experienced the α1-receptor stimulation. The nurse would assess the client for:

vasoconstriction

A client comes to the clinic and informs the nurse that he believes he is suffering from Parkinson disease. What objective data assessed by the nurse would correlate with the client's concern? Select all that apply. -bradykinesia -tachycardia -rapid speech -Tremor -rigidity

-Bradykinesia -Tremor -Rigidity

The nurse is caring for a school-aged client with suspected hydrocephalus. For which diagnostic test(s) should the nurse prepare the client? Select all that apply. -computed tomography (CT) scan of the head -ultrasound of the head -cerebrospinal fluid analysis -measurement of head circumference -x-ray of the head

-Computed tomography (CT) scan of the head - X-ray of the head

A client with a traumatic brain injury has developed extreme cerebral edema. Which clinical manifestations of brain herniation correlate to upward herniation of the midbrain known as uncal herniation? Select all that apply. -Deep coma -bilateral small, fixed pupils -Rhythmic movement of arms and legs -Respiratory rate of 8 with intermittent sighs -Intracranial bleeding from nose and ears

-Deep coma -Respiratory rate of 8 intermittent sighs -bilateral small, fixed pupils

The family of a multiple sclerosis client asks, "What psychological manifestations may we expect to see in our mother?" The health care provider informs them to expect which of the following? Select all that apply. -Forgetfulness -Delirium -Hallucinations -Inattentiveness -Depression

-forgetfulness -inattentiveness -Depression

The nurse is assessing a client with a motor function disorder. Which assessment(s) will the nurse perform to gather data specific to motor function? Select all that apply. -chest expansion -muscle size -spinal reflexes -posture and gait -muscle tone

-spinal reflexes -muscle tone -posture and gait -muscle size

A nurse is caring for a client who is prescribed an aldosterone receptor antagonist. Which best describes the mechanism of action of the medication?

It works by promoting sodium and water excretion.

The nurse is caring for a client who is displaying signs of an acute ischemic stroke. The nurse associates the neurologic symptoms with which primary pathophysiologic process?

Lack of access to oxygen and glucose, resulting in cellular dysfunction

Feelings of dread, high anxiety, or exquisite pleasure can be elicited by stimulation of areas in which structure?

Limbic system