Chapter 16: Disorders of Brain Function

Which intracranial pressure (ICP) would the nurse consider a normal reading? 0 to 15 mm Hg 30 to 45 mm Hg 15 to 30 mm Hg 45 to 60 mm Hg

0 to 15 mm Hg The cranial cavity contains blood, cerebrospinal fluid, 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.

According to the Glasgow Coma Scale, opening one's eyes to only painful stimuli would receive which score? 2 1 3 4

2 Only opening eyes to painful stimulation is scored as a 2. Spontaneously opening eyes is scored as a 4; opening eyes to speech is scored as a 3; no opening is scored as a 1.

The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed? Administration of antibiotics Administration of TPN Administration of oxygen Administration of pain medication

Administration of antibiotics The nurse should prepare to administer antibiotics as ordered by the physician while the diagnostic tests are being completed. Delay in initiation of antimicrobial therapy, most frequently due to medical imaging prior to lumbar puncture or transfer to another medical facility, can result in poor client outcomes.

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

Altered level of consciousness 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.

There are two main categories of glial tumors. One of the categories is: Astrocytic Oligohydramnios Ependymomas Meningiomas

Astrocytic Glial tumors are divided into two main categories: astrocytic and oligodendroglial.

Which type of seizure begins in a localized area of the brain but may progress rapidly to involve both hemispheres? Complex partial Tonic Myoclonic Tonic-clonic

Complex partial Complex partial seizures begin in a localized area of the brain but may progress rapidly to involve both hemispheres. Tonic, myoclonic, and tonic-clonic seizures do not change in intensity after onset.

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 level of oxygen Decreased level of PCO2 Decreased level of carbon dioxide Decreased hydrogen ions

Decreased level of oxygen Regulation of blood flow to the brain is controlled largely by autoregulatory or local mechanisms that respond to the metabolic needs of the brain. Metabolic factors affecting cerebral blood flow include an increase in carbon dioxide and hydrogen ion concentrations; cerebral blood flow is affected by decreased O2 levels and increased hydrogen ions, carbon dioxide, and PCO2 levels.

Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury? Hypoxic Ischemic Excitotoxic Increased intercranial volume and pressure

Excitotoxic Excitotoxicity is a final common pathway for neuronal cell injury and death. It is associated with excessive activity of excitatory amino acid neurotransmitters. Hypoxic injury involves oxygen deprivation. Ischemic injury is caused by a decrease of blood flow. Increased intracranial pressure may result in all three but is not caused by the excitotoxic effects.

Which would the nurse consider an ischemic stroke? Charcot-Bouchard aneurysm Acute demyelination Lacunar infarct Subarachnoid hemorrhage

Lacunar infarct Lacunar infarcts are small infarcts located in the deep, noncortical parts of the brain and/or brain stem and are one type of ischemic stroke. Other types of ischemic stroke include thrombotic stroke, cardiogenic embolic stroke, and those from undetermined causes (cryptogenic stroke).

The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be: Lumbar puncture Blood cultures CT of the head Sputum culture

Lumbar puncture The diagnosis of bacterial meningitis is confirmed with abnormal CSF findings. Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure. The other options do not confirm the diagnosis.

The nurse is conducting a community education program on concussions. The nurse will include that the brain is protected from external physical forces by which part of the nervous system? blood-brain barrier cerebrospinal fluid cerebral cortex reticular formation

cerebrospinal fluid The brain is protected from external physical forces by the rigid confines of the skull (musculoskeletal system) and the cushioning afforded by the cerebrospinal fluid (nervous system). The blood-brain barrier assists with protection from chemical or metabolic sources of potential injury. The reticular formation receives input from sensory pathways, and the cerebral cortex is the outermost layer of the cerebrum.

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

inadequate to meet the metabolic needs of the entire brain. 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 most common cause of an ischemic stroke is which of the following? Intracerebral arterial vasculitis Cardiogenic embolus Thrombosis Vasospasm

Thrombosis Thrombi are the most common cause of ischemic strokes, usually occurring in atherosclerotic blood vessels.

Following a head injury, a client is diagnosed with intracranial epidural hematoma. During the initial assessment, the client suddenly becomes unconscious. What additional clinical manifestations correlate with this diagnosis? Ipsilateral pupil dilation Ipsilateral hemiparesis Diffuse venous bleeding from the nose Increased head circumference with hydrocephalus

Ipsilateral pupil dilation With rapidly developing unconsciousness, there are focal symptoms related to the area of the brain involved. These symptoms can include ipsilateral (same side) pupil dilation and contralateral (opposite side) hemiparesis. Because bleeding is arterial in origin, rapid compression of the brain occurs from the expanding hematoma. Communicating hydrocephalus occurs as the result of impaired reabsorption of cerebrospinal fluid (CSF) from the arachnoid villi into the venous system. This is unrelated to this situation.

A nurse at a long-term care facility provides care for a client who has had recent transient ischemic attacks (TIAs). What significance should the nurse attach to the client's TIAs? TIAs result in an accumulation of small deficits that may eventually equal the effects of a CV. TIAs are relatively benign phenomena that necessitate monitoring, but not treatment. TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke. The small bleeds that define TIAs can be a warning sign of an impending stroke.

TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke. TIAs can be considered a warning sign for future strokes. They are not hemorrhagic in nature and their effects are not normally cumulative. They may require treatment medically or surgically.

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. There is an increase in the production of cerebrospinal fluid volume. Normal physiologic circumstances result in decreased adsorption of CSF. There is a decrease in the amount of fluid volume in the brain.

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

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

Weakness in the muscular wall of an artery 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 spouse of a client admitted to the hospital after a motor vehicle accident reports to the nurse that the client has become very drowsy. The nurse should: assess the client for additional signs/symptoms of increased intracranial pressure. contact the physician. instruct the spouse not to let the client fall asleep until the physician has assessed the client. prepare the client for EEG testing.

assess the client for additional signs/symptoms of increased intracranial pressure. Since decreased alertness and/or drowsiness can be an early sign of increased intracranial pressure, the nurse should assess for additional signs/symptoms of increased intracranial pressure. Then, once the assessment is complete, the nurse should contact the physician as needed. There is no indication that the client will undergo EEG testing at this time and the spouse should not be instructed to keep the client awake.

A client suffering global cerebral ischemia a week after a suicide attempt by hanging is in the intensive care unit receiving treatment. The parent asks the nurse why it is necessary to keep the client paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies: decrease metabolic needs and increase oxygenation. decrease the client's ability to attempt suicide again. decrease intracranial fluid volumes and pressures. increase oxygen demands and metabolic needs.

decrease metabolic needs and increase oxygenation. The general goal of treatment with global cerebral ischemia is to decrease metabolic needs and increase oxygenation to the injured cerebral tissue. Artificial ventilation provides appropriate oxygenation; keeping the client paralyzed decreases the body's metabolic needs.

A child with a history of a seizure disorder has been observed suddenly and repetitively patting his knee. The child has a brief loss of contact with the environment and then is ready to resume normal activity. What type of seizure did this client most likely experience? Simple partial seizure or focal seizures without impairment of consciousness Atonic seizure Myoclonic seizure Absence seizure

Absence seizure Absence seizures, which typically occur only in children, often are accompanied by automatisms, and there is often a brief loss of consciousness. The seizure usually lasts only a few seconds and the person is able to immediately resume normal activity. These symptoms do not accompany simple partial seizures. Atonic seizures are characterized by loss of muscle tone. Myoclonic seizures involve brief involuntary muscle contractions induced by stimuli of cerebral origin.

The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first? Assess for other signs/symptoms of increased intracranial pressure. Assess for signs/symptoms of cerebrovascular accident (stroke). Contact physician for anti-nausea medication orders. Document the finding as it is an expected symptom.

Assess for other signs/symptoms of increased intracranial pressure. The tumor may be causing increased intracranial pressure. Vomiting, with or without nausea, is a common symptom of increased intracranial pressure and/or brain stem compression. The nurse's first action is to assess for other signs/symptoms of increased intracranial pressure. Once the assessment is completed, the nurse should contact the physician if indicated by the findings.

An older adult is brought to the emergency department after experiencing some confusion, slurred speech, and a weak arm. Now the client is back to acting normally. Suspecting a transient ischemic attack (TIA), the health care provider prescribes diagnostic testing looking for which cause of this episode? Aneurysm leakage Minor residual deficits Diffuse cerebral electrical malfunctions Atherosclerotic lesions in cerebral vessels

Atherosclerotic lesions in cerebral vessels The traditional definition of TIA as a neurologic deficit resolving within 24 hours was developed before the mechanisms of ischemic cell damage and the penumbra were known and before the newer, more advanced methods of neuroimaging became available. A more accurate definition now is a transient deficit without time limits, best described as a zone of penumbra without central infarction. TIAs are important because they may provide warning of impending stroke. The causes of TIAs are the same as those of ischemic stroke, and include atherosclerotic disease of cerebral vessels and emboli. The most common predisposing factors for cerebral hemorrhage are advancing age and hypertension; other causes include aneurysm rupture. Cerebral electrical malfunctions usually occur with seizure activity.

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 TIAs and cerebrovascular infarction Momentary unconsciousness Status epilepticus

Brain contusions and hematomas Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as an acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. Status epilepticus is not related to this situation.

A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for: Brain death Paraplegia Confusion Amnesia

Brain death Severe brain injury that results in seriously compromised brain function can result in brain death.

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

Brain edema and disturbances in blood flow 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.

Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made? CT scan MRI Loss of cranial nerve reflexes Venography

CT scan The diagnosis of subarachnoid hemorrhage and intracranial aneurysms is made by clinical presentation, CT scan, and angiography. An MRI is not necessary for the diagnosis of subarachnoid hemorrhage and intracranial aneurysm. Loss of cranial nerve reflexes is not diagnostic of subarachnoid hemorrhage and intracranial aneurysm, and neither is venography.

The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include? CT scan MRI Intravenous antibiotics Pain medication

CT scan The nurse should anticipate that the client will be ordered a CT scan to rule out hemorrhagic stroke that would preclude the administration of tissue plasminogen activator (tPA).

Select the conditions that would place a client at risk for the development of hypoxia. Select all that apply. Carbon monoxide poisoning Increased oxygenation by the lungs Severe anemia Age Increased atmospheric pressure Thrombocytopenia

Carbon monoxide poisoning Severe anemia Hypoxia usually is seen in conditions such as exposure to reduced atmospheric pressure, carbon monoxide poisoning, and severe anemia. When the lungs fail to oxygenate the blood, the result is hypoxia. Therefore, increased oxygenation by the lungs is an incorrect answer. The other options will not alter oxygen levels.

Which intracranial volume is most capable of compensating for increasing intracranial pressure? Brain cell tissue Intravascular blood Surface sulci fluid Cerebrospinal fluid

Cerebrospinal fluid 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.

A client's emergency room report includes the presence of a contrecoup injury. The nurse plans care for a client with which of the following? Closed head injury in the area of impact Closed head injury opposite the area of impact Infection resulting from exposed brain tissue Open spinal cord injury with complete severing of neurons

Closed head injury opposite the area of impact In a contrecoup injury, the client experiences a rebound injury on the side of the brain opposite the site of external force.

A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following? Encephalitis Viral meningitis Meningioma Bacterial meningitis

Encephalitis Less frequent causes of encephalitis include ingesting toxic substances such as lead. People experience neurologic disturbances such as lethargy, disorientation, seizures, focal paralysis, delirium and coma. Bacterial and viral meningitis are caused by bacterial and viral infections. Meningiomas are a type of brain tumor that are seen in the middle or later years of life.

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? Petechiae over entire body BP 100/72 mm Hg Impaired neck flexion resulting from muscle spasm Appearance of red-purple discolorations on the skin that do not blanch on applying pressure

Impaired neck flexion resulting from muscle spasm Like meningitis, encephalitis is characterized by fever, headache, and nuchal rigidity (impaired neck flexion resulting from muscle spasm), but more often clients also experience neurologic disturbances, such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma. Meningococcal meningitis is characterized by a petechial (petite hemorrhagic spots) rash with palpable purpura (red-purple discolorations on the skin that do not blanch on applying pressure) in most people. This BP is within normal range.

The nurse reading a client's lumbar puncture results notifies the physician of findings consistent with meningitis when which sign/symptom is noted? Large number of polymorphonuclear neutrophils Clear cerebrospinal fluid Decreased protein count Increased glucose

Large number of polymorphonuclear neutrophils Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure. The CSF typically contains large numbers of polymorphonuclear neutrophils (up to 90,000/mm3), increased protein content, and reduced sugar content.

The nurse is caring for an older adult client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for developing which condition? Muscle atrophy Muscular dystrophy Involuntary movements Pseudohypertrophy

Muscle atrophy Muscle atrophy can occur with prolonged immobilization following a chronic illness. The client suffering from hemiplegia will have paralysis and immobility. Muscular dystrophy is a genetic disorder characterized by muscle necrosis and increased muscle size. Pseudohypertrophy is associated with muscular dystrophy. Involuntary movements are associated with extrapyramidal tract disorders. Stroke is a pyramidal tract disorder with extrapyramidal tract disorder.

The nurse planning interventions for a client with a brain tumor bases the intervention on the knowledge that the resultant brain injury is due to: Ischemia Excitation Trauma Pressure

Pressure The injury to the brain that stems from brain tumors is due to the pressure that leads to focal disturbances and increased intracranial pressure.

As a client explains to the nurse what occurred prior to the onset of seizure activity, the client describes perceiving a feeling or warning that the seizure would occur. The nurse documents the perceived warning as which of the following? Ictal Prodrome Clonic Atonic

Prodrome The nurse should document the perception of a warning of impending seizure activity as a prodrome; it is also referred to as an aura.

The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with: Encephalitis Subarachnoid hemorrhage Lacunar infarct Thrombotic stroke

Subarachnoid hemorrhage The rupture of a berry aneurysm leads to a subarachnoid hemorrhage.

A client suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which purpose? Thrombolysis Thrombogenesis Hemolysis Hemostasis

Thrombolysis Synthetic tissue plasminogen activators work with the body's natural tissue plasminogen activators to convert plasminogen to plasmin, which breaks down clots to allow for the reestablishment of blood flow. There are two causes of strokes: hemorrhagic and thrombotic, with thrombotic strokes occurring much more frequently. Thrombolytics play a large role in increased outcomes seen with thrombotic strokes.

A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to: administer IV tissue plasminogen activator (tPA). administer analgesics for the relief of pain. monitor vital signs closely for improvement. prepare the client for emergency surgery.

administer IV tissue plasminogen activator (tPA). tPA administration is the treatment of choice for an ischemic stroke after confirmation that it is not a hemorrhagic stroke. Monitor vital signs and provide pain relief to prevent complications.

The nurse observes a new nurse performing the test for Kernig sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that: the client should be in a sitting position. the sign elicited was the Brudzinski sign. resistance should be provided with the knee in a flexed position. the sign elicited was the obturator sign.

resistance should be provided with the knee in a flexed position. The test for Kernig sign for meningeal irritation is performed by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle.

The nurse is assessing a client and notes the client is now displaying decerebrate posturing. The position would be documented as: rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet. prone position with arms placed above the head and legs elevated; deep tendon reflexes showing hyperreflexia. flexion of the arms, wrists, and fingers, with abduction of the upper extremities, internal rotation, and plantar flexion of the lower extremities. active range of motion with increased strength in the upper extremities when painful stimulation applied.

rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet. Decerebrate (extensor) posturing results from increased muscle excitability. It is characterized by rigidity of the arms with palms of the hands turned away from the body and with stiffly extended legs and plantar flexion of the feet. Flexion of the arms, wrists, and fingers, with abduction of the upper extremities, internal rotation, and plantar flexion of the lower extremities, would be a response of decorticate posturing. The other options are not specific to a diagnosis.

The most common cause of ischemic stroke is: thrombosis. arterial vasculitis. vasospasms. cryptogenesis.

thrombosis. 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%).