Chapter 38: Disorders of Special Sensory Function: Vision, Hearing, and Vestibular Function- Patho http://thepoint.lww.com/Book/Show/ Level 3, Chapter 36: Disorders of Neuromuscular Function-Patho http://thepoint.lww.com/book/show/512209?focus=p#/Cou...

What percentage of the body's oxygen does the brain consume?

20% Explanation: The brain receives 15% of the body's resting cardiac output and consumes 20% of its oxygen. Page 825

A client has just begun to experience an ischemic stroke. The blood supply from the middle cerebral artery is being blocked by a large blood clot. How long before brain cells begin to die due to lack of ATP?

4 to 6 minutes Explanation: Without oxygen, brain cells continue to function for approximately 10 seconds, and the death of brain cells begins within 4 to 6 minutes. Twenty minutes is the time of cardiac cell death, and 3 hours is the window of time that thrombolytic medications can be safely used. Testing is done at each segmental level, or dermatome, moving upward along the body and neck from coccygeal segments through the high cervical levels to test the functional integrity of all the spinal nerves. Page 825

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? A) Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids B) A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins C) Cerebellar lesions; surgical and immunosuppressive treatment D) Excess acetylcholinesterase production; treatment with thymectomy

A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

The health care provider is reviewing diurnal variation pattern in adrenocorticotropic (ACTH) levels. Select the typical diurnal variation pattern in adrenocorticotropic (ACTH) levels.

ACTH peaks in the morning and declines throughout the day. Explanation: ACTH levels have diurnal variation in which they reach their peak in the early morning (around 6 to 8 AM) and decline as the day progresses related to rhythmic activity of the CNS. The diurnal pattern is reversed in people who work during the night and sleep during the day. The rhythm also may be changed by physical and psychological stresses, endogenous depression, and liver disease or other conditions that affect cortisol metabolism. Page 784

This type of pain is pain that is generally of short duration and remits when the underlying pathology has resolved.

Acute pain

For seizure disorders that do not respond to anticonvulsant medications, the option for surgical treatment exists. What is removed in the most common surgery for seizure disorders? a) Amygdala b) Temporal neocortex c) Hippocampus d) Entorhinal cortex

Amygdala The most common surgery consists of removal of the amygdala and an anterior part of the hippocampus and entorhinal cortex, as well as a small part of the temporal pole, leaving the lateral temporal neocortex intact. Only a portion of the hippocampus and entorhinal cortex, and temporal pole are removed.

Which of the following recent admissions to an emergency department is most likely to be diagnosed with a greenstick fracture? A) A 20-year-old football player who had an opposing player fall laterally on his leg B) An 8-year-old boy who fell out of a tree and on to his arm C) An 81-year-old woman with a history of osteoporosis who stumbled and fell on her hip D) A 32-year-old woman who fell awkwardly on her arm while skiing

An 8-year-old boy who fell out of a tree and on to his arm

A 46-year-old male has presented to the emergency department because of the eye pain, severe headache, and blurred vision that have followed an eye exam at an optometrist's office earlier in the day. The patient tells the triage nurse that he received eyedrops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect? Question options: Angle-closure glaucoma Corneal trauma Keratitis Infectious conjunctivitis

Angle-closure glaucoma

These disorders are characterized by intense fearfulness that occurs without a precipitating potentially dangerous event.

Anxiety

The _________ nervous system regulates, adjusts, and coordinates the visceral functions of the body.

Autonomic

The nurse is working at a first aid station in an amusement park. A 45-year-old client arrives reporting severe dizziness after a ride on the roller coaster. The nurse understands that a common cause of this sensation is which of the following? a) Barotrauma b) Acute otitis media c) Benign paroxysmal positional vertigo d) Otosclerosis

Benign paroxysmal positional vertigo Benign paroxysmal positional vertigo is the most common cause of pathologic vertigo and usually develops after the fourth decade of life. It commonly occurs when the person is getting in and out of bed, bending over and straightening up, or extending the head to look up. It also can be triggered by amusement rides that feature turns and twists. The other conditions are not manifested by severe sudden vertigo.

What side effects may a patient experience with narcotic analgesic for pain

CED. constipation, euphoria, drowsiness

Name nurses role in pain management

CORD: Communication, observation, respositioning, correct analgesic drub administration

This syndrome is a common mononeuropathy.

Carpal tunnel

The nervous system can be broadly divided into which two nervous systems?

Central and Peripheral

Myelinated neurons are found in which of the following component(s) of the nervous system? a) Central b) Peripheral c) Central and peripheral d) Gray matter

Central and peripheral Myelin formation is essentially the same in both the central (CNS) and peripheral nervous systems (PNS). Two types of neuroglial cells (oligodendrocytes in the CNS and Schwann cells in the PNS) produce the myelin used to insulate nerve cell processes and increase the velocity of nerve impulse conduction. Myelin has a high lipid content, which gives it a whitish color, and the name "white matter."

Reflexes can be considered predictable responses to stimuli that are wired to the

Central nervous system

what pain is continuous and is NOT connecting with ANS

Chronic pain

The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to which of the following? a) Conduction disorder b) Sensorineural disorder c) Mixed sensorineural and conduction disorder d) Infection

Conduction disorder Impacted earwax is one cause for conductive hearing loss. It is not a cause of the other answer choices.

describes the midbrain

Conveys the senses of pain, temperature, touch, and proprioception to the superficial and deep regions of the face

Name the sources of pain 12

Cutaneous, Deep somatic, Visceral, Functional/psychogenic, referred, acute, chronic, neuropathic, neuralia, trigeminal neuralgia, post herpetic neuralgia, phantom limb

Peripheral neuropathy occurs most commonly with which one of the following disorders? a) Cancer b) Alcoholism c) AIDS d) Diabetes

Diabetes Diabetes mellitus is a primary metabolic disorder that frequently leads to peripheral neuropathy.

Which of the following hormones are derivatives of cholesterol?

Eicosanoids and retinoids *******Aldosterone and testosterone Insulin and glucagon Epinephrine and norepinephrine

Which of the following types of synapse allows the quickest transmission from one neuron to another? a) Inhibitory b) Chemical c) Electrical d) Excitatory

Electrical Electrical synapses premit the passage of current-carrying ions through small openings called gap junctions. The gap junctions allow an action potential to pass directly and quickly from one neuron to another. Chemical synapses are the slowest component in progressive communication through a sequence of neurons. Chemical synapses are divided into two types: excitatory and inhibitory.

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? a) Encephalitis b) Bacterial meningitis c) Viral meningitis d) Meningioma

Encephalitis Less frequent causes of encephalitis include ingesting toxic substances such as lead. -People experience neurologic disturbances such as lethergy, 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.

The CT scan report identified that a client with a skull fracture has developed a hematoma that resulted from a torn artery. The report would be interpreted as: a) Epidural hematoma b) Intracranial hematoma c) Subdural hematoma d) Chronic subdural hematoma

Epidural hematoma An epidural hematoma is one that develops between the inner side of the skull and the dura, usually resulting from a tear in an artery, most often the middle meningeal, usually in association with a head injury in which the skull is fractured. -A subdural hematoma results from a torn vein; -chronic subdural hematoma is common in older persons: -brain atrophy causes the brain to shrink away from the dura and to stretch fragile bridging veins. - An intracranial hematoma occurs when a blood vessel ruptures within your brain or between your skull and your brain.

Which of the following catecholamines is formed in the adrenal gland? a) Norephinephrine b) Acetylcholine c) Dopamine d) Epinephrine

Epinephrine The catecholamines, which include norepinephrine, epinephrine, and dopamine, are synthesized in the axoplasm of sympathetic nerve terminal endings from the amino acid tyrosine. During catecholamine synthesis, tyrosine is hydroxylated to form dopamine, and dopamine is hydroxylated to form norephinephrine. In the adrenal gland, an additional step occurs during which norephinephrine is methylated to form epinephrine. Acetylcholine is not a catecholamine.

A 31-year-old male was diagnosed with genital herpes of the HSV-2 type 5 years ago. He is now broaching the subject with a woman he has recently formed a relationship with. Which of his statements is most accurate? A) If you've been exposed to the herpes virus in the past, then there's no significant risk of reinfection. B) The worst case scenario is that you'll develop cold sores, since this is the type of herpes virus that I've got. C) If you've had cold sores when you were younger, it means that you've got antibodies against this D) Even when I'm not having a recurrence, I could still pass the virus on to you.

Even when I'm not having a recurrence, I could still pass the virus on to you.

Which of the following potentials, when combining a neurotransmitter with a receptor site, causes partial depolarization of the postsynaptic membrane? a) Threshold b) Inhibitory postsynaptic c) Resting membrane d) Excitatory postsynaptic

Excitatory postsynaptic A neurotransmitter can cause an excitatory or an inhibitory-graded potential. When the combination of a neurotransmitter with a receptor site causes partial depolariztion of the postsynaptic membrane, it is called an excitatory postsynaptic potential. -Threshold potential and resting membrane potential are terms associated with membrane action potentials.

Loss of coordinated movement and balance is likely due to damage to which of the following? a) Peripheral neurons b) Pyramidal structures c) Cranial nerves d) Extrapyramidal structures

Extrapyramidal structures Disorders affecting the extrapyramidal system include involuntary movement, muscle rigidity, and immobility without paralysis.

A nurse on a medical unit is providing care for a 37-year-old female client who has a diagnosis of Graves' disease. Which assessments should the nurse prioritize?

Eye health and visual acuity Explanation: The ophthalmopathy of Graves' disease can cause severe eye problems, including tethering of the extraocular muscles resulting in diplopia; involvement of the optic nerve, with some visual loss; and corneal ulceration because the lids do not close over the protruding eyeball (due to the exophthalmos). Eye assessment is consequently a priority over assessment of skin integrity, cognition, or musculoskeletal status. Page 782

The nurse assessing for the doll's head response (doll's eye response) in an unconscious client documents which of the following as an abnormal response? a) Eyes turn up when head is tilted down b) Eyes turn toward right when head is turned to left c) Eyes turn right when head is turned right d) Eyes turn down when head is tilted up

Eyes turn right when head is turned right The normal doll's head response (doll's eye response) is movement of the eyes in conjugate gaze to the opposite side or direction when the head is moved from side to side or up and down. An abnormal response is fixed position of the eyes or movement in the same direction as the head.

A 30 year old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin?

Facilitating triglycerides from glucose in fat cells

Afferent neurons carry information from the central nervous system.

False

Each of the 10 cranial nerves corresponds to specific motor and sensory functions.

False

Mental illnesses are most often a manifestation of negative experiences and relationships prior to adulthood.

False

Migraines differ from other headaches in that they are both more severe and cannot normally be treated.

False

Peripheral nerves are incapable of regeneration or recovery following an insult.

False

Recent advantages in pharmacology allow clinicians to eliminate most manifestations of mental illness.

False

Seizures are a result of focal disruptions in blood supply to brain tissue.

False

The hormone most closely associated with the sleep wake cycle is thyroid hormone.

False

When giving pain medicine for acute pain, health care workers are reluctant to provide much needed opioid pain medicine. What is the major concern of health care workers when providing opioid pain relief?

Fear of addiction Explanation: Part of the reluctance of health care workers to provide adequate relief for acute pain has been fear of addiction. However, addiction to opioid medications is thought to be virtually nonexistent when these drugs are prescribed for acute pain. The other answers are not the major concern. Page 875

Which test can the nurse prepare the client for to determine the differentiation between a benign and a malignant thyroid disease?

Fine-needle aspiration biopsy Explanation: Ultrasonography can be used to differentiate cystic from solid thyroid lesions, and CT and MRI scans are used to demonstrate tracheal compression or impingement on other neighboring structures. Fine-needle aspiration biopsy of a thyroid nodule has proved to be the best method for differentiation of benign from malignant thyroid disease. Page 778

A campus-based peer counseling group is conducting an information blitz on sexually transmitted diseases. Which of the following statements about genital warts requires correction? A) Genital warts can take up to a month after exposure to first become visible. B) There is no existing treatment that can eradicate the virus once it's contracted. C) Condoms do not necessarily prevent the transmission of the virus that causes genital warts. D) There are a number of subtypes of the virus that cause genital warts, but current vaccines protect against most common causes of them.

Genital warts can take up to a month after exposure to first become visible.

When a 4-year-old boy stands erect with his medial malleoli touching, the distance between his knees is 2 inches. What is the child's most likely diagnosis and treatment? A) Genu varum, which can be treated by bracing B) Flatfoot, which will require orthopedic shoes C) Genu valgum necessitating a series of surgeries D) Femoral torsion, which will spontaneously resolve before puberty

Genu varum, which can be treated by bracing

A client is having an upper endoscopy to determine the presence of a gastric ulcer. After the procedure is performed, the nurse instructs the client that he cannot have anything to eat or drink until the return of the gag reflex. Which nerve is the nurse testing for return of function?

Glossopharyngeal Explanation: The glossopharyngeal nerve innervates the stylophargeus muscle, posterior external ear, taste buds of posterior half of tongue, oral pharynx, parotid gland, pharyngeal muscles, and the stylopharyngeus muscle. It affects the function of proprioception, somesthesia, taste, gag reflex, salivary reflex, and assists in swallowing. Page 834

A client is having an upper endoscopy to determine the presence of a gastric ulcer. After the procedure is performed, the nurse instructs the client that he cannot have anything to eat or drink until the return of the gag reflex. Which nerve is the nurse testing for return of function? a) Hypoglossal b) Glossopharyngeal c) Trigeminal d) Abducens

Glossopharyngeal The glossopharyngeal nerve innervates the stylophargeus muscle, posterior external ear, taste buds of posterior half of tongue, oral pharynx, parotid gland, pharyngeal muscles, and the stylopharyngeus muscle. It affects the function of proprioception, somesthesia, taste, gag reflex, salivary reflex, and assists in swallowing.

Which of the following organs found in muscle tendons transmits information about muscle tension or force of contraction at the junction of the muscle and the tendon that attaches to the bone? a) Myofibrils b) Effector neuron c) Golgi tendon d) Muscle spindles

Golgi tendon Golgi tendon organs are found in muscle tendons and transmit information about muscle tension or force of contraction at the junction of the muscle and the tendon that attaches to the bone. Normal muscle tone depends on stretch reflexes initiated by the muscle spindles, which monitors changes in muscle length.

A client has sustained damage to cranial nerve VIII. The nurse recognizes that the client may experience difficulty with: a) Taste b) Motor c) Smell d) Hearing

Hearing Cranial nerve VIII (vestibulocochlear nerve) is associated with hearing. The other options involve different nerves.

A client has sustained damage to cranial nerve VIII. The nurse recognizes that the client may experience difficulty with:

Hearing Explanation: Cranial nerve VIII (vestibulocochlear nerve) is associated with hearing. The other options involve different nerves. Page 834

Which virus is associated with debilitating thype of neuropathic pain

Herpes

A client comes to the clinic with fatigue and muscle weakness. The client also states she has been having diarrhea. The nurse observes the skin of the client has a bronze tone and when asked, the client says she has not had any sun exposure. The mucous membranes of the gums are bluish-black. When reviewing laboratory results from this client, what does the nurse anticipate seeing?

Increased levels of ACTH Explanation: Hyperpigmentation results from elevated levels of ACTH. The skin looks bronzed or suntanned in exposed and unexposed areas, and the normal creases and pressure points tend to become especially dark. The gums and oral mucous membranes may become bluish-black. The amino acid sequence of ACTH is strikingly similar to that of melanocyte stimulating hormone; hyperpigmentation occurs in greater than 90 percent of persons with Addison's disease and is helpful in distinguishing the primary and secondary forms of adrenal insufficiency. Page 787

The nurse should anticipate they will need to teach the newly diagnosed multiple sclerosis patient how to give injections if they are prescribed which medication to modify the course of the disease by reducing exacerbations? a) Plasmapheresis. b) Corticosteroids. c) Interferon-beta. d) Mitoxantrone.

Interferon-beta. Interferon-beta helps modify the course of treatment of MS. It may also reduce exacerbations in persons with relapsing-remitting MS. It is a cytokine that acts as an immune enhancer. It is administered by injection. The other medications are prescribed for MS but not given by injection.

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

Interneurons Explanation: Afferent (sensory) neurons transmit information to the central nervous system (CNS), whereas efferent (motor) neurons carry information away from the CNS. Interspersed between the afferent and efferent neurons is a network of interconnecting neurons (also called interneurons or internuncial neurons) that modulate and control the body's response to sensory input from the internal and external environments. Page 822

A patient reports a sudden intense headache. Which of the following factors would indicate the presence of a possible subarachnoid hemorrhage?

Intractable pain Explanation: Subarachnoid hemorrhage causes a severe intractable headache. Headaches that disturb sleep or occur with exercise or sexual activity may be caused by neurologic lesions. Migraine headaches tend to run in families but do not contribute to hemorrhage. Page 872

The nurse documents the presence of nystagmus when assessing a client. This can be interpreted as: a) Fixed eye movements that preserve eye fixation on unstable objects in the visual field b) Voluntary eye movements that preserve eye fixation on stable objects in the visual field c) Involuntary eye movements that preserve eye fixation on stable objects in the visual field d) Unilateral eye movement that preserve eye fixation on unstable objects in the visual field

Involuntary eye movements that preserve eye fixation on stable objects in the visual field Nystagmus refers to the involuntary eye movements that preserve eye fixation on stable objects in the visual field during angular and rotational movements of the head. As the body rotates, the vestibuloocular reflexes cause a slow compensatory drifting of eye movement in the opposite direction, thus stabilizing the binocular fixation point.

The nurse is conducting a community education class on acute otitis media. Which statement by the participants indicates to the nurse that they are understanding the education? a) It is another name for swimmer's ear. b) It can be caused by a bacterial infection. c) The tympanic membrane appears cloudy. d) Breastfed babies have a higher incidence of this condition.

It can be caused by a bacterial infection. The nurse determines that the participants are understanding the information when they state that acute otitis media can be caused by a bacterial infection. -Breast fed babies have a lower incidence of acute otitis media. -The tympanic membrane appears cloudy in otitis media with effusions. -Acute otitis media is not another name for swimmer's ear

A 40-year-old man who uses heroin intravenously was diagnosed with hepatitis C (HCV) 1 year ago and is now considered to have chronic viral hepatitis. Which of the following statements by the client to his care provider would warrant correction? A) I know the medications to treat this aren't fantastic, but at least there are some options for controlling the virus. B) It's at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms. C) Even though I'm sick, at least I won't feel sick most of the time. D) I'm not looking forward to all the side effects of the drug treatments for my HCV, but I hope I don't end up needing a liver transplant.

It's at least a bit reassuring that my liver isn't undergoing damage when I'm not experiencing symptoms.

A nurse on a post-surgical unit is providing care for a 76 year-old female client who is two days post-hemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which of the following guidelines should the nurse use for short-term and long-term treatment of the client's pain?

Knowing that the client's self-report of pain is the most reliable indicator of pain. Explanation: Clinically, the patient's self-report of pain is the most reliable indicator of pain. The risk of addiction to opioids is extremely low and since the client's pain is acute rather than chronic, it is likely self-limiting. Page 867

The health care provider is performing a spinal tap on a client with suspected infection. The provider would perform the procedure at: a) S3 or S4 b) C3 or C4 c) L3 or L4 d) T3 or T4

L3 or L4 A pocket of CSF, the dural cisterna spinalis, extends from approximately L2 to S2. Because this area contains an abundant supply of CSF and the spinal cord does not extend this far, the area often is used for sampling the CSF. A procedure called a spinal tap, or puncture, can be done by inserting a special needle into the dural sac at L3 or L4. The spinal roots, which are covered with pia mater, are in little danger of trauma from the needle used for this purpose

The health care provider is performing a spinal tap on a client with suspected infection. The provider would perform the procedure at:

L3 or L4 Explanation: A pocket of CSF, the dural cisterna spinalis, extends from approximately L2 to S2. Because this area contains an abundant supply of CSF and the spinal cord does not extend this far, the area often is used for sampling the CSF. A procedure called a spinal tap, or puncture, can be done by inserting a special needle into the dural sac at L3 or L4. The spinal roots, which are covered with pia mater, are in little danger of trauma from the needle used for this purpose. Page 838

When discussing pain with patient what needs to be considered

LDRS: Location, Duration, Radiation, Severity

When assessing neurologic response times, the nurse expects the fastest rate of transmission to be from fibers that have which characteristics?

Large diameter, myelinated Explanation: Signal transmission is fastest in large diameter, myelinated fibers such as type A. Type B fibers are smaller in diameter and myelinated. Unmyelinated, small- diameter Type C fibers have the slowest conduction. Page 858

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

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 aware that the primary function of the sympathetic nervous system is:

Maintenance of vital functions and responding when there is a critical threat to the integrity of the individual Explanation: The sympathetic division maintains vital functions and responds when there is a critical threat to the integrity of the individual—the "fight-or-flight" response. The parasympathetic nervous system is concerned with conservation of energy, resource replenishment, and maintenance of organ function during periods of minimal activity. Page 848

A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman's unique ability?

Meissner corpuscles Explanation: Meissner corpuscles, which are present on the hair-free areas like palms and fingers, are responsible for fine tactile sensation. Pacinian corpuscles provide input on vibration, while Ruffini end organs exist in deeper structures that signal continuous states of deformation. Free nerve endings also detect touch and pressure, but not to the highly-differentiated degree of Meissner corpuscles. Page 858

A nurse is assessing a patient for manifestations of chronic pain. Which of the following is characteristic of chronic pain? Select all that apply.

Mental depression Withdrawal from activities Loss of appetite Explanation: Acute pain generally is classified as being of short duration and arises from a specific pathologic process that resolves. Acute pain may lead to tachycardia, increased sympathetic activity such as sweating, decreased mobility, and shallow breathing. Chronic pain lasts longer than expected and may fluctuate. Signs of chronic pain include insomnia, depression, and loss of appetite. Patients may withdraw from outside activities. Page 865

A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in a chemical synapse? A) Two-way communication between neurons is permitted in contrast to the one-way communication in electrical synapses. B) Communication between a neuron and the single neuron it is connected with will be facilitated. C) The neurotransmitter will cross gap junctions more readily. D) More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.

More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors.

Which of the following is the primary component of white matter?

Myelinated fibers Explanation: Myelin has a high lipid content, which gives it a whitish color, and the name "white matter" is given to the masses of myelinated fibers in the spinal cord and brain. The other options are not myelinated. Page 835

Which of the following is the primary component of white matter? a) Dendrites b) Myelinated fibers c) Cell bodies d) Demyelinated lesions

Myelinated fibers Myelin has a high lipid content, which gives it a whitish color, and the name "white matter" is given to the masses of myelinated fibers in the spinal cord and brain. The other options are not myelinated

A young teenager is brought to the clinic for an eye exam. She has been complaining that she is having difficulty in school as she cannot see the blackboard as clearly as she used to. She tells the nurse that it is blurry. What should the nurse suspect is wrong with this child? a) Myopia b) Hyperopia c) Presbyopia d) Immature cataracts

Myopia Myopia is a condition also referred to as nearsightedness where the person can see close objects without problems, but distant objects are blurred. It can be corrected with an appropriate concave-surface lens. -Hyperopia is when near images are blurred. -Presbyopia refers to a decrease in accommodation and is usually seen due to aging. - Immature cataracts deal with a change in the lens opacity which leads to interference of the transmission of light to the retina.

An overweight, 14-year-old boy feels tired all the time. He sleeps 12 to 14 hours a day and has a voracious appetite but no energy to burn off the calories. He has been diagnosed with hypothyroidism brought about by the accumulation of a nonpitting mucosus type of edema. For which life-threatening condition should his care team be prepared?

Myxedematous coma Explanation: Myxedema implies the presence of a nonpitting mucous type of edema caused by an accumulation of a hydrophilic mucopolysaccharide substance in the connective tissues throughout the body. The hypothyroid state may be mild, with only a few signs and symptoms, or it may progress to a life-threatening condition called myxedematous coma. Phaeocytoma is a tumour of the adrenal gland, Thyroid storm is related to hyperthyroidism and paraneoplastic syndrome is a separate condition. Page 781

Migraine headaches affect millions of people worldwide. What are first-line agents for the treatment of migraine headaches?

Naproxen sodium and metoclopramide Explanation: Based on clinical trials, first-line agents include acetylsalicylic acid, combinations of acetaminophen, acetylsalicylic acid, and caffeine and nonsteroidal anti-inflammatory drug analgesics (e.g., naproxen sodium, ibuprofen), serotonin (5-HT1) receptor agonists (e.g., sumatriptan, naratriptan, rizatriptan, zolmitriptan), ergotamine derivatives (e.g., dihydroergotamine), and antiemetic medications (e.g., ondansetron, metoclopramide). Morphine, tramadol, and syrup of ipecac are not first-line drugs in the treatment of migraine. Page 873

Severe lighting like pain

Neuralgia

While explaining the role of skeletal muscle relaxants, such as succinylcholine, used during anesthesia, the faculty mentions that these effects are caused by blocking: a) N2, neuronal-type receptor, a type of nicotinic acetylcholine receptor b) Norepinephrine c) Nicotinic acetylcholine receptors, muscle-type receptor (NM) d) Muscarinic acetylcholine receptors

Nicotinic acetylcholine receptors, muscle-type receptor (NM) Some skeletal muscle relaxants, such as succinylcholine, can be used to induce muscle relaxation and short-term paralysis in anesthesia by blocking NM receptors at the neuromuscular junction. The drug atropine is a competitive antagonist for the muscarinic acetylcholine receptor that prevents the action of acetylcholine at excitatory and inhibitory muscarinic receptor sites. Norepinephrine is released at most sympathetic nerve endings.

These are receptive nerve endings that respond to noxious stimuli.

Nociceptors

The newborn-nursery nurse is preparing to perform a required neonatal screening for congenital hypothyroidism. What should the nurse do to obtain the necessary sample?

Perform a heel stick to obtain a drop of blood for a T4 and TSH. Explanation: Screening is usually done in the hospital nursery. In this test, a drop of blood is taken from the infant's heel and analyzed for T4 and TSH. Page 780

Spinal nerves that form complex nerve networks are called which of the following?

Plexuses Explanation: Spinal nerves do not go directly to skin and muscle fibers; instead, they form complicated nerve networks called plexuses. A plexus is a site of intermixing nerve branches. After emerging from the vertebral column, the spinal nerve divides into two branches, or rami. The choroid plexus produces cerebrospinal fluit in the lateral, third and fourth ventricles. Reticular formation is the location of many important reflex circuits of the spinal cord and brain stem. Page 839

Which parts of the brain make up the brain stem? a) Cerebellum and reticular system b) Circle of Willis and hypothalamus c) Pons and medulla oblongata d) Limbic and diencephalons

Pons and medulla oblongata The brain stem consists of the pons and the medulla

When educating a patient about to undergo a pacemaker insertion, the nurse explains the normal phases of cardiac muscle tissue. During the repolarization phase, the nurse will stress that membranes must be repolarized before they can be re-excited. Within the cell, the nurse understands that: a) Potassium channels open and while sodium channels close causing repolarization to the resting state. b) Only the electrical activity within the heart will determine when repolarization occurs. c) The cell membranes need to stay calm resulting in muscle tissue becoming refractive. d) The influx of calcium is the primary stimulus for the repolarization of cardiac tissue.

Potassium channels open and while sodium channels close causing repolarization to the resting state. Repolarization is the phase during which the polarity of the resting membrane potential is re-established. This occurs with the closure of the sodium channels and opening of the potassium channels.

Which of the following patients is exhibiting headache symptoms that indicate a need for further evaluation?

Pregnant mother with drowsiness and unrelenting headache Primary headaches such as migraine, tension headache, cluster headache, and chronic daily headache do not require additional evaluation. Patients with secondary headaches should receive further evaluation. Possible causes of secondary headaches are cerebral hemorrhage or aneurysm, meningitis, cancer, and nerve lesions. Additional patients requiring further evaluation are those with sudden onset or progression of headaches or someone who is immunosuppressed or pregnant. Page 872

When testing nociceptive stimuli to elicit a withdrawal reflex in the body, what stimuli are commonly used?

Pressure from a sharp object Explanation: Stimuli used include pressure from a sharp object, strong electric current to the skin, or application of heat or cold of approximately 10°C above or below normal skin temperature. The other answers are incorrect. Page 875

Release of neurotransmitters occurs at which of the following locations in the neuron? a) Postsynaptic membrane b) Presynaptic terminal c) Synaptic cleft d) Endoneurium

Presynaptic terminal Chemical synapses involve special presynaptic and postsynaptic membrane structures, separated by the synaptic cleft. The presynaptic terminal secretes one and often several chemical transmitter molecules. The secreted neurotransmitters diffuse into the synaptic cleft and bind to receptors on the postsynaptic membrane. Each of the Schwann cells along a peripheral nerve is encased in a continuous tube of basement membrane, which in turn is surrounded by a multilayer sheath of loose connective tissue known as the endoneurium.

A patient is asked to stand with feet together, eyes open, and hands by the sides. Then the patient is asked to close his eyes while the nurse observes for a full minute. What assessment is the nurse performing? Segmental reflex Posture Proprioception Crossed-extensor reflex

Proprioception

A client is experiencing deep somatic pain would manifest which clinical symptoms? Select all that apply.

Radiation of pain Pain reproduced by stimuli Explanation: Deep somatic pain originates in deep body structures, such as the periosteum, muscles, tendons, joints, and blood vessels. This pain is more diffuse than cutaneous pain. Various stimuli, such as strong pressure exerted on bone, ischemia to a muscle, and tissue damage, can produce deep somatic pain. Radiation of pain from the original site of injury can occur. Cutaneous pain is a sharp pain with a burning quality, abrupt or slow in onset, and can be localized. Page 864

A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as:

Referred Explanation: Referred pain is pain that is perceived at a site different from its point of origin but innervated by the same spinal segment. Visceral pain originates in the visceral organs and is one of the most common pains produced by disease, cutaneous pain arises from superficial structures, and somatic pain originates in deep body structures. Page 864

Which of the following is the period during repolarization when a portion of the recovery period is where the membrane can be excited, although only by a stronger-than-normal stimulus? a) Hypopolarization b) Hyperpolarization c) Absolute refractory period d) Relative refractory period

Relative refractory period During repolarization, the membrane remains refractory until repolarization is approximately one third complete and is called the absolute refractory period. During a portion of the recovery period, the membrane can be excited, although only by a stronger-than-normal stimulus, and is called a relative refractory period. -The excitability of neurons can be affected by conditions that alter the resting membrane potential, moving it either closer (hypopolarization) or further (hyperpolarization) from the threshold potential.

Which of the following would be a symptom that is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)? a) Respiratory muscle impairment b) Dysarthria c) Fatigue d) Optic nerve dysfunction

Respiratory muscle impairment Dysphagia with recurrent aspiration and weakness of the respiratory muscles produce the most significant acute complication of ALS. MS does not typically include respiratory muscle impairment.

A client has started having uncontrolled seizures that are not responding to usual medications. Nursing working with the client must pay special attention to which of the following priority aspects of this clients care? Assessment of: a) Ability to grasp hands and squeeze on command b) ECG for arrhythmias c) Respiratory status and oxygen saturation d) Urine output and continence

Respiratory status and oxygen saturation Tonic-clonic status epilepticus is a medical emergency and, if not promptly treated, may lead to respiratory failure and death. Treatment consists of appropriate life support measures. Airway/breathing is always the priority in this emergency situation

Cerebellar tremor is exhibited by which symptom? a) Over- or underreaching for a target, followed by overcorrection b) Slow, slurred speech of continuous, varying loudness c) Constant conjugate readjustment of eye position d) Rhythmic movement of the finger or toe that worsens as a target is approached

Rhythmic movement of the finger or toe that worsens as a target is approached Cerebellar tremor is a rhythmic back-and-forth movement of a finger or toe that worsens as the target is approached. Symptoms associated with damage to the cerebellum are manifested based on the site of injury. Cerebellar tremor results from the inability of the damaged cerebellum to maintain ongoing fixation of a body part and to make smooth, continuous correction in the trajectory of movement; overcorrection occurs, first in one direction and then in the other. The other options reflect the inability to establish fixation in other areas.

Pain Receptors are found where

SDVP: Skin, dental pup, viscera, periostium

Which types of cells are supporting cells of the peripheral nervous system?

Schwann cells Explanation: The Schwann cells play an important role in supporting the peripheral nervous system. The other cells support the central nervous system. Page 823

Which of the following statements best captures the essence of a second messenger in the mechanisms of the endocrine system? A) Second messengers act as the intracellular signal that responds to the presence of a hormone. B) Endocrine-producing cells must release both a hormone and a second messenger in order to exert a distant effect. C) Second messengers act to supplement hormone effects on cell receptors when the desired hormonal effect must be either increased. D) Second messengers provide an alternative pathway for endocrine effects on a cell that bypass the normal receptor pathways.

Second messengers act as the intracellular signal that responds to the presence of a hormone.

Following destruction of the pituitary gland, ACTH stimulation stops. Without ACTH to stimulate the adrenal glands, the adrenals' production of cortisol drops. This is an example of which type of endocrine disorder?

Secondary Explanation: In secondary disorders of endocrine function, the target gland is essentially normal, but defective levels of stimulating hormones or releasing factors from the pituitary system alter its function. Page 786

While explaining to a group of nursing students what the function of the first mucosal layer of the lower two thirds of the esophagus, the pathophysiology instructor mentions which of the following functions? Select all that apply. A) Secretion of mucus to lubricate and protect the inner surface of the alimentary canal B) Smooth muscle cells that facilitate movement of contents of the GI tract C) Holding the organs in place and storage of fats D) Barrier to prevent the entry of pathogenic organisms E) A cushioning to protect against injury from sports or car accidents

Secretion of mucus to lubricate and protect the inner surface of the alimentary canal Barrier to prevent the entry of pathogenic organisms

A client with migraines asks the nurse about symptoms of an aura. Which manifestations are characteristic of a migraine aura? Select all that apply.

Seeing flickering lights or spots Feeling numbness in fingers Slurred speech Explanation: Migraine with aura has reversible symptoms that may include flickering lights, spots and lines, loss of vision, sensation of numbness, or pins and needles and speech disturbances. These symptoms occur from 5 to 20 minutes before the headache and last up to an hour. The definition of a chronic migraine is getting it 15 or more days per month. Page 873

A 32-year-old man is complaining of burning, itching, photophobia, and severe pain in his right eye after swimming in the ocean. To determine that the eye condition is corneal rather than a conjunctival disease, which of the following would be the distinguishing symptom? A.) Burning B.) Itching c.) photophobia D.) Severe pain

Severe pain

A client is experiencing a cluster headache. The client would most likely manifest:

Severe pain behind the eye Explanation: Symptoms of cluster headache include severe, unrelenting unilateral pain located in the orbital area. The pain radiates behind the eye to the ipsilateral trigeminal nerve. The client may also experience symptoms such as restlessness or agitation, conjunctival redness, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, and eyelid edema. The other options are all associated with migraine headache. Page 874

These are also known as brain attacks.

Strokes

The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which of the following symptoms? a) Wheezing b) Chest pain c) Stupor d) Pupils that react to light

Stupor The most frequent sign of brain dysfunction is an altered level of consciousness such as stupor. Pupils that react to light, wheezing and chest pain are not symptoms of brain function.

Following a knee injury, a football player is taking ibuprofen, a non-steroidal anti-inflammatory drug, for the control of pain. Which of the following drug actions is most likely to result in diminished sensation of pain for the player?

The drug inhibits the enzyme needed for prostaglandin synthesis. Explanation: Analgesia can be achieved by inhibition of prostaglandin synthesis, as in the case many NSAIDs. These drugs do not affect the function of third order neurons, the action potential of C fibers or the conduction velocity of Aδ fibers.

A client is being treated for the ingestion of a neurotoxin that interferes with the depolarization phase of action potentials. What physiologic process will be disrupted?

The inflow of sodium ions Explanation: Sodium ions rapidly exit the neuron during the depolarization phase of the action potential. Potassium ions do not leave the cell during this phase. Resting potential and the establishment of the refractory period do not occur during the depolarization phase. Page 826

A clinician is conducting an assessment of a male patient suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? The patient displays weakness in the distal portions of his limbs. The patient's muscles appear atrophied. The patient displays increased muscle tone. The patient has decreased deep tendon reflexes.

The patient displays increased muscle tone.

The health care provider is assessing the functional integrity of all spinal nerves utilizing a pinpoint pressed against the skin. A normal response would be interpreted as:

The withdrawal reflex is activated. Explanation: Observation of a normal withdrawal reflex rules out peripheral nerve disease, disorders of the dorsal root and ganglion, disease of the myoneural junction, and severe muscle diseases. Having no response is abnormal and may identify neurological damage. A verbal response is not a reflex response. Page 855

Children feel pain just as much as adults do. What is the major principle in pain management in the pediatric population?

Treat on individual basis and match analgesic agent with cause and level of pain. Explanation: The overriding principle in all pediatric pain management is to treat each child's pain on an individual basis and to match the analgesic agent with the cause and the level of pain. The other answers are incorrect. Page 876

The nurse teaches a client about a new diagnosis of astrocytoma. Which statement indicates an accurate understanding?

Treatment is hard since glial cells support neurons and blood vessels in the brain. Explanation: Astrocytes are the most common of four types of neuroglial cells. Astrocytes support neurons, wrap around blood vessels and form a sealed barrier to protect the central nervous system (CNS). Due to these characteristics, tumors of the glial cells are difficult to kill without profound impact on the client's CNS. Page 823

The vertebral column provides protection for the spinal cord, spinal nerves, and supporting structures. a) False b) True

True

It is important to differentiate between the kinds of hearing loss so they can be appropriately treated. What is used to test between conductive and sensorineural hearing loss? a) Audioscope b) Tuning fork c) Tone analysis d) Audiometer

Tuning fork Tuning forks are used to differentiate conductive and sensorineural hearing loss. -Audioscope, audiometer, and tone analysis do not differentiate between conductive and sensorineural hearing loss.

There are ____ distinct ______ pathways that provide pain transmission.

Two; Neural

A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be: a) Tympanostomy tube insertion b) Monitoring for complications of OM c) The child will need a hearing aid d) Retreating with a stronger antibiotic

Tympanostomy tube insertion Tympanostomy tubes should be the next course of action with the child having hearing loss and OM persisting for 4 months or longer. The parents should be taught to continue to monitor for signs of OM.

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

Vasoconstriction Explanation: The α1 receptors are primarily found in postsynaptic effector sites; they mediate responses in vascular smooth muscle. It causes vasoconstriction in many blood vessels, including those of the skin, gastrointestinal tract, kidney, and brain. Page 852

A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood brain barrier and been transferred from the vascular space into the client's interstitial space. Which of the following diagnoses best captures this pathophysiology? Focal hypoxia Cytotoxic edema Hydrocephalus Vasogenic edema

Vasogenic edema

The nurse is preparing a client for a surgical procedure to create an endolymphatic shunt. The nurse understands that this procedure aims to relieve which of the following symptoms? a) Strabismus b) Vertigo c) Otalgia d) Diplopia

Vertigo A surgical method to treat Meniere disease includes the creation of an endolymphatic shunt in which excess endolymph from the inner ear is diverted into the subarachnoid space or the mastoid area. This relieves symptoms associated with Meniere disease, such as vertigo. The other symptoms are not manifestations of Meniere disease.

A female toddler has been diagnosed with toeing-in (metatarsus adductus). What teaching should the pediatrician provide to the parents of the child about her diagnosis? A) She will likely walk later than most children, but it will resolve itself with time. B) We'll likely need to start putting the first of a series of casts on her legs quite soon. C) The best time to perform the surgery that's needed will be at age 3 or 4. D) While there's no effective treatment for her toeing-in, most children learn to accommodate the problem and walk independently.

We'll likely need to start putting the first of a series of casts on her legs quite soon.

The parents of a 3-year-old boy have brought him to a pediatrician for assessment of the boy's late ambulation and frequent falls. Subsequent muscle biopsy has confirmed a diagnosis of Duchenne muscular dystrophy. Which of the following teaching points should the physician include when explaining the child's diagnosis to his parents? A) Your son's muscular dystrophy is a result of faulty connections between muscles and the nerves that normally control them. B) He'll require intensive physical therapy as he grows up, and there's a good chance that he will outgrow this problem as he develops. C) Your son will be prone to heart problems and decreased lung function because of this. D) His muscles will weaken and will visibly decrease in size relative to his body size throughout his childhood.

Your son will be prone to heart problems and decreased lung function because of this.

What type of pain is generally short duration and disappears when the underlying pathology is resolved

acute pain

Patients with pain under 5 should first be tried with .... to relieve pain

analgesics such as panadol, nsaids

Examples of conditions that cause of visceral pain

appendicitis, gastric ulcer

Which of the following types of synapse allows the quickest transmission from one neuron to another? a. Excitatory b. Electrical c. Chemical d. Inhibitory

b. Electrical

Neurons that connect sensory and motor neurons are known as which of the following? a. Afferent neurons b. Interneurons c. Cranial nerves d. Efferent neurons

b. Interneurons

A child is experiencing difficulty with chewing and swallowing. The nurse knows that which of the following cells may be innervating specialized gut-related receptors that provide taste and smell? a. Special somatic afferent fibers. b. Special visceral afferent cells. c. General somatic afferents. d. General visceral afferent neurons.

b. Special visceral afferent cells.

Through what specific component do neurotransmitters exert their action? a. Water b. Specific proteins c. Carbon dioxide d. Oxygen

b. Specific proteins

Neurons communicate with each other through which structure? a. Dendrites b. Synapses c. Neural crest cells d. Cell bodies

b. Synapses

Following a spinal cord injury suffered in a motor vehicle accident, a 22 year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? a. The reticular formation b. The outer layer (neolayer) c. The middle layer (paleolayer) d. The inner layer (archilayer)

b. The outer layer (neolayer)

A client has been recently diagnosed with Alzheimer disease and has been prescribed a cholinesterase inhibitor. This drug will slow the progression of the client's symptoms by: a. increasing the frequency of action potentials. b. decreasing ACh breakdown. c. increasing the rate of action potentials. d. decreasing ACh synthesis.

b. decreasing ACh breakdown.

A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman's diagnosis? Question options: Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes Atrophy and decreased blood flow in the amygdala Reduced activity and gray matter volume in the prefrontal cortex Decreased brain activity in the pons and brain stem

c

A 60-year-old male patient with a long history of back pain has had little success with a variety of analgesic regimens that his nurse practitioner has prescribed. He has recently been diagnosed formally with a chronic pain disorder. Which of the following teaching points about chronic pain would his nurse practitioner most likely emphasize to the patient? Question options: "You need to remind yourself that this is a purely physical phenomenon that requires physical treatment." "If your pain comes and goes, then we won't characterize it as chronic, and it will require different treatment." "These pain signals your body is sending likely serve no real, useful, or protective function." "Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about."

c

A client arrives in the clinic after having a tongue piercing performed and is unable to control the movement of the tongue. The nurse is aware that which nerve may have been damaged from the piercing? a. Trigeminal b. Abducens c. Hypoglossal d. Vagus

c. Hypoglossal

Which type of pain is visible and easily located

cutaneous pain

Which pain is deep body pain, of muscles, tendons,

deep somatic

what is the purpose of paleospinthalamic tract

group of fibres that carry and transmit slow pain impuses

give an example of referred pain

hearth attack, pain is usually left arm and jaw

When reviewing the purpose/action of neurotransmitters as they interact with different receptors, the nursing instructor gives an example using acetylcholine. When acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is A) positively charged. B) inhibitory. C) overstimulated. D) dormant.

inhibitory

Neurotransmitters like catecholamines (e.g., dopamine and epinephrine) have a reaction time of A) milliseconds. B) less than 10 minutes. C) 24 to 36 hours. D) 4 to 7 days.

milliseconds

Growth hormone (GH) secretion is inhibited by A) hypoglycemia. B) starvation. C) heavy exercise. D) obesity.

obesity.

What is the most common thing that promotes patients to seek assistance

pain

What is the unpleasant sensory and emotional experience associated with actual and potential tissue damage?

pain

Trigeminal neuralgia is best defined as

pain of unilaterd stabbing, sinus, mouth, tongue

The point at which stimuli is perceived as painful is the

pain threshold

The sense of limb and body movement and position without vision is called

proprioception

Which pain is felt elsewhere than injury

referred pain

An elderly woman comes to the clinic complaining of seeing flashing lights and small spots. She tells the nurse that this has been going on for over 24 hours but now it is as if she sees a dark curtain whenever she opens her eyes. She asks the nurse if this means she is going to be blind. What diagnosis should the nurse suspect ? a) conjunctivitis b) retinal detachment c) cataracts d) glaucoma

retinal detachment The primary symptom of retinal detachment consists of painless changes in vision. Commonly, flashing lights or sparks, followed by small floaters or spots in the filed of vision occur. As the detachment progresses the person perceives a shadow or dark curtain across the visual field.

define nociception

sense of pain

Define nocicptor

sensory receptor that responds to pain

Phantom limb pain occurs when

someone complains of pain after amputation

A 68-year-old African American man who has smoked for at least 50 years reports that lately he feels as though food is getting stuck in his throat. At first, this was a problem just with dry food, but now his morning oatmeal is getting stuck. On questioning, he reports drinking at least three alcoholic beverages nearly every day. His problem is most likely A) achalasia. B) squamous cell carcinoma of the esophagus. C) dysphagia secondary to scleroderma. D) gastrointestinal reflux disease.

squamous cell carcinoma of the esophagus.

A mother brings her toddler to the clinic and tells the nurse that she thinks something is wrong with the baby's eyes. Upon further assessment the nurse notices that the child has upper deviation in movement in only one eye. What should the nurse suspect is wrong with the child? a) cataract b) glaucoma c) amblyopia d) strabismus

strabismus Strabismus or squint, refers to any abnormality of eye coordination or alignment that results in loss of binocular vision. -Amblyopia refers to lazy eye. -Glaucoma is a chronic degenerative optic neuropathy and - cataract affects the lens of the eye.

Define myelinated

to have a myelated sheath. ie around axon

How many neural pathways are there that are distinct neural pathways that provide pain transmission

two: neospinothalamic and paleospinothalamic.

Which drug, administered by the nurse to a client with a heart rate of 40 and syncope, is a muscarinic blocking drug that will increase the heart rate? a) Atropine b) Dopamine c) Lidocaine d) Epinephrine

• Atropine The drug atropine is an antimuscarinic or muscarinic cholinergic blocking drug that prevents the action of acetylcholine at excitatory and inhibitory muscarinic receptor sites. Because it is a muscarinic blocking drug, it exerts little effect at nicotinic receptor sites.

The nurse assessing a patient with a traumatic brain injury assesses for changes in which of the following? Select all that apply. a) Sensory function b) Level of consciousness c) Metabolic function d) Motor function e) Cognition

• Cognition • Level of consciousness • Motor function • Sensory function Brain injuries can cause changes in level of consciousness and alterations in cognition, motor, and sensory function; therefore, the nurse assessing a patient with a traumatic brain injury should assess for changes in these areas.

Which symptoms would support the diagnosis of a stroke involving the posterior cerebral artery? Select all that apply. a) Repeating of verbal responses b) Loss of central vision c) Contralateral hemiplegia d) Denial of paralyzed side e) Aphasia

• Loss of central vision • Repeating of verbal responses Posterior cerebral artery stroke would produce visual defects and the repeat of verbal and motor responses. -The other options are seen in middle cerebral artery strokes.

Which structures are part of the brain stem? Select all that apply. a) Pons b) Midbrain c) Cerebellum d) Medulla oblongata

• Medulla oblongata • Pons • Midbrain The term brain stem is often used to include the medulla, pons, and midbrain. The cerebellum is not part of the brain stem.

The vertebral column provides protection of: Select all that apply. a) Supporting structures b) Tendons c) Spinal nerves d) Spinal cord e) Muscles

• Spinal cord • Spinal nerves • Supporting structures The vertebral column provides protection for the spinal cord, spinal nerves, and supporting structures.

Which of the following nursing interventions is the highest priority intervention for a nurse caring for a 26-year-old client diagnosed with benign paroxysmal positional vertigo implement? a) Adminster ordered antibiotic b) Weber test c) Skin assessment d) Fall precautions

Fall precautions The patient with benign paroxysmal positional vertigo experiences brief periods of vertigo when getting in and out of bed, bending over and straightening up, and extending head to look up. This places the patient at increased risk for falls and necessitates implementation of fall precautions. -The Weber test and administration of an antibiotic are not indicated when caring for a patient with benign paroxysmal positional vertigo. -Skin assessment, while always a part of the nursing assessment, has a lower priority than implementation of safety measures for this client.

Multiple sclerosis is caused by various neurotransmitter deficiencies.

False

A 28-year-old male who is 6 feet 11 inches tall has a diagnosis of acromegaly. The man is explaining to a curious but sympathetic coworker exactly what accounts for his extraordinary height. Which of the following explanations demonstrates a sound understanding of his health problem? "A tumor in my brain threw off my hormone levels after I was finished with adolescence." "My pituitary gland produced a much higher than normal amount of growth hormone when I was a child." "The high sugar levels that go along with my diabetes made my pituitary gland overproduce the hormones that cause you to grow." "My liver is malfunctioning and produces too many of the hormones that ultimately cause growth."

"A tumor in my brain threw off my hormone levels after I was finished with adolescence."

A client is being taught how to use a TENS unit .The nurse determines that teaching was effective when the client states:

"I should take my medication and apply the TENS unit to the painful area as soon as I feel the pain." Explanation: Early intervention for pain relief is the best practice. The client should understand that he or she should take his or her pain medication and apply the TENS unit. TENS units are noninvasive and should be applied as soon as the client starts to perceive pain. It is often used in conjunction with pain-relieving medication. Page 867

The nurse is teaching a teenaged client strategies to avoid recurrent ear infections. The nurse understands that further teaching is required when the client states which of the following? a) "I will take my allergy medication as it has been prescribed." b) "I will use the eardrops as prescribed for me." c) "I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming." d) "I'll wear ear plugs each time I swim."

"I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming." Otitis externa treatment usually includes the use of eardrops containing an appropriate antimicrobial or antifungal agent. -Use of ear plugs is recommended to prevent moisture. Cotton-tipped applicators and other devices should be avoided.

A female client with rheumatoid arthritis has taken high doses of aspirin for several years to control inflammatory pain. Which of the following statements leads the health care provider to suspect the client has developed ototoxicity?

"I've been getting dizzy and light-headed. I seem to have a constant ringing in my ear." Ototoxicity results in sensorineural hearing loss. Vestibular symptoms of ototoxicity include light-headedness, giddiness, and dizziness; if toxicity is severe, cochlear symptoms consisting of tinnitus or hearing loss occur. -The symptoms of drug-induced hearing loss may be transient, as often is the case with salicylates and diuretics, or they may be permanent. -Hearing loss in the elderly is further characterized by reduced hearing sensitivity and speech understanding in noisy environments, slowed central processing of acoustic information, and impaired localization of sound sources. -High-frequency warning sounds, such as beepers, turn signals, and escaping steam, are not heard and localized, with potentially dangerous results. -Clinical measures for hearing loss such as whispered voice tests and finger friction tests are reportedly imprecise and are not reliable methods for screening.

A beta-adrenergic blocker has been prescribed for a client diagnosed with migraines. The most important information for the nurse to teach the client would be:

"Take the medication daily as you have been directed." Explanation: Preventative medications such as beta-adrenergic blockers should be taken consistently to prevent vascular changes from occurring. In most cases, preventative treatment must be taken daily for months to years. They should not be stopped abruptly and should be weaned or tapered off. Page 874

A client with Graves' disease has opthalmopathy and asks the nurse if the eyes will stay like this forever. What is the best response by the nurse?

"With treatment of the hyperthyroid state, the opthalmopathy usually tends to stabilize." Explanation: The ophlalmopathy of Graves' disease can cause severe eye problems, including tethering of the extraocular muscles resulting in diplopia; involvement of the optic nerve, with some visual loss; and corneal ulceration because the lids do not close over the protruding eyeball. The opthalmopathy usually tends to stabilize after treatment of the hyperthyroidism. Page 782

A patient discharged from the hospital 5 days ago following a stroke has come to the emergency department with facial droop that progressed with hemiplegia and aphasia. The patient's spouse is extremely upset because the physician stated that the patient cannot receive thrombolytic medications to reestablish cerebral circulation and the spouse asks the nurse why. Which of the following is the nurse's most accurate response? a) "All the brain tissue damage is already done." b) "Thrombolytics may cause cerebral hemorrhage." c) "The medications do not work with subsequent strokes." d) "The stroke is hemorrhagic, not thrombotic."

"Thrombolytics may cause cerebral hemorrhage." A previous stroke, occurring within 3 months of the administration of thrombolytics, significantly increases the risk of intracranial hemorrhage.

Which of the following questions is most likely to be clinically useful in the differential diagnosis of sensorineural versus conductive hearing loss? "Do you ever hear a persistent ringing in your ears?" "Has your hearing loss developed quickly or more slowly?" "What effect is this hearing loss having on your quality of life?" "What medications do you currently take?"

"What medications do you currently take?"

An endocrinologist is providing care for a 30-year-old male who has lived with the effects of increased levels of GH. Which of the following teaching points about the patient's future health risks is most accurate? a.) "When your pituitary gland is enlarged, there's a real risk that you'll develop some sight deficiencies. b.) "The high levels of GH that circulate in your body can result in damage to your liver." c.) "GH excess inhibits your pancreas from producing enough insulin." d.) "It's not unusual for unusually high GH levels to cause damage to your hypothalamus."

"When your pituitary gland is enlarged, there's a real risk that you'll develop some sight deficiencies."

The spouse of a patient diagnosed with Alzheimer's disease asks the nurse why the patient often neglects to take a shower. The spouse states that the patient was always diligent with hygiene in the past; however, over the past few months that has not been the case. Which of the following is the nurse's best response? a) "The patient would be fine without showering." b) "You should remind the patient to shower." c) "The patient is experiencing a temporary relapse." d) "The patient just does not care anymore."

"You should remind the patient to shower." The patient should be reminded to shower because most likely he or she has difficulty remembering to do so. In the moderate stage of Alzheimer's disease, which can last for several years, it is not unusual for hygiene to be neglected because the person may just not remember if he or she did or did not shower. There is no information in the question to support the remaining responses.

The nurse is preparing a client for testing to determine if the client has Cushing syndrome. What tests are included in the screening process? Select all that apply.

-24-hour urine secretion of cortisol -Dexamethasone suppression test -Plasma levels of ACTH Explanation: The determination of 24-hour excretion of cortisol in urine provides a reliable and practical index of cortisol secretions. One of the prominent features of Cushing syndrome is loss of the diurnal pattern of cortisol secretion. The overnight 1 mg dexamethasone suppression test is also used as a screening tool for Cushing syndrome. Other tests include measurement of plasma levels of ACTH. Page 789

Which clients would be considered an example of referred pain? Select all that apply.

-One with a myocardial infarction who states, "an elephant is sitting on my chest." -One with renal calculi who describes a cramping colicky pain in the scrotum. Explanation: Referred pain is pain originating in one area of the body that is perceived at a different site. Organs of the chest and abdomen commonly refer pain to other locations. Heart pain commonly refers to the chest, left arm, and neck. The kidneys refer pain to the flank and groin. The bladder may refer to the inner thighs. The lungs and diaphragm may refer to the shoulder. Diabetic foot ulcers produce numbness in the lower leg which is the location of the problem and not referred pain. Page 864

The nurse witnesses a client go into cardiac arrest. If the nurse delays intervention, when will the death of brain cells begin?

4-6 minutes Explanation: Unconsciousness occurs almost simultaneously with cardiac arrest, and the death of brain cells begins within 4 to 6 minutes. Interruption of blood flow also leads to the accumulation of metabolic byproducts that are toxic to neural tissue. Page 825

Which client does the nurse recognize is at the most risk for the development of subacute thyroiditis?

A 32-year-old postpartum client Explanation: The transient hyperthyroid state is caused by leakage of preformed thyroid hormone from damaged cells of the gland. Subacute thyroiditis, which can occur in postpartum (postpartum thyroiditis) can also result in hypothyroidism. Page 780

Large amounts of glucagon were recently released into an individual's circulation, but glucagon circulation has now ceased. Which of the following situations could have led to this inhibition of glucagon release? a.) A decrease in cellular metabolic needs and an increase in glucose levels b.) Recent intake of large amounts of protein-rich food c.) Recent strenuous physical activity d.) A sharp decrease in blood glucose concentration

A decrease in cellular metabolic needs and an increase in glucose levels

Four weeks after returning from a tropical vacation, a 40-year-old man has presented to the emergency department with malaise, nausea, and yellow eyes. Serology has confirmed a diagnosis of hepatitis A (HAV), to the shock of the client. What teaching is most appropriate for this client? A)You can expect these symptoms to disappear after about 2 months, but you'll be a carrier of the disease indefinitely. B) A vaccine before your trip would have prevented this, but be assured your body will rid itself of the virus in time. C) You likely came in contact with blood or body fluids at some point, and you'll have to ensure no one is subsequently exposed to your own blood or body fluids. D) You likely got this by way of what we call the 'fecal oral' route; you will have chronic hepatitis now, but the symptoms can be controlled with medication

A vaccine before your trip would have prevented this, but be assured your body will rid itself of the virus in time.

Which of the following individuals is most likely to be diagnosed with a central vestibular disorder? a) A woman who has ongoing difficulty balancing herself when walking. b) A man who states that he feels car sick whenever he rides in the back seat of a vehicle. c) A man who got up quickly from his bed and sustained an injury after he "blacked out". d) A woman who suffered a loss of consciousness after being struck on the head during a soccer game.

A woman who has ongoing difficulty balancing herself when walking. Central vestibular disorders are marked by a sensation of motion that interferes with balance, but that is mild and constant and chronic in duration. It should be differentiated from postural hypotension, loss of balance from a head injury or motion sickness.

A nurse who is testing a patient's response to passive movement of the fingers with the patient's eyes closed, notes that the patient cannot accurately identify on which side the movement occurred or in what position the finger was placed. Which of the following is an appropriate interpretation of this result?

Abnormal discrimination pathway function Explanation: The discriminative dorsal column-medial lemniscus pathway is able to sense fine touch and discriminate between two points as close as 5 mm. This pathway also mediates sense of position. Loss of this pathway means only that the anterolateral pathway is functioning and is unable to make fine distinctions in touch proprioception and points. The test does not test reflexes or temperature. Page 856

Which of the following are the main neurotransmitters of the autonomic nervous system (ANS)? Select all that apply.

Acetylcholine Epinephrine Norepinephrine Explanation: The main neurotransmitters of the ANS are acetylcholine and the catecholamines epinephrine and norepinephrine. Monoamine oxidase is found in the nerve endings to degrade catecholamines. Tyrosine is an amino acid that is a precursor to catecholamines. Page 827

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: a) Prepare the client for emergency surgery b) Monitor vital signs closely for improvement c) Administer IV tissue-type plasmin activator (tPA) d) Administer analgesics for the relief of pain

Administer IV tissue-type plasmin 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 knows that which of the following patients listed below is at high risk for developing a hip fracture? A) A 77-year-old male who runs marathons and maintains a BMI of 25. B) An 82-year-old female with macular degeneration and uses a walker to go to the bathroom. C) A 64-year-old male with uncontrolled diabetes and chronic kidney disease on dialysis. D) A 73-year-old nursing home patient with long-term continence issues but able to walk the hallways for exercise.

An 82-year-old female with macular degeneration and uses a walker to go to the bathroom.

Chronic pain is difficult to treat. Cancer, a common cause of chronic pain, has been especially addressed by the World Health Organization (WHO). What has WHO created to assist clinicians in choosing appropriate analgesics?

An analgesic ladder for pain control Explanation: The World Health Organization has created an analgesic ladder for cancer pain that assists clinicians in choosing the appropriate analgesic. The other answers are incorrect. Page 867

The students are reviewing the anatomy of the eye and where the eye structures are located. Where is the anterior chamber located? a) Anterior segment of the globe b) Posterior segment of the globe c) Retina d) Choroid

Anterior segment of the globe The anterior chamber is in the anterior segment of the globe, not the posterior segment of the globe, choroid or retina.

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

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.

The nurse is explaining to the parent of a 5-year-old that the child has otitis media with effusion (OME), noted by otoscopic exam, following an upper respiratory infection. Unlike acute otitis media (AOM), OME does not require treatment with antibiotics because it is usually which of the following? a) Asymptomatic and requires the administration of antivirals b) Very symptomatic and requires immediate intervention c) Symptomatic and the tympanic membrane is blue d) Asymptomatic and often self-limiting

Asymptomatic and often self-limiting It is very important to distinguish appropriately AOM from OME to ensure the proper treatment and to avoid the unnecessary use of antimicrobials. AOM often presents with sudden onset of ear pain, fever, hearing loss, and middle ear infection, whereas OME often presents as an asymptomatic effusion of the middle ear.

The parasympathetic nervous system is part of which of the following systems?

Autonomic nervous system Explanation: The efferent outflow from the autonomic nervous system has two divisons: the sympathetic nervous system and the parasympathetic nervous system Page 847

The parasympathetic nervous system is part of which of the following systems? a) Central nervous system b) Autonomic nervous system c) Somatic nervous system d) Thoracolumbar nervouse system

Autonomic nervous system The efferent outflow from the autonomic nervous system has two divisons: the sympathetic nervous system and the parasympathetic nervous system.

Which classification of medication does the nurse prepare to administer to the client with hyperthyroidism that will block the effects of the hyperthyroid state on sympathetic nervous system function?

Beta-adrenergic blocking agent Explanation: The beta-adrenergic blocking drugs (propranolol, metoprolol, atenolol, and nadolol are preferred) are administered to block the effects of the hyperthyroid state on sympathetic nervous system function. They are given in conjunction with antithyroid drugs such as propylthiouracil and methimazole. Page 782

A patient admitted to the emergency department with a change in mental status and a history of AIDS and primary central nervous system (CNS) lymphoma becomes extremely combative with the medical personnel. A family member is very upset with the patient's behavior. The nurse explains that these behaviors are most likely caused by which of the following? a) Recurrence of primary CNS lymphoma b) Decrease in intracranial pressure c) Onset of early dementia d) AIDS-induced encephalopathy

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.

The health care provider is teaching a client about the metabolic effect of cortisol. The most appropriate information to provide would be:

Breakdown of proteins and fats Explanation: The best-known metabolic effect of cortisol and other glucocorticoids is their ability to stimulate gluconeogenesis (glucose production) by the liver. Metabolic effects of cortisol involve the metabolism of proteins, carbohydrates, and fats. Behavior and emotion regulation is a psychological effect of cortisol. The other two options are immunologic and inflammatory effects of cortisol. Page 784

A client with acromegaly comes to the clinic and informs the nurse that she is having a productive cough and a low grade fever. This is the client's fourth visit in one year for the same problem. What condition does the nurse understand results from this client's enlarged cartilaginous structures?

Bronchitis Explanation: The cartilaginous structures in the larynx and respiratory tract become enlarged, resulting in a deepening of the voice and tendency to develop bronchitis. Page 774

A 30-year-old man with a diagnosis of type 1 diabetes is aware of the multiple effects that insulin has on his metabolism. Which of the following physiological processes are actions of insulin? Select all that apply. A) Increasing the metabolic needs of body cells B) Promoting the breakdown of stored triglycerides C) Facilitating triglyceride synthesis from glucose in fat cells D) Inhibiting protein breakdown E) Promoting glucose uptake by target cells

C) Facilitating triglyceride synthesis from glucose in fat cells D) Inhibiting protein breakdown E) Promoting glucose uptake by target cells

A nurse educator is explaining basic neuroanatomy to a class of prospective nursing students. Which statement best conveys an aspect of the role of cerebrospinal fluid (CSF)?

CSF cushions the brain and provides a near-water medium for diffusion of nutrients. Explanation: In addition to providing a cushion for the CNS, CSF provides a medium that is 99% water in which nutrients, electrolytes, and wastes can be diffused. It is not centrally involved in the distribution of oxygen, plasma proteins, or blood cells. Page 844

Which of the following statements best conveys an aspect of the role of cerebrospinal fluid (CSF)? a) CSF distributes plasma proteins throughout the superficial gray matter of the CNS. b) It provides physical protection for the brain and ensures leukocytes and erythrocytes are evenly distributed in the CNS. c) CSF cushions the brain and provides a near-water medium for diffusion of nutrients. d) It ensures the high metabolic and oxygenation needs of the brain are met, as well as absorbing physical shocks.

CSF cushions the brain and provides a near-water medium for diffusion of nutrients. In addition to providing a cushion for the CNS, CSF provides a medium that is 99% water in which nutrients, electrolytes and wastes can be diffused. It is not centrally involved in the distribution of oxygen, plasma proteins or blood cells.

The thalamus is located in which of the following parts of the brain?

Diencephalon Explanation: The dorsal horn of the diencephalon consists of the thalamus and the subthalamus. Page 840

What can the nurse assume about a child's behavior when faced with the need to repeat a painful procedure?

Children act to avoid pain based on their memory of past painful events. Explanation: Children do feel pain and have been shown to reliably and accurately report pain. They also remember pain. This is evidenced in studies of children with cancer, whose distress during painful procedures increases over time without intervention, and in neonates in intensive care units, who demonstrate protective withdrawal responses to a heel stick after repeated episodes. The other options may not necessarily be true of most children. Page 875

The nurse is assessing a patient's risk for sensorineural hearing loss. Which of the following places the patient at greatest risk? a) Impacted earwax b) Nystagmus c) Chronic noise exposure d) Otitis media

Chronic noise exposure Chronic exposure to noise is a risk factor for sensorineural hearing losses. Impacted earwax and otitis media are risk factors for conductive hearing loss.

The parents of an active 9-year-old are leaving the emergency department (ED) following cast placement for their son's lower extremity as a result of a fall in soccer. The nurse should emphasize that assessment of the cast is important and that they should bring their son back to the ED if they note which of the following signs and symptoms? Select all that apply. A) Cold, pale toes on the side with the cast. B) Patient complaining of tingling and numbness in the casted leg. C) Swelling in the lower leg has remained the same since they left the ED 12 hours ago. D) Pulses are palpable below the level of the cast. E) Bruising noted in the lower foot and toes.

Cold, pale toes on the side with the cast. Patient complaining of tingling and numbness in the casted leg.

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? a) Contains the main motor pathways between the forebrain and the pons b) Coordinates smooth and accurate movements of the body c) Contains the pontine nuclei d) Conveys the senses of pain, temperature, touch, and proprioception to the superficial and deep regions of the face

Coordinates smooth and accurate movements of the body The cerebellum compares what is actually happening with what is intended to happen. It then transmits the appropriate corrective signals back to the motor system, instructing it to increase or decrease the activity of the participating muscle groups so that smooth and accurate movements can be performed. Answer B describes the trigeminal nerve, which exits the brain stem. Answer C describes the pons. Answer D describes the midbrain.

Which disorder is a result of excess cortisol?

Cushing syndrome Explanation: The term Cushing syndrome refers to the manifestations of hypercortisolism from any cause. Turner's and Marfan syndromes are chromosomal disorders that affect height while Hashimoto disease is a thyroid disorder. Page 788

A 9 year-old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte imbalances. The nurse knows which of the following aspects of the nervous system listed below would her healthcare providers focus their diagnostic efforts? A. Potential damage to the girl's cerebellum B. Possible damage to her pons and medulla C. Her afferent and efferent cranial nerve function D. Impaired function of her hypothalamus

D. Impaired function of her hypothalamus Explanation: The hypothalamus plays a central role in the maintenance of fluid and electrolyte balance and in the maintenance of endocrine control. Various cranial nerves, the hindbrain and the cerebellum would be less likely to be implicated. Page 850

A patient 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 patient paralyzed with medications and on the ventilator. The most appropriate response would be that these therapies do which of the following? a) Increase oxygen demands and metabolic needs b) Decrease the patient's ability to attempt suicide again c) Decrease metabolic needs and increase oxygenation d) Decrease intracranial fluid volumes and pressures

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 patient paralyzed decreases the body's metabolic needs.

A 22-year-old woman has sustained a lateral blow to her right knee during a game, and subsequent imaging has confirmed a severe meniscus injury. Which of the following consequences should the woman expect over the course of recovery? Select all that apply. A) Decreased lubrication in the knee joint B) Decreased stability of the knee C) Reduced shock absorption capacity D) microorganisms in the synovial capsule E) Rapid restoration of the cartilage cells in the meniscus

Decreased lubrication in the knee joint Decreased stability of the knee Reduced shock absorption capacity

Following surgery for a large malignant brain tumor, the nurse should anticipate discussing which further treatment option with the family that may ensure that any remaining cancer cells will be killed? a) Gamma knife radiation b) Immunotherapy c) Chemotherapy d) Stem cell transplant

Gamma knife radiation Most malignant brain tumors respond to external irradiation. Irradiation can increase longevity and sometimes can allay symptoms when tumors recur. The treatment dose depends on the tumor's histologic type, responsiveness to radiation, and anatomic site and on the level of tolerance of the surrounding tissue. A newer technique called gamma knife combines stereotactic localization of the tumor with radiosurgery, allowing delivery of high-dose radiation to deep tumors while sparing the surrounding brain.

When the assessment of thyroid autoantibodies is performed, what is the suspected diagnosis?

Hashimoto thyroiditis Explanation: The assessment of thyroid autoantibodies (e.g., antithyroid peroxidase antibodies in Hashimoto thyroiditis) is important in the diagnostic workup and consequent follow-up of thyroid clients. Page 778

A patient with memory loss is concerned about the possibility that it may be inherited. Which of the following disorders is an inherited dementia? a) Vascular dementia b) Wernicke-Korsakoff syndrome c) Frontotemporal dementia d) Huntington's disease

Huntington's disease Vascular dementia occurs as a result of brain injury from hemorrhage or occlusion. Frontotemporal dementia causes atrophy of the brain but is not hereditary. Wernicke-Korsakoff syndrome is a result of chronic alcoholism. Huntington's disease is an inherited disorder with chorea and dementia.

With which of the following activities would a patient experiencing astereognosis need help?

Identifying an object by touch Explanation: Astereognosis is the inability to identify objects by touch. The patient would be able to describe the object's characteristics but not recognize it without visual cues. Page 857

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

A 51-year-old woman has been experiencing signs and symptoms of perimenopause and has sought help from her nurse practitioner. Doctors have confirmed a deficiency in estrogen levels as a contributing factor. Which of the following phenomena could potentially underlie the woman's health problem? A lack of prohormone precursors needed for estrogen synthesis and release Insufficient estrogen production within the smooth endoplasmic reticulum of the relevant cells Inadequate synthesis in the rough endoplasmic reticulum of her ovarian cells Sufficient synthesis of estrogen but inadequate vesicle-mediated release

Insufficient estrogen production within the smooth endoplasmic reticulum of the relevant cells

While being tackled, a 20-year-old football player puts out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen with a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment? A) This strain will likely resolve itself with sufficient rest. B) You've suffered a severe sprain, and you might need a cast. C) Your wrist contusion will have to be observed for bleeding under the skin surface. D) It looks like a mild to moderate sprain, and you'll need to keep it immobilized for a few weeks.

It looks like a mild to moderate sprain, and you'll need to keep it immobilized for a few weeks.

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

Limbic system Explanation: Stimulation of specific areas of the limbic system can lead to feelings of dread, high anxiety, or exquisite pleasure. The temporal lobe is involved with auditory functions, the cerebellum with proprioception, and the occipital lobe with visual function. Page 843

The nurse knows which of the following phenomena listed below is an accurate statement about axonal transport? a) The unidirectional nature of the axonal transport system protects the CNS against potential pathogens. b) Materials can be transported to the nerve terminal by either fast or slow components. c) Anterograde and retrograde axonal transport allow for the communication of nerve impulses between and neuron and the central nervous system (CNS). d) Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials.

Materials can be transported to the nerve terminal by either fast or slow components. The bidirectional axonal transport system allows for the transport of molecular materials (as opposed to electrical impulses); anterograde transport has both slow and fast components.

A slow decrease in _______ function is a normal phenomenon of aging.

Memory

Meningitis is an infection of the

Meninges

Since catecholamines can be degraded by enzymes, the medication category usually prescribed to treat a Parkinson disease client, thereby controlling this interaction, is: a) β-Adrenergic blocker b) Epinephrine c) Dopamine d) Monoamine oxidase (MAO) inhibitor

Monoamine oxidase (MAO) inhibitor Catecholamines also can be degraded by enzymes, such as catechol-O-methyltransferase (COMT) in the synaptic space or monoamine oxidase (MAO) in the nerve terminals. COMT inhibitors and MAO inhibitors are used in the treatments of various conditions, such as Parkinson disease, major depression, and anxiety. The other medications listed do not perform this function.

The nurse is providing care for a medical client who has a complex regimen of care. Normal function of the client's blood--brain barrier will have what implication for the client's health status?

Most of the drugs that are administered to the client will not reach the nervous tissue of the client's brain. Explanation: The blood-brain barrier prevents many drugs from entering the brain. Neuronal pathways do not exist between the blood and brain, and blood vessels do not carry nerves of the afferent and efferent pathways. The blood--brain barrier does not confer immunity from the consequences of fluid volume deficit. Page 845

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) Depends on the brain's compensatory mechanisms and the extent of the swelling c) Neuronal cell injury and death d) 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

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

Which of the following will conduct injurious stimuli to alert the body of potential damage?

Nociceptors Explanation: Nociceptors are sensitive to painful and noxious stimuli and alert the system to injury. Thermoreceptors will perceive heat, proprioceptors will perceive body position, and odorant receptors will perceive the sensation of smell. Page 861

Myelinated neurons found in the central nervous system are covered by which of the following cells? a) T cells b) Lewy bodies c) Schwann cells d) Oligodendrocytes

Oligodendrocytes In the central nervous system, myelin is formed by the oligodendrocytes, chiefly those lying among the nerve fibers in the white matter. This function of oligodendrocytes is equivalent to that of the Schwann cells in the peripheral nervous system. The properties of the myelin sheath—high electrical resistance and low capacitance—permit it to function as an electrical insulator.

Following a fall 4 weeks prior that was caused by orthostatic hypotension, an 83-year-old male has fractured his femoral head. His care provider has stated that the healing process is occurring at a reasonable pace and that the man will regain full function after healing and rehabilitation. Which of the following cells is most responsible for restoring the integrity of the man's broken bone? A) Osteocyte B) Osteoclast C) Osteoblast D) Osteoma

Osteoblast

The point of total pain maximum felt before a person is willing to have drug relief

Pain tolerance

What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia? a) Guillain-BarrÉ syndrome b) Myasthenia gravis c) Huntington disease

Parkinson disease The aminoglycoside antibiotics (e.g., gentamicin) may produce a clinical disturbance similar to botulism by preventing the release of acetylcholine from nerve endings. These drugs are particularly dangerous in persons with preexisting disturbances of neuromuscular transmission, such as myasthenia gravis. The other answers are incorrect.

The nurse is caring for a client who has been diagnosed with Meniere disease. The nurse expects which of the following medications will be prescribed to manage the symptoms? a) Promethazine (Phenergan) b) Chlorpropamide (Diabenase) c) Clopidogrel (Plavix) d) Pantoprazole (Protonix)

Promethazine (Phenergan) Pharmacologic management includes suppressant drugs such as promethazine (Phenergan). -The other medications are not used to treat Meniere disease.

A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which of the following can best explain this? a) Likely a pre-existing mental illness b) Depression over new diagnosis c) A side effect of treatment d) Psychological manifestation due to involvement of white matter of cerebral cortex

Psychological manifestation due to involvement of white matter of cerebral cortex Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions.

Nystagmus due to cerebellar dysfunction would most likely interfere with which activity? a) Walking b) Speech c) Reading d) Fine motor skills

Reading Conjugate readjustment of eye position due to cerebellar damage can make reading very difficult.

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

Receptors Explanation: Neurotransmitters exert their actions through specific proteins that are known as called receptors, embedded in the postsynaptic membrane. Page 827

While walking down the street, a cat jumps out of an alley into the pathway of an adult. They note that his heart is "racing." This response is primarily due to: a) Parasympathetic effects on the vagus nerve b) The cell body of the first motor neuron that lies in the brain stem c) Reflex circuitry produced by the ANS reflexes d) Secretions of sympathetic neurotransmitters produced in the adrenal medulla

Reflex circuitry produced by the ANS reflexes The organization of many life-support reflexes occurs in the reticular formation of the medulla and pons. These areas of reflex circuitry, often called centers, produce complex combinations of autonomic and somatic efferent functions required for the cough, sneeze, swallow, and vomit reflexes, as well as for the more purely autonomic control of the cardiovascular system. One of the striking features of ANS function is the rapidity and intensity with which it can change visceral function. Within 3 to 5 seconds, it can increase heart rate to approximately twice its resting level. -The vagus nerve provides parasympathetic innervation for the heart, trachea, lungs, esophagus, etc. -The adrenal medulla, which is part of the sympathetic nervous system, contains postganglionic sympathetic neurons that secrete sympathetic neurotransmitters directly into the bloodstream. -The cell body of the first motor neuron, called the preganglionic neuron, lies in the brain stem or the spinal cord.

The nurse is studying sensory systems. She understands that signal transduction of an impulse to the thalamus for processing is accomplished by which of the following?

Second-order neurons Explanation: Second-order neurons communicate with various reflex networks and sensory pathways in the spinal cord and travel directly to the thalamus. First-order neurons transmit sensory information from the periphery to the CNS. Third-order neurons relay information from the thalamus to the cerebral cortex. Page 855

A three-year-old girl has been diagnosed with amblyopia. Which of the following pathophysiologic processes is most likely to underlie her health problem? a. The child may have a neural pathway disorder b. She may have been born with infantile cataracts c. The girl may have chronic bacterial conjunctivitis d. The child may have a congenital deficit of rods and/or cones

She may have been born with infantile cataracts

Which of the following statements best captures an aspect of the role of hormones in the body? A) Some chemical substances can function as hormones or be integrated with the central and peripheral nervous systems. B) Hormones directly initiate many of the processes that contribute to homeostasis. C) Control of body processes is ensured by the fact that a single hormone can only exert one effect on one specific system or tissue. D) Each hormone that exists in the body is produced by only one specific endocrine gland.

Some chemical substances can function as hormones or be integrated with the central and peripheral nervous systems.

A child is experiencing difficulty with chewing and swallowing. The nurse knows that which of the following cells may be innervating specialized gut-related receptors that provide taste and smell? A) Special somatic afferent fibers B) General somatic afferents C) Special visceral afferent cells D) General visceral afferent neurons

Special visceral afferent cells

The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with which of the following? a) Encephalitis b) Subarachnoid hemorrhage c) Thrombotic stroke

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

The nurse is discussing measures that a client may take to prevent barotrauma related to airplane travel. Which of the following measures will the nurse recommend during changes in air pressure? a) Swallowing b) Mouth breathing c) Forcefully coughing d) Cupping the ears with one's hands

Swallowing Swallowing, yawning, and chewing gum are measures that open the eustachian tube, which equalizes air pressure in the middle ear.

Neurons communicate with each other through which structure?

Synapses Explanation: Neurons communicate with each other through structures known as synapses. Cell bodies and dendrites are covered in synapses. Neural crest cells migrate aways from the forming neural tube and are progenitors to the parasympathetic nervous system. Page 826

A clinician is conducting an assessment of a male client suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? A) The client has decreased deep tendon reflexes. B) The client displays increased muscle tone. C) The client's muscles appear atrophied. D) The client displays weakness in the distal portions of his limbs.

The client displays increased muscle tone.

The hallmark manifestations of Cushing syndrome are a moon face, a "buffalo hump" between the shoulder blades, and a protruding abdomen. What other manifestations of Cushing syndrome occur?

Thin extremities and muscle weakness Explanation: The major manifestations of Cushing syndrome represent an exaggeration of the many actions of cortisol (see Table 32-2). Altered fat metabolism causes a peculiar deposition of fat characterized by a protruding abdomen, subclavicular fat pads or "buffalo hump" on the back, and a round, plethoric "moon face." There is muscle weakness, and the extremities are thin because of protein breakdown and muscle wasting. The other answers are incorrect. Page 788-790

The most common cause of an ischemic stroke is which of the following? a) Thrombosis b) Cardiogenic embolus c) Intracerebral arterial vasculitis d) Vasospasm

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

A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as, "like an electric shock." The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain?

Trigeminal neuralgia Explanation: Her symptoms are characteristic of trigeminal neuralgia, caused by damage to the fifth cranial nerve, which carries impulses of touch, pain, pressure, and temperature to the brain from the face and jaw. Page 870

A client has sustained damage to cranial nerve VIII. The nurse recognizes that the client may experience difficulty with: a. Hearing b. Taste c. Motor d. Smell

a. Hearing

Which pain would abdominal pain be

visceral pain

which pain is insensitive to cutting and buring, but highly sensitive to contraction, ischamea, distension

visceral pain

A patient is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is which one of the following? a) Cochlea b) Malleus c) Tympanic membrane d) Vestibular apparatus

Vestibular apparatus The vestibular system maintains and assists recover of stable body and head position and balance through control of postural reflexes. The vestibular system includes the three semicircular canals.

Which is more difficult to find. Location of visceral pain or cutaneous pain

Visceral pain is harder to locate

Which of the following are the main neurotransmitters of the autonomic nervous system (ANS)? Select all that apply. a. Norepinephrine b. Tyrosine c. Monoamine oxidase d. Epinephrine e. Acetylcholine

a. Norepinephrine d. Epinephrine e. Acetylcholine

When educating a patient about to undergo a pacemaker insertion, the nurse explains the normal phases of cardiac muscle tissue. During the repolarization phase, the nurse will stress that membranes must be repolarized before they can be re-excited. Within the cell, the nurse understands that: a. Potassium channels open and while sodium channels close causing repolarization to the resting state. b. The influx of calcium is the primary stimulus for the repolarization of cardiac tissue. c. Only the electrical activity within the heart will determine when repolarization occurs. d. The cell membranes need to stay calm resulting in muscle tissue becoming refractive

a. Potassium channels open and while sodium channels close causing repolarization to the resting state.

Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep? Question options: Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm. The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle. The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep. The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping-waking cycles.

b

The nurse measures a blood glucose level of 40 mg/dL for a client with diabetes type I. Why would it be important for the nurse to institute an intervention to elevate the glucose level in this client? a. The nurse should administer a food source of protein in order to increase the glucose level for improved cardiac function. b. Small amounts of glucose may be stored in the brain for a short period of time but are rapidly metabolized. c. Glucose is not stored in the brain and is a major fuel source for brain function. d. It is not necessary for glucose to be replaced immediately because the client will have enough stores to function for a while.

c. Glucose is not stored in the brain and is a major fuel source for brain function.

Post herpetic neuralgia is caused by which virus

chicken pox virus

The nurse is aware that the primary function of the sympathetic nervous system is: a. Suppression of responses during threatened periods b. Maintenance of organ function during periods of minimal activity c. Conservation of energy and resource replenishment d. Maintenance of vital functions and responding when there is a critical threat to the integrity of the individual

d. Maintenance of vital functions and responding when there is a critical threat to the integrity of the individual

Which of the following is the primary component of white matter? a. Demyelinated lesions b. Dendrites c. Cell bodies d. Myelinated fibers

d. Myelinated fibers

A middle-aged male walks into the emergency department complaining of chest pain radiating to the neck, shortness of breath, and nausea. His heart rate is 120 and BP is 94/60. The ED physician recognizes the patient is having an acute MI with decreased cardiac output. The nurse identifies the nausea to be in response to A) the patient not having a very high pain tolerance. B) hypoxia exerting a direct effect on the chemoreceptor trigger zone. C) the patient not having digested his meal completely. D) fear of having to make major lifestyle changes.

hypoxia exerting a direct effect on the chemoreceptor trigger zone.

While assessing a critically ill patient in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat that develops into ventricular tachycardia (VT). Immediately, the patient became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is A) metabolic acidosis that occurs spontaneously following any dysrhythmias. B) interruption of the blood/oxygen supply to the brain. C) massive cerebrovascular accident (CVA) resulting from increased perfusion. D) a blood clot coming from the heart and occluding the carotid arteries.

interruption of the blood/oxygen supply to the brain.

Patients with pain over 5 should be given.... to help pain

narcotic analgesics

what other symptoms would be associated with visceral pain

nausea, vomiting, sweating, pallor

Define endorphin

neuromodulator produced in CNS that inhibit activity along pain pathway and reduce sensation of pain

Dysfunctional peripheral nevrves result in what type of pain

neuropathic pain -

pins and needles feeling is

neuropathic pain which can result from tumour, surgery, chemo, radio therapy

What are the receptive nerve endings that respond to noxious stimuli - pain

nocicptor

As the nurse is performing a physical assessment of a client, the client begins to have seizure activity including loss of consciousness and limb jerking. The nurse's first priority is to: a) preserve brain functioning. b) treat underlying disease. c) protect the patient from injury. d) stop the seizure.

protect the patient from injury. The first priority for the nurse when a client begins to experience seizure activity is to protect the client from injury during the seizure. -Stopping or preventing the seizure, preserving brain functioning and/or treating underlying disease are important goals of treatment but secondary to protecting the client from injury.

Approximately 6 months after a spinal cord injury, a 29-year-old man has an episode of autonomic dysreflexia. What are the characteristics of autonomic dysreflexia? (Select all that apply.) a) Vasoconstriction b) Fever c) Skin pallor d) Piloerector response e) Hypertension

• Hypertension • Skin pallor • Piloerector response Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild (20 mm Hg above baseline) to severe (as high as 240/120 mm Hg or higher), skin pallor, and gooseflesh associated with the piloerector response. -Fever and vasoconstriction are not manifestations of autonomic dysreflexia

The nurse contacts the physician regarding a client's early signs of diminishing level of consciousness based on which of the following? Select all that apply. a) Stupor b) Inattention c) Disorientation d) Blunted responsiveness

• Inattention • Disorientation • Blunted responsiveness The earliest signs of diminution in level of consciousness are inattention, mild confusion, disorientation, and blunted responsiveness.

While batting, a baseball player is struck in the ribs by a pitch. Place the following components of the player's pain pathway in the chronological order as they contribute to the player's sensation of pain. Use all the options.

• Thalamus • Dorsal root ganglion body • Dorsal root ganglion periphery • Axon • Cerebral cortex Explanation: All somatosensory information from the limbs and trunk shares a common class of sensory neurons called dorsal root ganglion neurons. Somatosensory information from the face and cranial structures is transmitted by the trigeminal sensory neurons, which function in the same manner as the dorsal root ganglion neurons. The cell body of the dorsal root ganglion neuron, its peripheral branch (which innervates a small area of periphery), and its central axon (which projects to the CNS) communicate with the thalamus, which in turn communicates with the cerebral cortex using third order neurons. Page 855

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barre? syndrome in their medical history. The patient asks, "What is that?" How should the nursing student reply? a) "A degenerative disease where you have trouble walking without the help of a cane or walker." b) "Influenza-like illness where you had fever and chills for 2-3 days after your last flu shot." c) "A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles." d) "Swelling of your arm where you got your flu shot and maybe your eyes and lips had some swelling as well."

"A type of paralysis that affects movement on both sides of the body. It may even involve the respiratory muscles." Gullain-Barre Syndrome is an acute immune-mediated polyneuropathy. The majority of people report having had an acute, influenza-like illness before the onset of symptoms. It progresses along the ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. The rate of disease progression varies, and there may be disproportionate involvement of the upper or lower extremities. Option B is anaphylaxis following the flu shot. It is not a degenerative disease.

Pain treatment involves a choice between pharmacological and nonpharmacological treatments.

False

Name the three theories of phantom limb pain

NSB: Neuroma, Spinal cord, Brain theorie

The location of this type of pain tends to be more difficult to identify than of this other type of pain.

Visceral; Cutaneous

The thalamus is located in which of the following parts of the brain? a. Occipital lobe b. Parietal lobe c. Temporal lobe d. Diencephalon

d. Diencephalon

Which of the following are the main neurotransmitters of the autonomic nervous system (ANS)? Select all that apply. a) Norepinephrine b) Acetylcholine c) Monoamine oxidase d) Tyrosine e) Epinephrine

• Norepinephrine • Acetylcholine • Epinephrine The main neurotransmitters of the ANS are acetylcholine and the catecholamines epinephrine and norepinephrine. Monoamine oxidase is found in the nerve endings to degrade catecholamines. Tyrosine is an amino acid that is a precursor to catecholamines

An older adult tells the nurse, "My friend just developed shingles and has a lot of pain. Is there a way for me to protect myself from it?" Which of the following is an appropriate response from the nurse?

"Get a Zostavax vaccination." Explanation: Herpes zoster is the viral infection caused by the varicella zoster virus. The first infection is called chicken pox. When there is a recurrence it is called shingles. The virus is believed to remain dormant in the nerve root until the patient has a decline in cellular immunity when the virus will replicate. The pain is often described as throbbing, burning, or stabbing. The best prevention is a vaccine for adults age 60 and older. Antivirals will lessen the severity at the time but will not prevent infection. Page 870

A 30 year-old female has suffered a third-degree burn to her hand after spilling hot oil on it in a kitchen accident. Which of the following teaching points by a member of her care team is most appropriate?

"Opioids aren't without side effects, but we will take action to manage these side effects so you can continue getting these drugs." Explanation: While opioids carry side effect such as constipation, these can be managed in order to continue treatment; constipation would not preclude the continued use of opioids, but would require management. Pain medication should precede the onset of pain, and tolerance is not grounds for discontinuing treatment. Page 867

The father of a third grade girl has brought his daughter to a walk-in clinic because he believes the girl has pink eye, which has been going around the students in her class. The nurse at the clinic concurs with the father's suspicion of conjunctivitis. Which follow-up explanation by the nurse is most accurate? a) "An antibiotic ointment will likely resolve her infection, but pain control will be necessary in the mean time." b) "The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away." c) "It's important to aggressively treat this in children, since damage to her sight can result if it's not treated." d) "The insides of her eyelids have become infected. This often produces severe discomfort."

"The surfaces of her eyes have bacteria or a virus established, and it's important to maintain good hand hygiene until it goes away." Conjunctivitis often spontaneously resolves. The pain associated with conjunctivitis usually produces only mild discomfort compared with severe discomfort associated with corneal lesions or deep and severe pain associated with acute glaucoma. Conjunctivitis may spread to other family members. - The corneal surface is not primarily involved and pain that is severe suggests corneal involvement rather than conjunctivitis. Sight damage is not likely to result.

A female patient presented to her primary care physician with classic signs/symptoms of Cushing syndrome. Upon testing, it was discovered that the patient had vaginal small cell carcinoma. How can the healthcare providers explain her Cushing syndrome signs/symptoms to this patient?

"Your tumor in your vagina is secreting a hormone called adenocorticotropic hormone (ACTH) which is responsible for these signs/symptoms." Explanation: Hyperfunction is usually associated with excessive hormone production. This can result from excessive stimulation and hyperplasia of the endocrine gland or from a hormone-producing tumor. A clinical example of this phenomenon is evidenced by the case of a woman with vaginal small cell carcinoma who also presented with Cushing syndrome. After testing, it was determined that the tumor was secreting ACTH. In this situation, the cause was not related to a pituitary problem. There is a connection between Cushing syndrome and the carcinoma. The thyroid gland is not responsible for Cushing syndrome. Page 788

The nurse is caring for a client diagnosed with hyperthyroidism. Which of the following signs and symptoms are most likely to be seen in this client? Select all that apply.

-Weight loss -Hypertension -Tremor -Diarrhea Explanation: The signs and symptoms of hyperthyroidism relate to the increased metabolic rate associated with this condition. Hypertension, diarrhea, weight loss, and tremor are all signs and symptoms of hyperthyroidism, while the other choices reflect signs and symptoms of hypothyroidism. Page 781

Select the function of the occipital lobe: 1. Determination of objects through the sense of touch 2. Discrimination of sounds entering opposite ears 3. Anticipation and prediction of consequences of behavior 4. Color, motion, and depth perception

4. Color, motion, and depth perception

A 28-year-old male who is 6 S11 c tall has a diagnosis of acromegaly. The man is explaining to a curious but sympathetic coworker exactly what accounts for his extraordinary height. Which of the following explanations demonstrates a sound understanding of his health problem? A)My pituitary gland produced a much higher than normal amount of growth hormone when I was a child.¡¨ B) A tumor in my brain threw off my hormone levels after I was finished adolescence.¡¨ C) My liver is malfunctioning and produces too many of the hormones that ultimately cause growth.¡¨ D) The high sugar levels that go along with my diabetes made my pituitary gland overproduce the hormones that cause you to grow.¡¨

A tumor in my brain threw off my hormone levels after I was finished adolescence.

The nurse is caring for a client who has returned from surgery after having a colon resection. What is the best method for the nurse to use when administering an opioid for pain in order to optimize pain control?

Administer the opioid preemptively and before pain becomes extreme. Explanation: When giving opioids for relief of severe pain, such as that occurring after surgery, there is much evidence that opioids given routinely before the pain starts (preemptive analgesia) or becomes extreme are far more effective than those administered in a sporadic manner. People who are treated in this manner seem to require fewer doses and are able to resume regular activities sooner. Page 868

A 60-year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and appears to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice? A) Administration of 15 to 20 g of glucose in a concentrated carbohydrate source B) Administration of subcutaneous glucagon C) IV infusion of 50% dextrose and water solution D) Careful monitoring for level of consciousness and resolution of hypoglycemia

Administration of 15 to 20 g of glucose in a concentrated carbohydrate source

Which are functions of the frontal lobe? Select all that apply.

Anticipation of consequences of behavior Prediction of consequences of behavior Explanation: The occipital lobe is associated with being able to experience color, motion, and depth perception. Behavior is anticipated by the frontal lobe. Page 842

The two main categories of glial tumors include which of the following? a) Meningiomas b) Oligohydraminos c) Ependymomas d) Astrocytic

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

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

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.

A severe type of headache that occurs more frequently in men than women and is described as having unrelenting, unilateral pain located most frequently in the orbit is called what?

Cluster headache Explanation: Cluster headache is a type of primary neurovascular headache that typically includes severe, unrelenting, unilateral pain located, in order of decreasing frequency, in the orbital, retro-orbital, temporal, supraorbital, and infraorbital region. The other answers are incorrect. Page 874

The client asks the health care provider to explain what the purpose is for the application of cold to a sprained ankle. The best response would be:

Cold provides pain relief and suppresses the release of products from tissue damage. Explanation: Cold prevents the release of products of tissue damage and provides pain relief (produces vasoconstriction at the site). Application of heat would cause blood vessels to dilate and more blood to be drawn to the local area. Page 877

The thick area of myelinated axons that connects the two sides of the cerebral cortex is known as which of the following components?

Corpus callosum Explanation: The thick area of myelinated axons that connects the two sides of the cerebral cortex is known as the corpus callosum. The remaining options are all components of the basal ganglia. Page 842

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: a) Decreased level of carbon dioxide b) Decreased hydrogen ions c) Decreased level of PCO2 d) Decreased level of oxygen

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.

The nurse is caring for a client who has been diagnosed with presbycusis. The nurse understands that with this disorder, the client experiences which of the following? a) Difficulty hearing high-pitched frequencies b) Chronic ear drainage c) Severe pain in the mastoid area d) Fluid in the inner ear without infection

Difficulty hearing high-pitched frequencies Presbycusis is used to describe degenerative hearing loss that occurs with advancing age. It is characterized by high-frequency hearing loss.

The nurse understands that a distinguishing pathology of benign paroxysmal positional vertigo is which of the following? a) Proprioception deficit b) Orthostatic hypotension c) Visual deficit d) Disorder of otoliths

Disorder of otoliths Benign paroxysmal positional vertigo is caused by the otoliths or free-floating debris causing a portion of the vestibular system to become more sensitive, such that any movement of the head in the plane parallel to the posterior duct may cause vertigo and nystagmus.

As part of the diagnostic workup for a patient's long-standing vertigo, a clinician wants to gauge the patient's eye movements. Which of the following tests is the clinician most likely to utilize? Caloric stimulation Electronystagmography (ENG) Rotational tests Romberg test

Electronystagmography (ENG)

The underlying causative problem in Parkinsonism is which of the following? a) Genetic defect b) Autoimmune disorder c) Viral infection d) Failure of dopamine release

Failure of dopamine release Lack of dopamine release is the primary cause of Parkinson's disease and associated symptoms.

The most significant disadvantage of opioid analgesics is the high risk of addiction.

False

The adrenal medulla is innervated by parasympathetic nerve fibers.

False Explanation: The adrenal medulla is a modified prevertebral sympathetic ganglion. Page 850

An emergency room nurse receives a report that a client's Glasgow Coma Scale (GCS) is 3. The nurse prepares to care for a client with which of the following? a) Normal flexion b) Confused conversation c) Flaccid motor response d) Spontaneous eye opening

Flaccid motor response A score of 3 on the Glasgow Coma Scale indicates the lowest possible score in each of the three scoring categories (eye opening, motor response, and verbal response) and includes flaccid or no motor response, no verbal response and the inability to open the eyes.

During a late night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action? Cerebellum Thalamus Basal ganglia Frontal lobe

Frontal lobe

Addictions result from a combination of ________ disposition, __________ factors, and __________ adaptations.

Genetic; Environmental; Physiologic

A client with Graves' disease has had radioiodine treatment with worsening of ophthalmopathy. What medication does the nurse prepare to administer that the client will use for several weeks to decrease these symptoms?

Glucocorticoids Explanation: Some physicians prescribe glucocorticoids for several weeks surrounding the radioiodine treatment if the person had signs of ophthalhmopathy. Page 783

What is the purpose of neosphinothamic tract

Group of nerve fibres which split from the main tract of spinal cord and carrys fast pain level sensory impulses

A 29-year-old woman has been diagnosed with otosclerosis after several years of progressive hearing loss. What pathophysiologic process has characterized her diagnosis?

Her tympanic cavity is becoming filled with bone due to inappropriate osteogenesis. Her temporal bone is experiencing unusually rapid resorption. Her incus, malleus, and stapes have become disconnected from her normal neural pathways. **********New, sclerotic bone has been formed around her stapes and oval windo

The nurse is teaching a client diagnosed with Addison disease about the importance of lifetime oral replacement therapy. Select the pharmacologic agent that would be prescribed.

Hydrocortisone Explanation: Hydrocortisone is usually the drug of choice in treating Addison disease. In mild cases, hydrocortisone alone may be adequate. Ketoconazole causes excessive breakdown of glucocorticoids and can also result in adrenal insufficiency. Clients with Addison disease usually have elevated potassium levels, and insulin is not the treatment for Addison disease. Page 788

The nurse is caring for an elderly client with a suspected diagnosis of presbycusis. Select the most likely manifestation that the nurse would note. a) Inability to understand words during a conversation b) Feeling of continuous pressure in both ears c) Feeling a continuous drainage coming from both ears d) Buzzing or ringing in the ears

Inability to understand words during a conversation Presbycusis is a common report among the elderly. It is manifested by the inability to understand or hear what is being said in a conversation that progresses to not being able to hear. Pressure may result from increased fluid, and buzzing or ringing may be a complication of medication.

When the nurse is performing a health history for a client who is being admitted for hyperthyroidism, what symptoms does the client report that the nurse would find associated with this disorder?

Increase in appetite Explanation: Thyroid hormone enhances gastrointestinal function, causing an increase in motility and production of GI secretions that often results in diarrhea. An increase in appetite and food intake accompanies the higher metabolic rate that occurs with increased thyroid hormone levels. At the same time, weight loss occurs because of the increased use of calories. Page 781

The nurse knows that chronic pain lacks which of the characteristic pain-related reactions?

Increased heart rate Explanation: Characteristics of chronic pain do not include autonomic responses like increased heart and respiratory rate. Loss of appetite, disturbed sleep patterns and depression are common among people dealing with chronic pain. Page 866

Which of the following neurons connect sensory and motor neurons? a) Interneurons b) Efferent neurons c) Cranial nerves d) Afferent neurons

Interneurons Neurons that connect sensory and motor neurons are known as interneurons. Motor neurons receive input from axons descending from higher centers. These supraspinal signals can modify reflex responses to peripheral stimuli by facilitating or inhibiting different populations of interneurons. They also coordinate movements through these interneurons.

The arachnoid membrane is the middle layer of the three meninges. a) False b) True

True- the arachnoid membrane is the middle layer of the three meninges.

Conductive hearing loss can occur for a variety of reasons, including foreign bodies in the ear canal, damage to the ear drum, or disease. What disease is associated with conductive hearing loss? a) Huntington disease b) Paget disease c) Parkinson disease d) Alzheimer disease

Paget disease More permanent causes of hearing loss are thickening or damage of the tympanic membrane or involvement of the bony structures (ossicles and oval window) of the middle ear due to otosclerosis or Paget disease. -Huntington, Alzheimer, and Parkinson diseases are not associated with conductive hearing loss.

When a peripheral nerve is irritated enough, it becomes hypersensitive to the noxious stimuli, which results in increased painfulness or hyperalgesia. Health care professionals recognize both primary and secondary forms of hyperalgesia. What is primary hyperalgesia?

Pain sensitivity that occurs directly in damaged tissues Explanation: Primary hyperalgesia describes pain sensitivity that occurs directly in damaged tissues. The other answers are incorrect. Page 869

After being thrown off the back of a bull, the bull rider can move their arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is usually referred to as being a: a) Paraplegia. b) Quadriplegia. c) Anterior cord syndrome. d) Tetraplegia.

Paraplegia. Tetraplegia and quadriplegia is loss of motor or sensory function after damage to neural structures in the cervical segments of the spinal cord. Paraplegia refers to loss of motor or sensory function in thoracic, lumbar, or sacral segments. The arms function as normal. Anterior cord syndrome includes loss of motor function provided by the corticospinal tracts and loss of pain and temperature sensation from damage to the lateral spinothalamic tracts.

Spinal nerves that form complex nerve networks are called which of the following? a) Plexuses b) Choroid plexus c) Reticular formations d) Rami

Plexuses Spinal nerves do not go directly to skin and muscle fibers; instead, they form complicated nerve networks called plexuses. A plexus is a site of intermixing nerve branches. - After emerging from the vertebral column, the spinal nerve divides into two branches, or rami. -The choroid plexus produces cerebrospinal fluit in the lateral, third and fourth ventricles. -Reticular formation is the location of many important reflex circuits of the spinal cord and brain stem.

Multiple sclerosis is characterized by what type of neuron damage? a) Mononeuropathy b) Transneuropathy c) Aneuropathy d) Polyneuropathy

Polyneuropathy MS is classified as a polyneuropathy due to many nerves being affected by the disease, involving demyelination of peripheral nerves.

A patient is asked to stand with feet together, eyes open and hands by the sides. Then the patient is asked to close their eyes while the nurse observes for a full minute. What assessment is the nurse performing? a) Segmental reflex. b) Posture. c) Crossed-extensor reflex. d) Proprioception.

Proprioception. Information from the sensory afferents is relayed to the cerebellum and cerebral cortex and is experienced as proprioception or the sense of body movement and position independent of vision. The knee-jerk reflex is a form of stretch reflex. The crossed-extensor reflex serves to integrate motor movements so they function in a coordinated manner

Neurotransmitters exert their actions through specific proteins that are known as: a) Transformers b) Receptors c) Antibodies d) Autoantigens

Receptors Neurotransmitters exert their actions through specific proteins that are known as called receptors, embedded in the postsynaptic membrane.

A patient admitted to the emergency department with a change in mental status and a history of AIDS and primary central nervous system (CNS) lymphoma becomes extremely combative with the medical personnel. A family member is very upset with the patient's behavior. The nurse explains that these behaviors are most likely caused by which of the following? a) Recurrence of primary CNS lymphoma b) Onset of early dementia c) Decrease in intracranial pressure d) AIDS-induced encephalopathy

Recurrence of primary CNS lymphoma Primary CNS lymphoma has a higher incidence in people who are immunocompromised and who also have a high rate of recurrence in spite of treatment. The most common symptoms include behavioral and cognitive changes that occur in about 43% of the cases. There is no information in the question to support any of the other options.

Presbycusis is degenerative hearing loss associated with aging. What is the first symptom of this disorder? a) Inability to localize sounds b) Reduction in ability to identify sounds c) Reduction in ability to understand speech d) Inability to detect sound

Reduction in ability to understand speech The disorder first reduces the ability to understand speech and, later, the ability to detect, identify, and localize sounds.

Death caused by muscular dystrophy in early adulthood is usually due to which of the following? a) Severe skeletal muscle weakness b) Respiratory and cardiac muscle involvement c) Severe long bone fractures d) Malnutrition

Respiratory and cardiac muscle involvement Frequent respiratory infections and loss of reserve predispose to life-threatening illness. Cardiomyopathy may be severe and life-limiting in early adulthood.

A 45 year old diabetic male is experiencing erectile dysfunction. If his erectile dysfunction is caused by the nervous system, then the nurse can educate the patient that the venous blood supply to the penis is controlled by:

Sacral parasympathetic fibers. Explanation: The pelvic nerves leave the sacral plexus on each side of the cord and distribute their peripheral fibers to the bladder, uterus, urethra, prostate, distal portion of the transverse colon, descending colon, and rectum. Sacral parasympathetic fibers also supply the venous outflow from the external genitalia to facilitate erectile function. The hypothalamus, vagus nerve, and postganglionic sympathetic neurons do not control erectile function. Page 850

Cerebrospinal fluid (CSF) is produced by which of the following structures? a. Falx cerebri b. Choroid plexus c. Dura mater d. Arachnoid mater

b. Choroid plexus

A 7 year old child had an emergency appendectomy during the night. When trying to assess their pain, the nurse should:

Show them a scale with faces of actual children and have them point to the picture that best describes how they are feeling. Explanation: Children do feel pain and have been shown to reliably and accurately report pain...With children 3-8 years of age, scales with faces of actual children or cartoon faces can be used to obtain a report of pain. Physiologic measures, such as heart rate, are convenient to measure but they are nonspecific. They may be a sign of anxiety and not pain. Distraction methods are good but medications should be used on an individual basis to match the analgesic agent with the level of pain. Page 875

Neurons communicate with each other through which of the following structures? a) Neural crest cells b) Cell bodies c) Synapses d) Dendrites

Synapses Neurons communicate with each other through structures known as synapses. -Cell bodies and dendrites are covered in synapses. -Neural crest cells migrate aways from the forming neural tube and are progenitors to the parasympathetic nervous system.

After neurotransmitters are synthesized, in which of the following structures are they stored in the axon terminal? a) Synaptic vesicles b) Synaptic cleft c) Axon hillock d) Postsynaptic receptor

Synaptic vesicles After synthesis, the neurotransmitter molecules are stored in the axon terminal in tiny, membrane bound sacs called synaptic vesicles. After a nerve impulse stimulates the presynaptic neuron, the vesicles move to the cell membrane and release the neurotransmitter into the synaptic cleft. The neurotransmitter moves across the cleft and binds to postsynaptic receptors. The axon hillock is the initial segment of the axon where the action potential is initiated.

The nurse is aware that some drugs may be prevented from entering the brain as a function of: a) Elimination by the kidneys b) Rapid absorption in the gastric mucosa c) Detoxification by the liver d) The blood-brain barrier

The blood-brain barrier The blood-brain barrier prevents many drugs from entering the brain. Most highly water-soluble components are excluded from the brain, especially molecules with high ionic charge, such as many of the catecholamines.

The nurse is performing a test to determine a client's neurological function related to a suspected lesion in the parietal lobe. What would the nurse determine is a normal finding after assessment?

The client is able to determine correctly that the item placed in his hand is a paper clip. Explanation: Localized lesions of the parietal lobe can result in the inability to recognize the meaningfulness of an object (a condition called agnosia). With the person's eyes closed, a screwdriver can be felt and described as to shape and texture. Nevertheless, the person cannot integrate the sensory information required to identify it as a screwdriver. Page 842

A client has recently been diagnosed with chronic back pain that requires the daily use of hydromorphone, an opioid analgesic. For the first few weeks, the client achieved relief with 4 mg every 6 hours. However, the client now requires 6 mg doses to achieve the same effect. How should the nurse best interpret this phenomenon?

The client is developing opioid tolerance, which is expected Explanation: The client is developing a tolerance to the opioid, which is not unexpected and which is not synonymous with addiction. There may be a need to include nonpharmacologic interventions or NSAIDs, but these do not need to replace the opioid. Page 867

A child is born with dwarfism to normal-sized parents. The physician is explaining how growth hormone (GH) plays a central role in the increase in stature that characterizes childhood and adolescence. What is the first step in the growth hormone chain of events?

The hypothalamus secretes GHRH. Explanation: Like other pituitary functions, hypothalamic stimulation precedes hormone release. In the case of GH, stimulation is the result of GHRH by the hypothalamus. GH is then released by the pituitary gland, stimulating the liver to release IGFs, which ultimately causes the epiphyseal plates of long bones to grow. Page 771

The vertebral column provides protection for the spinal cord, spinal nerves, and supporting structures.

True Page 838

The arachnoid membrane is the middle layer of the three meninges.

True Page 844

An adult male has a new diagnosis of Guillain-Barré syndrome. The nurse knows which of the following pathophysiological processes underlie the deficits that accompany the degeneration of myelin in his peripheral nervous system (PNS)? A) The destruction of myelin causes fewer Schwann cells to be produced in the client's PNS. B) The axonal transport system is compromised by the lack of myelin surrounding nerve cells. C) Unless remyelination occurs, the axon will eventually die. D) A deficit of myelin predisposes the client to infection by potential pathogens.

Unless remyelination occurs, the axon will eventually die.

Which is considered the most accurate method of assessing pain in children ages 8 years and older?

Using a numeric 1-10 scale Explanation: Children between ages 3 and 8 years can accurately point to a scale of faces that ranges from very tearful to very happy to indicate their pain level. Children older than 8 are accurately able to report pain on a numeric scale, or using words ranging from "none" to "the most I have ever had." The older child may consider the faces scale juvenile. Physiologic responses to pain, such as tachycardia and guarding, are not very accurate because they are nonspecific and may not occur with chronic pain. A parent may say that their child is acting differently, but the child is the best person to describe his or her pain. Page 876

Dopamine is an intermediate compound made during the synthesis of norepinephrine. It is the principal inhibitory transmitter of the internuncial neurons in the sympathetic ganglia. What other action does it have? a) Vasodilates renal and coronary blood vessels when given intravenously b) Vasoconstricts renal and coronary blood vessels when given intravenously c) Acts as a neuromodulator in the hindbrain d) Acts as a neuromodulator in the forebrain

Vasodilates renal and coronary blood vessels when given intravenously Dopamine, which is an intermediate compound in the synthesis of norepinephrine, also acts as a neurotransmitter. It is the principal inhibitory transmitter of internuncial neurons in the sympathetic ganglia. It also has vasodilator effects on renal, splanchnic, and coronary blood vessels when given intravenously and is sometimes used in the treatment of shock.

Which neuroglial cells of the CNS provide protection and metabolic support to neurons? Select all that apply. a. Oligodendrocytes b. Microglia cells c. Ependymal cells d. Internuncial neurons e. Astrocytes

a. Oligodendrocytes b. Microglia cells c. Ependymal cells e. Astrocytes

A nurse practitioner and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family? Question options: Cognitive and behavioral therapy to counteract the agitation, depression, and suspiciousness associated with Alzheimer disease. The use of medications such as donepezil and rivastigmine to slow the progression of the disease Surgical treatment of the ischemic changes that underlie the manifestations of the man's disease Modest reversal of brain plaque formation and improved symptomatology through cholinesterase inhibitors

b

--A 21 year old male is brought to the ED following a night of partying in his fraternity. His friends found him "asleep" and couldn't get him to respond. They cannot recall how many alcoholic beverages he drank the night before. While educating a student nurse and the roommates in the fraternity, the nurse begins by explaining that alcohol is: a. Water-soluble compound that is easily absorbed by the gastric lining of the stomach. b. Able to reverse the transport of some substances to remove them from the brain. c. Very lipid soluble and rapidly crosses the blood-brain barrier. d. Very likely to cause sedation and therefore the patient just needs to sleep it off.

c. Very lipid soluble and rapidly crosses the blood-brain barrier.

Neurotransmitters exert their actions through specific proteins that are known as: a. Transformers b. Autoantigens c. Antibodies d. Receptors

d. Receptors

Which of the following is the lobe of the brain with functions of perception, long-term memory, and recognition of auditory stimuli? a. Occipital lobe b. Frontal lobe c. Parietal lobe d. Temporal lobe

d. Temporal lobe

When the sympathetic nervous system is stimulated, the interstitial cells of Cajal, pacemaker cells of the GI tract, react by A) decreasing amplitude or abolishing the slow waves that control the spontaneous oscillations in membrane potentials. B) increasing the peristaltic motion of the GI tract, thereby causing explosive diarrhea. C) increasing the amount of secretions being entered into each segment of the intestinal tract. D) signaling the vagus nerve to slow down motility and increase absorption of water from the large intestine.

decreasing amplitude or abolishing the slow waves that control the spontaneous oscillations in membrane potentials.

The region of the body wall that is supplied by a single pair of dorsal root ganglia is called

dermatome

Contains the pontine nuclei

describes the pons.

which pain would be a patient trying to gain benefit as in drugs, attention seeking

functional pscyhogenic pain

what pain originates in the mind

functional.psychogenic pain. can be due to diagnostic findings incomplete, patient has discorder of psyche that causes inappropriate pain perceptoin or pt is trying to gain benefit

A nurse caring for a patient in myasthenic crisis identifies a priority concern as: a) ongoing physical therapy to maintain strength. b) maintenance of airway and respiration. c) monitoring for difficulty chewing. d) monitoring for ptosis.

maintenance of airway and respiration. All symptoms and issues are present with myasthenia gravis. However, a priority concern during crisis is maintenance of airway and ventilatory support because of muscular weakness that may compromise breathing/respiration.

While reviewing the role of the parathyroid hormone in the balance of calcium and phosphate levels, the nursing faculty will emphasize that the kidney responds to parathyroid stimulation by A) increasing reabsorption of sodium in the distal tubules. B) reducing the reabsorption of phosphate. C) stimulating production of red blood cells. D) decreasing the reabsorption of calcium.

reducing the reabsorption of phosphate.

Neuropathic pain can be seen in

untrolled diabetes, ratiotherapy, chemotherapy,

A nurse on a medical unit is providing care for a 37-year-old female patient who has a diagnosis of Graves' disease. Which of the following treatments would the nurse most likely anticipate providing for the client?

β-adrenergic-blocking medications to reduce sympathetic nervous stimulation Explanation: The hyperthyroidism that constitutes Graves' disease can often be mitigated by the administration of β-adrenergic-blocking medications. Levothyroxine would be used to address hypothyroidism and calcium channel blockers are not an identified treatment modality for Graves' disease. Somatostatin analogs are used to treat GH excess. Page 782

A client has just begun to experience an ischemic stroke. The blood supply from the middle cerebral artery is being blocked by a large blood clot. How long before brain cells begin to die due to lack of ATP? a. 30 to 40 minutes b. 10 seconds c. 20 minutes d. 4 to 6 minutes

d. 4 to 6 minutes

Which of the following endocrine functions are responsible for increased resorption of bone that results in a reduction of the number and function of osteoclasts? Select all that apply. A) Calcitonin secretion B) Decrease in estrogen levels C) Stimulation of excess thyroid hormone D) Release of catecholamines E) Increase movement of calcium and phosphate from bone into the extracellular fluid

Calcitonin secretion Decrease in estrogen levels

Which drug, administered by the nurse to a client with a heart rate of 40 and syncope, is a muscarinic blocking drug that will increase the heart rate? a. Lidocaine b. Epinephrine c. Dopamine d. Atropine

d. Atropine

The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be which of the following? a) "The cranial sutures are fused and decrease brain damage." b) "Infants never have symptoms from hydrocephalus." c) "Because the skull sutures are not fused there may be no brain damage." d) "Unfortunately, there usually is significant brain dysfunction."

"Because the skull sutures are not fused there may be no brain damage." When hydrocephalus develops in utero, before the cranial sutures have fused, the head can swell and decrease intracranial pressure, thereby decreasing the amount of brain tissue that is compressed.

A patient is having difficulty with sleeping and has also been experiencing marital difficulties over the past couple of months. The patient tells the nurse at the physician's office that all this started after he had a car accident earlier that year. Which of the following would be the most important question for the nurse to ask? a) "What is your normal routine before bedtime?" b) "Did you go to the hospital following the accident?" c) "How long have you been married?" d) "Did you sustain any injuries in the accident?"

"Did you sustain any injuries in the accident?" Postconcussion syndrome can interfere with daily living and also with relationships and can continue for months. The syndrome can include amnesia, insomnia, headache, difficulty concentrating, and irritability. In this situation, it would be very important to determine if the patient sustained a head injury to rule out postconcussion syndrome.

The unique clinical presentation of a 3 month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? a) "Has your baby ever been directly exposed to any chemical cleaning products?" b) "Have you ever given your child any honey or honey-containing products?" c) "Is there any family history of neuromuscular diseases?" d) "Is there any mold in your home that you know of?"

"Have you ever given your child any honey or honey-containing products?" Botulism in infants is frequently attributable to honey. Family history is not a relevant consideration given the bacterial etiology, and mold and chemical cleaning products are not known to predispose to botulism toxicity.

A client is diagnosed with Addison's disease. What statement by the client indicates an understanding of the discharge instructions by the nurse?

"I will have to take my medication for the rest of my life." Explanation: Addison's disease, like type I diabetes, is a chronic metabolic disorder that requires lifetime hormone replacement therapy. The daily regulation of the chronic phase of Addison disease is usually accomplished with oral replacement therapy, with higher doses being given during periods of stress. Page 788

A 60-year-old man has presented to his nurse practitioner because of an earache that has become progressively more painful in recent days. After giving his history and having an examination with an otoscope, the man has been diagnosed with otitis externa. Which of the nurse practitioner's following statements to the man is most accurate? a. "This likely happened because your ears aren't draining like they should, but antibiotics that you'll put in your ears will resolve this." b. "I'll prescribe some ear drops for you, and in the meantime it's important not to use ear swabs." c. "I'm going to instill some warm water into your ear to flush out debris and bacteria." d. "You'll need to avoid getting any water in your ear until you finish your course of antibiotic pills."

"I'll prescribe some ear drops for you, and in the meantime it's important not to use ear swabs."

A client asks if pain threshold and pain tolerance are the same. The best response by the health care provider would be:

"Pain threshold is the point at which a stimulus is perceived as painful." Explanation: Pain threshold is closely associated with the point at which a nociceptive stimulus is perceived as painful. Pain tolerance relates more to the total pain experience; it is defined as the maximum intensity or duration of pain that a person is willing to endure before the he or she wants something done about the pain. Psychological, familial, cultural, and environmental factors significantly influence the amount of pain a person is willing to tolerate. The threshold for pain is fairly uniform from one person to another, whereas pain tolerance is extremely variable. Page 861

A 69-year-old patient comes to the clinic for a routine checkup. Upon examination the nurse practitioner informs the patient that she has cataracts. The patient then tells the nurse that she already knew that and her physician told her that she could use bifocals and that would take care of the problem. What would be the best response by the nurse practitioner? a) "Strong bifocal lenses can often cure cataracts." b) "Surgery is the only effective treatment for cataracts." c) "The doctor was correct and you are doing everything you can to help with this condition." d) "You are wrong and should not listen to your doctor."

"Surgery is the only effective treatment for cataracts." There is no effective medical treatment for cataract. -Strong bifocal lenses, magnification, appropriate lighting, and visual aids may be used as the cataract progresses, but surgery is the only treatment for correcting cataract-related vision loss. -Telling the patient that bifocals will cure cataracts is false as well as telling her that her doctor was correct. -The other option is not a therapeutic response by the nurse.

A client arrives in the clinic and informs the nurse that he is having pain in the left knee that has lasted for several weeks. The physician orders an x-ray of the left hip and knee. The client tells the nurse that the pain is in the knee, not the hip. What is the best response by the nurse?

"The pain you are having may be referred pain, which can cause the pain in the knee resulting from a hip problem." Explanation: Referred pain is pain that is perceived at a site different from its point of origin but innervated by the same spinal segment. It may be difficult for the brain to correctly identify the original source of pain. A and D are nontherapeutic responses. It is beyond the scope of practice for the nurse to change a physician's order. Page 864

A three-year-old girl has just been diagnosed with type 1A diabetes and her parents are currently receiving education from the diabetes education nurse at the hospital where their daughter is receiving treatment. How can the nurse best explain the etiology of their daughter's health problem to her parents? A.) Environmental and lifestyle factors are known to play a part in the fact that her pancreas secretes and withholds insulin at the wrong times." B.) "This tendency to produce insufficient amounts of insulin is likely something that she inherited." C.) "It's not known exactly why your daughter has completely stopped making insulin, and treatment will consist of your rigidly controlling her diet." D.) "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."

"The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin."

A child has been removed from a home in which she has experienced severe neglect and emotional abuse, and has been placed in foster care. The child has psychosocial dwarfism and the foster parents ask the nurse what this means for the future of the child. What is the best response by the nurse?

"The prognosis of the child depends on an improvement in behavior and catch-up growth." Explanation: Psychosocial dwarfism involves a functional hypopituitarism and is seen in some emotionally deprived children. These children usually present with poor growth, potbelly, and poor eating and drinking habits. Typically, there is a history of disturbed family relationships in which the child has been severely neglected or disciplined. Often, the neglect is confined to one child in the family. GH function usually returns to normal after the child is removed from the constraining environment. The prognosis is dependent on improvement in behavior and catch-up growth. Page 772

Which of the following clients may be experiencing a sensory focal seizure that has sent an abnormal cortical discharge to the Autonomic Nervous System (ANS)? a) 44 year old patient complaining of constant movement and pain in the legs that gets worse when they try to sleep. b) 85 year old patient experiencing drooping of the right side of face and numbness in right arm and leg. c) 56 year old complaining of tingling sensations and has both an elevated pulse and BP. d) 22 year old complaining of a stiff neck and achiness, along with some nausea and vomiting.

56 year old complaining of tingling sensations and has both an elevated pulse and BP. Sensory symptoms correlate with the location of seizure activity on the contralateral side of the brain and may involve somatic sensory disturbance (tingling). With abnormal cortical discharge stimulating ANS, see tachycardia, diaphoresis, hypo- or hypertension, or papillary changes. Distractor A is associated with restless leg syndrome (RLS). Distractor B is associated with stroke (CVA). Distractor D is associated with meningitis.

A 70 year-old woman with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond? a) "Unfortunately there aren't any proven treatments for your condition." b) "There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." c) "We usually don't actively treat BPPV unless it starts to affect your hearing." d) "Although they involve some risks, there are some options for ear surgery that can prevent future vertigo."

"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo." Nondrug therapies for BPPV using habituation exercises and canalith repositioning are successful in many people. Canalith repositioning involves a series of maneuvers in which the head is moved to different positions in an effort to reposition the free-floating debris in the endolymph of the semicircular canals. Surgery is not a noted treatment option and even in the absence of hearing loss, treatment is warranted.

A 20 year-old has been diagnosed with an astrocytic brain tumor located in the brainstem. Which of the following statements by the oncologist treating the client is most accurate? a) "Your prognosis will depend on whether we can surgically resect your tumor." b) "This is likely a result of a combination of heredity and lifestyle." c) "The major risk that you face is metastases to your lungs, liver or bones." d) "Our treatment plan will depend on whether your tumor is malignant or benign."

"Your prognosis will depend on whether we can surgically resect your tumor." The prognosis of people with pilocytic astrocytomas is influenced primarily by their location. The prognosis is usually better for people with surgically resectable tumors, such as those located in the cerebellar cortex, than for people with less accessible tumors, such as those involving the hypothalamus or brain stem. -Because of infiltration of brain tissue that prevents total resection, surgery rarely cures brain tumors. -The binary of malignant and benign is not used to characterize brain tumors and the etiology and substantive risk factors are largely unknown. - Brain tumors rarely metastasize outside the CNS.

The student nurse has to evaluate the function of cranial nerve XII. Which techniques would indicate that the student nurse needs further practice in correctly assessing cranial nerve XII function? Select all that apply.

-Evaluate the client's ability to say "fa-la-la" 3 to 4 times quickly. -Observe for symmetry when the patient opens her mouth and says "ahhh." -Evaluate the patient ability to hear sound equally in both right and left ears. Explanation: Having the patient stick out her tongue and noting any deviation to one side or the other are the best assessment techniques to observe CN XII. The tongue will deviate towards the damaged or weakened side. The other assessments are not relevant to CN XII function. Page 834

A client with hypothyroidism has not taken medication for several months, informing the nurse that she lost her insurance and is unable to afford the medication. When assessing the client's temperature tolerance and skin, what does the nurse anticipate finding? Select all that apply.

-Intolerance to cold -Decreased sweating -Coarse and dry skin and hair Explanation: The client with hypothyroidism experiences an intolerance to cold, decreased sweating, and coarse and dry skin and hair, related to the decrease in metabolic rate from the deficient thyroid secretion. Page 778

The nurse is educating a client with hyperthyroidism who has recovered from thyrotoxicosis (thyroid storm) and is preparing for discharge. What can the nurse inform the client that this hypermetabolic state can be caused by in order to decrease exacerbation? Select all that apply.

-Stress -Physical or emotional trauma -Manipulation of the thyroid gland Explanation: Thyroid storm is often precipitated by stress, such as an infection, by physical or emotional trauma, or by manipulation of a hyperactive thyroid gland during thyroidectomy. Page 783

Hyperthyroidism that is inadequately treated can cause a life-threatening condition known as a thyroid storm. What are the manifestations of a thyroid storm? (Select all that apply.)

-Tachycardia -Delirium -Very high fever Explanation: Thyroid storm is manifested by a very high fever, extreme cardiovascular effects (i.e., tachycardia, congestive failure, and angina), and severe CNS effects (i.e., agitation, restlessness, and delirium). The mortality rate is high. Very low fever and bradycardia are not manifestations of a thyroid storm. Page 783

Which statements are true regarding hypothyroidism? Select all that apply.

-Weight gain -Anorexia -Onset of symptoms is gradual Explanation: The hypometabolic state associated with hypothyroidism is characterized by a gradual onset of weakness and fatigue, a tendency to gain weight despite a loss of appetite, and cold intolerance. As the condition progresses, the skin becomes dry and rough and the hair becomes coarse and brittle. Gastrointestinal motility is decreased, producing constipation, flatulence, and abdominal distention. Page 780

Place the following components of the gastrointestinal tract in the chronological order that a bolus of food would pass through them. Use all the options. A) Hiatus B) Duodenum C) Ileum D) Pylorus E) Jejunum F) Cecum

1 Hiatus 2 Pylorus 3 Duodenum 4 Jejunum 5 Ileum 6 Cecum

A client is diagnosed with hyperthyroidism and is exhibiting weight loss, diarrhea, and tachycardia. What does the nurse understand that these clinical manifestations are related to?

A hypermetabolic state Explanation: Many of the manifestations of hyperthyroidism are related to the increase in oxygen consumption and use of metabolic fuels associated with the hypermetabolic state, as well as to the increase in sympathetic nervous system activity that occurs. Page 781

Which of the following hospital patients is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)?

A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident. Explanation: CRPS is marked the presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve with evidence at some time of edema, changes in skin blood flow, or abnormal sensorimotor activity in the region of pain. Pain related to shingles is an example of postherpetic neuralgia, while a need for analgesia prior to dressing changes would not indicated CRPS. Sudden attacks of pain accompanied by facial tics and spasms may be indicative of trigeminal neuralgia. Page 871

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? Excess acetylcholinesterase production; treatment with thymectomy Cerebellar lesions; surgical and immunosuppressive treatment A shortage of acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids

A shortage of acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

The mother of 6-year-old male and female fraternal twins has brought her son to see a pediatrician because he is nearly 4 inches shorter than his sister. Which of the following phenomena would the physician most likely suspect as contributing factor to the boy's short stature? A) Genetic short stature B) Lack of IGF receptors in epiphyseal long bones C) A shortage of hypothalamic GHRH production D) Excess insulin production resulting in chronically low blood glucose levels

A shortage of hypothalamic GHRH production

The mother of 6-year-old male and female fraternal twins has brought her son to see a pediatrician because he is nearly 4 inches shorter than his sister. Which of the following phenomena would the physician most likely suspect as contributing factor to the boy's short stature?

A shortage of hypothalamic GHRH production Explanation: Inadequate levels of hypothalamic GHRH will result in adequate production but inadequate release of GH by the pituitary. Genetic short stature is less likely given the disparity between his height and his twin's, and a shortage of IGF receptors is not a noted pathology. While poorly controlled diabetes can contribute to short stature, excess insulin production is not a likely factor. Page 772

A 26 year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced? a) An absence seizure b) A myoclonic seizure c) A complex partial seizure. d) A tonic-clonic seizure.

A tonic-clonic seizure. A tonic-clonic seizure often begins with tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness. Incontinence of bladder and bowel is common. Cyanosis may occur from contraction of airway and respiratory muscles. The tonic phase is followed by the clonic phase, which involves rhythmic bilateral contraction and relaxation of the extremities. -A myoclonic seizure involves bilateral jerking of muscles, generalized or confined to the face, trunk, or one or more extremities. -Absence seizures are nonconvulsive and -complex partial seizures are accompanied by automatisms (aimless and apparently undirected behavior that is not under conscious control and is performed without conscious knowledge).

Reflex activity involves which of the following? a) All of the above b) Efferent neurons c) Afferent neurons d) Interneurons

All of the above Afferent neurons synapse with efferent neurons directly, innervating a muscle or with an interneuron that synapses with an effector neuron.

Which complication of acromegaly can be life threatening?

Cardiac structures increase in size Explanation: While all the complications can exist, it is the enlargement of the heart and accelerated atherosclerosis that may lead to an early death. The teeth become splayed, causing a disturbed bite and difficulty in chewing. Vertebral changes often lead to kyphosis, or hunchback. Bone overgrowth often leads to arthralgias and degenerative arthritis of the spine, hips, and knees. Virtually every organ of the body is increased in size. Page 774

A nurse who works in the office of an endocrinologist is orienting a new staff member. Which of the following teaching points is the nurse justified in including in the orientation? Select all that apply. A) A bodily process can be the result of the combined effect of several different hormones from different sources.¡¨ B) A single hormone can act not only on one process or organ but often on several different locations or processes.¡¨ C) It's common for production of hormones to be far removed from the tissue where they ultimately exert their effect.¡¨ D) Sometimes hormones act locally on the area where they were produced, like in the case of paracrine and autocrine actions.¡¨ E) The regulation in homeostasis requires that hormones be absent from the body when their effect is not needed.¡¨

A) A bodily process can be the result of the combined effect of several different hormones from different sources.¡¨ B) A single hormone can act not only on one process or organ but often on several different locations or processes.¡¨ C) It's common for production of hormones to be far removed from the tissue where they ultimately exert their effect.¡¨ D) Sometimes hormones act locally on the area where they were produced, like in the case of paracrine and autocrine actions.¡¨

The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer's disease. What intervention will be implemented to slow cognitive decline? a) Psychotherapy b) Acetylcholinesterase inhibitors c) Antioxidant therapy d) Lipid-lowering agents

Acetylcholinesterase inhibitors Cognitive function in Alzheimer's disease (AD) can be enhanced by the use of medications. The acetylcholinsterase inhibitors donepezil, rivastigmine, and galantamine all increase concentration of acetylcholine in the cerebral cortex. -There has been no demonstrated improvement of cognitive function with use of lipid-lowering statins or antioxidant nutritional supplement therapy. -Psychotherapy is appropriate for depression.

The nurse is caring for a 42-year-old male client who is admitted for treatment of heart failure. He has abnormally large hands and feet and a broad face with a protruding jaw. Based on these signs and symptoms, the nurse identifies which of the following endocrine disturbances as the most likely cause for these physical changes?

Acromegaly Explanation: Enlargement of the small bones of the hands and feet and of the membranous bones of the face and skull results in a pronounced enlargement of the hands and feet, a broad and bulbous nose, a protruding jaw, and a slanting forehead. Bone overgrowth often leads to arthralgias and degenerative arthritis of the spine, hips, and knees. Virtually every organ of the body is increased in size. Enlargement of the heart and accelerated atherosclerosis may lead to an early death. Hyperthyroidism results from excess thyroid hormone. Myxedema and Cushing syndrome are the result of adrenal abnormalities and do not cause these bone changes. Page 773

At times, it is necessary to give medications that suppress the adrenal glands on a long-term basis. When the suppression of the adrenals becomes chronic, the adrenal glands atrophy. What does the abrupt withdrawal of these suppressive drugs cause?

Acute adrenal insufficiency Explanation: Chronic suppression causes atrophy of the adrenal gland, and the abrupt withdrawal of drugs can cause acute adrenal insufficiency. The other answers are incorrect. Page 786

A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing: a) Primary open-angle glaucoma b) Acute-onset wide-angle glaucoma c) Acute angle-closure glaucoma d) Subacute angle-closure glaucoma

Acute angle-closure glaucoma The sudden onset of eye pain, blurred vision, and a headache on the affected side indicate acute angle-closure glaucoma, which is an ophthalmic emergency. -Subacute angle-closure glaucoma manifests as recurrent short episodes of unilateral pain, conjunctival redness, and blurring of vision associated with halos around lights. -Open-angle glaucoma is usually asymptomatic and chronic.

During descent, an airplane passenger is complaining that his "ears are plugged." What aspect of the structure and function of the ear best accounts for the passenger's complaint? Air must be able to flow between the middle ear and the nasopharynx in order to accommodate pressure changes. The tympanic membrane is selectively permeable in order to accommodate pressure changes and this capacity is often impaired during upper respiratory infections. The eustachian tubes must remain patent to equalize pressure between the middle ear and inner ear. The inner ear adjusts its volume in response to atmospheric pressure, increasing during low pressure and decreasing in high pressure.

Air must be able to flow between the middle ear and the nasopharynx in order to accommodate pressure changes.

Which of the following hormones are derivatives of cholesterol? A) Epinephrine and norepinephrine B)Insulin and glucagon C) Aldosterone and testosterone D) Eicosanoids and retinoids

Aldosterone and testosterone

College students were given various amounts of alcohol within a specified timeframe 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: a) Interacts negatively with the potassium-sodium pump, allowing alcohol to freely flow into the capillaries of the brain." b) Allows alcohol, a very lipid-soluble molecule to rapidly enter the brain." c) Allows more bilirubin to cross the barrier producing brain damage." d) Excludes water-based compounds from crossing the brain with the exception of alcohol."

Allows alcohol, a very lipid-soluble molecule to rapidly enter the brain." The blood-brain barrier prevents many drugs from entering the brain. Most highly water-soluble compounds are excluded from the brain, especially molecules with high ionic charge, such as many of the catecholamines. In contrast, many lipid-soluble molecules cross the lipid layers of the blood-brain barrier with ease. Alcohol, nicotine, and heroin are very lipid soluble and rapidly enter the brain.

Neuromodulators can produce slower and longer-lasting changes in membrane excitability by acting on postsynaptic receptors. What do neuromodulators do?

Alter the release of or response to neurotransmitters Explanation: Neuromodulator molecules react with presynaptic or postsynaptic receptors to alter the release of or response to neurotransmitters. The other answers are incorrect. Page 829

Neuromodulators can produce slower and longer-lasting changes in membrane excitability by acting on postsynaptic receptors. What do neuromodulators do? a) Alter the release of or response to neurotransmitters b) Alter the inhibitory response of postsynaptic electrical receptors c) Alter the ligand gate response to electrical activity d) Alter the metabolic function of Schwann cells

Alter the release of or response to neurotransmitters Neuromodulator molecules react with presynaptic or postsynaptic receptors to alter the release of or response to neurotransmitters. The other answers are incorrect.

The nurse is performing an assessment for a client with Cushing syndrome and observes a "buffalo hump" on the back, a moon face, and a protruding abdomen. What does the nurse understand contributes to the distribution of fat in these areas?

Altered fat metabolism Explanation: The major manifestations of Cushing syndrome represent an exaggeration of the many actions of cortisol. Altered fat metabolism causes a peculiar deposition of fat characterized by a protruding abdomen, subclaviclar fat pads or "buffalo hump" on the back, and a round, plethoric "moon face." Page 789

A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of: a) Degeneration of the lower cell bodies of the lower motor neurons in the gray matter b) Degenerative changes in the musculoskeletal system c) Circulating antibodies attacking the postsynaptic acetylcholine levels d) An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve

An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve MS is an immune response against the components of the myelin sheath. There is a progressive demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and the optic nerve. The other options do not describe MS. (

A nurse is teaching a client newly diagnosed with a seizure disorder about medications. The most important information for the nurse to provide would be: a) Antiepileptic medications should never be discontinued abruptly. b) Pregnant women should reduce the dose of medication they are taking. c) All antiepileptic medications should be taken with food. d) Children can build up a tolerance to the medication quickly.

Antiepileptic medications should never be discontinued abruptly. Consistency in taking seizure medications is essential to obtaining and maintaining therapeutic blood levels of the medication. Abrupt withdrawal can cause seizure recurrence. Monitoring and assessment of drug levels are important. Each prescribed drug will provide information regarding administration to provide client safety.

What medication teaching should be done for a woman of childbearing age with a seizure disorder? a) Antiseizure drugs do not interact with oral contraceptives. b) Antiseizure drugs increase the risk for congenital abnormalities. c) All women of childbearing age should be advised to take a vitamin C supplement. d) Some antiseizure drugs can interfer with vitamin K metabolism.

Antiseizure drugs increase the risk for congenital abnormalities. For women with epilepsy who become pregnant, antiseizure drugs increase the risk for congenital abnormalities and other perinatal complications. - Many of the antiseizure medications interact with oral contraceptives and can interfere with vitamin D metabolism. -All woman should be advised to take folic acid supplementation.

The nurse is performing a Romberg test on a client. Select the statement that best describes purpose of the test. a) Assess for neurological weakness b) Assess for transient ischemic attacks c) Assess for static vestibular function d) Assess for conductive hearing loss

Assess for static vestibular function The Romberg test is used to demonstrate disorders of static vestibular function. It is done by having a person stand with his or her feet together and arms extended forward so that the degree of sway and arm stability can be observed. (less)

Staff at the care facility note that a woman has started complaining of back pain in recent weeks and occasionally groans in pain. She has many co-morbids that require several prescription medications. The nurse knows that which of the following factors is likely to complicate the clinician's assessment and treatment of the client's pain?

Assessment and treatment are possibly complicated by the large number of drugs that the client receives. Explanation: Polypharmacy complicates both assessment and treatment of pain in the older adult. While minor changes in pain pathways do occur as an age-related change, these do not mean that treatment is unsuccessful. Pain assessment is more difficult in clients with cognitive deficits, but it is not impossible. Reports of pain in the elderly, as with any client, may signal an underlying health problem. Page 876

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? a) CT scan b) MRI c) Intravenous antibiotics d) 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).

Following a stroke, injury to nerve cells within the central nervous system needs to be repaired. The health care provider knows that which of the following processes explains how this occurs? a) The microglia are responsible for cleaning up debris after cerebral infection, or cell death. b) Oligodendrocytes are responsible for integrative metabolism. c) Ependymal cells are responsible for phagocytosis. d) Astrocytes fill up the space to form a glial scar, repairing the area and replacing the CNS cells that cannot regenerate.

Astrocytes fill up the space to form a glial scar, repairing the area and replacing the CNS cells that cannot regenerate. Astrocytes are the largest and most numerous of neuroglia and are particularly prominent in the gray matter of the CNS. They form a network within the CNS and communicate with neurons to support and modulate their activities. Astrocytes are also the principal cells responsible for repair and scar formation in the brain. -The microglia is a small phagocytic cell that is available for cleaning up debris after cellular infection or cell death. -The ependymal cell forms the lining of the neural tube cavity, the ventricular system. -The oligodendrocytes form the myelin in the CNS. Instead of forming a myelin covering for a single axon, these cells reach out with several processes, each wrapping around and forming a multilayered myelin segment around several different axons.

Which of the following cell types are responsible for repair and scar formation (also called gliosis)in the brain? a) Schwann cells. b) Astrocytes. c) Microglia. d) Oligodendrocytes.

Astrocytes. Astrocytes, the most numerous of the neuroglial cells, are the principle cells responsible for repair and scar formation in the brain. This process is called gliosis. -Microglia, another neuroglial cell of the CNS, is a small phagocytic cell that is available for cleaning up debris after cellular damage, infection or cell death. -Oligodendrocytes are neuroglial cells that form myelin in the CNS. -Schwann cells are also neuroglial cells that produce myelin in the PNS.

The nurse caring for a client with a newly diagnosed intracranial tumor anticipates that the neoplasm will be which of the following? a) Oligodendroglioma b) Meningioma c) Astrocytic neoplasms d) Metastatic carcinoma

Astrocytic neoplasms Collectively, astrocytic neoplasms are the most common type of primary brain tumor in adults; therefore the nurse anticipates that this is the cause of te client's intracranial tumor.

When conducting a health assessment that focuses on the pain experienced by an older client diagnosed with early dementia, the nurse will pay particular attention to which of the following?

Behavioral signs of pain demonstrated by the client Explanation: The assessment of pain in older adults can range from relatively simple in a well-informed, alert, cognitively intact person with pain from a single source and no comorbidities to extraordinarily difficult in a confused person. When possible, a person's report of pain is the gold standard, but behavioral signs of pain should also be considered. This is especially true when the client's cognitive function is impaired. While the other options should be considered, the client's non verbal behaviors should be of particular interest to the nurse. Page 876

A practitioner is preparing to do a lumbar puncture on a patient with suspected meningitis. Which of the following areas on the spine does the practitioner choose to obtain a cerebrospinal fluid (CSF) sample? a) Between T1 and T2 b) Between T12 and L1 c) Between C7 and C8 d) Between L3 and L4

Between L3 and L4 The adult cord usually terminates at the inferior border of L1. The arachnoid and its enclosed subarachnoid space, which is filled with CSF, do not close down on the filum terminale until they reach the second sacral vertebra. This results in a formation of a pocket of CSF, the dural cisterna spinalis, which extends from approximately L2 to S2. Because this has an abundant supply of CSF and the spinal cord does not extend this far, the area (L3 or L4) is often used to perform a lumbar puncture to obtain CSF

Following a collision while mountain biking, the diagnostic work up of a 22 year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis? a) Blood has accumulated between the man's dura and subarachnoid space. b) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP. c) Blood has displaced CSF in the ventricles as a consequence of his coup-contrecoup injury. d) Vessels have burst between the client's skull and his dura.

Blood has accumulated between the man's dura and subarachnoid space. A subdural hematoma develops in the area between the dura and the arachnoid space while epidural hematomas exist between the skull and dura. -Intracerebral hematomas are located most often in the frontal or temporal lobe and the ventricles are not directly involved in a subdural hematoma.

Bone is connective tissue, in which the intercellular matrix has been impregnated with inorganic calcium salts, that has great tensile and compressible strength but is light enough to be moved by coordinate muscle contractions. One-third of the dry weight of bone is composed of which of the following? A) Bone cells, inorganic salts, and blood vessels B) Hydroxyapatite, calcium carbonate, and calcium fluoride C) Bone cells, blood vessels, and nerves D) Organic matter and inorganic salts

Bone cells, blood vessels, and nerves

Which components of the nervous system make up the central nervous system? a) Astrocytes and Schwann cells b) Brain and spinal cord c) Dendrites and axons d) Neurohormones and neurosecretory granules

Brain and spinal cord The brain and the spinal column make up the central nervous system. The peripheral nervous system lies outside of these two structures.

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

A teenager has been in a car accident and experienced 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? a) Status epilepticus b) Brain contusions and hematomas c) Momentary unconsciousness d) TIAs and cerebrovascular infarction

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 a 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 teenager has been in a car accident and experienced 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? a) Brain contusions and hematomas b) Momentary unconsciousness c) TIAs and cerebrovascular infarction d) 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 a 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.

An increased blood pressure is detected by the carotid sinus baroreceptor and results in stimulation of the vagus nerve to decrease the heart rate. At which of the following levels of the nervous system does this reflex adjustment occur? a) Spinal cord b) Brain stem (medulla and pons) c) Cerebral cortex d) Hypothalumus

Brain stem (medulla and pons) Reflex adjustment of cardiovascular and respiratory function occur at the level of the brain stem (medulla and pons). The other options do not provide autonomic control of the cardiovascular system.

A patient who has experienced a spinal cord injury has an ipsilateral loss of voluntary motor function and a contralateral loss of pain and temperature sensation. Based on these symptoms, which classification of spinal cord injury does the patient have? a) Brown Sequard b) Tetraplegia c) Paraplegia d) Anterior Cord Syndrome

Brown Sequard A condition called Brown-Séquard syndrome results from damage to a hemisection of the anterior and posterior cord. The effect is an ipsilateral loss of voluntary motor function from the corticospinal tract and proprioception loss with a contralateral loss of pain and temperature sensation from the lateral spinothalamic tracts for all levels below the lesion.

When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present? a) Kernig sign and Chadwick sign b) Chvostek sign and Guedel sign c) Brudzinski sign and Chadwick sign d) Brudzinski sign and Kernig sign

Brudzinski sign and Kernig sign Two assessment techniques can help determine whether meningeal irritation is present. Kernig sign is resistance to extension of the knee while the person is lying with the hip flexed at a right angle. Brudzinski sign is elicited when flexion of the neck induces flexion of the hip and knee. The other answers are incorrect.

The nurse on the pediatric unit is implementing distraction strategies for a child who is experiencing pain. Which strategies would be best for the nurse to implement? Select all that apply.

Bubbles Television Music Games Explanation: Distraction helps children of any age divert their attention away from pain and onto other activities. Common attention diverters include bubbles, music, television, conversation, and games. Page 876

Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply. A) Clouding of consciousness B) Decorticate posturing with painful stimulation C) Pupils fixed at approximately 5 mm in diameter D) Respiration rate of 40 breaths/minute E) Decerebrate posturing following painful stimulation of the sternum

C) Pupils fixed at approximately 5 mm in diameter D) Respiration rate of 40 breaths/minute E) Decerebrate posturing following painful stimulation of the sternum

The nurse is caring for an adult client with growth hormone deficiency. When performing an assessment of this client, which system should the nurse be sure to assess for complications related to this disorder?

Cardiovascular system Explanation: Evidence shows that cardiovascular mortality increases in GH-deficient adults. A higher prevalence of atherosclerotic plaques and endothelial dysfunction has been reported in both childhood and adult GH deficiency. The GH deficiency syndrome is associated with a cluster of cardiovascular risk factors, including central adiposity, insulin resistance, and dyslipidemia. Page 773

A 60-year-old man has long managed his type 1 diabetes effectively with a combination of vigilant blood sugar monitoring, subcutaneous insulin administration, and conscientious eating habits. This morning, however, his wife has noted that he appears pale and clammy and to be in a stupor, though he is responsive. She suspects that he has made an error in his insulin administration and that he is experiencing a hypoglycemic episode. Which of the following actions should be the wife's first choice?

Careful monitoring for level of consciousness and resolution of hypoglycemia IV infusion of 50% dextrose and water solution Administration of subcutaneous glucagon *********Administration of 15 to 20 g of glucose in a concentrated carbohydrate source

An adult client with growth-hormone deficiency related to hypopituitarism has been taking replacement therapy for several months. The client informs the nurse that she is having pain in the hand and wrist almost constantly. What does the nurse understand is a common side effect of this therapy that seems to have affected this client?

Carpal tunnel syndrome Explanation: The most common side effects of GH treatment in adults with hypopituitarism are peripheral edema, arthralgias, myalgias, carpal tunnel syndrome, paresthesias, and decreased glucose tolerance. Page 773

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: a) Lou Gehrig disease b) Carpal tunnel syndrome c) Muscular dystrophy

Carpal tunnel syndrome Carpal tunnel syndrome is characterized by pain, paresthesia (tingling), and numbness of the thumb and first, second, third, and half of the fourth digits of the hand; pain in the wrist and hand, which worsens at night; atrophy of the abductor pollicis muscle; and weakness in precision grip. All of these abnormalities may contribute to clumsiness of fine motor activity.

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy? a) Myasthenia gravis b) Carpal tunnel syndrome c) Guillain-BarrÉ syndrome d) Phalen syndrome

Carpal tunnel syndrome The most common clinical presentation is slowly progressive weakness and atrophy in distal muscles of one upper extremity. The other answers do not describe the clinical presentation of amyotrophic lateral sclerosis.

Which of the following is an aspect of the bone growth and development that occurs during the first two decades of life? A) Most bone abnormalities can be traced to anomalies in the embryonic stage of development. B) The physiological effects of in utero positioning normally remain into late adolescence. C) Cartilage cells at the metaphyseal end of the bone plate are replaced by bone cells. D) Bone length increases through childhood, while bone diameter remains static.

Cartilage cells at the metaphyseal end of the bone plate are replaced by bone cells.

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: a) Cause vasoconstriction of the renal system b) Cause alteration in the level of consciousness c) Cause vasodilatation of the coronary blood vessels d) Cause vasoconstriction of the splanchnic vessels

Cause vasodilatation of the coronary blood vessels Dopamine, which is an intermediate compound in the synthesis of norepinephrine, also acts as a neurotransmitter. It is the principal inhibitory transmitter of interconnecting neurons in the sympathetic ganglia. It also has vasodilator effects on renal, splanchnic, and coronary blood vessels when given intravenously and is sometimes used in the treatment of shock. Level of consciousness is not affected.

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 Explanation: Dopamine, which is an intermediate compound in the synthesis of norepinephrine, also acts as a neurotransmitter. It is the principal inhibitory transmitter of interconnecting neurons in the sympathetic ganglia. It also has vasodilator effects on renal, splanchnic, and coronary blood vessels when given intravenously and is sometimes used in the treatment of shock. Level of consciousness is not affected. Page 852

A patient is admitted to the hospital in Addisonian crisis one month after a diagnosis of Addison's disease. The nurse knows which of the following clinical manifestations would support this diagnosis?

Change in level of consciousness and profound hypotension Explanation: Acute adrenal crisis is a life-threatening situation. Exposure to even a minor illness or stress can cause a client with Addison's disease to develop nausea, vomiting, muscular weakness, hypotension, dehydration, and vascular collapse (which causes a change in LOC). Hemorrhage (low BP) can be caused by septicemia, adrenal trauma, anticoagulant therapy, adrenal vein thrombosis, or adrenal metastases. A hyperactive reflex may indicate disease of the pyramidal tract above the level of the reflex arc being tested. Generalized hyperactivity of DTRs may be caused by hyperthyroidism. Any tear or hole in the membrane that surrounds the brain and spinal cord (dura) can allow the fluid that surrounds those organs to leak. This fluid is called the cerebrospinal fluid (CSF). When it leaks out, the pressure around the brain and spinal cord drops. Causes of leakage through the dura include certain head, brain, or spinal surgeries; head injury; placement of tubes for epidural anesthesia or pain medications; or lumbar puncture. Irregular heart rates (arrhythmias) may be caused by many different factors, including coronary artery disease, electrolyte imbalances in the blood (such as sodium or potassium), changes in the heart muscle, or injury from a heart attack. Page 788

Nutrition students are studying the nervous system, which has a high rate of metabolism. Which of the following is its major fuel source? a) Protein b) Electrolyes c) Glucose d) Ketones

Glucose Glucose is the major fuel source for the nervous system, but neurons have no provision for storing glucose. Ketones can provide for limited, temporary energy requirements; however, these resources are rapidly depleted.

Drugs like diazepam (Valium), a benzodiazepine, exert their action on ion channels. These drugs do not open the GABA-operated ion channel, but they: a) Change the effect that GABA has when it binds to the channel at the same time as the drug b) Modulate the peripheral sympathetic nerves and can have both a transmitter and modulator function c) Play a necessary role in the long-term survival of presynaptic neurons d) Modulate the release from axon terminals

Change the effect that GABA has when it binds to the channel at the same time as the drug Amino acids, such as glutamine, glycine, and GABA, serve as neurotransmitters at most CNS synapses. GABA mediates most synaptic inhibition in the CNS. Drugs such as the benzodiazepines (e.g., the tranquilizer diazepam) and the barbiturates exert their action by binding to their own distinct receptor on a GABA-operated ion channel. The drugs by themselves do not open the channel, but they change the effect that GABA has when it binds to the channel at the same time as the drug. -Another class of messenger molecules, known as neuromodulators, also may be released from axon terminals. In contrast to neurotransmitters, neuromodulators do not directly activate ion channel receptors but bring about long-term changes that subtly enhance or depress the action of the receptors. -Neuromodulators, such as dopamine, serotonin, acetylcholine, histamine, and others, may act at either presynaptic or postsynaptic sites.

Cerebrospinal fluid (CSF) is produced by which of the following structures?

Choroid plexus Explanation: The CSF is produced by tiny reddish masses of specialized ependymal cells and capillaries, called the choroid plexus, which projects into the ventricles. The other options do not produce CSF. Page 844

Cerebrospinal fluid (CSF) is produced by which of the following structures? a) Arachnoid mater b) Choroid plexus c) Falx cerebri d) Dura mater

Choroid plexus The CSF is produced by tiny reddish masses of specialized ependymal cells and capillaries, called the choroid plexus, which projects into the ventricles. The other options do not produce CSF

Select the function of the occipital lobe.

Color, motion, and depth perception Explanation: The occipital lobe is associated with the ability to experience color, depth, and motion perception. The temporal lobe is responsible for behavior, and the parietal lobe helps us to determine objects through the sense of feel. Page 843

Select the function of the occipital lobe. a) Discrimination of sounds entering opposite ears b) Determination of objects through the sense of touch c) Anticipation and prediction of consequences of behavior d) Color, motion, and depth perception

Color, motion, and depth perception The occipital lobe is associated with the ability to experience color, depth, and motion perception. -The temporal lobe is responsible for behavior, -The parietal lobe helps us to determine objects through the sense of feel.

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment? A) Delirium B) Coma C) Brain death D) Vegetative state

Coma

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly but her respiratory rate is 45 breaths per minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment? a) Vegetative state b) Brain death c) Delirium d) Coma

Coma The continuum of loss of consciousness is marked by the degree of client responsiveness to stimuli, in addition to the preservation of brain stem reflexes. -Since this client still exhibits a pain response (the extended arms and legs indicate decerebrate posturing), even though her pupils are not responsive to light, she has sustained sufficient brain function that she fails to qualify as brain-dead or in a vegetative state.

Which of the following characterizes a function of the parasympathetic nervous system (PNS)? a) Conservation of energy b) Blood sugar increase c) Constriction of the stomach and intestine sphincters d) Blood flow shifting from the skin and gastrointestinal tract to the skeletal muscles and brain

Conservation of energy The functions of the PNS are concerned with conservation of energy, resource replenishment and storage, and maintenance of organ function during periods of minimal activity—the rest-digest response. All other options are functions of the sympathetic nervous system

Several months ago, a 20 year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced? a) Conus medullaris syndrome b) Brown-Sequard syndrome c) Anterior cord syndrome d) Central cord syndrome

Conus medullaris syndrome Functional deficits resulting from conus medullaris syndrome usually result in flaccid bowel and bladder and altered sexual function. Sacral segments occasionally show preserved reflexes if only the conus is affected. Motor function in the legs and feet may be impaired without significant sensory impairment. Anterior cord syndrome and Brown-Sequard syndrome include a loss of pain and temperature sensation while central cord syndrome manifests in spastic paralysis and is more common among older adults.

The nurse measures a blood glucose level of 40 mg/dL for a client with diabetes type I. Why would it be important for the nurse to institute an intervention to elevate the glucose level in this client?

Glucose is not stored in the brain and is a major fuel source for brain function. Explanation: Glucose is the major fuel source for the nervous system but neurons have no provision for storing glucose. Ketones can provide for limited temporary energy requirements. However, these sources are rapidly depleted. Page 825

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 Explanation: The cerebellum compares what is actually happening with what is intended to happen. It then transmits the appropriate corrective signals back to the motor system, instructing it to increase or decrease the activity of the participating muscle groups so that smooth and accurate movements can be performed. Answer B describes the trigeminal nerve, which exits the brain stem. Answer C describes the pons. Answer D describes the midbrain. Page 840

The thick area of myelinated axons that connects the two sides of the cerebral cortex is known as which of the following components? a) Striatum b) Corpus callosum c) Caudate nucleus d) Globus pallidus

Corpus callosum The thick area of myelinated axons that connects the two sides of the cerebral cortex is known as the corpus callosum. The remaining options are all components of the basal ganglia

A client is diagnosed with adrenocorticotropic hormone deficiency (ACTH) and is to begin replacement therapy. Regarding which type of replacement will the nurse educate the client?

Cortisol replacement therapy. Explanation: Cortisol replacement is started when ACTH deficiency is present; thyroid replacement when TSH deficiency is detected; and sex hormone replacement when LH and FSH are deficient. GH replacement is indicated for pediatric GH deficiency, and is increasingly being used to treat GH deficiency in adults. Page 770

The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computerized tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage? a) Craniotomy and clipping of the affected vessel. b) STAT administration of tissue-type plasminogen activator (tPA). c) Administration of a diuretic such as mannitol to reduce cerebral edema and ICP. d) Monitoring in ICU for signs and symptoms of cerebral insult.

Craniotomy and clipping of the affected vessel. Surgery for treatment of aneurysmal subarachnoid hemorrhage involves craniotomy and inserting a specially designed silver clip that is tightened around the neck of the aneurysm. Administration of tPA would exacerbate bleeding and a diuretic would not address the issue of bleeding. Monitoring alone would be an insufficient response given the severity of the problem.

The newborn-nursery nurse is obtaining a blood sample to determine if a newborn has congenital hypothyroidism. What long-term complication is the nurse aware can occur if this test is not performed and the infant has congenital hypothyroidism?

Cretinism Explanation: Congenital hypothyroidism is a common cause of preventable intellectual disability. It affects approximately 1 in 4000 infants. The manifestations of untreated congenital hypothyroidism are referred to as cretinism. The term does not apply to the normally developing infant in whom replacement thyroid hormones therapy was instituted shortly after birth. Page 780

A patient's chart documents the finding of cholesteatoma. The nurse interprets this to mean that the patient has which of the following? a) Pain in the middle ear b) Drainage from the ear c) Build up of cerumen d) Cystlike mass in the middle ear

Cystlike mass in the middle ear Cholesteatoma is a cystlike mass of the middle ear that often extends to involve the temporal bone.

The provider is testing the patient's ability to identify the specific location of skin touch in two different areas. This ability is communicated through which pathway?

Discriminative Explanation: The discriminative pathway relays precise information regarding spatial orientation. This is the only pathway taken by the sensations of muscle and joint movement, vibration and delicate discriminative touch, as is required to differentiate the location of touch on the skin at two neighboring points. The anterolateral pathway (anterion and lateral spinothalamic pathways) provide transmission of sensory information such as pain, thermal sensations, crude touch and pressure that does not require discrete localization or fine discrimination. The paleospinothalamic tract gives touch its affective or emotional aspects, such as heavy pressure. Page 855

After evaluating the patient, the physician thinks that his elderly patient is exhibiting signs and symptoms of normal pressure hydrocephalus. Which of the following symptoms would be seen? a) Papilledema b) Headache c) Vomiting d) Disturbances in gait

Disturbances in gait In adults, slowly developing hydrocephalus may produce deficits such as progressive dementia and gait changes. The other options are symptoms of increased ICP seen in acute onset hydrocephalus.

The nurse is caring for an elderly client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for which of the following conditions? a) Pseudohypertrophy b) Disuse atrophy c) Muscular dystrophy d) Involuntary movements

Disuse atrophy Disuse 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.

A client affected by postural hypotension will likely display what symptoms? a) Flushing of skin with repositioning b) Dizziness and pallor when moved to upright position c) Sudden pain with movement to sitting position d) Inability to sit upright due to muscle weakness

Dizziness and pallor when moved to upright position Postural hypotension is caused by interruption of sympathetic outflow to vessels in abdomen and extremities. Pooling of blood leads to impaired venous blood return and symptoms with position change to upright

A male college student has arrived at the student clinic complaining of tingling, itching, and pains in his groin. Upon inspection, the nurse notices some pustules and vesicles. While taking a detailed sexual history, the nurse should ask which of the following questions to rule out further complications? A) Do you get cold sores very often? B) Do you have pain when you urinate or have difficulty starting the stream? C) Have you noticed excessive swelling in your scrotum the last few days? D) Have you been experiencing flank pain and bloody urine?

Do you have pain when you urinate or have difficulty starting the stream?

Which of the following catecholamines may have a vasodilator effect on the renal blood vessels and be prescribed for clients in shock who are experiencing renal insufficiency manifestations? a) Acetylcholine b) Enkephalin c) Norepinephrine d) Dopamine

Dopamine The catecholamines, which include norepinephrine, epinephrine, and dopamine, are synthesized in the sympathetic nervous system and are the neurotransmitters for most postganglionic sympathetic neurons. Dopamine, which is an intermediate compound in the synthesis of norepinephrine, also acts as a neurotransmitter. It is the principal inhibitory transmitter of interconnecting neurons in the sympathetic ganglia. It also has vasodilator effects on renal, splanchnic, and coronary blood vessels when given intravenously and is sometimes used in the treatment of shock. -Endorphins and enkephalins are involved in pain sensation and perception. -Acetylcholine is the transmitter for all preganglionic neurons, for postganglionic parasympathetic neurons, and for selected postganglionic sympathetic neurons.

Which one of the following meninges provides the major protection for the brain and spinal cord? a) Pia mater b) Dura mater c) Arachnoid membrane d) Tentorium cerebelli

Dura mater All surfaces of the spinal cord, brain, and segmental nerves are covered with a delicate connective tissue layer called the pia mater. A second, very delicate, nonvascular, and waterproof layer, called the arachnoid, encloses the entire central nervous system. Immediately outside the arachnoid is a continuous sheath of strong connective tissue, the dura mater, which provides the major protection for the brain and spinal cord. The tentorium cerebelli is the inner layer of the dura that anchors the brain to the skull

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

Dura mater Explanation: All surfaces of the spinal cord, brain, and segmental nerves are covered with a delicate connective tissue layer called the pia mater. A second, very delicate, nonvascular, and waterproof layer, called the arachnoid, encloses the entire central nervous system. Immediately outside the arachnoid is a continuous sheath of strong connective tissue, the dura mater, which provides the major protection for the brain and spinal cord. The tentorium cerebelli is the inner layer of the dura that anchors the brain to the skull. Page 844

Parents of a 7-year-old girl are concerned about their daughter because she has begun to develop secondary sexual characteristics. What etiologic factor is most likely to underlie the child's condition?

Early activation of the hypothalamic--pituitary--gonadal axis Explanation: Isosexual or central precocious puberty involves early activation of the hypothalamic--pituitary--gonadal axis, resulting in the development of appropriate sexual characteristics and fertility. It is not caused by trauma such as sexual abuse and it does not involve thyroid function. Precocious puberty is not noted to be a genetic trait. Page 775

Which of the following types of synapse allows the quickest transmission from one neuron to another?

Electrical Explanation: Electrical synapses premit the passage of current-carrying ions through small openings called gap junctions. The gap junctions allow an action potential to pass directly and quickly from one neuron to another. Chemical synapses are the slowest component in progressive communication through a sequence of neurons. Chemical synapses are divided into two types: excitatory and inhibitory. Page 826

A client who sustained a complete C6 spinal cord injury 6 months ago has been admitted to the hospital for pneumonia. The nurse observes the client with diaphoresis above the level of C6 and the blood pressure is 260/140 mm Hg. What is the first intervention the nurse should provide? a) Disimpact the stool from the anal vault. b) Elevate the head of the bed. c) Give the client some orange juice and sugar. d) Insert an indwelling catheter.

Elevate the head of the bed. Autonomic dysreflexia is a clinical emergency, and without prompt and adequate treatment, convulsions, loss of consciousness, and even death can occur. The major components of treatment include monitoring blood pressure while removing or correcting the initiating cause or stimulus. The person should be placed in an upright position, and all support hose or binders should be removed to promote venous pooling of blood and reduce venous return.

Congenital adrenal hyperplasia is a congenital disorder in which a deficiency exists in any of the enzymes necessary for the synthesis of cortisol. Infants of both sexes are affected, although boys are not diagnosed at birth unless of enlarged genitalia. Female infants often have ambiguous genitalia because of the oversecretion of adrenal androgens. What are the manifestations of the ambiguous genitalia caused by congenital adrenal hyperplasia?

Enlarged clitoris, fused labia, and urogenital sinus Explanation: In female infants, an increase in androgens is responsible for creating the virilization syndrome of ambiguous genitalia with an enlarged clitoris, fused labia, and urogenital sinus. The other answers are incorrect. Page 786

A patient with diabetes mellitus has just undergone a right, below the knee amputation following gangrene infection. A few days post-op, the patient confides in the nurse that he still feels his right foot. Knowing the pathophysiologic principles behind this, the nurse can:

Explain that many amputees have this sensation and that one theory surmises the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site. Explanation: Multiple theories exist related to the causes of phantom limb pain. One rationale is that the end of the regenerating nerve becomes trapped in the scar tissue that forms a barrier to regenerating outgrowth of the axon. The usual treatment includes: the use of sympathetic blocks; TENS of the large myelinated afferents innervating the area; hypnosis; and, relaxation training. Page 871

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 but is oriented to person and place but not time. What type of seizure did this client most likely experience? a) Focal seizure with impairment to consciousness b) Atonic seizure c) Tonic-clonic seizure d) Myoclonic seizure

Focal seizure with impairment to consciousness Focal seizures with impairment of consciousness, sometimes referred to as psychomotor seizures, are often accompanied by automatisms or repetitive nonpurposeful activities such as lip smacking, grimacing, patting, or rubbing clothing. Confusion during the postictal period (after a seizure) is common. -Atonic seizures are characterized by loss of muscle tone, and -myoclonic seizures involve brief involuntary muscle contractions induced by stimuli of cerebral origin. -With tonic-clonic seizures, formerly called grand mal seizures, a person has a vague warning (probably a simple focal seizure) and experiences a sharp tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness.

A client is seeking treatment for infertility. What decrease in hormone secretion from the anterior lobe of the pituitary gland that regulates fertility would the nurse recognize may cause this issue?

Follicle stimulating hormone (FSH) Explanation: ACTH controls the release of cortisol from the adrenal gland. TSH controls the secretion of thyroid hormone from the thyroid gland. LH regulates sex hormones. FSH regulates fertility. Page 768

Nutrition students are studying the nervous system, which has a high rate of metabolism. Which of the following is its major fuel source?

Glucose Explanation: Glucose is the major fuel source for the nervous system, but neurons have no provision for storing glucose. Ketones can provide for limited, temporary energy requirements; however, these resources are rapidly depleted. Page 825

The nurse measures a blood glucose level of 40 mg/dL for a client with diabetes type I. Why would it be important for the nurse to institute an intervention to elevate the glucose level in this client? a) Glucose is not stored in the brain and is a major fuel source for brain function. b) It is not necessary for glucose to be replaced immediately because the client will have enough stores to function for a while. c) Small amounts of glucose may be stored in the brain for a short period of time but are rapidly metabolized. d) The nurse should administer a food source of protein in order to increase the glucose level for improved cardiac function.

Glucose is not stored in the brain and is a major fuel source for brain function. Glucose is the major fuel source for the nervous system but neurons have no provision for storing glucose. Ketones can provide for limited temporary energy requirements. However, these sources are rapidly depleted.

Which of the following statements best describes an aspect of the normal process of glucose metabolism? a. Glucose that exceeds metabolic needs is converted and stored by the liver. b. Blood glucose levels are kept in a steady state by selective excretion and reuptake by the kidneys. c. Ingested glucose that is not needed for cellular metabolism circulates in the blood until it is taken up to meet cellular needs. d. Blood glucose levels are primarily a result of the timing, quantity, and character of food intake.

Glucose that exceeds metabolic needs is converted and stored by the liver.

Which of the following statements best describes an aspect of the normal process of glucose metabolism? A) Blood glucose levels are primarily a result of the timing, quantity, and character of food intake. B) Ingested glucose that is not needed for cellular metabolism circulates in the blood until it is taken up to meet cellular needs. C) Blood glucose levels are kept in a steady state by selective excretion and reuptake by the kidneys. D) Glucose that exceeds metabolic needs is converted and stored by the liver.

Glucose that exceeds metabolic needs is converted and stored by the liver.

A 25-year-old female client exhibits exophthalmos of both eyes. The health care provider recognizes this as a manifestation of:

Graves disease Explanation: Graves disease is a state of hyperthyroidism in which opthalmopathies, such as exophthalmos, typically occur. The other conditions are states of hypothyroidism and are not associated with this abnormality. Page 781

During pathophysiology class, a nursing student asks the faculty what purpose do the osteoprogenitor cells serve. From the following list, identify the purpose of these cells. Select all that apply. A) Formation of red blood cells B) Growth and remodeling of bone C) Anchorage point for blood vessels D) Repair of bone E) Supply nerves to the bone matrix

Growth and remodeling of bone Repair of bone

A 30-year-old woman has sought care because of her recurrent photophobia, tearing, and eye irritation. During assessment, her care provider asks about any history of cold sores or genital herpes. What is the rationale for the care provider's line of questioning? A history of HSV with eye irritation is suggestive of glaucoma. Chronic viral infection of the eyes can result in HSV autoinoculation of the mouth and labia. HSV infection of the cornea is a common cause of corneal ulceration and blindness. Herpes simplex virus (HSV) conjunctivitis indicates a need for antiviral rather than antibacterial treatment.

HSV infection of the cornea is a common cause of corneal ulceration and blindness.

A 9-year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain, and nausea. Examination reveals a petechial rash. Which of the following assessment questions by the emergency room physician is most appropriate? A) Is your son currently taking any medications? B) Has your son had any sinus or ear infections in the last little while? C) Does your son have a history of cancer? D) Was your son born with any problems that affect his bone marrow or blood?

Has your son had any sinus or ear infections in the last little while?

A 9 year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain and nausea. Examination reveals a petechial rash. Which of the following assessment questions by the emergency room physician is most appropriate? a) "Does your son have a history of cancer?" b) "Has your son had any sinus or ear infections in the last little while?" c) "Was your son born with any problems that affect his bone marrow or blood?" d) "Is your son currently taking any medications?"

Has your son had any sinus or ear infections in the last little while?" The most common symptoms of acute bacterial meningitis are fever and chills; headache; stiff neck; back, abdominal, and extremity pains; and nausea and vomiting. Risk factors associated with contracting meningitis include otitis media and sinusitis or mastoiditis. -Particular medications, a history of neoplasm and hematopoietic problems would be unlikely to relate directly to his symptoms of meningitis.

The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? A) Have you ever given your child any honey or honey-containing products? B) Is there any family history of neuromuscular diseases? C) Has your baby ever been directly exposed to any chemical cleaning products? D) Is there any mold in your home that you know of?

Have you ever given your child any honey or honey-containing products?

The nurse is performing an assessment for a client who has hyperthyroidism that is untreated. When obtaining vital signs, what is the expected finding?

Heart rate 110 and bounding Explanation: Cardiovascular and respiratory functions are strongly affected by thyroid function. With an increase in metabolism, there is a rise in oxygen consumption and production of metabolic end products, with an accompanying increase in vasodilation. Blood volume, cardiac output, and ventilation are all increased. Heart rate and cardiac contractility are enhanced as a means of maintaining the needed cardiac output. Blood pressure is likely to change little because the increase in vasodilation tends to offset the increase in cardiac output. Page 781

A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts are likely responsible for his symptoms? a) Increased tissue perfusion at the site of the malformation. b) High pressure and local hemorrhage of the venous system. c) Hydrocephalus and protein in the cerebral spinal fluid. d) Localized ischemia with areas of necrosis noted on CT angiography.

High pressure and local hemorrhage of the venous system. Answer B is incorrect since arteriovenous malformation is associated with blood vessels and not the fluid within the ventricles of the brain. Answer D is incorrect in that there is blood flow to the area. Ischemia is associated with decreased arterial flow resulting in death to brain tissue. In arteriovenous malformations, a tangle of arteries and veins acts as a bypass between the cerebral arterial and venous circulation, in place of the normal capillary bed. However, the capillaries are necessary to attenuate the high arterial blood pressure before this volume drains to the venous system. As a result, the venous channels experience high pressure, making hemorrhage and rupture more likely; the lack of perfusion of surrounding tissue causes neurologic deficits such as learning disorders. Headaches are severe, and people with the disorder may describe them as throbbing (synchronous with their heartbeat). Increased tissue profusion means that more oxygenated blood is brought to the area which is not the case. The elevated arterial and venous pressures divert blood away from the surrounding tissue, impairing tissue perfusion.

A client arrives in the clinic after having a tongue piercing performed and is unable to control the movement of the tongue. The nurse is aware that which nerve may have been damaged from the piercing?

Hypoglossal Explanation: The general somatic efferent LMNs of the lower segments of the medulla supply the extrinsic and intrinsic muscles of the tongue by means of the hypoglossal nerve (CN XII). Damage to the hypoglossal nerve results in weakness or paralysis of tongue muscles. When the tongue is protruded, it deviates toward the damaged and therefore weaker side because of the greater protrusion strength on the normal side. Page 834

A client arrives in the clinic after having a tongue piercing performed and is unable to control the movement of the tongue. The nurse is aware that which nerve may have been damaged from the piercing? a) Abducens b) Vagus c) Hypoglossal d) Trigeminal

Hypoglossal The general somatic efferent LMNs of the lower segments of the medulla supply the extrinsic and intrinsic muscles of the tongue by means of the hypoglossal nerve (CN XII). Damage to the hypoglossal nerve results in weakness or paralysis of tongue muscles. When the tongue is protruded, it deviates toward the damaged and therefore weaker side because of the greater protrusion strength on the normal side

A client is unable to stick out his tongue as a result of injury to cranial nerve XII. The nurse recognizes that the client has sustained as damage to which nerve? a) Hypoglossal b) Trigeminal c) Vestibular d) Gustatory

Hypoglossal The name of cranial nerve XII is the hypoglossal nerve. It is responsible for the client's ability to stick out his or her tongue without deviation.

A 30-year-old male who manages his type 1 diabetes with glyburide presents at the emergency room complaining of headache, confusion, and tachycardia. He has come from a party at which he drank two beers to celebrate running his first half-marathon. Which of the following is likely to be the cause of his complaints? A) Diabetic ketoacidosis B) Hyperosmolar hyperglycemic state C) Hypoglycemia D) Somogyi effect

Hypoglycemia

The nurse is caring for an infant in the neonatal intensive care unit who has growth hormone deficiency. What critical issues should the nurse carefully monitor for in this infant?

Hypoglycemia and seizures Explanation: In the neonate, GH deficiency can lead to hypoglycemia and seizures. If ACTH deficiency also is present, the hypoglycemia often is more severe. Page 772

Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which of the following parts of the brain?

Hypothalamus Explanation: The hypothalamus is the area of master level integration of homeostatic control of the body's internal environment. Maintenance of blood gas concentrations, water balance, food consumption, and major aspects of endocrine and autonomic nervous system control require hypothalamic function. Page 842

Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which of the following parts of the brain? a) Cerebral hemispheres b) Hypothalamus c) Basal ganglia d) Cerebellum

Hypothalamus The hypothalamus is the area of master level integration of homeostatic control of the body's internal environment. Maintenance of blood gas concentrations, water balance, food consumption, and major aspects of endocrine and autonomic nervous system control require hypothalamic function.

Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which of the following parts of the brain? a) Cerebral hemispheres b) Hypothalamus c) Basal ganglia d) Cerebellum

Hypothalamus The hypothalamus is the area of master level integration of homeostatic control of the body's internal environment. Maintenance of blood gas concentrations, water balance, food consumption, and major aspects of endocrine and autonomic nervous system control require hypothalamic function.

What does a high level of thyroid-stimulating hormone indicate? A.) Thyroid nodule B.) Hyperthyroidism C.) Myxedema D.) Hypothyroidism

Hypothyroidism

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

Hypoxia produces a generalized depressive effect on the brain. 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.

The sympathetic and the parasympathetic nervous systems are continuously at work in our bodies. This continual action gives a basal activity to all parts of the body. What is this basal activity referred to as?

Tone Explanation: The sympathetic and parasympathetic nervous systems are continually active. The effect of this continual or basal (baseline) activity is referred to as tone. Page 847

Which interventions are appropriate for a client with acute pain following abdominal surgery? Select all that apply.

Ibuprofen (Motrin) Cold therapy Hydrocodone (Vicodin) Guided imagery Explanation: Chronic pain interventions may include neural blockade, transcutaneous electrical nerve stimulation, physical therapy, cognitive-behavioral interventions, nonnarcotic medications such as tricyclic antidepressants, antiseizure medications and NSAIDs, and narcotic medications. Acute pain interventions include many of the interventions for chronic pain but with a stronger focus on narcotic analgesics but not on using tricyclic antidepressants or antiseizure medications. Page 867

A nurse practitioner is providing care for a male client with a long-standing hiatal hernia. Which of the following statements most accurately captures an aspect of the pathophysiology of hiatal hernias? A) Paraesophageal hiatal hernias are common and are normally not treated if the client is asymptomatic. B) The root causes of hiatal hernias are normally treatable with medication. C) If esophageal acid clearance is impaired, esophagitis can result. D) An incompetent pyloric sphincter and high-fat diet are commonly implicated in the development of hiatal hernias.

If esophageal acid clearance is impaired, esophagitis can result.

A pregnant 23-year-old diagnosed with herpes simplex virus (HSV) is receiving prenatal care from her family physician. To prevent transmission of the virus to her baby, the physician will educate to include which of the following accurate statements? A) After your caesarean section, it will be safest if you don't breast-feed your child. B) If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with. C) A vaginal delivery will be safe as long as you are consistent with taking your valacyclovir. D) We'll have to book you a caesarian delivery in order to ensure your baby isn't exposed to the virus.

If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with.

-A 9 year-old girl has a diffuse collection of symptoms that are indicative of deficits in endocrine and autonomic nervous system control. She also suffers from persistent fluid and electrolyte imbalances. The nurse knows which of the following aspects of the nervous system listed below would her healthcare providers focus their diagnostic efforts?

Impaired function of her hypothalamus Explanation: The hypothalamus plays a central role in the maintenance of fluid and electrolyte balance and in the maintenance of endocrine control. Various cranial nerves, the hindbrain and the cerebellum would be less likely to be implicated. Page 850

Following the identification of low blood levels of cortisol and low 24-hour urinary free cortisol, a 51-year-old female client has been diagnosed with a primary adrenal cortical insufficiency. Which of the following health consequences would be attributable to her low levels of cortisol?

Impaired immunological and inflammatory response Explanation: Cortisol plays a central role in the normal functioning of the immune response and inflammation. Exophthalmos is associated with Graves' disease and secondary sex characteristics are a function of adrenal androgens. Potassium and sodium are regulated by mineralocorticoids. Page 785

A family is sitting with a patient in the intensive care unit who sustained significant head injuries in a motorcycle accident. They are questioning the nurse about why the patient's eyes open but do not stay open for long. The nurse explains that the patient is probably in which of the following states? a) In a stuporous state due to a reticular activated system (RAS) injury b) In a stuporous state due to acidosis c) In an obtunded state due to possible brain injury d) In an obtunded state due to a concussion

In a stuporous state due to a reticular activated system (RAS) injury Injury to the RAS would be suspected due to the change in the level of consciousness. The RAS and functional cerebral hemispheres are necessary for arousal and wakefulness; damage to either will negatively affect a person's level of consciousness.

Neurotransmitters are small molecules that exert their actions through specific proteins, called receptors, embedded in the postsynaptic membrane. Where are neurotransmitters synthesized?

In the axon terminal Explanation: Neurotransmitters are synthesized in the cytoplasm of the axon terminal. The other answers are incorrect. Page 826

Neurotransmitters are small molecules that exert their actions through specific proteins, called receptors, embedded in the postsynaptic membrane. Where are neurotransmitters synthesized? a) In the dendrite terminal b) In the postsynaptic junction c) In the presynaptic junction d) In the axon terminal

In the axon terminal Neurotransmitters are synthesized in the cytoplasm of the axon terminal. The other answers are incorrect.

Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto thyroiditis. In light of this diagnosis, which of the following assessment results would constitute an unexpected finding? Increased white cell count and audible crackles on chest auscultation Coarse, dry skin and hair with decreased sweat production Recent weight gain despite a loss of appetite and chronic fatigue The presence of myxedema in the woman's face and extremities

Increased white cell count and audible crackles on chest auscultation

Following the identification of low levels of T3 and T4 coupled with the presence of a goiter, a 28-year-old female has been diagnosed with Hashimoto's thyroiditis. In light of this diagnosis, which of the following assessment results would constitute an unexpected finding?

Increased white cell count and audible crackles on chest auscultation. Explanation: An increased white cell count and the presence of adventitious fluid in the lungs are not classic findings associated with hypothyroidism. Myxedema, weight gain, lethargy, and dry skin and nails are commonly associated with low levels of thyroid hormones. Page 780

In describing the ideal analgesic, what factors would be included? (Select all that apply.)

Inexpensive Effective Have minimal adverse effects Explanation: The ideal analgesic would be effective, nonaddictive, and inexpensive. In addition, it would produce minimal adverse effects and not affect the person's level of consciousness. Page 867

When reviewing the purpose/action of neurotransmitters as they interact with different receptors, the nursing instructor gives an example using acetylcholine. When acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is:

Inhibitory. Explanation: The action of a transmitter is determined by the type of receptor to which it binds. Acetylcholine is excitatory when it is released at a myoneural junction, and it is inhibitory when it is released at the sinoatrial node in the heart. Page 827

When reviewing the purpose/action of neurotransmitters as they interact with different receptors, the nursing instructor gives an example using acetylcholine. When acetylcholine is released at the sinoatrial node in the right atrium of the heart, it is: a) Inhibitory. b) Overstimulated. c) Dormant. d) Positively charged.

Inhibitory. The action of a transmitter is determined by the type of receptor to which it binds. Acetylcholine is excitatory when it is released at a myoneural junction, and it is inhibitory when it is released at the sinoatrial node in the heart

While assessing a critically ill patient in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat which develops into ventricular tachycardia (VT). Immediately, the patient became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is:

Interruption of the blood/oxygen supply to the brain. Explanation: The brain receives 15-20% of the total resting cardiac output and consumes 20% of its oxygen. The brain cannot store oxygen or engage in anaerobic metabolism. An interruption of blood supply or oxygen to the brain rapidly leads to clinically observable signs/symptoms. Unconsciousness occurs almost simultaneously with cardiac arrest. Metabolic acidosis will occur later in the cardiac arrest but not immediately and is not responsible for the patients unresponsiveness. CVAs can be caused by thrombosis formation or plaque occlusions, but is not the primary reason for unconsciousness in VT. Page 825

While assessing a critically ill patient in the emergency department, the nurse notes on the cardiac monitor an R-on-T premature ventricular beat which develops into ventricular tachycardia (VT). Immediately, the patient became unresponsive. The nurse knows that based on pathophysiologic principles, the most likely cause of the unresponsiveness is: a) Interruption of the blood/oxygen supply to the brain. b) Massive cerebrovascular accident (CVA) resulting from increased perfusion. c) A blood clot coming from the heart and occluding the carotid arteries. d) Metabolic acidosis that occurs spontaneously following any dysrhythmias.

Interruption of the blood/oxygen supply to the brain. The brain receives 15-20% of the total resting cardiac output and consumes 20% of its oxygen. The brain cannot store oxygen or engage in anaerobic metabolism. An interruption of blood supply or oxygen to the brain rapidly leads to clinically observable signs/symptoms. Unconsciousness occurs almost simultaneously with cardiac arrest. Metabolic acidosis will occur later in the cardiac arrest but not immediately and is not responsible for the patients unresponsiveness. CVAs can be caused by thrombosis formation or plaque occlusions, but is not the primary reason for unconsciousness in VT.

The instructor asks a group of nursing students to explain the function of the omentum. The students will respond based on which pathophysiologic principle? A) It holds organs in place. B) It attaches the jejunum and ileum to the abdominal wall. C) It has lots of mobility and moves around in the peritoneal cavity with D) It is mainly there to prevent any noxious substance from inner into the gut.

It has lots of mobility and moves around in the peritoneal cavity with peristaltic movements.

The region of the brain involved in emotional experience and control of emotional behavior is the: a) Limbic system b) Occipital lobe c) Parietal lobe d) Cerebral hemisphere

Limbic system The limbic region of the brain is involved in emotional experience and in the control of emotion-related behavior. Stimulation of specific areas in this system can lead to feelings of dread, high anxiety, or exquisite pleasure. It also can result in violent behaviors, including attack, defense, or explosive and emotional speech. - The occipital lobe plays an important role in the meaningfulness of visual experience, including experiences of color, motion, depth perception, pattern, form, and location in space. -The parietal lobe is necessary for perceiving the meaningfulness of integrated sensory information from various sensory systems, especially the perception of "where" the stimulus is in space and in relation to body parts. -Axons of the olfactory nerve, or cranial nerve I, terminate in the most primitive portion of the cerebrum—the olfactory bulb, where initial processing of olfactory information occurs.

A patient has been diagnosed with hemianopia. The patient asks the nurse what this is describing concerning the eye?

Loss of half of the visual field in one eye Blindness in one eye is called anopia. If half of the visual field for one eye is lost, the defect is called hemianopia; - if a quarter of the field is lost, it is called quadrantanopia. - Loss of the temporal or peripheral visual fields on both sides results in a narrow binocular field, commonly called tunnel vision.

The nurse is aware that the primary function of the sympathetic nervous system is: a) Maintenance of organ function during periods of minimal activity b) Conservation of energy and resource replenishment c) Suppression of responses during threatened periods d) Maintenance of vital functions and responding when there is a critical threat to the integrity of the individual

Maintenance of vital functions and responding when there is a critical threat to the integrity of the individual The sympathetic division maintains vital functions and responds when there is a critical threat to the integrity of the individual—the "fight-or-flight" response. The parasympathetic nervous system is concerned with conservation of energy, resource replenishment, and maintenance of organ function during periods of minimal activity.

The nurse knows which of the following phenomena listed below is an accurate statement about axonal transport? A) Anterograde and retrograde axonal transport allow for the communication of nerve impulses between the neuron and the central nervous system (CNS). B) Materials can be transported to the nerve terminal by either a fast or slow component. C) The unidirectional nature of the axonal transport system protects the CNS against potential pathogens. D) Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials.

Materials can be transported to the nerve terminal by either a fast or slow component.

Amblyopia, or lazy eye, occurs at a time when visual deprivation or abnormal binocular interactions occur in visual infancy. Whether amblyopia is reversible depends on what? a) The child has to be older than 5 years. b) Maturity of the visual system at time of onset c) The child has to have bilateral congenital cataracts. d) The child has to be able to wear contact lenses.

Maturity of the visual system at time of onset The reversibility of amblyopia depends on the maturity of the visual system at the time of onset and the duration of the abnormal experience. The other answers are incorrect

Which of the following diagnostic findings is likely to result in the most serious brain insult? A) Mean arterial pressure (MAP) that equals intracranial pressure (ICP) B) Moderate decrease in brain tissue volume secondary to a brain tumor removal C) Increased ICP accompanied by hyperventilation D) High intracellular concentration of glutamate

Mean arterial pressure (MAP) that equals intracranial pressure (ICP)

The nurse instructs the certified nursing assistant (CNA) to be sure to turn the client every 2 hours in order to avoid pressure on the skin and avoid a pressure ulcer. What type of stimuli is the nurse encouraging the CNA to avoid?

Mechanical stimuli Explanation: Mechanical stimuli can arise from intense pressure applied to skin or from the violent contraction or extreme stretch of a muscle. Chemical stimuli arise from a number of sources, including tissue trauma, ischemia, and inflammation. Thermal stimuli can result from extremes of heat or cold. Pain stimuli is not a stimuli. Page 862

Select the statement that best describes Meniere disease. a) Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing a triad of hearing loss, vertigo, and tinnitus. b) Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear: the client will be asymptomatic. c) Meniere disease is a disorder of the middle ear due to constriction of the endolymphatic compartment of the inner ear, causing hearing loss. d) Meniere disease is a bacterial infection of the outer inner ear due to distention of the endolymphatic compartment.

Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing a triad of hearing loss, vertigo, and tinnitus.

A client with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in a chemical synapse?

More neurotransmitters will cross the synaptic cleft and bond with postsynaptic receptors. Explanation: In chemical synapses, neurotransmitters cross the synaptic cleft and bond with postsynaptic receptors to facilitate communication between neurons. This communication is one-way, not two-way, and each neuron has synaptic connections with thousands of other neurons. Gap junctions are associated with electrical synapses, not chemical synapses. Page 826

A client has been brought to the emergency department following an overdose of insulin that resulted in unconsciousness. When explaining the rationale for this to the family, the nurse will emphasize that neurons: a) Must rely on glucose from the blood to meet their energy needs b) Store glycogen within the brain cavity c) Can cause the liver to convert triglycerides into energy if needed quickly d) Require many amino acids in order to produce enough energy to function properly

Must rely on glucose from the blood to meet their energy needs Nervous tissue has a high rate of metabolism. Glucose is the major fuel source for the nervous system. Unlike muscle cells, neurons have no glycogen stores and must rely on glucose from the blood or the glycogen stores of supporting glial cells to meet their energy needs. Persons receiving insulin for diabetes may experience signs of neural dysfunction and unconsciousness when blood glucose drops because of insulin excess. Neither amino acid production nor liver conversion of triglycerides will produce the quick energy that the brain requires to function properly.

Which statement explains how nonsteroidal anti-inflammatory drugs (NSAIDs) control pain?

NSAIDs block the enzyme that synthesizes prostaglandins. Explanation: Nociceptors respond to three different types of stimuli: chemical, thermal, and mechanical. The chemical mediators such as bradykinin, histamine, serotonin, and potassium activate or sensitize nociceptors and continue the inflammatory response by releasing prostaglandins. Aspirin, ibuprofen, and other NSAIDs block inflammation by blocking the enzyme needed to synthesize prostaglandins. Page 861

A 48-year-old male has a new diagnosis of Guillain-Barré syndrome. Which of the following processes underlies the deficits that accompany the degeneration of myelin in his peripheral nervous system (PNS)? A deficit of myelin predisposes the patient to infection by potential pathogens. Nerve cells lack insulation and impulse conduction is compromised by the destruction of myelin. The axonal transport system is compromised by the lack of myelin surrounding nerve cells. The destruction of myelin causes fewer Schwann cells to be produced in the patient's PNS.

Nerve cells lack insulation and impulse conduction is compromised by the destruction of myelin.

Which of the following peripheral nerve injuries will likely result in cellular death with little chance of regeneration? a) Crushing injury where the nerve is traumatized but not severed b) Incomplete amputation where tubular implants are used to fill in the gaps of nerves c) Nerve fibers destroyed close to the neuronal cell body d) Cutting injury where slow-regeneration axonal branches are located

Nerve fibers destroyed close to the neuronal cell body The successful regeneration of a nerve fiber in the PNS depends on many factors. If a nerve fiber is destroyed relatively close to the neuronal cell body, the chances are that the nerve cell will die; if it does, it will not be replaced. If a crushing type of injury has occurred, partial or often full recovery of function occurs. - Cutting-type trauma to a nerve is an entirely different matter. A number of scar-inhibiting agents have been used in an effort to reduce this hazard, but have met with only moderate success. Various types of tubular implants have been used to fill longer gaps in the endoneurial tube but again only with moderate success

The nurse is providing discharge instructions for a client with Graves' disease who has ophthalmopathy. What should the nurse be sure to include in the instructions to decrease exacerbation of this clinical manifestation?

The client should be strongly urged not to smoke. Explanation: Ophthalmopathy can also be aggravated by smoking, which should be strongly discouraged. It is not necessary for the client to avoid contact with others. Alcohol is not contraindicated but should be limited when taking any medication regimen. The client should not adjust the doses of medications without first consulting the physician. Page 783

During embryonic development, which of the following structures develops into the central nervous system (CNS)? a) Neural crest cells b) Ectoderm c) Neural tube d) Notochord

Neural tube During embryonic development, the neural tube develops into the CNS, whereas the notochord becomes the foundation around which the vertebral column ultimately develops. As the neural tube closes, ectoderm cells called neural crest cells, migrate away from the dorsal surface of the neural tube to become progenitors of the neurons and supporting cells of the parasympathetic nervous system. The surface ectoderm separates from the neural tube and fuses over the top to become the outer layer of skin.

During embryonic development, which of the following structures develops into the central nervous system (CNS)?

Neural tube Explanation: During embryonic development, the neural tube develops into the CNS, whereas the notochord becomes the foundation around which the vertebral column ultimately develops. As the neural tube closes, ectoderm cells called neural crest cells, migrate away from the dorsal surface of the neural tube to become progenitors of the neurons and supporting cells of the parasympathetic nervous system. The surface ectoderm separates from the neural tube and fuses over the top to become the outer layer of skin. Page 830

Which of the following types of pain is characterized by severe, brief, often repetitive pain?

Neuralgia Explanation: Neuralgia is characterized by severe, brief, often repetitive attacks of lightning-like or throbbing pain. Neuropathic pain is widespread and is not otherwise explainable, burning pain and attacks of pain that occur without seeming provocation. Tic douloureux is characterized by paroxysmal attacks of stabbing pain that usually are limited to the unilateral sensory distribution of one or more branches of the trigeminal nerve, most often the maxillary or mandibular divisions. Postherpetic neuralgia affects sensory ganglia, and the peripheral nerve to the skin of the corresponding dermatomes cause a unilateral localized vesicular eruption and abnormally exaggerated subjective response to pain. Page 870

If the patient's dorsal columns are not functioning, the nurse will observe which of the following responses during neuro testing, where the nurse asks the patient to close their eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points?

No response to two-point discrimination. Explanation: When comparing discriminative dorsal column-medial lemniscus pathway compared with anterolateral tactile pathways with testing (with eyes closed), gently brush the skin with cotton, touch an area with 1-2 sharp points, touch corresponding parts of the body on each side simultaneously or random sequence, and passively bend the person's finger one way and then another. If dorsal columns are not functioning, the tactile threshold 2-point discrimination and proprioception are missing and the person has difficulty discriminating which side of the body received stimulation. Page 856

A client on an acute medicine unit with a diagnosis of small bowel obstruction is reporting intense, diffuse abdominal pain. Which physiologic phenomenon is most likely contributing to the client's pain?

Nociceptive afferents are conducting along the cranial and spinal nerve pathways of the ANS. Explanation: Visceral pain, as characterized by the client's description of her pain, is conducted by way of nociceptive afferents that use the cranial and spinal nerve pathways of the ANS. The problem is not likely rooted in the inappropriate firing of first order neurons or the substitution of conduction by C fibers. Pain that is attributable to a pathologic process apart from the neural pain network is not normally considered to be neuropathic. Page 864

A client on an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is complaining of intense, diffuse pain in her abdomen. Which of the following physiological phenomena is most likely contributing to her complaint?

Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS. Explanation: Visceral pain, as characterized by the client's description of her pain, is conducted by way of nociceptive afferents that use the cranial and spinal nerve pathways of the ANS. The problem is not likely rooted in the inappropriate firing of first order neurons or the substitution of conduction by C fibers. Pain that is attributable to a pathological process apart from the neural pain network is not normally considered to be neuropathic. Page 863

The nursing student is caring for a client with a pheochomocytoma and is aware that the release of catecholamines induces the hypertensive state. Which catecholamines are responsible for this high blood pressure? Select all that apply.

Norepinephrine Epinephrine Dopamine Explanation: The catecholamines, which include norepinephrine, epinephrine, and dopamine, are synthesized in the axoplasm of sympathetic nerve terminal endings from the amino acid tyrosine. Epinephrine accounts for approximately 80% of the catecholamine released from the adrenal gland. Acetylcholine is excitatory to most muscarinic receptors. Serotonin is an important chemical neurotransmitter in the human body. It is commonly regarded as a chemical that is responsible for maintaining mood balance. Page 852

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as: a) Normal manifestations of Parkinson disease b) Signs of clinical improvement c) Signs of clinical deterioration d) Manifestations of another disease process

Normal manifestations of Parkinson disease The client is manifesting normal responses of the disease. The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia or slowness of movement.

The nurse is providing education to a client with Addison's disease who has been treated for hyponatremia and hypoglycemia related to the disease. What should the nurse inform the client should be done to ensure control of these conditions?

The client should eat and exercise on a regular schedule. Explanation: Because people with Addison's disease are likely to have episodes of hyponatremia and hypoglycemia, they need to have a regular schedule for meals and exercise. It is not necessary to limit carbohydrate and fat intake or salt related to this disorder. Page 788

A client who has experienced a spinal cord injury still has use of the arms and has impaired motor and sensory function of the trunk, legs, and pelvic organs. The injury would be classified as: a) Brown-Séquard syndrome b) Quadriplegia c) Tetraplegia d) Paraplegia

Paraplegia The loss of motor and sensory function in the trunk, legs, and pelvic organs while maintaining use of the arms is called paraplegia. Tetraplegia is the loss of function in all areas. Quadriplegia is the loss of function of all four limbs. Clients with Brown-Séquard syndrome suffer from ipsilateral upper motor neuron paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensation.

A patient reports feeling a tingling sensation in the last two fingers of one hand after hitting the inner surface of the elbow on a desk. Which of the following is the cause of this symptom?

Paresthesia from temporary nerve compression Explanation: Temporary mild compression of a peripheral nerve can lead to paresthesia. Hypersensitivity is an increased response to mild stimuli. Hyperpathia is a syndrome in which pain is explosive after the raised sensory threshold is reached. Hypoesthesia is reduced or lost sensation of touch or temperature and may be an inherited trait. Page 869

This disease is associated with a tremor and slow movement thought to be related to a lack of dopamine.

Parkinson's

A nurse assesses a patient with a cerebral infarct for sensation. Which of the following results indicates that second-order neurons are intact?

Patellar reflex +2 Explanation: First-order neurons transmit sensory information from the periphery of the neurons to the central nervous system. Second-order neurons communicate directly with the thalamus and work with the reflex networks and sensory pathways in the spinal cord. Third-order neurons relay information from the thalamus to the cerebral cortex. Level of consciousness does not indicate sensation. Page 861

Which type of receptor is mediated through vision in dim light? a) Mechanoreceptors b) Chemoreceptors c) Osmoreceptors d) Photoreceptors

Photoreceptors Vision in dim light is mediated through photoreceptors. - Hair cells are classified as mechanoreceptors. -The sensation of taste is recognized by ligand binding to chemoreceptors. -Osmoreceptors are not associated with vision

Guillain-Barré syndrome is characterized by which of the following forms of neuron damage? a) Polyneuropathy b) Transneuropathy c) mM d) Aneuropathy

Polyneuropathy Polyneuropathies involve demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits. Guillain-Barré syndrome is an acute immune-mediated polyneuropathy. (l

Which of the following factors influence pharmacologic choices for pain management in older adults? Select all that apply.

Polypharmacy may cause drug interactions. Poor nutrition may lead to poor drug distribution. Organ function may be less efficient. Explanation: Older adults may experience less effective organ function that interferes with medication function. Organ changes may include reduced drug absorption from the gastrointestinal tract, slower renal clearance, impaired liver function, and reduced blood flow. In addition, other illnesses requiring medication may create a situation of polypharmacy where multiple drugs interact to increase side effects. While acetaminophen is considered a first line drug for mild to moderate pain, opioids are generally used for several pain and palliative care and not restricted as a result of potential addiction. Addiction potential is reduced in any client with adequate pain control. Page 876

A 51-year-old woman has been diagnosed with Cushing syndrome after a diagnostic work-up that reveals cortisol hypersecretion. Which assessment findings would be inconsistent with her diagnosis?

Poor stress management and electrolyte imbalances Explanation: A low tolerance for stress and unstable electrolyte levels are associated with Addison disease and its consequent elevated levels of ACTH. High blood pressure, hypokalemia, a buffalo hump, and moon face are all characteristic of the elevated steroid levels that denote Cushing syndrome. Page 788

A 51 year-old woman has been diagnosed with Cushing syndrome after a diagnostic workup that reveals cortisol hypersecretion. The nurse knows which of the following assessment findings would be inconsistent with her diagnosis?

Poor stress management and hyperpigmentation Explanation: Hyperpigmentation and a low tolerance for stress are associated with Addison's disease and its consequent elevated levels of ACTH. High blood pressure, hypokalemia, and buffalo hump and moon face are all characteristic of the elevated steroid levels that denote Cushing syndrome. Page 788

Which of the following treatments should take place immediately in a patient experiencing autonomic dysreflexia? a) Apply binders and support hose to shunt the blood to the main organs. b) Increase the patient's blood pressure to allow for adequate perfusion. c) Position the patient in upright position, and correct the initiating stimulus. d) Place the patient in a supine position, and increase intravenous fluids.

Position the patient in upright position, and correct the initiating stimulus. Autonomic dysreflexia is a clinical emergency, and requires monitoring of blood pressure while correcting the initiating stimulus (i.e., full bladder, pain). The nurse should place the patient in an upright position and remove all support hose binders to promote venous pooling to help decrease an extremely elevated blood pressure. -Intravenous fluids are not an immediate intervention for this condition.

When educating a patient about to undergo a pacemaker insertion, the nurse explains the normal phases of cardiac muscle tissue. During the repolarization phase, the nurse will stress that membranes must be repolarized before they can be re-excited. Within the cell, the nurse understands that:

Potassium channels open and while sodium channels close causing repolarization to the resting state. Explanation: Repolarization is the phase during which the polarity of the resting membrane potential is re-established. This occurs with the closure of the sodium channels and opening of the potassium channels. Page 826

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. Which is the most accurate description? This drug: a) Inhibits the peripheral metabolism of dopamine b) Prevents the depolarizing effect of the neurotransmitters c) Produces paralysis of the larynx muscles by blocking acetylcholine release d) Will slow the decline in muscle strength and function

Produces paralysis of the larynx muscles by blocking acetylcholine release Pharmacologic preparations of the botulinum toxin (botulinum type A toxin [Botox] and botulinum type B toxin [Myobloc]) produce paralysis by blocking acetylcholine release. -Glucocorticoids are the only medication currently available to slow the decline in muscle strength and function in DMD. - Curare acts on the postjunctional membrane of the motor endplate to prevent the depolarizing effect of the neurotransmitter. -Neuromuscular transmission is blocked by curare-type drugs during many types of surgical procedures to facilitate relaxation of involved musculature. -Levodopa, a dopamine agonist used in Parkinson disease, is administered with carbidopa, which inhibits its peripheral metabolism, allowing therapeutic concentrations of the drug to enter the brain without disabling adverse effects

There are two types of nervous tissue cells. One type is neurons, and the other type is the supporting cells. What is the function of the supporting cells?

Protect the nervous system and provide metabolic support for the neurons Explanation: The supporting cells, such as Schwann cells in the PNS and the neuroglial cells in the CNS, protect the nervous system and provide metabolic support for the neurons. The other answers are incorrect. Page 822

After several months of persistent heartburn, a 57-year-old female client has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following treatment regimens is likely to best address the woman's health problem? A) Surgical correction of the incompetent pylorus B) Antacids; avoiding positions that exacerbate reflux; a soft-textured diet C) Weight loss and administration of calcium channel blocking medications D) Proton pump inhibitors; avoiding large meals; remaining upright after meals

Proton pump inhibitors; avoiding large meals; remaining upright after meals

A 55-year-old man has been diagnosed with a gastroesophageal reflux disease (GERD), in which the function of his lower esophageal sphincter is compromised. Which of the following consequences of this condition is most likely to occur? A) Decreased absorption of ingested foods and fluids B) Impaired control of the gastric emptying rate C) Protrusion of the stomach or regurgitation of stomach contents into the esophagus D) Inappropriate release of gastric enzymes

Protrusion of the stomach or regurgitation of stomach contents into the esophagus

A 48-year-old woman has been diagnosed with extrahepatic cholestasis following a thorough history, ultrasound, and blood work. Which of the following symptoms most likely caused her to seek medical treatment, and what consequence to her health problem would the medical team anticipate? A) Complaints of lower flank pain with consequences of impaired fat metabolism B) Anorexia with consequences of impaired drug metabolism and blood filtration C) Skin xanthomas (focal accumulations of cholesterol) with consequences of increased risk of bleeding due to deficient clotting factors D) Pruritus with consequences of deficient levels of fat-soluble vitamins

Pruritus with consequences of deficient levels of fat-soluble vitamins

The parent of a toddler with Duchenne muscular dystrophy reports that the child has an increase in muscle size but a decrease in strength. The nurse documents this using which of the following medical terms? a) Dysdiadochokinesia b) Chorea c) Fasciculations d) Pseudohypertrophy

Pseudohypertrophy Pseudohypertrophy, as occurs with Duchenne muscular dystrophy (DMD), refers to an increase in bulk without an accompanying increase in strength.

A 4-year-old boy has had otitis media with effusion (OME) for several weeks and his condition has recently progressed to acute otitis media (AOM). Which of the following factors could have contributed to his AOM? Exposure to respiratory syncytial virus (RSV) Sensorineural deficits in the auditory control apparatus Accumulation of cerumen in the external acoustic meatus A deficiency in immunoglobulin G Reflux of fluid from the boy's nose into his middle ear

Reflux of fluid from the boy's nose into his middle ear

The transmission of impulses at the neuromuscular junction is mediated by which of the following actions? a) Release of neurotransmitter acetylcholine from autonomic nerve endings b) Nerve origin in thoracolumbar spine c) Connection to paraspinal ganglion chain d) Nerve stimulation of the adrenal medulla

Release of neurotransmitter acetylcholine from autonomic nerve endings The neuromuscular junction serves as a synapse between a motor neuron and a skeletal muscle fiber. It consists of the axon terminals of a motor neuron and a specialized region of the muscle membrane called the endplate. The transmission of impulses at the neuromuscular junction is mediated by the release of the neurotransmitter acetylcholine from the axon terminals. Acetylcholine binds to specific receptors in the endplate region of the muscle fiber surface to cause muscle contraction. Acetylcholine is active in the neuromuscular junction only for a brief period, during which an action potential is generated in the innervated muscle cell.

Potassium outflow from the cell is characteristic of which of the following phases of the action potential? a) Threshold potential b) Repolarization c) Resting membrane potential d) Depolarization

Repolarization Repolarization is the phase during which the polarity of the resting membrane potential is reestablished. This is accomplished with closure of the sodium channels and opening of the potassium channels. The outflow of the positively charged potassium ions across the cell membrane returns the membrane potential to negativity. During depolarization and resting membrane potential, potassium does not flow out of the cell. A threshold potential represents the membrane potential at which neruon or other excitable tissues are stimulated to fire

The nurse takes a patient's blood pressure in the primary care provider's office. The last three times the patient has been in the office it has been high. What structure in the eye is this adverse effect of hypertension most likely to affect? a) Ciliary body b) Lens c) Retina d) Iris

Retina The retina is the structure in the eye that the adverse effect of hypertension most likely to affect. -The lens is affected with a cataract. -The iris and ciliary body are not impacted.

A parent arrives in the endocrinology clinic with her 8-year-old son, concerned about his rapid development and tall stature. What significant assessment finding does the nurse recognize is important to report to the physician related to the development of precocious puberty?

Significant genital enlargement Explanation: Diagnosis of precocious puberty is based on physical findings of early thelarche, adrenarche, and menarche. The most common sign in boys is early genital enlargement. Radiologic findings may indicate advanced bone age. People with precocious puberty are unusually tall for their age as children but short as adults because of the early closure of the epiphyses. Page 775

The nurse is providing nonpharmacologic pain relief for a client who has a pain level of 2 in the leg. What intervention provided by the nurse would be considered distraction?

Sitting with the client and having a conversation Explanation: Distraction does not eliminate pain, but it can make pain more tolerable. It may serve as a type of sensory shielding whereby attention to pain is sacrificed to pay attention to other stimuli that are easily perceived. Examples of distraction include counting, repeating phrases or poems, and engaging in activities that require concentration, such as projects, activities, work, conversation, or describing pictures. Television, adventure movies, music, and humor also can provide distraction. Page 867

Which of the following complications of spinal cord injury is the most preventable in a paraplegic patient? a) Deep vein thrombosis b) Muscle atrophy c) Skin breakdown d) Autonomic dysreflexia

Skin breakdown The lack of sensory warning mechanisms and voluntary motor ability below the level of injury, coupled with circulatory changes, places the spinal cord-injured person at major risk for disruption of skin integrity. Significant factors associated with disruption of skin integrity are pressure, shearing forces, and localized trauma and irritation. Relieving pressure, allowing adequate circulation to the skin, and inspecting the skin are primary ways of maintaining skin integrity. Of all the complications after spinal cord injury, skin breakdown is the most preventable

A client with severe hypothyroidism is presently experiencing hypothermia. What nursing intervention is a priority in the care of this client?

Slow rewarming of the client to prevent vasodilation and vascular collapse Explanation: If hypothermia is present, active rewarming of the body is contraindicated because it may induce vasodilation and vascular collapse. Prevention is preferable to treatment and entails special attention to high risk populations, such as women with a history of Hashimoto thyroiditis. Page 781

Which of the following statements best captures an aspect of the role of hormones in the body? A.) Some chemical substances can function as hormones or be integrated with the central and peripheral nervous systems. B)Hormones directly initiate many of the processes that contribute to homeostasis. C)Control of body processes is ensured by the fact that a single hormone can only exert one effect on one specific system or tissue. D)Each hormone that exists in the body is produced by only one specific endocrine gland.

Some chemical substances can function as either hormones or neurotransmitters.

A child is experiencing difficulty with chewing and swallowing. The nurse knows that which of the following cells may be innervating specialized gut-related receptors that provide taste and smell?

Special visceral afferent cells. Explanation: Special visceral afferent cells innervate specialized gut-related receptors. Their central processes communicate with special VIA column neurons that project to reflex circuits producing salivation, chewing, swallowing, and other responses. Special somatic afferent fibers are concerned with joint and tendon sensation. General somatic afferents respond to stimuli that produce pressure or pain. General visceral afferent neurons innervate visceral structures such as GI tract, urinary bladder, and the heart and great vessels. Page 833

Through what specific component do neurotransmitters exert their action?

Specific proteins Explanation: Neurotransmitters exert their actions through specific proteins, called receptors, embedded in the postsynaptic membrane. Water, carbon dioxide, and oxygen enter the brain with relative ease. Page 827

The emergency department nurse is caring for a patient who fell and had a head injury. Which of the following assessments would be noted during the early stage of intracranial pressure increase? a) Vomiting b) Hemiplegia c) Nonreactive pupils d) Stable vital signs

Stable vital signs The vital signs remain unchanged in the early stage of increased intracranial pressure. The remaining options are characteristic of late signs.

A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the bag other than the phone. The nurse knows that which of the following terms best describes one's ability to sense of shape and size of an object in the absence of visualization?

Stereognosis. Explanation: The sense of shape and size of an object in the absence of visualization is known as stereognosis. Astereognosis is a deficit whereby a person can correctly describe the object but does not recognize that it is a screwdriver. Modalities is a term used for qualitative, subjective distinctions between sensations such as touch, heat, and pain. Somesthesia describes most of the perceptive aspects of body sensation and requires the function of the parietal association cortex. Page 856

A 21-year-old female is suspected of having inadequate function of her hypothalamic-pituitary-thyroid system. Her care provider is planning to inject thyrotropin-releasing hormone (TRH) and then measure her levels of TSH. Which of the following diagnostic tests is being performed? Metabolite excretion test Stimulation test Radioimmunoassay (RIA) test Suppression test

Stimulation test

A client who is being treated for chronic low back pain is using a TENS unit for relief of pain. The nurse is aware that the use of this device is considered what type of pain relief?

Stimulus-induced analgesia Explanation: Stimulus-induced analgesia is one of the oldest known methods of pain relief. Electrical stimulation methods of pain relief include TENS, electrical acupuncture, and neurostimulation. A physical agent would be the use of heat or cold. Distraction is a nonpharmacologic method of reduction of pain by distracting the patient from his pain. Biofeedback is used to provide feedback to a person concerning the current status of some body function, temperature, temporal artery pulsation, blood pressure, or muscle tension. Page 867

A client's low serum T4 level has led to a diagnosis of hypothyroidism. When planning this client's care, the nurse should:

Teach the client about the safe and effective use of synthetic thyroid hormones. Explanation: Hypothyroidism is treated by replacement therapy with synthetic preparations of T3 or T4. Graves disease is associated with hyperthyroidism, not hypothyroidism. Surgery is not a usual treatment modality. Page 781

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

Temporal lobe Explanation: The temporal lobe is important in discrimination of sounds entering opposite ears. The superior temporal gyrus involves the auditory association or perception area. The remaining portions of the temporal cortex are apparently important in long-term memory recall. This is particularly true with respect to perception and memory of complex sensory patterns. The parietal lobe is necessary for somesthetic perception; the occipital is involved with the meaningfulness of visual experiences; and the frontal lobe is thought to be involved in anticipation and predictions of consequences of behavior. Page 842

A 25-year-old woman who works as an air-traffic controller presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at the airport. What is the most likely diagnosis?

Temporomandibular joint syndrome Explanation: Temporomandibular joint syndrome causes pain that originates in the temporomandibular joint and is usually referred to the face, neck, or ear. Headache is also common. It is aggravated by jaw function and can be particularly severe in people under stress, especially if they grind their teeth. Page 875

A client who works in a high stress job presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at work. Which diagnosis is most likely associated with these symptoms?

Temporomandibular joint syndrome Explanation: Temporomandibular joint syndrome causes pain that originates in the temporomandibular joint and is usually referred to the face, neck, or ear. Headache is also common. It is aggravated by jaw function and can be particularly severe in people under stress, especially if they grind their teeth. Migraine, sinus, and cluster headaches less commonly affect the ear. Page 875

The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to non-medication centered therapy?

Tension Explanation: Tension-type headaches often are more responsive to nonpharmacologic techniques, such as biofeedback, massage, acupuncture, relaxation, imagery, and physical therapy, than other types of headache. For people with poor posture, a combination of range-of-motion exercises, relaxation, and posture improvement may be helpful. The other options are usually best treated with medications that focus on the cause of the pain. Page 867

A badly burned firefighter has been in an induced coma for three weeks. When he awakens, he thanks his son for singing Happy Birthday to him a week earlier. Which part of the brain is responsible for allowing him to hear and comprehend while comatose? a) Corpus callosum b) Hypothalamus c) Basal ganglia d) Thalamus

Thalamus Coordination and integration of peripheral sensory stimuli occur in the thalamus, along with some crude interpretation of highly emotion-laden auditory experiences that not only occur but also can be remembered. For example, a person can recover from a deep coma in which cerebral cortex activity is minimal and remember some of what was said at the bedside. Inferior to the thalamus, and representing the ventral horn portion of the diencephalon, is the hypothalamus; it is the area of master-level integration of homeostatic control of the body's internal environment. -The corpus callosum is a massive commissure, or bridge, of myelinated axons that connects the cerebral cortex of the two sides of the brain. -The basal ganglia lie on either side of the internal capsule, just lateral to the thalamus; they supply axial and proximal unlearned and learned postures and movements, which enhance and add gracefulness to UMN-controlled manipulative movements

Which of the following statements best captures the role of the adrenal cortex in maintaining homeostasis? Question 1 options: A. Normal sexual function is dependent on adequate adrenal cortical function. B. Redundant, secondary production of adrenal cortical hormones can compensate for the loss of the adrenal glands. C. The adrenal cortical hormones are primarily steroids and sex hormones. D. The adrenal cortex is responsible for the production of epinephrine and norepinephrine, which are part of the sympathetic nervous system.

The adrenal cortical hormones are primarily steroids and sex hormones.

A woman with a diagnosis of type 2 diabetes has been ordered by her primary care provider to have a hemoglobin A1C test for the first time. The woman states, "I don't see why you want to test my blood cells when it's sugar that's the problem." What aspect of physiology will underlie the care provider's response to the patient? A) The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell. B) Hemoglobin synthesis by the bone marrow is inversely proportionate to blood glucose levels, with low A1C indicating hyperglycemia. C) The high metabolic needs of red cells and their affinity for free glucose indicate the amount of glucose that has been available over 6 to 12 weeks. D) Insulin is a glucose receptor agonist on the hemoglobin molecule, and high glucose suggests low insulin levels.

The amount of glucose attached to A1C cells reflects the average blood glucose levels over the life of the cell.

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) Normal physiologic circumstances result in decreased adsorption of CSF. b) There is a decrease in the amount of fluid volume in the brain. c) The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. d) There is an increase in the production of cerebral spinal fluid volume.

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. (less

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) There is a decrease in the amount of fluid volume in the brain. b) There is an increase in the production of cerebral spinal fluid volume. c) Normal physiologic circumstances result in decreased adsorption of CSF. d) The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.

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.

Following bone density scanning and diagnostic imaging, a 4-year-old boy has been diagnosed with Legg-Calvé-Perthes disease. Which of the following findings, signs, and symptoms would lead clinicians to this conclusion? Select all that apply. A) The boy has significant difficulty in walking. B) The boy's feet toe-in when standing upright. C) The child has limited abduction of the affected hip. D) His femoral head region is noted to be necrotic. E) There are numerous microfractures where his patellar tendon and tibia articulate.

The boy has significant difficulty in walking. The child has limited abduction of the affected hip. His femoral head region is noted to be necrotic.

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 Page 825

When explaining the role of liver Kupffer cells to a group of nursing students, which of the following statements about the function of these cells is most accurate? A)The primary function of Kupffer cells is to secrete bile. B) These cells are the functional unit of the liver and are responsible for all liver secretions. C) The cells are capable of removing and phagocytizing old and defective blood cells. D) The role of the Kupffer cells is to provide at least 50% of cardiac output each minute to each lobular of the liver.

The cells are capable of removing and phagocytizing old and defective blood cells.

A parent brings his child to the clinic, concerned about her short stature and asking the nurse if there is a problem with her height. What indication is the nurse aware of when performing the assessment that determines whether this child has short stature?

The child's height is well below the third percentile on several clinic visits. Explanation: Short stature is a condition in which the attained height is well below the third percentile, or linear growth is below normal for age and sex. Diagnosis of short stature is not made on a single measurement, but is based on sequential height measurements and on velocity of growth and parental height. Page 771

During a clinical assessment of a 68 year-old client who has suffered a head injury, a neurologist suspects that a client has a sustained damage to her vagus (CN X). Which of the following assessment findings is most likely to lead the physician to this conclusion?

The client has difficulty swallowing and has had recent constipation and hypoactive bowel sounds. Explanation: Dysphagia and impaired GI motility are associated with damage to the vagus nerve. Lateral movement of the head is mediated by CN XI. Facial droop and dry eyes are associated with CN VII, the facial nerve, while abnormal tongue movement is a result of damage to CN XII., the hypoglossal nerve. Page 850

The nurse is educating a newly diagnosed client with Hashimoto thyroiditis who is to be discharged from the acute care facility. What should the nurse be sure to include in the education to prevent complications?

The client should be informed about the signs and symptoms of severe hypothyroidism and the need for early intervention. Explanation: Prevention is preferable to treatment and entails special attention to high-risk populations, such as women with a history of Hashimoto thyroiditis. These persons should be informed about the signs and symptoms of severe hypothyroidism and the need for early medical treatment. Page 780

During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description? a) The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction b) Muscle necrosis with resultant increase in fat/connective tissue replacing the muscle fibers c) Autoimmune disease where antibody loss of acetylcholine receptors at the neuromuscular junction causes decrease motor response d) Atherosclerotic destruction of circulation to the brain resulting in lactic acid buildup that affects nerve transmission

The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction Multiple sclerosis (MS) is an immune-mediated disorder that occurs in genetically susceptible individuals. The pathophysiology of MS involves demyelination and subsequent degeneration of nerve fibers in the central nervous system (CNS), marked by prominent lymphocytic invasion in the lesion. The infiltrate in nerve fiber (rather than vascular) sclerotic plaques contains CD8+ and CD4+ T cells as well as macrophages, which are thought to induce oligodendrocyte injury. With muscular dystrophy, the muscle undergoes necrosis, and fat and connective tissue replace the muscle fibers, which increases muscle size and results in muscle weakness. Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated loss of acetylcholine receptors in the neuromuscular junction.

A newborn is screened for congenital hypothyroidism and is found to have the disorder. When educating the mother about the importance of the infant's taking thyroid hormone supplement, what should be included in the education?

The infant will have dosage levels adjusted as he grows. Explanation: Congenital hypothyroidism is treated by hormone replacement. Evidence indicates that it is important to normalize T4 levels as rapidly as possible because a delay is accompanied by poorer psychomotor and mental development. Dosage levels are adjusted as the child grows. When early and adequate treatment regimens are followed, the risk of intellectual disability in infants detected by screening programs is essentially nonexistent. Page 780

A stroke affecting which of the following areas of the brain would be most likely to leave an individual's vestibular system intact and posture and balance maintained? a.) The limbic system of the cerebrum b.) The temporal and parietal cortex c.) The thalamus d.) The brain stem

The limbic system of the cerebrum

A 51-year-old male has been diagnosed with alcohol-induced liver disease. He admits to the nurse providing his care that, I know what the lungs do, and I know what the heart does, but honestly I have no idea what the liver does in the body. Which of the following statements would best underlie the explanation that the nurse provides? A)The liver is responsible for the absorption of most dietary nutrients as well as the production of growth hormones. B) The liver contributes to the metabolism of ingested food and provides the fluids that the GI tract requires. C) The liver metabolizes most components of food and also cleans the blood of bacteria and drugs. D) The liver maintains a balanced level of electrolytes and pH in the body and stores glucose, minerals, and vitamins.

The liver metabolizes most components of food and also cleans the blood of bacteria and drugs.

A nurse is discussing how vascular dementia differs from Alzheimer disease with a client. Select the most appropriate information. a) The main presenting symptom of vascular dementia is slow psychomotor function. b) Alzheimer disease most often presents with a rapid onset of memory loss followed by slowly progressive dementia that has a course of several years. c) Vascular dementia develops between the ages of 35 and 45. d) Vascular dementia is caused by neuritic (senile) plaques.

The main presenting symptom of vascular dementia is slow psychomotor function. The main presenting symptom of vascular dementia is slow psychomotor function. Alzheimer disease has been linked to neuritic plaque and has a slow onset. Vascular dementia usually manifests at age 50 or beyond.

Following a long history of fatigue, weakness, and poor appetite, a 39-year-old male has been diagnosed with hypopituitarism. Which of the following clinical findings would most likely cause his care team to suspect that the man has an additional endocrine disorder from a different source? The man displays the signs and symptoms of hypothyroidism. The patient is 5 feet 2 inches tall and was consistently short for his age as a child. The man has a chronic platelet deficiency and is occasionally anemic. The man has a low sperm count and has been unable to have children.

The man has a chronic platelet deficiency and is occasionally anemic.

Following a spinal cord injury suffered in a motor vehicle accident, a 22 year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged?

The outer layer (neolayer) Explanation: Fine manipulation skills are the domain of the outer, or neolayer, of the tract systems. The inner and middle layers and the reticular formation are not noted to be responsible for these functions. Page 836

A client is having an upper endoscopy to determine the presence of a gastric ulcer. After the procedure is performed, the nurse instructs the client that he cannot have anything to eat or drink until the return of the gag reflex. Which nerve is the nurse testing for return of function? a. Glossopharyngeal b. Abducens c. Hypoglossal d. Trigeminal

a. Glossopharyngeal

Which of the following statements best captures an aspect of the function of the hypothalamic¡Vpituitary¡Vadrenal (HPA) system? A) Adrenocorticotropic hormone (ACTH) released by the hypothalamus controls to release of cortisol. B) The pituitary gland communicates with the adrenal cortex through the release of ACTH. C) The adrenal cortex receives corticotrophin-releasing hormone (CRH) and in turn releases cortisol. D) The pituitary gland causes a release of CRH from the hypothalamus, which promotes hormone release from the adrenal cortex.

The pituitary gland communicates with the adrenal cortex through the release of ACTH.

A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the backpack. Which component of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items?

The primary dorsal root ganglion neuron, dorsal column neuron, and the thalamic neuron Explanation: The discriminative pathway, which is associated with the fine touch of item discrimination, involves just three neurons: the primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron. Slow-conduction and anterolateral pathways that involve the reticular activating system are associated with pain, thermal sensation, and indiscriminate touch. Page 856

A 3-year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes? A) The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin.¡¨ B) It's not known exactly why your daughter has completely stopped making insulin, and treatment will consist of your rigidly controlling her diet.¡¨ C) This tendency to produce insufficient amounts of insulin is likely something that she inherited.¡¨ D) Environmental and lifestyle factors are known to play a part in the fact that her pancreas secretes and withholds insulin at the wrong times.¡¨

The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin

A mother is placing her child into the bathtub. The child immediately jumps out of the tub and begins to cry, stating their feet are 'burning'. The nurse in the emergency department knows that the child's response is based on which of the following pathophysiological principles listed below?

The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first. Explanation: If a person places a foot in a tub of hot water, the tactile sensation occurs well in advance of the burning sensation. The foot has been removed from the hot water by the local withdrawal reflex well before the excessive heat is perceived by the forebrain. All other responses are incorrect. Page 858

The nurse is performing a health history from a client with acromegaly. The client informs the nurse that he is waking up several times a night and has been told he has sleep apnea. What does the nurse inform the client is the rationale for this syndrome?

There is an increase in pharyngeal soft tissue accumulation. Explanation: The pathogenesis of sleep apnea syndrome is obstructive in the majority of people due to increased pharyngeal soft tissue accumulation. Page 774

A toddler is displaying signs and symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor neuron disease called spinal muscular atrophy (SMA). The patient's family asks how he got this. The nurse will respond A) This could result from playing in soil and then ingesting bacteria that are now attacking his motor neurons. B) No one really knows how this disease is formed. We just know that in time, he may grow out of it. C) This is a degenerative disorder that tends to be inherited as an autosomal recessive trait. D) This is a segmental demyelination disorder that affects all nerve roots and eventually all muscle groups as well.

This is a degenerative disorder that tends to be inherited as an autosomal recessive trait.

A 20-year-old male has presented to a health clinic with multiple genital lesions that are filled with a viscous, creamy exudate and has subsequently been diagnosed with molluscum contagiosum. What is his care provider most likely to tell him about the plan for treating the diagnosis? A) This kind of infection often subsides on its own and doesn't grow more serious over time. B) These lesions usually respond well to oral antiviral medications. C) Treatment of this problem is usually successful, but if untreated, it can lead to sterility. D) The bacteria that cause this disease are often latent for several years at a time, and you would be contagious for the entire period.

This kind of infection often subsides on its own and doesn't grow more serious over time.

Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? A) Your daughter has lost all her cognitive functions as well as all her basic reflexes. B) Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change. C) If you or the care team notices any spontaneous eye opening, then we will change our treatment plan. D) Your daughter's condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.

Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.

A patient 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 of the following purposes? a) Hemolysis b) Hemostasis c) Thrombolysis d) Thrombogenesis

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 who has just undergone a thyroidectomy is experiencing high fever, tachycardia, and extreme restlessness. The nurse would interpret these manifestations as:

Thyroid crisis Explanation: The symptoms this client is experiencing are related to thyroid crisis or storm and must be treated immediately to prevent death. Myxedematous coma is related to hypothyroidism but typically does not occur after a thyroidectomy. Addisonian crisis is related to hypoadrenalism. Page 781

The sympathetic and the parasympathetic nervous systems are continuously at work in our bodies. This continual action gives a basal activity to all parts of the body. What is this basal activity referred to as? a) Relaxation b) Tone c) Strength d) Tension

Tone The sympathetic and parasympathetic nervous systems are continually active. The effect of this continual or basal (baseline) activity is referred to as tone.

A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing: a) Transient ischemic attack (TIA) b) Lacunar infarct c) Cardiogenic embolic stroke d) Thrombotic stroke

Transient ischemic attack (TIA) Transient ischemic attacks are brief episodes of neurologic function resulting in focal cerebral ischemia not associated with infarction that usually resolve in 24 hours. The causes of transient ischemic attack are the same as they are for stroke. Embolic stroke usually has a sudden onset with immediate maximum deficit. Lacunar infarcts produce classic recognizable "lacunar syndromes" such as pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with clumsy hand syndrome.

A patient reports chronic pain. Assessment indicates it is located at the T6 dermatome. How will this information assist the nurse to develop an effective plan of care?

Treatment can be tailored to the specific location. Explanation: A dermatome is the region of the body wall that is supplied by a single pair of dorsal root ganglia. Isolating the location of the pain allows for focused treatment. Pain commonly interferes with ADLs. Interventions are designed to minimize disruption of ADLs. Management may reduce referred pain but may not alleviate them because the visceral and somatic neurons share the same dorsal horn projections. Clients with chronic pain benefit most from interventions that include physical, emotional, financial, and spiritual components of care. Using biologic treatments alone is less effective than the combination of all modalities. Page 855

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 Explanation: The trigeminal nerve (CN V), which has both sensory and motor subdivisions, exits the brain stem laterally on the forward surface of the pons. The trigeminal is the main sensory nerve conveying the modalities of pain, temperature, touch, and proprioception to the superficial and deep regions of the face. Regions innervated include the skin of the anterior scalp and face, the conjunctiva and orbit, the meninges, the paranasal sinuses, and the mouth, including the teeth and the anterior two thirds of the tongue. Page 833

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? a) Hypoglossal b) Trigeminal c) Abducens d) Glossopharyngeal

Trigeminal The trigeminal nerve (CN V), which has both sensory and motor subdivisions, exits the brain stem laterally on the forward surface of the pons. The trigeminal is the main sensory nerve conveying the modalities of pain, temperature, touch, and proprioception to the superficial and deep regions of the face. Regions innervated include the skin of the anterior scalp and face, the conjunctiva and orbit, the meninges, the paranasal sinuses, and the mouth, including the teeth and the anterior two thirds of the tongue.

A client comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as "like an electric shock." The pain occurs on only one side of her face. It seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. Often it is accompanied by involuntary grimacing. What diagnosis is most likely?

Trigeminal neuralgia Explanation: Her symptoms are characteristic of trigeminal neuralgia, caused by damage to the fifth cranial nerve, which carries impulses of touch, pain, pressure, and temperature to the brain from the face and jaw. Postherpetic neuralgia is a complication of shingles, migraine headache symptoms feel as if they occur in one or more regions of the head, not the face, and complex regional pain syndrome affects either one arm or leg. Page 870

Nonopioids, such as acetaminophen (Tylenol), are the first line of therapy for managing mild to moderate pain in the elderly because they are safe.

True Explanation: Opiods are used for more severe pain and palliative care Page 867

Global or diffuse brain injury is manifested by changes in the level of consciousness. a) False b) True

True Global brain injury nearly always results in altered levels of consciousness, ranging from inattention to stupor or coma.

A patient with a history of an endocrine disorder exhibits signs and symptoms of hormone deficiency. Which of the following processes would the patient's care team most likely rule out first as a contributing factor? Up-regulation has increased the sensitivity of the body to particular hormone levels. The process of down-regulation has resulted in decreased hormone sensitivity. Hormone production is sufficient, but affinity on the part of the target cells is lacking. The patient's target cells lack sufficient receptors for the hormone in question.

Up-regulation has increased the sensitivity of the body to particular hormone levels.

A 21 year old male is brought to the ED following a night of partying in his fraternity. His friends found him "asleep" and couldn't get him to respond. They cannot recall how many alcoholic beverages he drank the night before. While educating a student nurse and the roommates in the fraternity, the nurse begins by explaining that alcohol is: a) Able to reverse the transport of some substances to remove them from the brain. b) Very likely to cause sedation and therefore the patient just needs to sleep it off. c) Very lipid soluble and rapidly crosses the blood-brain barrier. d) Water-soluble compound that is easily absorbed by the gastric lining of the stomach.

Very lipid soluble and rapidly crosses the blood-brain barrier. The blood-brain barrier prevents many drugs from entering the brain. Most highly water-soluble compounds are excluded from the brain. Many lipid-soluble molecules cross the lipid layers of the blood-brain barrier with ease...Alcohol, nicotine, and heroin are very lipid soluble and rapidly enters the brain. Alcohol toxicity can kill patients, especially if they are not use to consuming beverages. These patients should never be left alone to "sleep it off".

The nurse is testing her cliient's tactile sensation. She knows that the pacinian corpusles are functioning when the patient reports which sensation?

Vibration Explanation: The pacinian corpusles detect tissue vibration. Hair follicle end organs detect movement on the surface of the body. Free nerve endings detect touch and pressure. Skin stretching is detected by the Ruffini end organs. Page 858

A client is admitted to the acute care facility with severe pain in the abdomen related to inflammatory bowel disease. What type of pain will the nurse be administering medication to relieve?

Visceral pain Visceral pain has its origin in the visceral organs and is one of the most common pains produced by disease. While similar to somatic pain in many ways, both the neurologic mechanisms and the perception of visceral pain differ from somatic pain. One of the most important differences between surface pain and visceral pain is the type of damage that causes pain. Strong contractions, distention, or ischemia affecting the walls of the viscera can induce severe pain. Page 864

A client with a history of migraine headaches tells the physician that he or she usually experiences an aura before the onset of the headache. The client is most likely experiencing:

Visual disturbances Explanation: Migraine aura is associated with visual symptoms, including flickering lights, spots, or loss of vision; sensory symptoms, including feeling of pins or needles, or numbness; and speech disturbances or other neurologic symptoms. Page 873

Ion channels in nervous system cells generate action potentials in the cells. What are the ion channels guarded by?

Voltage-dependent gates Explanation: These membrane channels are guarded by voltage-dependent gates that open and close with changes in the membrane potential. The other answers are incorrect. Page 825

Ion channels in nervous system cells generate action potentials in the cells. What are the ion channels guarded by? a) Voltage-dependent gates b) Ligand gates c) Leyte cells d) Schwann cells

Voltage-dependent gates These membrane channels are guarded by voltage-dependent gates that open and close with changes in the membrane potential. The other answers are incorrect.

A care aide at a long-term care facility has informed a resident's nurse practitioner that the 80-year-old woman's eyes appear to be inflamed and her eyelids are caked with sticky secretions. The woman subsequently has been diagnosed with posterior blepharitis. Which of the following treatments is the nurse practitioner likely to initiate? Intravenous steroids coupled with topical antibiotic ointment Regularly scheduled cleansing of the woman's eyes with normal saline Warm compresses to be applied regularly to her eyes in addition to oral antibiotics Surgical repair of the woman's blocked meibomian glands

Warm compresses to be applied regularly to her eyes in addition to oral antibiotics

A female neonate has been in respiratory distress since delivery and is unresponsive to oxygen therapy. Endoscopy has confirmed a diagnosis of esophageal atresia and tracheoesophageal fistulae (EA/TEF). Which of the following explanations should the care team provide to the infant's parents? A) We will have to perform surgery to correct the hole in her throat to make sure that she is able to swallow and breathe normally. B) This problem will require respiratory therapy and supplementary feeding, but it will likely resolve itself over time. C) The biggest risk that your daughter will face until this is fixed is the danger of malnutrition and dehydration. D) The priority in our immediate treatment prior to her surgery will be pain management, as the contents of her stomach can burn her lungs.

We will have to perform surgery to correct the hole in her throat to make sure that she is able to swallow and breathe normally.

A client asks the nurse when during embryonic growth the nervous system develops. The best response would be:

Week 3 Explanation: The nervous system appears very early in week 3 of embryonic development. The nervous system appears very early in embryonic development (22 to 23 days). This early development is essential because it influences the development and organization of many other body systems, including the axial skeleton, skeletal muscles, and sensory organs such as the eyes and ears. Page 830

A patient with a new diagnosis of an endocrine disorder is unclear about how the body can control the levels of different hormones over time. Which of the following statements most accurately underlies the dominant regulation process of hormone levels in the body? The pituitary gland is genetically programmed to stimulate and inhibit hormone production and/or release based on needs at different points in the life cycle. The hypothalamus ensures that hormone levels correspond accurately to the diurnal cycle. With input from various sensors, hormone production and release are adjusted based on existing hormone levels. A positive feedback cycle ensures that stable levels of hormones exist in the body over time.

With input from various sensors, hormone production and release are adjusted based on existing hormone levels.

Which of the following types of reflex is stimulated by a nociceptive stimulus?

Withdrawal reflex Explanation: The withdrawal reflex is stimulated by a damaging (nociceptive) stimulus. The myotatic, or stretch reflex, controls muscle tone and helps maintain posture. The carotid sinus baroreflex assists adjustment of the cardiovascular system at the level of the brain stem. Page 840

Which of the following types of reflex is stimulated by a nociceptive stimulus? a) Carotid sinus baroreflex b) Stretch reflex c) Myotatic reflex d) Withdrawal reflex

Withdrawal reflex The withdrawal reflex is stimulated by a damaging (nociceptive) stimulus. -The myotatic, or stretch reflex, controls muscle tone and helps maintain posture. -The carotid sinus baroreflex assists adjustment of the cardiovascular system at the level of the brain stem.

A patient has been diagnosed with bacterial conjunctivitis. This type of infection is usually characterized by large amounts of what color drainage? a) Serous b) Yellow-green c) Blue-yellow d) Pink-red

Yellow-green The infection usually is characterized by large amounts of yellow-green drainage. The eyelids are sticky, and there may be excoriation of the lid margins.

Following genetic testing and a thorough history from the child's mother and father, a 5-month-old boy has been diagnosed with osteogenesis imperfecta. What teaching point should the care team provide to the mother and father? A) His skeleton is prone to breakage, and we'll begin hormone therapy to treat this. B) His hips are extremely susceptible to dislocation, so rough play is out of the question. C) You'll need to commit to calcium supplementation for the duration of his development. D) You'll need to be very careful to avoid causing fractures to his fragile bones.

You'll need to be very careful to avoid causing fractures to his fragile bones.

A female patient presented to her primary care physician with classic signs and symptoms of Cushing syndrome. Upon testing, it was discovered that the patient had vaginal small cell carcinoma. How can the health care providers explain her Cushing syndrome signs and symptoms to this patient? A) Your tumor in your vagina is secreting a hormone called adrenocorticotropic hormone (ACTH), which is responsible for these signs and symptoms.¡¨ B) We are going to have to run some more tests. We think you might have a problem with your pituitary gland.¡¨ C) There is no connection between the Cushing syndrome and the vaginal carcinoma. You have two very distinct problems occurring at the same time.¡¨ D) We need to check your thyroid. Your Cushing syndrome may be caused by hypofunction of this gland.¡¨

Your tumor in your vagina is secreting a hormone called adrenocorticotropic hormone (ACTH), which is responsible for these signs and symptoms

A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood-brain barrier and been transferred from the vascular space into the patient's interstitial space. Which of the following diagnoses best captures this pathophysiology? Question options: Vasogenic edema Hydrocephalus Cytotoxic edema Focal hypoxia

a

After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures? Question options: The components of the patient's limbic system The man's parietal lobe The patient's temporal lobe in general and Wernicke area in particular The man's occipital lobe

a

During a late-night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system has the highest level of control over her arm and hand action? Question options: Frontal lobe Basal ganglia Thalamus Cerebelum

a

patient with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in her chemical synapses? Question options: More serotonin molecules will cross the synaptic cleft and bond with postsynaptic receptors. The neurotransmitter will cross gap junctions more readily. Communication between a neuron and the single neuron it is connected with will be facilitated. Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.

a

The nurse witnesses a client go into cardiac arrest. If the nurse delays intervention, when will the death of brain cells begin? a. 4-6 minutes b. 2-3 minutes c. 1-2 minutes d. 7-8 minutes

a. 4-6 minutes

Which of the following statements best conveys an aspect of the role of cerebrospinal fluid (CSF)? a. CSF cushions the brain and provides a near-water medium for diffusion of nutrients b. It provides physical protection for the brain and ensures leukocytes and erythrocytes are evenly distributed in the CNS c. It ensures the high metabolic and oxygenation needs of the brain are met, as well as absorbing physical shocks d. CSF distributes plasma proteins throughout the superficial gray matter of the CNS

a. CSF cushions the brain and provides a near-water medium for diffusion of nutrients

The nurse knows which phenomena listed below is an accurate statement about axonal transport? a. Materials can be transported to the nerve terminal by either fast or slow components b. The unidirectional nature of the axonal transport system protects the CNS against potential pathogens c. Anterograde and retrograde axonal transport allow for the communication of nerve impulses between and neuron and the central nervous system (CNS) d. Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials

a. Materials can be transported to the nerve terminal by either fast or slow components

During a clinical assessment of a 68 year-old client who has suffered a head injury, a neurologist suspects that a client has a sustained damage to her vagus (CN X). Which of the following assessment findings is most likely to lead the physician to this conclusion? a. The client has difficulty swallowing and has had recent constipation and hypoactive bowel sounds. b. The client is unable to perform any fine motor movements of her tongue. c. The client has a unilateral facial droop, dry eyes and decreased salivary production. d. The client is unable to turn her head from side to side and her tongue is flaccid.

a. The client has difficulty swallowing and has had recent constipation and hypoactive bowel sounds.

The sympathetic and the parasympathetic nervous systems are continuously at work in our bodies. This continual action gives a basal activity to all parts of the body. What is this basal activity referred to as? a. Tone b. Relaxation c. Tension d. Strength

a. Tone

A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? Question options: "Is your son generally pain free during the intervals between headaches?" "Does your son have any food allergies that have been identified?" "When your son has a headache, does he ever have nausea and vomiting as well?" "Does your son have a family history of migraines?"

b

A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman's ability? Question options: Free nerve endings Meissner corpuscles Ruffini end organs Pacinian corpuscles

b

Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? Question options: The reticular formation The outer layer (neolayer) The middle layer (paleolayer) The inner layer (archilayer)

b

Which of the following individuals would be most likely to experience global ischemia to his or her brain? Question options: A woman who is being brought to the hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater A man who has entered cardiogenic shock following a severe myocardial infarction A woman who has been admitted to the emergency department with a suspected intracranial bleed A male patient who has just had an ischemic stroke confirmed by CT of his head

b

Which are functions of the frontal lobe? Select all that apply. a. Experiencing depth perception b. Anticipation of consequences of behavior c. Prediction of consequences of behavior d. Experiencing color and motion

b. Anticipation of consequences of behavior c. Prediction of consequences of behavior

The parasympathetic nervous system is part of which of the following systems? a. Somatic nervous system b. Autonomic nervous system c. Central nervous system d. Thoracolumbar nervous system

b. Autonomic nervous system

A nurse practitioner is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. Which of the following pharmacologic therapies is most likely to benefit the woman? Question options: An epinephrine and norepinephrine supplement An antipsychotic medication that blocks dopamine receptors A selective serotonin reuptake inhibitor (SSRI) A drug that influences gamma-aminobutyric acid (GABA) levels

d

A nurse educator is explaining basic neuroanatomy to a class of prospective nursing students. Which statement best conveys an aspect of the role of cerebrospinal fluid (CSF)? a. It provides physical protection for the brain and ensures leukocytes and erythrocytes are evenly distributed in the CNS. b. CSF cushions the brain and provides a near-water medium for diffusion of nutrients. c. CSF distributes plasma proteins throughout the superficial gray matter of the CNS. d. It ensures the high metabolic and oxygenation needs of the brain are met, as well as absorbing physical shocks.

b. CSF cushions the brain and provides a near-water medium for diffusion of nutrients.

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? a. Contains the pontine nuclei b. Coordinates smooth and accurate movements of the body c. Conveys the senses of pain, temperature, touch, and proprioception to the superficial and deep regions of the face d. Contains the main motor pathways between the forebrain and the pons

b. Coordinates smooth and accurate movements of the body

Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which of the following parts of the brain? a. Basal ganglia b. Hypothalamus c. Cerebellum d. Cerebral hemispheres

b. Hypothalamus

Feelings of dread, high anxiety, or exquisite pleasure can be elicited by stimulation of areas in which of the following structures? a. Cerebellum b. Limbic system c. Temporal lobe d. Occipital lobe

b. Limbic system

A client is undergoing a diagnostic workup of the autonomic nervous system. Which statement should inform the nurse's analysis of the results? a. The client's ANS can be roughly divided into ? and ? branches b. Neurotransmitters in the ANS are capable of both excitation and inhibition c. The major neurotransmitters of the ANS are acetylcholine and dopamine d. The ANS is primarily responsible for mediating between the different components of the CNS

b. Neurotransmitters in the ANS are capable of both excitation and inhibition

Which types of cells are supporting cells of the peripheral nervous system? a. Ependymal cells b. Schwann cells c. Oligodendrocytes d. Astrocytes

b. Schwann cells

Dopamine is an intermediate compound made during the synthesis of norepinephrine. It is the principal inhibitory transmitter of the internuncial neurons in the sympathetic ganglia. What other action does it have? a. Vasoconstricts renal and coronary blood vessels when given intravenously b. Vasodilates renal and coronary blood vessels when given intravenously c. Acts as a neuromodulator in the forebrain d. Acts as a neuromodulator in the hindbrain

b. Vasodilates renal and coronary blood vessels when given intravenously

Following a motor vehicle accident three months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? Question options: "Your daughter's condition is an unfortunate combination of total loss of consciousness with continuation of all other normal brain functions." "If you or the care team notice any spontaneous eye opening, then we will change our treatment plan." "Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change." "Your daughter has lost all her cognitive functions as well as all her basic reflexes."

c

An increased blood pressure is detected by the carotid sinus baroreceptor and results in stimulation of the vagus nerve to decrease the heart rate. At which of the following levels of the nervous system does this reflex adjustment occur? a. Spinal cord b. Cerebral cortex c. Brain stem (medulla and pons) d. Hypothalumus

c. Brain stem (medulla and pons)

The health care provider is performing a spinal tap on a client with suspected infection. The provider would perform the procedure at: a. C3 or C4 b. T3 or T4 c. L3 or L4 d. S3 or S4

c. L3 or L4

Ion channels in nervous system cells generate action potentials in the cells. What are the ion channels guarded by? a. Schwann cells b. Ligand gates c. Voltage-dependent gates d. Leyte cells

c. Voltage-dependent gates

Which of the following types of reflex is stimulated by a nociceptive stimulus? a. Stretch reflex b. Carotid sinus baroreflex c. Withdrawal reflex d. Myotatic reflex

c. Withdrawal reflex

how is a person affected by shingles

chicken pox virus settles after recovery then lays dormant. On susceptible host the virus reappears as shingles. Common old age, hiv,

what pain is depression associated with and why

chronic pain, as the patient will feel med team cant help them and they cannot get relief

A male newborn infant has been diagnosed with spina bifida occulta. Which of the following pathophysiologic processes has most likely contributed to the infant's health problem? Question options: The infant's soma and viscera are underdeveloped. The child's central and peripheral nervous systems have insufficiently differentiated during embryonic development. The infant's spinal cord and meninges protrude through his skin. The vertebral arches around his neural tube have failed to completely close.

d

Which of the following diagnostic findings is likely to result in the most serious brain insult? Question options: High intracellular concentration of glutamate Increased ICP accompanied by hyperventilation Moderate increase in brain tissue volume secondary to a brain tumor Mean arterial blood pressure (MABP) that equals intracranial pressure (ICP)

d

A practitioner is preparing to do a lumbar puncture on a patient with suspected meningitis. Which of the following areas on the spine does the practitioner choose to obtain a cerebrospinal fluid (CSF) sample? a. Between T1 and T2 b. Between C7 and C8 c. Between T12 and L1 d. Between L3 and L4

d. Between L3 and L4

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: a. Cause vasoconstriction of the splanchnic vessels b. Cause alteration in the level of consciousness c. Cause vasoconstriction of the renal system d. Cause vasodilatation of the coronary blood vessels

d. Cause vasodilatation of the coronary blood vessels

The thick area of myelinated axons that connects the two sides of the cerebral cortex is known as which of the following components? a. Globus pallidus b. Caudate nucleus c. Striatum d. Corpus callosum

d. Corpus callosum

The nursing student who is studying pathophysiology correctly identifies the condition that characteristically has an increase in the aqueous humor which fills the anterior and posterior chambers of the eye as which disease? a) cataract b) glaucoma c) retinopathy d) amblyopia

glaucoma Glaucoma is a chronic degenerative optic neuropathy characterized by optic disk cupping and visual field loss. It is usually associated with an elevation in intraocular pressure. Amblyopia is lazy eye while retinopathy is a disorder of the retinal vessels which interrupt blood flow to the visual receptors leading to visual impairment. A cataracts is a lens opacity that interferes with the transmission light to the retina

A client begins to exhibit signs and symptoms of a stroke at a community health fair. Emergency care for the client includes: a) going to an urgent care center. b) seeing his/her physician. c) going to the nearest stroke center. d) going to the nearest emergency room.

going to the nearest stroke center. Salvaging brain tissue, preventing secondary stroke, and minimizing long-term disability are the treatment goals for an acute ischemic stroke. The care of patients with stroke has shifted away from the "nearest hospital" to certified stroke centers. These are hospitals that have been certified by some external agency, most commonly the state or Joint Commission on Accreditation of Healthcare Organizations, the federal agency overseeing all facilities that care for Medicare patients.

The nurse observes a new nurse performing the test for Kernig's 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: a) the sign elicited was the Budzinski's sign. b) the sign elicited was the obturator sign. c) resistance should be provided with the knee in a flexed position. d) the client should be in a sitting position.

resistance should be provided with the knee in a flexed position. The test for Kernig's 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 neurotransmitter GABA mainly functions to trigger inhibitory postsynaptic potentials (IPSPs). Therefore, when explaining this to a group of nursing students, the nurse will state that A) it takes at least three chemical substances (amino acids, neuropeptides, and monoamines) to stimulate any activity between the cells. B) there is a symbiotic relationship; therefore, the end result will be depolarization of the postsynaptic membrane. C) the combination of GABA with a receptor site is inhibitory since it causes the local nerve membrane to become hyperpolarized and less excitable. D) the neurotransmitters will interact with cholinergic receptors to bind to acetylcholine in order to produce hypopolarization within the cell.

the combination of GABA with a receptor site is inhibitory since it causes the local nerve membrane to become hyperpolarized and less excitable.

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

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%).

Which of the following clients are at risk for developing and acute episode of angle-closure glaucoma? Select all that apply.

• A 60-year-old female emotionally devastated after divorcing her husband of 35 years • A soldier ordered to stay in a pitch-black cave to observe enemy militants for an extended period of time • A surgical client who has received many doses of IV atropine to keep heart rate above 50 Manifestations of acute angle-closure glaucoma are related to sudden, intermittent increases in intraocular pressure. These occur after prolonged periods in the dark, emotional upset, and other conditions that cause extensive and prolonged dilation of the pupil. Administration of pharmacologic agents, such as atropine, that cause pupillary dilation (mydriasis) also can precipitate an acute episode. -Age-related macular degeneration (AMD) is the most common cause of reduced vision in the elderly. In addition to older age, identifiable risk factors include cigarette smoking, obesity, and low dietary intake of lutein, omega 3 fatty acids, zinc, and vitamins A, C, and E. Persons with high grades of myopia or nearsightedness may have abnormalities in the peripheral retina that predispose to sudden detachment.

A client may be at risk for the development of hypoxia. Select the conditions that would place a client at risk. Select all that apply. a) Increased atmospheric pressure b) Increased oxygenation by the lungs c) Thrombocytopenia d) Age e) Severe anemia f) Carbon monoxide poisoning

• Carbon monoxide poisoning • Increased oxygenation by the lungs • Severe anemia 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. The other options will not alter oxygen levels.

When trying to explain the difference between vasogenic versus cytotoxic cerebral edema, the physiology instructor mentions that cytotoxic edema displays which of the following functions in the brain? Select all that apply. a) May cause herniation by displacing a cerebral hemisphere b) Impaired blood-brain barrier that allows water/proteins to leave vessels and go into the interstitial space c) Allows cells to increase volume to the point of rupture, damaging neighboring cells d) Mainly allows edema to form in the white mater of the brain e) Causes ischemia to build up lactic acid due to anaerobic metabolism

• Causes ischemia to build up lactic acid due to anaerobic metabolism • Allows cells to increase volume to the point of rupture, damaging neighboring cells Cytotoxic edema involves an increase in intracellular fluid. Ischemia results in the inadequate removal of anaerobic metabolic end products such as lactic acid, producing extracellular acidosis. If blood flow is reduced to low levels for extended periods or to extremely low levels for a few minutes, cellular edema can cause the cell membrane to rupture, allowing the escape of intracellular contents into the surrounding extracellular fluid. This leads to damage of neighboring cells. Vasogenic edema occurs with conditions that impair the function of the blood-brain barrier and allow transfer of water and proteins from the vascular into the interstitial space. It occurs primarily in the white matter of the brain, possibly because the white matter is more compliant than the gray matter. Vasogenic edema can result in displacement of a cerebral hemisphere and various types of brain herniation.

A patient has an abrupt onset of mental slowing and depression. Which of the following conditions in the patient's history would indicate vascular dementia as a cause of these changes? Select all that apply. a) Cigarette smoking b) Peptic ulcer c) Diabetes insipidus d) Cardiac dysrhythmias e) Cerebrovascular accident

• Cerebrovascular accident • Cardiac dysrhythmias • Cigarette smoking The hallmarks of vascular dementia are mental slowing and depression. They usually occur as a result of brain injury from hemorrhage or occlusion. Common disorders associated with this diagnosis are cerebrovascular accident, cardiac dysrhythmias, cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus, and autoimmune disorders.

Which cranial nerves that have their origin in the pons assist with the manipulation of the jaw during chewing and speech? Select all that apply. a) Cranial nerve VI b) Cranial nerve VIII c) Cranial nerve I d) Cranial nerve VII e) Cranial nerve III

• Cranial nerve VI • Cranial nerve VII • Cranial nerve VIII In the pons, the reticular formation is large and contains the circuitry for manipulating the jaw during chewing and speech. Cranial nerves VIII, VII, and VI have their origin in the pons. -Axons of the olfactory nerve, or cranial nerve I, terminate in the most primitive portion of the cerebrum—the olfactory bulb, where initial processing of olfactory information occurs. The outflow from the midbrain passes through the oculomotor nerve (cranial nerve III) to supply the pupillary sphincter muscle of each eye and the ciliary muscles that control lens thickness for accommodation.

A brain tumor causing clinical manifestations of headache, nausea, projectile vomiting and mental changes is likely located in which part of the brain? Select all that apply. a) Temporal lobe. b) Frontal lobe. c) Intra-axially. d) Brain stem. e) Extra-axially.

• Intra-axially. • Extra-axially. • Frontal lobe. Tumors within the intracranial (intra-axially) cavity is fixed and cause s/s of increased ICP like headache, n/vomiting, mental changes, papilledema, visual disturbances, alterations in sensory and motor function... Outside the brain tissue (extra-axially) but within the cranium, tumors may reach large sizes without producing s/s. After they reach a sufficient size, s/s of increased ICP appear. -Temporal lobe tumors often produce seizures as their first symptom. -Brain stem tumors commonly produce upper/lower motor neuron s/s such as weakness of facial muscles and ocular palsies. -Frontal lobe tumors also grow to a large size and cause s/s of increased ICP.

A nurse in the emergency room is assessing a client's level of consciousness. The client appears very drowsy but is able to follow simple commands and respond to painful stimuli appropriately. The nurse should document the client's level of consciousness as which of the following? a) Confusion b) Obtundation c) Lethargy

• Obtundation Characteristics of obtundation include responding verbally with a word, arousable with stimulation, responds appropriately to painful stimuli, follows simple commands, and appears very drowsy.

Following his annual influenza vaccination, a client begins to feel achy, like he has developed the flu. An hour later, the client is rushed to the emergency department. Diagnosis of Guillain-Barré syndrome was made based on which of the following assessment findings? Select all that apply. a) Rapid deterioration of respiratory status b) Pale, cool, dry skin c) Flaccid paralysis of limbs d) BP 90/62 e) Lack of any physical pain

• Rapid deterioration of respiratory status • Flaccid paralysis of limbs • BP 90/62 Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. The disorder is characterized by progressive ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. Paralysis may progress to involve the respiratory muscles. Autonomic nervous system involvement that causes postural hypotension, arrhythmias, facial flushing, abnormalities of sweating, and urinary retention is common. Pain is another common feature of Guillain-Barré syndrome.

Stepping out of a mall and into the sunshine has caused a man's pupils to constrict. Place the following anatomical components of the man's pupillary reflex in the ascending chronological order that they responded to the light. Use all the options. a) Retinal ganglionic cells b) Oculomotor nuclei c) Pretectal nuclei d) Preganglionic neurons

• Retinal ganglionic cells • Oculomotor nuclei • Pretectal nuclei • Preganglionic neurons Pretectal areas on each side of the brain are connected, explaining the binocular aspect of the light reflex. The afferent stimuli for pupillary constriction arise in the ganglionic cells of the retina and are transmitted to the pretectal nuclei at the junction of the thalamus and the midbrain, and from there to preganglionic neurons in the oculomotor (CN III) nuclei via the pretecto-oculomotor tract

The nurse is providing discharge instructions on the antiseizure medication valproic acid to a woman of childbearing age. Which of the following should the nurse include? Select all that apply. a) The medication may interact with oral contraceptives. b) The medication should be stopped in the third trimester of pregnancy c) The medication may predispose her to osteoporosis. d) The medication should be taken consistently. e) The client should also take a folic acid supplement daily.

• The client should also take a folic acid supplement daily. • The medication may predispose her to osteoporosis. • The medication should be taken consistently. • The medication may interact with oral contraceptives. The nurse should include in the teaching that the client should also take folic acid supplementation daily, that the medication may predispose the client to osteoporosis, and that it may interact with oral contraceptives. The nurse should also caution the client to take the medication on a consistent basis to prevent recurring seizures.

The nurse is caring for a client who has received tissue plasminogen activator (tPA). The nurse's plan of care should include education relating to which of the following? Select all that apply. a) Warfarin (Coumadin) therapy b) Aspirin (ASA) therapy c) Reduction of risk factors d) Signs and symptoms of occurrence

• Warfarin (Coumadin) therapy • Reduction of risk factors • Signs and symptoms of occurrence Clients receive tPA as treatment for ischemic stroke. In her plan of care the nurse should include education related to: warfarin (Coumadin therapy), signs and symptoms of stroke recurrence (most likely in first week post-tPA administration) and ways for the client to reduce risk factors for another stroke.