Patho Test 3 - Neuro

25. A client's primary care provider has prescribed a -adrenergic receptor blocker. Which of the following therapeutic effects do the client and care provider likely seek? A) Reduction in heart rate and blood pressure B) Slowing of gastrointestinal motility C) Increase in mental acuity D) Decreased production of gastric acid

Ans: A Feedback: 1-Adrenergic receptors are located primarily in the heart, the blood vessels of skeletal muscle, and the bronchioles. As such, drugs that block these receptors can bring about a reduction in heart rate, stroke volume, and blood pressure.

7. What pain theory proposes that pain receptors share pathways with other sensory modalities and that different activity patterns of the same neurons can be used to signal painful or nonpainful stimuli? A) Pattern B) Specificity C) Gate control D) Neuromatrix

Ans: A Feedback: A group of pain theories known as the pattern theory proposes that receptors share pathways with other sensory modalities, and different activity patterns of the same neurons can be used to signal painful or nonpainful stimuli. The specificity theory regards pain as a separate sensory modality evoked by the activity of specific receptors that transmit information to forebrain pain centers, where pain is experienced. Gate control theory postulated the presence of neural gating mechanisms at the segmental spinal cord level to account for interactions between pain and other sensory modalities. The neuromatrix theory proposes that the brain contains a widely distributed neural network.

22. A client with a spinal cord injury at T8 would likely retain normal motor and somatosensory function of her: A) Arms B) Bowels C) Bladder D) Perineal musculature

Ans: A Feedback: A spinal cord injury at T8 would likely allow the client to retain normal function of the upper extremities, while innervations governing the function of the bowels, bladder, and perineum would be severed.

15. A client's recent diagnosis of Parkinson disease has prompted his care provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the client's levels of: A) Dopamine B) Acetylcholine C) Serotonin D) Adenosine

Ans: A Feedback: Although some antiparkinsonian drugs act by reducing the excessive influence of excitatory cholinergic neurons, most act by improving the function of the dopaminergic system. Serotonin and adenosine are not known to participate directly in the pathophysiology of Parkinson disease.

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

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

2. Following a car accident that has resulted in partial amputation of the lower limbs, the client's body has implemented a compensatory mechanism releasing antidiuretic hormone (ADH) into the blood stream, causing retention of water and vasoconstriction of blood vessels. This is accomplished as a result of: A) Rapid axonal transport of ADH from the hypothalamus into the posterior pituitary B) Extension of Nissl bodies and free ribosomes carrying ADH into the dendrites C) Dendrites conducting information and ADH toward the cell body D) Afferent, or sensory, neurons of the PNS transmitting information to the CNS

Ans: A Feedback: Antidiuretic hormone (ADH) and oxytocin, which are synthesized by neurons in the hypothalamus, are carried by rapid axonal transport to the posterior pituitary, where the hormones are released into the bloodstream. ADH increases peripheral vascular resistance (vasoconstriction) and thus increases arterial blood pressure. This becomes an important compensatory mechanism for restoring blood pressure in hypovolemic shock such as that which occurs during hemorrhage. The proteins and other materials used by the axon are synthesized in the cell body and then flow down the axon through its cytoplasm. The Nissl bodies and free ribosomes extend into the dendrites, but not into the axon. The dendrites (i.e., "treelike") are multiple, branched extensions of the nerve cell body; they conduct information toward the cell body and are the main source of information for the neuron. The dendrites and cell body are studded with synaptic terminals that communicate with axons and dendrites of other neurons.

4. 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) Astrocytes fill up the space to form a glial scar, repairing the area and replacing the CNS cells that cannot regenerate. B) The microglia are responsible for cleaning up debris after cerebral infection, or cell death. C) Ependymal cells are responsible for phagocytosis. D) Oligodendrocytes are responsible for integrative metabolism.

Ans: A Feedback: 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.

6. 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) TIAs and cerebrovascular infarction C) Momentary unconsciousness D) Status epilepticus

Ans: A Feedback: 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.

13. Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement: A) Without causing paralysis B) Posture and muscle tone C) And cortical responses D) Of upper motor neurons

Ans: A Feedback: Disorders of the basal ganglia comprise a complex group of motor disturbances characterized by tremor and other involuntary movements, changes in posture and muscle tone, and poverty and slowness of movement. They include tremors and tics, spasticity, hypokinetic disorders, and hyperkinetic disorders. Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement but do not cause paralysis. Disorders of the upper motor neuron pyramidal tracts are characterized by spasticity and paralysis.

2. Disorders of the pyramidal tracts, such as a stroke, are characterized by: A) Paralysis B) Hypotonia C) Muscle rigidity D) Involuntary movements

Ans: A Feedback: Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis, whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) by involuntary movements, muscle rigidity, and immobility without paralysis. Hypotonia is a condition of less than normal muscle tone, hypertonia or spasticity is a condition of excessive tone, and paralysis refers to a loss of muscle movement. Upper motor neuron (UMN) lesions produce spastic paralysis and lower motor neuron (LMN) lesions flaccid paralysis.

12. Which of the following messages is most likely to be carried by general somatic afferent (GSA) neurons? A) The sensation of cold when touching ice B) The message to move a finger and thumb C) The message to move the larynx during speech D) Information about the position of a joint

Ans: A Feedback: General somatic afferent (GSA) neurons innervate the skin and other somatic structures, responding to stimuli such as those that produce pressure or pain. Initiation of motion is the control of efferent neurons, whereas information about the position of a joint is undercarried by the special somatic afferent (SSA) fibers.

7. A neuron has been hyperpolarized. How will this affect the excitability of the neuron? A) The neuron will have a membrane potential farther from the threshold. B) The neuron will be more difficult to repolarize after firing. C) The membrane potential of the neuron will be closer to the threshold. D) The neuron's excitability will be significantly increased.

Ans: A Feedback: Hyperpolarization brings the membrane potential farther from the threshold and has an inhibitory effect, decreasing the likelihood that an action potential will be generated. Hypopolarization increases the excitability of the postsynaptic neuron by bringing the membrane potential closer to the threshold potential so that a smaller subsequent stimulus is needed to cause the neuron to fire. Neither situation has a direct bearing on the process of repolarization after the neuron fires.

17. 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) Atherosclerotic destruction of circulation to the brain resulting in lactic acid buildup that affects nerve transmission D) Autoimmune disease where antibody loss of acetylcholine receptors at the neuromuscular junction causes decrease motor response

Ans: A Feedback: 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.

1. More complex patterns of movements, such as throwing a ball or picking up a fork, are controlled by which portion of the frontal lobe? A) Premotor cortex B) Primary motor cortex C) Reflexive circuitry D) Supplementary motor cortex

Ans: A Feedback: Nerve signals generated by the premotor cortex produce much more complex "patterns" of movement; the movement pattern to accomplish a particular objective, such as throwing a ball or picking up a fork, is programmed by the prefrontal association cortex and associated thalamic nuclei. The primary motor cortex is concerned with the purpose and planning of the motor movement and controls specific muscle movement sequences. The lowest level of the hierarchy occurs at the spinal cord, which contains the basic reflex circuitry needed to coordinate the function of the motor units involved in the planned movement. The supplementary motor cortex, which contains representations of all parts of the body, is involved in the performance of complex, skillful movements that require coordination of both sides of the body.

8. A high school senior sustained a concussion during a football game. Which of the following signs and symptoms would indicate the presence of postconcussion syndrome in the days and weeks following his injury? A) Headaches and memory lapses B) Recurrent nosebleeds and hypersomnia C) Unilateral weakness and decreased coordination D) Neck pain and decreased neck range of motion

Ans: A Feedback: Postconcussion syndrome includes mild symptoms, such as headache, irritability, insomnia, and poor concentration and memory. Nosebleeds, hypersomnia, unilateral motor changes, and neck pain are indicative of more severe brain injury and/or soft tissue injury.

23. 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) Nicotinic acetylcholine receptors, muscle-type receptor (NM) B) Norepinephrine C) Muscarinic acetylcholine receptors D) N2, neuronal-type receptor, a type of nicotinic acetylcholine receptor

Ans: A Feedback: 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.

20. A sudden traumatic complete transection of the spinal cord results in what type of injury below the site? A) Flaccid paralysis B) Vasoconstriction C) Deep visceral pain D) 3+ tendon reflexes

Ans: A Feedback: Sudden complete transection of the spinal cord results in complete loss of motor, sensory, reflex, and autonomic function below the level of injury. This immediate response to spinal cord injury, spinal cord shock, is characterized by flaccid paralysis with loss of tendon reflexes below the level of injury, absence of somatic and visceral sensations below the level of injury, and loss of bowel and bladder function. Loss of systemic sympathetic vasomotor tone may result in vasodilation, increased venous capacity, and hypotension. These manifestations occur regardless of whether the level of the lesion eventually will produce spastic or flaccid paralysis. In persons in whom the loss of reflexes persists, hypotension and bradycardia may become critical but manageable problems. In general, the higher the level of injury, the greater is the effect.

9. When a person is stung on the index finger by a bee, the thalamus interprets the pain as: A) Somewhere on the hand B) A spot on the index finger C) Attributable to a bee stung D) Similar to a previous bee sting

Ans: A Feedback: The basic sensation of hurtfulness, or pain, occurs at the level of the thalamus. In the neospinothalamic system, interconnections between the lateral thalamus and the somatosensory cortex are necessary to add precision and discrimination to the pain sensation. In addition, association areas of the parietal cortex are essential to the learned meaningfulness of the pain experience. For example, if a person is stung on the index finger by a bee and only the thalamus is functional, the person reports pain somewhere on the hand. With the primary sensory cortex functional, the person can localize the pain to the precise area on the index finger. With the association cortex functional, the person can interpret the buzzing and sight of the bee that preceded the pain as being related to the bee sting.

14. A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which of the following abnormalities in the client's gait? A) Slow to start walking and has difficulty when asked to "stop" suddenly B) Difficulty putting weight on soles of feet and tends to walk on tiptoes C) Hyperactive leg motions like he just can't stand still D) Takes large, exaggerated strides and swings arms/hands wildly

Ans: A Feedback: The cardinal symptoms of Parkinson disease (PD) are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Persons with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn. When they walk, they lean forward to maintain their center of gravity and take small, shuffling steps without swinging their arms.

19. 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

Ans: A Feedback: 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.

22. 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) Reflex circuitry produced by the ANS reflexes B) Parasympathetic effects on the vagus nerve C) Secretions of sympathetic neurotransmitters produced in the adrenal medulla D) The cell body of the first motor neuron that lies in the brain stem

Ans: A Feedback: 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.

14. Which area of the brain is responsible for respiration? A) Brain stem B) Midbrain C) Diencephalon D) Frontal lobe

Ans: A Feedback: The respiratory center is located in the brain stem.

1. Which of the following physiologic principles would be considered a function of the somatic nervous system? A) The act of typing a report using a computer keyboard B) Withdrawing the hand after touching a hot surface C) The patellar reflex "knee jerk" activated by tapping the patellar tendon abdominal viscera D) The beginning of depolarization in the cardiac conduction of impulses

Ans: A Feedback: The somatic nervous system provides sensory and motor innervation for all parts of the central nervous system (CNS) and peripheral nervous system (PNS) except viscera, smooth muscle, and glands. The autonomic nervous system (ANS) provides efferent motor innervation to smooth muscle, the conducting system of the heart, and glands.

1. The somatosensory system consists of three types of sensory neurons. The special somatic type of afferent sensory neurons has receptors that sense: A) Muscle position B) Visceral fullness C) Temperature D) Painful touch

Ans: A Feedback: The somatosensory system is designed to provide the central nervous system (CNS) with information about the body. Sensory neurons can be divided into three types that vary in distribution and the type of sensation detected: general somatic, special somatic, and general visceral afferent neurons. General somatic afferent neurons have branches with widespread distribution throughout the body and with many distinct types of receptors that result in sensations such as pain, touch, and temperature. Special somatic afferent neurons have receptors located primarily in muscles, tendons, and joints. These receptors sense position and movement of the body. General visceral afferent neurons have receptors on various visceral structures and sense fullness and discomfort.

9. Which of the following peripheral nerve injuries will likely result in cellular death with little chance of regeneration? A) Nerve fibers destroyed close to the neuronal cell body B) Crushing injury where the nerve is traumatized but not severed C) Cutting injury where slow-regeneration axonal branches are located D) Incomplete amputation where tubular implants are used to fill in the gaps of nerves

Ans: A Feedback: 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.

24. Which of the following statements by the husband of a client with Alzheimer disease demonstrates an accurate understanding of his wife's medication regimen? A) "I'm really hoping these medications will slow down her mental losses." B) "We're both holding out hope that this medication will cure her Alzheimer's." C) "I know that this won't cure her, but we learned that it might prevent a bodily decline while she declines mentally." D) "I learned that if we are vigilant about her medication schedule, she may not experience the physical effects of her disease."

Ans: A Feedback: There is presently no cure for Alzheimer disease. Medications do not directly address the physical manifestations of Alzheimer disease. Rather, drugs are used primarily to slow the progression and to control depression, agitation, or sleep disorders.

3. A clinician is assessing the muscle tone of a client who has been diagnosed with a lower motor neuron (LMN) lesion. Which of the following assessment findings is congruent with the client's diagnosis? A) Hypotonia B) Spasticity C) Tetany D) Rigidity

Ans: A Feedback: Typically, UMN lesions produce increased tone (e.g., spasticity, tetany, and rigidity), whereas LMN lesions produce decreased tone (hypotonia).

7. Following a head injury, a client is diagnosed with a possible intracranial epidural hematoma. During the initial assessment, the client suddenly becomes unconscious. Other clinical manifestations that correlate with this diagnosis may include: A) Ipsilateral pupil dilation B) Ipsilateral hemiparesis C) Diffuse venous bleeding from the nose D) Increased head circumference with hydrocephalus

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

14. Which of the following interventions would be considered a nonpharmacologic method of pain control? Select all that apply. A) Distraction by knitting B) Guided imagery C) Biofeedback D) OTC acetaminophen

Ans: A, B, C Feedback: A number of nonpharmacologic methods of pain control are used in pain management. These include cognitive-behavioral interventions (e.g., relaxation, distraction, imagery, and biofeedback), physical agents (e.g., heat and cold), electroanalgesia (transcutaneous electrical nerve stimulation [TENS]), and acupuncture. Even though acetaminophen is an over-the-counter pain medication, it is still a pharmacologic intervention.

20. Following an automobile accident that resulted in a traumatic amputation of the right lower leg, the client complains of feeling tingling, heaviness, and shooting pain in the amputated limb. The health care providers treat phantom limb pain by which of the following interventions? Select all that apply. A) TENS of the large myelinated afferents innervating the area B) Hypnosis C) Relaxation techniques D) Warm, moist compresses E) Use of mirrors to visualize the limb is no longer there

Ans: A, B, C Feedback: Treatment of phantom limb pain has been accomplished by the use of sympathetic blocks, TENS of the large myelinated afferents innervating the area, hypnosis, and relaxation training. There is no extremity to place the warm compresses on.

7. A client presents to a health clinic complaining of several vague symptoms. As the history/physical continues, the health care provider clearly thinks the client may have myasthenia gravis. Which statements by the client would correlate with this diagnosis? Select all that apply. A) "Sometimes I have double vision." B) "I have more energy in the morning but get worse as the day goes by." C) "Sometimes I have numbness/tingling on my face." D) "I had what felt like an electric shock race down the back of my leg when I bend my neck." E) "I feel like I don't have enough energy to chew my food sometimes."

Ans: A, B, E Feedback: Now recognized as an autoimmune disease, myasthenia gravis is caused by an antibody-mediated destruction of acetylcholine receptors in the neuromuscular junction. This results in both muscle weakness and fatigability with sustained effort. Most commonly affected are the eye and periorbital muscles, with ptosis (drooping of eyelids) or diplopia (double vision) due to weakness of the extraocular muscles as an initial symptom. The disease may progress from ocular muscle weakness to generalized weakness. Chewing and swallowing may be difficult. In most persons, symptoms are least evident when arising in the morning, but grow worse with effort and as the day proceeds. Multiple sclerosis clients have paresthesias exhibited as numbness, tingling, burning sensations, or pressure on the face or involved extremities. The Lhermitte sign is an electric shock-like tingling down the back and onto the legs that is produced by flexion of the neck.

11. When lecturing about heart attacks (myocardial infarctions), the instructor will emphasize the client may present with: Select all that apply. A) Substernal chest pain B) Neck pain C) Umbilicus pain D) Deep, right-sided abdominal pain E) Pain that radiates to the left arm

Ans: A, B, E Feedback: Referred pain is perceived at a site different from the location of its point of origin but innervated by the same spinal segment. The sites of referred pain are determined embryologically with the development of visceral and somatic structures that share the same site for entry of sensory information into the central nervous system (CNS) and then move to more distant locations. Pain that originates in the abdominal or thoracic viscera is diffuse and poorly localized and is often perceived at a site far removed from the affected area. For example, the pain associated with myocardial infarction commonly is referred to the left arm, neck, and chest, which may delay diagnosis and treatment of a potentially life-threatening condition.

11. 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) Lack of any physical pain C) Flaccid paralysis of limbs D) BP 90/62 E) Pale, cool, dry skin

Ans: A, C, D Feedback: 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.

5. While explaining the somatosensory cortex to a group of nursing students, the instructor asks, "What is involved in the final processing of somatosensory information?" The correct response includes: Select all that apply. A) Full localization B) Autonomic nervous system C) Discrimination of intensity D) Interpretation of somatosensory stimuli E) Pacinian corpuscle receptors

Ans: A, C, D Feedback: The full localization, discrimination of the intensity, and interpretation of the meaning of the stimuli require processing by the somatosensory cortex. The anterolateral pathway gives off numerous branches that travel to the reticular formation of the brain stem; the branches provide the basis for increased wakefulness or awareness after strong somatosensory stimulation and for the generalized startle reaction that occurs with sudden and intense stimuli. They also stimulate the autonomic nervous system. Ruffini end organs are found in the skin and deeper structures and detect tissue vibration, heavy and continuous touch, and pressure. Stretch-sensitive receptors in the skin (i.e., Ruffini endings, Pacinian corpuscles, and Merkel cells) also signal postural information.

23. The health care provider for a client with degenerative Alzheimer-type dementia recognizes the client has moved from the initial stage to the moderate stage based on which of the following clinical manifestations? Select all that apply. A) Extreme confusion and disorientation B) Incontinence of urine and bowel C) Need for direct supervision for ADLs D) Social withdrawal from all family and friends E) Inability to problem solve simple tasks

Ans: A, C, E Feedback: Although different staging schemas exist, three broad stages of Alzheimer dementia have been identified, each of which is characterized by progressive degenerative changes. The early stage is characterized by short-term memory loss, lack of spontaneity, and social withdrawal. The moderate stage of dementia is marked by extreme confusion, disorientation, and personal hygiene (ADLs) is neglected. During this stage, there are also changes in higher cortical functioning needed for language, spatial relationships, and problem solving. In severe Alzheimer disease, in the terminal stage, the person typically becomes incontinent.

4. A traumatic brain injury client has developed extreme cerebral edema. The nurse is monitoring the client closely for signs of brain herniation. Which clinical manifestations would correlate to upward herniation of the midbrain from the infratentorial compartment? Select all that apply. A) Deep coma B) Rhythmic movement of arms and legs C) Respiratory rate of 8 with intermittent sighs D) Intracranial bleeding from nose and ears E) Bilateral small, fixed pupils

Ans: A, C, E Feedback: Infratentorial herniation results from increased pressure in the infratentorial compartment. Herniation may occur superiorly (upward) through the tentorial incisura or inferiorly (downward) through the foramen magnum. The most prominent signs of upward herniation include immediate onset of deep coma; small equal, fixed pupils; and abnormal respirations (slow rate with intermittent sighs or ataxia) and other vital signs. Downward displacement of the midbrain through the tentorial notch or of the cerebellar tonsils through the foramen magnum can interfere with medullary functioning and cause cardiac or respiratory arrest. Tissue infarction and intracranial bleeding are causes of cerebral edema, rather than an outcome of herniation. Rhythmic movement of arms and legs could be caused by many things and is not specific to infratentorial herniation.

10. A client works as a data entry worker for a large company. The client goes to employee health with pain in the wrist/hand. The nurse suspects that it is carpal tunnel syndrome based on which of the following assessment findings? Select all that apply. A) Describes numbness/tingling in the thumb and first digit B) States his forearm feels funny (paresthesia) C) Loss of tendon reflexes on the affected extremity D) Precision grip weakness in the affected hand E) Pain interferes with sleeping

Ans: A, D, E Feedback: Carpal tunnel syndrome is a mononeuropathy with compression of the median nerve as it travels with the flexor tendons through a canal made by the carpal bones and transverse carpal ligament. The condition can be caused by a variety of conditions that produce a reduction in the capacity of the carpal tunnel or an increase in the volume of the tunnel contents. Carpal tunnel syndrome is characterized by hand and wrist pain, hand or finger paresthesia, and numbness of the thumb and first two and one half digits of the hand; atrophy of abductor pollicis muscle; pain interferes with sleep; and weakness in precision grip. Guillain-Barré syndrome is characterized by rapidly progressive limb weakness and loss of tendon reflexes.

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

Ans: A, D, E Feedback: Psychological manifestations, such as mood swings, may represent an emotional reaction to the nature of the disease or, more likely, involvement of the white matter of the cerebral cortex. Depression, euphoria, inattentiveness, apathy, forgetfulness, and loss of memory may occur. Hallucinations and delirium are not usually associated as a manifestation of MS.

3. While playing outside in the snow, a young child complained of painful fingertips since he would not keep his gloves on. In the emergency department, the nurse knows this painful sensation is a result of which transmission of proprioceptive somatosensory information? A) Reflexive networks B) Type C dorsal root ganglion neurons C) Anterolateral pathway D) Myelinated type B trigeminal sensory neurons

Ans: B Feedback: All somatosensory information from the limbs and trunk shares a common class of sensory neurons called dorsal root ganglion neurons. The unmyelinated type C fibers have the smallest diameter and the slowest rate of conduction. They convey warm-hot sensation and mechanical and chemical as well as heat- and cold-induced pain sensation. Somatosensory information from the face and cranial structures, however, is transmitted by trigeminal sensory neurons, which function in the same manner as the dorsal root ganglion neurons. The second-order neurons communicate with various reflex networks and sensory pathways in the spinal cord and contain the ascending pathways that travel to the thalamus. In contrast to the dorsal column-medial lemniscal pathway, the anterolateral pathway transmits sensory signals such as pain, thermal sensations, crude touch, and pressure that do not require highly discrete localization of the signal source or fine discrimination of intensity.

23. The nurse is caring for a spinal cord injury client. Assessment reveals shallow breath sounds with a very weak cough effort. The nurse correlates this with which level of injury on the spinal column? A) C2 B) C5 C) T1 D) T10

Ans: B Feedback: Although a C3-to-C5 injury allows partial or full diaphragmatic function, ventilation is diminished because of the loss of intercostal muscle function, resulting in shallow breaths and a weak cough. Cord injuries involving C1 to C3 result in a lack of respiratory effort, and affected clients require assisted ventilation. The intercostal muscles, which function in elevating the rib cage and are needed for coughing and deep breathing, are innervated by spinal segments T1 through T7. The major muscles of expiration are the abdominal muscles, which receive their innervation from levels T6 to T12.

4. An elderly client has been brought to his primary care provider by his wife, who is concerned about his recent decrease in coordination. Upon assessment, his primary care provider notes that the client's gait is wide-based, unsteady, and lacking in fluidity, although his muscle tone appears normal. This client requires further assessment for which of the following health problems? A) Muscle atrophy B) Cerebellar disorders C) Impaired spinal reflexes D) Lower motor neuron lesions

Ans: B Feedback: An ataxic gait is characteristic of cerebellar and/or vestibular disorders. An LMN lesion typically results in decreased muscle tone. Impaired spinal reflexes would not normally manifest as ataxia, and muscle atrophy would cause weakness and decreased muscle tone.

10. While lecturing to a group of physiology students, the instructor asks, "What metabolic factors cause vasodilation of cerebral vessels thereby increasing cerebral blood flow to the brain?" The student with the best response would be: A) Increased oxygen saturation B) Increased carbon dioxide level C) Decreased serum sodium level D) Decreased hydrogen ion concentration

Ans: B Feedback: At least three metabolic factors affect cerebral blood flow: carbon dioxide, hydrogen ion, and oxygen concentration. Increased carbon dioxide provides a potent stimulus for vasodilation—a doubling of the PCO2 in the blood results in a doubling of cerebral blood flow. Increased hydrogen ion concentrations also increase cerebral blood flow, serving to wash away the neurally depressive acidic materials. Decreased oxygen concentration also increases cerebral blood flow. Low sodium is a hypoosmolar intravascular environment that will pull sodium out of the cells—a response unrelated to blood cell volume or flow.

17. Which of the following clients may be experiencing the effects of neuropathic pain? A) A girl whose playground accident resulted in an arm fracture B) A man with pain secondary to his poorly controlled diabetes C) An elderly woman with a stage III pressure ulcer D) A man whose pain is caused by gastric cancer

Ans: B Feedback: Conditions that can lead to pain by causing damage to peripheral nerves in a wide area include diabetes mellitus, alcohol use, hypothyroidism, rash, and trauma. Fractures, wounds, and cancer pain do not typically have an etiology that is rooted in the neurologic system.

2. A woman has cut her finger while dicing onions in the kitchen, causing her to drop her knife in pain. Which of the following components of this pain signal was transmitted by a third-order neuron? The neurons: A) Between the woman's finger and her spinal cord B) Between the thalamus and the cortex C) Between the CNS and the thalamus D) Of the efferent pathway that causes muscle contraction

Ans: B Feedback: First-order neurons transmit sensory information from the periphery to the CNS. Second-order neurons communicate with various reflex networks and sensory pathways in the spinal cord and travel directly to the thalamus. Third-order neurons relay information from the thalamus to the cerebral cortex. This typology does not apply to motor neurons.

5. A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which of the following treatment measures is most likely to resolve this health problem? A) Aggressive diuresis B) Placement of a shunt C) Administration of hypertonic intravenous solution D) Lumbar puncture

Ans: B Feedback: Hydrocephalus represents a progressive enlargement of the ventricular system due to an abnormal increase in cerebrospinal fluid (CSF) volume. This increase in CSF volume can be resolved by the placement of a shunt to drain the offending fluid volume. Diuresis, hypertonic solution administration, and lumbar puncture are not usual treatment modalities.

21. In contrast to the sympathetic nervous system, the functions of the parasympathetic nervous system include: A) Sweating B) Anabolism C) Pupil dilation D) Vasoconstriction

Ans: B Feedback: In contrast to the sympathetic nervous system, the functions of the parasympathetic nervous system are concerned with conservation of energy, resource replenishment and storage (i.e., anabolism), and maintenance of organ function during periods of minimal activity. The parasympathetic nervous system contracts the pupil, protecting the retina from excessive light during periods when visual function is not vital to survival. Sweating and regulation of arteriolar blood vessel diameter are controlled by a single division of the autonomic nervous system (ANS), in this case the sympathetic nervous system.

17. The perception of "where" a stimulus is in space and in relation to body parts is a function of the: A) Occipital lobe B) Parietal lobe C) Hypothalamus D) Prefrontal cortex

Ans: B Feedback: In the parietal lobe, just behind the primary sensory cortex is the somatosensory association cortex (areas 5 and 7), which is connected with the thalamic nuclei, and with the primary sensory cortex is the region 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. Maintenance of blood gas concentration, water balance, food consumption, and major aspects of endocrine and autonomic nervous system control requires hypothalamic function. The prefrontal cortex is involved in anticipation and prediction of consequences of behavior. Integrity of the association cortex of the occipital lobe is required for gnostic visual function, by which the meaningfulness of visual experience occurs.

17. Common manifestations of acute meningococcal meningitis, a highly contagious and lethal form of meningitis, include: A) Diplopia B) Petechiae C) Papilledema D) Focal paralysis

Ans: B Feedback: Meningococcal meningitis causes a petechial rash with palpable purpura in most people. The most common manifestations of acute bacterial meningitis are fever and chills; headache; stiff neck (nuchal rigidity) and back; abdominal and extremity pains; and nausea and vomiting. Other signs include seizures, cranial nerve damage (especially the eighth nerve, with resulting deafness), and focal cerebral signs. General signs and symptoms of brain tumor include headache, papilledema, nausea, vomiting, mental changes, visual disturbances (e.g., diplopia), alterations in sensory and motor function, and seizures. Like meningitis, encephalitis is characterized by fever, headache, and nuchal rigidity, but more often clients also experience neurologic disturbances, such as focal paralysis, lethargy, disorientation, seizures, delirium, and coma.

5. 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) Store glycogen within the brain cavity B) Must rely on glucose from the blood to meet their energy needs C) Require many amino acids in order to produce enough energy to function properly D) Can cause the liver to convert triglycerides into energy if needed quickly

Ans: B Feedback: 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.

8. Nociceptors are sensory receptors that are activated by: A) Cortisol B) Noxious stimuli C) Pressure and touch D) Sudden movements

Ans: B Feedback: Nociceptors, or pain receptors, are sensory receptors that are activated by noxious insults to peripheral tissues and respond to several forms of painful stimulation, including mechanical, thermal, and chemical. Nociceptive stimuli are objectively defined as stimuli of such intensity that they cause or are close to causing tissue damage. Hormones do not activate nociceptors. Pressure, touch, and startle are not considered painful stimuli unless sufficiently extreme to elicit the reflexive withdrawal response.

24. Which of the following principles should underlie the pain control strategy in the care of a child with a diagnosis of cancer? A) Opioids should be avoided in order to prevent liver and kidney insult. B) Dosing and timing should aim for a steady serum level of the prescribed drug. C) Doses of analgesia should be given only when the client's pain becomes severe. D) Drugs from numerous classifications should be used to maximize pain control.

Ans: B Feedback: Pain control can be maximized and side effects minimized by timing the administration of analgesia so that a steady blood level is achieved and, as much as possible, pain is prevented. Opioids can be safely used in children, and analgesia should not be withheld until pain is severe. Using drugs from numerous classifications will not necessarily increase pain control.

6. 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) Will slow the decline in muscle strength and function B) Produces paralysis of the larynx muscles by blocking acetylcholine release C) Prevents the depolarizing effect of the neurotransmitters D) Inhibits the peripheral metabolism of dopamine

Ans: B Feedback: 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.

20. 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) Allows more bilirubin to cross the barrier producing brain damage." B) Allows alcohol, a very lipid-soluble molecule to rapidly enter the brain." C) Excludes water-based compounds from crossing the brain with the exception of alcohol." D) Interacts negatively with the potassium-sodium pump, allowing alcohol to freely flow into the capillaries of the brain."

Ans: B Feedback: 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.

11. The pathophysiologic effects of spina bifida are due to: A) Malformation of the brain and spinal column causing spinal fluid to pool at the base of the spine B) Failure of one or more neural arches to close within the vertebral column of the neural tube C) Cystic lesions growing into the dorsal root ganglia D) Hypertrophy of the primary vesicles, which eventually causes the excess fluid to bulge in weakened structures

Ans: B Feedback: The major morphogenic defects of the spinal cord and brain are due to the abnormal formation or closure of the neural tube and surrounding tissues, problems that often result in spina bifida. The health problem is not due to the malformation of the mesoderm, lesions in the dorsal root ganglia, or hypertrophy of the primary vesicles.

6. Stretch-sensitive receptors in the skin (Ruffini end organs, Pacinian corpuscles, and Merkel cells) help signal postural information and are processed through the: A) Third-order neurons B) Dorsal column-medial lemniscus pathway C) Anterolateral pathway D) Posterior column of the spinal cord

Ans: B Feedback: There are two submodalities of proprioception: the stationary or static component (limb position sense) and the dynamic aspects of position sense (kinesthesia). Both of these depend on constant transmission of information to the CNS regarding the degree of angulation of all joints and the rate of change in angulation. In addition, stretch-sensitive receptors in the skin (Ruffini end organs, pacinian corpuscles, and Merkel cells) also signal postural information. Signals from these receptors are processed through the dorsal column-medial lemniscus pathway. In addition, stretch-sensitive receptors in the skin (Ruffini end organs, pacinian corpuscles, and Merkel cells) also signal postural information. Third-order neurons forward information from the thalamus to the somatosensory cortex. The anterolateral pathway crosses within the first few segments of entering the spinal cord and consists of bilateral, multisynaptic, slow-conducting tracts that transmit information such as pain, thermal sensations, crude touch, and pressure. Lesions affecting the posterior column of the spinal cord impair position sense.

4. A client who has had a spinal injury now has sensory changes on the distal forearm and fourth and fifth fingers. The nurse can predict that this client has experienced an injury to the: Select all that apply. A) Cervical (C) 7 B) Cervical (C) 8 C) Thoracic (T) 1 dorsal root D) Thoracic (T) 2 dorsal root

Ans: B, C Feedback: Dermatome maps are helpful in interpreting the level and extent of sensory deficits that are the result of segmental nerve and spinal cord damage. For example, on the basis of the dermatomal map, we can predict that sensory changes limited to the distal forearm and fourth and fifth fingers are the result of injury to the cervical (C) 8 and thoracic (T) 1 dorsal roots.

18. A client with trigeminal neuralgia usually complains of excruciating pain. Which of the following activities may trigger an acute pain attack? Select all that may apply. A) Brushing the teeth with lukewarm water B) Working in the office that has an air duct located directly overhead C) One's significant other lightly stroking their face D) Applying lipstick E) Walking outside on a windy day

Ans: B, C, E Feedback: Trigeminal neuralgia is manifested by facial tics or spasms and characterized by paroxysmal attacks of stabbing pain that usually are limited to the unilateral sensory distribution of one or more branches of the trigeminal cranial nerve (CN V). Although intermittent, the pain often is excruciating and may be triggered by light touch, movement, drafts (like an air duct overhead), and eating. Brushing ones teeth and applying lipstick should not increase the pain.

12. A client with chronic low back pain presents to the clinic. In addition to a detailed pain assessment, which of the following questions would be appropriate to ask? Select all that apply. A) "Do you have trouble making water?" B) "Can you financially afford your medicine?" C) "What kind of stressors are you experiencing?" D) "Do you consider yourself a good driver?" E) "Are you having trouble sleeping?"

Ans: B, C, E Feedback: Unlike acute pain that serves as a warning system, persistent chronic pain usually serves no useful function. To the contrary, it imposes physiologic, psychological, interpersonal, and economic stresses and may exhaust a person's resources. It is often associated with loss of appetite, sleep disturbances, and depression, which commonly is relieved once the pain is removed. Trouble urinating (dysuria) is usually not associated with chronic pain syndrome (unless this is a preexisting condition like BPH). A person's ability to drive is not a priority question asked of a client with chronic pain.

10. Neurotrophic factors contribute to the maintenance of homeostasis by promoting the growth and survival of neurons. Which of the following clients may be experiencing an alteration in neurotrophin levels? Select all that apply. A) A 92-year-old who fell and fractured the hip getting out of a shower B) A 55-year-old who is exhibiting clinical manifestations of early-onset Alzheimer disease C) A 38-year-old recently diagnosed with multiple sclerosis following initial complaint of vision loss as he was driving to work D) A 44-year-old with a family history of Huntington disease who is exhibiting jerky, uncontrollable movements

Ans: B, D Feedback: Neurotrophic or nerve growth factors are required to maintain the long-term survival of the postsynaptic cell and are secreted by axon terminals independent of action potentials. Alterations in neurotrophin levels have been implicated in neurodegenerative disorders such as Alzheimer disease and Huntington disease, as well as psychiatric disorders such as depression and substance abuse.

16. An otherwise healthy client has been referred to a pain clinic because she claims to experience exquisite pain from the friction of her clothes on her torso. This client is likely to be diagnosed with which of the following health problems? A) Visceral pain B) Hypoalgesia C) Allodynia D) Primary hyperalgesia

Ans: C Feedback: Allodynia is pain that follows a nonnoxious stimulus to apparently normal skin. Visceral pain is a deep, nonspecific pain that results from disruption of organs or deep tissues. Hypoalgesia is an abnormal decrease in pain sensitivity, whereas primary hyperalgesia describes pain sensitivity that occurs directly in damaged tissues.

13. A client with a diagnosis of lung cancer has developed bone metastases resulting in severe and protracted pain. Which of the following assessment components should the nurse prioritize when assessing the client's pain? A) The appearance of grimacing, guarding, or wincing B) The presence of changes in vital signs that correspond to pain C) The client's subjective report of the character and severity of pain D) The results of a detailed neurologic assessment

Ans: C Feedback: Although objective signs of pain may or may not be evident, the priority component of any pain assessment is the client's self-report.

9. 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) Modulate the release from axon terminals B) Modulate the peripheral sympathetic nerves and can have both a transmitter and modulator function C) Change the effect that GABA has when it binds to the channel at the same time as the drug D) Play a necessary role in the long-term survival of presynaptic neurons

Ans: C Feedback: 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.

16. A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client? A) Ability to turn from side to side, thereby preventing skin breakdown B) Ability to empty bladder completely, thereby preventing autonomic dysreflexia C) Respiratory ventilation assessment and prevention of aspiration pneumonia D) Assessment of lower extremities to prevent deep vein thrombosis

Ans: C Feedback: Amyotrophic lateral sclerosis is a mixed upper motor neuron (UMN) and lower motor neuron (LMN) disorder. In the more advanced stages of ALS, muscles of the palate, pharynx, tongue, neck, and shoulders become involved, causing impairment of chewing, swallowing (dysphagia), and speech. Dysphagia with recurrent aspiration and weakness of the respiratory muscles produces the most significant acute complications of the disease. Airway/breathing is always the priority over bladder emptying; skin breakdown, and assessing for DVT.

19. Among the treatments for multiple sclerosis (MS), which medication will reduce the exacerbation of relapsing-remitting MS? A) Long-term corticosteroid administration B) Mitoxantrone, an antineoplastic agent C) Interferon-, a cytokine injection D) Baclofen, a muscle relaxer

Ans: C Feedback: Disease-modifying agents include interferon-b and glatiramer acetate. These agents have shown some benefit in reducing exacerbations in persons with relapsing-remitting MS. Interferon- is a cytokine that acts as an immune enhancer. Corticosteroids are the mainstay of treatment for acute attacks of MS. These agents are thought to reduce the inflammation, improve nerve conduction, and have important immunologic effects. Long-term administration does not, however, appear to alter the course of the disease and can have harmful side effects. Mitoxantrone, an anticancer drug, is recommended for persons with worsening forms of the disease. Baclofen is a muscle relaxer for helping with symptom relief.

18. A family brings a client to the emergency department with increasing lethargy and disorientation. They think the client had a seizure on the drive over to the hospital. The client has been sick with a "cold virus" for the last few days. On admission, the clients' temperature is 102°F. Which other clinical manifestations may lead to the diagnosis of encephalitis? A) Petechia over entire body B) BP 100/72 C) Impaired neck flexion resulting from muscle spasm D) Appearance of red-purple discolorations on the skin that do not blanch on applying pressure

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

23. A 44-year-old woman has sought care for the treatment of headaches that have been increasing in severity and frequency and has been subsequently diagnosed with migraines. Which of the following teaching points should her care provider emphasize? A) "Weight loss and exercise are very important components of your treatment." B) "Stopping all of your current medications, even temporarily, should provide some relief." C) "It would be helpful for you to take control of your diet, sleep schedule, and stress levels." D) "Your headaches are likely a result of a nerve disorder and, unfortunately, cannot be treated successfully."

Ans: C Feedback: Migraines may be precipitated by certain foods as well as stress and lack of sleep. Obesity and sedentary lifestyle are not thought to be risk factors. Migraines are not believed to result from a nerve disorder, and treatment is often difficult, but positive. It would be inappropriate and ineffective to recommend the cessation of all the client's drugs.

20. 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) Chemotherapy B) Immunotherapy C) Gamma knife radiation D) Stem cell transplant

Ans: C Feedback: 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.

8. A client with a diagnosis of myasthenia gravis has required a mastectomy for the treatment of breast cancer. The surgery has been deemed a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which of the following measures should the care team prioritize in this client's immediate care? A) Positioning the client to minimize hypertonia and muscle rigidity B) Seizure precautions with padded side rails and bed in lowest height C) Respiratory support and protection of the client's airway D) Monitoring the client for painful dyskinesias

Ans: C Feedback: Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation to the extent that ventilatory support and airway protection are needed. Seizures, dyskinesias, hypertonia, and muscle rigidity are not associated with myasthenia gravis in general or myasthenic crisis in particular.

11. An elderly male client has been brought to the emergency department after experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care team's emphasis on restoring circulation? A) Failure to restore blood flow creates a severe risk for future transient ischemic attacks. B) Necrosis will continue unabated throughout the brain unless blood flow is restored. C) Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored. D) Unless blood flow is restored, the client faces the risk of progressing to hemorrhagic stroke.

Ans: C Feedback: Prompt return of circulation increases the chance that the cells of the penumbra will continue to survive. Cell death does not spread to areas that are not normally supplied by the affected vessel, and future risk of transient ischemic attacks (TIAs) is not an immediate priority. Ischemic stroke does not progress to hemorrhagic stroke because the two types have distinct etiologies.

24. 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) Enkephalin B) Norepinephrine C) Dopamine D) Acetylcholine

Ans: C Feedback: 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.

21. The client has a traumatic complete spinal cord transection at the C5 level. Based on this injury, the health care worker can expect the client to have control of which body function/part? A) Bladder B) Finger flexion C) Diaphragm D) Trunk muscle

Ans: C Feedback: The functional levels of cervical injury are related to C5, C6, C7, or C8 innervation. All motor and sensory function is absent below the level of cord transection. At the C5 level, deltoid and biceps function is spared, allowing full head, neck, and diaphragm control with good shoulder strength and full elbow flexion. At the C8 level, finger flexion is added. Thoracic cord injuries (T1 to T12) allow full upper extremity control with limited to full control of intercostal and trunk muscles and balance. Sacral (S1 to S5) innervation allows for full leg, foot, and ankle control and innervation of perineal musculature for bowel, bladder, and sexual function.

3. A 60-year-old woman has been recently diagnosed with multiple sclerosis, a disease in which the oligodendrocytes of the client's central nervous system (CNS) are progressively destroyed. Which physiologic process within the neurologic system is most likely to be affected by this disease process? A) Oxygen metabolism B) Neurotransmitter synthesis C) Nerve conduction D) Production of cerebrospinal fluid

Ans: C Feedback: The oligodendrocytes form the myelin in the central nervous system (CNS). As with peripheral myelinated fibers, the covering of axons in the CNS increases the velocity of nerve conduction. Oxygen metabolism and synthesis of CSF and neurotransmitters are not directly affected.

18. When providing discharge teaching related to some newly prescribed medications, the client who received a head injury on the left temporal lobe area will need for the health care provider to: A) Print materials using extra large font sizes, so the client will be able to see the instructions B) Bring one of the pills into the room during teaching, so the client can recognize the color and shape C) Sit on the right side and speak slowly and clearly during the education D) Draw the shades on the window to minimize glare from bright lights

Ans: C Feedback: The temporal lobe lies below the lateral sulcus and merges with the parietal and occipital lobes. The primary auditory cortex is important in discrimination of sounds entering opposite ears. The auditory association area (area 22) functions in the recognition of certain sound patterns and their meaning. Therefore, the injury is on the left side, so the health care provider should sit on the right side so they can speak directly into the right ear. The occipital lobe contains the primary visual cortex (area 17), stimulation of which causes the experience of bright lights called phosphenes in the visual field.

13. A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis? A) Status epilepticus B) Subarachnoid hemorrhage C) Ischemic stroke D) Encephalitis

Ans: C Feedback: Thrombolytic therapy for the acute treatment of ischemic stroke consists of the intravenous administration of tPA. This drug would exacerbate a subarachnoid hemorrhage by inhibiting the clotting mechanism, and it is not relevant to the care of clients with encephalitis of status epilepticus.

19. Which of the following individuals has the highest chance of having a medulloblastoma? A) An 88-year-old man who has begun displaying signs and symptoms of increased ICP B) A 60-year-old woman who is soon to begin radiation therapy for the treatment of breast cancer C) A 4-year-old child who has become uncoordinated in recent months D) A 68-year-old man who is a smoker and has a family history of cancer

Ans: C Feedback: Tumors of neuronal origin (e.g., medulloblastoma) usually occur during infancy and childhood. This is due to the fact that a cell must be capable of replication to undergo neoplastic transformation.

25. A client with a long history of cigarette smoking and poorly controlled hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The client's psychomotor deficits are likely the result of: A) Alzheimer disease B) Frontotemporal dementia (FTD) C) Vascular dementia D) Wernicke-Korsakoff syndrome

Ans: C Feedback: Vascular dementia is caused by brain injury resulting from ischemic or hemorrhagic damage. Smoking and hypertension are contributing factors, and slowness in psychomotor functioning is a main clinical feature of vascular dementia. The client's history and symptomatology are not characteristic of Alzheimer disease, FTD, or Wernicke-Korsakoff syndrome.

15. 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 I B) Cranial nerve III C) Cranial nerve VI D) Cranial nerve VII E) Cranial nerve VIII

Ans: C, D, E Feedback: 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.

22. While talking about their migraine headaches, two women have found that they have some common triggers for their migraines, which may include: Select all that apply. A) Nonpharmacologic treatments like yoga B) Piercings of their nose and cheeks C) At the time of their menstrual cycle D) When drinking white wine E) Consuming chocolate

Ans: C, E Feedback: Although the pathophysiology of migraines is not well understood, it is thought that hormone levels, particularly estrogen levels, may underlie their increased prevalence in women. Fluctuations in hormone levels, particularly in estrogen levels, are thought to play a role in the pattern of migraine attacks. For many women, migraine headaches coincide with their menstrual periods. The greater predominance of migraine headaches in women is thought to be related to the aggravating effect of estrogen on the migraine mechanism. Dietary substances, such as monosodium glutamate, aged cheese, and chocolate, also may precipitate migraine headaches. Yoga, piercings, and drinking white wine are not known to be triggers for migraines.

10. Opioid receptors are highly concentrated in which region of the CNS and produce pain relief through the release of endogenous opioids? A) The enkephalins B) Primary afferent neurons C) Thalamus D) Periaqueductal gray (PAG) region

Ans: D Feedback: A major advance in understanding pain was the discovery of neuroanatomic pathways that arise in the midbrain and brain stem, descend to the spinal cord, and modulate ascending pain impulses. One such pathway begins in an area of the midbrain called the periaqueductal gray (PAG) region. Opioid receptors are highly concentrated in this region of the CNS and produce analgesia (pain relief) through the release of endogenous opioids. Three families of opioid peptides have been identified—the enkephalins, endorphins, and dynorphins. Although they appear to function as neurotransmitters, their full significance in pain control and other physiologic functions is not completely understood. There is evidence that opioid receptors and endogenously synthesized opioid peptides are found on the peripheral processes of primary afferent neurons and in many regions of the CNS.

13. Which of the following processes is most likely to occur as a result of a spinal reflex? A) Peristalsis of the small and large bowel B) Control of oculomotor function in changing light levels C) Pain sensation from a potentially damaging knee movement D) Withdrawal of a hand from a hot stove element

Ans: D Feedback: A reflex is a highly predictable relationship between a stimulus and an elicited motor response. The withdrawal reflex is stimulated by a painful (nociceptive) stimulus and quickly moves the body part away from the offending stimulus, usually by flexing a limb part. Peristalsis, oculomotor function, and pain are not mediated by spinal reflexes.

15. A hospital client has been reluctant to accept morphine sulfate despite visible signs of pain. Upon questioning, the client reveals that he is afraid of becoming addicted to the drug. How can a member of the care team best respond to the client's concern? A) "You might become addicted, but there are excellent resources available in the hospital to deal with that development." B) "You should likely prioritize the control of your pain over any fears of addiction that you have." C) "If you start needing higher doses to control your pain, then we'll address those concerns." D) "There's only a minute chance that you will become addicted to these painkillers."

Ans: D Feedback: Although long-term treatment with opioids can result in opioid tolerance (i.e., increasingly greater drug dosages being needed to achieve the same effect) and physical dependence, this should not be confused with addiction. Long-term drug-seeking behavior is rare in persons who are treated with opioids only during the time that they require pain relief.

21. Which of the following characteristics differentiates a migraine with aura from a migraine without aura? A) Gastrointestinal involvement in the hours leading up to the headache B) A decrease in mood and affect prior to the headache C) Lack of response to nonpharmacologic treatments D) Visual symptoms that precede the headache

Ans: D Feedback: An aura is visual (flickering lights, spots, or loss of vision), sensory (feeling of pins and needles, or numbness), and/or speech disturbance that precedes a migraine. Nonpharmacologic treatments may be used with varying success in both types of migraine, and nausea and vomiting may precede or accompany each. Changes in mood and affect are not central to an aura.

24. A recently injured (3 months ago) client with a spinal cord injury at T4 to T5 is experiencing a complication. He looks extremely ill. The nurse recognizes this as autonomic dysreflexia (autonomic hyperreflexia). His BP is 210/108; skin very pale; gooseflesh noted on arms. The priority nursing intervention would be to: A) Check the mouth/throat for pustules and redness B) Check the jugular vein for distention C) Assess calves of legs for redness, warmth, or edema D) Scan his bladder to make sure it is empty

Ans: D Feedback: Autonomic hyperreflexia, an acute episode of exaggerated sympathetic reflex responses that occur in persons with injuries at T6 and above, in which central nervous system (CNS) control of spinal reflexes is lost, does not occur until spinal shock has resolved and autonomic reflexes return. Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild to severe, skin pallor, and gooseflesh associated with the piloerector response. In many cases, the dysreflexic response results from a full bladder. There is no indication the client has right-sided heart failure (jugular vein distention); has a DVT (calf redness, warmth, or edema); or has strep throat (pustules and red throat/tonsils).

8. Since catecholamines can be degraded by enzymes, the medication category usually prescribed to treat a Parkinson disease client, thereby controlling this interaction, is: A) Dopamine B) -Adrenergic blocker C) Epinephrine D) Monoamine oxidase (MAO) inhibitor

Ans: D Feedback: 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.

19. Complex regional pain syndrome is characterized by: A) Repetitious dermatome pain attacks B) Trigeminal neuralgia with facial tics C) Severe limb pain after amputation D) Disproportionate pain with mobility

Ans: D Feedback: Complex regional pain syndrome is a rare disorder of the extremities characterized by autonomic and vasomotor instability. Most persons with the disorder have had an identifiable inciting or irritating injury, which may be trivial, such as a minor joint sprain, or severe, such as trauma involving a major nerve or nerves. The IASP lists the diagnostic criteria of CRPS I as the presence of an initiating traumatic event, continuing pain, allodynia (perception of pain from a nonpainful stimulus), or hyperalgesia disproportionate to the inciting event with evidence at some time of edema, changes in skin blood flow, or abnormal sensorimotor activity in the area of pain. The hallmark is pain and mobility problems more severe than the injury warrants. Neuralgia is characterized by severe, brief, often repetitiously occurring attacks of lightning-like pain that occurs along the distribution of a spinal or cranial nerve. Trigeminal neuralgia is manifested by facial tics or grimaces. Phantom limb pain, a neurologic pain, can occur after amputation of a limb or part of a limb.

9. Following a head injury on the football field, the medical team is assessing the player for injury. One of the earliest signs of decreased level of consciousness to assess for would be: A) Stupor B) Lethargy C) Delirium D) Inattention

Ans: D Feedback: Consciousness is a state of awareness of self and environment. Any deficit in level of consciousness, from mild confusion to stupor or coma, indicates injury to either the RAS or to both cerebral hemispheres concurrently. A fully conscious person is totally aware of her or his surroundings. The earliest signs of diminution in level of consciousness are inattention, mild confusion, disorientation, and blunted responsiveness. With further deterioration, an individual under delirium becomes markedly inattentive and variably lethargic or agitated. Persons who cannot be fully aroused are obtunded, and those who remain in a sleep-like state are stuporous.

12. A client who experienced a traumatic head injury from a severe blow to the back of his head now lives with numerous function deficits, including an inability to maintain steady posture while he is in a standing position, although he is steadier when walking. Which of the following disorders most likely resulted from his injury? A) Cerebellar dystaxia B) Cerebellar tremor C) A lower motor neuron lesion D) A vestibulocerebellar disorder

Ans: D Feedback: Damage to the part of the cerebellum associated with the vestibular system leads to difficulty in maintaining or to inability to maintain a steady posture of the trunk, which normally requires constant readjusting movements. Tremors are repetitive movements, while dystaxia is a characterized by uneven movement. An LMN lesion typically manifests as hypotonia.

6. What happens during the depolarization phase of nerve cells? A) It is an undisturbed period of the action potential during which the nerve is not transmitting impulses. B) The cell membrane decreases its permeability to sodium. C) The neurons are stimulated to fire. D) A rapid change in polarity to one that is positive on the inside and the membrane becomes open to sodium.

Ans: D Feedback: Depolarization is characterized by a rapid change in polarity of the resting membrane potential, which was negative on the inside and positive on the outside, to one that is positive on the inside and negative on the outside. During the depolarization phase, the membrane suddenly becomes permeable to sodium ions. The rapid inflow of sodium ions produces local electric currents that travel through the adjacent cell membrane, causing the sodium channels in this part of the membrane to open. The resting membrane potential is the undisturbed period of the action potential during which the nerve is not transmitting impulses. A threshold potential represents the membrane potential at which neurons or other excitable tissues are stimulated to fire.

14. A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is: A) Characterized by an inability to comprehend the speech of others or to comprehend written material B) Nearly normal speech except for difficulty with finding singular words C) Manifested as impaired repetition and speech riddled with letter substitutions, despite good comprehension and fluency D) Characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing

Ans: D Feedback: Expressive or nonfluent aphasia is characterized by an inability to easily communicate spontaneously or translate thoughts or ideas into meaningful speech or writing. Conduction aphasia is manifest as impaired repetition and speech riddled with letter substitutions, despite good comprehension and fluency. Anomic aphasia is speech that is nearly normal except for difficulty with finding singular words. Wernicke aphasia is characterized by an inability to comprehend the speech of others or to comprehend written material.

21. 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) Tonic-clonic seizure B) Atonic seizure C) Myoclonic seizure D) Focal seizure with impairment to consciousness

Ans: D Feedback: 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.

16. Which of the following pathophysiologic processes occurs in cases of bacterial meningitis? A) Infection in the cerebrospinal fluid causes vasoconstriction and cerebral hypoxia. B) Trauma introduces skin-borne pathogens to the cerebrospinal fluid. C) Infection in the cerebrospinal fluid causes spinal cord compression and neurologic deficits. D) Inflammation allows pathogens to cross into the cerebrospinal fluid.

Ans: D Feedback: In the pathophysiologic process of bacterial meningitis, the bacterial organisms replicate and undergo lysis in the CSF, releasing endotoxins or cell wall fragments. These substances initiate the release of inflammatory mediators, which set off a complex sequence of events permitting pathogens, neutrophils, and albumin to move across the capillary wall into the CSF. Cerebral hypoxia does not result directly from meningitis, and the causative pathogens are not introduced from the skin nor is trauma an initiating event. Spinal cord compression is not an expected consequence of meningitis.

2. The intracranial volume that is most capable of compensating for increasing intracranial pressure is the: A) Brain cell tissue B) Intravascular blood C) Surface sulci fluid D) Cerebrospinal fluid

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

25. Pain assessment is likely to be most challenging when providing care for which of the following older adult clients? A) A 90-year-old client who takes multiple medications for cardiac and respiratory conditions B) A 77-year-old man who has sustained burns on the lower part of his body C) An 82-year-old woman who has been diagnosed with diabetes and an anxiety disorder D) An 87-year-old man with vascular dementia and other health problems like heart failure

Ans: D Feedback: Pain in the elderly has been associated with impaired appetite, increased sleep disturbances, and in some cases a decrease in cognitive functions. Anxiety, polypharmacy, and the presence of acute pain are factors that may also influence the assessment process, but these are more likely to have a bearing on pain treatment and management than on pain assessment.

5. Knowing that she is a carrier for Duchene muscular dystrophy (DMD), a pregnant woman arranged for prenatal genetic testing, during which her child was diagnosed with DMD. As her son develops, the woman should watch for which of the following early signs that the disease is progressing? A) Impaired sensory perception and frequent wounds B) Spasticity and hypertonic reflexes C) Muscle atrophy with decreased coordination D) Frequent falls and increased muscle size

Ans: D Feedback: Pseudohypertrophy, falls, and muscle weakness are characteristic signs during the early course of DMD. Spasticity and muscle atrophy do not occur and sensory function is not affected.

25. While teaching a class of nursing students about spinal cord injury, the instructor mentions that male SCI clients will be able to have a sexual response if their injury is at which level on the spinal column? A) T12 B) S1 C) L2 D) S4

Ans: D Feedback: Sexual function, like bladder and bowel control, is mediated by the S2 to S4 segments of the spinal cord. The S2 to S4 cord segments have been identified as the sexual touch reflex center. The T11 to L2 cord segments have been identified as the mental-stimulus, or psychogenic, sexual response area, where autonomic nerve pathways in communication with the forebrain leave the cord and innervate the genitalia. In T10 or higher injuries, reflex sexual response to genital touch may occur freely. However, a sexual response to mental stimuli (T11 to L2) does not occur because of the spinal lesion blocking the communication pathway. In an injury at T12 or below, the sexual reflex center may be damaged, and there may be no response to touch.

3. A late indicator of increased intracranial pressure is: A) Tachycardia B) Right-sided heart failure C) Narrow pulse pressure D) High mean arterial pressure

Ans: D Feedback: The cerebral perfusion pressure (CPP), which represents the difference between the mean arterial blood pressure (MABP) and the ICP (CPP

16. A client with a diagnosis of epilepsy has required surgical removal of part of her prefrontal cortex. Which of the following effects should her family and care team anticipate? A) Lapses in balance and coordination B) Deficits in regulation of the endocrine system C) Sensory losses D) Changes in behavior and judgment

Ans: D Feedback: The prefrontal cortex is thought to be involved in anticipation and prediction of consequences of behavior. It does not contribute directly to balance, sensation, or endocrine function.

12. A family brings their elderly mom to the emergency department. The client had a short period of time where she was confused, had slurred speech and appeared to have a weak arm. Now she is back to her normal self. Suspecting a transient ischemic attacks (TIAs), the health care provider will order diagnostic testing looking for: A) Aneurysm leakage B) Cause of minor residual deficits C) Diffuse cerebral electrical malfunctions D) Atherosclerotic lesions in cerebral vessels

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

22. 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) ECG for arrhythmias B) Urine output and continence C) Ability to grasp hands and squeeze on command D) Respiratory status and oxygen saturation

Ans: D Feedback: 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.

1. 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) Impaired blood-brain barrier that allows water/proteins to leave vessels and go into the interstitial space B) Mainly allows edema to form in the white mater of the brain C) May cause herniation by displacing a cerebral hemisphere D) Causes ischemia to build up lactic acid due to anaerobic metabolism E) Allows cells to increase volume to the point of rupture, damaging neighboring cells

Ans: D, E Feedback: 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.