Pathophysiology Unit 5 Prep U Chs 13, 14, 15, 16
The thalamus is located in which part of the brain?
Diencephalon The dorsal horn of the diencephalon consists of the thalamus and the subthalamus.
The most common cause of ischemic stroke is:
thrombosis Ischemic stroke includes those caused by large artery thrombosis (20%), small artery thrombosis (25%), cardiogenic embolism (20%) and cryptogenic (undetermined cause)(30%), making thrombosis the most common cause (45%).
The nurse knows that chronic pain lacks which of the characteristic pain-related reactions?
Increased heart rate Characteristics of chronic pain do not include autonomic responses like increased heart and respiratory rate. Loss of appetite, disturbed sleep patterns, and depression are common among people dealing with chronic pain.
How will the nurse explain to a client the changes in blood flow during exercise?
"Heat dilates blood vessels and increases local blood flow to skeletal muscles." As the client exercises, blood vessels to skeletal muscles dilate to increase blood flow. Blood vessels to the organs constrict.
A client who has been exercising says to the nurse, "My skin is so hot!" What is the nurse's best response?
"Your body is trying to lower your temperature." After exercise, the body dilates blood vessels and shunts blood to the skin to help to decrease the temperature. Skin typically feels hot and sweaty. Evaporation of sweat from the skin surface contributes to loss of heat. As the heat is lost through the skin, the skin typically feels hot. The nurse should calm the client and explain that this is a normal response to exercise.
A client reports general malaise and has a temperature is 103.8°F (39.9°C). What is the rationale for administering a prescribed aspirin, an antipyretic, to this client?
Antipyretics protect vulnerable organs, such as the brain, from extreme temperature elevation. There is little research to support the belief that fever is harmful unless the temperature rises to extreme levels; it has been shown that small elevations in temperature, such as those that occur with fever, enhance immune function. Antipyretics are effective in lowering core body temperature. They alleviate discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature.
The parasympathetic nervous system is part of which system?
Autonomic nervous system
Which components of the nervous system make up the central nervous system?
Brain and spinal cord
The thick area of myelinated axons that connects the two sides of the cerebral cortex is known as which component?
Corpus callosum
Which substance provides the majority of the fuel needs of the neurologic system?
Glucose
A client arrives in the clinic after having a tongue piercing performed and is unable to control the movement of the tongue. The nurse is aware that which nerve may have been damaged from the piercing?
Hypoglossal
A client has been diagnosed with osteomyelitis and admitted to the hospital. The client's fever persists throughout most of the day but returns to normal at least twice a day. Which pattern of fever is this client displaying?
Intermittent Intermittent fever patterns are very changeable, but they do return to normal at least once every 24 hours. A remitting fever pattern temperature does not return to normal and varies a few degrees in either direction. In a sustained fever pattern, the temperature remains above normal with minimal variations. A relapsing fever is one in which there is one or more episodes of fever, each as long as several days, with 1 or more days of normal temperature between episodes.
Which neurotransmitter is responsible for the action taken by most sympathetic postganglionic neurons?
Norepinephrine
Potassium outflow from the cell is characteristic of which phase of the action potential?
Repolarization
Which types of cells are supporting cells of the peripheral nervous system?
Schwann cells
Which lobe of the brain performs functions of perception, long-term memory, and recognition of auditory stimuli?
Temporal lobe
A client diagnosed with early multiple sclerosis (MS) will likely demonstrate which manifestations? Select all that apply.
Visual clouding Fatigue Paresthesia Bladder dysfunction Visual disturbances, paresthesias, abnormal gait (ataxia), bladder and sexual dysfunction, vertigo, nystagmus, fatigue, and speech disturbances are early signs of MS. Anxiety and depression are often seen later as a result of the changes the disease causes.
The nurse is teaching a client about various methods of pain control. Which information will the nurse include when teaching the client about applying heat for pain control?
"Heat promotes more blood flow to the area to improve oxygen supply." Heat dilates blood vessels and increases local blood flow, which reduces the level of nociceptive stimulation by reducing local ischemia. Although it can help reduce swelling, this is not done through vasoconstriction. Prostaglandin release promotes the inflammatory response and the sensation of pain, so this would not be a desired effect and is not an effect of heat application. Heat has been thought to increase endogenous opioids, which can help reduce the experience of pain. Although heat can modulate pain, it does not block the brain's ability to interpret pain signals.
The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advice by the nurse is most appropriate?
"Many people find that maintaining regular eating and sleeping habits is beneficial." Nonpharmacologic treatment includes the avoidance of migraine triggers, such as foods, that precipitate an attack. Many persons with migraines benefit from maintaining regular eating and sleeping habits. The client may need to change her lifestyle, but not to the extent of moving and changing jobs. Migraines are avoidable, most of the time, if individuals adhere to their diets and watch the triggers. Medication is very useful for most clients.
A client awakes after being in a coma several days following a traumatic head injury. The client is able to give the family a detailed account of what was said at the bedside while the client was in a coma. The family asks the nurse, "How is this possible?" Which response is most accurate?
"The thalamus can interpret highly emotional auditory experiences and remember them." The thalamus is divided into distinct nuclei, which are the major relay stations for information going to and from the cerebral cortex. All sensory pathways have direct projections to thalamic nuclei, which conveys the information to restricted areas of the sensory cortex. Coordination and integration of peripheral sensory stimuli occur in the thalamus, along with some crude interpretation of highly emotional-laden auditory experiences that not only occur but can be remembered. For example, a person can recover from a deep coma in which cerebral cortex activity is minimal and remember some of what is said at the bedside.
A client has just begun to experience an ischemic stroke. The blood supply from the middle cerebral artery is being blocked by a large blood clot. How long before brain cells begin to die due to lack of ATP?
4 to 6 minutes
The nurse witnesses a client go into cardiac arrest. If the nurse delays intervention, when will the death of brain cells begin?
4-6 minutes Unconsciousness occurs almost simultaneously with cardiac arrest, and the death of brain cells begins within 4 to 6 minutes. Interruption of blood flow also leads to the accumulation of metabolic byproducts that are toxic to neural tissue.
Which client will the nurse be assessing in relation to problems with thermoregulation?
66-year-old client with damage to the hypothalamus secondary to a cerebral vascular accident. Core body and skin temperatures are sensed and integrated by thermoregulatory regions of the hypothalamus. Syphilis, a T8 fracture, and damage to the cerebellum would be unlikely to manifest by difficulties with thermoregulation.
Which symptom indicates the next stage of a fever after a prodrome?
A chill. The physiologic behaviors that occur during the development of fever can be divided into four successive stages: prodrome, chill, flush, and defervescence. The stages are successive.
What happens during the depolarization phase of nerve cells?
A rapid change in polarity to one that is positive on the inside, and the membrane becomes open to sodium ions. 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.
A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of:
An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve MS is an immune response against the components of the myelin sheath. There is a progressive demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and the optic nerve. The other options do not describe MS.
The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?
Assess for other signs/symptoms of increased intracranial pressure. The tumor may be causing increased intracranial pressure. Vomiting, with or without nausea, is a common symptom of increased intracranial pressure and/or brain stem compression. The nurse's first action is to assess for other signs/symptoms of increased intracranial pressure. Once the assessment is completed, the nurse should contact the physician if indicated by the findings.
A practitioner is preparing to do a lumbar puncture on a client with suspected meningitis. Which area on the spine does the practitioner choose to obtain a cerebrospinal fluid (CSF) sample?
Between L3 and L4
Select the function of the occipital lobe.
Color, motion, and depth perception The occipital lobe is associated with the ability to experience color, depth, and motion perception. The temporal lobe is responsible for behavior, and the parietal lobe helps us to determine objects through the sense of feel.
Which cardinal assessment finding would lead the nurse to suspect a client has developed Parkinson disease?
Bradykinesia The cardinal symptoms of Parkinson disease are tremor, rigidity (hypertonicity), and bradykinesia (slowness of movement). Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Because the basal ganglia also influence the autonomic nervous system, persons with Parkinson disease often have excessive and uncontrolled sweating, sebaceous gland secretion, and salivation. Paresthesia is characteristic of demyelinating disease such as multiple sclerosis, rather than Parkinson disease.
A client has sustained a severe, diffuse brain injury that resulted in seriously compromised brain function. The client is at greatest risk for:
Brain death Severe brain injury that results in seriously compromised brain function can result in brain death.
Which area of the brain is responsible for respiration?
Brain stem
Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made?
CT scan The diagnosis of subarachnoid hemorrhage and intracranial aneurysms is made by clinical presentation, CT scan, and angiography. An MRI is not necessary for the diagnosis of subarachnoid hemorrhage and intracranial aneurysm. Loss of cranial nerve reflexes is not diagnostic of subarachnoid hemorrhage and intracranial aneurysm, and neither is venography.
The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include?
CT scan The nurse should anticipate that the client will be ordered a CT scan to rule out hemorrhagic stroke that would preclude the administration of tissue plasminogen activator (tPA).
An older adult has had a recent decrease in coordination, with gait being described as wide-based, unsteady, and lacking in fluidity, although the client's muscle tone appears normal. This client requires further assessment for which condition that is involved with coordination of movement?
Cerebellar disorder 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.
Which type of seizure begins in a localized area of the brain but may progress rapidly to involve both hemispheres?
Complex partial Complex partial seizures begin in a localized area of the brain but may progress rapidly to involve both hemispheres. Tonic, myoclonic, and tonic-clonic seizures do not change in intensity after onset.
Which intracranial volume is most capable of compensating for increasing intracranial pressure?
Cerebrospinal fluid Initial increases in intracranial pressure (ICP) are largely buffered by a translocation of cerebrospinal fluid (CSF) to the spinal subarachnoid space and increased reabsorption of CSF. Of the intracranial volumes, the tissue volume is least capable of undergoing change. Surface sulcus fluid is negligible and not a factor in increased ICP. The compensatory ability of the intravascular blood compartment is also limited by the small amount of blood that is in the cerebral circulation. As the volume-buffering capacity of this compartment becomes exhausted, venous pressure increases and cerebral blood volume and ICP rise.
The client asks the health care provider, "What is the purpose of applying cold to a sprained ankle?" Which response by the health care provider is best?
Cold provides pain relief and suppresses the release of products from tissue damage. Cold prevents the release of products of tissue damage and provides pain relief (produces vasoconstriction at the site). Application of heat would cause blood vessels to dilate and more blood to be drawn to the local area.
A client has been diagnosed with amyotrophic lateral sclerosis, a disease resulting in the loss of efferent signals. Which aspect of neurologic function will be primarily affected by this client's condition?
Conduction of information away from central nervous system (CNS) Efferent conduction is away from the CNS, where afferent information travels toward the CNS. Efferent neurons are usually motor neurons that control actions of muscles and glands.
A client's recent diagnosis of Parkinson disease has prompted the care provider to promptly begin pharmacologic therapy. The drugs prescribed will likely influence the client's levels of which substance?
Dopamine 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.
A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain?
Dopamine nigrostriatal system The destruction of the dopamine nigrostriatal system upsets the balance of the basal ganglia, resulting in uncontrolled and uncoordinated movement. The cortex is involved in higher processing, serotonin is involved in the limbic system, and the cerebellum is unrelated to Parkinson disease; cerebellar disorders, however, will cause Parkinsonism.
What are the main neurotransmitters of the autonomic nervous system (ANS)? Select all that apply.
Epinephrine Acetylcholine Norepinephrine The main neurotransmitters of the ANS are acetylcholine and the catecholamines epinephrine and norepinephrine. Monoamine oxidase is found in the nerve endings to degrade catecholamines. Tyrosine is an amino acid that is a precursor to catecholamines.
An emergency room nurse receives a report that a client's Glasgow Coma Scale (GCS) is 3. The nurse prepares to care for a client with which of the following?
Flaccid motor response A score of 3 on the Glasgow Coma Scale indicates the lowest possible score in each of the three scoring categories (eye opening, motor response, and verbal response) and includes flaccid or no motor response, no verbal response and the inability to open the eyes.
A client has sustained damage to cranial nerve VIII. The nurse recognizes that the client may experience difficulty with:
Hearing Cranial nerve VIII (vestibulocochlear nerve) is associated with hearing. The other options involve different nerves.
A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which food?
Home-grown and canned vegetables Botulism spores may be present in soil-grown items, and may be resistant to heat and germinate over time. Home-canned items may not have been properly preserved.
What is the most common cause of drug fever?
Hypersensitivity reaction to medication The most common cause of drug fever is a hypersensitivity reaction. Drug fever can also be caused by the antithyroid medication propylthiouracil (PTU), atropine and anticholinergic medications, antipsychotic agents, tricyclic antidepressants, cocaine, and amphetamines. The agitation, hyperthermia, and hyperactivity of serotonin syndrome occur with overdose of serotonin reuptake inhibitors.
Maintenance of blood gas concentrations, water balance, and food consumption are controlled by which part of the brain?
Hypothalamus
With which activity would a client experiencing astereognosis need help?
Identifying an object by touch Astereognosis is the inability to identify objects by touch. The client would be able to describe the object's characteristics but not recognize it without visual cues.
The health care provider is performing a spinal tap on a client with suspected infection. The provider would perform the procedure at:
L3 or L4
Feelings of dread, high anxiety, or exquisite pleasure can be elicited by stimulation of areas in which structure?
Limbic System
The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:
Lumbar puncture The diagnosis of bacterial meningitis is confirmed with abnormal CSF findings. Lumbar puncture findings, which are necessary for accurate diagnosis, include a cloudy and purulent CSF under increased pressure. The other options do not confirm the diagnosis.
The nurse assessing a client with a traumatic brain injury assesses for changes in which neurologic component? Select all that apply.
Motor function Sensory function Level of consciousness Cognition Brain injuries can cause changes in level of consciousness and alterations in cognition, motor, and sensory function; therefore, the nurse assessing a client with a traumatic brain injury should assess for changes in these areas.
The nurse is caring for an older adult client with hemiplegia following a stroke. While planning the client's care, the nurse knows the client is at risk for developing which condition?
Muscle atrophy Muscle atrophy can occur with prolonged immobilization following a chronic illness. The client suffering from hemiplegia will have paralysis and immobility. Muscular dystrophy is a genetic disorder characterized by muscle necrosis and increased muscle size. Pseudohypertrophy is associated with muscular dystrophy. Involuntary movements are associated with extrapyramidal tract disorders. Stroke is a pyramidal tract disorder with extrapyramidal tract disorder.
Which is the primary component of white matter?
Myelinated fibers
While there is no laboratory test that is diagnostic for multiple sclerosis, some clients have alterations in their cerebrospinal fluid (CSF) that can be seen when a portion of the CSF is removed during a spinal tap. What finding in CSF is suggestive of multiple sclerosis?
Oligoclonal patterns A large percentage of clients with multiple sclerosis have elevated immunoglobulin G (IgG) levels, and some have oligoclonal patterns (i.e., discrete electrophoretic bands) even with normal IgG levels.
When a peripheral nerve is irritated enough, it becomes hypersensitive to the noxious stimuli, which results in increased painfulness or hyperalgesia. Health care professionals recognize both primary and secondary forms of hyperalgesia. What is primary hyperalgesia?
Pain sensitivity that occurs directly in damaged tissues Primary hyperalgesia describes pain sensitivity that occurs directly in damaged tissues.
Which disease can result in symptoms that can occur when a brain tumor causes damage to the nigrostriatal pathway?
Parkinson disease Symptoms of parkinsonism can occur when damage to the nigrostriatal pathway occurs in such conditions as cerebral vascular disease, brain tumors, repeated head trauma, or a degenerative neurologic disease.
A client's recent computed tomography (CT) scan has revealed the presence of hydrocephalus. Which treatment measure is most likely to resolve this health problem?
Placement of a shunt 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.
Guillain-Barré syndrome is characterized by which form of neuron damage?
Polyneuropathy Polyneuropathies involve demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits. Guillain-Barre syndrome is an acute immune-mediated polyneuropathy.
Muscle spindles and Golgi tendon organs are two types of sensory receptors that provide information to the central nervous system (CNS). This information is relayed to the thalamus and sensory cortex and is experienced as:
Proprioception Specialized sensory nerve terminals in the skeletal muscles (muscle spindles) and tendons (Golgi tendon organs) relay information about muscle stretch and joint tension to the CNS. This information is relayed to the thalamus and sensory cortex and is experienced as proprioception, the sense of body movement and position. The other functions are not mediated by these receptors.
A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which cause can best explain this?
Psychological manifestation due to involvement of white matter of cerebral cortex Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions.
The route considered the most accurate to measure a core body temperature is:
Rectal The rectal temperature is used as a measure of core temperature and is least invasive of all of these options.
A client's primary care provider has prescribed a β-adrenergic receptor blocker. About which desired therapeutic effects should the nurse educate the client?
Reduction in heart rate and blood pressure
A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as:
Referred. Referred pain is pain that is perceived at a site different from its point of origin but innervated by the same spinal segment. Visceral pain originates in the visceral organs and is one of the most common pains produced by disease. Cutaneous pain arises from superficial structures. Somatic pain originates in deep body structures.
A client with a diagnosis of myasthenia gravis underwent a mastectomy. The surgery was a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which priority measure should the care team initiate immediately?
Respiratory support and protection of the client's airway 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.
Which complication of spinal cord injury is the most preventable in a paraplegic client?
Skin breakdown The lack of sensory warning mechanisms and voluntary motor ability below the level of injury, coupled with circulatory changes, places the person with spinal cord injury at major risk for disruption of skin integrity. Significant factors associated with disruption of skin integrity are pressure, shearing forces, and localized trauma and irritation. Relieving pressure, allowing adequate circulation to the skin, and inspecting the skin are primary ways of maintaining skin integrity. Of all the complications after spinal cord injury, skin breakdown is the most preventable.
A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait?
Slow to start walking and has difficulty when asked to "stop" suddenly 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.
Which client is most likely to be susceptible to developing a neurogenic fever?
Sustained a head injury in a bicycle crash Neurogenic fever is the result of damage to the hypothalamus caused by central nervous system trauma, intracerebral bleeding, or an increase in intracranial pressure. All these problems may be precipitated by a head injury. Alzheimer disease and drug administration are not typical causes of a neurogenic fever.
After neurotransmitters are synthesized, in which structure are they stored in the axon terminal?
Synaptic vesicles After synthesis, the neurotransmitter molecules are stored in the axon terminal in tiny, membrane bound sacs called synaptic vesicles. After a nerve impulse stimulates the presynaptic neuron, the vesicles move to the cell membrane and release the neurotransmitter into the synaptic cleft. The neurotransmitter moves across the cleft and binds to postsynaptic receptors. The axon hillock is the initial segment of the axon where the action potential is initiated.
The nurse is caring for a client who has been taking prednisone for the treatment of asthma. The nurse is monitoring the client for increased levels of stress. When glucocorticoid levels are increased, what symptoms should the nurse monitor for?
Tachycardia Any situation sufficiently stressful to evoke increased levels of glucocorticoids also increases epinephrine levels. Catecholamines can cause excitation or inhibition of smooth muscle contraction, depending on the site, dose, and type of receptor present. Tachycardia, hypertension, or any state of excitation can be provoked.
During physiology class, the instructor asks students to explain the pathology behind development of multiple sclerosis. Which student gave the most accurate description?
The demyelination and subsequent degeneration of nerve fibers and decreased oligodendrocytes, which interfere with nerve conduction 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.
Which message is most likely to be carried by general somatic afferent (GSA) neurons?
The sensation of cold when touching ice
The health care provider is assessing the functional integrity of all spinal nerves utilizing a pinpoint pressed against the skin. A normal response would be interpreted as:
The withdrawal reflex is activated. Observation of a normal withdrawal reflex rules out peripheral nerve disease, disorders of the dorsal root and ganglion, disease of the myoneural junction, and severe muscle diseases. Having no response is abnormal and may identify neurologic damage. A verbal response is not a reflex response.
A client suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which purpose?
Thrombolysis Synthetic tissue plasminogen activators work with the body's natural tissue plasminogen activators to convert plasminogen to plasmin, which breaks down clots to allow for the reestablishment of blood flow. There are two causes of strokes: hemorrhagic and thrombotic, with thrombotic strokes occurring much more frequently. Thrombolytics play a large role in increased outcomes seen with thrombotic strokes.
Which pain disorder is a manifestation of a disruption of cranial nerve function?
Trigeminal neuralgia 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). Cranial nerve involvement is not implicated in postherpetic neuralgia, phantom limb pain, or TMJ syndrome.
Which types of sensation are transmitted via the discriminative pathway? Select all that apply.
Two-point touch Vibration Joint movement The discriminative pathway transmits specific information about spatial orientation. It allows for point discrimination and transmits vibration, muscle movement, and joint movement. Cranial nerves use the trigeminal sensory neurons. Pain is transmitted by the anterolateral pathway.
Which characteristic differentiates a migraine with aura from a migraine without aura?
Visual symptoms such as flickering lights precede the headache 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.
A client has been diagnosed with a cerebral aneurysm and placed under close observation before treatment commences. Which pathophysiologic condition has contributed to this client's diagnosis?
Weakness in the muscular wall of an artery 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.
Which type of reflex is stimulated by a nociceptive stimulus?
Withdrawal reflex
A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is:
characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing. Expressive or nonfluent aphasia is characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing. Conduction aphasia 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.
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:
must rely on glucose from the blood to meet their energy needs.
A client is said to be in the chill stage of the fever process when the nurse:
observes piloerection on the skin. During the second stage or chill, there is the uncomfortable sensation of being chilled and the onset of generalized shaking (rigors). Vasoconstriction and piloerection usually precede the onset of shivering. At this point, the skin is pale and covered with goose flesh. Sweating is an indication of the third stage or flushing. The other options are not descriptive of stages but rather interventions.
Which stimulus would be used to elicit the withdrawal reflex when testing response to nociceptive stimuli?
pressure from a sharp object Of the stimuli listed, only pressure from a sharp object is sufficient to predictably produce a withdrawal reflex. The stimulus must be sufficient to produce a signal via the pain pathway and elicit a predictable response in the subject. Mild stimuli such as a weak electrical current or contact with objects close to body temperature will not be sufficient.
The nurse observes a new nurse performing the test for Kernig sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that:
resistance should be provided with the knee in a flexed position. The test for Kernig sign for meningeal irritation is performed by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle.
A client is experiencing a cluster headache. The client would most likely manifest:
severe pain behind the eye. Symptoms of cluster headache include severe, unrelenting unilateral pain located in the orbital area. The pain radiates behind the eye to the ipsilateral trigeminal nerve. The client may also experience symptoms such as restlessness or agitation, conjunctival redness, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, and eyelid edema. The other options are associated with migraine headache.
Following a traumatic head injury from a severe blow to the back of the head, a client is unable to maintain steady posture while in a standing position, although the client is steadier when walking. Which brain disorder most likely resulted from this injury?
A vestibulocerebellar disorder 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. Dystaxia is characterized by uneven movement. An LMN lesion typically manifests as hypotonia.
The nurse is caring for a client who has returned from surgery after having a colon resection. What is the best method for the nurse to use when administering an opioid for pain in order to optimize pain control?
Administer the opioid preemptively and before pain becomes extreme. When giving opioids for relief of severe pain, such as that occurring after surgery, there is much evidence that opioids given routinely before the pain starts (preemptive analgesia) or becomes extreme are far more effective than those administered in a sporadic manner. People who are treated in this manner seem to require fewer doses and are able to resume regular activities sooner.
Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?
Altered level of consciousness In contrast to focal injury, which causes focal neurologic deficits without altered consciousness, global injury nearly always results in altered levels of consciousness ranging from inattention to stupor or coma. The other answers are manifestations of different types of brain injury, not a global injury.
Following a stroke, injury to nerve cells within the central nervous system needs to be repaired. The health care provider knows that which process explains how this occurs?
Astrocytes fill up the space to form a glial scar, repairing the area and replacing the CNS cells that cannot regenerate. Astrocytes are the largest and most numerous of neuroglia and are particularly prominent in the gray matter of the CNS. They form a network within the CNS and communicate with neurons to support and modulate their activities. Astrocytes are also the principal cells responsible for repair and scar formation in the brain. The microglia is a small phagocytic cell that is available for cleaning up debris after cellular infection or cell death. The ependymal cell forms the lining of the neural tube cavity, the ventricular system. The oligodendrocytes form the myelin in the CNS. Instead of forming a myelin covering for a single axon, these cells reach out with several processes, each wrapping around and forming a multilayered myelin segment around several different axons.
A teenager has been in a car accident and experienced an acceleration-deceleration head injury. Initially, the client was stable but then started to develop neurological signs/symptoms. The nurse caring for this client should be assessing for which type of possible complication?
Brain contusions and hematomas Contusions (focal brain injury) cause permanent damage to brain tissue. The bruised, necrotic tissue is phagocytized by macrophages, and scar tissue formed by astrocyte proliferation persists as a crater. The direct contusion of the brain at the site of external force is referred to as an acceleration injury, whereas the opposite side of the brain receives the deceleration injury from rebound against the inner skull surfaces. As the brain strikes the rough surface of the cranial vault, brain tissue, blood vessels, nerve tracts, and other structures are bruised and torn, resulting in contusions and hematomas. TIAs and cerebral vascular infarction (stroke) are often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. In mild concussion head injury, there may be momentary loss of consciousness without demonstrable neurologic symptoms or residual damage, except for possible residual amnesia. Status epilepticus is not related to this situation.
Manifestations of brain tumors are focal disturbances in brain function and increased ICP. What causes the focal disturbances manifested by brain tumors?
Brain edema and disturbances in blood flow Intracranial tumors give rise to focal disturbances in brain function and increased ICP. Focal disturbances occur because of brain compression, tumor infiltration, disturbances in blood flow, and brain edema. Blood pressure, either increased or decreased, is not a manifestation of a brain tumor.
Neurotoxins such as the botulism organism can produce paralysis by what mechanism?
By blocking release of acetylcholine Myasthenia gravis is characterized by loss of acetylcholine receptors. A recessive single gene defect on X chromosome describes muscular dystrophy. Demyelination of peripheral nerves describes polyneuropathies.
Severe head trauma from a coup-contrecoup injury may result in which type of brain injury?
Cerebral hematoma The direct contusion of the brain at the site of external force is referred to as a coup injury; whereas, the opposite side of the brain receives the contrecoup 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. Cerebral vascular infarction (stroke) is often caused by atherosclerotic brain vessel occlusions that cause ischemic injuries. Arteriovenous malformations are an underlying condition not associated with trauma head injury. Ataxia describes the lack of muscle coordination when a voluntary movement is attempted. It may affect any motion that requires muscles to work together to perform a function, from walking to picking up an object to swallowing. Ataxia may be inherited and caused by a genetic defect or it may be acquired due to structural damage to the cerebellum or spinal cord.
The loss of heat from the body through the circulation of air currents is known as:
Convection Convection refers to heat transfer through the circulation of air currents, while radiation is the transfer of heat through air or a vacuum. Conduction is the direct transfer of heat from one molecule to another, and evaporation involves the use of body heat to convert water on the skin to water vapor.
The cerebellum, separated from the cerebral hemispheres by the tentorium cerebelli, lies in the posterior fossa of the cranium. What is one of the functions of the cerebellum?
Coordinates smooth and accurate movements of the body The cerebellum compares what is actually happening with what is intended to happen. It then transmits the appropriate corrective signals back to the motor system, instructing it to increase or decrease the activity of the participating muscle groups so that smooth and accurate movements can be performed.
Select the laboratory blood test that would be a used to suggest a diagnosis of muscular dystrophy (MD).
Creatinine kinase Serum levels of the enzyme creatine kinase (CK), which leaks out of damaged muscle fibers, suggest the presence of the disease. A muscle biopsy, which shows a mixture of muscle cell degeneration and regeneration and reveals fat and scar tissue replacement, may be done to confirm the diagnosis.
The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:
Decreased level of oxygen Regulation of blood flow to the brain is controlled largely by autoregulatory or local mechanisms that respond to the metabolic needs of the brain. Metabolic factors affecting cerebral blood flow include an increase in carbon dioxide and hydrogen ion concentrations; cerebral blood flow is affected by decreased O2 levels and increased hydrogen ions, carbon dioxide, and PCO2 levels.
Regarding the pathophysiology of Parkinson disease, which statement is true?
Degeneration of the nigrostriatal dopamine neurons occurs. The primary brain abnormality found in all persons diagnosed with Parkinson disease is degeneration of the nigrostriatal dopamine neurons. Acetylcholine has no bearing on Parkinson development. There is a decrease in dopamine rather than an increase.
A client who is diagnosed with seizures describes feeling confused after experiencing a seizure. The family members report that the client has been smacking his lips prior to having a seizure. The client most likely experienced which type of seizure?
Focal 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. The other seizures do not display these manifestations.
In what part of the body does the highest level of motor function occur?
Frontal cortex of the brain The highest level of function, which occurs at the level of the frontal cortex, is concerned with the purpose and planning of the motor movement. The efficiency of movement depends on input from sensory systems that operate in parallel with the motor systems. The other options are responsible for lower-level functions.
The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced:
Generalized seizure When seizure activity begins simultaneously in both cerebral hemispheres, it is considered a generalized seizure.
The nurse measures a blood glucose level of 40 mg/dL (2.22 mmol/L) for a client with type 1 diabetes. Why would it be important for the nurse to institute an intervention to elevate the glucose level in this client?
Glucose is not stored in the brain and is a major fuel source for brain function.
The region of the brain involved in emotional experience and control of emotional behavior is the:
Limbic system The limbic region of the brain is involved in emotional experience and in the control of emotion-related behavior. Stimulation of specific areas in this system can lead to feelings of dread, high anxiety, or exquisite pleasure. It also can result in violent behaviors, including attack, defense, or explosive and emotional speech. The occipital lobe plays an important role in the meaningfulness of visual experience, including experiences of color, motion, depth perception, pattern, form, and location in space. The parietal lobe is necessary for perceiving the meaningfulness of integrated sensory information from various sensory systems, especially the perception of "where" the stimulus is in space and in relation to body parts. Axons of the olfactory nerve, or cranial nerve I, terminate in the most primitive portion of the cerebrum—the olfactory bulb, where initial processing of olfactory information occurs.
Which chemical does blood-brain and CSF-brain barrier control with easy entrance?
Oxygen Two barriers, the blood-brain barrier and the cerebrospinal fluid (CSF)-brain barrier, provide the means for maintaining the stable chemical environment of the brain. Only water, carbon dioxide, and oxygen enter the brain with relative ease. Large molecules such as proteins are largely excluded from crossing the blood-brain barrier. In the brain, ammonia is converted to glutamine by astrocytes. Potassium has controlled entrance into the brain; the result of slight fluctuations of potassium concentration in the brain would be uncontrolled neural activity because ions such as potassium influence the threshold for neural firing.
A client who has experienced a spinal cord injury still has use of the arms but has impaired motor and sensory function of the trunk, legs, and pelvic organs. Which term best describes how this injury is classified?
Paraplegia The loss of motor and sensory function in the trunk, legs, and pelvic organs while maintaining use of the arms is called paraplegia. Tetraplegia is the loss of function in all areas. Quadriplegia is the loss of function of all four limbs. Clients with Brown-Séquard syndrome suffer from ipsilateral upper motor neuron paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensation.
A client reports feeling a tingling sensation in the last two fingers of one hand after hitting the inner surface of the elbow on a desk. What is the cause of this symptom?
Paresthesia from temporary nerve compression Temporary mild compression of a peripheral nerve can lead to paresthesia. Hypersensitivity is an increased response to mild stimuli. Hyperpathia is a syndrome in which pain is explosive after the raised sensory threshold is reached. Hypoesthesia is reduced or lost sensation of touch or temperature and may be an inherited trait.
What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?
Parkinson disease Parkinson disease is a neurodegenerative disorder originating from the basal ganglia. It presents with tremor, rigidity, and difficulty initiating voluntary movements due to progressive destruction of the nigrostriatal pathway, and decreased dopamine levels. Huntington disease is an inherited disorder primarily affecting neurons of the caudate nucleus and putamen of the basal ganglia. Myasthenia gravis is a disorder caused my autoimmune destruction of acetylcholine receptors of muscles. Guillain-Barré syndrome is an acute immune-mediated polyneuropathy leading to rapidly progressive ascending symmetrical limb weakness and loss of tendon reflexes.
A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client?
Respiratory ventilation assessment and prevention of aspiration pneumonia 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.
A client who is being treated for chronic low back pain is using a TENS unit for relief of pain. The nurse is aware that the use of this device is considered what type of pain relief?
Stimulus-induced analgesia Stimulus-induced analgesia is one of the oldest known methods of pain relief. Electrical stimulation methods of pain relief include TENS, electrical acupuncture, and neurostimulation. A physical agent would be the use of heat or cold. Distraction is a nonpharmacologic method of reduction of pain by distracting the client from his pain. Biofeedback is used to provide feedback to a person concerning the current status of some body function, temperature, temporal artery pulsation, blood pressure, or muscle tension.
A nurse is providing education to a client newly diagnosed with Guillain-Barré syndrome. Which statement reflects accurate information about the course of the disease?
The disorder may present with rapid life-threatening symptoms or may present as a slow insidious process. It is a chronic disorder that is often progressive, but may present with life-threatening cardiopulmonary symptoms. Clients need considerable, supportive nursing and medical care. It is not contagious, but a viral connection is suspected as many report a flu-like illness preceding onset of symptoms.
Which process is most likely to occur as a result of a spinal reflex?
Withdrawal of a hand from a hot stove element 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.
College students were given various amounts of alcohol within a specified time frame and then asked to drive an obstacle course. The rationale for poor performance in driving as the amount of alcohol intake increased includes, "The blood-brain barrier:
allows alcohol, a very lipid-soluble molecule, to rapidly enter the brain."
The spouse of a client admitted to the hospital after a motor vehicle accident reports to the nurse that the client has become very drowsy. The nurse should:
assess the client for additional signs/symptoms of increased intracranial pressure. Since decreased alertness and/or drowsiness can be an early sign of increased intracranial pressure, the nurse should assess for additional signs/symptoms of increased intracranial pressure. Then, once the assessment is complete, the nurse should contact the physician as needed. There is no indication that the client will undergo EEG testing at this time and the spouse should not be instructed to keep the client awake.
Drugs like diazepam, a benzodiazepine, exert their action on ion channels. These drugs do not open the GABA-operated ion channel, but they:
change the effect that GABA has when it binds to the channel at the same time as the drug. 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.
Death caused by muscular dystrophy in early adulthood is usually due to:
respiratory and cardiac muscle involvement. Frequent respiratory infections and loss of reserve predispose to life-threatening illness. Cardiomyopathy may be severe and life-limiting in early adulthood.
While sponging a client who has a high temperature, the nurse observes the client begins to shiver. At this point, the priority nursing intervention would be to:
stop sponging the client and retake a set of vital signs. Modification of the environment ensures that the environmental temperature facilitates heat transfer away from the body. Sponge baths with cool water or an alcohol solution can be used to increase evaporative heat losses. More profound cooling can be accomplished through the use of a cooling blanket or mattress, which facilitates the conduction of heat from the body into the coolant solution that circulates through the mattress. Care must be taken so that cooling methods do not produce vasoconstriction and shivering that decrease heat loss and increase heat production.
