Week 8 Neurological and Psychological Disorders

10. The entire human nervous system develops from the 1. brainstem. 2. neural ectoderm. 3. mesoderm. 4. telencephalon.

10. The entire human nervous system develops from the 1. brainstem. 2. neural ectoderm. 3. mesoderm. 4. telencephalon. ANS: B The nervous system starts to take shape during the third week of embryonic development. A thickened plate of ectoderm gives rise to the central nervous system and peripheral nervous system. The neural tube is the precursor of the future brain and spinal cord. The mesoderm and telencephalon are not the primary sources of nervous system development. REF: Pg. 887

11. Blood flow to the brain is interrupted with the occlusion of which artery? 1. Distal aortic 2. Pulmonary 3. Vertebral 4. Left anterior descending

11. Blood flow to the brain is interrupted with the occlusion of which artery? 1. Distal aortic 2. Pulmonary 3. Vertebral 4. Left anterior descending ANS: C Blood supply to the brain is provided by two pairs of arteries; the anterior circulation is supplied by the internal carotid arteries, and the posterior circulation is supplied by the vertebral arteries. The distal aortic artery does not supply blood to the brain. The pulmonary artery does not supply blood to the brain. Occlusion of the left anterior descending artery would not interrupt blood flow to the brain. REF: Pg. 859

12. Activation of touch receptors on the left side of the body is transmitted primarily to the ________ cortex. 1. right somatosensory 2. occipital 3. left temporal 4. right motor

12. Activation of touch receptors on the left side of the body is transmitted primarily to the ________ cortex. 1. right somatosensory 2. occipital 3. left temporal 4. right motor ANS: A Stimulation of points in the primary somatosensory cortex results in discrete sensations in the contralateral side of the body. The perception of sensation from the body occurs at the level of the cortex. The sensations of fine touch and pain are separated in the cord, they reunite in the somatosensory cortex that lies in the cerebral hemisphere opposite the site of sensory receptor origin. Corticospinal tract neurons originate in the primary motor cortex, which is arranged in a similar manner to the somatosensory cortex. REF: Pg. 890

13. When nerve impulses travel up the ________ side of the cord, the sensations of touch, pressure, and vibration are affected. a. anterolateral b. ipsilateral c. contralateral d. bilateral

13. When nerve impulses travel up the ________ side of the cord, the sensations of touch, pressure, and vibration are affected. a. anterolateral b. ipsilateral c. contralateral d. bilateral ANS: B The well-localized sensations of touch, pressure, and vibration travel up the ipsilateral side of the cord. The sensations of pain, itch, and temperature usually cross over and travel to the brain on the contralateral side. Specifically, the anterolateral tract carries the impulses for these sensations. The contralateral side is responsible for the sensations of pain, itch, and temperature. The ipsilateral side is responsible for touch, pressure, and vibration. REF: Pgs. 889-890

14. The language center in most individuals is located in the 1. frontal lobe. 2. left hemisphere. 3. right hemisphere 4. limbic area.

14. The language center in most individuals is located in the 1. frontal lobe. 2. left hemisphere. 3. right hemisphere 4. limbic area. ANS: B Language expression and interpretation have been mapped to areas in the temporal lobe, in the left hemisphere. Damage to the frontal lobe interferes with the ability to use language. The right hemisphere is not the language center of the brain.The limbic system is associated with memory and emotion. REF: Pgs. 862-863

15. Voluntary fine-motor movements are produced by activation of the _____ tract(s). 1. dorsal horn-lemniscal 2. lateral corticospinal 3. spinothalamic 4. medial brainstem

15. Voluntary fine-motor movements are produced by activation of the _____ tract(s). 1. dorsal horn-lemniscal 2. lateral corticospinal 3. spinothalamic 4. medial brainstem ANS: B Corticospinal neurons from the primary motor cortex activate motor neurons to execute voluntary fine-motor commands. The dorsal column-medial lemniscal tract carries fine touch, vibration sense, and proprioception and remains ipsilateral until the level of the medulla. The anterolateral tract (previously called the spinothalamic tract) carries impulses for sensations of pain, itch, and temperature. Activation of the medial brainstem tracts is not associated with voluntary fine-motor movements. REF: Pg. 892

16. A patient who is experiencing swings in heart rate and irregular breathing during sleep is most likely in the stage of ________ sleep. 1. deep 2. REM 3. alpha wave 4. delta wave

16. A patient who is experiencing swings in heart rate and irregular breathing during sleep is most likely in the stage of ________ sleep. 1. deep 2. REM 3. alpha wave 4. delta wave ANS: B REM sleep is characterized by irregular breathing and heartbeat, rapid eye movements, depressed muscle tone, and activedreaming. Most sleep is of the restful, slow-wave type of deep sleep. Alpha waves predominate during a relaxed state with the eyes closed. Beta waves are apparent during the REM sleep phase. REF: Pgs. 895-896

17. Memories are stored in the nervous system by 1. specific neurons in the cortex. 2. rearrangement of synaptic contacts. 3. selective apoptosis of neurons. 4. changes in synaptic efficiency.

17. Memories are stored in the nervous system by 1. specific neurons in the cortex. 2. rearrangement of synaptic contacts. 3. selective apoptosis of neurons. 4. changes in synaptic efficiency. ANS: D Memory is a synaptic phenomenon in which neurons in the memory trace or circuit alter the efficiency of synaptic transmission. Memories are not stored by specific neurons in the cortex. Selective apoptosis of neurons is not the process of memory storage. REF: Pg. 895

18. The primary function of the central nervous system is to 1. process information to be relayed to muscles and glands. 2. serve the afferent sensory system. 3. serve the efferent motor system. 4. mediate involuntary functions.

18. The primary function of the central nervous system is to 1. process information to be relayed to muscles and glands. 2. serve the afferent sensory system. 3. serve the efferent motor system. 4. mediate involuntary functions. ANS: A The CNS includes the brain and spinal cord. Its primary functions are receiving and processing sensory information and creating appropriate responses to be relayed to muscles and glands. The peripheral nervous system serves both afferent sensory functions and efferent motor functions of the somatic and autonomic systems. The autonomic nervous system is composed of neurons in the CNS and PNS that mediate automatic or involuntary functions. REF: Pg. 858

19. The ________ protects the soft tissue of the brain. 1. dural septa 2. dura 3. falx cerebri 4. tentorium cerebella

19. The ________ protects the soft tissue of the brain. 1. dural septa 2. dura 3. falx cerebri 4. tentorium cerebella ANS: B The tough dura protects the soft tissue of the brain. Support and stability are provided by dural septa. The falx cerebri is a thin wall of dura that folds down the cortical midline, separating the two hemispheres. The tentorium cerebelli is a septum that separates the cerebellum and brainstem from the rest of the cerebrum. REF: Pg. 858

20. The integrity of the blood-brain barrier is maintained in part by CNS cells called a. ganglia. b. leptocytes. c. neurocytes. d. astrocytes.

20. The integrity of the blood-brain barrier is maintained in part by CNS cells called a. ganglia. b. leptocytes. c. neurocytes. d. astrocytes. ANS: D The integrity of the blood-brain barrier is maintained in part by CNS cells called astrocytes. These specialized glial cells have foot processes that contact the brain capillaries and are thought to help regulate transport across the capillary endothelium. The ganglia is not associated with integrity of the blood-brain barrier. Leptocytes are not responsible for maintaining the integrity of the blood-brain barrier. The integrity of the blood-brain barrier is not maintained by neurocytes. REF: Pg. 861

21. The pathologic process called hydrocephalus would be manifested by _____ ventricular size. 1. decreased CSF, increased 2. increased CSF, increased 3. decreased CSF, decreased 4. increased CSF, decreased

21. The pathologic process called hydrocephalus would be manifested by _____ ventricular size. 1. decreased CSF, increased 2. increased CSF, increased 3. decreased CSF, decreased 4. increased CSF, decreased ANS: B CSF will continue to be produced even when its path of circulation or absorption is blocked. If this occurs, the amount of CSF increases, as does the size of the ventricles. This pathologic process is called hydrocephalus. Although hydrocephalus is usually caused by blockage of CSF pathways, it can also be caused by overproduction and malabsorption of CSF. Hydrocephalus is associated with increases in CSF and an increase in the size of ventricles. REF: Pg. 859

22. The peripheral nervous system contains a total of ____ nerves. a. 12 b. 31 c. 24 d. 86

22. The peripheral nervous system contains a total of ____ nerves. a. 12 b. 31 c. 24 d. 86 ANS: D The PNS consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves. The total number is 86. There are a total of 24 cranial nerves. REF: Pg. 869

23. Within the spinal nerves, there are ____ pairs of thoracic nerves. a. 8 b. 12 c. 5 d. 2 ANS: B There are 12 pairs of thoracic nerves within the spinal nerves. There are 8 cervical nerves in the spinal vertebral segments. There are 5 lumbar and 5 sacral pairs of nerves in the spinal nerves. REF: Pg. 871

23. Within the spinal nerves, there are ____ pairs of thoracic nerves. a. 8 b. 12 c. 5 d. 2 ANS: B There are 12 pairs of thoracic nerves within the spinal nerves. There are 8 cervical nerves in the spinal vertebral segments. There are 5 lumbar and 5 sacral pairs of nerves in the spinal nerves. REF: Pg. 871

24. Neurons with one dendrite and one axon are a. unipolar. b. bipolar. c. dipolar. d. multipolar.

24. Neurons with one dendrite and one axon are a. unipolar. b. bipolar. c. dipolar. d. multipolar. ANS: B Bipolar neurons have only one dendrite and one axon extending from the cell body. These neurons are prevalent in the retina, cochlea, and olfactory structures, but are rare elsewhere. Unipolar neurons have a single process protruding from the cell body, which splits to form a dendrite and axon. Neurons with one dendrite and one axon are known as bipolar. Multipolar neurons have a large number of dendrites extending from the cell body and one axon. Most neurons are of this type. REF: Pg. 878

25. Pupil constriction is controlled by cranial nerve a. II. b. III. c. VIII. d. IX.

25. Pupil constriction is controlled by cranial nerve a. II. b. III. c. VIII. d. IX. ANS: B Cranial nerve III mediates pupil constriction. Cranial nerve II conveys visual information from the retina to the brain.Cranial nerve VIII transmits auditory information from the cochlea and vestibular information from inner ear structures. Cranial nerveIX innervates tongue muscles and controls their action during speech and swallowing. REF: Pg. 871

26. Which are functions of neuroglia? (Select all that apply.) 1. Generation of action potential 2. Modulation of ionic composition of extracellular fluid in the brain 3. Production of CSF 4. Phagocytosis of wastes within the CNS 5. Slowing the rate of conduction to the nerve axons

26. Which are functions of neuroglia? (Select all that apply.) 1. Generation of action potential 2. Modulation of ionic composition of extracellular fluid in the brain 3. Production of CSF 4. Phagocytosis of wastes within the CNS 5. Slowing the rate of conduction to the nerve axons ANS: B, C, D Astrocytes regulate ionic balance of the interstitial fluid and may influence the transfer of nutrients from capillaries to neurons. Ependymal cells line the ventricles and central canal of the spinal cord, producing CSF. Microglias provide phagocytic functions within the CNS. Glial cells in the nervous system are not capable of generating action potentials. The myelin sheath wraps around nerve axons to insulate and speed the rate of conduction. REF: Pg. 878

27. Which are parts of the meninges? (Select all that apply.) 1. Dura mater 2. Pia mater 3. Choroid 4. Arachnoid 5. Ganglia

27. Which are parts of the meninges? (Select all that apply.) 1. Dura mater 2. Pia mater 3. Choroid 4. Arachnoid 5. Ganglia ANS: A, B, D The dura mater is the outermost meningeal layer. The pia mater is the third meningeal layer. The arachnoid layer is beneath and continuous with the dura. The choroid is not a part of the meninges. The ganglia are not considered to be part of the meninges. REF: Pg. 858

28. It is true that a N-methyl-D-aspartate (NMDA) receptor (select all that apply) 1. is activated by glutamate. 2. is a ligand-gated calcium ion channels. 3. opens only when the membrane has been previously depolarized. 4. blockade is associated with enhanced short-term memory. 5. is blocked by a sodium ion.

28. It is true that a N-methyl-D-aspartate (NMDA) receptor (select all that apply) 1. is activated by glutamate. 2. is a ligand-gated calcium ion channels. 3. opens only when the membrane has been previously depolarized. 4. blockade is associated with enhanced short-term memory. 5. is blocked by a sodium ion. ANS: A, B, C NMDA receptors will not open unless they are bound to glutamine. The NMDA receptor is a ligand-gated calcium ion channel. The N-methyl-D-aspartate (NMDA) receptors are interesting, because they will not open unless the binding of glutamate is paired with a cotransmitter and concurrent depolarization of the membrane. The NMDA receptor is thought to be responsible for long-term memory. The NMDA receptor is blocked by a magnesium ion. REF: Pgs. 884-886

29. It is true that the arachnoid layer of the meninges (Select all that apply.) 1. is thick and tough for support and protection. 2. lies between the dura and the skull. 3. contains spaces that are only evident in the presence of pathologic processes. 4. is semitransparent and weblike. 5. contains collagenous connective tissue.

29. It is true that the arachnoid layer of the meninges (Select all that apply.) 1. is thick and tough for support and protection. 2. lies between the dura and the skull. 3. contains spaces that are only evident in the presence of pathologic processes. 4. is semitransparent and weblike. 5. contains collagenous connective tissue. ANS: C, D, E Only in the presence of pathologic processes, notably epidural and subdural hemorrhages, do the potential spaces of thearachnoid layer become evident. It is semitransparent and weblike in appearance, hence its name. From the arachnoid layer come strands of collagenous connective tissue called trabeculae that extend down to the pia mater, forming a subarachnoid space. The arachnoid is a thin, delicate membrane. Beneath, and continuous with, the dura is the arachnoid layer. The spaces between the dura and the skull and between the dura mater and the arachnoid are potential spaces. REF: Pg. 858

9. Repetitive or ritualistic acts that a person performs with urgency are referred to as a. obsessions. b. delusions. c. hallucinations. d. compulsions.

9. Repetitive or ritualistic acts that a person performs with urgency are referred to as a. obsessions. b. delusions. c. hallucinations. d. compulsions. ANS: D Compulsions are repetitive, ritualistic behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person performs with urgency and rigidly. Obsessions are strong, persistent, intrusive, uncontrollable thoughts. Delusions are not acts that are performed by a person in a ritualistic manner. Hallucinations are not repetitive or ritualistic acts performed with urgency. REF: Pg. 994

10. In individuals dealing with obsessive-compulsive disorder, ____ are most bothered by both obsessions and compulsions. a. 20% b. 28% c. 50% d. 90%

10. In individuals dealing with obsessive-compulsive disorder, ____ are most bothered by both obsessions and compulsions. a. 20% b. 28% c. 50% d. 90% ANS: C Fifty percent of people with OCD are most bothered by both obsessions and compulsions. Twenty percent are bothered by compulsions only. Twenty-eight percent of people with OCD are bothered by obsessions only. Ninety percent of patients have features of both obsessions and compulsions. REF: Pg. 994

1. Seizures that involve both hemispheres at the outset are termed a. partial. b. complex. c. focal. d. generalized.

1. Seizures that involve both hemispheres at the outset are termed a. partial. b. complex. c. focal. d. generalized. ANS: D Episodes in which the entire brain is involved from the onset of the seizure are referred to as generalized seizures. Partial seizures are those in which activity is restricted to one brain hemisphere. Complex partial seizures are restricted to one area of the brain. Focal seizures are classified as partial. REF: Pg. 923

1. Neurotransmitter binding to neuronal receptors occurs primarily at the dendrite and 1. cell body. 2. nucleus. 3. axon hillock. 4. axon terminal.

1. Neurotransmitter binding to neuronal receptors occurs primarily at the dendrite and 1. cell body. 2. nucleus. 3. axon hillock. 4. axon terminal. ANS: A Neurotransmitters bind to receptors on the dendrite and cell body. The nucleus is not the location of neurotransmitter binding. The axon hillock is the point where the axon emerges from the cell body. Neurotransmitter is stored at the axon terminal. REF: Pg. 881

8. An anxiety disorder that is precipitated by a traumatic event is known as 1. generalized anxiety disorder. 2. posttraumatic stress disorder. 3. panic disorder. 4. phobia.

8. An anxiety disorder that is precipitated by a traumatic event is known as 1. generalized anxiety disorder. 2. posttraumatic stress disorder. 3. panic disorder. 4. phobia. ANS: B PTSD is currently classified as an anxiety disorder and is related to a traumatic event. Generalized anxiety disorder is not precipitated by a traumatic event. Panic disorder is characterized by acute episodes of anxiety symptoms. Phobias are not related to traumatic events. REF: Pg. 994

1. Tachycardia is a common finding in individuals with 1. panic attacks. 2. generalized anxiety disorder. 3. obsessive-compulsive disorder. 4. bipolar disorder.

ANS: A Physical symptoms of panic disorder include heart palpitations and tachycardia in addition to chest pains. Palpitations may occur in generalized anxiety disorder. The hallmarks of OCD are obsessions and compulsions. Bipolar disorder is not typically associated with cardiac symptoms.

1. Schizophrenia is characterized by 1. generalized anxiety. 2. depression. 3. disorganized thinking. 4. eating disorders.

1. Schizophrenia is characterized by 1. generalized anxiety. 2. depression. 3. disorganized thinking. 4. eating disorders. ANS: C Schizophrenia is now correctly understood as a split or separation among normally well-synchronized brain functions. This loss of synchronized brain functioning leads to thoughts, behaviors, and feelings that are disordered, disorganized, and disconnected from reality. Generalized anxiety and eating disorders are not associated with schizophrenia. Schizophrenia is not characterized by depression. REF: Pg. 975

1. The physiologic change most likely to lead to an increase in intracranial pressure is 1. cerebral vasodilation. 2. hypernatremia. 3. respiratory hyperventilation. 4. REM sleep.

1. The physiologic change most likely to lead to an increase in intracranial pressure is 1. cerebral vasodilation. 2. hypernatremia. 3. respiratory hyperventilation. 4. REM sleep. ANS: A Cerebral edema starts a cyclic process whereby fluid collection in the brain leads to compression of vessels, which results in inadequate blood and oxygen perfusion into the cells. This results in ischemia, which triggers vasodilation, increased capillary pressure, and increased edema. An increase in intracranial pressure is not associated with hypernatremia nor caused by respiratory hyperventilation. The physiologic change most likely to lead to increased intracranial pressure is not related to sleep. REF: Pg. 903

10. The most important preventative measure for hemorrhagic stroke is 1. anticoagulation. 2. blood pressure control. 3. thrombolytics. 4. management of dysrhythmias.

10. The most important preventative measure for hemorrhagic stroke is 1. anticoagulation. 2. blood pressure control. 3. thrombolytics. 4. management of dysrhythmias. ANS: B Hemorrhagic stroke is a hemorrhage that is usually the result of longstanding hypertension. Blood pressure control is the most important preventative measure. Anticoagulation would be useful for preventing embolic stroke. Risk reduction strategies for thrombotic stroke are aimed at reducing atherosclerosis. Dysrhythmias are not related to a risk of hemorrhagic stroke. REF: Pg. 915

10. The symptoms of hallucinations and paranoia that accompany schizophrenia are thought to be due to altered neurotransmitter activity in the brain, which results in excessive ________ receptor activation. a. D2 b. serotonin c. -adrenergic d. acetylcholine

10. The symptoms of hallucinations and paranoia that accompany schizophrenia are thought to be due to altered neurotransmitter activity in the brain, which results in excessive ________ receptor activation. a. D2 b. serotonin c. -adrenergic d. acetylcholine ANS: A The positive symptoms of schizophrenia are thought to result from excessive dopamine D2 receptor activity in the brain. Depression is thought to be related to decreases in serotonin. Hallucinations and paranoia that accompany schizophrenia are not the result on excessive -adrenergic receptor activation. Excessive acetylcholine receptor activation is not the cause of hallucinations or paranoia.

10. Upper extremity weakness in association with degeneration of CNS neurons is characteristic of 1. multiple sclerosis. 2. Guillain-Barré syndrome. 3. myasthenia gravis. 4. amyotrophic lateral sclerosis.

10. Upper extremity weakness in association with degeneration of CNS neurons is characteristic of 1. multiple sclerosis. 2. Guillain-Barré syndrome. 3. myasthenia gravis. 4. amyotrophic lateral sclerosis. ANS: D Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of the hands, arms, and legs. Symptoms of multiple sclerosis include doublevision, weakness, poor coordination, and sensory deficits. Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis that usually begins in the legs. Upper extremity weakness associated with degeneration of CNS neurons is not characteristic of myasthenia gravis. REF: Pg. 935

11. A person who frequently spends hours each day attending to hand hygiene is referred to as a a. hoarder. b. washer. c. checker. d. counter.

11. A person who frequently spends hours each day attending to hand hygiene is referred to as a a. hoarder. b. washer. c. checker. d. counter. ANS: B "Washers" constitute 25% to 50% of the OCD samples and are concerned with dirt, contaminants, and germs; the person frequently spends hours each day washing hands or showering. "Hoarding," the inability to dispossess meaningless, worthless objects, is one example of more complex compulsions. "Checkers" compulsively check to see if they have done something, such as run over someone with a car or left the door unlocked. One syndrome of OCD is related to excessive counting or ordering. REF: Pg. 994

11. Ascending paralysis with no loss of sensation is characteristic of 1. multiple sclerosis. 2. Guillain-Barré syndrome. 3. myasthenia gravis. 4. amyotrophic lateral sclerosis.

11. Ascending paralysis with no loss of sensation is characteristic of 1. multiple sclerosis. 2. Guillain-Barré syndrome. 3. myasthenia gravis. 4. amyotrophic lateral sclerosis. ANS: B Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis. It usually begins in the legs, spreading often to the arms and face. Symptoms of multiple sclerosis include double vision, weakness, poor coordination, and sensory deficits. Ascending paralysis is not characteristic of myasthenia gravis. Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of thehands, arms, and legs. REF: Pg. 938

11. In the acute phase of stroke, treatment is focused on 1. stabilization of respiratory and cardiovascular function. 2. risk factor modification. 3. prevention of bedsores and contractures. 4. neurologic rehabilitation.

11. In the acute phase of stroke, treatment is focused on 1. stabilization of respiratory and cardiovascular function. 2. risk factor modification. 3. prevention of bedsores and contractures. 4. neurologic rehabilitation. ANS: A The primary consideration in the acute phase of stroke is assuring the patient's airway, respiratory and cardiovascularfunction. In the acute phase of stroke, risk factor modification is not appropriate. Treatment aimed at preventing bedsores and contractions is not a typical consideration in the acute phase. Neurologic rehabilitation is not the focus of treatment in the acute phase. REF: Pg. 915

11. The assessment of a client recently diagnosed with schizophrenia confirms good cognitive function and reveals affect that is animated. The client is open about describing the voices and the content of their comments, but demonstrates a disorganized thought process. These findings suggest that 1. "negative" psychotic symptoms predominate. 2. there is a high risk for suicidal behaviors. 3. drug therapy is likely to be ineffective. 4. "positive" psychotic symptoms predominate.

11. The assessment of a client recently diagnosed with schizophrenia confirms good cognitive function and reveals affect that is animated. The client is open about describing the voices and the content of their comments, but demonstrates a disorganized thought process. These findings suggest that 1. "negative" psychotic symptoms predominate. 2. there is a high risk for suicidal behaviors. 3. drug therapy is likely to be ineffective. 4. "positive" psychotic symptoms predominate. ANS: D Positive symptoms of schizophrenia include the psychotic dimension and distortions of thought and perception, as well as the disorganization dimension. Auditory hallucinations are commonly experienced as voices. Negative symptoms are consideredto be restricted affect, or asociality. The patient in this scenario does not appear to be at high risk for suicidal behaviors. The findings suggested do not indicate that the patient has ineffective drug therapy. REF: Pg. 978

12. Cerebral aneurysm is most frequently the result of 1. embolic stroke. 2. subarachnoid hemorrhage. 3. subdural hemorrhage. 4. meningitis.

12. Cerebral aneurysm is most frequently the result of 1. embolic stroke. 2. subarachnoid hemorrhage. 3. subdural hemorrhage. 4. meningitis. ANS: B Although trauma is an important cause of subarachnoid hemorrhage, it is more commonly associated with rupture of cerebral aneurysms. Embolic stroke is usually from a cardiac source. Subdural hematomas are related to trauma. Meningitis is caused by microbial invasion of the CNS. REF: Pg. 917

12. Drug therapy with a dopamine receptor antagonist is initiated to manage a patient's symptoms of schizophrenia. The goalof treatment is to 1. increase dopamine activity. 2. reduce serotonin activity. 3. stabilize dopamine activity. 4. effect serotonin and norepinephrine neurotransmitters.

12. Drug therapy with a dopamine receptor antagonist is initiated to manage a patient's symptoms of schizophrenia. The goalof treatment is to 1. increase dopamine activity. 2. reduce serotonin activity. 3. stabilize dopamine activity. 4. effect serotonin and norepinephrine neurotransmitters. ANS: C The aim for effective antipsychotic medication is to stabilize, rather than reduce, dopamine activity. The newest medications show greater affinity for serotonin receptors (negative symptoms) and moderate affinity for dopamine and norepinephrine receptors (positive symptoms). REF: Pg. 980

12. PET scans performed on the brains of individuals diagnosed with obsessive compulsive disorder (OCD) has shown 1. decreases in glucose metabolism. 2. increases in glucose metabolism. 3. increases in serotonin activity. 4. decreases in serotonin activity.

12. PET scans performed on the brains of individuals diagnosed with obsessive compulsive disorder (OCD) has shown 1. decreases in glucose metabolism. 2. increases in glucose metabolism. 3. increases in serotonin activity. 4. decreases in serotonin activity. ANS: B OCD studies using PET brain scans have shown significant increases in glucose metabolism rates in the frontal lobes, caudate nucleus, and cingulate gyrus regions of the brain. OCD studies using PET scans have shown increases in glucose metabolism. Serotonin activity is related to generalized anxiety disorder. OCD studies have not revealed a correlation in serotonin activity. REF: Pg. 994

14. Rupture of a cerebral aneurysm should be suspected if the patient reports 1. ringing in the ears. 2. transient episodes of numbness. 3. transient episodes of vertigo. 4. sudden, severe headache.

14. Rupture of a cerebral aneurysm should be suspected if the patient reports 1. ringing in the ears. 2. transient episodes of numbness. 3. transient episodes of vertigo. 4. sudden, severe headache. ANS: D Warning leaks may occur before an aneurysm ruptures and often produce severe headache, which is typically described by the patient as "the worst headache I have ever had." Ringing in the ears is not a symptom associated with rupture of a cerebral aneurysm. Transient episodes of numbness are not indicative of a cerebral aneurysm rupture. Transient episodes of vertigo are not indicative of a cerebral aneurysm rupture. REF: Pg. 917

12. The stage of spinal shock that follows spinal cord injury is characterized by 1. reflex urination and defecation. 2. autonomic dysreflexia. 3. absent spinal reflexes below the level of injury. 4. motor spasticity and hyperreflexia below the level of injury.

12. The stage of spinal shock that follows spinal cord injury is characterized by 1. reflex urination and defecation. 2. autonomic dysreflexia. 3. absent spinal reflexes below the level of injury. 4. motor spasticity and hyperreflexia below the level of injury. ANS: C Spinal shock may occur after injury to the spinal cord, and can last from a few hours to a few weeks. Symptoms below thelevel of injury include flaccid paralysis of all skeletal muscles; loss of all spinal reflexes; loss of pain, proprioception, and other sensations; bowel and bladder dysfunction with paralytic ileus; and loss of thermoregulation. Bowel and bladder dysfunction may occur with spinal shock. Spinal shock is not characterized by autonomic dysreflexia. Spinal shock is generally associated with flaccid paralysis and loss of spinal reflexes. REF: Pg. 936

13. A mild form of hyperactivity in which social functioning is not significantly impaired is called a. anhedonia. b. dysphoria. c. dysthymia. d. hypomania.

13. A mild form of hyperactivity in which social functioning is not significantly impaired is called a. anhedonia. b. dysphoria. c. dysthymia. d. hypomania. ANS: D The individual experiencing hypomania has a sudden onset of increased energy, expanded self-esteem, and decreased anxiety; these typically are reported to have improved his or her productivity and are experienced as an acceptable natural high. Anhedonia is a loss of pleasure. Dysphoria is not a condition in which social functioning is not impaired. Depression with one or two symptoms that last 2 years or more is commonly referred to as dysthymia. REF: Pg. 985

13. Autonomic dysreflexia is characterized by 1. hypertension and bradycardia. 2. hypotension and shock. 3. pallor and vasoconstriction above the level of injury. 4. extreme pain below the level of injury.

13. Autonomic dysreflexia is characterized by 1. hypertension and bradycardia. 2. hypotension and shock. 3. pallor and vasoconstriction above the level of injury. 4. extreme pain below the level of injury. ANS: A Autonomic dysreflexia is a potentially life-threatening complication that may occur any time after spinal shock has resolved. It is characterized by a sudden episode of hypertension, headache, bradycardia, upper-body flushing and lower body vasoconstriction, piloerection, and sweating. Autonomic dysreflexia is associated with hypertension and lower body vasoconstriction. Extreme pain below the level of injury is not characteristic of autonomic dysreflexia. REF: Pg. 936

13. Leakage of CSF from the nose or ears is commonly associated with 1. epidural hematoma. 2. temporal skull fracture. 3. basilar skull fracture. 4. cerebral aneurysm.

13. Leakage of CSF from the nose or ears is commonly associated with 1. epidural hematoma. 2. temporal skull fracture. 3. basilar skull fracture. 4. cerebral aneurysm. ANS: C Sometimes fractures at the base of the skull are not visible on the routine CT scan, but allow drainage of CSF into the nasal sinuses. Head-injured patients who have drainage of clear fluid from the ears or nose should be evaluated for basilar skull fracture. Epidural hematomas are not associated with leakage of CSF from the nose or ears. Fracture of the temporal bone commonly results in an acute epidural hemorrhage. Cerebral aneurysm is not associated with leakage of cerebrospinal fluid. REF: Pg. 912

13. The first-line treatment for post traumatic stress disorder (PTSD) is 1. adrenergic blockers. 2. benzodiazepines 3. tricyclic antidepressants. 4. selective serotonin reuptake inhibitors.

13. The first-line treatment for post traumatic stress disorder (PTSD) is 1. adrenergic blockers. 2. benzodiazepines 3. tricyclic antidepressants. 4. selective serotonin reuptake inhibitors. ANS: D SSRIs are the first-line treatment for PTSD and are associated with marked improvement. Adrenergic blockers show some improvement with both PTSD and acute stress disorder symptoms. Benzodiazepines are not the first-line treatment for PTSD. TCAs have not been reported to be very effective in the management of PTSD. REF: Pg. 995

14. As many as ____ of children in the United States aged 3 to 17 years are affected by some type of neurodevelopmental disorder. a. 5% b. 12% c. 25% d. 30%

14. As many as ____ of children in the United States aged 3 to 17 years are affected by some type of neurodevelopmental disorder. a. 5% b. 12% c. 25% d. 30% ANS: B As many as 12% of children in the United States aged 3 to 17 years are affected by at least one neurodevelopmental disorder, such as ADHD, a learning disorder, or an intellectual disability. More than 5% of children in the United States are affected by some type of neurodevelopmental disorder. Less than 25% of children are affected by neurodevelopmental disorders. Less than 30% of children in the United States are affected by some type of neurodevelopmental disorder. REF: Pg. 996

14. In youth, it is estimated that ____ will be diagnosed with serious mental illness between the ages of 13 and 18 years. a. 5% b. 26.2% c. 46.3% d. 75%

14. In youth, it is estimated that ____ will be diagnosed with serious mental illness between the ages of 13 and 18 years. a. 5% b. 26.2% c. 46.3% d. 75% ANS: C In youth, 46.3% will be diagnosed with serious mental illness between the ages of 13 and 18 years. In the United Statestoday, approximately 5% of all adults meet criteria for serious mental illness. 26.2% of the U.S. adult population will have experienced an SMI in the previous year. 75% of youth are not diagnosed with serious mental illness. REF: Pg. 971

14. It is true that Bell palsy is a 1. permanent facial paralysis after stroke. 2. painful neuropathic pain affecting the trigeminal nerve. 3. paralysis of the muscles innervated by the facial nerve. 4. herpetic outbreak in a facial dermatome.

14. It is true that Bell palsy is a 1. permanent facial paralysis after stroke. 2. painful neuropathic pain affecting the trigeminal nerve. 3. paralysis of the muscles innervated by the facial nerve. 4. herpetic outbreak in a facial dermatome. ANS: C Bell palsy is an acute idiopathic paresis or paralysis of the facial nerve involving an inflammatory reaction. Bell palsy patients generally recover facial nerve function spontaneously within 3 weeks. Patients with Bell palsy may complain of a heavy sensation in their face. Bell palsy is not related to a herpetic outbreak. REF: Pg. 939

15. A patient who experiences early symptoms of muscle twitching, cramping, and stiffness of the hands may be demonstratingsigns of 1. Guillain-Barré syndrome. 2. amyotrophic lateral sclerosis. 3. Parkinson disease. 4. hydrocephalus.

15. A patient who experiences early symptoms of muscle twitching, cramping, and stiffness of the hands may be demonstratingsigns of 1. Guillain-Barré syndrome. 2. amyotrophic lateral sclerosis. 3. Parkinson disease. 4. hydrocephalus. ANS: B Most patients with ALS demonstrate muscle weakness and atrophy. The earliest symptoms may be muscle twitching, cramping,and stiffness. Often the hands or upper extremities are affected first. Guillain-Barré syndrome is characterized by ascending weakness that usually begins in the legs. Tremors at rest are usually the earliest symptoms of Parkinson disease. Hydrocephalus is characterized by abnormal accumulation of CSF in the cerebral ventricular system. REF: Pg. 935

15. Studies on brain neuroanatomy and neurocircuitry suggest that post traumatic stress disorder (PTSD) patients show ________________ left hippocampus volumes compared with control subjects. 1. decreased right and 2. increased right and 3. decreased right and increased 4. increased right and decreased

15. Studies on brain neuroanatomy and neurocircuitry suggest that post traumatic stress disorder (PTSD) patients show ________________ left hippocampus volumes compared with control subjects. 1. decreased right and 2. increased right and 3. decreased right and increased 4. increased right and decreased ANS: A Multiple studies on brain neuroanatomy and neurocircuitry suggest that PTSD patients show decreased right and left hippocampus volumes compared to traumatized and nontraumatized control subjects. It remains unclear about whether hippocampi size plays a role in contributing to vulnerability to PTSD. Limited research is available to compare before and after PTSD treatment. Multiple studies on brain neuroanatomy and neurocircuitry suggest that PTSD patients show decreased right and left hippocampus volumes compared to traumatized and nontraumatized control subjects. REF: Pg. 995

15. Subarachnoid hemorrhage is usually managed with volume expansion and blood pressure support to enhance cerebral perfusion. This is necessary because subarachnoid hemorrhage predisposes to 1. cerebral vasospasm. 2. hypotension. 3. excessive volume loss. 4. increased intracranial pressure.

15. Subarachnoid hemorrhage is usually managed with volume expansion and blood pressure support to enhance cerebral perfusion. This is necessary because subarachnoid hemorrhage predisposes to 1. cerebral vasospasm. 2. hypotension. 3. excessive volume loss. 4. increased intracranial pressure. ANS: A In patients experiencing subarachnoid hemorrhage as a consequence of ruptured aneurysm, the complications of cerebral vasospasm and hydrocephalus must be monitored and managed. Vasospasm can be managed by keeping blood volume and blood pressure at normal to high levels. Vasospasm is managed by keeping blood volume and blood pressure at normal to high levels. Subarachnoid hemorrhage does not predispose to excessive volume loss. Subarachnoid hemorrhage is not associated with predisposition to increases in intracranial pressure. REF: Pg. 918

15. ________ is a term used to describe a serious and debilitating mental state. 1. Psychosis 2. Schizophrenia 3. Major depressive disorder 4. Dysthymia

15. ________ is a term used to describe a serious and debilitating mental state. 1. Psychosis 2. Schizophrenia 3. Major depressive disorder 4. Dysthymia ANS: A Psychosis is a term used to describe a serious and debilitating mental state. The narrowest definition refers to delusions and prominent hallucinations. Schizophrenia refers to a chronic, remitting and relapsing psychotic disorder. Major depressive disorder involves a complex diagnosis which encompasses depression symptoms. Dysthymia is associated with long-term depression. REF: Pg. 975

16. A college student living in a dormitory, reports a stiff neck and headache and is found to have a fever of 102° F. Thisinformation is most consistent with 1. encephalitis. 2. meningitis. 3. skull fracture. 4. cerebral ischemia.

16. A college student living in a dormitory, reports a stiff neck and headache and is found to have a fever of 102° F. Thisinformation is most consistent with 1. encephalitis. 2. meningitis. 3. skull fracture. 4. cerebral ischemia. ANS: B The combination of headache, fever, stiff neck, and signs of confusion are classic symptoms of meningitis. Clinical manifestations of encephalitis include fever, headache, and confusion that evolve over several days. Symptoms of a skull fracture are unrelated to fever and headache. Fever is not associated with cerebral ischemia. REF: Pg. 919

16. Childlike silliness in a patient with schizophrenia is known as 1. delusions. 2. disorganized thinking. 3. grossly disorganized behavior. 4. asociality.

16. Childlike silliness in a patient with schizophrenia is known as 1. delusions. 2. disorganized thinking. 3. grossly disorganized behavior. 4. asociality. ANS: C Grossly disorganized behavior can range from childlike silliness to unpredictable agitation, and impairs tasks of daily living. Delusions, or systematic, fixed, false beliefs, usually involve themes of persecution, REF, somatization, religiosity, or grandiosity. Disorganized thinking is usually evaluated by an individual's speech, and is frequently characterized by frequent derailment or loose associations, invented words, tangential idea, and, when most severe, incomprehensible speech. Asociality is a negative symptom of schizophrenia. REF: Pg. 978

16. The most common childhood psychiatric disorder is 1. bipolar disorder. 2. attention-deficit hyperactivity disorder. 3. autism spectrum disorder. 4. psychosis.

16. The most common childhood psychiatric disorder is 1. bipolar disorder. 2. attention-deficit hyperactivity disorder. 3. autism spectrum disorder. 4. psychosis. ANS: B ADHD is the most common childhood psychiatric disorder. It typically begins in childhood and continues throughout adolescence and adulthood. The most common childhood psychiatric disorder is not bipolar disorder. Autism spectrum disorder is not the most common childhood psychiatric disorder. Psychosis is not the most common childhood psychiatric disorder. REF: Pg. 996

16. What type of seizure usually occurs in children and is characterized by brief staring spells? a. Epileptic b. Idiopathic c. Partial d. Absence

16. What type of seizure usually occurs in children and is characterized by brief staring spells? a. Epileptic b. Idiopathic c. Partial d. Absence ANS: D Absence or petite mal seizures usually occur only in children. They are very brief (2 to 10 seconds), and episodes are characterized by staring spells that last only seconds. Epilepsy refers to recurrent seizures. Idiopathic seizures are those that haveno explanation for the disorder. Partial seizures are those in which activity is restricted to one brain hemisphere. REF: Pg. 923

17. Children with social or communication deficits, fixated interests and repetitive behaviors are likely exhibiting symptoms of 1. attention deficient hyperactivity disorder (ADHD) 2. a learning disorder. 3. inattention. 4. autism spectrum disorder.

17. Children with social or communication deficits, fixated interests and repetitive behaviors are likely exhibiting symptoms of 1. attention deficient hyperactivity disorder (ADHD) 2. a learning disorder. 3. inattention. 4. autism spectrum disorder. ANS: D Autism spectrum disorder is defined by a common set of behaviors: social/communication deficits and fixated interests and repetitive behaviors. ADHD is characterized by difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). Learning disorders are a form of neurodevelopmental disorders in children. Inattention isnot exhibited by social or communication deficits. REF: Pg. 997

17. It is true that encephalitis is usually 1. due to a bacterial infection in the CNS. 2. fatal. 3. due to a viral infection in brain cells. 4. asymptomatic.

17. It is true that encephalitis is usually 1. due to a bacterial infection in the CNS. 2. fatal. 3. due to a viral infection in brain cells. 4. asymptomatic. ANS: C Encephalitis is an inflammation of the brain which is caused by a variety of agents. Viral causes account for the majority of encephalitis cases. Bacteria can be responsible for the inflammation of the brain associated with encephalitis. Death occurs in 5% to 20% of encephalitis cases. Clinical manifestations of HSV encephalitis typically evolve over several days. REF: Pg. 919

17. The initial treatment of an individual experiencing a seizure is concentrated on 1. maintaining an airway. 2. administering anticonvulsant medication. 3. documenting the seizure pattern. 4. obtaining an EEG.

17. The initial treatment of an individual experiencing a seizure is concentrated on 1. maintaining an airway. 2. administering anticonvulsant medication. 3. documenting the seizure pattern. 4. obtaining an EEG. ANS: A Treatment of an individual experiencing a seizure is concentrated on maintaining an airway and protecting the individual from injury. If the seizures are due to irreversible or unidentifiable factors, anticonvulsant medications specific to the type of seizure are the best management. Recording the course of the seizure episode is useful, but is not the initial focus of care. EEG studies may be useful in determining abnormalities which elicit the pathologic mechanism. REF: Pg. 924

17. The schizophrenia category which indicates that the disturbance has continued but the active-phase symptoms are no longer met is the _____ Type. a. Residual b. Undifferentiated c. Paranoid d. Disorganized

17. The schizophrenia category which indicates that the disturbance has continued but the active-phase symptoms are no longer met is the _____ Type. a. Residual b. Undifferentiated c. Paranoid d. Disorganized ANS: A The Residual Type indicates that the disturbance has continued but the active-phase symptoms are no longer met. The Undifferentiated Type is essentially a catch-all category where the individual does not meet criteria for any of the other subtypes. The Paranoid and Disorganized Types are the least severe (in that order). The Paranoid and Disorganized Types are the least severe (in that order). REF: Pg. 979

18. It is true that epidural bleeding is 1. associated with widespread vascular disruption. 2. located between the arachnoid and the dura mater. 3. usually due to venous leakage. 4. characterized by a lucid interval immediately after injury.

18. It is true that epidural bleeding is 1. associated with widespread vascular disruption. 2. located between the arachnoid and the dura mater. 3. usually due to venous leakage. 4. characterized by a lucid interval immediately after injury. ANS: D The source of bleeding in most epidural hematomas is arterial. The patient may suffer only a brief period of disturbed consciousness followed by a period of normal cognition (lucid interval). Then consciousness rapidly deteriorates as the epidural hematoma expands and compresses brain structures. As the epidural hematoma expands, pressure is placed on the brain structures. The bleeding associated with an epidural hematoma occurs between the inner surface of the skull and the dura mater. The source of bleeding in most epidural hematomas is arterial. REF: Pg. 911

18. Researchers suggest a mediating role between the later development of schizophrenia and 1. prenatal radiation exposure. 2. prenatal influenza exposure. 3. childhood vaccinations. 4. childhood chickenpox.

18. Researchers suggest a mediating role between the later development of schizophrenia and 1. prenatal radiation exposure. 2. prenatal influenza exposure. 3. childhood vaccinations. 4. childhood chickenpox. ANS: B Researchers have suggested that delivery complications could be a factor, playing a mediating role between prenatal influenza exposure and later development of schizophrenia. Prenatal radiation exposure is not a suggested mediator in the development of schizophrenia. The development of later schizophrenia is not suggested to be associated with childhood vaccinations. It is not suggested that childhood chickenpox is related to the development of schizophrenia. REF: Pg. 977

18. Which disorders are classified as anxiety-related? (Select all that apply.) 1. Panic 2. Generalized anxiety 3. Obsessive-compulsive 4. Borderline personality 5. Attention-deficit hyperactivity disorder

18. Which disorders are classified as anxiety-related? (Select all that apply.) 1. Panic 2. Generalized anxiety 3. Obsessive-compulsive 4. Borderline personality 5. Attention-deficit hyperactivity disorder ANS: A, B, C Panic disorder is characterized by acute episodes of anxiety. Generalized anxiety disorder is considered to be anxiety related. Obsessive-compulsive disorder is considered to be an anxiety disorder. Borderline personality is not associated with anxiety disorders. ADHD is a common childhood psychiatric disorder. REF: Pg. 990

18. _________ is a form of spina bifida in which a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. 1. Spina bifida occulta 2. Meningocele 3. Myelomeningocele 4. Meningomyelocele

18. _________ is a form of spina bifida in which a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. 1. Spina bifida occulta 2. Meningocele 3. Myelomeningocele 4. Meningomyelocele ANS: B In the meningocele form of spina bifida cystica, a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. In spina bifida occulta, the posterior vertebral laminae have failed to fuse. A myelomeningocele or meningomyelocele deformity contains meninges, CSF, and a portion of the spinal cord that protrudes from the vertebral defect in a cystlike sac. REF: Pg. 935

19. It is recommended that women of childbearing age take folic acid daily for prevention of 1. neural tube defects. 2. seizure disorders. 3. cerebral palsy. 4. hydrocephalus.

19. It is recommended that women of childbearing age take folic acid daily for prevention of 1. neural tube defects. 2. seizure disorders. 3. cerebral palsy. 4. hydrocephalus. ANS: A The use of folic acid during the period prior to conception has been shown to significantly decrease the risk of having a child with a neural tube defect. Folic acid does not prevent seizure disorders. An etiologic factor in the development of cerebral palsy is mechanical trauma before, during, or after birth. Hydrocephalus is not prevented with the use of folic acid. REF: Pg. 935

19. The action of most antidepressants currently available is to 1. improve brain norepinephrine and serotonin activity. 2. inhibit norepinephrine and serotonin activity. 3. convert into catecholamines in the brain. 4. block D2 receptors in the brain.

19. The action of most antidepressants currently available is to 1. improve brain norepinephrine and serotonin activity. 2. inhibit norepinephrine and serotonin activity. 3. convert into catecholamines in the brain. 4. block D2 receptors in the brain. ANS: A Most currently available antidepressants act by improving brain norepinephrine and serotonin activity. Earlier generations of antidepressants had less specific effects on these neurotransmitters and significantly more side effects. The action of antidepressants is unrelated to conversion of catecholamines in the brain. D2 receptors in the brain are not blocked by antidepressants. REF: Pg. 983

19. The most important determinant for prescribing therapy for acute stroke is 1. location of ischemia. 2. thrombotic versus embolic cause. 3. ischemic versus hemorrhagic cause. 4. age of the patient.

19. The most important determinant for prescribing therapy for acute stroke is 1. location of ischemia. 2. thrombotic versus embolic cause. 3. ischemic versus hemorrhagic cause. 4. age of the patient. ANS: C Treatment pathways differ between ischemic and hemorrhagic stroke. The goals of therapy for ischemic stroke are to minimize infarct size and preserve neurologic function. Secondary prevention for thrombotic stroke includes lifestyle modification to address risk factors. It is critical to prevent further hypoxia or ischemia after ischemic stroke regardless of the age of the patient. REF: Pg. 915

19. Which statements are true about post-traumatic stress disorder (PTSD)? (Select all that apply.) 1. PTSD occurs up to 1 month after an event. 2. PTSD is an acute condition. 3. Remission may take as long as 3 to 4 years. 4. Women appear to take longer to recover from PTSD than men. 5. Acute stress disorder and PTSD are precipitated by a traumatic event.

19. Which statements are true about post-traumatic stress disorder (PTSD)? (Select all that apply.) 1. PTSD occurs up to 1 month after an event. 2. PTSD is an acute condition. 3. Remission may take as long as 3 to 4 years. 4. Women appear to take longer to recover from PTSD than men. 5. Acute stress disorder and PTSD are precipitated by a traumatic event. ANS: D,E Women appear to take four times longer to recover from PTSD than men, and are two times more likely to meet the criteria for PTSD than men. Acute stress disorder is very similar to PTSD, as both are precipitated by a traumatic event. Acute stress disorder occurs up to 1 month after the event; PTSD occurs beyond 1 month. PTSD is typically a chronic condition. One longitudinal study with young adults reported that more than half of the sample showed no signs of remission after a 3- to 4-year period. REF: Pg. 994

2. In contrast to other cell types, nerve and muscle cells are able to conduct action potentials because they 1. are polarized to respond to membrane voltage. 2. are permeable to potassium at rest. 3. have voltage-gated ion channels. 4. are impermeable to sodium at rest.

2. In contrast to other cell types, nerve and muscle cells are able to conduct action potentials because they 1. are polarized to respond to membrane voltage. 2. are permeable to potassium at rest. 3. have voltage-gated ion channels. 4. are impermeable to sodium at rest. ANS: C Voltage-gated ion channels allow the cell membranes of excitable cell types, like nerve and muscle, to open and close inresponse to fluctuations in membrane voltage. Potassium channels allow for repolarization of cells. The cell membrane is permeable to potassium at rest. Fast sodium channels allow sodium influx during the upstroke of the action potential. REF: Pg. 881

2. Individuals with obsessive-compulsive disorder 1. are not aware that obsessive thoughts are from their own brains. 2. may become highly anxious if prevented from performing rituals. 3. have disordered thinking and poor reality orientation. 4. have a severe, unmanageable psychotic illness.

2. Individuals with obsessive-compulsive disorder 1. are not aware that obsessive thoughts are from their own brains. 2. may become highly anxious if prevented from performing rituals. 3. have disordered thinking and poor reality orientation. 4. have a severe, unmanageable psychotic illness. ANS: B Anxiety is frequently associated with the symptoms of OCD, and yielding to compulsions decreases anxiety temporarily. People with OCD typically strive to avoid disclosing their symptoms to relatives, friends, and health professionals. Disordered thinking and poor reality orientation are not associated with OCD patients. Individuals with OCD do not have severe

2. Manifestations of acute brain ischemia (Cushing reflex) are due primarily to 1. parasympathetic nervous system activation. 2. sympathetic nervous system activation. 3. autoregulation of body systems. 4. loss of brainstem reflexes.

2. Manifestations of acute brain ischemia (Cushing reflex) are due primarily to 1. parasympathetic nervous system activation. 2. sympathetic nervous system activation. 3. autoregulation of body systems. 4. loss of brainstem reflexes. ANS: B An extreme increase in ICP can precipitate an intense reaction by the sympathetic nervous system as it attempts to maintain cerebral perfusion through the compressed blood vessels. This has been termed an ischemic response or Cushing reflex. Manifestations of acute brain ischemia are due to sympathetic nervous system activation. The sympathetic nervous system activates to attempt to lower the intracranial pressure accompanied by acute brain ischemia. The Cushing reflex generally is viewed as a "last-ditch" effort by the brain to re-establish cerebral perfusion but is not due to loss of brainstem reflexes. REF: Pg. 904

2. The primary reason that prolonged seizure activity predisposes to ischemic brain damage is that 1. neurons are unable to transport glucose. 2. cardiovascular regulation is impaired. 3. the brainstem is depressed. 4. the lack of airway maintenance can lead to hypoxia.

2. The primary reason that prolonged seizure activity predisposes to ischemic brain damage is that 1. neurons are unable to transport glucose. 2. cardiovascular regulation is impaired. 3. the brainstem is depressed. 4. the lack of airway maintenance can lead to hypoxia. ANS: D Status epilepticus is a continuing series of seizures without a period of recovery between seizure episodes. Irreversible brain damage and possible death from hypoxia, cardiac arrhythmias, or lactic acidosis can occur if the airway is not maintained and seizure activity is not halted. Prolonged seizure activity is unrelated to glucose transportation by neurons. Status epilepticus can cause cardiac arrhythmias, but the primary concern of prolonged seizure activity is maintaining a proper airway. Brainstem depression is not the primary reason that prolonged seizure activity causes ischemic brain damage. REF: Pgs. 923-924

2. The usual age of onset for schizophrenia in men is 1. before puberty. 2. 15 to 25 years. 3. 40 to 65 years. 4. after 65 years.

2. The usual age of onset for schizophrenia in men is 1. before puberty. 2. 15 to 25 years. 3. 40 to 65 years. 4. after 65 years. ANS: B The most common age of onset and diagnosis is between 15 and 25 years for men. Women are typically diagnosed between 25and 35 years. Most persons first diagnosed with schizophrenia are between the ages of 15 and 54 years. The usual age of onset of schizophrenia occurs before the age of 25. REF: Pg. 975

20. Intracranial pressure normally ranges from ______ mm Hg. 1. 0 to 15 2. 10 to 20 3. 15 to 25 4. 20 to 30

20. Intracranial pressure normally ranges from ______ mm Hg. 1. 0 to 15 2. 10 to 20 3. 15 to 25 4. 20 to 30 ANS: A ICP is the pressure exerted by the contents of the cranium, and it normally ranges from 0 to 15 mm Hg. Normal ICP rangesfrom 0 to 15 mm Hg. Fifteen to 25 mm Hg is considered to be high. Elevated ICP may occur in most types of acute brain injury. ICP of 20 to 30 mm Hg is high and is associated with impaired neurologic function due to compression of brain structures. REF: Pg. 902

20. Which neurological disorder is commonly referred to as Lou Gehrig disease? 1. Multiple sclerosis 2. Parkinson disease 3. Alzheimer disease 4. Amyotrophic lateral sclerosis

20. Which neurological disorder is commonly referred to as Lou Gehrig disease? 1. Multiple sclerosis 2. Parkinson disease 3. Alzheimer disease 4. Amyotrophic lateral sclerosis ANS: D ALS is also known as Lou Gehrig disease, after the famed "Iron Man" of the New York Yankees, who died from the disease. Multiple sclerosis, Parkinson disease, and Alzheimer disease are not named after Lou Gehrig. REF: Pg. 935

20. Which statement is true about the incidence of mental illness? 1. There are minimal differences in how cultures view mental health. 2. Women have twice the risk of experiencing anxiety disorders than men. 3. Men are more likely to suffer from depression and anxiety than women are. 4. Mood disorders are not likely to occur after the age of 65.

20. Which statement is true about the incidence of mental illness? 1. There are minimal differences in how cultures view mental health. 2. Women have twice the risk of experiencing anxiety disorders than men. 3. Men are more likely to suffer from depression and anxiety than women are. 4. Mood disorders are not likely to occur after the age of 65. ANS: B Women are more than twice as likely to suffer from depression (including unipolar depression, dysthymia) and anxiety disorders (including panic disorder, post-traumatic stress disorder, generalized anxiety disorder, social anxiety, and phobias), than men. There are known differences in how cultures and regions around the world view mental health, and thus in how they express concerns about the body, self, and emotions. Reproductive hormones may play a role in exacerbating anxiety and depression in women. Mood disorders in the elderly are likely to be associated with concomitant illnesses or treatment. REF: Pg. 986

21. An elderly patient is taking antipsychotic drugs and begins to develop involuntary chewing motions. The patient is likely exhibiting signs of 1. dementia. 2. Parkinson disease. 3. tardive dyskinesia. 4. dysthymia.

21. An elderly patient is taking antipsychotic drugs and begins to develop involuntary chewing motions. The patient is likely exhibiting signs of 1. dementia. 2. Parkinson disease. 3. tardive dyskinesia. 4. dysthymia. ANS: C Older patients may suffer side effects such as tardive dyskinesia, a disorder related to antipsychotic drug dosage and duration and characterized by involuntary chewing motions and darting of the tongue. It is generally accepted practice that antidepressants should be prescribed at lower dosages and titrated upward more slowly in the elderly. Antipsychotic medication use is not related to the development of dementia. Parkinson disease is not diagnosed by involuntary chewing motions. Dysthymia is related to major depressive disorder. REF: Pg. 987

21. Which statement is true about the incidence of multiple sclerosis? 1. The age of onset ranges from 20 to 50 years. 2. MS is more common in men than women. 3. There is a higher incidence of MS in military veterans. 4. There is a higher rate of MS in African-Americans.

21. Which statement is true about the incidence of multiple sclerosis? 1. The age of onset ranges from 20 to 50 years. 2. MS is more common in men than women. 3. There is a higher incidence of MS in military veterans. 4. There is a higher rate of MS in African-Americans. ANS: A The age of onset of MS ranges from 20 to 50 years. MS is two to three times more common in women than in men. There is a higher incidence of ALS in military veterans, especially those of the Persian Gulf. MS occurs at a higher rate among individuals from Caucasian northern European descent and those who live in northern latitudes. REF: Pg. 932

21. ________ edema occurs when ischemic tissue swells because of cellular energy failure. a. Interstitial b. Osmotic c. Vasogenic d. Cytotoxic

21. ________ edema occurs when ischemic tissue swells because of cellular energy failure. a. Interstitial b. Osmotic c. Vasogenic d. Cytotoxic ANS: D Cytotoxic edema occurs when ischemic tissue swells because of cellular energy failure. A lack of ATP allows Na+ to accumulate in the cell, creating an osmotic force to draw in water. Interstitial edema is usually secondary to increased capillary pressure, damage to the capillary endothelium from a chemical injury, or sudden increase in vascular pressure beyond autoregulatory limits. A lack of ATP allows Na+ to accumulate in the cell, creating an osmotic force to draw in water. Vasogenic edema is a consequence of stroke, ischemia, and severe hypertension, and may occur surrounding brain tumors. REF: Pg. 903

22. A severe complication of elevated intracranial pressure is 1. Cushing reflex. 2. brain herniation. 3. burr hole. 4. hydrocephalus.

22. A severe complication of elevated intracranial pressure is 1. Cushing reflex. 2. brain herniation. 3. burr hole. 4. hydrocephalus. ANS: B A dreaded complication of elevated ICP is brain compression and herniation. Compression of midbrain and brainstem structures is associated with rapid neurologic demise unless corrected quickly. An extreme increase in ICP precipitates a reaction bythe sympathetic nervous system as it attempts to maintain perfusion. Cushing reflex is the brain's effort to reestablish cerebral perfusion. A burr hole is an opening in the skull which is used to monitor ICP. A cause of increased ICP is an excessive accumulation of CSF (hydrocephalus). REF: Pg. 904

22. Orthostatic hypotension may be a manifestation of 1. Alzheimer disease. 2. multiple sclerosis. 3. Parkinson disease. 4. amyotrophic lateral sclerosis.

22. Orthostatic hypotension may be a manifestation of 1. Alzheimer disease. 2. multiple sclerosis. 3. Parkinson disease. 4. amyotrophic lateral sclerosis. ANS: C In patients with Parkinson disease, involvement of the autonomic nervous system may result in orthostatic hypotension. Alzheimer disease is not typically associated with orthostatic hypotension. Orthostatic hypotension is not associated with multiple sclerosis. Amyotrophic lateral sclerosis is not manifested by orthostatic hypotension. REF: Pg. 929

22. When a client is diagnosed with schizophrenia and asks what could have caused the disorder, the statements that could serve as a basis for answering include which of the following? (Select all that apply.) 1. Schizophrenia may be related to abnormal cerebral structure. 2. Schizophrenia is inherited as an autosomal recessive gene defect. 3. Schizophrenia often develops in the absence of family psychopathology. 4. Chronic prolonged stress may contribute to development of schizophrenia. 5. Symptoms of schizophrenia may be associated with smoking.

22. When a client is diagnosed with schizophrenia and asks what could have caused the disorder, the statements that could serve as a basis for answering include which of the following? (Select all that apply.) 1. Schizophrenia may be related to abnormal cerebral structure. 2. Schizophrenia is inherited as an autosomal recessive gene defect. 3. Schizophrenia often develops in the absence of family psychopathology. 4. Chronic prolonged stress may contribute to development of schizophrenia. 5. Symptoms of schizophrenia may be associated with smoking. ANS: A, C, D A groundbreaking study showed that the neurochemical basis of schizophrenia might involve two processes: dopamine neurotransmission dysregulation and abnormal cerebral structure. Schizophrenia can and does develop in persons with no family history. In MRI studies of persons with schizophrenia, a link was found when psychological stress was placed on an individual. Genetic studies have found that the percentage of offspring who do and do not develop schizophrenia is about equal. Tobacco dependence is a common secondary disorder with schizophrenia. REF: Pgs. 976-977

23. A tool used to assess levels of consciousness is 1. magnetic resonance imaging (MRI). 2. intracranial pressure (ICP) monitoring. 3. Glasgow Coma Scale (GCS). 4. central perfusion pressure (CPP).

23. A tool used to assess levels of consciousness is 1. magnetic resonance imaging (MRI). 2. intracranial pressure (ICP) monitoring. 3. Glasgow Coma Scale (GCS). 4. central perfusion pressure (CPP). ANS: C The Glasgow Coma Scale (GCS) is a standardized tool developed for the purpose of assessing the level of consciousness in acutely brain-injured patients. An MRI is useful in evaluating a patient with an increase in ICP or change in mental status. ICP monitoring is useful in monitoring and treating patients with head trauma or other sources of excessive CSF. Central perfusion pressure is a useful tool in guiding therapy along with ICP. REF: Pg. 907

23. Which conditions are risk factors for the development of cerebral palsy? (Select all that apply.) 1. Birth trauma 2. Seizure disorder 3. Kernicterus 4. Prenatal maternal infection 5. Scoliosis

23. Which conditions are risk factors for the development of cerebral palsy? (Select all that apply.) 1. Birth trauma 2. Seizure disorder 3. Kernicterus 4. Prenatal maternal infection 5. Scoliosis ANS: A, C, D Mechanical trauma to the head before, during, or after birth is a factor in cerebral palsy. Kernicterus is an etiologicfactor associated with cerebral palsy. Etiologic factors associated with cerebral palsy include prenatal infections or diseases of the mother. Seizure disorder is not associated with the development of cerebral palsy. Scoliosis may contribute to health decline in older individuals with cerebral palsy. REF: Pg. 929

23. Which symptoms would support a diagnosis of major depressive disorder? (Select all that apply.) 1. Diminished interest or pleasure 2. Incomprehensible speech 3. Altered reality 4. Psychomotor agitation or retardation 5. Appetite disturbance

23. Which symptoms would support a diagnosis of major depressive disorder? (Select all that apply.) 1. Diminished interest or pleasure 2. Incomprehensible speech 3. Altered reality 4. Psychomotor agitation or retardation 5. Appetite disturbance ANS: A, D, E To be diagnosed with MDD, an individual must experience five (or more) specified symptoms during the same 2-week period; this must also represent a change from previous functioning. In addition, at least one of the symptoms must be either depressed mood or loss of interest or pleasure. Symptoms include depressed mood, diminished interest or pleasure, appetite disturbance, insomnia, hypersomnia, psychomotor agitation or retardation. Incomprehensible speech is associated with a positive symptom of schizophrenia. Altered reality is a symptom of psychosis. REF: Pgs. 982-983

24. The first indication of brain compression from increasing intracranial pressure (ICP) may be 1. decorticate posturing. 2. absence of verbalization. 3. sluggish pupil response to light. 4. Glasgow Coma Scale score of 13.

24. The first indication of brain compression from increasing intracranial pressure (ICP) may be 1. decorticate posturing. 2. absence of verbalization. 3. sluggish pupil response to light. 4. Glasgow Coma Scale score of 13. ANS: C Careful monitoring of the pupillary response to light during the acute phase is critical, as a failing response may be the first indication of brain compression from increasing ICP. Mild dilation of a pupil with sluggish or absent light response is ominous. Decorticate posturing is related to a deteriorating motor status. Absence of verbalization is not the first indication of brain compression. A GCS score of 13 is not the first indication of brain compression. Although, acute changes in level of consciousness should be further investigated. REF: Pgs. 908-909

24. Which are common causes of acquired parkinsonism? (Select all that apply.) 1. Degeneration of dopaminergic neurons 2. History of infection 3. History of intoxication 4. History of trauma 5. Seizure disorder

24. Which are common causes of acquired parkinsonism? (Select all that apply.) 1. Degeneration of dopaminergic neurons 2. History of infection 3. History of intoxication 4. History of trauma 5. Seizure disorder ANS: B, C, D Common causes of acquired parkinsonism include infection, intoxication, and trauma. Typically, parkinsonism due to drug toxicity evolves rapidly, unlike the slow, insidious onset of the idiopathic disease. Parkinson disease results from degeneration of the pigmented dopaminergic neurons found in the substantia nigra. Acquired parkinsonism is not related to seizure disorder. REF: Pg. 927

25. A level of ____ on the Glasgow Coma Scale indicates likely fatal damage. a. 3 b. 8 c. 12 d. 15

25. A level of ____ on the Glasgow Coma Scale indicates likely fatal damage. a. 3 b. 8 c. 12 d. 15 ANS: A On the GCS, the lowest total score of 3 indicates likely fatal damage, especially if both pupils fail to respond to light and oculovestibular responses are absent; however, the severity and prognosis are predicted more accurately by also considering diagnostic imaging and other factors. A GCS level of 8 indicates severe damage. A GCS level of 12 or higher indicates mild damage. A GCS level of 15 is considered to be normal. REF: Pg. 908

26. ________ occurs when a brainstem impaired patient exhibits a persistent rhythmic or jerky movement in one or both eyes. 1. Nystagmus 2. Dysconjugate movement 3. Ocular palsy 4. Doll's eye

26. ________ occurs when a brainstem impaired patient exhibits a persistent rhythmic or jerky movement in one or both eyes. 1. Nystagmus 2. Dysconjugate movement 3. Ocular palsy 4. Doll's eye ANS: A Nystagmus is a persistent rhythmic or jerky movement in one or both eyes. Dysconjugate movements occur when the eyes donot move together in the same direction. Ocular palsies occur when one or more cranial nerves are dysfunctional such that motor paralysis of the eye muscles impairs movements in one or more directions. The doll's-eyes test is performed by holding open the patient's eyelids and rotating the head from one side to the other. If the brainstem is intact, the eyes will turn in adirection opposite to the direction of head rotation. REF: Pg. 909

27. Stroke is the leading cause of disability in the United States. Among the long-term survivors, the most common disability is 1. inability to perform ADLs. 2. aphasia. 3. clinical depression. 4. hemiparesis.

27. Stroke is the leading cause of disability in the United States. Among the long-term survivors, the most common disability is 1. inability to perform ADLs. 2. aphasia. 3. clinical depression. 4. hemiparesis. ANS: D Stroke is the leading cause of serious disability. Among long-term survivors (>6 months), 50% have hemiparesis. Twenty-six percent of stroke survivors have an inability to perform activities of daily living in an independent manner. Nineteen percent of stroke survivors have aphasia. Clinical depression affects 35% of stroke survivors. REF: Pg. 913

28. Which brain disorders are a cause of acute brain injury? (Select all that apply.) 1. Seizure disorders 2. Brain trauma 3. Dementias 4. Brain hemorrhage 5. Central nervous system infections.

28. Which brain disorders are a cause of acute brain injury? (Select all that apply.) 1. Seizure disorders 2. Brain trauma 3. Dementias 4. Brain hemorrhage 5. Central nervous system infections. ANS: B, D, E Brain trauma is a primary cause of acute brain injury. Brain hemorrhage is a primary cause of acute brain injury. Earlydetection and prompt management are necessary to prevent death and minimize morbidity. CNS infections are an acute cause of brain injury and progress rapidly. Seizure disorders and dementias are chronic aspects of neurologic diseases. REF: Pg. 899

3. The dementia of Alzheimer disease is associated with structural changes in the brain, including 1. deposition of amyloid plaques in the brain. 2. degeneration of basal ganglia. 3. hypertrophy of frontal lobe neurons. 4. significant aluminum deposits in the brain.

3. The dementia of Alzheimer disease is associated with structural changes in the brain, including 1. deposition of amyloid plaques in the brain. 2. degeneration of basal ganglia. 3. hypertrophy of frontal lobe neurons. 4. significant aluminum deposits in the brain. ANS: A The hallmark pathophysiologic changes associated with Alzheimer disease include intracellular neurofibrillary tangles and extracellular amyloid plaques. Degeneration of the basal ganglia is not associated with dementia of Alzheimer disease. Brain atrophy occurs as a result of the amyloid plaques in the brain. Aluminum deposits in the brain are not responsible for dementia of Alzheimer disease. REF: Pg. 925

3. The fearful expectation of panic anxiety is known as 1. a nervous breakdown. 2. anticipatory anxiety. 3. a phobia. 4. avoidance anxiety

3. The fearful expectation of panic anxiety is known as 1. a nervous breakdown. 2. anticipatory anxiety. 3. a phobia. 4. avoidance anxiety ANS: B Anticipatory anxiety refers to fearful expectation of panic anxiety onset. Patients may seek medical attention for what they perceive as a nervous breakdown. Panic attacks can be situational. Avoidance anxiety refers to personal strategies used to increase feelings of control and thereby decrease the risk of panic anxiety.

3. The resting membrane potential in nerve and skeletal muscle is determined primarily by 1. extracellular sodium ion concentration. 2. the ratio of intracellular to extracellular potassium ion. 3. activation of voltage-gated sodium channels. 4. activity of energy-dependent membrane ion pumps.

3. The resting membrane potential in nerve and skeletal muscle is determined primarily by 1. extracellular sodium ion concentration. 2. the ratio of intracellular to extracellular potassium ion. 3. activation of voltage-gated sodium channels. 4. activity of energy-dependent membrane ion pumps. ANS: B At equilibrium, the electrical gradient pulling K+ into the cell and the chemical gradient pulling it out are balanced. This equilibrium point leaves a few extra negatively charged ions inside the cell with no positive ion to neutralize them. The resting membrane potential in nerve and skeletal muscle is not determined by the extracellular sodium concentration. The membrane potential changes in response to potassium changes. Ion channels open and close in response to fluctuations in membrane voltage, but the resting membrane potential is not determined by the activity of membrane ion pumps. REF: Pg. 881

3. Which manifestation is characteristic of the "positive" symptoms of schizophrenia? 1. Social withdrawal 2. Flat affect 3. Lack of speech 4. Hallucinations

3. Which manifestation is characteristic of the "positive" symptoms of schizophrenia? 1. Social withdrawal 2. Flat affect 3. Lack of speech 4. Hallucinations ANS: D Positive symptoms include the psychotic dimension, or distortions in thought content (delusions) and perception (hallucinations), as well as the disorganization dimension, or disorganization in speech and behavior. Asociality is considered a negative symptom. Flat affect is considered to be a cognitive symptom. Lack of speech is not considered to be a positive symptom of schizophrenia. REF: Pg. 978

4. Before making a diagnosis of Alzheimer disease 1. a brain biopsy demonstrating organic changes is necessary. 2. biochemical tests for aluminum toxicity must be positive. 3. other potential causes of dementia must be ruled out. 4. increased protein is found in a lumbar puncture.

4. Before making a diagnosis of Alzheimer disease 1. a brain biopsy demonstrating organic changes is necessary. 2. biochemical tests for aluminum toxicity must be positive. 3. other potential causes of dementia must be ruled out. 4. increased protein is found in a lumbar puncture. ANS: C All manageable causes for dementia or delirium should be ruled out before diagnosing Alzheimer disease. Neuroimaging may be useful in ruling out other neurologic diagnoses. A brain biopsy is not indicated. Evaluation of blood chemistry does not include the presence of aluminum. Increased protein in a lumbar puncture is not indicative of Alzheimer dementia. REF: Pg. 927

4. Exocytosis of neurotransmitter in response to depolarization of the presynaptic nerve membrane is mediated by 1. neurotransmitter binding to presynaptic carrier proteins. 2. potassium influx through voltage-gated channels. 3. sodium-potassium ATPase. 4. calcium influx through voltage-gated channels.

4. Exocytosis of neurotransmitter in response to depolarization of the presynaptic nerve membrane is mediated by 1. neurotransmitter binding to presynaptic carrier proteins. 2. potassium influx through voltage-gated channels. 3. sodium-potassium ATPase. 4. calcium influx through voltage-gated channels. ANS: D Calcium influx mediates exocytosis of neurotransmitter into the interneuronal synapse. Neurotransmitter binds and activates specific receptors on the postsynaptic cell. Depolarization opens voltage-gated calcium channels. Exocytosis is not mediated by sodium-potassium ATPase. REF: Pg. 889

4. It is true that panic disorders 1. are diagnosed more often in women. 2. are diagnosed more often in men. 3. generally occur after age 45. 4. are common in the elderly.

4. It is true that panic disorders 1. are diagnosed more often in women. 2. are diagnosed more often in men. 3. generally occur after age 45. 4. are common in the elderly. ANS: A Depending on the subtype, panic disorder is diagnosed two to three times more often in women than in men. Panic disorders are diagnosed more often in women. Initial onset usually occurs in late adolescence or young adulthood, with a mean age of onset of 26.6 years. Initial symptom onset in older age adults is less typical. REF: Pg. 991

4. It is true that the "negative" symptoms of schizophrenia 1. are more easily managed than the positive symptoms. 2. are thought to be mediated by D1 receptors in the brain. 3. include rambling speech and delusional thoughts. 4. are due to a deficiency of brain dopamine.

4. It is true that the "negative" symptoms of schizophrenia 1. are more easily managed than the positive symptoms. 2. are thought to be mediated by D1 receptors in the brain. 3. include rambling speech and delusional thoughts. 4. are due to a deficiency of brain dopamine. ANS: B Negative symptoms of schizophrenia are thought to be associated with dopamine D1 receptor activity in the brain. Negative symptoms can be more difficult to recognize than positive symptoms. Rambling speech and delusional thoughts are positive symptoms. The positive symptoms of schizophrenia are thought to result from excessive dopamine D2 receptor activity in the brain. REF: Pg. 978

5. Acetylcholine is released into the synapse by 1. passive reuptake of acetylcholine into the presynaptic neuron. 2. active reuptake of acetylcholine into the presynaptic neuron. 3. passive diffusion into the postsynaptic membrane. 4. degradation by acetylcholinesterase.

5. Acetylcholine is released into the synapse by 1. passive reuptake of acetylcholine into the presynaptic neuron. 2. active reuptake of acetylcholine into the presynaptic neuron. 3. passive diffusion into the postsynaptic membrane. 4. degradation by acetylcholinesterase. ANS: D When acetylcholine is released into the synapse, it is quickly degraded by acetylcholinesterase to limit the duration ofaction. Acetylcholine receptors provide a negative feedback loop. The presynaptic neuron monitors the amount of acetylcholine inthe synapse. Acetylcholine is not cleared by passive diffusion. REF: Pgs. 881-882

5. Depression is thought to be associated with 1. abnormal personality development. 2. early childhood emotional trauma. 3. deficient brain norepinephrine and serotonin. 4. excessive stimulation of D1 and D2 receptors in the brain.

5. Depression is thought to be associated with 1. abnormal personality development. 2. early childhood emotional trauma. 3. deficient brain norepinephrine and serotonin. 4. excessive stimulation of D1 and D2 receptors in the brain. ANS: C Depression is thought to occur when serotonin and norepinephrine activity in the brain is low. Depression is not associated with abnormal personality development. Early childhood emotional trauma is not necessarily associated with depression. Symptoms associated with schizophrenia are thought to be related to dopamine receptors. REF

5. Early treatment of panic anxiety disorder focuses on 1. the use of sedative agents. 2. cognitive-behavioral therapy. 3. dopamine antagonistic medications. 4. the use of respiratory stimulants.

5. Early treatment of panic anxiety disorder focuses on 1. the use of sedative agents. 2. cognitive-behavioral therapy. 3. dopamine antagonistic medications. 4. the use of respiratory stimulants. ANS: B Panic anxiety disorder can be effectively managed with cognitive-behavioral therapy aimed at reducing fearful thinking and desensitization of cognitive and physical stress responses. When panic symptoms are disabling, medication for symptom management is recommended. Long-acting benzodiazepines, such as clonazepam, are the sedatives of choice when short-term calming and symptom relief are mandatory. Many atypical psychiatric medications that can target serotonin, dopamine, or norepinephrine receptors have been clinically tested and shown to be effective treatment for anxiety symptoms. Respiratory stimulants have not been found to be effective in early treatment of panic anxiety disorders. REF

5. Parkinson disease is associated with 1. demyelination of CNS neurons. 2. a pyramidal nerve tract lesion. 3. insufficient production of acetylcholine in the basal ganglia. 4. a deficiency of dopamine in the substantia nigra.

5. Parkinson disease is associated with 1. demyelination of CNS neurons. 2. a pyramidal nerve tract lesion. 3. insufficient production of acetylcholine in the basal ganglia. 4. a deficiency of dopamine in the substantia nigra. ANS: D Parkinson disease results from degeneration of the pigmented dopaminergic neurons found in the substantia nigra. Demyelination of CNS neurons is not associated with Parkinson disease. Parkinson disease is not associated with a pyramidal nerve tract lesion. Decreased acetylcholine synthesis has been found in some studies related to Alzheimer disease. REF: Pg. 927

6. A patient who experiences sudden-onset, acute fearfulness for no apparent reason has a disorder called 1. generalized anxiety disorder. 2. phobia. 3. panic disorder. 4. post traumatic stress disorder.

6. A patient who experiences sudden-onset, acute fearfulness for no apparent reason has a disorder called 1. generalized anxiety disorder. 2. phobia. 3. panic disorder. 4. post traumatic stress disorder. ANS: C Panic disorder is characterized by acute episodes of anxiety symptoms that are unexpected, sudden, recurrent, and generate intense feelings of fear. Generalized anxiety disorder is characterized by chronic, persistent worry. Phobias are not related toanxiety, which occurs for no apparent reason. While PTSD is an anxiety disorder it has a known traumatic cause. REF: Pgs. 990-991

6. An example of inappropriate treatment for head trauma would be 1. head elevation. 2. free water restriction. 3. hypoventilation. 4. bed rest.

6. An example of inappropriate treatment for head trauma would be 1. head elevation. 2. free water restriction. 3. hypoventilation. 4. bed rest. ANS: C Hyperventilation, not hypoventilation, is indicated in the management of an acute elevation of intracranial pressure. Elevating the head is aimed at maintaining intracranial pressure and cerebral blood flow. Normal intravascular volume is indicated in the management of intracranial pressure. Bed rest would be indicated for the head trauma patient. REF: Pg. 912

6. Binding of neurotransmitter to receptors on the postsynaptic neuronal membrane results in 1. a change in ion conductance through the membrane. 2. the opening of voltage-gated calcium channels. 3. an action potential. 4. hyperpolarization.

6. Binding of neurotransmitter to receptors on the postsynaptic neuronal membrane results in 1. a change in ion conductance through the membrane. 2. the opening of voltage-gated calcium channels. 3. an action potential. 4. hyperpolarization. ANS: A Postsynaptic neurons have receptors for these neurotransmitters and respond by changing the flow of ions through channels in the cell membrane. Action potentials reaching the axon terminal open voltage-gated calcium channels. Depolarization of the neuronal membrane results in the generation of action potentials. Some neurotransmitters inhibit depolarization and may produce hyperpolarization of the postsynaptic membrane by opening Cl- or K+ channels. REF: Pgs. 880-881

6. Dopamine precursors and anticholinergics are all used in the management of Parkinson disease, because they 1. increase dopamine activity in the basal ganglia. 2. induce regeneration of neurons in the basal ganglia. 3. prevent progression of the disease. 4. produce excitation of basal ganglia structures.

6. Dopamine precursors and anticholinergics are all used in the management of Parkinson disease, because they 1. increase dopamine activity in the basal ganglia. 2. induce regeneration of neurons in the basal ganglia. 3. prevent progression of the disease. 4. produce excitation of basal ganglia structures. ANS: A The mainstay of Parkinson therapy has been aimed at increasing the level of dopamine in the CNS. Anticholinergics and dopamine precursors are not related to regeneration of neurons. Preventing the progression of Parkinson disease is not the mechanism of action in medications used to treat the disease. Excitation of basal ganglia structures is not produced with dopamine precursors and anticholinergics. REF: Pg. 929

6. Mania and depression are both characterized by 1. high energy and hyperactivity. 2. poor appetite. 3. hopelessness. 4. altered decision-making ability.

6. Mania and depression are both characterized by 1. high energy and hyperactivity. 2. poor appetite. 3. hopelessness. 4. altered decision-making ability. ANS: D Depression is manifested by reduced decision-making capacity and mania is manifested by an inability to concentrate. High energy and hyperactivity is seen in mania only. Depression is manifested by poor appetite, whereas mania is associated with anincreased appetite. Hopelessness is associated with depression. REF: Pg. 987

7. A common inhibitory central nervous system (CNS) neurotransmitter is 1. acetylcholine. 2. norepinephrine. 3. -aminobutyric acid (GABA). 4. glutamate.

7. A common inhibitory central nervous system (CNS) neurotransmitter is 1. acetylcholine. 2. norepinephrine. 3. -aminobutyric acid (GABA). 4. glutamate. ANS: C Glycine and GABA are inhibitory amino acids and are located throughout the spinal cord and brain. Acetylcholine is the sole neurotransmitter in its class. Norepinephrine is an amine that is involved in the limbic system, hypothalamus, and basal ganglia. Glutamate is a principal excitatory amino acid. REF: Pg. 881

7. Lithium is used to manage mania because it 1. inhibits norepinephrine and serotonin activity in the brain. 2. is a CNS sedative. 3. is converted to catecholamines within the brain. 4. blocks D2 receptors in the brain.

7. Lithium is used to manage mania because it 1. inhibits norepinephrine and serotonin activity in the brain. 2. is a CNS sedative. 3. is converted to catecholamines within the brain. 4. blocks D2 receptors in the brain. ANS: A The management of mania is accomplished with the use of lithium because it inhibits the action of norepinephrine and serotonin in the brain. Mania is not managed with the use of a CNS sedative. The mechanism of lithium is not related to a conversion of catecholamine in the brain. Lithium does not have a mechanism of action where D2 receptors in the brain are blocked. REF: Pg. 987

7. Persistent, intrusive, uncontrollable thoughts that an individual recognizes as a product of his or her own mind are called a. compulsions. b. delusions. c. obsessions. d. hallucinations.

7. Persistent, intrusive, uncontrollable thoughts that an individual recognizes as a product of his or her own mind are called a. compulsions. b. delusions. c. obsessions. d. hallucinations. ANS: C Obsessions are strong, persistent, intrusive, uncontrollable thoughts. Compulsions are repetitive, ritualistic behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person performswith urgency and rigidly. Delusions are not persistent, intrusive, uncontrollable thoughts. Hallucinations are not persistent, intrusive, uncontrollable thoughts that an individual recognizes as a product of his or her own mind. REF: Pg. 994

7. Risk factors for hemorrhagic stroke include 1. atherosclerosis. 2. dysrhythmias. 3. acute hypertension. 4. sedentary lifestyle.

7. Risk factors for hemorrhagic stroke include 1. atherosclerosis. 2. dysrhythmias. 3. acute hypertension. 4. sedentary lifestyle. ANS: C Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often long-standing hypertension. Risk factors for stroke are similar to those for other atherosclerotic vascular disease. Cardiac disease complicated by atrial fibrillation is an important risk factor for embolic stroke. Sedentary lifestyle is not a risk factor for hemorrhagic stroke. REF: Pgs. 914-915

7. The classic manifestations of Parkinson disease include 1. intention tremor and akinesia. 2. rest tremor and skeletal muscle rigidity. 3. ataxia and intention tremor. 4. skeletal muscle rigidity and intention tremor.

7. The classic manifestations of Parkinson disease include 1. intention tremor and akinesia. 2. rest tremor and skeletal muscle rigidity. 3. ataxia and intention tremor. 4. skeletal muscle rigidity and intention tremor. ANS: B Tremor is often the first symptom of Parkinson disease that prompts patients to seek treatment. The tremor is generally at rest, unilateral affecting distal extremities. Difficulty initiating and controlling movements results in akinesia, tremor, and rigidity. The clinical manifestations of cerebellar disorders primarily include ataxia, hypotonia, intention tremors, and disturbances of gait and balance. Skeletal muscle rigidity and intention tremors are not the classic manifestations of Parkinson disease. REF: Pg. 928

8. Axonal myelination generally increases the 1. metabolic needs of the neuron. 2. flow of ions across the neuronal membrane. 3. sodium permeability. 4. speed of action potential conduction.

8. Axonal myelination generally increases the 1. metabolic needs of the neuron. 2. flow of ions across the neuronal membrane. 3. sodium permeability. 4. speed of action potential conduction. ANS: D The speed at which an action potential travels is determined by axonal diameter and myelination. Larger and myelinated neurons conduct impulses more quickly. The metabolic needs of the neuron are not increased by axonal myelination. The flow of ions across the membrane occurs in response to membrane voltage. When neurotransmitters bind to receptors on the dendrite and cell body, sodium is allowed to leak in. REF: Pg. 881

8. Drugs that inhibit reuptake of norepinephrine or serotonin may be helpful in the management of 1. schizophrenia. 2. panic attacks. 3. depression. 4. delusional disorder.

8. Drugs that inhibit reuptake of norepinephrine or serotonin may be helpful in the management of 1. schizophrenia. 2. panic attacks. 3. depression. 4. delusional disorder. ANS: C The management of major depressive disorder is aimed at increasing norepinephrine and serotonin activity in the brain. The goal of therapy in the management of schizophrenia is to alleviate some of the negative symptoms by blocking D1 receptors. Drugs that inhibit the reuptake of norepinephrine or serotonin are not useful in managing panic attacks. Delusional disorder is not managed with drugs that inhibit the reuptake of norepinephrine or serotonin. REF: Pg. 983

8. The stroke etiology with the highest morbidity and mortality is 1. intracranial hemorrhage. 2. intracranial thrombosis. 3. intracranial embolization. 4. cardiac arrest.

8. The stroke etiology with the highest morbidity and mortality is 1. intracranial hemorrhage. 2. intracranial thrombosis. 3. intracranial embolization. 4. cardiac arrest. ANS: A Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often longstanding hypertension. It carries a 38% mortality, with death usually occurring within minutes to hours. Ischemic strokes are the most common and include thrombotic and embolic types. Embolic and ischemic strokes are the most common type. Stroke is the third leading cause of death in the United States. Cardiac arrest is not the stroke etiology with the highest morbidity and mortality. REF: Pgs. 914-915

8. What effect do demyelinating disorders such as multiple sclerosis have on neurotransmission? 1. Slower rate of action potential conduction 2. Increased rate of action potential conduction 3. Facilitation of action potential initiation 4. Faster rate of repolarization

8. What effect do demyelinating disorders such as multiple sclerosis have on neurotransmission? 1. Slower rate of action potential conduction 2. Increased rate of action potential conduction 3. Facilitation of action potential initiation 4. Faster rate of repolarization ANS: A The inflammation and scarring that occur with MS slow or interrupt the conduction of nerve impulses. Multiple sclerosis does not have an increased rate of action potential conduction on neurotransmission. Action potential initiation is not facilitated in demyelinating disorders. There is not a faster rate of repolarization in demyelinating disorders such as MS. REF: Pg. 932

9. A client who reported hearing voices, some of them saying bad and hurtful things, will now eat only food from unopened sealed packages. The behaviors described indicate that the patient may be experiencing a(n) _____ disorder. a. bipolar b. obsessive-compulsive c. personality d. psychotic

9. A client who reported hearing voices, some of them saying bad and hurtful things, will now eat only food from unopened sealed packages. The behaviors described indicate that the patient may be experiencing a(n) _____ disorder. a. bipolar b. obsessive-compulsive c. personality d. psychotic ANS: D Psychosis associated with MDD is thought to result from extreme symptoms of a prolonged duration. Auditory hallucinations, delusions and disorganization may become prominent symptoms. Bipolar disorder is characterized by recurring symptoms of depression and elation. Obsessive-compulsive disorder is not typically evidenced by withdrawn behavior or auditory hallucinations. Withdrawn behavior and auditory hallucinations are symptoms of psychosis. REF: Pg. 983

9. Clinical manifestations of a stroke within the right cerebral hemisphere include 1. cortical blindness. 2. right visual field blindness. 3. expressive and receptive aphasia. 4. left-sided muscle weakness and neglect.

9. Clinical manifestations of a stroke within the right cerebral hemisphere include 1. cortical blindness. 2. right visual field blindness. 3. expressive and receptive aphasia. 4. left-sided muscle weakness and neglect. ANS: D Manifestations of ischemic stroke are related to the cerebral vasculature involved and the area of brain tissue the vessel supplies. Contralateral hemiplegia is a usual finding. Contralateral hemiplegia, hemisensory loss, and contralateral visual field blindness are usual manifestations of stroke. Left visual blindness would be more indicative of a stroke affecting the right cerebral hemisphere. Aphasia is an integrative language disorder that occurs with brain damage to the dominant cerebral hemisphere (usually left) and involves all language modalities. REF: Pgs. 913-914

9. One component of the peripheral nervous system is the 1. cerebral cortex. 2. brainstem. 3. spinal cord. 4. spinal nerve.

9. One component of the peripheral nervous system is the 1. cerebral cortex. 2. brainstem. 3. spinal cord. 4. spinal nerve. ANS: D The peripheral nervous system consists of 31 pairs of spinal nerves. The cerebral cortex is not a component of the peripheral nervous system. The brainstem is not a component of the peripheral nervous system. The spinal cord is not a part of the peripheral nervous system. REF: Pg. 869

9. Steroids may be used in the management of acute exacerbation of symptoms in patients with multiple sclerosis, because 1. viral damage can be inhibited. 2. demyelination is mediated by immune mechanisms. 3. steroids reverse the progression of the disease. 4. steroids inhibit synaptic degradation of neurotransmitters.

9. Steroids may be used in the management of acute exacerbation of symptoms in patients with multiple sclerosis, because 1. viral damage can be inhibited. 2. demyelination is mediated by immune mechanisms. 3. steroids reverse the progression of the disease. 4. steroids inhibit synaptic degradation of neurotransmitters. ANS: B In the treatment of MS, corticosteroids such as prednisone are used to reduce edema and the inflammatory response in acute exacerbations. Steroids are not used to inhibit viral damage in patients with MS. Recovery may be hastened by the use of steroids, but the extent of recovery is unchanged. Steroids are not utilized as synaptic degradation inhibitors. REF: Pgs. 932-933