Pathophysiology Chapter 17 – Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function

Pathophysiology

Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function

MULTIPLE CHOICE

1. Cognitive operations cannot occur without the effective functioning of what part of the brain?

a. Pons

b. Medulla oblongata

c. Reticular activating system

d. Cingulate gyrus

 

2. Which intracerebral disease process is capable of producing diffuse dysfunction?

a. Closed-head trauma with bleeding

b. Subdural pus collections

c. Neoplasm

d. Embolic infarct

 

3. What is the most common infratentorial brain disease process that results in the direct destruction of the reticulating activation system (RAS)?

a. Cerebrovascular disease

b. Demyelinating disease

c. Neoplasms

d. Abscesses

 

4. What stimulus causes posthyperventilation apnea (PHVA)?

a. Changes in PaO2 levels

b. Changes in PaCO2 levels

c. Damage to the forebrain

d. Any arrhythmic breathing pattern

 

5. A healthcare professional reads in the patient’s chart and notes the patient has Cheyne-Stokes respirations. What clinical finding would the professional correlate with this condition?

a. Sustained deep rapid but regular pattern of breathing

b. Crescendo-decrescendo pattern of breathing, followed by a period of apnea

c. Prolonged pause after the inspiratory period with occasional end-expiratory pause

d. Completely random, irregular breathing pattern with pauses

 

6. Vomiting is associated with central nervous system (CNS) injuries that compress which of the brain’s anatomic locations?

a. Vestibular nuclei in the lower brainstem

b. Floor of the third ventricle

c. Any area in the midbrain

d. Diencephalon

 

7. Which midbrain dysfunction causes pupils to be pinpoint size and fixed in position?

a. Diencephalon dysfunction

 b. Oculomotor cranial nerve dysfunction

c. Dysfunction of the tectum

d. Pontine dysfunction

 

8. A healthcare professional suspects a patient is brain dead. How would the professional assess for brain death?

a. Determine if the patient can make voluntary movements.

b. Perform tests to assess if the patient is in a coma.

c. Remove the patient’s ventilator to see if spontaneous breathing occurs.

d. Monitor the patient for eye movements that seem purposeful.

 

9. A patient has damage to the lower pons and medulla. What finding does the healthcare professional associate with this injury?

a. Flexion with or without extensor response of the lower extremities

b. Extension response of the upper and lower extremities

c. Extension response of the upper extremities and flexion response of the lower

extremities

d. Flaccid response in the upper and lower extremities

 

10Which hospitalized patient does the healthcare professional assess as a priority for the development of delirium?

a. An individual with diabetes celebrating a 70th birthday

b. A depressed Hispanic woman

 c. An elderly male on the second day after hip replacement

d. A man diagnosed with schizophrenia

 

11. A patient suffered a seizure for the first time. The spouse asks the healthcare professional to explain what a seizure is. What response by the professional is best?

a. Actions that occur without conscious thought because of a stimulus

b. A sudden, explosive, disorderly discharge of brain cells

c. A disease where a person has frequent seizures like this one

d. A series of excessive, purposeless movements.

 

12. A patient had a seizure that consisted of impaired consciousness and the appearance of a dreamlike state. How does the healthcare professional chart this episode?

a. Focal seizure

b. Complex focal seizure

c. Tonic-clonic seizure

d. Atonic seizure

 

13. A patient is in status epilepticus. In addition to giving medication to stop the seizures, what would the healthcare professional place highest priority on?

a. Facilitating a CT scan of the head

b. Providing oxygen

c. Assessing for brain death

d. Assessing for drug overdose

 

14. What is the most critical aspect in correctly diagnosing a seizure disorder and establishing its cause?

a. Computed tomographic (CT) scan

b. Cerebrospinal fluid analysis

c. Skull x-ray studies

d. Health history

 

15. What area of the brain mediates the executive attention functions?

a. Limbic

b. Prefrontal

c. Parietal

d. Occipital

 

16. A healthcare professional is caring for a patient diagnosed with aphasia. What action by the professional would be best in working with this patient?

a. Provide physical therapy.

b. Provide speech therapy.

c. Provide special thickened foods.

d. Provide balance activities.

 

17. A patient’s chart notes receptive aphasia. What does the healthcare professional understand about this patient’s abilities related to speech?

a. Speak in made up words.

b. Produce verbal speech, but not comprehend language.

c. Comprehend speech, but not verbally respond.

d. Neither respond verbally nor comprehend speech.

 

18. The healthcare professional notes that the patient’s intracranial pressure is 12 mmHg. What action should the professional take?

a. Do nothing; this is a normal finding.

b. Give medications to immediately lower the pressure.

c. Give medication to immediately raise the pressure.

d. Repeat the reading because the first one was inaccurate.

 

19. Cerebral edema is an increase in the fluid content of what part of the brain?

a. Ventricles

b. Tissue

c. Neurons

d. Meninges

 

20. What type of cerebral edema occurs when permeability of the capillary endothelium increases after injury to the vascular structure?

a. Cytotoxic

b. Interstitial

c. Vasogenic

d. Ischemic

 

21. What is a communicating hydrocephalus caused by an impairment of?

a. Cerebrospinal fluid flow between the ventricles

b. Cerebrospinal fluid flow into the subarachnoid space

c. Blood flow to the arachnoid villi

d. Absorption of cerebrospinal fluid

 

22. Which dyskinesia involves involuntary movements of the face, trunk, and extremities?

a. Paroxysmal

b. Tardive

c. Hyperkinesia

d. Cardive

 

23. Antipsychotic drugs cause tardive dyskinesia by mimicking the effects of an increase of what?

a. Dopamine

b. Gamma-aminobutyric acid

c. Norepinephrine

d. Acetylcholine

 

24. The existence of regular, deep, and rapid respirations after a severe closed head injury is indicative of neurologic injury to what?

a. Lower midbrain

 b. Pontine area

c. Supratentorial

d. Cerebral area

 

25. What type of posturing exists when a person with a severe closed head injury has all four extremities in rigid extension with the forearms in hyperpronation and the legs in plantar extension?

a. Decorticate

b. Decerebrate

c. Spastic

d. Cerebellar

 

26. After a cerebrovascular accident, a patient has been diagnosed with anosognosia. What action by the healthcare professional would be most helpful?

a. Provide a white board for the patient to write on.

b. Ensure the patient has a safe environment.

c. Provide physical therapy for strengthening exercises.

d. Practice naming colors using flash cards.

 

27. After a cerebrovascular accident, a man is unable to either feel or identify a comb with his eyes closed. What is this an example of?

a. Agraphia

b. Tactile agnosia

c. Anosognosia

d. Prosopagnosia

 

28. Most aphasias are associated with cerebrovascular accidents involving which artery?

a. Anterior communicating

b. Posterior communicating

c. Circle of Willis

d. Middle cerebral

 

29. A healthcare professional reads in a patient’s chart that the patient shows behaviors suggestive of neurofibrillary tangles. What information does the healthcare professional plan to provide the spouse?

a. The patient will probably develop seizures.

b. The patient will lose all motor function.

c. The patient will have a gradual decline in function.

d. The patient’s intracranial pressure will rise.

 

30. The body compensates for a rise in intracranial pressure by first displacing what?

a. Cerebrospinal fluid

b. Arterial blood

c. Venous blood

d. Cerebral cells

 

31. A patient is in the intensive care unit and has intercranial pressure (ICP) monitoring. The

patient’s ICP is 17 mmHg. The healthcare professional notes that the chart indicates the patient is now in stage 1 intracranial hypertension. What assessment finding does the professional associate with this condition?

a. Rapid spike in measured ICP

b. No significant change in ICP readings

c. Restlessness and subtle breathing and pupil changes

d. A widened pulse pressure and bradycardia

 

32. Dilation of the ipsilateral pupil following uncal herniation is the result of pressure on which cranial nerve (CN)?

a. Optic (CN I)

b. Abducens (CN VI)

c. Oculomotor (CN III)

d. Trochlear (CN IV)

 

33. To quickly assess a patient’s nervous system for dysfunction, what assessment should the healthcare professional perform as the priority?

a. Size and reactivity of pupils

b. Pattern of breathing

c. Motor response

d. Level of consciousness

 

34. What does diagnostic criteria for a persistent vegetative state include?

 a. Absence of eye opening

b. Lack of subcortical responses to pain stimuli

c. Roving eye movements with visual tracking

d. Return of autonomic functions

 

35. When does uncal herniation occur?

a. The hippocampal gyrus shifts from the middle fossa through the tentorial notch into the posterior fossa.

b. The diencephalon shifts from the middle fossa straight downward through the tentorial notch into the posterior fossa.

c. The cingulate gyrus shifts under the falx cerebri.

d. A cerebellar tonsil shifts through the foramen magnum.

 

36. Which assessment finding marks the end of spinal shock?

a. Return of blood pressure and heart rate to normal

b. Gradual return of spinal reflexes

c. Return of bowel and bladder function

d. Evidence of diminished deep tendon reflexes and flaccid paralysis

 

37. A patient demonstrates rippling under the skin on the arms. The patient’s spouse asks the healthcare professional to explain why this occurs. What response by the professional is most accurate?

 

 

a. Loss of temperature regulation in distal, proximal, or midline muscles

b. Atrophy of primary motor neurons

c. Loss of sensation leading to flaccid paralysis

d. Spastic movements due to increased deep tendon reflexes

 

38. A patient has finally been diagnosed with amyotrophic lateral sclerosis (ALS) after seeing several physicians. The patient expresses frustration that the diagnosis has taken so long. What information can the healthcare professional give to the patient about this situation?

a. Many diseases cause weakness and fatigue.

b. Only upper motor neurons are involved.

c. Several nerves are connected to each muscle.

d. Lack of sensation makes it hard to describe.

 

39. Parkinson disease is a degenerative disorder of which part of the brain?

a. Hypothalamus

b. Anterior pituitary

c. Frontal lobe

d. Basal ganglia

 

40. Clinical manifestations of Parkinson disease are caused by a deficit in which of the brain’s neurotransmitters?

a. Gamma-aminobutyric acid

b. Dopamine

c. Norepinephrine

d. Acetylcholine

 

41. Tremors at rest, rigidity, akinesia, and postural abnormalities are a result of the atrophy of neurons in which part of the brain?

a. Caudate that produces serotonin

b. Putamen that produces gamma-aminobutyric acid

c. Substantia nigra that produces dopamine

d. Hypothalamus that produces acetylcholine

 

MULTIPLE RESPONSE

 

1. Dementia is commonly characterized by the deterioration in which abilities? (Select all that apply.)

a. Sociability

b. Balance

c. Memory

d. Speech

e. Decision making

 

2. What do the clinical manifestations of Parkinson disease include? (Select all that apply.)

a. Fragmented sleep

b. Drooping eyelids

c. Depression

d. Muscle stiffness

e. Bradykinesia

 

3. In Parkinson disease the basal ganglia influence the hypothalamic function to produce which clinical manifestations? (Select all that apply.)

a. Inappropriate diaphoresis

b. Gastric retention

c. Vomiting

d. Diarrhea

e. Urinary retention