Deck 16: Concepts of Neurologic Dysfunction

Question 1

Excess cerebrospinal fluid within the cranial vault,subarachnoid space,or both is called cerebral edema.

Answer 1

False

Question 2

In posthyperventilation apnea (PHVA),respirations stop after hyperventilation followed by the return of rhythmic breathing.What change occurs to alter the breathing pattern from apnea to a breathing pattern?

A) Arterial carbon dioxide increases.
B) Arterial carbon dioxide decreases.
C) Arterial carbon dioxide becomes normal.
D) Arterial oxygen increases.
E) Arterial oxygen decreases.

Answer 2

Arterial carbon dioxide becomes normal.

Question 3

The most critical index of nervous system function or dysfunction is motor response.

Answer 3

False

Question 4

Which disease process is infratentorial?

A) Cerebellar neoplasm
B) Encephalitis
C) Parkinson disease
D) Cerebral neoplasm

Question 5

Vomiting is associated with CNS injuries that compress which anatomic location(s)?

A) Vestibular nuclei in lower pons and medulla oblongata
B) Floor of the third ventricle
C) Vestibular nuclei in the midbrain
D) Diencephalon

Question 6

Which is an example of a disease process producing diffuse cortical dysfunction?

A) Cerebrovascular accident (CVA)
B) Encephalitis
C) Cerebral neoplasm
D) Cerebral emboli

Question 7

Upper motor neuron paralysis affects the pyramidal motor neurons by creating flaccid paralysis.

Question 8

Brain death has occurred when there is no discernable evidence of cerebral hemisphere function or function of the brain stem's vital centers for 1 to 6 hours.

Question 9

In posthyperventilation apnea (PHVA),respirations stop after hyperventilation followed by the return of rhythmic breathing.What stimulus causes the hyperventilation?

A) High arterial carbon dioxide
B) Low arterial carbon dioxide
C) Normal arterial carbon dioxide
D) High arterial oxygen
E) Low arterial oxygen

Question 10

The general pathophysiologic mechanisms underlying cognitive network deficits are compression and ischemia.

Question 11

Criteria for brainstem death is the same for children as for adults,but the with a longer observation period.

Question 12

Huntington disease is inherited as an autosomal dominant trait with high penetrance.

Question 13

In 66% of cases,the etiology of epilepsy is not identified.

Question 14

The reticular activating system provides arousal to the cerebral hemispheres.

Question 15

Vegetative state is another term for locked-in syndrome.

Question 16

The neural center that controls normal breathing is believed to be located in the brain stem.

Question 17

During a generalized seizure,the clonic phase begins as inhibitory neurons in the cortex,anterior thalamus,and basal ganglia to reduce the cortical excitation.

Question 18

Which is a description of Cheyne-Stokes respirations?

A) A sustained deep rapid,but regular pattern of breathing
B) A smooth increase in rate and depth followed by a gradual smooth decrease in rate and depth
C) A prolonged inspiratory period followed gradually by a short expiratory period
D) A completely irregular breathing pattern with random shallow and deep breaths and irregular pauses

Question 19

Cognitive operations cannot occur without the _____ functioning.

A) pons
B) medulla oblongata
C) reticular activating system
D) cingulate gyrus

Question 20

The tonic phase of a generalized seizure is characterized by alternating contractions and relaxation of muscles.

Question 21

_____ is the loss of speech or the loss of comprehension of spoken or written language.

A) Agnosia
B) Aphasia
C) Akinesia
D) Dysphasia

Question 22

What are the areas of the brain that mediate several cognitive functions,including vigilance,reasoning,and executive functions?

A) Limbic
B) Prefrontal
C) Parietal
D) Occipital

Question 23

What type of cerebral edema occurs when there is increased permeability of capillary endothelium after injury to the vascular structure?

A) Cytotoxic
B) Interstitial
C) Vasogenic
D) Ischemic

Question 24

What are characteristics of receptive dysphasia (fluent)?

A) Clients are able to respond in writing,but not in speech.
B) Clients are able to speak back,but not comprehend speech.
C) Clients are able to comprehend speech,but not respond verbally.
D) Clients are able to respond verbally,but not comprehend speech.

Question 25

Cerebral edema is an increase in the fluid content of the:

A) ventricles.
B) brain tissue.
C) central nervous system neurons.
D) meninges.

Question 26

Which is a characteristic of brainstem death?

A) Vegetative state
B) Comatose
C) Apnea
D) Locked-in syndrome

Question 27

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

A) Diencephalon dysfunction
B) Oculomotor cranial nerve dysfunction
C) Midbrain dysfunction
D) Pontine dysfunction

Question 28

How does subarachnoid hemorrhage cause communicating hydrocephalus?

A) By obstructing the cerebrospinal fluid flow between the ventricles
B) By increasing the cerebrospinal fluid secretion into the subarachnoid space
C) By impairing blood flow to the arachnoid villi
D) By obstructing the absorption of cerebrospinal fluid by the arachnoid villi

Question 29

Which are clinical manifestations caused by damage to the midbrain?

A) Abnormal flexion with or without extensor response of the lower extremities
B) Abnormal extension response of the upper and lower extremities
C) Abnormal extension response of the upper extremities and flexion of the lower extremities
D) Flaccid response in the upper and lower extremities

Question 30

Alterations in emotions or emotional control arise from dysfunction of the:

A) limbic system.
B) thalamus.
C) occipital lobe.
D) medulla oblongata.
E) pons.

Question 31

Which description is consistent with a complex partial seizure?

A) Alternative tonic and clonic movements
B) Repetitive movements with loss of consciousness
C) Focal motor movement without loss of consciousness
D) One seizure followed by another in less than one minute

Question 32

Why is status epilepticus considered a medical emergency?

A) Because the person loses consciousness
B) Because of the cerebral hypoxia
C) Because of head injury during the seizures
D) Because brain metabolism is decreased

Question 33

What is normal intracranial pressure?

A) 5 to 15 mm Hg
B) 7 to 20 mm Hg
C) 12 to 14 mm Hg
D) 80 to 120 mm Hg

Question 34

The most critical aspect in diagnosing a seizure disorder and establishing its cause is:

A) computed tomography (CT)scan.
B) cerebrospinal fluid analysis.
C) skull x-ray films.
D) health history.

Question 35

A sudden,explosive,disorderly discharge of cerebral neurons is termed:

A) reflex.
B) seizure.
C) epilepsy.
D) convulsion.

Question 36

A patient has a seizure that starts with her fingers and progressively spreads up the arm and extends to the leg.This is known as:

A) simple partial seizure.
B) focal seizure.
C) psychomotor seizure.
D) adversive seizure.

Question 37

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

A) Paroxysmal
B) Tardive
C) Hyper-
D) Cardive

Question 38

Antipsychotic drugs cause tardive dyskinesia by mimicking the effects of increased:

A) dopamine.
B) gamma aminobutyric acid (GABA).
C) norepinephrine (NE).
D) acetylcholine.

Question 39

What is the best prognostic indicator of recovery of consciousness or functional outcome?

A) Glasgow Coma Scale
B) Glasgow Outcome Score
C) Etiology of injury and time since onset of coma
D) Pupillary reaction and reflective eye movements

Question 40

Which edema is most often seen with noncommunicating hydrocephalus?

A) Metabolic
B) Interstitial
C) Vasogenic
D) Ischemic

Question 41

The condition of a patient with a severe closed head injury is deteriorating.His pupils are dilated and sluggish,pulse pressure is widening,and the pulse is bradycardic.These clinical findings are evidence of what stage of intracranial hypertension?

A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4

Question 42

Diagnostic criteria for vegetative states 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 such as gastrointestinal function.

Question 43

Since his cerebrovascular accident,a patient has been denying his left hemiplegia.What term is used to describe this finding?

A) Visual agnosia
B) Anosognosia
C) Amusia agnosia
D) Agraphia agnosia

Question 44

Which clinical manifestations are produced by damage to the frontal lobes and frontolimbic tracts that impair the normal influence of the limbic system?

A) Irritability,impulsiveness,mood swings,and loss of control
B) Deficits in attention and coherence of thought with inability to concentrate
C) Loss of motor movement and coordination on the side opposite the damage
D) Change in level of consciousness,breathing patterns,and pupillary reaction

Question 45

What causes stage 1 of intracranial hypertension?

A) Loss of autoregulation that normally maintains constant blood flow during changes in cerebral perfusion pressure (CPP)
B) Displacement of cerebrospinal fluid followed by compression of the cerebral venous system
C) Vasoconstriction of the cerebral arterial system with reciprocal increase in systemic blood pressure
D) Compression of the medulla oblongata in the brain stem by herniation of the cerebral cortex

Question 46

After a cerebrovascular accident,a patient is unable to feel and identify a comb with his eyes closed.This is an example of:

A) agraphiA.
B) tactile agnosia.
C) anosognosia.
D) prosopagnosia.

Question 47

Tactile agnosia is related to injury of the:

A) frontotemporal lobe.
B) parietal lobe.
C) temporal lobe.
D) Broca area.

Question 48

Which are characteristics of primary motor neuron amyotrophies?

A) Loss of sensation in distal,proximal,or midline muscles
B) Fasciculations and muscle cramps in distal,proximal,or midline muscles
C) Flaccid paralysis with paresthesia in distal,proximal,or midline muscles
D) Spastic paralysis with increased deep tendon reflexes in distal,proximal,or midline muscles

Question 49

Most dysphasias are associated with cerebrovascular accidents involving which artery?

A) Anterior communicating artery
B) Posterior communicating artery
C) Circle of Willis
D) Middle cerebral artery

Question 50

Which assessment finding marks the end of spinal shock?

A) Blood pressure and heart rate return to normal
B) Deep tendon reflexes return and spastic paralysis is evident
C) Bowel and bladder function return
D) Deep tendon reflexes diminish and flaccid paralysis is evident

Question 51

What are characteristics of dementia?

A) The person has deficits in attention and coherence of thought.
B) The person is easily distracted and unable to concentrate.
C) The person has loss of recent and remote memory.
D) The person is irritable,agitated,and restless with frequent mood changes.

Question 52

Why does the ipsilateral pupil dilate following uncal herniation?

A) Because of pressure on the optic cranial nerve (CN I)
B) Because of pressure on the abducens cranial nerve (CN VI)
C) Because of pressure on the oculomotor cranial nerve (CN III)
D) Because of pressure on the trochlear cranial nerve (CN IV)

Question 53

In amyotrophies,the paresis and paralysis are segmental.Why is the segmental character of weakness difficult to recognize?

A) Because upper motor neurons are involved
B) Because posterior horn cell injury is involved
C) Because each muscle is supplied by two or more nerve roots
D) Because the patient is unable to feel the involved muscles

Question 54

A patient is admitted to the intensive care unit with a severe closed head injury.He develops regular,deep,and rapid respirations.This is indicative of what level of neurologic injury?

A) Midbrain and upper pons
B) Pontine
C) Supratentorial
D) Cerebral

Question 55

How does the body compensate first when there is a rise in intracranial pressure?

A) Displaces the cerebrospinal fluid
B) Displaces arterial blood
C) Displaces venous blood
D) Displaces cerebral cells

Question 56

The nurse notes that a patient with a severe closed head injury has all four extremities in rigid extension and forearm hyperpronation and legs with plantar extension.This finding is documented as __________ posturing.

A) decorticate
B) decerebrate
C) spastic
D) cerebellar

Question 57

When does uncal herniation occur?

A) When the hippocampal gyrus shifts from the middle fossa through the tentorial notch into the posterior fossa
B) When the diencephalon shifts from the middle fossa straight downward through the tentorial notch into the posterior fossa
C) When the cingulate gyrus shifts under the falx cerebri
D) When a cerebellar tonsil shifts through the foramen magnum

Question 58

Which of the following is the most critical index of nervous system dysfunction?

A) Size and reactivity of pupils
B) Pattern of breathing
C) Motor response
D) Level of consciousness

Question 59

Damage to tracts from the _____ lobe to the limbic system may also result in alterations in emotional control.

A) occipital
B) parietal
C) frontal
D) temporal

Question 60

Which neurologic disorder is characterized by a protein detaching from neurons causing the cortical nerve cell processes that become twisted and dilated?

A) Dementia syndrome
B) Delirium
C) Alzheimer disease
D) Parkinson disease

Question 61

Clinical manifestations of Parkinson disease are caused by a deficit in which neurotransmitter?

A) Gamma aminobutyric acid (GABA)
B) Dopamine
C) Norepinephrine (NE)
D) Acetylcholine

Question 62

MATCHING
Match the terms with the corresponding descriptions.
Upper motor neuron disorders

A)Paroxysmal dyskinesia
B)Flaccidity
C)Wernicke disease
D)Spasticity
E)Akinesia
F)Broca area

Question 63

MATCHING
Match the terms with the corresponding descriptions.
Abnormal involuntary movement

A)Paroxysmal dyskinesia
B)Flaccidity
C)Wernicke disease
D)Spasticity
E)Akinesia
F)Broca area

Question 64

MATCHING
Match the terms with the corresponding descriptions.
Decrease in voluntary movement

A)Paroxysmal dyskinesia
B)Flaccidity
C)Wernicke disease
D)Spasticity
E)Akinesia
F)Broca area

Question 65

MATCHING
Match the terms with the corresponding descriptions.
Expressive dysphasia

A)Paroxysmal dyskinesia
B)Flaccidity
C)Wernicke disease
D)Spasticity
E)Akinesia
F)Broca area

Question 66

What pathologic alteration produces tremors at rest,rigidity,akinesia,and postural abnormalities?

A) Atrophy of neurons in the caudate that produce serotonin
B) Atrophy of neurons in the putamen that produce gamma aminobutyric acid (GABA)
C) Atrophy of neurons in the substantia nigra that produce dopamine
D) Atrophy of neurons in the hypothalamus that produce acetylcholine

Question 67

A patient is diagnosed with Parkinson disease.This is a degenerative disorder of the:

A) hypothalamus.
B) anterior pituitary.
C) frontal lobe.
D) basal ganglia.

Question 68

What are clinical manifestations of Parkinson disease?

A) Muscle tremor;slow,rigid movements;and postural abnormalities
B) Muscle weakness,difficulty chewing,and drooping eye lids
C) Decreased memory,depression,and indifference
D) Paralysis and absent sensation below the level of the lesion

Question 69

MATCHING
Match the terms with the corresponding descriptions.
Lower motor neuron disorders

A)Paroxysmal dyskinesia
B)Flaccidity
C)Wernicke disease
D)Spasticity
E)Akinesia
F)Broca area

Question 70

MATCHING
Match the terms with the corresponding descriptions.
Receptive dysphasia

A)Paroxysmal dyskinesia
B)Flaccidity
C)Wernicke disease
D)Spasticity
E)Akinesia
F)Broca area

Question 71

In Parkinson disease the basal ganglia influences the hypothalamic function to produce which clinical manifestations?

A) Inappropriate diaphoresis,orthostatic hypotension,constipation,and urinary retention
B) Asymmetric,regular,rhythmic tremors with slow alternating flexion and extension contractions
C) Involuntary contractions of skeletal muscles that impair active and passive movement
D) Bradykinesia of chewing,swallowing and articulation