Deck 15: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function

Question 1

A patient presents to the emergency room (ER) reporting excessive vomiting. A CT scan of the brain reveals a mass in the:

A) skull fractures.
B) thalamus.
C) medulla oblongata.
D) frontal lobe.

Answer 1

medulla oblongata.

Question 2

A 20-year-old experiences a severe closed head injury as a result of a motor vehicle accident. Which of the following structures is most likely keeping the patient in a vegetative state (VS)?

A) Cerebral cortex
B) Brainstem
C) Spinal cord
D) Cerebellum

Answer 2

Brainstem

Question 3

A teenager sustains a severe closed head injury following an all-terrain vehicle (ATV) accident and is in a state of deep sleep that requires vigorous stimulation to elicit eye opening. How should the nurse document this in the chart?

A) Confusion
B) Coma
C) Obtundation
D) Stupor

Answer 3

Stupor

Question 4

For legal purposes, brain death is defined as:

A) cessation of entire brain function.
B) lack of cortical function.
C) a consistent vegetative state (VS).
D) death of the brainstem.

Question 5

The progress notes read: the cerebellar tonsil has shifted through the foramen magnum due to increased pressure within the posterior fossa. What type of herniation is this?

A) Supratentorial
B) Central
C) Cingulated gyrus
D) Infratentorial

Question 6

The primary care provider states that a patient is experiencing vasogenic edema. Why is this clinically important?

A) Vasogenic edema usually has an infectious cause.
B) The blood-brain barrier is disrupted.
C) ICP is excessively high.
D) The edema always causes herniation.

Question 7

A 65-year-old patient who recently suffered a cerebral vascular accident is now unable to recognize and identify objects by touch because of injury to the sensory cortex. How should the nurse document this finding?

A) Hypomimesis
B) Agnosia
C) Dysphasia
D) Echolalia

Question 8

A 16-year-old's level of arousal was altered after taking a recreational drug. Physical examination revealed a negative Babinski sign, equal and reactive pupils, and roving eye movements. Which of the following diagnoses will the nurse most likely see on the chart?

A) Psychogenic arousal alteration
B) Metabolically induced coma
C) Structurally induced coma
D) Structural arousal alteration

Question 9

A patient is admitted to the neurological critical care unit with a severe closed head injury. When an intraventricular catheter is inserted, the intracranial pressure (ICP) is recorded at 24 mm Hg. How should the nurse interpret this reading?

A) Higher than normal
B) Lower than normal
C) Normal
D) Borderline

Question 10

A patient has memory loss of events that occurred before a head injury. What cognitive disorder does the nurse suspect the patient is experiencing?

A) Selective memory deficit
B) Anterograde amnesia
C) Retrograde amnesia
D) Executive memory deficit

Question 11

A patient experiences a severe head injury hitting a tree while riding a motorcycle. Breathing becomes deep and rapid but with normal pattern. What term should the nurse use for this condition?

A) Gasping
B) Ataxic breathing
C) Apneusis
D) Central neurogenic hyperventilation

Question 12

What term describes a compensatory alteration in the diameter of cerebral blood vessels in response to increased intracranial pressure?

A) Herniation
B) Vasodilation
C) Autoregulation
D) Amyotrophy

Question 13

What term is used to describe an excessive and disorderly discharge of cortical neurons?

A) Reflex
B) Seizure
C) Inattentiveness
D) Brain death

Question 14

A patient is experiencing an increase in intracranial pressure. What does this increase result in?

A) Brain tissue hypoxia
B) Intracranial hypotension
C) Ventricular swelling
D) Expansion of the cranial vault

Question 15

A patient experiences a stroke and now has difficulty writing and producing language. This condition is most likely caused by occlusion of the:

A) anterior communicating artery.
B) posterior communicating artery.
C) circle of Willis.
D) middle cerebral artery.

Question 16

A patient with an addiction to alcohol checked into a rehabilitation centre experiencing delirium, an inability to concentrate, and being easily distracted. What term would be used to document this state?

A) Acute confusional state
B) Echolalia
C) Dementia
D) Dysphagia

Question 17

What is a patient experiencing when thought content and arousal level are intact, but a patient cannot communicate and is immobile?

A) Cerebral death
B) Locked-in syndrome
C) Dysphagia
D) Cerebellar motor syndrome

Question 18

A 70-year-old patient is being closely monitored in the neurological critical care unit for a severe closed head injury. After 48 hours, signs of deterioration occur: pupils are small and sluggish, pulse pressure is widening, and heart rate 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 19

What part of the brain is responsible for mediating arousal?

A) The cerebral cortex
B) The medulla oblongata
C) The reticular activating system
D) The cingulate gyrus

Question 20

What breathing pattern reflects respirations based primarily on carbon dioxide (CO₂) levels in the blood?

A) Cheyne-Stokes
B) Ataxic
C) Central neurogenic
D) Normal

Question 21

A patient reports tiring easily, having difficulty rising from a sitting position, and the inability to stand on toes. What is this an example of?

A) Parkinson's disease
B) Hypotonia
C) Huntington's disease
D) Paresis

Question 22

A nurse recalls that neural systems basic to cognitive functions include _____ systems. (Select all that apply.)

A) attentional
B) memory and language
C) affective
D) sensory and motor
E) tactile

Question 23

A patient is admitted to the neurological critical care unit with a severe closed head injury. All four extremities are in rigid extension, the forearms are hyperpronated, and the legs are in plantar extension. How should the nurse chart this condition?

A) Decorticate posturing
B) Decerebrate posturing
C) Dystonic posturing
D) Basal ganglion posturing

Question 24

A patient has paralysis of both legs. What type of paralysis does the patient have?

A) Paraplegia
B) Quadriplegia
C) Infraparaplegia
D) Paresthesia

Question 25

A nurse notes that a patient walks with the leg extended and held stiff, causing a scraping over the floor surface. What type of gait is the patient experiencing?

A) Spastic gait
B) Cerebellar gait
C) Basal ganglion gait
D) Scissors gait

Question 26

A 40-year-old male complains of uncontrolled excessive movement and progressive dysfunction of intellectual and thought processes. He is experiencing movement problems that begin in the face and arms and eventually affect the entire body. What is the most likely diagnosis?

A) Tardive dyskinesia
B) Huntington's disease
C) Hypokinesia
D) Alzheimer's disease

Question 27

An adult is diagnosed with communicating hydrocephalus. What is this form of hydrocephalus most often caused by?

A) Overproduction of CSF
B) Intercellular edema
C) Elevated arterial blood pressure
D) Defective CSF reabsorption

Question 28

A patient has excessive movement. What disorder will the nurse see documented on the chart?

A) Hypokinesia
B) Akinesia
C) Hyperkinesia
D) Dyskinesia

Question 29

A 16-year-old male fell off the bed of a pickup truck and hit his forehead on the road. He now has resistance to passive movement that varies proportionally with the force applied. What is he most likely suffering from?

A) Spasticity
B) Paratonia
C) Rigidity
D) Dystonia

Question 30

What is spinal shock characterized by?

A) Loss of voluntary motor function with preservation of reflexes
B) Cessation of spinal cord function below the lesion
C) Loss of spinal cord function at the level of the lesion only
D) Temporary loss of spinal cord function above the lesion

Question 31

The nurse is explaining clinical manifestations of alterations in the extrapyramidal system. The nurse would correctly include: (Select all that apply.)

A) little or no paralysis of voluntary movement.
B) normal or slightly increased tendon reflexes.
C) positive (present) Babinski.
D) presence of tremor.
E) rigidity in muscle tone.

Question 32

An infant is diagnosed with noncommunicating hydrocephalus. What is an immediate priority concern for this patient?

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