Question 1

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

Accepted Answer

The medulla oblongata is responsible for controlling vital autonomic functions such as breathing, heart rate, and vomiting. A mass in this region can disrupt the normal regulation of these functions leading to excessive vomiting. Skull fractures or a mass in the frontal lobe or thalamus would not necessarily be associated with vomiting as a presenting symptom.

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)?

Accepted Answer

The brainstem is responsible for basic life functions such as breathing, heart rate, and wakefulness. Damage to the cerebral cortex with an intact brainstem can result in a vegetative state, where the patient is awake but not aware.

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?

Accepted Answer

D

Question 4

For legal purposes, brain death is defined as:

Accepted Answer

Brain death is legally defined as the cessation of entire brain function, which includes the brainstem and cerebral cortex. This means there is no more electrical activity in the brain and the person is no longer alive. The other options, lack of cortical function and consistent vegetative state, do not meet the criteria for brain death as there may still be some brain activity present.

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?

Accepted Answer

This describes a tonsillar herniation, which is a type of infratentorial herniation where the cerebellar tonsils move through the foramen magnum.

Question 6

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

Accepted Answer

Vasogenic edema is clinically important because it involves the disruption of the blood-brain barrier, allowing fluid to leak into the extracellular space of the brain, which can lead to increased intracranial pressure and other complications.

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?

Accepted Answer

Agnosia is the loss of ability to recognize and identify objects, people, or sounds despite normal sensory function. Hypomimesis refers to reduced facial expressions and gestures. Dysphasia is difficulty in language production or comprehension. Echolalia is the repetition of words and phrases without understanding their meaning.

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?

Accepted Answer

The negative Babinski sign, equal and reactive pupils, and roving eye movements suggest a metabolically induced coma rather than a structural cause, as structural causes often present with focal neurological deficits.

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?

Accepted Answer

A normal ICP reading is between 5-15 mm Hg, so a reading of 24 mm Hg is higher than normal and indicates increased pressure within the skull. This can lead to further brain damage if not managed appropriately.

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?

Accepted Answer

Retrograde amnesia is the loss of memories that occurred before a head injury. Selective memory deficit and executive memory deficit are not specific types of memory loss. Anterograde amnesia is the loss of ability to form new memories after a head injury.

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?

Accepted Answer

The deep and rapid breathing with a normal pattern is characteristic of central neurogenic hyperventilation, which is caused by damage to the brainstem. Gasping is a reflexive breathing pattern that occurs in response to severe brain injury or hypoxia. Ataxic breathing is an irregular, unpredictable breathing pattern that is also caused by damage to the brainstem. Apneusis is a rare and severe breathing pattern characterized by prolonged inspiratory pauses, and is also caused by damage to the brainstem.

Question 12

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

Accepted Answer

Autoregulation is the process by which cerebral blood vessels adjust their diameter to maintain consistent blood flow despite changes in intracranial pressure.

Question 13

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

Accepted Answer

A seizure is characterized by an excessive and disorderly discharge of cortical neurons in the brain.

Question 14

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

Accepted Answer

Increased intracranial pressure can lead to brain tissue hypoxia due to reduced cerebral perfusion and oxygen delivery.

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:

Accepted Answer

Difficulty with writing and producing language is a symptom of aphasia, which is commonly caused by a stroke in the left hemisphere of the brain. The middle cerebral artery supplies blood to this area and is the most likely artery to be occluded in a stroke leading to this symptom. Choices A, B, and C are less likely to cause this symptom.

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?

Accepted Answer

The symptoms described, such as delirium, inability to concentrate, and being easily distracted, are characteristic of an acute confusional state, often seen in alcohol withdrawal.

Question 17

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

Accepted Answer

Locked-in syndrome is characterized by intact thought content and arousal level, but the patient is unable to communicate verbally or move due to paralysis.

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?

Accepted Answer

The clinical findings described in the scenario are indicative of Stage 3 intracranial hypertension, characterized by a worsening of symptoms such as decreased level of consciousness, dilated pupils, and vital sign instability. Stage 1 is characterized by subtle changes in consciousness and behavior, Stage 2 includes further deterioration with more pronounced symptoms, and Stage 4 is the most severe stage with the potential for brain herniation.

Question 19

What part of the brain is responsible for mediating arousal?

Accepted Answer

The reticular activating system is responsible for regulating wakefulness and sleep-wake transitions, thus mediating arousal.

Question 20

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

Accepted Answer

Cheyne-Stokes breathing is a pattern of respiration that is characterized by periods of hyperventilation followed by periods of apnea. This pattern of breathing is typically seen in patients with heart failure or other conditions that affect the brain's ability to control breathing. Cheyne-Stokes breathing is thought to be caused by an imbalance between the levels of carbon dioxide and oxygen in the blood. When the levels of carbon dioxide in the blood are high, the brain stimulates the respiratory center to increase the rate and depth of breathing. This leads to a period of hyperventilation, which lowers the levels of carbon dioxide in the blood. When the levels of carbon dioxide in the blood are low, the brain decreases the rate and depth of breathing. This leads to a period of apnea, which raises the levels of carbon dioxide in the blood. The cycle then repeats itself.

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

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

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 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?

For legal purposes, brain death is defined as:

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?

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

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

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?

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

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

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

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

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?

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

What part of the brain is responsible for mediating arousal?

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

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

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

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 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?

For legal purposes, brain death is defined as:

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?

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

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

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?

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

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

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

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

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?

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

What part of the brain is responsible for mediating arousal?

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

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