Deck 19: Disorders of Visual Function

Question 1

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?

A) Delirium
B) Coma
C) Brain death
D) Vegetative state

Answer 1

Coma

Question 2

Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents?

A) "Your daughter has lost all her cognitive functions as well as all her basic reflexes."
B) "Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change."
C) "If you or the care team notices any spontaneous eye opening, then we will change our treatment plan."
D) "Your daughter's condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions."

Answer 2

"Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change."

Question 3

Which of the following individuals would most likely experience global ischemia to his or her brain?

A) A male client who has just had an ischemic stroke confirmed by CT of his head
B) A woman who has been admitted to the emergency department with a suspected intracranial bleed
C) A man who has entered cardiogenic shock following a severe myocardial infarction
D) A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater

Answer 3

A man who has entered cardiogenic shock following a severe myocardial infarction

Question 4

Which of the following diagnostic findings is likely to result in the most serious brain insult?

A) Mean arterial pressure (MAP) that equals intracranial pressure (ICP)
B) Moderate decrease in brain tissue volume secondary to a brain tumor removal
C) Increased ICP accompanied by hyperventilation
D) High intracellular concentration of glutamate

Question 5

Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply.

A) Clouding of consciousness
B) Decorticate posturing with painful stimulation
C) Pupils fixed at approximately 5 mm in diameter
D) Respiration rate of 40 breaths/minute
E) Decerebrate posturing following painful stimulation of the sternum

Question 6

A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood-brain barrier and been transferred from the vascular space into the client's interstitial space. Which of the following diagnoses best captures this pathophysiology?

A) Focal hypoxia
B) Cytotoxic edema
C) Hydrocephalus
D) Vasogenic edema

Question 7

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a "coup" injury. How will the nurse explain this to the family so they can understand?

A) "It's like squeezing an orange so tight that the juice runs out of the top."
B) "Your son has a huge laceration inside his brain where the bat hit his skull."
C) "Your son has a contusion of the brain at the site where the bat hit his head."
D) "When the bat hit his head, his neck jerked backward causing injury to the spine."

Question 8

Following an injury where a child hit his head from a fall, the CT scan reveals a contusion that the doctor classifies as a moderate brain injury. Which of the following manifestations will the nurse more than likely assess on this child that support this diagnosis? Select all that apply.

A) Coma with total paralysis
B) Periods of unconsciousness
C) Aphasia at times
D) Nuchal rigidity
E) Weakness or slight paralysis affecting one side of the body

Question 9

Following a collision while mountain biking, the diagnostic workup of a 22-year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis?

A) Blood has accumulated between the man's dura and subarachnoid space.
B) Vessels have burst between the client's skull and his dura.
C) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP.
D) Blood has displaced CSF in the ventricles as a consequence of his coup-contrecoup injury.

Question 10

A 20-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the client's history would be considered to have contributed to his stroke? Select all that apply. The client

A) is an African American male.
B) takes iron supplements for the treatment of chronic anemia.
C) blood pressure has historically been in the range of 150s/90s.
D) was diagnosed with type 2 diabetes 8 years ago.
E) takes corticosteroids for the treatment of rheumatoid arthritis.

Question 11

A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs

A) are an accumulation of small deficits that may eventually equal the effects of a full CVA.
B) are a relatively benign sign that necessitates monitoring but not treatment.
C) resolve rapidly but may place the client at an increased risk for stroke.
D) are caused by small bleeds that can be a warning sign of an impending stroke.

Question 12

Which of the following clients' signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult

A) has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days.
B) has experienced a sudden loss of balance and slurred speech.
C) has vomited and complained of a severe headache.
D) states that his left arm and leg are numb, and gait is consequently unsteady.

Question 13

The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage?

A) Stat administration of tissue plasminogen activator (tPA)
B) Administration of a diuretic such as mannitol to reduce cerebral edema and ICP
C) Monitoring in the ICU for signs and symptoms of cerebral insult
D) Craniotomy and clipping of the affected vessel

Question 14

A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms?

A) Increased tissue perfusion at the site of the malformation
B) Hydrocephalus and protein in the cerebral spinal fluid
C) High pressure and local hemorrhage of the venous system
D) Localized ischemia with areas of necrosis noted on CT angiography

Question 15

A 9-year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain, and nausea. Examination reveals a petechial rash. Which of the following assessment questions by the emergency room physician is most appropriate?

A) "Is your son currently taking any medications?"
B) "Has your son had any sinus or ear infections in the last little while?"
C) "Does your son have a history of cancer?"
D) "Was your son born with any problems that affect his bone marrow or blood?"

Question 16

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?

A) Rocky Mountain spotted fever
B) Lyme disease
C) Encephalitis
D) Spinal infection

Question 17

A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate?

A) "Your prognosis will depend on whether we can surgically resect your tumor."
B) "Our treatment plan will depend on whether your tumor is malignant or benign."
C) "This is likely a result of a combination of heredity and lifestyle."
D) "The major risk that you face is metastases to your lungs, liver, or bones."

Question 18

A brain tumor causing clinical manifestations of headache, nausea, projectile vomiting, and mental changes is likely located in which parts of the brain? Select all that apply.

A) Intra-axially
B) Extra-axially
C) Brain stem
D) Temporal lobe
E) Frontal lobe

Question 19

Which of the following clients may be experiencing a sensory focal seizure that has sent an abnormal cortical discharge to the autonomic nervous system (ANS)?

A) A 44-year old patient complaining of constant movement and pain in the legs that gets worse when he tries to sleep
B) An 85-year-old patient experiencing drooping of the right side of the face and numbness in the right arm and leg
C) A 56-year-old complaining of tingling sensations and has both an elevated pulse and BP
D) A 22-year-old complaining of a stiff neck and achiness, along with some nausea and vomiting

Question 20

A 26-year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced?

A) A myoclonic seizure
B) A tonic-clonic seizure
C) An absence seizure
D) A complex partial seizure