Chapter 15: cognitive systems

A neurologist explains that arousal is mediated by the:

a.      cerebral cortex.

b.     medulla oblongata.

c.      reticular activating system.

d.     cingulate gyrus.

reticular activating system

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) 1 month after the accident?

a. Cerebral cortex

b. Brainstem

c. Cerebellum

d.  Spinal cord

Brainstem

A 16-year-old’s level of arousal was altered after taking a recreational drug. Physical exam 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

metabolic induced coma

The breathing pattern that reflects respirations based primarily on carbon dioxide (CO₂) levels in the blood is:

a.      Cheyne-Stokes.

b.     ataxic.

c.      central neurogenic.

d.     normal.

Cheyne stokes

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

stupor

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

central neurogenic hyperventilation

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.

medulla oblangata

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.

cessation of entire brain function

When thought content and arousal level are intact but a patient cannot communicate and is immobile, the patient is experiencing:

a. cerebral death.

b.     locked-in syndrome.

c.      dysphagia.

d.     cerebellar motor syndrome.

locked in syndrome

What term is used to describe an explosive, disorderly discharge of cortical neurons?

a. Reflex

b.     Seizure

c.      Inattentiveness

d.     Brain death

 

seizure

9.        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

retrograde amnesia

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

dysphasia

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.

middle cerebral artery

A patient with an addiction to alcohol checked into a rehabilitation center as a result of experiencing delirium, 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

acute confusional state

13.     The patient is experiencing an increase in intracranial pressure. This increase results in:

a. brain tissue hypoxia.

b.     intracranial hypotension.

c.      ventricular swelling.

d.     expansion of the cranial vault.

brain tissue hypoxia

A compensatory alteration in the diameter of cerebral blood vessels in response to increased intracranial pressure is called:

a. herniation.

b.     vasodilation.

c.      autoregulation.

d.     amyotrophy.

autoregulation

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

higher than normal

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

stage 3

The primary care provider states that the patient is experiencing vasogenic edema. The nurse realizes vasogenic edema is clinically important because:

a. it usually has an infectious cause.

b.     the blood-brain barrier is disrupted.

c.      ICP is excessively high.

d.     it always causes herniation.

the blood brain barrier is disrupted

The progress notes read: the cerebellar tonsil has shifted through the foramen magnum due to increased pressure within the posterior fossa. The nurse would identify this note as a description of _____ herniation. a. supratentorial

b.     central

c.      cingulated gyrus

d.     infratentorial

infratentorial

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

interstitial edema

An adult is diagnosed with communicating hydrocephalus. The form of hydrocephalus in adults is most often caused by:

a. overproduction of CSF.

b.     intercellular edema.

c.      elevated arterial blood pressure.

d.     defective CSF reabsorption.

defective CSF reabsorption

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. He is most likely suffering from:

a. spasticity.

b.     paratonia.

c.      rigidity.

d.     dystonia.

paratonia

A patient reports tiring easily, having difficulty rising from a sitting position, and the inability to stand on toes. The nurse would expect a diagnosis of:

a. Parkinson disease.

b.     hypotonia.

c.      Huntington disease.

d.     paresis.

hypotonia

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

a. Paraplegia 

b. Quadriplegia

c.      Infraparaplegia

d.     Paresthesia

paraplegia

Spinal shock is 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.

cessation of spinal cord function below the lesion

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

a.      Hypokinesia

b.     Akinesia

c.      Hyperkinesia

d.     Dyskinesia

Hyperkinesia

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. The most likely diagnosis is:

a. tardive dyskinesia.

b.     Huntington disease.

c.      hypokinesia.

d.     Alzheimer disease.

Hypokinesia

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

Spastic gait

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

Decerebrate posturing

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

A, B, C

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.

A, B, D, E