Chapter 17. Disorders of the Central and Peripheral Nervous Systems and Neuromuscular Junction

A neurologist is teaching about brain injuries. Which information should the neurologist include? The most severe diffuse brain injury caused by rotational acceleration is most likely to be located _____ the brainstem.
a. More peripheral to
b. In the central portion of
c. Throughout
d. Distal to

a. More peripheral to

Which statement by a patient indicates teaching was successful regarding myasthenia gravis? Myasthenia gravis results from:
a. Viral infection of skeletal muscle
b. Atrophy of motor neurons in the spinal cord
c. Demyelination of skeletal motor neurons
d. Autoimmune injury at the neuromuscular junction

d. Autoimmune injury at the neuromuscular junction

A patient is admitted with amyotrophic lateral sclerosis (ALS). Which classic assessment findings will support the diagnosis of ALS?
a. Progressive dementia
b. Muscle weakness and atrophy
c. Severe paresthesias
d. Autonomic dysfunctions

b. Muscle weakness and atrophy

When a patient asks, What is the cause of multiple sclerosis? how should the nurse reply? The cause of MS seems to be an interaction between:
a. Vascular and metabolic factors
b. Bacterial infection and the inflammatory response
c. Autoimmunity and genetic susceptibility
d. Neurotransmitters and inherited genes

c. Autoimmunity and genetic susceptibility

A 23-year-old female begins having problems with tiredness, weakness, and visual changes. Her diagnosis is multiple sclerosis (MS). What is occurring in the patients body?
a. Depletion of dopamine in the central nervous system (CNS)
b. Demyelination of nerve fibers in the CNS
c. The development of neurofibril webs in the CNS
d. Reduced amounts of acetylcholine at the neuromuscular junction

b. Demyelination of nerve fibers in the CNS

A 15-month-old child from Pennsylvania was brought to the ER for fever, seizure activity, cranial palsies, and paralysis. Which of the following diagnosis will be documented in the chart?
a. Eastern equine encephalitis
b. Venezuelan encephalitis
c. St. Louis encephalitis
d. West Nile encephalitis

a. Eastern equine encephalitis

A neurologist is teaching about encephalitis. Which information should the neurologist include? Most causes of encephalitis are:
a. Bacterial
b. Viral
c. Fungal
d. Toxoid

b. Viral

A 25-year-old female presents to her primary care provider reporting fever, headache, nuchal rigidity, and decreased consciousness. She was previously treated for sinusitis. Which of the following is the most likely diagnosis?
a. Aseptic meningitis
b. Bacterial meningitis
c. Fungal meningitis
d. Nonpurulent meningitis

b. Bacterial meningitis

A 65-year-old male suffers a subarachnoid hemorrhage secondary to uncontrolled hypertension. He appears drowsy and confused with pronounced focal neurologic deficits. This condition is grade:
a. I
b. II
c. III
d. IV

c. III

A cause of hydrocephalus in subarachnoid hemorrhage is:
a. Scarring of meninges and impairment of CSF resorption
b. Choroid plexus injury
c. Impairment of CSF flow through the ventricles
d. Vasoconstriction related to carbon dioxide (CO2) changes in the cerebral circulation

a. Scarring of meninges and impairment of CSF resorption

A 48-year-old female presents at the ER reporting an acute severe headache, nausea, photophobia, and nuchal rigidity. What does the nurse suspect caused these signs and symptoms?
a. Diffuse brain injury
b. Subarachnoid hemorrhage
c. Epidural hematoma
d. Classic concussion

b. Subarachnoid hemorrhage

A 25-year-old male died from a gunshot wound to the heart. Upon autopsy, abnormalities in the media of the arterial wall and degenerative changes were detected. Which of the following most likely accompanied this finding?
a. Fusiform aneurysm
b. Saccular aneurysm
c. Arteriovenous malformation
d. Thrombotic stroke

b. Saccular aneurysm

A 75-year-old male experienced a lacunar stroke. When looking through the history of the patients chart, which of the following would the nurse expect to find?
a. An embolus
b. Hypertension
c. A hemorrhage
d. An aneurysm

b. Hypertension

A 60-year-old female with a recent history of head trauma and a long-term history of hypertension presents to the ER for changes in mental status. MRI reveals that she had a hemorrhagic stroke. What does the nurse suspect caused this type of stroke?
a. Rheumatic heart disease
b. Thrombi
c. Aneurysm
d. Hypotension

c. Aneurysm

A major contributing process in CVAs is the development of atheromatous plaques in cerebral circulation. These most commonly form:
a. In the larger veins
b. Near capillary sphincters
c. In cerebral arteries
d. In the venous sinuses

c. In cerebral arteries

A 72-year-old male demonstrates left-sided weakness of upper and lower extremities. The symptoms lasted 4 hours and resolved with no evidence of infarction. The patient most likely experienced a(n):
a. Stroke in evolution
b. Arteriovenous malformation
c. Transient ischemic attack
d. Cerebral hemorrhage

c. Transient ischemic attack

Of the following groups, who are at highest risk for a cerebrovascular accident (CVA)?
a. Blacks over 65 years of age
b. Whites over 65 years of age
c. Blacks under 65 years of age
d. Whites under 65 years of age

a. Blacks over 65 years of age

Which of the following would increase a patients risk for thrombotic stroke?
a. Hyperthyroidism
b. Hypertension
c. Anemia
d. Dehydration

d. Dehydration

A 30-year-old white male recently suffered a cerebrovascular accident. Which of the following is the most likely factor that contributed to his stroke?
a. Age
b. Gender
c. Diabetes
d. Race

c. Diabetes

The majority of intervertebral disk herniations occur between which vertebral levels (cervical, C; thoracic, T; lumbar, L; sacral, S)?
a. C1 to C3
b. T1 to T4
c. T12 to L3
d. L4 to S1

d. L4 to S1

A 50-year-old male presents with low back pain. He denies trauma and says he just woke up and it was hurting. An MRI reveals that the vertebra at L5 slid forward relative to those above and below it. Which of the following conditions will be documented on the chart?
a. Degenerative disk disease
b. Spondylolysis
c. Spondylolisthesis
d. Spinal stenosis

c. Spondylolisthesis

A 20-year-old female suffered from spinal cord injury that resulted from a motor vehicle accident. She had spinal shock lasting 15 days and is now experiencing an uncompensated cardiovascular response to sympathetic stimulation. What does the nurse suspect caused this condition?
a. Toxic accumulation of free radicals below the level of the injury
b. Pain stimulation above the level of the spinal cord lesion
c. A distended bladder or rectum
d. An abnormal vagal response

c. A distended bladder or rectum

Six weeks ago a female patient suffered a T6 spinal cord injury. She then developed a blood pressure of 200/120, a severe headache, blurred vision, and bradycardia. What does the nurse suspect the patient is experiencing?
a. Extreme spinal shock
b. Acute anxiety
c. Autonomic hyperreflexia
d. Parasympathetic areflexia

c. Autonomic hyperreflexia

A 15-year-old male is brought to the ER for treatment of injuries received in a motor vehicle accident. An MRI reveals spinal cord injury, and his body temperature fluctuates markedly. The most accurate explanation of this phenomenon is that:
a. He developed pneumonia.
b. His sympathetic nervous system has been damaged and thermal control disturbed.
c. He has a brain injury.
d. He has septicemia from an unknown source

b. His sympathetic nervous system has been damaged and thermal control disturbed.

A 33-year-old male is brought to the ER for treatment of injuries received in a motor vehicle accident. An MRI reveals an injury of the cervical cord. Cord swelling in this region may be life threatening because:
a. Increased ICP may occur.
b. Reflexes will be disrupted.
c. Diaphragm function may be impaired.
d. Bladder emptying will not occur.

c. Diaphragm function may be impaired.

A 20-year-old male is brought to the emergency room (ER) for treatment of injuries received in a motor vehicle accident. A spinal cord injury is suspected. What two regions should the nurse assess as they are most likely to be damaged?
a. Cervical and thoracic regions
b. Thoracic and lumbar regions
c. Lumbar and sacral regions
d. Cervical and lumbar regions

d. Cervical and lumbar regions

When a patient asks how bad the injuries will be from a spinal injury, what is the nurses best response? It is difficult to know the full extent of the injury because of:
a. Incomplete transection of the spinal cord
b. Swelling within the spinal cord
c. Necrosis of the spinal cord
d. Free radical injury and scarring of the glial cells

b. Swelling within the spinal cord

are most at risk of spinal cord injury from minor trauma.
a. Infants
b. Men
c. Women
d. The elderly

d. The elderly

An initial assessment finding associated with acute spinal cord injury is the injury.
a. Pain below the level of
b. Loss of autonomic reflexes above
c. Loss of voluntary control below
d. Hyperactive spinal reflexes below

c. Loss of voluntary control below

A 10-year-old male was climbing on a house and fell. He suffered a severe brain injury. His Glasgow Coma Scale (GCS) was 5 initially and 7 after 1 day. He remained unconscious for 2 weeks, then was confused and suffered from anterograde amnesia. Which of the following is he most likely experiencing?
a. Mild diffuse brain injury
b. Moderate diffuse brain injury
c. Severe diffuse brain injury
d. Postconcussive syndrome

b. Moderate diffuse brain injury

A 39-year-old male suffers a severe brain injury when he falls off a building while working. CT scan reveals that he has a basilar skull fracture. Based upon his injuries, what major complication should the nurse observe for in this patient?
a. Hematoma formation
b. Meningeal infection
c. Increased intracranial pressure (ICP)
d. Cognitive deficits

b. Meningeal infection

A 65-year-old female loses her balance while walking in the woods, causing her to fall and hit her head. She loses consciousness and is in a coma for 5 days. She is diagnosed as having diffuse brain injury. Which of the following would most likely occur in this patient?
a. Complete loss of vision
b. Arrhythmia
c. Blunted affect
d. Meningitis infection

c. Blunted affect

Which assessment finding by the nurse characterizes a mild concussion?
a. A brief loss of consciousness
b. Significant behavioral changes
c. Retrograde amnesia
d. Permanent confusion

c. Retrograde amnesia

A 15-year-old male was struck by a motor vehicle and suffered a traumatic brain injury. Paramedics found him unconscious at the scene of the accident. During the ambulance ride, he regained consciousness and was able to maintain a conversation with the medical staff. Upon arrival to hospital, he was alert and oriented. Physical exam reveals confusion and impaired responsiveness. What is the probable nature of his brain injury based on this history?
a. Mild concussion
b. Subdural hematoma
c. Extradural (epidural) hematoma
d. Mild diffuse axonal injury

c. Extradural (epidural) hematoma

A 69-year-old male with a history of alcohol abuse presents to the emergency room (ER) after a month-long episode of headaches and confusion. Based on his alcoholism, a likely cause of his neurologic symptoms is:
a. Concussion
b. Chronic subdural hematoma
c. Epidural hematoma
d. Subacute subdural hematoma

b. Chronic subdural hematoma

While planning care for a patient with an extradural hematoma, which principle should the nurse remember? The main source of bleeding in extradural (epidural) hematomas is:
a. Arterial
b. Venous
c. Capillary
d. Sinus

a. Arterial

A 25-year-old male was in an automobile accident. At impact, his forehead struck the windshield. In this situation, a nurse recalls the coup injury would occur in the region.
a. Frontal
b. Temporal
c. Parietal
d. Occipital

a. Frontal

A 15-year-old male suffered diffuse brain injury after wrecking an all-terrain vehicle. He had momentary confusion and retrograde amnesia after 5 to 10 minutes. His injury could be categorized as:
a. Grade I
b. Grade II
c. Grade III
d. A mild concussion

b. Grade II

A nurse is preparing to teach staff about the most common type of traumatic brain injury. Which type of traumatic brain injury should the nurse discuss?
a. Penetrating trauma
b. Diffuse axonal injury
c. Focal brain injury
d. Concussion

d. Concussion