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UT Arlington NURS 5315 - Chapter 17 Exam

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Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor FunctionMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. Cognitive operations cannot occur without the effective functioning of what part of the brain?a. Ponsb. Medulla oblongatac. Reticular activating systemd. Cingulate gyrusANS: CCognitive cerebral functions require a functioning reticular activating system (RAS). Cognitive operations are not managed by the pons, medulla oblongata, or the cingulate gyrus.PTS: 1 DIF: Cognitive Level: Remembering 2. Which intracerebral disease process is capable of producing diffuse dysfunction?a. Closed-head trauma with bleedingb. Subdural pus collectionsc. Neoplasmd. Embolic infarctANS: DDisorders within the brain substance (intracerebral)—bleeding, infarcts due to emboli, and tumors—primarily functioning as masses may cause diffuse dysfunction. Such localized destructive processes directly impair functioning of the thalamic or hypothalamic activating systems. Disorders outside the brain but within the cranial vault (extracerebral), including neoplasms, closed-head trauma with subsequent bleeding, and subdural empyema (accumulation of pus), can cause similar dysfunction.PTS: 1 DIF: Cognitive Level: Remembering 3. What is the most common infratentorial brain disease process that results in the direct destruction of the reticulating activation system (RAS)?a. Cerebrovascular diseaseb. Demyelinating diseasec. Neoplasmsd. AbscessesANS: AInfratentorial disorders produce a decline in arousal through a direct destruction of the RAS and its pathways. The most common cause of direct destruction is cerebrovascular disease, but demyelinating diseases, neoplasms, granulomas, abscesses, and head injury also may cause brainstem destruction by tissue compression.PTS: 1 DIF: Cognitive Level: Remembering 4. What stimulus causes posthyperventilation apnea (PHVA)?a. Changes in PaO2 levelsb. Changes in PaCO2 levelsc. Damage to the forebraind. Any arrhythmic breathing patternANS: BWith normal breathing, a neural center in the forebrain (cerebrum) produces a rhythmic breathing pattern. When consciousness decreases, lower brainstem centers regulate the breathing pattern by responding only to changes in PaCO2 levels. This irregular breathing pattern is called PHVA. The breathing pattern is not regulated by changes in PaO2, damage to the forebrain, or other arrhythmic breathing patterns.PTS: 1 DIF: Cognitive Level: Remembering 5. A healthcare professional reads in the patient’s chart and notes the patient has Cheyne-Stokes respirations. What clinical finding would the professional correlate with this condition?a. Sustained deep rapid but regular pattern of breathingb. Crescendo-decrescendo pattern of breathing, followed by a period of apneac. Prolonged pause after the inspiratory period with occasional end-expiratory paused. Completely random, irregular breathing pattern with pausesANS: BCheyne-Stokes respiration is an abnormal rhythm of breathing (periodic breathing) that alternates between hyperventilation and apnea. Central reflex hyperpnea is characterized by a sustained deep rapid but regular breathing pattern. A prolonged inspiratory pause is characteristic of apneusis. A common variant of apneusis includes expiratory pauses. A completely random and irregular breathing pattern is termed ataxic breathing.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. Vomiting is associated with central nervous system (CNS) injuries that compress which of the brain’s anatomic locations?a. Vestibular nuclei in the lower brainstemb. Floor of the third ventriclec. Any area in the midbraind. DiencephalonANS: AVomiting, yawning, and hiccups are complex reflexlike motor responses that are integrated by neural mechanisms in the lower brainstem. Vomiting often accompanies CNS injuries that involve the vestibular nuclei. The remaining options will not trigger vomiting when compressed.PTS: 1 DIF: Cognitive Level: Remembering 7. Which midbrain dysfunction causes pupils to be pinpoint size and fixed in position?a. Diencephalon dysfunctionb. Oculomotor cranial nerve dysfunctionc. Dysfunction of the tectumd. Pontine dysfunctionANS: DPinpoint fixed pupils are a result of pontine dysfunction. The diencephalon is not related to pupillary function. Occulomotor nerve dysfunction would result in abnormalities in eye movement. Dysfunction of the tectum results in large, dilated pupils.PTS: 1 DIF: Cognitive Level: Remembering 8. A healthcare professional suspects a patient is brain dead. How would the professional assess for brain death?a. Determine if the patient can make voluntary movements.b. Perform tests to assess if the patient is in a coma.c. Remove the patient’s ventilator to see if spontaneous breathing occurs.d. Monitor the patient for eye movements that seem purposeful.ANS: CApnea is viewed as a criterion of brainstem death which represents irreversible total brain damage. If the healthcare professional removed the patient’s ventilator and the patient made spontaneous respirations, the healthcare professional could conclude that the patient demonstrates the criteria of brain death. The inability to make any voluntary movements may demonstrate akinetic mutism. A coma indicates injury or death to the cerebrum. Eye movements that seem purposeful could be a sign of locked-in syndrome.PTS: 1 DIF: Cognitive Level: Applying 9. A patient has damage to the lower pons and medulla. What finding does the healthcare professional associate with this injury?a. Flexion with or without extensor response of the lower extremitiesb. Extension response of the upper and lower extremitiesc. Extension response of the upper extremities and flexion response of the lower extremitiesd. Flaccid response in the upper and lower extremitiesANS: DA flaccid state with little or no motor response to stimuli is characteristic of damage to the lower pons and medulla. Flexion of the upper extremities with or without extensor response in the lower extremities would signify hemispheric injury above the midbrain. Extension of both upper and lower extremities is seen in extensive midbrain, or upper pons injuries. Extension in the upper extremities and flexion in the lower extremities would be indicative of a pons injury.PTS: 1 DIF: Cognitive


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