Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular JunctionMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. What do diffuse axonal injuries (DAIs) of the brain often result in?a. Reduced levels of consciousnessb. Mild but permanent dysfunctionc. Fine motor tremorsd. Visual disturbancesANS: ADiffuse axonal injuries occur from mechanical forces of acceleration, deceleration, and rotation that cause stretching and shearing of axons. The injury can be mild, moderate, or severe. Persons with head injury can experience headaches, nausea and vomiting, confusion, disorientation, attention-deficit, dizziness, and impaired ability to concentrate for days after the injury, contributed to DAI among other processes. DAI can cause permanent or temporary dysfunction. DAI do not cause fine motor tremors or visual disturbances.PTS: 1 DIF: Cognitive Level: Remembering 2. What event is most likely to occur when a person experiences a closed head injury?a. Brief period of vital sign instabilityb. Cerebral edema throughout the cerebral cortexc. Cerebral edema throughout the diencephalond. Disruption of axons extending from the diencephalon and brainstemANS: ATransient cessation of respiration can occur with brief periods of bradycardia, and a decrease in blood pressure occurs, lasting 30 sec or less. Vital signs stabilize within a few seconds to within normal limits. Edema does not occur immediately. Disruption of axons in the diencephalon and brainstem may or may not occur.PTS: 1 DIF: Cognitive Level: Remembering 3. A healthcare professional wants to volunteer for a community education project to help prevent spinal cord injury. What activity would the professional most likely volunteer for?a. Teaching school aged children bicycle safetyb. Teaching stretching to high school athletesc. Teaching adults good body mechanics for liftingd. Teaching older adults how to prevent trip-and-fall eventsANS: DBecause of preexisting degenerative vertebral disorders, older adults are particularly at risk for minor trauma, resulting in serious spinal cord injury, especially from falls. Although any of the events listed could help prevent spinal cord injury, the activity targeting older adults would have the biggest impact because the risk to the other groups is less than that of the older adult.PTS: 1 DIF: Cognitive Level: Applying 4. A patient has a spinal cord injury at C4. What should the healthcare professional assess as the priority in this patient?a. Blood pressureb. Respirationsc. Pulsed. TemperatureANS: BIn the cervical region, the swelling that accompanies an injury to C3 to C5 can be life-threatening because of the possibility of resulting impairment of the diaphragm function (phrenic nerves exit C3 to C5). All vital signs are important, but because of this possibility the priority is to monitor signs of respiratory impairment.PTS: 1 DIF: Cognitive Level: Applying 5. What indicates that spinal shock is terminating?a. Voluntary movement below the level of injuryb. Reflex emptying of the bladderc. Paresthesia below the level of injuryd. Decreased deep tendon reflexes and flaccid paralysisANS: BIndications that spinal shock is terminating include the reappearance of reflex activity, hyperreflexia, spasticity, and reflex emptying of the bladder. Termination of spinal shock is not evidenced by voluntary movement, paresthesia, decreased deep tendon reflexes, or paralysis.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. A healthcare professional is caring for a patient who has a spinal cord injury at T5. The patient exhibits severe hypertension, a heart rate of 32 beats/min, and sweating above the spinal cord lesion. How does the professional chart this event?a. Craniosacral dysreflexiab. Parasympathetic dysreflexiac. Autonomic hyperreflexiad. Retrograde hyperreflexiaANS: CIndividuals most likely to be affected have lesions at the T6 level or above. Paroxysmal hypertension (up to 300 mmHg systolic), a pounding headache, blurred vision, sweating above the level of the lesion with flushing of the skin, nasal congestion, nausea, piloerection caused by pilomotor spasm, and bradycardia (30 to 40 beats/min) characterize autonomic hyperreflexia. This does not describe craniosacral dysreflexia, parasympathetic dysreflexia, or retrograde hyperreflexia.PTS: 1 DIF: Cognitive Level: Remembering 7. Why does a person who has a spinal cord injury experience faulty control of sweating?a. The hypothalamus is unable to regulate body heat as a result of damage to the sympathetic nervous system.b. The thalamus is unable to regulate body heat as a result of damage to the sympathetic nervous system.c. The hypothalamus is unable to regulate body heat as a result of damage to the parasympathetic nervous system.d. The thalamus is unable to regulate body heat as a result of damage to spinal nerve roots.ANS: AA spinal cord injury results in disturbed thermal control because the hypothalamus is unable to regulate a damaged sympathetic nervous system. This damage causes faulty control of sweating and radiation through capillary dilation. The thalamus is not involved in temperature regulation.PTS: 1 DIF: Cognitive Level: Remembering 8. Autonomic hyperreflexia-induced bradycardia is a result of stimulation of what?a. Sympathetic nervous system to β-adrenergic receptors to the sinoatrial nodeb. Carotid sinus to the vagus nerve to the sinoatrial nodec. Parasympathetic nervous system to the glossopharyngeal nerve to the atrioventricular noded. Bundle branches to the α-adrenergic receptors to the sinoatrial nodeANS: BThe intact autonomic nervous system reflexively responds with an arteriolar spasm that increases blood pressure. Baroreceptors in the cerebral vessels, the carotid sinus, and the aorta sense the hypertension and stimulate the parasympathetic system. The heart rate decreases, but the visceral and peripheral vessels do not dilate because efferent impulses cannot pass through the cord. The sympathetic system is damaged and not able to stimulate receptors. Without sympathetic balance, the parasympathetic nervous system dominates. The glossopharyngeal nerve is not involved in heart rate regulation. α-Adrenergic receptors would be stimulated by the sympathetic system.PTS: 1 DIF: Cognitive Level:
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