URDEN NEURO FINAL EXAM Questions Guide
1. Which of the following arterial blood gas values would indicate a need for oxygen therapy?
a.
PaO2 of 80 mm
... [Show More] Hg
c.
HCO3- of 24 mEq
b.
PaCO2 of 35 mm Hg
d.
SaO2 of 87%
ANS: D
The amount of oxygen administered depends on the pathophysiologic mechanisms affecting the patient's oxygenation status. In most cases, the amount required should provide an arterial partial pressure of oxygen (PaO2) of greater than 60 mm Hg or an arterial hemoglobin saturation (SaO2) of greater than 90% during both rest and exercise.
2. Which of the following oxygen administration devices can deliver oxygen concentrations of 90%?
a.
Nonrebreathing mask
c.
Partial rebreathing mask
b.
Nasal cannula
d.
Simple mask
ANS: A
With an FiO2 of 55% to 70%, a nonrebreathing mask with a tight seal over the face can deliver 90% to 100% oxygen. It is used in emergencies and short-term therapy requiring moderate to high FiO2.
3. The most accurate and reliable control of FiO2 can be achieved through the use of a(n)
a.
simple mask.
c.
air-entrainment mask.
b.
nonrebreathing circuit (closed).
ANS: B
The most reliable and accurate means of delivering a prescribed concentration of oxygen is through the use of a nonrebreathing circuit (closed).
4. Use of oxygen therapy in the patient who is hypercapnic may result in
a.
oxygen toxicity.
c.
carbon dioxide retention.
b.
absorption atelectasis.
d.
pneumothorax.
ANS: C
Deoxygenated hemoglobin carries more CO2 compared with oxygenated hemoglobin. Administration of oxygen increases the proportion of oxygenated hemoglobin, which causes increased release of CO2 at the lung level. Because of the risk of CO2 accumulation, all patients who are chronically hypercapnic require careful low-flow oxygen administration.
5. The correct procedure for selecting an oropharyngeal airway is to:
a.
measure from the tip of the nose to the ear lobe.
b.
measure from the mouth to the ear lobe.
c.
measure from the tip of the nose to the middle of the trachea.
d.
measure the airway from the corner of the patient's mouth to the angle of the jaw.
ANS: D
An oropharyngeal airway's proper size is selected by holding the airway against the side of the patient's face and ensuring that it extends from the corner of the mouth to the angle of the jaw. If the airway is improperly sized, it will occlude the airway. Nasopharyngeal airways are measured by holding the tube against the side of the patient's face and ensuring that it extends from the tip of the nose to the ear lobe.
6. The finding of normal breath sounds on the right side of the chest and absent breath sounds on the left side of the chest in a newly intubated patient is probably caused by a
a.
right mainstem intubation.
c.
right hemothorax.
b.
left pneumothorax.
d.
gastric intubation.
ANS: A
The finding of normal breath sounds on the right side of the chest and absent breath sounds on the left side of the chest in a newly intubated patient is probably caused by a right mainstem intubation
7. Long-term ventilator management over 21 days is best handled through use of a(n)
a.
oropharyngeal airway.
c.
tracheostomy tube.
b.
esophageal obturator airway.
d.
endotracheal intubation.
ANS: C
Although no ideal time to perform the procedure has been identified, it is commonly accepted that if a patient has been intubated or is anticipated to be intubated for longer than 7 to 10 days, a tracheostomy should be performed.
8. Which of the following statements is correct concerning endotracheal tube cuff management?
a.
The cuff should be deflated every hour to minimize pressure on the trachea.
b.
A small leak should be heard on inspiration if the cuff has been inflated using the minimal leak technique.
c.
Cuff pressures should be kept between 40 to 50 mm Hg to ensure an adequate seal.
d.
Cuff pressure monitoring should be done once every 24 hours.
ANS: B
The minimal leak technique consists of injecting air into the cuff until no leak is heard and then withdrawing the air until a small leak is heard on inspiration. Problems with this technique include difficulty maintaining positive end-expiratory pressure and aspiration around the cuff.
9. Nursing interventions to limit the complications of suctioning include
a.
inserting the suction catheter no more than 5 inches.
b.
premedicating the patient with atropine.
c.
hyperoxygenating the patient with 100% oxygen.
d.
increasing the suction to 150 mm Hg.
ANS: C
Hypoxemia can be minimized by giving the patient three hyperoxygenation breaths (breaths at 100% FiO2) with the ventilator before the procedure and again after each pass of the suction catheter.
10. Which of the following levels would be classified as a low-flow system of oxygen administration?
a.
O2 via nasal cannula at 4 L/min
b.
O2 via nasal catheter at a FiO2 range of 60% to 75%
c.
O2 via transtracheal catheter at 10 L/min
d.
O2 via simple mask at 12 L/min.
ANS: A
A low-flow oxygen delivery system provides supplemental oxygen directly into the patient's airway at a flow of 8 L/min or less. Because this flow is insufficient to meet the patient's inspiratory volume requirements, it results in a variable FiO2 as the supplemental oxygen is mixed with room air. Nasal catheter FiO2 range is 22% to 45%. Oxygen flow through a transtracheal catheter is 0.25 to 4 L/min. A simple mask is a reservoir delivery system.
11. The ventilator variable that causes inspiration is called the
a.
cycle.
c.
flow.
b.
trigger.
d.
pressure.
ANS: B
The phase variable that initiates the change from exhalation to inspiration is called the trigger. Breaths may be pressure triggered or flow triggered based on the sensitivity setting of the ventilator and the patient's inspiratory effort or time triggered based on the rate setting of the ventilator.
12. The assist-control mode of ventilation functions in which of the following manners?
a.
It delivers gas at preset volume, at a set rate, and in response to the patient's inspiratory efforts.
b.
It delivers gas at a preset volume, allowing the patient to breathe spontaneously at his or her own volume.
c.
It applies positive pressure during both ventilator breaths and spontaneous breaths.
d.
It delivers gas at preset rate and tidal volume regardless of the patient's inspiratory efforts.
ANS: A
Whereas a breath that is initiated by the patient is known as a patient-triggered or patient-assisted breath, a breath that is initiated by the ventilator is known as a machine-triggered or machine-controlled breath. A time-triggered breath is a machine-controlled breath that is initiated by the ventilator after a preset length of time has elapsed. It is controlled by the rate setting on the ventilator (e.g., a rate of 10 breaths/min yields 1 breath every 6 seconds). Flow-triggered and pressure-triggered breaths are patient-assisted breaths that are initiated by decreased flow or pressure, respectively, within the breathing circuit.
13. Preset positive pressure used to augment the patient's inspiratory effort is known as
a.
positive end-expiratory pressure (PEEP).
b.
continuous positive airway pressure (CPAP).
c.
pressure control ventilation (PCV).
d.
pressure support ventilation (PSV).
ANS: D
Preset positive pressure used to augment the patient's inspiratory efforts is known as pressure support ventilation. With continuous positive airway pressure, positive pressure is applied during spontaneous breaths; the patient controls rate, inspiratory flow, and tidal volume. Positive end-expiratory pressure is positive pressure applied at the end of expiration of ventilator breaths.
14. Which of the following statements best describes the effects of positive-pressure ventilation on cardiac output?
a.
Positive-pressure ventilation increases intrathoracic pressure, which increases venous return and cardiac output.
b.
Positive-pressure ventilation decreases venous return, which increases preload and cardiac output.
c.
Positive-pressure ventilation increases venous return, which decreases preload and cardiac output.
d.
Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return and cardiac output.
ANS: D
Positive-pressure ventilation increases intrathoracic pressure, which decreases venous return to the right side of the heart. Impaired venous return decreases preload, which results in a decrease in cardiac output.
15. Nursing management of the patient receiving a neuromuscular blocking agent should include
a.
withholding all sedation and narcotics.
b.
protecting the patient from the environment.
c.
keeping the patient supine.
d.
speaking to the patient only when necessary.
ANS: B
Patient safety is a major concern for the patient receiving a neuromuscular blocking agent because these patients are unable to protect themselves from the environment. Special precautions should be taken to protect the patient at all times.
16. A patient was admitted to the critical care unit with acute respiratory failure. The patient has been on a ventilator for 3 days and is being considered for weaning. The ventilator high-pressure alarm keeps going off. When you enter the room, the ventilator inoperative alarm sounds. What is the primary action the nurse would take?
a.
Troubleshoot the ventilator until the problem is found.
b.
Take the patient off the ventilator and manually ventilate her.
c.
Call the respiratory therapist for help.
d.
Silence the ventilator alarms until the problem is resolved.
ANS: B
Ensure emergency equipment is at bedside at all times (e.g., manual resuscitation bag connected to oxygen, masks, suction equipment or supplies), including preparations for power failures. If the ventilator malfunctions, the patient should be removed from the ventilator and ventilated manually with a manual resuscitation bag.
17. A patient was admitted to the critical care unit with acute respiratory failure. The patient has been on a ventilator for 3 days and is being considered for weaning. The ventilator high-pressure alarm keeps going off. When you enter the room, the ventilator inoperative alarm sounds. All of the following conditions would set off the high-pressure alarm except
a.
a leak in the patient's ET tube cuff
b.
a kink in the ET tubing
c.
coughing
d.
increased secretions in the patient's airway
ANS: A
Low inspiratory pressure alarms will sound because of altered settings, unattached tubing or a leak around the endotracheal tube (ETT), the ETT displaced into the pharynx or esophagus, poor cuff inflation or leak, tracheoesophageal fistula, peak flows that are too low, low tidal volume (Vt), decreased airway resistance resulting from decreased secretions or relief of bronchospasm, increased lung compliance resulting from decreased atelectasis, reduction in pulmonary edema, resolution of ARDS, or a change in position. High-pressure alarms will sound because of improper alarm setting; airway obstruction resulting from patient fighting ventilator (holding breath as ventilator delivers Vt); patient circuit collapse; kinked tubing; the ETT in the right mainstem bronchus or against the carina; cuff herniation; increased airway resistance resulting from bronchospasm, airway secretions, plugs, and coughing; water from the humidifier in the ventilator tubing; and decreased lung compliance resulting from tension pneumothorax, change in patient position, acute respiratory distress syndrome, pulmonary edema, atelectasis, pneumonia, or abdominal distention.
18. A patient was admitted to the critical care unit with acute respiratory failure. The patient has been on a ventilator for 3 days and is being considered for weaning. The ventilator high-pressure alarm keeps going off. When you enter the room, the ventilator inoperative alarm sounds. Which of the following criteria would indicate that the patient is ready to be weaned?
a.
FiO2 greater than 50%
b.
Rapid shallow breathing index less than 105
c.
Minute ventilation greater than 10 L/min
d.
Vital capacity/kg greater than or equal to 15 mL
ANS: B
The rapid shallow breathing index (RSBI) has been shown to be predictive of weaning success. To calculate the RSBI, the patient's respiratory rate and minute ventilation are measured for 1 minute during spontaneous breathing. The measured respiratory rate is then divided by the tidal volume (expressed in liters). An RSBI less than 105 is considered predictive of weaning success. If the patient meets criteria for weaning readiness and has an RSBI less than 105, a spontaneous breathing trial can be performed.
19. A patient was admitted to the critical care unit with acute respiratory failure. The patient has been on a ventilator for 3 days and is being considered for weaning. The ventilator high-pressure alarm keeps going off. When you enter the room, the ventilator inoperative alarm sounds. Which of the following criteria would indicate that the patient is not tolerating weaning?
a.
A decrease in heart rate from 92 to 80 beats/min
b.
An SpO2 of 92%
c.
An increase in respiratory rate from 22 to 38 breaths/min
d.
Spontaneous tidal volumes of 300 to 350 mL
ANS: C
Weaning intolerance indicators include (1) a decrease in level of consciousness; (2) a systolic blood pressure increased or decreased by 20 mm Hg; (3) a diastolic blood pressure greater than 100 mm Hg; (4) a heart rate increased by 20 beats/min; (5) premature ventricular contractions greater than 6/min, couplets, or runs of ventricular tachycardia; (6) changes in ST segment (usually elevation); (7) a respiratory rate greater than 30 breaths/min or less than 10 breaths/min; (8) a respiratory rate increased by 10 breaths/min; (9) a spontaneous tidal volume less than 250 mL; (10) a PaCO2 increased by 5 to 8 mm Hg or pH less than 7.30; (11) an SpO2 less than 90%; (12) use of accessory muscles of ventilation; (13) complaints of dyspnea, fatigue, or pain; (14) paradoxical chest wall motion or chest abdominal asynchrony; (15) diaphoresis; and (16) severe agitation or anxiety unrelieved with reassurance.
20. Patient safety precautions when working with oxygen involve
a.
observation for signs of oxygen-introduced hyperventilation.
b.
restriction of smoking.
c.
removal of all oxygen devices when eating to prevent aspiration.
d.
administration of oxygen at the nurse's discretion.
ANS: B
Patient safety precautions when working with oxygen involve administration of oxygen and monitoring of its effectiveness. Activities include restricting smoking, administering supplemental oxygen as ordered, observing for signs of oxygen-induced hypoventilation, monitoring the patient's ability to tolerate removal of oxygen while eating, and changing the oxygen delivery device from a mask to nasal prongs during meals as tolerated.
21. Which route for ETT placement is used in an emergency?
a.
Orotracheal
c.
Nasopharyngeal
b.
Nasotracheal
d.
Trachea
ANS: A
An endotracheal tube (ETT) may be placed through the orotracheal or the nasotracheal route. In most situations involving emergency placement, the orotracheal route is used because it is simpler and allows the use of a larger diameter ETT. Nasotracheal intubation provides greater patient comfort over time and is preferred in patients with a jaw fracture.
22. The Passy-Muir valve is contraindicated in patients
a.
who are trying to relearn normal breathing patterns.
b.
who experience low secretions.
c.
with laryngeal or pharyngeal dysfunction.
d.
who want to speak while on the ventilator.
ANS: C
The Passy-Muir valve is contraindicated in patients with laryngeal or pharyngeal dysfunction, excessive secretions, or poor lung compliance.
23. A patient was taken to surgery for a left lung resection earlier today. The patient has been in the postoperative care unit for 30 minutes. When you are completing your assessment, you notice that the chest tube has drained 125 cc of red fluid in the past 30 minutes. The nurse contacts the physician and suspects that the patient has developed
a.
pulmonary edema.
c.
acute lung failure.
b.
hemorrhage.
d.
bronchopleural fistula.
ANS: B
Hemorrhage is an early, life-threatening complication that can occur after a lung resection. It can result from bronchial or intercostal artery bleeding or disruption of a suture or clip around a pulmonary vessel. Excessive chest tube drainage can signal excessive bleeding. During the immediate postoperative period, chest tube drainage should be measured every 15 minutes; this frequency should be decreased as the patient stabilizes. If chest tube loss is greater than 100 mL/hr, fresh blood is noted, or a sudden increase in drainage occurs, hemorrhage should be suspected.
24. Which medication may be administered with a bronchodilator because it can cause bronchospasms?
a.
β2-Agonists
c.
Anticholinergic agents
b.
Mucloytics
d.
Xanthines
ANS: B
Mucolytics may be administered with a bronchodilator because it can cause bronchospasms and inhibit ciliary function. Treatment is considered effective when bronchorrhea develops and coughing occurs. β2-Agonists are used to relax bronchial smooth muscle and dilate airways to prevent bronchospasms. Anticholinergic agents are used to block the constriction of bronchial smooth muscle and reduce mucus production. Xanthines are used to dilate bronchial smooth muscle and reverse diaphragmatic muscle fatigue.
25. Indications to support a pneumonectomy are
a.
lesions confined to a single lobe.
c.
unilateral tuberculosis.
b.
bronchiectasis.
d.
lung abscesses or cyst.
ANS: C
A pneumonectomy is the removal of entire lung with or without resection of the mediastinal lymph nodes. Indications include malignant lesions, unilateral tuberculosis, extensive unilateral bronchiectasis, multiple lung abscesses, massive hemoptysis, and bronchopleural fistula.
26. The therapeutic blood level for theophylline (Xanthines) is
a.
5 to 10 mg/dL.
c.
20 to 30 mg/dL.
b.
10 to 20 mg/dL.
d.
35 to 45 mg/dL.
ANS: B
Therapeutic blood level for theophylline is 10 to 20 mg/dL.
1. Complications of ETT tubes include (Select all that apply.)
a.
tracheoesophageal fistula.
b.
cricoid abscess.
c.
tracheal stenosis.
d.
tube obstruction.
e.
tube displacements.
ANS: A, B, C, D, E
Complications of endotracheal tubes include tube obstruction, tube displacement, sinusitis and nasal injury, tracheoesophageal fistula, mucosal lesions, laryngeal or tracheal stenosis, and cricoid abscess.
2. Which of the following should be used when suctioning a mechanically ventilated patient? (Select all that apply.)
a.
Three hyperoxygenation breaths (breaths at 100% FiO2)
b.
Hyperinflation (breaths at 150% tidal volume)
c.
Limit the number of passes to three.
d.
Instill 5 to 10 mL of normal saline to facilitate secretion removal.
e.
Use intermittent suction to avoid damaging tracheal tissue.
ANS: A, B, C
Hyperoxygenation, hyperinflation, and limiting the number of passes help avoid desaturation. There is no evidence to suggest that intermittent suction reduces damage, and saline instillation can actually increase the risk for infection.
3. Which of the following statements are true regarding rotational therapy? (Select all that apply.)
a.
Continuous lateral rotation therapy (CLRT) can be effective for improving oxygenation if used for at least 18 hours/day.
b.
Kinetic therapy can decrease the incidence of ventilator-acquired pneumonia in neurologic and postoperative patients.
c.
Use of rotational therapy eliminates the need for other pressure ulcer prevention strategies.
d.
CLRT helps avoid hemodynamic instability secondary to the continuous, gentle turning of the patient.
e.
CLRT has minimal pulmonary benefits for critically ill patients.
ANS: A, B, E
Studies have found that to achieve benefits with CLRT or kinetic therapy, rotation must be aggressive, and the patient must be at least 40 degrees per side, with a total arc of at least 80 degrees for at least 18 hours a day. Kinetic therapy has been shown to decrease the incidence of ventilator-acquired pneumonia, particularly in neurologic and postoperative patients. Complications of the procedure include dislodgment or obstruction of tubes, drains, and lines; hemodynamic instability; and pressure ulcers. Lateral rotation does not replace manual repositioning to prevent pressure ulcers. CLRT has been shown to be of minimal pulmonary benefit for the critically ill patients.
4. Identify the clinical manifestations associated with oxygen toxicity. (Select all that apply.)
a.
Substernal chest pain that increases with deep breathing
b.
Moist cough and tracheal irritation
c.
Pleuritic pain occurring on inhalation, followed by dyspnea
d.
Increasing CO2
e.
Sore throat and eye and ear discomfort
ANS: A, C, E
A number of clinical manifestations are associated with oxygen toxicity. The first symptom is substernal chest pain that is exacerbated by deep breathing. A dry cough and tracheal irritation follow. Eventually, definite pleuritic pain occurs on inhalation followed by dyspnea. Upper airway changes may include a sensation of nasal stuffiness, sore throat, and eye and ear discomforts.
1. Which of the following structures form(s) the blood-brain barrier?
a.
Postsynaptic terminals
c.
Vascular endothelial cells
b.
Pia mater
d.
Myelin sheath
ANS: C
The blood-brain barrier operates on the concept of tight junctions between adjacent cells and actually consists of three separate barriers: the endothelial cells of cerebral blood vessels, the epithelial cells of the choroid plexus, and the cells that form the outermost layer of the arachnoid.
2. CNS response to the periphery to produce contraction of the skeletal muscles is the result of
a.
efferent fibers.
c.
myelin sheath.
b.
afferent fibers.
d.
neurotransmitters.
ANS: A
Efferent fibers (motor fibers) transmit the central nervous system (CNS) response to the periphery to produce a motor response such as contraction of skeletal muscles, contraction of the smooth muscles of organs, or secretion by endocrine glands. This sensory information is transmitted to the CNS by afferent fibers (sensory fibers). Fibers enclosed in the sheath are called myelinated fibers. Neurotransmitters help with nerve transmission from one neuron to the next.
3. Neuronal function is driven by
a.
nodes of Ranvier.
c.
repolarization-depolarization cycles.
b.
saltatory conduction.
d.
depolarization-repolarization cycles.
ANS: D
Neuronal function is driven by depolarization-repolarization cycles, similar to that described for cardiac physiology. Myelinated fibers use a process called saltatory conduction to support rapid axonal transmission of nerve impulses. Structurally, axons participating in this form of impulse transmission are laid out with a noncontinuous myelin cover, interrupted with 2-micrometer bare segments called the nodes of Ranvier.
middle meningeal artery?
a.
Subdural
c.
Subarachnoid
b.
Epidural
d.
Intercerebral
ANS: B
The main blood supply for the dura mater is the middle meningeal artery. This artery lies on the surface of the dura in the epidural space within grooves formed on the inside of the parietal bone. Traumatic disruption of the parietal bone may result in tearing of the middle meningeal artery and development of an epidural hematoma.
5. Which area of the ventricular system is usually cannulated for intracranial pressure monitoring?
a.
Frontal horn of the lateral ventricle
c.
Foramen of Monro
b.
Aqueduct of Sylvius
d.
Fourth ventricle
ANS: A
When cannulation of the ventricular system is required for intracranial pressure monitoring, cerebrospinal fluid (CSF) drainage, or placement of a CSF shunt, the frontal horn of the lateral ventricle on the nondominant side of the brain is most often selected.
6. What percentage of the body's total resting cardiac output is used by the brain?
a.
5%
c.
20%
b.
10%
d.
40%
ANS: C
The brain constitutes 2% of the body's weight but uses 20% of the body's total resting cardiac output. It requires approximately 750 mL of blood flow per minute and can extract as much as 45% of arterial oxygen to meet normal metabolic needs.
7. Which areas of the spinal cord have tenuous blood supply and are especially vulnerable to circulatory embarrassment?
a.
C2 to C3
c.
T8 to T10
b.
C5 to C6
d.
L4 to L5
ANS: A
Arterial supply to the spinal cord is segmented at best, making portions of the spinal cord that receive blood supply from two separate sources vulnerable to low flow states. The most vulnerable of these areas are C2 to C3, T1 to T4, and L1 to L2.
8. Damage to the upper portion of the reticular activating system results in which condition?
a.
Seizures
c.
Apnea
b.
Diabetes insipidus
d.
Impaired consciousness
ANS: D
The reticular activating system (RAS) works through activation of the hypothalamus, which results in diffuse cortical stimulation and autonomic stimulation. Damage to the thalamic or hypothalamic RAS pathways results in impaired consciousness.
9. A person with a cerebellar lesion will have difficulty with
a.
breathing.
c.
memory.
b.
equilibrium.
d.
speech.
ANS: B
Cerebellar impulses are communicated to descending motor pathways to integrate spatial orientation and equilibrium with posture and muscle tone, ensuring synchronized adjustments in movement that maintain overall balance and motor coordination. Cerebellar monitoring and adjustment of motor activity occurs simultaneously with movement, enabling significant control of fine motor function.
10. The large opening at the base of the cranium is known as the
a.
cisterna magna.
c.
foramen magnum.
b.
median foramen.
d.
lateral foramen.
ANS: C
The cranium is a solid, nonexpanding bony vault with only one large opening at the base called the foramen magnum, through which the brainstem projects and connects to the spinal cord.
11. Which statement best describes the role of neuroglial cells?
a.
They are fewer in number than neurons.
b.
They provide support to the neuron in nutrients and structural formation.
c.
They protect the CNS from nonmetabolic primary neoplasms.
d.
They produce a steady supply of neurotransmitters.
ANS: B
These cells provide the neuron with structural support, nourishment, and protection (Table 26-1). They also retain their ability to replicate but can replicate abnormally and hence are the primary source of central nervous system neoplasms.
12. Tissue that adheres directly to the brain tissue and is rich in small blood vessels that supply a large amount of arterial blood to the CNS is known as the
a.
dura mater.
c.
pia mater.
b.
arachnoid mater.
d.
CNS.
ANS: C
The outermost layer of meninges directly beneath the skull is the dura mater. The arachnoid membrane is a delicate, fragile membrane that loosely surrounds the brain. Cerebrospinal fluid (CSF) circulates freely in the subarachnoid space fragile membrane that loosely surrounds the brain. The pia mater adheres directly to brain tissue. Rich in small blood vessels that supply a large volume of arterial blood to the central nervous system, this membrane closely follows all folds and convolutions of the brain's surface.
13. Obstructive hydrocephalus can occur in the presence of
a.
blockage in the arachnoid villi.
b.
malformation of the falx cerebelli.
c.
blockage of CSF flow in the ventricular system.
d.
increased production of CSF with poor outlet.
ANS: C
Blockage of CSF flow occurring within the ventricular system obstructs the normal circulation of CSF, causing dilation of the ventricles, a condition called obstructive hydrocephalus.
14. Substances most likely to pass across the blood-brain barrier have which of the following characteristics?
a.
Low pH compared with body fluids
c.
Large particle size
b.
Lipid solubility
d.
A close relation to toxic metabolites
ANS: B
Passage of substances across the blood-brain barrier is a function of particle size, lipid solubility, and protein-binding potential. Most drugs or compounds that are lipid soluble and stable at body pH rapidly cross the blood-brain barrier. The blood-brain barrier is also very permeable to water, oxygen, carbon dioxide, and glucose.
15. Control of the rate of respirations occurs in the
a.
apneustic center.
c.
reticular activating system.
b.
pneumotaxic center.
d.
midbrain.
ANS: B
Two respiratory control centers are located in the pons, namely the apneustic and pneumotaxic centers. Whereas the apneustic center controls the length of inspiration and expiration, the pneumotaxic center controls respiratory rate.
16. The sensory, motor, and cognitive functions are the primary functions of the
a.
diencephalon.
c.
cerebellum.
b.
basal ganglia.
d.
cerebrum.
ANS: D
The outermost aspect of the cerebrum is called the cerebral cortex. The primary functions of the cerebral cortex include sensory, motor, and intellectual (cognitive) functions, making this area of the brain vital to normal human functioning and providing capabilities that make humans unique as a species.
17. The region of the brain that acts as a relay station for both motor and sensory activity is the
a.
cerebrum.
c.
thalamus.
b.
cerebellum.
d.
hypothalamus.
ANS: C
The thalamus consists of two connected ovoid masses of gray matter and forms the lateral walls of the third ventricle. The two thalami serve as a relay station and gatekeeper for motor and sensory stimuli, preventing or enhancing transmission of impulses based on the behavioral needs of the person.
18. When a patient with neurologic damage continues with extremely high core body temperature despite interventions to lower temperature, the area of the brain most likely affected is the
a.
cerebrum.
c.
thalamus.
b.
cerebellum.
d.
hypothalamus.
ANS: D
Areas of the internal environment regulated and maintained by the hypothalamus include temperature regulation, autonomic nervous system responses, food and water intake, hormonal secretions, and behavioral responses.
19. A lack or inadequate amount of which two substances can cause disruption in neuronal function and irreversible damage?
a.
Oxygen and glucose
c.
Oxygen and protein
b.
Protein and insulin
d.
Protein and glucose
ANS: A
No reserve of either oxygen or glucose is found in the cerebral tissues. A lack or inadequate amount of either one rapidly disrupts cerebral function and produces irreversible damage.
20. Based on the circle of Willis, if the right internal carotid artery is blocked so that inadequate blood flows to the cerebral arteries, oxygen and nutrients to the brain
a.
can be supported by the circle of Willis.
c.
are diminished by 50%.
b.
are diminished by 25%.
d.
are blocked.
ANS: A
When complete, the circle of Willis is capable of supporting some degree of collateral blood flow in the case of arterial occlusion, although a sufficient arterial supply in the face of arterial obstruction is not guaranteed.
21. The ability to access CSF by a lumbar puncture is attributable to the flow of CSF in the
a.
dura mater.
c.
epidural cavity.
b.
pia mater.
d.
subarachnoid space.
ANS: D
Cerebrospinal fluid fills the ventricular system and surrounds the brain and spinal cord in the subarachnoid space.
22. A patient is admitted to the critical care unit after a stroke. The patient has an altered level of consciousness and garbled speech. A computed tomography scan is performed to determine the cause of the stroke, and a lumbar puncture is performed for analysis of CSF. Because the patient's speech is garbled, the nurse documents the occurrence of which type of aphasia?
a.
Fluent
c.
Expressive
b.
Receptive
d.
Global
ANS: C
The area involved in the formulation of verbal speech is the Broca area. Damage to this area results in an expressive or nonfluent aphasia.
23. A patient has coherent speech but the words are illogical. Which part of the brain has been affected?
a.
The cerebellum
c.
The Wernicke area
b.
The Broca area
d.
The hypothalamus
ANS: C
The Wernicke area (Brodmann area 22) is partially located within the parietal lobe and partially in the temporal lobe, most commonly on the left side of the cerebral cortex. This area is concerned with reception of written and verbal language and includes many intricate connections to other parts of the brain associated with auditory and visual functions, cognitive appraisal, and expressive language. Injury to this area of the brain may result in disability ranging from minor receptive language dysfunction to receptive or fluent aphasia, in which expressive language function remains but is illogical in content or a "word salad."
24. Which lobe of the brain deals primarily with sensory function?
a.
Frontal lobe
c.
Occipital lobe
b.
Temporal lobe
d.
Parietal lobe
ANS: D
The parietal lobe is primarily concerned with sensory functions, including integration of sensory information; awareness of body parts; interpretation of touch, pressure, and pain; and recognition of object size, shape, and texture. Injury to these areas may result in tactile sensory loss on the opposite side of the body.
25. The primary functions of which lobe are hearing, speech, behavior, and memory?
a.
Frontal lobe
c.
Occipital lobe
b.
Temporal lobe
d.
Parietal lobe
ANS: B
The temporal lobe lies beneath the temporal bone in the lateral portion of the cranium. Separated from the frontal and parietal lobes by the lateral fissure, this lobe has the primary functions of hearing, speech, behavior, and memory.
26. Cranial nerves IX, X, XI, and XII are located in which section of the brainstem?
a.
Midbrain
c.
Medulla oblongata
b.
Pons
d.
Reticular formation
ANS: C
The medulla oblongata forms the last section of the brainstem, situated between the pons and the spinal cord. The cell bodies of cranial nerves IX (glossopharyngeal), X (vagus), XI (spinal accessory), and XII (hypoglossal) are located in the medulla oblongata
27. Stimulation of this nerve will elicit the gag reflex.
a.
Glossopharyngeal
c.
Spinal accessory
b.
Facial
d.
Hypoglossal
ANS: A
The glossopharyngeal nerve is a sensory nerve whose functions are taste in the posterior third of the tongue and sensation in the back of the throat; stimulation elicits the gag reflex.
28. An afferent pathway that carries sensory impulses from the body into the spinal cord is the
a.
subarachnoid.
c.
ventral root.
b.
spinal nerves.
d.
dorsal root.
ANS: D
The dorsal root is an afferent pathway that carries sensory impulses from the body into the spinal cord. The ventral root is an efferent pathway that carries motor information from the spinal cord to the body.
1. Examples of small-molecule transmitters include (Select all that apply.)
a.
acetylcholine.
b.
glucose.
c.
norepinephrine.
d.
dopamine.
e.
epinephrine.
f.
GABA receptors.
ANS: A, C, D, E
Examples of small-molecule transmitters include acetylcholine, dopamine, norepinephrine, epinephrine, serotonin, histamine, γ-aminobutyric acid, glycine, and glutamate.
2. Which cranial nerves are responsible for motor functions of the eye? (Select all that apply.)
a.
Optic nerve
b.
Oculomotor
c.
Trochlear
d.
Trigeminal
e.
Abducens
f.
Acoustic
ANS: B, C, E
The oculomotor nerve is the motor nerve whose function is raising the eyelids and extraocular movement of the eyes. The trochlear nerve is the motor nerve whose function is the extraocular movement of the eyes. The abducens nerve is the motor nerve that functions with extraocular eye movement and rotates the eyeball outward. The optic nerve is the sensory nerve whose function is vision. The trigeminal nerve is the sensory nerve that gives sensation to the cornea, ciliary body, iris, and lacrimal gland. The acoustic nerve is the sensory nerve whose function is hearing. [Show Less]