Chapter 16 Test Questions

Question 1

A 60-year-old male with a history of poorly controlled hypertension complains of a sudden, severe headache. Within a few minutes, his level of consciousness rapidly deteriorates. This is MOST suggestive of a(n):

A. frontal lobe infarction.

B. acute ischemic stroke.

C. ruptured cerebral artery.

D. transient ischemic attack.

Answer 1

C. ruptured cerebral artery.

Question 2

You respond to a residence for a 27-year-old male with an altered mental status. As you are assessing him, his girlfriend tells you that he does not have any medical problems that she is aware of; however, he did fall two days ago and struck his head. These clinical and historical findings should make you MOST suspicious for:

A. acute hypoglycemia.

B. meningeal artery rupture.

C. epidural hemorrhaging.

D. subdural hemorrhaging.

Answer 2

D. subdural hemorrhaging.

Question 3

A patient experiencing status epilepticus:

A. commonly has a therapeutic anticonvulsant level.

B. has a return of consciousness in between seizures.

C. typically maintains bowel and bladder continence.

D. is having a prolonged generalized motor seizure.

Answer 3

D. is having a prolonged generalized motor seizure.

Question 4

A 70-year-old male presents with acute aphasia, unilateral weakness, and confusion. In addition to administering 100% oxygen, it is important to:

A. use the Cincinnati Stroke Scale to rule out a stroke.

B. start an IV line with a hypertonic crystalloid solution.

C. assess his blood glucose level to rule out hypoglycemia.

D. apply an AED in case the patient develops cardiac arrest.

Answer 4

C. assess his blood glucose level to rule out hypoglycemia.

Question 5

An idiopathic seizure is a seizure:

A. without an identifiable etiology.

B. resulting from alcohol withdrawal.

C. caused by an intracranial pathology.

D. caused by subtherapeutic drug levels.

Answer 5

A. without an identifiable etiology.

Question 6

In most people, speech is controlled by the:

A. left hemisphere.

B. right hemisphere.

C. frontal lobe.

D. occipital lobe.

Answer 6

A. left hemisphere.

Question 7

The hypertension that is commonly observed in patients with an intracerebral hemorrhage is usually the result of:

A. massive vasoconstriction within the cerebrum.

B. a reflex bradycardia as the body compensates.

C. the body’s attempt to shunt blood to the brain.

D. systemic vasodilation caused by autoregulation.

Answer 7

C. the body’s attempt to shunt blood to the brain.

Question 8

A hemorrhagic stroke occurs as a result of:

A. a ruptured cerebral artery.

B. uncontrolled hypertension.

C. a blot clot within the brain.

D. blood in the arachnoid space.

Answer 8

A. a ruptured cerebral artery.

Question 9

The clonic phase of a generalized motor seizure is characterized by:

A. paralysis of the intercostal muscles and the diaphragm.

B. continuous and unremitting total body muscular contractions.

C. muscle contraction and relaxation occurring in rapid succession.

D. total body muscle flaccidity immediately following the seizure.

Answer 9

C. muscle contraction and relaxation occurring in rapid succession.

Question 10

Located just behind the brainstem, the ___________ controls muscle and body coordination.

A. cerebrum

B. cerebellum

C. diencephalon

D. cerebral cortex

Answer 10

B. cerebellum

Question 11

A 57-year-old female with a history of peripheral vascular disease presents with an acute onset of confusion, aphasia, left-sided hemiparesis, and loss of muscle control to the right side of her face. You should suspect an:

A. arterial hemorrhage in the left cerebral hemisphere.

B. arterial blockage in the right cerebral hemisphere.

C. arterial blockage in the left cerebral hemisphere.

D. arterial hemorrhage in the right cerebral hemisphere.

Answer 11

B. arterial blockage in the right cerebral hemisphere.

Question 12

Migraine headaches are thought to be caused by:

A. an intracranial lesion, such as a tumor or abscess.

B. shunting of excess amounts of blood from the brain.

C. changes in blood vessel size within the base of the brain.

D. excess psychological stress that is poorly managed.

Answer 12

C. changes in blood vessel size within the base of the brain.

Question 13

Which of the following conditions would MOST likely mimic the signs and symptoms of an acute ischemic stroke?

A. Low blood glucose level

B. Severe intracranial pressure

C. Ruptured cerebral aneurysm

D. Hyperglycemic ketoacidosis

Answer 13

A. Low blood glucose level

Question 14

You are assessing a 45-year-old male who experienced a syncopal episode. He is conscious and alert, and complains only of slight weakness. He denies any medical problems or drug allergies. His blood pressure is 140/90 mm Hg, pulse is 40 beats/min, and respirations are 22 breaths/min. What is the MOST likely cause of this patient’s syncopal episode?

A. Severe dehydration

B. Hypertensive crisis

C. Acute bradycardia

D. An acute infection

Answer 14

C. Acute bradycardia

Question 15

You are assessing the arm drift of an elderly male with a suspected stroke and note that both of his arms drift toward the ground. You should:

A. conclude that the patient is having a left-sided ischemic stroke.

B. treat the patient for a hemorrhagic stroke to the right side of the brain.

C. assess the arm drift by having the patient hold up one arm at a time.

D. ensure the patient understood your instructions and repeat the test.

Answer 15

D. ensure the patient understood your instructions and repeat the test.

Question 16

An ischemic stroke is MOST often the result of a(n):

A. cerebral embolism.

B. blocked cerebral artery.

C. intracerebral hemorrhage.

D. sudden cerebral vasospasm.

Answer 16

B. blocked cerebral artery.

Question 17

Patients with a hemorrhagic stroke typically experience a rapidly declining level of consciousness because of:

A. pressure on the brain stem.

B. global anoxia of the cerebrum.

C. blood in the subarachnoid space.

D. increasing intracranial pressure.

Answer 17

D. increasing intracranial pressure.

Question 18

A 20-year-old female with a history of chronic epilepsy, who is compliant with her anticonvulsant medication, experiences a “breakthrough” seizure. This usually happens when:

A. the patient misses several doses of his or her anticonvulsant.

B. a seizure occurs despite a therapeutic medication blood level.

C. the patient experiences a sudden increase in body temperature.

D. a seizure occurs as the result of another underlying cause.

Answer 18

B. a seizure occurs despite a therapeutic medication blood level.

Question 19

A patient with a possible stroke is a potential candidate for fibrinolytic therapy unless he or she:

A. has a history of coronary artery disease.

B. is treated greater than 1 hour after the stroke.

C. has a history of well-controlled hypertension.

D. is experiencing an intracranial hemorrhage.

Answer 19

D. is experiencing an intracranial hemorrhage.

Question 20

A degenerative cerebral disease is an example of a(n) ______________ cause of a seizure.

A. idiopathic

B. epileptic

C. metabolic

D. structural

Answer 20

D. structural

Question 21

You are called to the county jail for a 50-year-old male who is “drunk.” When you assess him, you note the smell of alcohol on his breath and a markedly decreased level of consciousness. The sheriff’s deputy tells you that this patient is a “regular.” On the basis of the information that you have obtained, you should:

A. administer 20 mL/kg of normal saline boluses to rehydrate him.

B. treat the patient for liver failure secondary to chronic alcohol abuse.

C. give oxygen and draw blood to determine his blood-alcohol level.

D. assess the patient’s blood glucose and suspect intracranial bleeding.

Answer 21

D. assess the patient’s blood glucose and suspect intracranial bleeding.

Question 22

You are dispatched to an assisted-living center for a 67-year-old male with “mental status changes.” You arrive at the scene and begin to assess the patient. He is responsive to painful stimuli only, has rapid and shallow breathing, and a slow radial pulse. You should:

A. start an IV and administer a fluid bolus.

B. begin assisting the patient’s ventilations.

C. apply a nonrebreathing mask set at 15 L/min.

D. assess his blood glucose level and start an IV.

Answer 22

B. begin assisting the patient’s ventilations.

Question 23

Which of the following statements regarding the twelve cranial nerves is correct?

A. They branch out from between each of the spinal vertebrae.

B. They arise from the brain and innervate the head and face.

C. All twelve nerves exit the brain through the foramen magnum.

D. Their primary function is to send messages to and from the brain.

Answer 23

B. They arise from the brain and innervate the head and face.

Question 24

The largest part of the brain is the:

A. occiput.

B. cerebrum.

C. brain stem.

D. cerebellum.

Answer 24

B. cerebrum.

Question 25

Which of the following scenarios is MOST descriptive of an absence seizure?

A. A 2-year-old male with high fever and a sudden onset of generalized muscle twitching; symptoms subside after 2 minutes.

B. A 4-year-old female with tonic-clonic muscle movement to her entire body; the child remains unresponsive after the event.

C. A 6-year-old male who is conscious, but will not respond to his mother; symptoms subside spontaneously within a few minutes.

D. An 8-year-old female with a brief period of unresponsiveness and unilateral muscle twitching; becomes agitated after the event.

Answer 25

C. A 6-year-old male who is conscious, but will not respond to his mother; symptoms subside spontaneously within a few minutes.

Question 26

When using the Cincinnati Stroke Scale to assess a 59-year-old female with a suspected stroke, you note a left-sided facial droop when you ask her to smile. You should:

A. start an IV line and administer 25g of 50% dextrose (D50).

B. ask the patient to keep her eyes open as you assess arm drift.

C. suspect intracerebral bleeding with mild intracranial pressure.

D. determine if the patient has dysarthria or is unable to speak.

Answer 26

D. determine if the patient has dysarthria or is unable to speak.

Question 27

To minimize the amount of brain-cell damage that occurs following an ischemic stroke, fibrinolytic therapy must be administered within:

A. 3 hours after the call is received.

B. 2 hours after assessing the patient.

C. 3 hours after the onset of symptoms.

D. 2 hours after arriving at the hospital.

Answer 27

C. 3 hours after the onset of symptoms.

Question 28

During a seizure, neurons are in a hypermetabolic state. This means that:

A. they are using large amounts of glucose and producing lactic acid.

B. electrical impulses travel from one neuron to another very slowly.

C. the cells have converted to aerobic metabolism and are producing CO2.

D. brain cell death occurs in as little as 60 seconds after a seizure begins.

Answer 28

A. they are using large amounts of glucose and producing lactic acid.

Question 29

A 30-year-old male presents with a partial seizure to his left arm. His wife denies that he has ever had seizures in the past. Which of the following conditions would be the LEAST likely cause of this patient’s seizure?

A. Idiopathic epilepsy

B. An intracerebral tumor

C. Intracranial hemorrhage

D. A serious cerebral infection

Answer 29

A. Idiopathic epilepsy

Question 30

You respond to a call for a 39-year-old female with an altered mental status. Your primary assessment reveals that she is conscious but confused, has a heart rate of 88 beats/min, and has respirations of 22 breaths/min with adequate tidal volume. After administering supplemental oxygen, you should:

A. start an IV and assess her blood glucose level.

B. perform a focused history and physical exam.

C. start an IV and administer 50% dextrose (D50).

D. start an IV and administer 2 mg of naloxone.

Answer 30

B. perform a focused history and physical exam.

Question 31

Following a head injury, a patient is verbally abusive and combative. He MOST likely has an injury to the ___________ lobe of the brain.

A. parietal

B. temporal

C. occipital

D. frontal

Answer 31

D. frontal

Question 32

A 45-year-old female is found semiconscious by a neighbor. She is incontinent of urine and is bleeding from her mouth. Which of the following medications found in her residence would lead you to suspect that she experienced a seizure?

A. Lamictal

B. Valium

C. Ativan

D. Elavil

Answer 32

A. Lamictal

Question 33

Your 23-year-old female patient complains of pain to the superior portion of her face. She tells you that the pain has persisted for the past few days and gets worse when she bends down to pick something up. This is MOST consistent with a:

A. sinus headache.

B. cluster headache.

C. tension headache.

D. migraine headache.

Answer 33

A. sinus headache.

Question 34

You are dispatched to a local convenience store for a 30-year-old male who is actively seizing. Upon your arrival, the patient is confused and combative. This is indicative of the ___________ phase.

A. tonic

B. postictal

C. myoclonic

D. hypertonic

Answer 34

B. postictal

Question 35

A 69-year-old female is found to be semiconscious, hypertensive, and bradypneic. You should:

A. apply oxygen via nonrebreathing mask and start an IV line.

B. assist ventilations and start an IV set to keep the vein open.

C. insert a multilumen airway device and rapidly transport her.

D. assist ventilations and give a 20 mL/kg bolus of normal saline.

Answer 35

B. assist ventilations and start an IV set to keep the vein open.

Question 36

__________ brain cells receive a minimal supply of oxygen and are unable to function normally.

A. Ischemic

B. Infarcted

C. Anoxic

D. Hypocarbic

Answer 36

A. Ischemic

Question 37

A 68-year-old male presents with confusion, left-sided hemiparesis, and decreased muscle tone to the right side of his face. You administer oxygen, start an IV, and begin transport to the hospital. En route, the patient becomes more coherent and slowly regains use of his left arm. These findings are MOST suggestive of:

A. permanent injury to the left side of the brain.

B. temporary ischemia to the right side of the brain.

C. an impending massive stroke within 24 hours.

D. a transient infarct to the right side of the brain.

Answer 37

B. temporary ischemia to the right side of the brain.

Question 38

Routine treatment for a patient who has just experienced a generalized tonic-clonic seizure and is postictal includes all of the following EXCEPT:

A. an IV of normal saline or a saline lock.

B. 50% dextrose via IV administration.

C. assessing for trauma to the long bones or spine.

D. 100% oxygen and ventilatory assistance as needed.

Answer 38

B. 50% dextrose via IV administration.

Question 39

The __________, which is present wherever a nerve cell terminates, connects to the next cell via__________.

A. axon, catecholamines

B. synapse, neurotransmitters

C. dendrite, nerve fibers

D. neuron, catecholamines

Answer 39

B. synapse, neurotransmitters

Question 40

With regard to potential treatment in the hospital, which of the following questions is MOST important to ask the spouse of a 66-year-old female who presents with signs and symptoms of an acute ischemic stroke?

A. “When did you first notice the symptoms?”

B. “Does your wife have high blood pressure?”

C. “Did your wife pass out or have a seizure?”

D. “When was the last time that your wife ate?”

Answer 40

A. “When did you first notice the symptoms?”