Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor

Question 1

Cognitive operations cannot occur without the effective functioning of the brain’s:

a. Pons
c. Reticular activating system
b. Medulla oblongata
d. Cingulate gyru

Answer 1

ANS: C
Cognitive cerebral functions require a functioning reticular activating system (RAS).
Cognitive operations are not managed by any of the other options.
PTS: 1 REF: Page 528

Question 2

Which intracerebral disease process is capable of producing diffuse dysfunction?

a. Closed head trauma with bleeding
c. Neoplasm
b. Subdural pus collections d. Infarct emboli

Answer 2

ANS: D
Disorders within the brain substance (intracerebral)—bleeding, infarcts 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 REF: Page 528

Question 3

What is the most common infratentorial brain disease process that results in the direct
destruction of the reticulating activation system (RAS)?
a. Cerebrovascular disease
c. Neoplasms
b. Demyelinating disease
d. Abscesses

Answer 3

ANS: A
Infratentorial 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 REF: Page 528

Question 4

What stimulus causes posthyperventilation apnea (PHVA)?

a. Changes in PCO2 levels
c. Damage to the forebrain
b. Changes in PaCO2 levels
d. Any arrhythmic breathing pattern

Answer 4

ANS: B
With 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 other options are not responsible for PHVA

Question 5

. Which midbrain dysfunction causes pupils to be pinpoint size and fixed in position?

a. Diencephalon dysfunction
b. Oculomotor cranial nerve dysfunction
c. Dysfunction of the tectum
d. Pontine dysfunction

Answer 5

ANS: D

Question 6

A clinical manifestation caused by damage to the lower pons includes an abnormal:
a. Flexion with or without extensor response of the lower extremities
b. Extension response of the upper and lower extremities
c. Extension response of the upper extremities and flexion response of the lower
extremities
d. Flaccid response in the upper and lower extremities

Answer 6

ANS: B
A flaccid state with little or no motor response to stimuli is characteristic of damage to the
pons. None of the other responses are considered a clinical manifestation of damage to the
lower pons.

Question 7

A sudden, explosive, disorderly discharge of cerebral neurons is termed:

a. Reflex
c. Epilepsy
b. Seizure
d. Convulsion

Answer 7

ANS: B
A sudden, explosive, disorderly discharge of cerebral neurons describes a seizure. This
description is not accurate for the other options.

Question 8

A complex partial seizure is described as:

a. Alternating of tonic and clonic movements
b. Impairment of both consciousness and the ability to react to exogenous stimuli
c. Focal motor movement without loss of consciousness
d. One seizure followed by another in less than 1 minute

Answer 8

ANS: B
A complex partial seizure results is impaired consciousness, as well as the inability to
respond to exogenous stimuli. None of the other options accurately describe a complex
partial seizure.
PTS: 1 REF: Page 552

Question 9

What type of seizure starts in the fingers and progressively spreads up the arm and extends
to the leg?
a. Complex-psychomotor seizure 
c. Generalized seizures
b. Focal (partial) Jacksonian seizure 
d. Atonic-drop seizure

Answer 9

ANS: B
Focal (partial) Jacksonian seizures most often begin in the face and fingers and then
progressively spread to other body parts. The other options do not begin and spread in the
fashion described.
PTS: 1 REF: Page 551 | Table 17-16

Question 10

With receptive dysphasia (fluent), the individual is able to:

a. Respond in writing, but not in speech.
b. Produce verbal speech, but not comprehend language.
c. Comprehend speech, but not verbally respond.
d. Neither respond verbally nor comprehend speech.

Answer 10

ANS: C
The individual experiencing receptive dysphasia may be able to produce verbal language,
but language is meaningless because of a disturbance in understanding all language. The
remaining options do not describe receptive dysphasia.
PTS: 1 REF: Page 543 | Table 17-10

Question 11

What is the normal intracranial pressure (in mm Hg)?

a. 5 to 15
c. 12 to 14
b. 7 to 20
d. 80 to 120

Answer 11

ANS: A
Intracranial pressure is normally 5 to 15 mm Hg or 60 to 180 cm water (H2O). The
remaining options reflect increased intracranial pressure.
PTS: 1 REF: Pages 555-556

Question 12

Cerebral edema is an increase in the fluid content of the brain’s:

a. Ventricles
c. Neurons
b. Tissue
d. Meninge

Answer 12

ANS: B
Cerebral edema is an increase in the fluid content of brain tissue; that is, a net
accumulation of water within the brain. Cerebral edema is not noted in the brain’s
ventricles, neurons, or meninges.
PTS: 1 REF: Page 557

Question 13

What type of cerebral edema occurs when permeability of the capillary endothelium
increases after injury to the vascular structure?
a. Cytotoxic
c. Vasogenic
b. Interstitial
d. Ischemic

Answer 13

ANS: C
Increased permeability of the capillary endothelium of the brain after injury to the vascular
structure causes vasogenic edema. The remaining options are not consistent with this
description.
PTS: 1 REF: Pages 557-558

Question 14

A communicating hydrocephalus is caused by an impairment of the:

a. Cerebrospinal fluid flow between the ventricles
b. Cerebrospinal fluid flow into the subarachnoid space
c. Blood flow to the arachnoid villi
d. Absorption of cerebrospinal fluid

Answer 14

ANS: D
Hydrocephalus from impaired absorption outside the ventricles is called communicating
(extraventricular) hydrocephalus. The other options do not accurately describe the cause
of a communicating hydrocephalus.
PTS: 1 REF: Page 558

Question 15

Which edema is most often observed with noncommunicating hydrocephalus?

a. Metabolic
c. Vasogenic
b. Interstitial
d. Ischemic

Answer 15

ANS: B
Interstitial edema is observed most often with noncommunicating hydrocephalus.
Noncommunicating hydrocephalus is not the cause of any of the other options.
PTS: 1 REF: Page 558

Question 16

Which dyskinesia involves involuntary movements of the face, trunk, and extremities?

a. Paroxysmal
c. Hyperkinesia
b. Tardive
d. Cardive

Answer 16

ANS: B
Tardive dyskinesia is the involuntary movement of the face, trunk, and extremities. The
other terms do not describe involuntary movements of the face, trunk, and extremities.
PTS: 1 REF: Page 562

Question 17

Antipsychotic drugs cause tardive dyskinesia by mimicking the effects of increased:

a. Dopamine
c. Norepinephrine
b. Gamma-aminobutyric acid d. Acetylcholine

Answer 17

ANS: A
The antipsychotic drugs cause denervation hypersensitivity, which mimics the effect of too
much dopamine. None of the other options produce such an affect.

Question 18

What type of posturing exists when a person with a severe closed head injury has all four
extremities in rigid extension with the forearms in hyperpronation and the legs in plantar
extension?
a. Decorticate
c. Spastic
b. Decerebrate
d. Cerebellar

Answer 18

ANS: B
Decerebrate posturing includes opisthotonos (hyperextension of the vertebral column) with
clenching of the teeth; extension, abduction, and hyperpronation of the arms; and
extension of the lower extremities including plantar extension. The other options do not
describe such posturing.
PTS: 1 REF: Page 534 | Page 575 | Table 17-6

Question 19

Since his cerebrovascular accident, a man has been denying his left hemiplegia. What term
is used to describe this finding?
a. Visual agnosia 
c. Amusia agnosia
b. Anosognosia 
d. Agraphia agnosia

Answer 19

ANS: B
Anosognosia is ignorance or denial of the existence of disease. None of the remaining
options describes such denial.
PTS: 1 REF: Page 542 | Table 17-9

Question 20

After a cerebrovascular accident, a man is unable to either feel or identify a comb with his
eyes closed. This is an example of:
a. Agraphia 
c. Anosognosia
b. Tactile agnosia 
d. Prosopagnosia

Answer 20

ANS: B
Tactile agnosia is the inability to recognize objects by touch. None of the other options
define the inability to recognize objects by touch.
PTS: 1 REF: Page 542 | Table 17-9

Question 21

Most dysphasias are associated with cerebrovascular accidents involving which artery?

a. Anterior communicating
c. Circle of Willis
b. Posterior communicating d. Middle cerebral

Answer 21

ANS: D
Dysphasias are usually associated with a cerebrovascular accident involving the middle
cerebral artery or one of its many branches. Damage to or occlusion of any of the other
options does not cause dysphasias.
PTS: 1 REF: Pages 539-540

Question 22

Tactile agnosia is related to injury of which area of the brain?

a. Frontotemporal
c. Temporal
b. Parietal
d. Broca area

Answer 22

ANS: B
Tactile agnosia (astereognosis) is the inability to recognize objects by touch as a result of
damage to the parietal lobe. Tactile agnosia is not related to an injury to any of the other
options.
PTS: 1 REF: Page 542 | Table 17-9

Question 23

Neurofibrillary tangles characterize which neurologic disorder?

a. Dementia syndrome
c. Alzheimer disease
b. Delirium
d. Parkinson disease

Answer 23

ANS: C
Amyloid plaques, neurofibrillary tangles, as well as neuronal and synaptic losses in the
brain, characterize Alzheimer disease.
PTS: 1 REF: Pages 546-549 | Table 17-13

Question 24

Dilation of the ipsilateral pupil, following uncal herniation, is the result of pressure on
which cranial nerve (CN)?
a. Optic (CN I) 
c. Oculomotor (CN III)
b. Abducens (CN VI) 
d. Trochlear (CN IV)

Answer 24

ANS: C
The oculomotor CN (III) is involved in this manifestation of pupil dilation. None of the
other options would result in pupil dilation when subjected to pressure

Question 25

Uncal herniation occurs when:
a. The hippocampal gyrus shifts from the middle fossa through the tentorial notch
into the posterior fossa.
b. The diencephalon shifts from the middle fossa straight downward through the
tentorial notch into the posterior fossa.
c. The cingulate gyrus shifts under the falx cerebri.
d. A cerebellar tonsil shifts through the foramen magnum

Answer 25

ANS: A
Uncal herniation (i.e., hippocampal herniation, lateral mass herniation) occurs when the
uncus or hippocampal gyrus (or both) shifts from the middle fossa through the tentorial
notch into the posterior fossa. This shift results in the compression of the ipsilateral third
cranial nerve (CN), impairing parasympathetic function. This impairment is carried on in
the periphery of the nerve, then in the contralateral third CN, and finally in the
mesencephalon, inducing coma. The other options do not appropriately describe when
uncal herniation occurs.
PTS: 1 REF: Page 557 | Box 17-4

Question 26

Which assessment finding marks the end of spinal shock?

a. Return of blood pressure and heart rate to normal
b. Gradual return of spinal reflexes
c. Return of bowel and bladder function
d. Evidence of diminished deep tendon reflexes and flaccid paralysis

Answer 26

ANS: B
A gradual return of spinal reflexes marks the end of spinal shock. The other options are not
an indication of the cessation of spinal shock

Question 27

Characteristics of primary motor neuron atrophy include:

a. Loss of sensation in distal, proximal, or midline muscles
b. Fasciculations and muscle cramps
c. Flaccid paralysis with paresthesia
d. Spastic paralysis with increased deep tendon reflexes

Answer 27

ANS: B
Fasciculations are particularly associated with primary motor neuron injury, and muscle
cramps are common. The other options do not describe characteristics of primary motor
neuron atrophy.

Question 28

Tremors at rest, rigidity, akinesia, and postural abnormalities are a result of the atrophy of
neurons in the brain’s:
a. Caudate that produces serotonin
b. Putamen that produces gamma-aminobutyric acid
c. Substantia nigra that produces dopamine
d. Hypothalamus that produces acetylcholine

Answer 28

ANS: C
The hallmark characteristics of Parkinson disease (PD) are a result of a loss of
dopaminergic-pigmented neurons in the substantia nigra pars compacta with dopaminergic
deficiency in the putamen portion of the striatum (the striatum includes the putamen and
caudate nucleus). The remaining options are not characteristics of PD.

Question 29

Dementia is commonly characterized by the deterioration in which abilities? (Select all
that apply.)
a. Sociability
b. Balance
c. Memory
d. Speech
e. Decision making

Answer 29

ANS: C, D, E
Dementia is the progressive failure (an acquired deterioration) of many cerebral functions
that include impairment of intellectual function with a decrease in orienting, memory,
language, executive attentional functions, and alterations in behavior. Loss of the need for
social contact and impaired balance are not associated with dementia, although a person
with such a diagnosis may exhibit these deficiencies.

Question 30

. The clinical manifestations of Parkinson disease include: (Select all that apply.)

a. Fragmented sleep
b. Drooping eyelids
c. Depression
d. Muscle stiffness
e. Bradykinesia

Answer 30

ANS: A, C, D, E
The classic motor manifestations of Parkinson disease (PD) are bradykinesia, tremor at
rest (resting tremor), rigidity (muscle stiffness), and postural abnormalities. Nonmotor
symptoms associated with PD include hyponosmia, fatigue, pain, autonomic dysfunction,
sleep fragmentation, depression, and dementia with or without psychosis. Drooping
eyelids are not characteristics of PD

Question 31

In Parkinson disease the basal ganglia influence the hypothalamic function to produce
which clinical manifestations? (Select all that apply.)
a. Inappropriate diaphoresis
b. Gastric retention
c. Vomiting
d. Diarrhea
e. Urinary retention

Answer 31

ANS: A, B, E
The basal ganglia influence hypothalamic function (autonomic and neuroendocrine)
through pathways connecting the hypothalamus with the basal ganglia and cerebral cortex.
Common autonomic symptoms in Parkinson disease include inappropriate diaphoresis,
gastric retention, constipation, and urinary retention. Neither vomiting nor diarrhea would
be clinical manifestation observed under these circumstances