Pathophysiology

Question 1

Which pathway carries sensory information toward the central nervous system (CNS)?

a. Ascending
b. Descending
c. Somatic
d. Efferent

Answer 1

ANS: A
Peripheral nerve pathways can be afferent (ascending) pathways that carry sensory
impulses toward the CNS. The remaining options do not carry sensory information to the
CNS. Page 448

Question 2

Which type of axon transmits a nerve impulse at the highest rate?

a. Large nonmyelinated
b. Large myelinated
c. Small nonmyelinated
d. Small myelinated

Answer 2

ANS: B
If the myelin layer is tightly wrapped many times around the axon and is forming the
nodes of Ranvier, then conduction velocity increases and the neuron is referred to as
myelinated. The increased diameter of the myelinated axons allows for the transmission of
impulses at a faster rate. The other options do not affect nervous impulse transmission
rates. p. 448-450.

Question 3

Which nerves are capable of regeneration?

a. Nerves within the brain and spinal cord
b. Peripheral nerves that are cut or severed
c. Myelinated nerves in the peripheral nervous system
d. Unmyelinated nerves of the peripheral nervous system

Answer 3

ANS: C
Nerve regeneration is limited to only myelinated fibers and generally occurs only in the
peripheral nervous system.
p. 450-51

Question 4

The neurotransmitter, norepinephrine, is secreted in the:

a. Somatic nervous system
b. Parasympathetic preganglion
c. Sympathetic postganglion
d. Parasympathetic postganglion

Answer 4

ANS: C
Most postganglionic sympathetic fibers release norepinephrine (adrenaline). The
remaining options do not reflect the correct site of norepinephrine secretion.
p. 473-74

Question 5

Both oligodendroglia and Schwann cells share the ability to:

a. Form a myelin sheath
b. Remove cellular debris
c. Transport nutrients
d. Line the ventricles

Answer 5

ANS: A
The function of oligodendroglia (oligodendrocytes) is to deposit myelin within the central
nervous system (CNS). Oligodendroglia are the CNS counterpart of Schwann cells. The
remaining options are not reflective of the common function of these structures.
p. 449-50

Question 6

During a synapse, what change occurs after the neurotransmitter binds to the receptor?
a. The permeability of the presynaptic neuron changes; consequently, its membrane
potential is changed as well.
b. The permeability of the postsynaptic neuron changes; consequently, its membrane
potential is changed as well.
c. The postsynaptic cell prevents any change in permeability and destroys the action
potential.
d. The presynaptic cell synthesizes and secretes additional neurotransmitters.

Answer 6

ANS: B
The binding of the neurotransmitter at the receptor site changes the permeability of the
postsynaptic neuron and, consequently, its membrane potential. The remaining options do
not accurately describe the occurrence.
p. 452-53

Question 7

What name is given to a large network of neurons within the brainstem that is essential for
maintaining wakefulness?
a. Midbrain 
b. Reticular activating system
c. Medulla oblongata 
d. Pons

Answer 7

ANS: B
The reticular activating system is essential for maintaining wakefulness. The remaining
options are not essential to this function.
p. 454

Question 8

Thought and goal-oriented behaviors are functions of which area of the brain?

a. Cerebellum
b. Limbic system
c. Prefrontal lobe
d. Occipital lobe

Answer 8

ANS: C
The prefrontal area is responsible for goal-oriented behavior (i.e., ability to concentrate),
short-term or recall memory, and the elaboration of thought and inhibition on the limbic
(emotional) areas of the CNS. The remaining options are not involved in these functions.
p. 456

Question 9

The region responsible for the motor aspects of speech is located in the:

a. Wernicke area in the temporal lobe
b. Broca area in the frontal lobe
c. Wronka area in the parietal lobe
d. Barlow area in the occipital lobe

Answer 9

ANS: B
Broca speech area is the only region responsible for the motor aspects of speech
p. 457

Question 10

Parkinson and Huntington diseases are associated with defects in which area of the brain?

a. Thalamus
b. Medulla oblongata
c. Cerebellum
d. Basal ganglia

Answer 10

ANS: D
Parkinson and Huntington diseases are conditions associated with defects of the basal
ganglia. No current research supports the role of any of the other options in these diseases.
p. 457

Question 11

Maintenance of a constant internal environment and the implementation of behavioral
patterns are main functions of which area of the brain?
a. Thalamus
b. Epithalamus
c. Subthalamus
d. Hypothalamus

Answer 11

ANS: D
Hypothalamic function falls into two major areas: (1) maintenance of a constant internal
environment, and (2) implementation of behavioral patterns. The remaining options do not
address these functions.
p. 459

Question 12

The ability of the eyes to track moving objects through a visual field is primarily a
function of which colliculi?
a. Inferior 
b. Superior
c. Mid 
d. Posterior

Answer 12

ANS: B
The superior colliculi are involved with voluntary and involuntary visual motor
movements (e.g., the ability of the eyes to track moving objects in the visual field).
Tracking moving objects is not the primary function of the remaining options.
p. 459

Question 13

What parts of the brain mediate the expression of affect, both emotional and behavioral
states?
a. Hypothalamus and subthalamus 
b. Parietal and frontal lobes 
c. Limbic system and prefrontal cortex
d. Basal ganglia and medulla oblongata

Answer 13

ANS: C
Extensive connections with the limbic system and prefrontal cortex mediate the expression
of affect, both emotional and behavioral states. The remaining options are not involved in
these expressions.
p. 457

Question 14

Reflex activities concerned with heart rate, blood pressure, respirations, sneezing,
swallowing, and coughing are controlled by which area of the brain?
a. Pons
b. Midbrain
c. Cerebellum
d. Medulla oblongata

Answer 14

ANS: D
The medulla oblongata makes up the myelencephalon and is the lowest portion of the
brainstem. Reflex activities, such as heart rate, respiration, blood pressure, coughing,
sneezing, swallowing, and vomiting, are controlled only in this area.
p. 460

Question 15

From which part of the midbrain do cranial nerves V to VIII emerge?

a. Midbrain
b. Pons
c. Medulla oblongata
d. Lateral colliculi

Answer 15

ANS: B
The nuclei of cranial nerves V through VIII (see Table 15-6 for discussion) are located
only in the pons.
p. 459-460

Question 16

From which part of the midbrain do cranial nerves IX to XII emerge?

a. Midbrain
b. Pons
c. Medulla oblongata
d. Lateral colliculi

Answer 16

ANS: C
The nuclei of cranial nerves IX through XII (see Table 15-6 for discussion) are located
only in the medulla oblongata.

Question 17

Which area of the brain assumes the responsibility for conscious and unconscious muscle
synergy and for maintaining balance and posture?
a. Cerebrum
b. Cerebellum
c. Diencephalon
d. Brainstem

Answer 17

ANS: B
The cerebellum is responsible for conscious and unconscious muscle synergy and for
maintaining balance and posture. This role is not assumed by any of the remaining options.

Question 18

Which statement is true regarding upper motor neurons?

a. Upper motor neurons directly influence muscles.
b. They modify spinal reflex arcs.
c. Upper motor neurons are located in the gray matter of the spinal cord.
d. They extend their dendritic processes out of the CNS.

Answer 18

ANS: B
Upper motor neurons (i.e., corticospinal tract) are the classification of motor pathways
completely contained within the CNS. Their primary roles include directing, influencing,
and modifying reflex arcs, lower-level control centers, and motor and some sensory
neurons. The remaining options do not accurately describe the characteristic functions of
upper motor neurons.

Question 19

The membrane that separates the brain’s cerebellum from its cerebrum is the:

a. Tentorium cerebelli
b. Falx cerebric.
c. Arachnoid membrane
d. Falx cerebelli

Answer 19

ANS: A
The tentorium cerebelli is a membrane that separates the cerebellum below from the
cerebral structures above. The remaining options do not perform the function described in
the stem.

Question 20

The function of arachnoid villi is to:

a. Produce cerebrospinal fluid
b. Provide nutrients to the choroid plexuses
c. Transmit impulses within the meninges
d. Absorb cerebrospinal fluid into the cerebral venous sinuses

Answer 20

ANS: D
CSF is reabsorbed by means of a pressure gradient between the arachnoid villi and the
cerebral venous sinuses. The remaining options do not accurately describe the function of
arachnoid villi.

Question 21

Where is the cerebrospinal fluid produced?

a. Arachnoid villi
b. Choroid plexuses
c. Ependymal cells
d. Pia mater

Answer 21

ANS: B
The choroid plexuses are the structures that produce CSF; they arise from the pia mater.
The remaining options do not have a role in CSF production.

Question 22

Which of the meninges closely adheres to the surface of the brain and spinal cord and
follows the sulci and fissures?
a. Dura mater 
b. Arachnoid
c. Pia mater 
d. Inner dura

Answer 22

ANS: C
The delicate pia mater closely adheres to the surface of the brain and spinal cord and even
follows the sulci and fissures. The remaining options are not represented in the description
provided in the stem.

Question 23

Norepinephrine produces what primary response?

a. Increased contractility of the heart
b. Release of renin from the kidney
c. Vasoconstriction
d. Pupillary dilation

Answer 23

ANS: C
The primary response from norepinephrine is the stimulation of the 1-adrenergic
receptors that cause vasoconstriction. The remaining options do not accurately reflect the
primary response of norepinephrine.

Question 24

What is an effect of the sympathetic nervous system?

a. Stimulation of peristalsis
b. Increased blood sugar levels
c. Reduction in heart rate
d. Pupillary constriction

Answer 24

ANS: B
In general, sympathetic stimulation promotes responses that are concerned with the
protection of the individual, which include increased blood sugar levels, temperature, and
blood pressure. The responses noted in the remaining options are not a result of
sympathetic stimulation.

Question 25

The brain receives approximately what percentage of the cardiac output?

a. 80%
b. 40%
c. 20%
d. 10%

Answer 25

ANS: C
The brain receives approximately 20% of the cardiac output, or 800 to 1000 ml of blood
flow per minute.

Question 26

The collateral blood flow to the brain is provided by the:

a. Carotid arteries
b. Basal artery
c. Circle of Willis
d. Vertebral arteries

Answer 26

ANS: C
The arterial circle (circle of Willis) (see Figure 15-20) is a structure credited with the
ability to compensate for reduced blood flow from any one of the major contributors
(collateral blood flow). The remaining options are not considered sources of collateral
blood flow.

Question 27

The nurse recognizes that a patient’s diagnosis of a viral infection of the brain’s meningeal
layer is supported by which diagnostic laboratory result?
a. Chloride <110 mEq/L
b. Leukocytes >10/mm3
c. Protein <10 mg/dl
d. Glucose <40 mg/dl

Answer 27

ANS: B
Viral infections causing meningitis will produce a white blood cell (leukocyte) count
greater than 10/mm 3. The chloride level is observed in tuberculous meningitis, the protein
level has little clinical significance, and the glucose level is observed in patients with acute
bacterial meningitis.

Question 28

Which cranial nerves contain parasympathetic nerves? (Select all that apply.)

a. I (olfactory)
b. III (oculomotor)
c. VII (facial)
d. IX (glossopharyngeal)
e. X (vagus)

Answer 28

ANS: B, C, D, E

All but cranial nerve I (olfactory) contain parasympathetic nerves.

Question 29

The sympathetic nervous system primarily serves to protect an individual by doing which
of the following? (Select all that apply.)
a. Decreasing mucous production
b. Increasing blood sugar levels e. Increasing blood pressure
c. Increasing body temperature
d. Decreasing sweat excretion

Answer 29

ANS: B, C, E
In general, sympathetic stimulation promotes responses that are concerned with the
protection of the individual, which include increasing blood sugar levels, temperature, and
blood pressure. The remaining options are not protective measures resulting from
initiatives made by the sympathetic nervous system.

Question 30

The aging process brings about what changes to human cells? (Select all that apply.)

a. Increased neurofibrillary tangles
b. Imbalance of neurotransmitters
c. Increased neuron production
d. Decreased myelin presence
e. Altered dendrite structure

Answer 30

ANS: A, B, D, E
Principal cellular changes associated with aging include a decrease in the number of
neurons, decreased myelin, decreased number of dendritic processes and synaptic
connections, intracellular neurofibrillary tangles, and an imbalance in the amount and
distribution of neurotransmitters. The aging process does not bring about an increase in
neuron production.

Question 31

Which statement is true regarding the blood-brain barrier (BBB)? (Select all that apply.)
a. The BBB is dependent on astrocytes.
b. It uses the meningeal layers of the brain.
c. It restricts the flow of large molecules, such as potassium.
d. Naturally occurring inflammatory mediators affect the BBB.
e. The BBB appears to play a role in slowing down the onset of degenerative brain
disease.

Answer 31

ANS: A, C, D, E
The BBB is a term used to describe cellular structures that selectively inhibit certain
substances in the blood from entering the interstitial spaces of the brain or CSF. This term
emphasizes the impermeability of the nervous system to large and potentially harmful
molecules. Astrocytes wrap their foot processes around the epithelial cells of brain
capillaries, thereby contributing to the formation of the BBB. Tight junctions between
capillary endothelial cells form a barrier that regulates the passage of ions (e.g., sodium,
potassium) that could interfere with nerve transmission, prevent toxins from entering the
brain, and promote transport of nutrients and the removal of metabolites. Hormones,
neurotransmitters, and inflammatory mediators can affect BBB permeability. Inhibiting
these endogenous chemicals with drug therapy may reduce brain edema and slow the onset
of degenerative brain diseases. The statement regarding the meningeal layers of the brain
is incorrect.

Question 32

A nurse caring for an older adult patient would expect which functional changes to occur?
(Select all that apply.)
a. Increased risk for falls
b. Increased risk for falls
c. Loss of muscle in the arms and legs
d. Decrease in the need for social interaction
e. Increased agitation and frustration levels

Answer 32

ANS: A, B, C
Functional changes with aging include skeletal muscle atrophy, progressive deficits in
taste and smell, and a decrease in neuromuscular control with changes in gait and posture.
Neither increased agitation and frustration nor a decreased need for social interaction is
considered an expected change resulting from the aging process.

Question 33

What evidence does the nurse expect to see when a patient experiences trauma to the
hypothalamus? (Select all that apply.)
a. Uneven expression of mood
b. Unstable blood glucose levels
c. Poor regulation of body temperature
d. Visual disturbances such as blurred vision
e. Nausea, vomiting, and symptoms of gastroesophageal reflux disease

Answer 33

ANS: A, B, C
The hypothalamus forms the base of the diencephalon. Hypothalamic function controls
autonomic nervous system (ANS) function, regulation of body temperature, endocrine
function (e.g., unstable glucose levels), and regulation of emotional expression. Visual and
gastrointestinal symptoms would not likely be related to hypothalamus function.

Question 34

A Schwann cell: (Select all that apply.)

a. Can form the myelin sheath.
b. Is also referred to as a neurolemmocyte.
c. Affects the function of the nodes of Ranvier.
d. Is located in the peripheral nervous system.
e. Is responsible of decreasing conduction velocity.

Answer 34

ANS: A, B, C, D
The Schwann cell, or neurolemmocyte, is a glial cell that wraps around and covers axons
in the peripheral nervous system. Schwann cells form and maintain the myelin sheath, and
the nodes of Ranvier form the spaces on either side of the Schwann cell. If the myelin
layer is tightly wrapped many times around the axon, forming nodes of Ranvier, then it
increases conduction velocity and the neuron is referred to as myelinated.

Question 35

Glossopharyngeal nerve function?

Answer 35

Controls motor functions to the pharynx and salivary glands and sensory
functions from the pharynx and tongue.

(MSC: The glossopharyngeal nerve affects control over the motor fibers that serve the pharynx
(throat) and salivary glands, as well as the sensory fibers that carry impulses from the pharynx,
posterior tongue (taste buds), and pressure receptors of the carotid artery.)

Question 36

Oculomotor nerve function?

Answer 36

Fibers emerge from the midbrain, exit from the skull, and extend to the eye.
(The oculomotor nerve fibers emerge from the midbrain, exit from the skull, and extend to
the eye. These fibers control: (1) the motor fibers to the inferior oblique, superior, inferior, and
medial rectus extraocular muscles that direct the eyeball; (2) the levator muscles of the eyelid; (1)
the smooth muscles of the iris and ciliary body; and (4) proprioception (sensory) to brain from the extraocular muscles.

Question 37

Trochlear nerve function?

Answer 37

Fibers emerge from the posterior midbrain and exit from the skull to run to
the eye.
(The trochlear nerve fibers emerge from posterior midbrain and exit from skull to affect
control over the proprioceptor and motor fibers for the superior oblique muscle of eye).

Question 38

Abducens nerve function?

Answer 38

Innervates muscles that move the eye laterally.
(The abducens nerve affects control over the motor fibers to the lateral rectus muscle and the
proprioceptor fibers from the same muscle to the brain, allowing the eyes to move laterally.)

Question 39

Trigeminal nerve function?

Answer 39

Provides motor and sensory functions to the face, mouth, nose, and eyes.
(The trigeminal nerve affects control over both the motor and sensory functions to the face;
conducts sensory impulses from the mouth, nose, surface of eye, and dura mater; it also contains
motor fibers that stimulate the chewing muscles.)

Question 40

Hypoglossal nerve function?

Answer 40

Affects control over the motor fibers to the muscles of tongue and sensory
impulses from the tongue to the brain.

Question 41

Vagus nerve function?

Answer 41

Is made up of parasympathetic motor fibers that supply the smooth muscles of the abdominal organs.

Question 42

Spinal accessory nerve function?

Answer 42

Carries sensory and motor fibers to the pharynx and larynx.

Question 43

Olfactory nerve function?

Answer 43

Is purely sensory and carries impulses for the sense of smell.

Question 44

Vestibulocochlear nerve function?

Answer 44

Transmits impulses for the sense of hearing.