UNIT 5: Ch 16 (Porth's 5th Ed) Disorders of Brain Function Flashcards
A nurse on a neurology unit is assessing a female brain-injured client. The client is
unresponsive to speech, and her pupils are dilated and do not react to light. She is
breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a
noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?
A) Delirium
B) Coma
C) Brain death
D) Vegetative state
Ans: B
Feedback:
The continuum of loss of consciousness is marked by the degree of client’s
responsiveness to stimuli, in addition to the preservation of brain stem reflexes. Since
this client still exhibits a pain response (the extended arms and legs indicate decerebrate
posturing), even though her pupils are not responsive to light, she has sustained
sufficient brain function that she fails to qualify as being brain dead or in a vegetative
state
Following a motor vehicle accident 3 months prior, a 20-year-old female who has been
in a coma since her accident has now had her condition declared a persistent vegetative
state. How can her care providers most accurately explain an aspect of her situation to
her parents?
A) “Your daughter has lost all her cognitive functions as well as all her basic
reflexes.”
B) “Though she still goes through a cycle of sleeping and waking, her condition is
unlikely to change.”
C) “If you or the care team notices any spontaneous eye opening, then we will
change our treatment plan.”
D) “Your daughter’s condition is an unfortunate combination with total loss of
consciousness but continuation of all other normal brain functions.”
Ans: B
Feedback:
A continuation of the sleep–wake cycle can exist in a persistent vegetative state.
Reflexes often remain, as does spontaneous eye opening. Aspects of brain function
beyond those governing consciousness are affected.
Which of the following individuals would most likely experience global ischemia to his or her brain?
A) A male client who has just had an ischemic stroke confirmed by CT of his head
B) A woman who has been admitted to the emergency department with a suspected
intracranial bleed
C) A man who has entered cardiogenic shock following a severe myocardial
infarction
D) A woman who is being brought to hospital by ambulance following suspected
carbon monoxide poisoning related to a faulty portable heater
Ans: C
Feedback:
Global ischemia is associated with a cessation of blood flow to the entire brain, as often
occurs during cardiac arrest or myocardial infarction. Ischemic stroke and intracranial
bleeding are likely to cause focal ischemia; carbon monoxide toxicity is associated with
hypoxia.
Which of the following diagnostic findings is likely to result in the most serious brain
insult?
A) Mean arterial pressure (MAP) that equals intracranial pressure (ICP)
B) Moderate decrease in brain tissue volume secondary to a brain tumor removal
C) Increased ICP accompanied by hyperventilation
D) High intracellular concentration of glutamate
Ans: A
Feedback:
When the pressure in the cranial cavity approaches or exceeds the MAP, tissue
perfusion becomes inadequate; cellular hypoxia results; and neuronal death may occur.
Displacement of CSF and blood can partially compensate for decreased brain tissue
volume. Hyperventilation partially mitigates, rather than exacerbates, increase in ICP.
Glutamate is normally in far higher concentrations intracellularly than extracellularly.
Following a car accident of a male teenager who did not have his seatbelt on, he arrived
in the emergency department with a traumatic brain injury. He has severe cerebral
edema following emergent craniotomy. Throughout the night, the nurse has been
monitoring and reporting changes in his assessment. Which of the following
assessments correspond to a supratentorial herniation that has progressed to include
midbrain involvement? Select all that apply.
A) Clouding of consciousness
B) Decorticate posturing with painful stimulation
C) Pupils fixed at approximately 5 mm in diameter
D) Respiration rate of 40 breaths/minute
E) Decerebrate posturing following painful stimulation of the sternum
Ans: C, D, E
Feedback:
With midbrain involvement, pupils are fixed and midsized (5 mm in diameter), and
reflex adduction of the eyes is impaired; pain elicits decerebrate posturing; and
respirations change from Cheyne-Stokes respiration to neurogenic hyperventilation.
Cloudiness of consciousness occurs in early diencephalic stages. Decorticate posturing
with pain occurs in the diencephalic stage.
A patient in the intensive care unit who has a brain tumor has experienced a sharp
decline. The care team suspects that water and protein have crossed the blood–brain
barrier and been transferred from the vascular space into the client’s interstitial space.
Which of the following best captures this pathophysiology?
A) Focal hypoxia
B) Cytotoxic edema
C) Hydrocephalus
D) Vasogenic edema
Ans: D
Feedback:
Vasogenic edema occurs with conditions that impair the function of the blood–brain
barrier and allow transfer of water and protein from the vascular into the interstitial
space. It occurs in conditions such as tumors, prolonged ischemia, hemorrhage, brain
injury, and infectious processes. Focal hypoxia is associated with localized delivery of
blood with inadequate oxygen, and cytotoxic edema is an absolute increase in
intracellular fluid. Hydrocephalus is an abnormal increase in CSF volume in any part or
all of the ventricular system.
A baseball player was hit in the head with a bat during practice. In the emergency
department, the physician tells the family that he has a “coup” injury. How will the
nurse explain this to the family so they can understand?
A) “It’s like squeezing an orange so tight that the juice runs out of the top.”
B) “Your son has a huge laceration inside his brain where the bat hit his skull.”
C) “Your son has a contusion of the brain at the site where the bat hit his head.”
D) “When the bat hit his head, his neck jerked backward causing injury to the spine.”
Ans: C
Feedback:
A direct contusion of the brain at the site of external force is referred to as a coup injury.
Contrecoup injury (answer choice D) is the rebound injury on the opposite side of the
brain. Answer choice B relates to lacerations that are usually not caused by a direct blow
to the head. However, depending on how hard the head was hit with a bat, a hematoma
could form as the brain strikes the rough surface of the cranial vault.
Following an injury where a child hit his head from a fall, the CT scan reveals a
contusion that the doctor classifies as a moderate brain injury. Which of the following
manifestations will the nurse more than likely assess on this child that support this
diagnosis? Select all that apply.
A) Coma with total paralysis
B) Periods of unconsciousness
C) Aphasia at times
D) Nuchal rigidity
E) Weakness or slight paralysis affecting one side of the body
Ans: B, C, E
Feedback:
Moderate brain injury is characterized by a period of unconsciousness and may be
associated with focal manifestations such as hemiparesis (weakness or slight paralysis
affecting one side of the body), aphasia, and cranial nerve palsy. Coma with total
paralysis is seen in severe brain injury. Nuchal rigidity is a classic sign of meningitis.
Following a collision while mountain biking, the diagnostic workup of a 22-year-old
male has indicated the presence of an acute subdural hematoma. Which of the following
pathophysiological processes most likely underlies his diagnosis?
A) Blood has accumulated between the man’s dura and subarachnoid space.
B) Vessels have burst between the client’s skull and his dura.
C) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP.
D) Blood has displaced CSF in the ventricles as a consequence of his
coup–contrecoup injury
Ans: A
Feedback:
A subdural hematoma develops in the area between the dura and the arachnoid space,
while epidural hematomas exist between the skull and dura. Intracerebral hematomas
are located most often in the frontal or temporal lobe, and the ventricles are not directly
involved in a subdural hematoma.
A 20-year-old has been admitted to a rehabilitation center after hospital treatment for an
ischemic stroke. Which of the following aspects of the client’s history would be
considered to have contributed to his stroke? Select all that apply. The client
A) is an African American male.
B) takes iron supplements for the treatment of chronic anemia.
C) blood pressure has historically been in the range of 150s/90s.
D) was diagnosed with type 2 diabetes 8 years ago.
E) takes corticosteroids for the treatment of rheumatoid arthritis.
Ans: A, C, D
Feedback:
African American race, male gender, hypertension, and diabetes are all
well-documented risk factors for stroke. Anemia, autoimmune disorders like rheumatoid
arthritis, and the use of corticosteroids are not noted to predispose to stroke.
A nurse at a long-term care facility provides care for an 85-year-old man who has had
recent transient ischemic attacks (TIAs). Which of the following statements best
identifies future complications associated with TIAs? TIAs
A) are an accumulation of small deficits that may eventually equal the effects of a
full CVA.
B) are a relatively benign sign that necessitates monitoring but not treatment.
C) resolve rapidly but may place the client at an increased risk for stroke.
D) are caused by small bleeds that can be a warning sign of an impending stroke.
Ans: C
Feedback:
TIAs can be considered a warning sign for future strokes. They are not hemorrhagic in
nature, and their effects are not normally cumulative. They may require treatment
medically or surgically.
Which of the following clients’ signs and symptoms would allow a clinician to be most
justified in ruling out stroke as a cause? An adult
A) has had a gradual onset of weakness, headache, and visual disturbances over the
last 2 days.
B) has experienced a sudden loss of balance and slurred speech.
C) has vomited and complained of a severe headache.
D) states that his left arm and leg are numb, and gait is consequently unsteady.
Ans: A
Feedback:
A cardinal trait of the manifestations of stroke is that the onset is sudden, and a gradual
onset of symptoms over 2 days would suggest an alternative etiology. Ataxia, slurred
speech, and unilateral numbness are associated with stroke, with sudden vomiting and
headache being particularly indicative of a hemorrhagic CVA.
The nurse knows that which of the following treatment plans listed below is most likely
to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset
aneurysmal subarachnoid hemorrhage?
A) Stat administration of tissue plasminogen activator (tPA)
B) Administration of a diuretic such as mannitol to reduce cerebral edema and ICP
C) Monitoring in the ICU for signs and symptoms of cerebral insult
D) Craniotomy and clipping of the affected vessel
Ans: D
Feedback:
Surgery for treatment of aneurysmal subarachnoid hemorrhage involves craniotomy and
inserting a specially designed silver clip that is tightened around the neck of the
aneurysm. Administration of tPA would exacerbate bleeding, and a diuretic would not
address the issue of bleeding. Monitoring alone would be an insufficient response given
the severity of the problem.
A college student has been experiencing frequent headaches that he describes as
throbbing and complaining of difficulty concentrating while studying. Upon cerebral
angiography, he is found to have an arteriovenous malformation. Which of the
following pathophysiological concepts is likely responsible for his symptoms?
A) Increased tissue perfusion at the site of the malformation
B) Hydrocephalus and protein in the cerebral spinal fluid
C) High pressure and local hemorrhage of the venous system
D) Localized ischemia with areas of necrosis noted on CT angiography
Ans: C
Feedback:
In arteriovenous malformations, a tangle of arteries and veins acts as a bypass between
the cerebral arterial and venous circulation, in place of the normal capillary bed.
However, the capillaries are necessary to attenuate the high arterial blood pressure
before this volume drains to the venous system. As a result, the venous channels
experience high pressure, making them to hemorrhage and rupture more likely; the lack
of perfusion of surrounding tissue causes neurologic deficits such as learning disorders.
Headaches are severe, and people with the disorder may describe them as throbbing
(synchronous with their heartbeat). Increased tissue perfusion means that more
oxygenated blood is brought to the area, which is not the case. The elevated arterial and
venous pressures divert blood away from the surrounding tissue, impairing tissue
perfusion. Answer choice B is incorrect since arteriovenous malformation is associated
with blood vessels and not the fluid within the ventricles of the brain. Answer choice D
is incorrect in that there is blood flow to the area. Ischemia is associated with decreased
arterial flow resulting in death to brain tissue.
A 9-year-old boy has been brought to the emergency department by his father who is
concerned by his son’s recent fever, stiff neck, pain, and nausea. Examination reveals a
petechial rash. Which of the following assessment questions by the emergency room
physician is most appropriate?
A) “Is your son currently taking any medications?”
B) “Has your son had any sinus or ear infections in the last little while?”
C) “Does your son have a history of cancer?”
D) “Was your son born with any problems that affect his bone marrow or blood?”
Ans: B
Feedback:
The most common symptoms of acute bacterial meningitis are fever and chills;
headache; stiff neck; back, abdominal, and extremity pains; and nausea and vomiting.
Risk factors associated with contracting meningitis include otitis media and sinusitis or
mastoiditis. Particular medications, a history of neoplasm, and hematopoietic problems
would be unlikely to relate directly to his symptoms of meningitis.
