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NURS 5315: EXAM 4 QUESTIONS & VERIFIED CORRECT ANSWERS
“Which pathway carries sensory information toward the central nervous system? - CORRECT
ANSWER Ascending"
"What parts of the brain mediate the expression of affect, both emotional and behavioral
states? - CORRECT ANSWER Limbic system and prefrontal cortex"
"What stimulus causes posthyperventilation apnea (PHVA)? - CORRECT ANSWER Changes
in PaCO2 levels" "Posthyperventilation apnea (PHVA) ceases and rhythmic breathing is resumed when levels of
arterial: - CORRECT ANSWER Carbon dioxide become normal"
"Cheyne-Stokes respirations are described as a: - CORRECT ANSWER Crescendo-
decrescendo pattern of breathing, followed by a period of apnea" "Vomiting is associated with central nervous system (CNS) injuries that compress which of the
brain's anatomic locations? - CORRECT ANSWER Vestibular nuclei in the lower brainstem"
"Which midbrain dysfunction causes pupils to be pinpoint size and fixed in position? -
CORRECT ANSWER Pontine dysfunction"
"What characteristic is a medical criterion of brain death? - CORRECT ANSWER Apnea"
"A clinical manifestation caused by damage to the lower pons includes an abnormal: -
CORRECT ANSWER Extension response of the upper and lower extremities"
"Which person is at the greatest risk for developing deliriuim? - CORRECT ANSWER An
individual on the second day after hip replacement"
"Which characteristic is the most critical index of nervous system dysfunction? - CORRECT
ANSWER Level of consciousness"
"Diagnostic criteria for a persistent vegetative state include: - CORRECT ANSWER Return
of autonomic functions such as gastrointestinal function"
"Uncal herniation occurs when: - CORRECT ANSWER The hippocampal gyrus shifts from
the middle fossa through the tentorial notch into the posterior fossa"
"Which assessment finding marks the end of spinal shock? - CORRECT ANSWER Gradual
return of spinal reflexes"
"Autonomic hyperreflexia-induced bradycardia is a result of stimulation of the: - CORRECT
ANSWER Carotid sinus to the vagus nerve to the sinoatrial node"
"A herniation of which disk will likely result in motor and sensory changes of the lateral lower
legs and soles of the feet? - CORRECT ANSWER L5-S1"
"Which condition poses the highest risk for a cerebrovascular accident (CVA)? - CORRECT
ANSWER Hypertension"
"A right h emisphere embolic CVA has resulted in left-sided paralysis and reduced sensation of
the left foot and leg. Which cerebral artery is most likely affected by the emboli? - CORRECT
ANSWER Anterior cerebral"
"Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which
type of stroke? - CORRECT ANSWER Embolic"
"Microinfarcts resulting in pure motor or pure sensory deficits are the result of which type of
stroke? - CORRECT ANSWER Lacunar"
"Which vascular malformation is characterized by arteries that feed directly into veins through
vascular tangles of abnormal vessels? - CORRECT ANSWER Arteriovenous malformation"
"The type of vascular malformation that most often results in hemorrhage is: - CORRECT
ANSWER Arteriovenous malformation"
"Atheromatous plaques are most commonly found: - CORRECT ANSWER At branches of
arteries"
"Multiple sclerosis is best described as a: - CORRECT ANSWER Central nervous system
demyelination, possible from an immunogenic virus" "What is the most common opportunistic infection associated with acquired immunodeficiency
syndrome (AIDS)? - CORRECT ANSWER Toxoplasmosis"
of bright red blood in the stools, suggest a lower GI bleed usually in the rectum, sigmoid colon or descending colon"
"Peptic Ulcer Disease - CORRECT ANSWER Is a break in the integrity of the mucosa of the
esophagus, stomach or duodenum resulting in exposure of the tissue to gastric acid. Risk factors include smoking, advanced age, NSAID use, ETOH, chronic disease, acute pancreatitis, COPD, obesity, socioeconomic status, gastrinoma, and infection with Helicobacter pylori. S&S: Epigastric pain is worse with eating, melena or hematemesis"
"Duodenal ulcers - CORRECT ANSWER most common and tend to develop in younger
patients. S&S: epigastric pain that is relieved by food. Patients may have melena(black and tarry stool) or hematemesis"
"Diverticular disease - CORRECT ANSWER Characterized as the presence of diverticula in
the large intestine. Risk factors include older age, genetic predisposition, obesity, smoking, diet, lack of exercise, ASA and other NSAIDS, altered DI microbiome and abnormal colonic peristalsis"
"Diverticulosis/Diverticulitis - CORRECT ANSWER Diverticula are outpouchings of mucosa
from the muscle layer of the intestine that protrude into the intestinal lumen most commonly in the sigmoid colon. Diverticulosis is the presence of diverticula in an asymptomatic person. Diverticulitis is an inflammation of diverticula and cause LLQ pain. Results in abscess formation, rupture and peritonitis"
"Appendicity - CORRECT ANSWER Inflammation of the appendix usually in persons 10-19.
S&S: periumbilical pain, RLQ pain, nvd, anorexia. Pain may initially be epigastric or periumbilical then settle in RLQ. Perforation, peritonitis and abscess formation are all potential complications"
"Small bowel obstruction - CORRECT ANSWER Most commonly caused by postop
adhesions, tumors, Crohn's disease, hernias and intussusception. SBO causes distention 2nd to impaired absorption and increased secretions which leads tofluid accumulation and gas proximal to the ileus. Distention in the intestines decreases their ability to absorb water and increases secretion of those things."
"SBO S&S - CORRECT ANSWER At the level of the pylorus or higher-->metabolic alkalosis.
Lower in the GI tract -->metabolic acidsis. colicky abdominal pain, n/v, distention, if dehydrated then hypotension and tachycardia may occur, fever, leukocytosis and rebound tenderness if ischemia is present. Obstruction of pylorus results in proguse vomiting of clear gastric fluid. Partial SBO causes diarrhea. Complete SBO causes constipation and increased bowel sounds"
"Large bowel obstruction - CORRECT ANSWER not as common and typically occurs 2nd to
a tumor, but can also be diverticulitis, inflammatory bowel disease and volvulus. S&S: hypogastric pain, abdominal distention and vomiting which will occur late"
"Portal Hypertension - CORRECT ANSWER Abnormally high blood pressure in the portal
venous system caused by resistance to portal blood flow. Commonly caused by fibrosis, obstruction from cirrhosis, thrombosis, or narrowing of hepatic portal vein. Most common S&S is vomiting blood from bleeding esophageal varices."
"Ascites - CORRECT ANSWER accumulation of fluid in the peritoneal cavity and is a
complication of portal hypertension. Cirrhosis is most common cause. S&S: abdominal distension, increased abd girth, weight gain and in large volumes dyspnea, increased respiratory rate, peripheral edema, dilutional hyponatremia and may develop peritonitis."
"Hepatic Encephalopathy - CORRECT ANSWER due to ammonia accumulation. Ammonia
causes the neurons to swell which leads to cerebral edema and IICP. Triggers for this include: ETOH abuse, infection, GI bleed, portal vein thrombosis, sedatives, volume depletion, constipation, electrolyte imbalances and diuretics. Asterixis AKA liver flap is most common sign."
"Jaundice - CORRECT ANSWER not a disorder but a manifestation. It is the yellowing of
skin and other tissues. Visible when bilirubin reaches 2.5-3mg/dL."
"Non-obstructive jaundice - CORRECT ANSWER Increase in the amount of
indirect(unconjugated) bilirubin typically from RBC hemolysis. Caused from ABO or RH incompatibility, sickle cell anemia, in newborns, and hepatocellular damage from hepatitis, cirrhosis or cancer. Total bili levels are elevated, direct bili is low and indirect bili is high"
"Obsructive jaundice - CORRECT ANSWER Occurs when the liver can conjugate bilirubin
fine but there is an obstruction of outward flow to the intestines. Most commonly caused by obstruction in the biliary tract. Hallmark sign is gray stools"
"Alcoholic Cirrhosis - CORRECT ANSWER The change of healthy liver parenchyma to
fibrotic scar tissue which is nonfunctioning. The injury results in cellular necrosis, inflammation and regeneration which leads to fibrosis. The fibrotic changes compress the blood vessels and develop portal hypertension."
"Effects of cirrhosis - CORRECT ANSWER Decreased clotting factors, decreased synthesis of
albumin, ascites, decreased detox of medications, hormones and toxins, jaundice, esophagel and gastric varices, anemia, hematemesis/coffee ground emesis, black stools, splenomegaly,
positive and all other test are negative then person has acquired immunity from vaccine. Hep. B total core antibody positive and all other are negative, person had previous infection. Hep. B core antibody(IgM) is positive in acute infections."
"Hepatitis C screening - CORRECT ANSWER All positive C antibody test indicates a chronic
hepatitis C infection"
"Cholelithiasis - CORRECT ANSWER Presence of stones in the gallbladder. Risk factors
include obesity, rapid weight loss, middle age, female gender, oral contraceptives, native american ancestry, ileal disease, low HDLs, malabsorption disorders and hypertriglyceridemia."
"Gallstones S&S - CORRECT ANSWER May not cause any S&S if they are small. Some can
pass into the common bile duct and cause an obstruction which will cause painful spasms and contraction of the bile duct in the RUQ area called biliary colic. Pain is also felt in the back, right should or right scapula. N/V."
"Cholecystitis - CORRECT ANSWER inflammation of the gallbladder from obstruction in
biliary tract. S&S: precipitated by a fatty meal, GERD, positive murphy's sign and rebound tenderness. Lab abnormalities include leukocytosis, increased alkaline phosphatase and direct bilirubin."
"Acute Pancreatitis - CORRECT ANSWER Associated with the escape of pancreatic enzymes
into the surrounding area. Enzymes begin the digestive process of the tissues they touch which may lead to hemorrhaging."
"Acute pancreatitis causes - CORRECT ANSWER ETOH, gallstones, PUD, abdominal trauma,
hyperlipidemia, smoking, some drugs, genetic factors, viral infections, autoimmune, ischemia, post ERCP, scorpion bite."
"Acute pancreatitis S&S - CORRECT ANSWER abrupt post prandial pain, epifastric pain
that radiates to the back and is worse when lying down, n/v and if hemorrhaging occurs then persons will have signs of hypovolemic shock, fever, hypocalcemia, jaundice and a lot of fluid loss"
"Acute pancreatitis diagnosis and complications - CORRECT ANSWER 1 of 3: symptoms
consistent with acute pancreatitis, elevated lipase or findings consistent with acute pancreatitis on CT. Complications: ARDS, heart failure, renal failure, coagulopathies, sepsis, paralytic ileus and GI bleed"
"Esophageal cancer - CORRECT ANSWER not common. Related to chronic inflammation
and metaplastic changes in the esophagus. Do not show signs until later in the disease. 2 main symptoms are chest pain and dysphagia"
"Colon cancer - CORRECT ANSWER Occurs in any portion of colon or rectum in persons
over 50.. Casues age, high fat, low fiber diets, smoking, obesity, family history, low levels of exercise, inflammatory bowel disease and gastrectomy. Commonly arise from polyps"
"Colorectal cancer signs and screening - CORRECT ANSWER S&S: pain, abdominal mass,
anemia, occult bleeding, obstruction, distention. Screening starts at age 50 and includes yearly test for occult blood, colonoscopy every 5-10 years, sigmoidoscopy every 5 years"
"Pancreatic cancer - CORRECT ANSWER Incidence increases with age and is more common
in males and african americans. Risk factors: ETOH use, family history, smoking, non O blood type, DM type 2, and chronic pancreatitis.K-ras mutation, a proto-oncogene is most common genetic alteration. S&S: jaundice, dull back pain, protein and fat malabsorption, lethary, weight loss, n/v, diabetes, changes in bowel patterns and pruritis"
"Cleft lip/palate - CORRECT ANSWER abnormalities that arise during embryonic
development due to vit. B6, folic acid and B12 deficiencies, smoking, ETOH ingestion during pregnancy, steroid or statin use, maternal hyperhomocysteinemia, diabetes and genetic mutations. Cleft lips arise during the 4th week of gestation and cleft palate during the 3rd month"
"Pyloric stenosis - CORRECT ANSWER the pylorus is narrowed which slows the flow of
food from stomach to deuodenum. most common cause of intestinal obstruction in infancy. Usually causes vomiting after eating. Increase gastrin secretion in 3rd trimester has been linked to cause this. Other causes include deficiency in nitric oxide synthase containingneurons, abnormal innervation of myenteric plexus and presence of infantile hypergastrinemia and exposure to macrolide antibiotics"
"Neonatal jaundice - CORRECT ANSWER present in an infant when the total bilirubin level
is greater than the 95th percentile for infants age in hours or bilirubin level greater than 20mg/dL. When bilirubin level reaches 2, jaundice is visible"
"Physiologic neonatal jaundice - CORRECT ANSWER Normally a transient condition that
begins during the first week of life in healthy, full term infants. Caused by mild unconjugated hyperbilirubinemia. Subsides after a couple weeks"
"Pathologic neonatal jaundice - CORRECT ANSWER Onset is 24 hours after birth. bilirubin
levels>20 or indirect bilirubin>15. Risk factors include ABO or RH incompatibility, prematurity, exclusive breast feeding, maternal age greater than 25, male infant, delayed meconium passage and birth trauma. Most common cause is hemolytic disease of the newborn"
"From which part of the midbrain do cranial nerves IX to XII emerge? - CORRECT ANSWER
Medulla Oblongata" "Which area of the brain assumes responsibility for conscious and unconscious muscle synergy
and for maintaining balance and posture? - CORRECT ANSWER Cerebellum"
"Which statement is true regarding upper motor neurons? - CORRECT ANSWER The
modify spinal reflex arcs"
"The membrane that separates the brain's cerebellum from it's cerebrum is the: - CORRECT
ANSWER Tentorium cerebelli"
"The function of arachnoid villi is to: - CORRECT ANSWER Absorb cerebrospinal fluid into
the cerebral venous sinuses"
"Where is the cerebrospinal fluid produced? - CORRECT ANSWER Choroid plexuses"
"Which of the meninges closely adheres to the surface of the brain and spinal cord and follows
the sulci and fissures? - CORRECT ANSWER Pia mater"
"Norepinephrine produces what primary response? - CORRECT ANSWER
Vasoconstriction"
"What is an effect of the sympathetic nervous system? - CORRECT ANSWER Increased
blood sugar levels"
"The brain receives approximately what percentage of the cardiac output? - CORRECT
ANSWER 20%"
"The collateral blood flow to the brain is provided by the: - CORRECT ANSWER Circle of
Willis" "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? - CORRECT ANSWER Leukocytes
10/mm3"
"Cognitive operations cannot occur without the effective functioning of the brain's: -
CORRECT ANSWER Reticular activating system"
"Which intracerebral disease process is capable of producing diffuse dysfuntion? - CORRECT
ANSWER Infarct emboli"
"What is the most common infratentorial brain disease process that results in the direct
destruction of the reticulating activation system (RAS)? - CORRECT ANSWER
Cerebrovascular disease"
"A sudden, explosive, disorderly discharge of cerebral neurons is termed: - CORRECT
ANSWER Seizure"
"A complex partial seizure is described as: - CORRECT ANSWER Impairment of both
consciousness and the ability to react to exogenous stimuli"
"Status epilepticus is considered a medial emergency because of the: - CORRECT ANSWER
Development of cerebral hypoxia" "The most critical aspect in correctly diagnosing a seizure disorder and establishing it's cause
is: - CORRECT ANSWER Health history"
"What type of seizure starts in the fingers and progressively spreads up the arm and extends to
the leg? - CORRECT ANSWER Focial (partial) Jacksonian seizure"
"What area of the brain mediates the executive attention functions? - CORRECT ANSWER
Prefrontal"
"What term describes the loss of the comprehension or production of language? - CORRECT
ANSWER Aphasia"
"With receptive dysphasia (fluent), the individual is able to: - CORRECT ANSWER Produce
verbal speech, but not comprehend language"
"What is the normal intranial pressure (in mmHg)? - CORRECT ANSWER 5 to 15"
"Cerebral edema is an increase in the fluid content of the brain's: - CORRECT ANSWER
Tissue" "What type of cerebral edema occurs when permeability of the capillary endothelium increases
after injury to the vascular structure? - CORRECT ANSWER Vasogenic"
"Which edema is most often observed with noncommunicating hydrocephalus? - CORRECT
ANSWER Interstitial"
"Characteristics of primary motor neuron atrophy include: - CORRECT ANSWER
Fasciculations and muscle cramps" "The weakness resulting from the segmental paresis and paralysis characteristic of anterior
horn cell injury is difficult to recognize because: - CORRECT ANSWER Two or more nerve
roots supply each muscle"
"Parkinson disease is a degenerative disorder of the brain's: - CORRECT ANSWER Basal
ganglia" "Clinical manifestations of Parkinson disease are caused by a deficit in which of the brain's
neurotransmitters? - CORRECT ANSWER Dopamine"
"Tremors at rest, rigidity, akinesia, and postural abnormalities are a resulte of the atrophy of
neurons in the brain's: - CORRECT ANSWER Substantia nigra that produces dopamine"
"Diffuse axonal injuries (DAI's) of the brain often result in: - CORRECT ANSWER Reduced
levels of consciousness"
"What event is most likely to occur to the brain in a classic (moderate) cerebral concussion? -
CORRECT ANSWER Brief period of vital sign instability"
"Which disorder has clinical manifestations that include decreased consciousness for up to 6
hours, as well as retrograde and postraumatic amnesia? - CORRECT ANSWER Classic
(Moderate) Cerebral Concussion"
"What group is most at risk of spinal cord injury from minor trauma? - CORRECT ANSWER
Older adults" "The edema of the upper cervical cord after spinal cord injury is considered life threatening
because of which possible outcome? - CORRECT ANSWER Breathing difficulties from an
impairment to the diaphragm"
"What indicates that spinal shock is terminating? - CORRECT ANSWER Reflex emptying of
the bladder" "What term is used to describe the complication that can result from a spinal cord injury above T6 that is producing paroxysmal hypertension, as well as piloerection and sweating above the
spinal cord lesion? - CORRECT ANSWER Autonomic hyperreflexia"
"Why does a person who has a spinal cord injury experience faulty control of sweating? -
CORRECT ANSWER The hypothalamus is unable to regulate body heat as a result of
damage to the sympathetic nervous system" "Which clinial finding is considered a diagnostic indicator for an arteriovenous malformation
(AVM)? - CORRECT ANSWER Systolic bruit over the carotid artery"
"Which cerebral vascular hemorrhage causes meningeal irritation, photophobia, and positive
Kernig and Brudzinski signs? - CORRECT ANSWER Subarachnoid"
"In adults, most intracranal tumors are located: - CORRECT ANSWER Infratentorially"
"In children, most intracranial tumors are located: - CORRECT ANSWER Supratentiorially"
"The most common primary central nervous system (CNS) tumor is the: - CORRECT
ANSWER Astrocytoma"
"Meningiomas characteristically compress from: - CORRECT ANSWER Outside the spinal
cord"
"What is the central component of the pathogenic model of multiple sclerosis? - CORRECT
ANSWER Demyelination of nerve fibers in the CNS"
"A blunt force injury to the forehead would result in a coup injury to which region of the brain?
- CORRECT ANSWER Frontal"
"A blunt force injury to the forehead would result in a contrecoup injury to which rebion of the
brain? - CORRECT ANSWER Occipital"
"Apinal cord injuries most likely occur in which region? - CORRECT ANSWER Cervical and
thoracic-lumbar" "The most likelly rationale for body temperature fluctuations after cervical spinal cord injury is
that the person has: - CORRECT ANSWER Sustain sympathetic nervious system damage
resulting in disturbed thermal control." "A man who sustained a cervical spinal cord injury 2 days ago suddenly develops severe hypertension and bradycardia. He reports severe head pain and blurred vision. The most likely
explanation for these clinical manifestations is that he is: - CORRECT ANSWER Developing
autonomic hyperreflexia"
"Hepatoportal circulation - CORRECT ANSWER hepatic artery receives oxygenated blood
from the inferior mesenteric, gastric, and cystic veins. The hepatic portal vein receives deoxygenated blood from the inferior and superior mesenteric vein and splenic vein and delivers nutrients that have been absorbed from the intestinal system"
"Osmotic diarrhea - CORRECT ANSWER Caused by the presence of a nonabsorbable
substance in the intestines. This pulls water by osmosis into the intestinal lumen and results in large volume diarrhea. This is how mag citrate, lactulose and miralax work. Causes include: excessive ingestion of nonabsorbable sugars, tube feedings, dumping syndrome, malabsorption, pancreatic enzyme deficiency, bile salt deficiency, small intestine bacterial overgrowth or celiac disease"
"Secretory diarrhea - CORRECT ANSWER Results in large volume losses secondary to
infectious causes such as rotavirus, bacterial enterotoxins, or c-diff."
"Motility diarrhea - CORRECT ANSWER AKA short bowel syndrome. Results from
resection of small intestine or surgical bypass of small intestine, IBS, diabetic neuropathy, hyperthyroidism, and laxative abuse. Fatty stools and bloating are common in malabsorption syndrome. Complications include: dehydration, electrolyte imbalance, metabolic acidosis, weight loss and malabsorption."
"Ulcerative colitis (UC) - CORRECT ANSWER Inflammatory disease of the large instestine
in persons 20-40y/o. Less common in people who smoke. Has periods of remission and exacerbations. Characterized by inflammation and ulcerations that remain superficial and in the small intestine."
"UC S&S - CORRECT ANSWER recurrent diarrhea, bloody stools, febrile, polyarthritis,
uveitis, sclerosing cholangitis, erythema nodosum and pyoderma gangrenosum"
"UC complications - CORRECT ANSWER fissures, hemorrhoids, perirectal abscess, toxic
megacolon, colon perforation, and colorectal adenocarcinoma. Increased risk of VTE and microthrombi, and colon cancer"
"Crohn's disease - CORRECT ANSWER Chronic inflammatory disorders that can affect any
portion of the GI tract but most often in the ileum and proximal colon. Affects persons in their 20-30s and of jewish decent. CARD15/NOD2 gene mutation commonly associated."
"Crohn's disease risk factors - CORRECT ANSWER smoking, family history, Jewish decent,
age less than 40, slight predominance in women and altered gut microbiome."
"Crohn's disease patho - CORRECT ANSWER includes trasmural involvement of the
affected area(entire wall of intestine is affected) and the presence of skip lesions. Disease
progression may lead to abscess formation in GI tract. Possible causes include infectious agents, autoimmune, psychosomatic, impaired T-cell immunity"
"Crohn's disease S&S - CORRECT ANSWER abd pain, diarrhea, dehydration, bloody stools,
malabsorption, malnutrition, weight loss, intestinal obstruction from chronic inflammation, fistulas and perforation of the intestine"
