Function
MULTIPLE CHOICE
1. Cognitive operations cannot occur without the effective functioning of the brains:
a. Pons
c. Reticular activating system
b. Medulla oblongata
d. Cingulate gyrus
ANS: C
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
3. What is the most common infratentorial brain disease process that results in the direct
a. Cerebrovascular disease
b. Demyelinating disease
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
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.
PTS: 1
5. Posthyperventilation apnea (PHVA) ceases and rhythmic breathing is resumed when levels of
arterial:
a. Carbon dioxide increase
b. Carbon dioxide become normal
c. Oxygen increase
d. Oxygen decrease
ANS: B
Rhythmic breathing returns when the PCO2 level returns to normal. None of the remaining
options would affect normal rhythmic breathing after PHVA.
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irregular pauses
ANS: B
7. Vomiting is associated with central nervous system (CNS) injuries that compress which of the
Vomiting, yawning, and hiccups are complex reflexlike motor responses that are integrated by
neural mechanisms in the lower brainstem. Vomiting often accompanies CNS injuries that
involve the vestibular nuclei. The remaining options will not trigger vomiting when
compressed.
PTS: 1
8. 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
ANS: D
Pinpoint fixed pupils are a result of pontine dysfunction. The diencephalon, oculomotor
cranial nerve, and tectum are not involved in such a pupil reaction.
PTS: 1
Apnea is viewed as a criterion of brainstem death, whereas the remaining options reflect
cerebral death.
PTS: 1
10. 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
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.
PTS: 1
Delirium is associated with autonomic nervous system overactivity and typically develops in
2 to 3 days, most commonly in critical care units, postsurgically, or during withdrawal from
CNS depressants (e.g., alcohol, narcotic agents). Age, gender, and chronic illnesses are not
generally associated with delirium triggers.
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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
Status epilepticus is a true medical emergency because a single seizure can last longer than 30
minutes, resulting in hypoxia of the brain. The other options are not the criteria used to
consider status epilepticus.
PTS: 1
15. The most critical aspect in correctly diagnosing a seizure disorder and establishing its cause is:
a. Computed tomographic (CT) scan
c. Skull x-ray studies
b. Cerebrospinal fluid analysis
d. Health history
ANS: D
Although the history may be supplemented with the remaining options, it remains the pivotal
tool for establishing the cause of a seizure disorder.
PTS: 1
16. What type of seizure starts in the fingers and progressively spreads up the arm and extends to
the leg?
a. Complex-psychomotor seizure
b. Focal (partial) Jacksonian seizure
c. Generalized seizures
d. Atonic-drop seizure
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
17. What area of the brain mediates the executive attention functions?
a. Limbic
c. Parietal
b. Prefrontal
d. Occipital
ANS: B
The prefrontal areas mediate several cognitive functions, called executive attention functions
(e.g., planning, problem solving, setting goals). The remaining options are not areas involved
with the mediation of executive attention functions.
PTS: 1
18. What term describes the loss of the comprehension or production of language?
a. Agnosia
c. Akinesia
b. Aphasia
d. Dysphasia
ANS: B
Aphasia is the loss of the comprehension or production of language. The remaining options
are not terms used to describe this loss of function.
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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
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 brains ventricles, neurons, or
meninges.
PTS: 1
22. What type of cerebral edema occurs when permeability of the capillary endothelium increases
a. Cytotoxic
b. Interstitial
c. Vasogenic
d. Ischemic
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
25. Which dyskinesia involves involuntary movements of the face, trunk, and extremities?
a. Paroxysmal
c. Hyperkinesia
b. Tardive
d. Cardive
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
26. Antipsychotic drugs cause tardive dyskinesia by mimicking the effects of increased:
a. Dopamine
c. Norepinephrine
b. Gamma-aminobutyric acid
d. Acetylcholine
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.
PTS: 1
27. The existence of regular, deep, and rapid respirations after a severe closed head injury is
c. Supratentorial
d. Cerebral area
ANS: A
Central reflex hyperpnea, which is a sustained deep and rapid but regular respiratory pattern
that is the result of central nervous system (CNS) damage or disease, involves the lower
midbrain and upper pons. This neurologic injury is observed after increased intracranial
pressure and blunt head trauma. Damage to any of the other areas listed would not produce
this breathing pattern.
PTS: 1
28. 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
ANS: B
29. Since his cerebrovascular accident, a man has been denying his left hemiplegia. What term is
c. Amusia agnosia
d. Agraphia agnosia
ANS: B
Anosognosia is ignorance or denial of the existence of disease. None of the remaining options
describes such denial.
PTS: 1
30. After a cerebrovascular accident, a man is unable to either feel or identify a comb with his
c. Anosognosia
d. Prosopagnosia
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
31. Most dysphasias are associated with cerebrovascular accidents involving which artery?
a. Anterior communicating
c. Circle of Willis
b. Posterior communicating
d. Middle cerebral
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.
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Amyloid plaques, neurofibrillary tangles, as well as neuronal and synaptic losses in the brain,
characterize Alzheimer disease.
PTS: 1
34. The body compensates for a rise in intracranial pressure by first displacing the:
a. Cerebrospinal fluid
c. Venous blood
b. Arterial blood
d. Cerebral cells
ANS: A
A rise in intracranial pressure necessitates an equal reduction in the volume of the other
contents. The most readily displaced content of the cranial vault is cerebrospinal fluid (CSF),
not any of the other options.
PTS: 1
If intracranial pressure remains high after cerebrospinal fluid (CSF) displacement out of the
cranial vault, then cerebral blood volume is altered, resulting in stage 1 intracranial
hypertension. Vasoconstriction and external compression of the venous system occur in an
attempt to further decrease the intracranial pressure. None of the remaining options accurately
describe the cause of stage 1 intracranial hypertension.
PTS: 1
36. Dilated and sluggish pupils, widening pulse pressure, and bradycardia are clinical findings
a. 1
b. 2
ANS: C
37. Dilation of the ipsilateral pupil, following uncal herniation, is the result of pressure on which
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.
PTS: 1
38. Which characteristic is the most critical index of nervous system dysfunction?
a. Size and reactivity of pupils
c. Motor response
b. Pattern of breathing
d. Level of consciousness
ANS: D
Level of consciousness is the most critical clinical index of nervous system function or
dysfunction. An alteration in consciousness indicates either improvement or deterioration of a
persons condition. No other option is used as the critical index of nervous system.
PTS: 1
Diagnostic criteria for vegetative state (VS) include the return of professed vegetative
(autonomic) functions, including sleep-wake cycles and normalization of respiratory and
digestive system functions. Only the correct option appropriately describes the diagnostic
criteria for a VS.
PTS: 1
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.
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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.
PTS: 1
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.
PTS: 1
43. The weakness resulting from the segmental paresis and paralysis characteristic of anterior
a.
b.
c.
d.
ANS: C
The paresis and paralysis associated with anterior horn cell injury are segmental; however,
because two or more roots supply each muscle, the segmental character of the weakness may
be difficult to recognize. The reason this pathophysiologic condition is difficult to recognize is
not appropriately explained by any of the other options.
PTS: 1
Parkinson disease is a commonly occurring degenerative disorder of the basal ganglia and not
of any of the other brain structures.
PTS: 1
45. Clinical manifestations of Parkinson disease are caused by a deficit in which of the brains
neurotransmitters?
a. Gamma-aminobutyric acid
b. Dopamine
c. Norepinephrine
d. Acetylcholine
ANS: B
46. Tremors at rest, rigidity, akinesia, and postural abnormalities are a result of the atrophy of
The hallmark characteristics of Parkinson disease (PD) are a result of a loss of dopaminergicpigmented 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.
PTS: 1
MULTIPLE RESPONSE
47. Dementia is commonly characterized by the deterioration in which abilities? (Select all that
apply.)
Sociability
Balance
Memory
Speech
Decision making
a.
b.
c.
d.
e.
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.
PTS: 1
48. The clinical manifestations of Parkinson disease include: (Select all that apply.)
a. Fragmented sleep
b. Drooping eyelids
c. Depression
d. Muscle stiffness
e. Bradykinesia
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.
PTS: 1
49. In Parkinson disease the basal ganglia influence the hypothalamic function to produce which
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.
PTS: 1