Porth's Pathophysiology, Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth
Porth's Pathophysiology, Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth
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Chapter 20- Disorders of Brain Function
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
| 1. | 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. | ||
| 2. | 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. | ||
| 3. | 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. | ||
| 4. | 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. | ||
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