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Chapter 15 Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function
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- Galen College Of Nursing
Chapter 15 Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function
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Chapter 15: Alterations in Cognitive Systems, CerebralHemodynamics, and Motor Function
MULTIPLE CHOICE
1. A neurologist explains that arousal is mediated by the:
a. cerebral cortex.
b. medulla oblongata.
c. reticular activating system.
d. cingulate gyrus.
ANS: C
Arousal is mediated by the reticular activating system, which regulates aspects of
attention and information processing and maintains consciousness. The cerebral cortex
affects movement. The medulla oblongata controls things such as hiccups and vomiting.
The cingulate gyrus plays other roles in response.
REF: p. 359
2. A 20-year-old experiences a severe closed head injury as a result of a motor vehicle accident.
Which of the following structures is most likely keeping the patient in a vegetative state (VS)
1 month after the accident?
a. Cerebral cortex
b. Brainstem
c. Spinal cord
d. Cerebellum
ANS: B
When a person loses cerebral function, the reticular activating system and brainstem can
maintain a crude waking state known as a VS. Cognitive cerebral functions, however, cannot
occur without a functioning reticular activating system. A VS is not associated with the
cerebral cortex, spinal cord, or cerebellum.
REF: p. 364
3. A 16-year-old’s level of arousal was altered after taking a recreational drug. Physical
exam revealed a negative Babinski sign, equal and reactive pupils, and roving eye
movements. Which of the following diagnoses will the nurse most likely see on the chart?
a. Psychogenic arousal alteration
b. Metabolically induced coma
c. Structurally induced coma
d. Structural arousal alteration
ANS: B
Persons with metabolically induced coma generally retain ocular reflexes even when other
signs of brainstem damage are present. Psychogenic arousal activation demonstrates a general
psychiatric disorder. Structurally induced coma is manifested by asymmetric responses.
Structural arousal alteration does not have drug use as its etiology.
, REF: p. 360, Table 15-2
4. The breathing pattern that reflects respirations based primarily on carbon dioxide (CO2) levels
in the blood is:
a. Cheyne-Stokes.
b. ataxic.
c. central neurogenic.
d. normal.
ANS: A
Cheyne-Stokes respirations occur as a result of CO2 levels in the blood. Ataxic breathing
occurs as a result of dysfunction of the medullary neurons. Central neurogenic patterns occur
as a result of uncal herniation. Normal respirations are based on the levels of oxygen (O2) in
the blood.
REF: p. 361
5. A teenager sustains a severe closed head injury following an all-terrain vehicle (ATV)
accident and is in a state of deep sleep that requires vigorous stimulation to elicit eye opening.
How should the nurse document this in the chart?
a. Confusion
b. Coma
c. Obtundation
d. Stupor
ANS: D
Stupor is a condition of deep sleep or unresponsiveness from which a person may be aroused
or caused to open his or her eNyesRonlIy byGvigBo.roCus aMnd repeated stimulation.
U S
Confusion is the loss of the ability to think rapidly and clearly and is characterized by
impaired judgment and N T
decision making. Coma is a condition in which there is no verbal response to the external
environment or to any stimuli; noxious stimuli such as deep pain or suctioning do not yield
motor movement. Obtundation is a mild-to-moderate reduction in arousal (awakeness)
with limited response to the environment.
REF: p. 361, Table 15-3
6. A patient experiences a severe head injury hitting a tree while riding a motorcycle.
Breathing becomes deep and rapid but with normal pattern. What term should the nurse use
for this condition?
a. Gasping
b. Ataxic breathing
c. Apneusis
d. Central neurogenic hyperventilation
ANS: D
Central neurogenic hyperventilation is a sustained, deep, rapid, but regular, pattern
(hyperpnea) of breathing. Gasping is a pattern of deep “all-or-none” breaths accompanied by
a slow respiratory rate. Ataxic breathing is completely irregular breathing that occurs with
random shallow and deep breaths and irregular pauses. Apneusis is manifested by a prolonged
inspiratory pause alternating with an end-expiratory pause.
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