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WorksheetsNeurology Worksheet - Brain and Spinal Cord Injuries
Total questions: 100
Worksheet time: 50mins
What event is most likely to occur to the brain in a classic cerebral concussion?
Brief period of vital sign instability
Cerebral edema throughout the cerebral cortex
Cerebral edema throughout the diencephalon
Disruption of axons extending from the diencephalon and brainstem
What is the result of a Chiari type II malformation associated with a myelomeningocele?
Upward displacement of the cerebellum into the diencephalon
Motor and sensory lesions below the level of the myelomeningocele
Downward displacement of the cerebellum, brainstem, and fourth ventricle
Generalized cerebral edema and hydrocephalus
What type of positioning exists when all four extremities are in rigid extension with forearm hyper-pronation and plantar extension?
Decorticate
Decerebrate
Spastic
Cerebellar
Vomiting is associated with CNS injuries that compress which area?
Vestibular nuclei in the lower brainstem
Floor of the third ventricle
Any area of the midbrain
Diencephalon
What name is given to a large network of neurons essential for maintaining wakefulness?
Midbrain
Reticular activating system
Medulla oblongata
Pons
Spinal cord injuries most often occur in which regions?
Cervical and thoracic
Thoracic and lumbar
Lumbar and sacral
Cervical and thoracolumbar (C1–C2, C4–C7, T1–L2)
A patient has a spinal cord injury involving upper motor neurons. What finding is expected?
Permanent paralysis below injury
Initial paralysis with partial recovery
Hemiplegia on contralateral side
Increased cerebrospinal fluid
What term describes the complication from SCI above T6 causing hypertension, sweating, and bradycardia?
Craniosacral dysreflexia
Parasympathetic dysreflexia
Autonomic hyperreflexia
Retrograde hyperreflexia
Why does a person with SCI experience faulty sweating control?
Hypothalamus unable to regulate heat due to sympathetic nerve damage
Thalamus unable to regulate heat due to sympathetic nerve damage
Hypothalamus unable to regulate heat due to parasympathetic damage
Thalamus unable to regulate heat due to spinal nerve root damage
A blunt force injury to the forehead would result in a coup injury to which brain region?
Frontal
Temporal
Parietal
Occipital
A blunt-force injury to the forehead would result in a contrecoup injury to which region of the brain?
Frontal
Temporal
Parietal
Occipital
The most likely rationale for body-temperature fluctuations after cervical spinal cord injury is that the person has:
Developed bilateral pneumonia or a UTI
Sustained sympathetic nervous system damage resulting in disturbed thermal control
Sustained a head injury that damaged the hypothalamus
Developed septicemia
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 is that he is:
Experiencing acute anxiety
Developing spinal shock
Developing autonomic hyperreflexia
Experiencing parasympathetic areflexia
What are the initial clinical manifestations immediately noted after a spinal cord injury?
Headache
Bladder incontinence
Loss of deep tendon reflexes
Hypertension
Flaccid paralysis
The paresthesia that occurs in vitamin B12 deficiency anemia is a result of:
Reduction in acetylcholine receptors
Myelin degeneration in the spinal cord
Destruction of myelin in peripheral nerves
Altered function of parietal-lobe neurons
What indicates that spinal shock is terminating?
Voluntary movement below the level of injury
Reflex emptying of the bladder
Paresthesia below the level of injury
Decreased deep tendon reflexes and flaccid paralysis
Which nerves are capable of regeneration?
Nerves within the brain and spinal cord
Peripheral nerves that are cut or severed
Myelinated nerves in the peripheral nervous system
Unmyelinated nerves of the peripheral nervous system
Which statements are correct regarding the functions of the pancreas?
Cholecystokinin stimulates the release of pancreatic enzymes.
Bilirubin and S cells inhibit pancreatic enzymes.
Pancreatic polypeptide is released after eating.
Acetylcholine is liberated from pancreatic branches of the vagus nerve.
ACh stimulates the release of pancreatic enzymes.
Why does cystic fibrosis lead to exocrine pancreatic insufficiency?
Pancreatic ducts obstructed with mucus
Ischemia
Pancreas can't make enzymes
Volvulus
Small-bowel obstruction at the pylorus or high small bowel causes metabolic alkalosis because of:
Gain of pancreatic bicarbonate
Excessive loss of H+ from gastric juice
Loss of K+
Loss of bile acids
What medication compensates for the digestive-enzyme deficit in CF?
Salt tabs
Pancreatic enzymes
Antihypertensives
Antibiotics
Why CF → exocrine pancreatic insufficiency?
Pancreatic ducts obstructed with mucus
Ischemia
Pancreas can't make enzymes
Volvulus
Why does fatty maldigestion occur in CF?
Bile ducts blocked
Fail to metabolize fat-soluble vitamins
Deficiency of pancreatic enzymes
Jejunal fat malabsorption
Which pancreatic enzyme is responsible for the breakdown of carbohydrates?
Trypsin
Amylase
Lipase
Chymotrypsin
Gastric emptying is delayed by the presence of which substances?
Solids
Carbohydrates
Non-isotonic solutions
Bacteria
Fats
How does intussusception cause intestinal obstruction?
Telescoping of bowel → strangulation of blood supply
Twisting on mesentery
Loss of peristalsis
Adhesions
Considering the innervation of the circular muscles of the bladder neck, which classification of drug is used to treat bladder-neck obstruction?
β-Adrenergic blocking medications
α-Adrenergic blocking medications
Parasympathomimetic medications
Anticholinesterase medications
What is the most immediate result of a small-intestinal obstruction?
Vomiting
Dehydration
electrolyte imbalance
distension
Cardinal symptoms of small intestinal obstruction:
Constant dull pain relieved by defecation
Acute intermittent pain 30–120 min after eating
Colicky pain from distention, followed by vomiting
Excruciating hypogastric ischemic pain
Telescoping of ileum into cecum → obstruction:
Hirschsprung
Malrotation
Intussusception
Volvulus
Sudden colicky pain, knees to chest, then “currant jelly” stool →
Hirschsprung
Intussusception
Malrotation
Volvulus
What is the most common cause of uncomplicated urinary tract infections?
Staphylococcus
Klebsiella
Proteus
Escherichia coli
Which clinical manifestations of a urinary tract infection may be demonstrated in an 85-year-old individual?
Confusion and poorly localized abdominal discomfort
Dysuria, frequency, and suprapubic pain
Hematuria and flank pain
Pyuria, urgency, and frequency
Which bladder conditions would result from lesions of the sacral segments below S1?
Frequency
Urge incontinence
Bladder distension
Urgency
Urinary retention
What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion?
Macula densa
Visceral epithelium
Juxtaglomerular apparatus (JGA)
Filtration slits
When renin is released, is it capable of which action?
Inactivation of autoregulation
Direct activation of angiotensin II
Direct release of antidiuretic hormone (ADH)
Formation of angiotensin I
What effect do natriuretic peptides have during heart failure when the heart dilates?
Stimulate antidiuretic hormone
Inhibit antidiuretic hormone
Stimulate renin and aldosterone
Inhibit renin and aldosterone
What is the direct action of atrial natriuretic hormone (ANH)?
Sodium retention
Sodium excretion
Water retention
Water excretion
Which hormone is required for water to be reabsorbed in the distal tubule and collecting duct?
Antidiuretic hormone
Aldosterone
Cortisol
Adrenocorticotropin hormone (ACTH)
The concentration of the final urine is determined by ADH, which is secreted by which gland?
Posterior pituitary
Thyroid
Parathyroid
Anterior pituitary
Which hormone is synthesized and secreted by the kidneys?
Antidiuretic hormone
Aldosterone
Erythropoietin
Angiotensinogen
Thought and goal-oriented behaviors are functions of which area of the brain?
Cerebellum
Limbic system
Prefrontal lobe
Occipital lobe
Where is the region responsible for the motor aspects of speech located?
Wernicke area in the temporal lobe
Broca speech area in the frontal lobe
Wronka area in the parietal lobe
Barlow area in the occipital lobe
Dysfunction of cranial nerve VII results in what finding?
Unable to open mouth against resistance
Absent gag reflex
Smile only on one side of the face
Tongue deviates to the right
Which of the meninges closely adheres to the surface of the brain and spinal cord and follows the sulci and fissures?
Dura mater
Arachnoid
Pia mater
Inner dura
The brain receives approximately what percentage of the cardiac output?
80%
40%
20%
10%
What provides collateral blood flow to the brain?
Carotid arteries
Basilar artery
Circle of Willis
Vertebral arteries
Bilirubin is a by-product of the destruction of which aged cells?
Platelets
Protein
Leukocytes
Erythrocytes
Fetal hematopoiesis primarily occurs in the:
Gut
Spleen
Bone marrow
Thymus
Where are mature erythrocytes removed from the bloodstream?
Liver
Lymph nodes
Thymus
Spleen
Dilation of the ipsilateral pupil, following uncal herniation, is the result of pressure on which cranial nerve (CN)?
Optic (CN II)
Abducens (CN VI)
Oculomotor (CN III)
Trochlear (CN IV)
Normal intracranial pressure in adults is approximately:
5 to 15
7 to 20
12 to 14
80 to 120
Dilated and sluggish pupils, widening pulse pressure, and bradycardia are clinical findings evident of which stage of intracranial hypertension?
Stage 1
Stage 2
Stage 3
Stage 4
Vomiting is associated with CNS injuries that compress which of the brain’s anatomic locations?
Vestibular nuclei in the lower brainstem
Floor of the third ventricle
Any area of the midbrain
Diencephalon
What effect results from inhibiting the parasympathetic nervous system with a drug such as atropine?
Salivation becomes thinner.
Salivation decreases.
The pH of saliva changes.
Digestive enzymes are inhibited.
Where is the neurotransmitter norepinephrine secreted?
Somatic nervous system
Parasympathetic pre-ganglion
Sympathetic post-ganglion
Parasympathetic post-ganglion
Norepinephrine produces what primary response?
Increased contractility of the heart
Release of renin from the kidney
Vasoconstriction
Sleep cycle disturbance
where is the region responsible for the motor aspects of speech located
Wernicke area in the temporal lobe
Release of renin from the Broca speech area in the frontal lobe
Wronka area in the parietal lobe
Barlow area in the occipital lobe
Formed elements that are disk-shaped fragments and essential for clotting:
Monocytes
Platelets
Macrophages
Erythrocytes
Which cerebral vascular hemorrhage causes meningeal irritation, photophobia, and positive Kernig and Brudzinski signs?
Intracranial
Subarachnoid
Epidural
Subdural
The type of vascular malformation that most often results in hemorrhage is:
Cavernous angioma
Venous angioma
Capillary telangiectasia
Arteriovenous malformation
Prerenal injury from poor perfusion can result from which condition? (Select all that apply.)
Bilateral ureteral obstruction
Renal vasoconstriction
Renal artery thrombosis
Hemorrhage
Hypotension
Which statements are true regarding parietal pain? (Select all)
Arises from parietal peritoneum
More localized than visceral
Less intense than visceral
Nerve fibers go to spinal cord
Corresponds to dermatomes T6–L1
What part of the brain mediates the physical expression of emotions?
Hypothalamus
Basal ganglia
Medulla oblongata
Subthalamus
Cerebral edema is an increase in the fluid content of the brain’s:
Ventricles
Tissue
Neurons
Meninges
Which clinical manifestations of a urinary tract infection may be demonstrated in an 85-year-old individual?
Confusion and poorly localized abdominal discomfort
Dysuria, frequency, and suprapubic pain
Hematuria and flank pain
Pyuria, urgency, and frequency
Bacteria gain access to the female urinary tract by which means?
Via blood filtered through kidney
Via lymph
Ascending the urethra into the bladder
Via static urine colonization
Fetal hematopoiesis primarily occurs in the:
Gut
Spleen
Bone marrow
Thymus
The statement true regarding urodilatin is:
Urodilatin inhibits sodium chloride and water reabsorption in the medullary part of the collecting duct.
It inhibits ADH to prevent water reabsorption.
Urodilatin is stimulated by a fall in blood pressure and a decrease in extracellular volume.
The concentration of the final urine is determined by ADH, which is secreted by which gland?
Posterior pituitary
Thyroid
Parathyroid
Anterior pituitary
Stage 1 intracranial hypertension is caused by the:
Displacement of CSF followed by compression of the cerebral venous system
Loss of autoregulation of blood flow
Vasoconstriction with reciprocal BP increase
Compression of the medulla oblongata
Dilated and sluggish pupils, widening pulse pressure, and bradycardia are clinical findings evident of which stage of intracranial hypertension?
Stage 1
Stage 2
Stage 3
Stage 4
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?
Cerebral cortex
Brainstem
Spinal cord
Cerebellum
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 diagnosis will the nurse most likely see on the chart?
Metabolically induced coma
Psychogenic coma
Structurally induced coma
Structural arousal alteration
The breathing pattern that reflects respirations based primarily on carbon dioxide (CO₂) levels in the blood is:
Cheyne-Stokes
Ataxic
Central neurogenic
Normal respirations
An increase in intracranial pressure results in:
Brain tissue hypoxia
Ventricular swelling
Expansion of cranial vault
Cerebral vasoconstriction
A patient’s ICP is recorded at 24 mm Hg. How should the nurse interpret this?
Higher than normal
Normal
Lower than normal
Dangerously low
A patient shows widened pulse pressure, bradycardia, and sluggish pupils. What stage of intracranial hypertension is this?
Stage 3
Stage 1
Stage 2
Stage 4
A 16-year-old male hit his forehead and now shows resistance to passive movement that varies with applied force. Diagnosis?
Paratonia
Spasticity
Rigidity
Dystonia
The body compensates for a rise in ICP first by displacing the:
Cerebrospinal fluid
Arterial blood
Venous blood
Cerebral cells
Which antibiotics are considered “major culprits” in causing nephrotoxic acute tubular necrosis (ATN)?
Penicillin and ampicillin
Vancomycin and bacitracin
Gentamicin and tobramycin
Cefazolin and cefepime
Detrusor hyperreflexia develops from neurologic disorders that originate where?
Spinal cord between C2 and S1
Spinal cord between S2 and S4
Above the pontine micturition center
Below the cauda equina
Cheyne-Stokes respirations are described as a:
Sustained deep, rapid, but regular pattern of breathing
Crescendo–decrescendo pattern of breathing followed by a period of apnea
Prolonged inspiratory period, followed by a short expiratory period
Completely irregular breathing pattern with shallow and deep breaths
A 6-month-old male presents with sudden abdominal pain, irritability, vomiting, then “currant jelly” stool. Ultrasound shows ileum collapsed through the ileocecal valve. This obstruction is called:
Prolapse
Pyloric stenosis
Intussusception
Imperforation
Which condition should the nurse assess for in mothers carrying fetuses affected by esophageal malformations?
Enlarged placentas
excessive amniotic fluid
short umbilical cords
foul smelling amniotic fluid
A 2-week-old infant vomits forcefully immediately after feeding for no apparent reason and is frequently constipated. These signs support which diagnosis?
Pyloric stenosis
Meconium ileus
Esophageal atresia
Galactosemia
A sign that a newborn infant may have pyloric stenosis is:
Diarrhea
Bile regurgitation
Olive-sized mass in the upper abdomen
Ascites with a fluid wave visible across the abdomen
Occurrence of gastroesophageal reflux (GER) is highest in which pediatric population?
Premature infants
Infants with Down syndrome
Children with cystic fibrosis
Children with esophageal atresia
Prolonged diarrhea is more serious in children than adults because:
Children have lower adipose reserves
Fluid reserves are lower in children
Children have a lower metabolic rate
Children are more resistant to antimicrobial therapy
A 20-year-old recently diagnosed with lactose intolerance eats an ice cream cone and develops diarrhea. This diarrhea can be classified as _____ diarrhea.
Osmotic
Secretory
Hypotonic
Motility
Assuming that midline epigastric pain is caused by a stimulus acting on an abdominal organ, the pain felt is classified as:
Visceral
Somatic
Parietal
Referred
A 50-year-old is diagnosed with gastroesophageal reflux. This condition is caused by:
Fibrosis of the lower third of the esophagus
Sympathetic nerve stimulation
Loss of muscle tone at the lower esophageal sphincter
Reverse peristalsis of the stomach
A 50-year-old male reports episodes of frequently recurring crampy abdominal pain, diarrhea, and bloody stools. A possible diagnosis would be:
Ulcerative colitis
Hiatal hernia
Pyloric obstruction
Achalasia
A 19-year-old presents with abdominal pain in the right lower quadrant, rebound tenderness, and low-grade fever. A possible diagnosis would be:
Colon cancer
pancreatitis
appendicitis
hepatitis
Digestion begins in the mouth with salivary α-amylase (ptyalin) that initiates the digestion of:
proteins
carbohydrates
fats
amino acids
By which structure are mature erythrocytes removed from the blood stream
liver
lymph nodes
thymus
spleen
What is the function of erythrocytes?
tissue oxygenation
hemostasis
infection control
allergy response
How much urine accumulates in the bladder before the mechanoreceptors sense bladder fullness?
75-100mL
100 to 150 mL
250-500mL
350-400mL
Glucose transport enhances the absorption of which electrolyte?
sodium
phosphate
potassium
chloride
What process increases intrathoracic and intraabdominal pressure to facilitate defecation?
relaxation of the internal anal sphinctor
intestinal peristalsis
valsalva manuever
ileogastric reflex
