NU 545 EXAM 2
Study Guide
Physio-Patho Basis of Adv Nsg
University of South Alabama
This Study Guide contains:
✓ verified questions and Answers with Reference pg.
✓ key concepts
✓ advanced clinical reasoning.
✓ Designed to help nursing students master course
outcomes
✓ prepare for midterm or final exams with confidence.
,NU 545 Unit 2 Study Guide
Chapter 15 Structure and Function of the Neurologic System
1. Review the anatomy of the brain. Which portion is responsible for keeping
you awake, controlling thought, speech, emotions and behavior, maintaining
balance and posture? Pg 439 brain starts
• The prefrontal area is responsible for goal oriented behavior
(ability to concentrate), short-term or recall memory, and the
elaboration of thought and inhibition on the limbic (emotional)
areas of the CNS. Pg 441
• Primary motor area (Brodmann area 4) causes specific muscles
to move. Pg 442
• Broca area in the inferior frontal lobe is important for speech
and language processing.
• Wernicke area responsible for reception and interpretation of
speech. Pg 444
• Limbic system involved in behavioral responses, visceral
reactions to emotion, motivation, mood, feeding behaviors,
biologic rhythms, sense of smell. Pg 446.
• Cerebellum motor control and maintaining balance and posture.
Pg 447
2. Know the function of the arachnoid villi.
• Pg 451 Function as one way valves directing CSF outflow into the blood
but preventing blood flow into the subarachnoid space.
3. Where is the primary defect in Parkinson’s disease and Huntington’s?
• Pg. 447 The cerebellum. Also the dysfunction of dopaminergic neurons in
the substania nigra is associated with Parkinson.
• Parkinson Disease, where is the primary defect? (p.564) The main disease
feature is degeneration of the basal ganglia (corpus striatum, globus
pallidus, subthalmic nucleus, and substantia nigra) involving the
dopaminergic nigrostriatal pathway.
• Huntington Disease - where is the primary defect? (p.562) The principal
pathologic feature of HD is severe degeneration of the basal ganglia,
particularly the caudate and putamen nuclei and the frontal cerebral
cortex. The degeneration of the basal ganglia leaves enlarged lateral
ventricles.
4. What is the function of the CSF? Where is it produced? Where is it
absorbed?
• Pg 451 The choroid plexuses in the lateral, third, and fourth
ventricles produce the major portion of CSF. The CSF protects
the intracranial and spinal cord structures from jolts and blows.
It also prevents the brain from tugging on the meninges, nerve
roots, and blood vessels. It is absorbed into the venous
circulation.
5. Review blood flow to the brain.
• Pg 452-454. Internal carotid arteries supply a great amount of blood flow.
Originate at common carotid arteries at the base of the skull and pass
through cavernous sinus. Three major paired arteries perfuse the
cerebellum and brainstem: 1. Posterior inferior cerebellar artery. 2.
, Anterior inferior cerebellar artery. 3. Superior cerebellar arteries. Circle of
Willis alternative route to blood flow if one of the main arteries is
obstructed. (collateral blood flow)
Chapter 16 Pain, Temp regulation, Sleep, and Sensory Function
6. What is the gate control theory of pain?
• Pg. 469 Pain transmission is modulated by a balance of impulse conducted
to the spinal cord where cells in the substantia gelatinosa function as a
“gate.” The gate regulates pain transmissions to the CNS
7. Know the type of nerve fibers that transmit pain impulses.
• Pg 470. A delta fibers, Unmyelinated C fibers, a beta fibers.
8. Where in the CNS does pain perception occur?
• Pg. 470-471 primarily the reticular and limbic systems and the cerebral
cortex.
9. Know different clinical descriptions of pain (acute, chronic,
neuropathic); pain threshold/tolerance.
• Pg 473 Pain threshold is the point which a stimulus is
perceived as pain and it does not vary significantly
among people or in the same person over time. Pain
tolerance is the duration of time or the intensity of pain
that an individual will endure before initiating an overt
pain responses and is generally decreased with
increased exposure to pain.
• Pg 474-475. Acute pain alerts a person to an
experience or condition that makes you take immediate
action to relieve it. Transient- lasts seconds to days and
up to 3 mnths.
• Chronic pain lasts more than 3-6 mnths and lasts way
beyond the expected healing time.
• Neuropathic pain is chronic pain initiated or caused by
primary lesion or dysfunction in the CNS and leads to
long term changes in pain pathway
10. Know endogenous opioids.
• Pg 472-473 Family of morphine-like neuropeptides that inhibit
transmission of pain impulses in the spinal cord, brain, and periphery.
Four types:
• 1. Enkephalins- most prevalent, concentrated in hypothalamus, the PAG
matter, the nucleus raphe magnus of the medulla, and dorsal horns of the
spinal cord.
• 2. Endorphins- (endogenous morphine) produced in brain, produce
greatest sense of exhilaration as well as natural pain relief
• 3. Dynorphins- most potent, impede pain signals in brain. Play role in
mood disorders and drug addiction and stimulate chronic pain.
• 4. Endomorphins- analgesic and anti-inflammatory effects
11. What are the two types of fibers that transmit the nerve action
potentials generated by excitation of any of the nociceptors. Pg 470
A delta and A beta fibers?
12. What is the relationship between epinephrine and body temperature?
, • Pg. 478 Epi causes vasoconstriction, stimulates glycolysis, and
increases metabolic rate thus increasing body heat.
13. Know mechanisms of heat production and heat loss.
• Pg. 478-479
• Mechanisms of Heat Production:
• 1) Chemical Reactions of Metabolism—these processes occur in the body core
(primarily the liver) and are in part responsible for the maintenance of core
temperature.The chemical reactions that occur during the ingestion and
metabolism of food and those requires to maintain the body at rest (basal
metabolism) require energy and produce heat.
• 2) Skeletal Muscle Contraction—Skeletal muscles produce heat through two
mechanisms: gradual increase in muscle tone and production of rapid muscle
oscillations-(shivering) - and shivering does not occur in neonates. Both
increased muscle tone and shivering are controlled by the posterior
hypothalamus and occur in response to cold. As perisperhal temp drops,
muscle tone increases and shivering begins.
• 3) Chemical Thermogenesis—results from the release of epinephrine and
norepinephrine that produce a rapid, transient increase in heat production by
raising the body's basal metabolic rate. Chemical thermogenesis produces a
quick, brief rise in BMR, whereas hormone thyroxine triggers a slow,
prolonged rise. Occurs in brown and beige adipose tissue that is rich with
mitochondria and blood vessels and is essential for non-shivering
thermogenesis. Beige (bright) adipocytes store energy, and boon and beige
adipocytes produce heat. Beige adipocytes demonstrate transdifferentiation to
white adipocytes. With chronic cold exposure white to beige conversion
increased thermogenesis
• Mechanims of Heat Loss:
• 1) Radiation—refers to heat loss through electromagnetic waves. These wave
emanate from surfaces with temperatures higher than the surrounding air
temperature. If the temperature of the skin is greater than the temp of the air,
the skin and therefore the body will lose heat to the air.
• 2) Conduction—refers to heat loss by direct molecule-to-molecule transfer
from one surface to another. Through conduction, the warmer surface loses
heat to the cooler surface. Thus the skin loses heat through direct contact with
the colder air, water or another surface. In the same manner the core fo the
body loses heat to the cooler body surface.
• 3) Convection—the transfer of heat through currents of gases or liquids. It aids
heat loss through conduction by exchanging warmer air at the surface of the
body with cooler air in the surrounding space. Convection occurs passively as
warmer air at the surface of the body rises away from the body and is replaced
by cooler air; but the process may be aided by fans or wind.
• .4) Vasodilation— peripheral vasodilation increases heat loss by diverting
core-warmed blood to the surface of the body. AS the core warmed blood
passes through the periphery, heat is transferred by conduction to the skin
surface and from the skin to the surrounding environment. Vasodilation occurs
in response to autonomic stimulation under the control of the hypothalamus.
As core temp increases, vasodilation increased until max dilation is achieved,
at this point the body must use additional heat loss mechanisms.
Study Guide
Physio-Patho Basis of Adv Nsg
University of South Alabama
This Study Guide contains:
✓ verified questions and Answers with Reference pg.
✓ key concepts
✓ advanced clinical reasoning.
✓ Designed to help nursing students master course
outcomes
✓ prepare for midterm or final exams with confidence.
,NU 545 Unit 2 Study Guide
Chapter 15 Structure and Function of the Neurologic System
1. Review the anatomy of the brain. Which portion is responsible for keeping
you awake, controlling thought, speech, emotions and behavior, maintaining
balance and posture? Pg 439 brain starts
• The prefrontal area is responsible for goal oriented behavior
(ability to concentrate), short-term or recall memory, and the
elaboration of thought and inhibition on the limbic (emotional)
areas of the CNS. Pg 441
• Primary motor area (Brodmann area 4) causes specific muscles
to move. Pg 442
• Broca area in the inferior frontal lobe is important for speech
and language processing.
• Wernicke area responsible for reception and interpretation of
speech. Pg 444
• Limbic system involved in behavioral responses, visceral
reactions to emotion, motivation, mood, feeding behaviors,
biologic rhythms, sense of smell. Pg 446.
• Cerebellum motor control and maintaining balance and posture.
Pg 447
2. Know the function of the arachnoid villi.
• Pg 451 Function as one way valves directing CSF outflow into the blood
but preventing blood flow into the subarachnoid space.
3. Where is the primary defect in Parkinson’s disease and Huntington’s?
• Pg. 447 The cerebellum. Also the dysfunction of dopaminergic neurons in
the substania nigra is associated with Parkinson.
• Parkinson Disease, where is the primary defect? (p.564) The main disease
feature is degeneration of the basal ganglia (corpus striatum, globus
pallidus, subthalmic nucleus, and substantia nigra) involving the
dopaminergic nigrostriatal pathway.
• Huntington Disease - where is the primary defect? (p.562) The principal
pathologic feature of HD is severe degeneration of the basal ganglia,
particularly the caudate and putamen nuclei and the frontal cerebral
cortex. The degeneration of the basal ganglia leaves enlarged lateral
ventricles.
4. What is the function of the CSF? Where is it produced? Where is it
absorbed?
• Pg 451 The choroid plexuses in the lateral, third, and fourth
ventricles produce the major portion of CSF. The CSF protects
the intracranial and spinal cord structures from jolts and blows.
It also prevents the brain from tugging on the meninges, nerve
roots, and blood vessels. It is absorbed into the venous
circulation.
5. Review blood flow to the brain.
• Pg 452-454. Internal carotid arteries supply a great amount of blood flow.
Originate at common carotid arteries at the base of the skull and pass
through cavernous sinus. Three major paired arteries perfuse the
cerebellum and brainstem: 1. Posterior inferior cerebellar artery. 2.
, Anterior inferior cerebellar artery. 3. Superior cerebellar arteries. Circle of
Willis alternative route to blood flow if one of the main arteries is
obstructed. (collateral blood flow)
Chapter 16 Pain, Temp regulation, Sleep, and Sensory Function
6. What is the gate control theory of pain?
• Pg. 469 Pain transmission is modulated by a balance of impulse conducted
to the spinal cord where cells in the substantia gelatinosa function as a
“gate.” The gate regulates pain transmissions to the CNS
7. Know the type of nerve fibers that transmit pain impulses.
• Pg 470. A delta fibers, Unmyelinated C fibers, a beta fibers.
8. Where in the CNS does pain perception occur?
• Pg. 470-471 primarily the reticular and limbic systems and the cerebral
cortex.
9. Know different clinical descriptions of pain (acute, chronic,
neuropathic); pain threshold/tolerance.
• Pg 473 Pain threshold is the point which a stimulus is
perceived as pain and it does not vary significantly
among people or in the same person over time. Pain
tolerance is the duration of time or the intensity of pain
that an individual will endure before initiating an overt
pain responses and is generally decreased with
increased exposure to pain.
• Pg 474-475. Acute pain alerts a person to an
experience or condition that makes you take immediate
action to relieve it. Transient- lasts seconds to days and
up to 3 mnths.
• Chronic pain lasts more than 3-6 mnths and lasts way
beyond the expected healing time.
• Neuropathic pain is chronic pain initiated or caused by
primary lesion or dysfunction in the CNS and leads to
long term changes in pain pathway
10. Know endogenous opioids.
• Pg 472-473 Family of morphine-like neuropeptides that inhibit
transmission of pain impulses in the spinal cord, brain, and periphery.
Four types:
• 1. Enkephalins- most prevalent, concentrated in hypothalamus, the PAG
matter, the nucleus raphe magnus of the medulla, and dorsal horns of the
spinal cord.
• 2. Endorphins- (endogenous morphine) produced in brain, produce
greatest sense of exhilaration as well as natural pain relief
• 3. Dynorphins- most potent, impede pain signals in brain. Play role in
mood disorders and drug addiction and stimulate chronic pain.
• 4. Endomorphins- analgesic and anti-inflammatory effects
11. What are the two types of fibers that transmit the nerve action
potentials generated by excitation of any of the nociceptors. Pg 470
A delta and A beta fibers?
12. What is the relationship between epinephrine and body temperature?
, • Pg. 478 Epi causes vasoconstriction, stimulates glycolysis, and
increases metabolic rate thus increasing body heat.
13. Know mechanisms of heat production and heat loss.
• Pg. 478-479
• Mechanisms of Heat Production:
• 1) Chemical Reactions of Metabolism—these processes occur in the body core
(primarily the liver) and are in part responsible for the maintenance of core
temperature.The chemical reactions that occur during the ingestion and
metabolism of food and those requires to maintain the body at rest (basal
metabolism) require energy and produce heat.
• 2) Skeletal Muscle Contraction—Skeletal muscles produce heat through two
mechanisms: gradual increase in muscle tone and production of rapid muscle
oscillations-(shivering) - and shivering does not occur in neonates. Both
increased muscle tone and shivering are controlled by the posterior
hypothalamus and occur in response to cold. As perisperhal temp drops,
muscle tone increases and shivering begins.
• 3) Chemical Thermogenesis—results from the release of epinephrine and
norepinephrine that produce a rapid, transient increase in heat production by
raising the body's basal metabolic rate. Chemical thermogenesis produces a
quick, brief rise in BMR, whereas hormone thyroxine triggers a slow,
prolonged rise. Occurs in brown and beige adipose tissue that is rich with
mitochondria and blood vessels and is essential for non-shivering
thermogenesis. Beige (bright) adipocytes store energy, and boon and beige
adipocytes produce heat. Beige adipocytes demonstrate transdifferentiation to
white adipocytes. With chronic cold exposure white to beige conversion
increased thermogenesis
• Mechanims of Heat Loss:
• 1) Radiation—refers to heat loss through electromagnetic waves. These wave
emanate from surfaces with temperatures higher than the surrounding air
temperature. If the temperature of the skin is greater than the temp of the air,
the skin and therefore the body will lose heat to the air.
• 2) Conduction—refers to heat loss by direct molecule-to-molecule transfer
from one surface to another. Through conduction, the warmer surface loses
heat to the cooler surface. Thus the skin loses heat through direct contact with
the colder air, water or another surface. In the same manner the core fo the
body loses heat to the cooler body surface.
• 3) Convection—the transfer of heat through currents of gases or liquids. It aids
heat loss through conduction by exchanging warmer air at the surface of the
body with cooler air in the surrounding space. Convection occurs passively as
warmer air at the surface of the body rises away from the body and is replaced
by cooler air; but the process may be aided by fans or wind.
• .4) Vasodilation— peripheral vasodilation increases heat loss by diverting
core-warmed blood to the surface of the body. AS the core warmed blood
passes through the periphery, heat is transferred by conduction to the skin
surface and from the skin to the surrounding environment. Vasodilation occurs
in response to autonomic stimulation under the control of the hypothalamus.
As core temp increases, vasodilation increased until max dilation is achieved,
at this point the body must use additional heat loss mechanisms.
