Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the
Neuromuscular Junction
MULTIPLE CHOICE
1. Diffuse axonal injuries (DAIs) of the brain often result in:
a. Reduced levels of consciousness c. Fine motor tremors
b. Mild but permanent dysfunction d. Visual disturbances
ANS: A
Focal brain injuries account for more than two-thirds of head injury deaths; DAIs accounts for
less than one third. However, more severely disabled survivors, including those in an unre-
sponsive state or reduced level of consciousness, have DAIs. The other options do not appro-
priately complete the stem.
PTS: 1 REF: Page 582
2. What event is most likely to occur to the brain in a classic cerebral concussion?
a. Brief period of vital sign instability
b. Cerebral edema throughout the cerebral cortex
c. Cerebral edema throughout the diencephalon
d. Disruption of axons extending from the diencephalon and brainstem
ANS: A
Transient cessation of respiration can occur with brief periods of bradycardia, and a decrease
in blood pressure occurs, lasting 30 seconds or less. Vital signs stabilize within a few seconds
to within normal limits. The other options do not accurately describe an event associated with
a classic cerebral concussion.
PTS: 1 REF: Page 588
3. Which disorder has clinical manifestations that include decreased consciousness for up to 6
hours, as well as retrograde and posttraumatic amnesia?
a. Mild concussion c. Cortical contusion
b. Classic concussion d. Acute subdural hematoma
ANS: B
Evidence of a classic concussion is the immediate loss of consciousness, which lasts less than
6 hours. Retrograde and anterograde (posttraumatic) amnesia is also present. The other op-
tions do not apply.
PTS: 1 REF: Page 588
4. What group is most at risk of spinal cord injury from minor trauma?
a. Children c. Adults
b. Adolescents d. Older adults
ANS: D
Because of preexisting degenerative vertebral disorders, older adults are particularly at risk for
minor trauma, resulting in serious spinal cord injury, especially from falls. The risk to the
other age groups is less than that of the older adult.
, PTS: 1 REF: Page 634
5. The edema of the upper cervical cord after spinal cord injury is considered life threatening be-
cause of which possible outcome?
a. Hypovolemic shock from blood lost during the injury
b. Breathing difficulties from an impairment to the diaphragm
c. Head injury that likely occurred during the injury
d. Spinal shock immediately after the injury
ANS: B
In the cervical region, spinal cord swelling may be life threatening because of the possibility
of resulting impairment of the diaphragm function (phrenic nerves exit C3-C5). The other op-
tions do not appropriately explain the threat.
PTS: 1 REF: Page 591
6. What indicates that spinal shock is terminating?
a. Voluntary movement below the level of injury
b. Reflex emptying of the bladder
c. Paresthesia below the level of injury
d. Decreased deep tendon reflexes and flaccid paralysis
ANS: B
Indications that spinal shock is terminating include the reappearance of reflex activity, hyper-
reflexia, spasticity, and reflex emptying of the bladder. Termination of a spinal cord injury is
not evidenced by any of the other options.
PTS: 1 REF: Page 592
7. What term is used to describe the complication that can result from a spinal cord injury above
T6 that is producing paroxysmal hypertension, as well as piloerection and sweating above the
spinal cord lesion?
a. Craniosacral dysreflexia c. Autonomic hyperreflexia
b. Parasympathetic dysreflexia d. Retrograde hyperreflexia
ANS: C
Individuals most likely to be affected have lesions at the T6 level or above. Paroxysmal hyper-
tension (up to 300 mm Hg systolic), a pounding headache, blurred vision, sweating above the
level of the lesion with flushing of the skin, nasal congestion, nausea, piloerection caused by
pilomotor spasm, and bradycardia (30 to 40 beats/minute) characterize autonomic hyper-
reflexia. No other options appropriately describe this complication.
PTS: 1 REF: Pages 593-594
8. Why does a person who has a spinal cord injury experience faulty control of sweating?
a. The hypothalamus is unable to regulate body heat as a result of damage to the sym-
pathetic nervous system.
b. The thalamus is unable to regulate body heat as a result of damage to the sympa-
thetic nervous system.
c. The hypothalamus is unable to regulate body heat as a result of damage to the
parasympathetic nervous system.
Neuromuscular Junction
MULTIPLE CHOICE
1. Diffuse axonal injuries (DAIs) of the brain often result in:
a. Reduced levels of consciousness c. Fine motor tremors
b. Mild but permanent dysfunction d. Visual disturbances
ANS: A
Focal brain injuries account for more than two-thirds of head injury deaths; DAIs accounts for
less than one third. However, more severely disabled survivors, including those in an unre-
sponsive state or reduced level of consciousness, have DAIs. The other options do not appro-
priately complete the stem.
PTS: 1 REF: Page 582
2. What event is most likely to occur to the brain in a classic cerebral concussion?
a. Brief period of vital sign instability
b. Cerebral edema throughout the cerebral cortex
c. Cerebral edema throughout the diencephalon
d. Disruption of axons extending from the diencephalon and brainstem
ANS: A
Transient cessation of respiration can occur with brief periods of bradycardia, and a decrease
in blood pressure occurs, lasting 30 seconds or less. Vital signs stabilize within a few seconds
to within normal limits. The other options do not accurately describe an event associated with
a classic cerebral concussion.
PTS: 1 REF: Page 588
3. Which disorder has clinical manifestations that include decreased consciousness for up to 6
hours, as well as retrograde and posttraumatic amnesia?
a. Mild concussion c. Cortical contusion
b. Classic concussion d. Acute subdural hematoma
ANS: B
Evidence of a classic concussion is the immediate loss of consciousness, which lasts less than
6 hours. Retrograde and anterograde (posttraumatic) amnesia is also present. The other op-
tions do not apply.
PTS: 1 REF: Page 588
4. What group is most at risk of spinal cord injury from minor trauma?
a. Children c. Adults
b. Adolescents d. Older adults
ANS: D
Because of preexisting degenerative vertebral disorders, older adults are particularly at risk for
minor trauma, resulting in serious spinal cord injury, especially from falls. The risk to the
other age groups is less than that of the older adult.
, PTS: 1 REF: Page 634
5. The edema of the upper cervical cord after spinal cord injury is considered life threatening be-
cause of which possible outcome?
a. Hypovolemic shock from blood lost during the injury
b. Breathing difficulties from an impairment to the diaphragm
c. Head injury that likely occurred during the injury
d. Spinal shock immediately after the injury
ANS: B
In the cervical region, spinal cord swelling may be life threatening because of the possibility
of resulting impairment of the diaphragm function (phrenic nerves exit C3-C5). The other op-
tions do not appropriately explain the threat.
PTS: 1 REF: Page 591
6. What indicates that spinal shock is terminating?
a. Voluntary movement below the level of injury
b. Reflex emptying of the bladder
c. Paresthesia below the level of injury
d. Decreased deep tendon reflexes and flaccid paralysis
ANS: B
Indications that spinal shock is terminating include the reappearance of reflex activity, hyper-
reflexia, spasticity, and reflex emptying of the bladder. Termination of a spinal cord injury is
not evidenced by any of the other options.
PTS: 1 REF: Page 592
7. What term is used to describe the complication that can result from a spinal cord injury above
T6 that is producing paroxysmal hypertension, as well as piloerection and sweating above the
spinal cord lesion?
a. Craniosacral dysreflexia c. Autonomic hyperreflexia
b. Parasympathetic dysreflexia d. Retrograde hyperreflexia
ANS: C
Individuals most likely to be affected have lesions at the T6 level or above. Paroxysmal hyper-
tension (up to 300 mm Hg systolic), a pounding headache, blurred vision, sweating above the
level of the lesion with flushing of the skin, nasal congestion, nausea, piloerection caused by
pilomotor spasm, and bradycardia (30 to 40 beats/minute) characterize autonomic hyper-
reflexia. No other options appropriately describe this complication.
PTS: 1 REF: Pages 593-594
8. Why does a person who has a spinal cord injury experience faulty control of sweating?
a. The hypothalamus is unable to regulate body heat as a result of damage to the sym-
pathetic nervous system.
b. The thalamus is unable to regulate body heat as a result of damage to the sympa-
thetic nervous system.
c. The hypothalamus is unable to regulate body heat as a result of damage to the
parasympathetic nervous system.
