APEA_3P_EXAM_Prep_Neuro Exam Questions with Verified Answers,100% CORRECT, Exams of Nursing

Download APEA_3P_EXAM_Prep_Neuro Exam Questions with Verified Answers,100% CORRECT and more Exams Nursing in PDF only on Docsity! APEA 3P EXAM Prep Neuro Questions With Answers and Explanation A patient who is 82 years old is brought into the clinic. His wife states that he was working in his garden today and became disoriented and had slurred speech. She helped him back into the house, gave him cool fluids, and within 15 minutes his symptoms resolved. He appears in his usual state of health when he is examined. He states that although he was scared by the event, he feels fine now. How should the nurse practitioner proceed? Prescribe an aspirin daily. Re-examine him tomorrow. Send him to the emergency department. Order an EKG. This patient likely suffered a transient ischemic attack. He needs urgent evaluation with head CT and/or MRI, ECG, lab work (CBC, PTT, lytes, creatinine, glucose, lipids and sedimentation rate); possible magnetic resonance angiography, carotid ultrasound, and/or transcranial Doppler ultrasonography. He is at increased risk of stroke within the first 48 hours after an event like this one. On initial evaluation, the most important determination to be made is whether the etiology of the stroke or TIA is ischemic or hemorrhagic. After this determination, treatment can begin. Unfortunately, this determination cannot be made in the clinic. The patient needs urgent referral to a center where this evaluation and possible treatment can be performed. The most common presenting sign of Parkinson’s disease is: muscular rigidity. tremor. falling. bradykinesia . Driving will probably not increase your risk of an accident. The healthcare provider should recommend that the patient stop driving today. The healthcare provider should recommend assessment of driving to determine risk of an accident. The patient may continue to drive as long as he feels comfortable. Dementia independently increases the risk of motor vehicle accidents if the patient drives. The healthcare provider should discuss this with the patient and a family member if a family member is present during the older adult’s evaluation. Depending on the degree of impairment, the healthcare provider could recommend stopping driving, or recommend that an assessment be done. The assessment is usually completed by either an occupational or physical therapist or someone trained to assess this. A person with 20/60 vision: is legally blind. will have difficulty reading a newspaper. will be unable to see the big “E” on the eye chart. has better vision than someone with 20/80 vision. Using the Snellen nomenclature for describing visual acuity (example 20/80), the first number represents the test distance. In most cases this is 20 feet. The second number represents the distance at which the average eye can see the letters on a specific line of the chart. In other words, the examinee can see at 20 feet what an average eye (20/20) can see at 80 feet. 20/80 is a measure of distant vision, not near vision such as reading a newspaper. The big “E” represents 20/200 vision. 20/200 is considered legally blind by most standards. A patient reports a history of transient ischemic attack (TIA) 6 months ago. His daily medications are lisinopril, pravastatin, and metformin. After advising him to quit smoking, what intervention is most important in helping to prevent stroke in him? Auscultation of carotid arteries at each visit Taking low dose aspirin daily Assessing hemoglobin A1C every 3-6 months Encouraging smoking cessation at each visit Antiplatelet therapy, usually aspirin, inhibits the enzyme cyclooxygenase and reduces thromboxane A2 production, which stimulates platelet aggregation. Thus, risk of ischemic stroke is reduced. The dosage of aspirin needed to prevent an event is debatable. Most studies found that 75-150 mg daily was as effective in preventing stroke as was higher doses. Lower doses of aspirin are associated with less GI toxicity and fewer side effects. A 75-year-old is diagnosed with essential tremor. What is the most commonly used medication to treat this? Carbidopa Long-acting propanolol Phenobarbital Gabapentin Tremor is the most common of all movement disorders and essential tremor is the most common cause of all tremors. It is characterized by rhythmic movement of a body part, commonly the hands or head. Beta blockers are the most commonly used medication class to treat essential tremor. Propanolol is the most commonly used medication, but other beta blocking agents are used as well. Both gabapentin and phenobarbital are used, but, not nearly as often. Carbidopa is used in patients with Parkinson’s disease. A patient who had an embolic stroke has recovered and is performing all of her activities of daily living. Taking aspirin for stroke prevention is an example of: primary prevention. secondary prevention. tertiary prevention. quaternary ankylosing spondylitis. disk disease. systemic illness. Systemic illness, like cancer or infection, is a serious consideration when patients report no relief of pain with position change. Additionally, this patient is female, older, and has had pain longer than 4 weeks. These are three risk factors for systemic cause of low back pain. Sciatica presents with pain that radiates down the leg. Ankylosing spondylitis is typical in males in their 40s and produces pain at nighttime that is improved with being upright. Disk disease is a consideration, but, an absence of relief with lying down is unusual. A patient complains of severe right-sided facial pain. She states that her symptoms have worsened over the past 48 hours. Which diagnosis below is NOT part of the differential diagnosis? Bell’s palsy Trigeminal neuralgia Tooth abscess Shingles Bell’s palsy does not produce pain. It usually produces symptoms over several hours. Common symptoms include sagging eyebrow, an impaired eye blink or the inability to blink the eye on the affected side, and mouth drawn up on the affected side. The facial nerve, Cranial Nerve VII, is affected in patients who present with Bell’s palsy. Trigeminal neuralgia (TN) is a common cause of facial pain characterized by paroxysmal electric shock like pains. TN involves the Cranial Nerve V (trigeminal nerve). A patient has developed loss of hearing over the past several weeks. His otoscopic exam is normal. What cranial nerve should be assessed? Cranial Nerve III Cranial Nerve V Cranial Nerve VIII Cranial Nerve X Cranial Nerve (CN) VIII is the CN responsible for hearing. When assessing CN VIII, each ear should be assessed individually. The Weber and Rinne tests can be used to distinguish between conductive and sensorineural hearing loss. Many, many diseases impact an elder patient’s ability to eat. About 50% of patients who have had stroke have impaired ability to eat. This can include difficulty feeding self as well as difficulty swallowing. Parkinson’s disease and many other neurological diseases have great impact on eating, since coordinated muscle movement is needed for swallowing and feeding. Hyperlipidemia has no significant impact on a patient’s ability to eat. Mr. Williams has moderate cognitive deficits attributed to Alzheimer’s disease and has been started on a cholinesterase inhibitor. The purpose of this drug is to: decrease agitation. increase anticholinergic stimulation of the brain. improve depression. slow progression of his cognitive deficits. This drug is a cholinesterase inhibitor. It will cause more acetylcholine to be available to neurons. Many patients show a slowing of cognitive decline when these medications are used for at least 1 year. A small percentage of patients, 10-25%, show significant improvement in symptoms. An anticholinergic medication would be contraindicated in these patients. There is no direct benefit on agitation or depression in patients who take this class of medications. A neurologic disease that produces demyelination of the nerve cells in the brain and spinal cord is: Parkinson’s disease. late stage Lyme disease. multiple sclerosis. amyotrophic lateral sclerosis. Multiple sclerosis (MS) is a disease of the central nervous system characterized by demyelination of the nerve cells. This produces varied neurological symptoms and deficits. This disease is typical in women between the ages of 16 and 40 years. It is rarely diagnosed after age 50 years. MS can be diagnosed in an adult who has one or more clinically distinct episodes of CNS dysfunction followed by at least partial remission. An older adult patient is at increased risk of stroke and takes an aspirin daily. Aspirin use in this patient is an example of: primary prevention. secondary prevention. tertiary prevention. primary or secondary prevention. Primary prevention refers to an action that has the potential to prevent an event prior to its occurrence. Secondary prevention refers to an intervention demonstrated to help prevent a second occurrence of a deleterious event or may refer to an intervention designed for early detection. Tertiary prevention is an action designed to prevent additional deleterious events from occurring. Mini mental status exam helps to identify patients who have symptoms of: cognitive impairment. depression. behavioral changes. stroke. The mini mental status exam (MMSE) is the most widely used screening tool in primary care to evaluate cognitive impairment. The exam helps healthcare providers evaluate six areas: orientation, short-term memory- retention/recall, language, attention, calculation, and constructional praxis. It does not diagnose Alzheimer’s disease but is used to assess cognition as described above. A patient diagnosed with cluster headaches: usually has scotomas. can be diagnosed with an imaging study. should eliminate triggers like nicotine and alcohol. may exhibit nuchal rigidity. Lifestyle measures like avoiding alcohol, nicotine, and high altitudes may help prevent cluster headaches. Avoiding afternoon naps, bright lights, near vision. distant vision. color vision. peripheral vision. The Snellen eye chart was named after Dr. Hermann Snellen. The Snellen fractions, 20/20, 20/30, etc. are measures of sharpness of distant vision. Actually, 20/20 is not normal vision; it is a reference standard. Average acuity in a population is 20/15 or 20/10 (hence the reason there are two lines beneath the 20/20 vision line). When visual acuity is assessed, each eye is covered and assessed independently; this is termed monocular. The Mini-Cog is helpful in screening patients who have suspected: delirium. dementia. Parkinson’s disease stroke. The Mini-Cog is a screening tool for dementia. It is performed by telling the patient the names of three unrelated but familiar items. The patient is distracted by being asked to draw the face of a clock, and to indicate two specific times by drawing the hands on the clock. Then, the patient is asked to repeat the names of the three objects. Scores are received for correct naming of the items and clock drawings. Which of the following would NOT be part of the differential diagnosis for an 84- year-old patient with dementia symptoms? Tumor Cerebral hemorrhage Cerebral infarct Normal aging process Changes in cognition are not associated with the aging process, though 50% of adults over age 90 have some form of dementia. All patients should have some type of imaging to rule out tumor, infection, hemorrhage, infarct, etc. Experts have not agreed on which neuroimaging studies are most valuable. A patient is diagnosed with carpal tunnel syndrome. Which finger is not affected by carpal tunnel syndrome? Thumb Second finger Fourth finger Fifth finger Carpal tunnel syndrome is an entrapment neuropathy of the median nerve at the wrist due to inflammation of the wrist tendons, transverse carpal ligament, and/or surrounding soft tissue. Compression of the median nerve produces paresthesias in of the forehead. Early treatment with oral steroids like prednisone (60 mg/d and tapered over 10 days) should be started within 72 hours of the onset of symptoms. This has been found to decrease the risk of permanent facial paralysis. Oral antiviral agents may be of benefit because of the likely possibility of Bell’s palsy occurring secondary to infection with the herpes simplex virus. A patient is examined and found to have a positive Kernig's and Brudzinski's signs. What is the most likely diagnosis? Hepatitis Encephalitis Meningitis Pneumoniti s The findings of positive Kernig’s and Brudzinski’s signs are highly suggestive of meningitis. Kernig’s sign is elicited by leg extension, then observing for neck pain and flexion. Brudzinski’s sign is elicited by passively flexing the neck and observing for flexion of the legs. The "get up and go" test in an older adult patient is used to evaluate: risk for falls. lower extremity strength. mental acuity. driving safety. The “get up and go” test is used to evaluate musculoskeletal function. The patient is asked to rise from a seated position in an armchair, walk across the room, turn around, and return to the chair. This test evaluates the patient’s gait, balance, leg strength, and vestibular function. It should be assessed in patients who report a fall or who present after a fall but who appear without injury. Sumatriptan (Imitrex) is a medication used to abort migraine headaches. It may also be used to treat: tension headaches. cluster headaches. serotonin abnormalities. depression. Sumatriptan is a member of the medication class used to abort migraine headaches. Sumatriptan is also used to treat patients who experience cluster headaches. Relief is usually realized in about 10 minutes or less after using sumatriptan. The triptans are not helpful for patients with tension headaches. Migraine prophylactic agents may be helpful in patients who have serotonin abnormalities or depression. A 70-year-old male who is diabetic presents with gait difficulty, cognitive disturbance, and urinary incontinence. What is part of the nurse practitioner’s differential diagnosis? Diabetic neuropathy Normal pressure hydrocephalus Parkinson’s Disease Multiple sclerosis The classic triad of normal pressure hydrocephalus is described above. Diabetic neuropathy would not be typical because this involves three different areas of complaint. Parkinson’s disease presents with tremor, gait disturbance, and bradykinesia. Multiple sclerosis almost never presents beyond the age of 50 years and would be even less likely presentation in a 70-year-old. The incidence of normal pressure hydrocephalus varies from 2-20 million people per year. It is more common in elderly patients and affects both genders equally. This is diagnosed by the presence of enlarged ventricles on CT scan. An older adult patient has an audible carotid bruit. He has a history of Rapidly increasing intensity of headache Fully reversible speech disturbance Fully reversible speech disturbance in conjunction with migraine-type symptoms likely represents a typical aura. Nausea and photophobia are typical of migraine headaches. A normal neurological exam in conjunction with typical migraine symptoms, even on the first occurrence, does not compel the examiner to order an imaging study. A headache with rapidly increasing intensity, a history of lack of coordination, localized neurologic symptoms, or a headache that awakens the patient from sleep all increase the likelihood that a neurologic abnormality exists. Any of these findings should compel the examiner to order an imaging study. The study most likely to be ordered is a CT scan or MRI with and without contrast. However, an MRA may be ordered depending on the suspected underlying abnormality. A 70-year-old male patient is diagnosed with vertigo. Which choice below indicates that the vertigo is more likely to be of central etiology? Brief duration Nystagmus present Nausea and vomiting Persistent symptoms Central etiologies involve the brainstem or cerebellum; peripheral etiologies typically involve the vestibular system. Vertigo in a patient is a common complaint and can be due to multiple etiologies. Hyperventilation can produce dizziness. In an older adult, the etiology is more likely from multiple factors: taking 5 or more medications, orthostatic hypotension. Tinnitus (ringing in the ears) and hearing loss typically indicate a peripheral etiology. An audible carotid bruit would steer the healthcare provider to explore carotid stenosis and underlying cardiovascular disease. A 60-year-old patient has anosmia. Which cranial nerve must be assessed? I I I V X Anosmia refers to the inability to smell. Cranial nerve I is the olfactory nerve and is not usually tested. However, cranial nerve I lesions do occur. Anosmia would be a clinical manifestation of this. If CN I is assessed, the examiner uses a familiar smell like coffee or peppermint and asks the examinee to identify the smell. The inability to do this with a familiar smell is termed anosmia. A typical description of sciatica is: Beta-blockers Calcium channel blockers Triptans Tricyclic antidepressants The class of medications known as triptans, which includes sumatriptan, is used as abortive agents, not for prophylaxis. The other classes mentioned can be used for prophylaxis. Other prophylactic agents commonly used include lithium, SSRIs, anticonvulsants, and fever. The most common polyneuropathy in older adults is associated with: Charcot-Marie-Tooth disease. diabetes mellitus. urinary incontinence. Guillain-Barre syndrome. A polyneuropathy is a term that refers to a process that affects multiple nerves, usually peripheral. The distal nerves are more commonly affected. Symptoms described by patients are burning, weakness, or loss of sensation. Charcot-Marie- Tooth disease is a rare, hereditary primary motor sensory neuropathy. Guillain-Barre is an acute autoimmune neuropathy that is primarily demyelinating. Urinary incontinence does not represent a common polyneuropathy in older adults. Which symptom below is true of cluster headaches but not migraine headaches? It is more common in females. The length of the headache duration is about 30-90 minutes. The most common characteristic is family history. Sunlight is a common trigger. The typical cluster headache lasts less than 3 hours; usually less than 90 minutes. Migraine headaches usually last 4-72 hours, and are more common in females. Cluster headaches are more common in males and can be triggered by alcohol or nicotine intake. Migraines may be triggered by diet, skipping meals, sunlight, red wine, aged cheeses, or menses. Family history is a common finding in patients who have migraine headaches. Which headache listed below is more likely to be triggered by food? Cluster Migrai ne Tensio n Vascul ar Migraine headaches are more likely to be triggered by food than tension headaches or others. Common food triggers are alcohol, chocolate, aged cheeses, nuts, nitrates, nitrites, and caffeine. Restless legs syndrome is part of the differential diagnosis for Mr. Wheaton. What should be part of the laboratory workup? BUN/Cr Serum ferritin ALT/AST Urinalysis Restless legs syndrome (RLS) is the unrelenting urge to move the legs. This rarely affects the upper extremities. The symptoms are relieved by movement of the affected limbs and only occur if the affected limbs are at rest. Iron deficiency has been considered as a cause of RLS. The exact indicates: intention tremor. alcohol withdrawal. Parkinson’s disease. benign essential tremor. Parkinson’s disease is an idiopathic neurodegenerative movement disorder characterized by 4 prominent features: bradykinesia, muscular rigidity, resting tremor, and postural instability. The "pill-rolling" tremor is the presenting sign in 50- 80% of patients with Parkinson’s disease. Approximately 30% of patients do not present with tremors of any type. A 62-year-old female patient presents to the clinic with very recent onset of intermittent but severe facial pain over the right cheek. She is diagnosed with trigeminal neuralgia. What assessment finding is typical of this? Pain is much worse with sticking her tongue out Pain is better with light touch over the affected area Pain is relieved with NSAIDs Pain may be triggered with light touch of the right cheek Trigeminal neuralgia is a common cause of severe facial pain. It is described by patients as electric or shocking pain. Triggers for pain are light touch to the affected area, chewing, cool breeze on the cheek, and smiling or grimacing. It is more common in older adults. In a patient with end-of-life physical pain, constipation commonly occurs. What is the most common cause of this? Decreased activity Decreased fluids Opioid use General slowing of body processes Opioids can cause severe constipation. At end of life, this can be a significant cause of discomfort for the patient. Measures for relief of constipation should be instituted. A 26-year-old HIV-positive patient presents with photophobia and temperature of 103.2° F. He complains of a headache. On exam, he is unable to demonstrate full extension of the knee when his hip is flexed. Which choice below is the most likely diagnosis? Pneumocystis infection Meningitis Septic bursitis Septic arthritis The inability to demonstrate full extension of the knee when the hip is flexed is a positive Brudzinski's sign. This is present in patients who have meningitis. It is not present in patients who have septic bursitis or septic arthritis. HIV-positive patients are more likely to exhibit pneumonia secondary to pneumocystis infection, but he has no respiratory symptoms. accompany Bell’s palsy. Alcohol intoxication might be considered, but a stroke must be ruled out. When headache accompanies stroke, it is often hemorrhagic stroke, but ischemic stroke can cause headache too. 60- Mrs. Jopson is unable to name a familiar object. How is this described? Anomia Anosmia Acanthosis Incompeten t Anomia is difficulty in the naming of familiar objects. This is an example of mild impairment. Other evidence of mild impairment is recent recall problems, decreased insight, and difficulty managing finances. Many mildly impaired adults are not able to state today’s date. All the following characteristics may be found in an older adult with dementia. Which one is common in a patient with Alzheimer’s disease, but uncommon in a patient with another type of dementia? Visual hallucinations Personality change Abrupt onset Indifference The most common characteristics in a patient with Alzheimer’s disease (AD) are memory impairment, visual-spatial disturbances, indifference, occasional delusions, and agitation. Personality change can be seen in patients with fronto-temporal dementia. Abrupt onset can be seen in patients with delirium and vascular dementia. Visual hallucinations can be seen in patients with Lewy-body dementia. A family member of a newly diagnosed Alzheimer’s disease patient asks how long the patient should take donepezil (Aricept), an acetylcholinesterase inhibitor, before learning whether it is beneficial or not. You reply: 4 - 8 weeks. about 12 weeks. 6 - 12 months. at least 1 year. The ideal time to evaluate the efficacy of an acetylcholinesterase inhibitor (Ach-I) is 6-12 months of continuous use. The evaluation should include caregiver feedback, repeat mental status assessments, ability to perform activities of daily living, healthcare provider’s assessment, side effects, and cost. If the Ach-I is stopped, it can be restarted at a later date.