Question 1

A 78-year-old female presents with a seizure that occurred over the weekend.In selecting the most important diagnostics for this presentation,it is important to know that the least common site of seizures in the elderly is:

Accepted Answer

C

Question 2

The most common neurological cause of seizures in an older adult is:

Accepted Answer

Stroke is the most common neurological cause of seizures in older adults. This is because as people age, they are at a greater risk for strokes, which can damage the brain and lead to seizures. While conditions like Alzheimer's disease and multiple sclerosis can cause seizures, they are less common causes in older adults. Peripheral neuropathy is not a neurological cause of seizures.

Question 3

A middle-aged patient has been diagnosed with Parkinson's disease.What influences the nurse practitioner's decision to begin pharmacological treatment for this patient?

Accepted Answer

The nurse practitioner's decision to begin pharmacological treatment for a patient with Parkinson's disease is influenced by symptoms interfering with functional ability. This includes symptoms such as rigidity, bradykinesia, and tremors, which can greatly impact a patient's ability to perform activities of daily living. Treatment aims to improve these symptoms and maintain the patient's independence and quality of life. It is recommended to initiate medication only when symptoms significantly affect the patient's functional ability, rather than at the first sign of unilateral involvement. Gait instability requiring the use of a cane is another symptom that may indicate the need for pharmacological treatment. Intentional tremors are also a symptom of Parkinson's disease, but the decision to initiate treatment is not based solely on the presence of tremors.

Question 4

An older adult client with a history of a seizure disorder comes into the clinic for a routine check-up.Although seizure free,the client continues on long-term phenytoin treatment.The nurse practitioner would assess for which of the following long-term effects?

Accepted Answer

Long-term use of phenytoin has been associated with gingival hyperplasia, a condition where the gums become overgrown and potentially lead to periodontal disease. Additionally, nystagmus can occur as a side effect of phenytoin use. Lid lag and microcytic anemia are not typically associated with long-term phenytoin use. Iron deficiency anemia may occur if the medication affects the absorption of nutrients, but this is not a common side effect.

Question 5

A 78-year-old man with Parkinson's disease is being cared for in a nursing home.The nurses observe that he coughs at mealtime;he has the ability to still feed himself with adaptive equipment.He has had no aspirations.Oral exam is normal,except during his swallowing assessment you note there is slight delayed elicitation.You assess that he has only mild dysphagia.You recommend which of the following as the next step in his care?

Accepted Answer

Providing a trial of foods of differing consistency can help determine which textures are safest and easiest for him to swallow, potentially reducing the risk of aspiration.

Question 6

An older adult patient is being evaluated following a stroke,which affected the anterior cerebral circulatory system.Which of the following signs/symptoms would be positive in the assessment of this patient?

Accepted Answer

A stroke affecting the anterior cerebral circulation system would lead to disorders in behavior and cognition. This is because the anterior cerebral arteries supply blood to the frontal lobes of the brain, which play an important role in personality, behavior, and decision-making. The other options (A, B, and D) are associated with stroke affecting different areas of the brain, such as the posterior cerebral circulation system (A) for vision disturbance, dysarthria and speech difficulties (B) associated with the middle cerebral circulation system, and motor and sensory problems on both sides of the body (D) associated with stroke affecting the corticospinal tract, which runs through the posterior limb of the internal capsule.

Question 7

When assessing an elderly client who reports a tremor,which assessment findings would be most reliable in identifying Parkinson's disease?

Accepted Answer

Resting tremor, slow unsteady gait, and cogwheel resistance are all classic signs of Parkinson's disease. The other options are either too general (A) or include symptoms not specific to Parkinson's disease (B and D).

Question 8

The Mini-Cog is a short screening tool used to assess cognition.Which of the following statements pertaining to the test is a true statement?

Accepted Answer

The Mini-Cog test includes a three-item recall and a clock drawing test. A score of 0-2 is considered a positive screen for dementia, indicating possible cognitive impairment.

Question 9

An older adult female patient had a stroke.What symptoms are not usually expressed by patients who have had a vertebrobasilar stroke?

Accepted Answer

Monocular blindness is not usually expressed in patients with a vertebrobasilar stroke, as this type of stroke affects the posterior part of the brain, which is not usually involved in vision processing. Vertigo, ataxia, and dysarthria are common symptoms of a vertebrobasilar stroke.

Question 10

An older male presents with incontinence,has a wide-based and irregular gait,and progressive dementia.Which of the following presents with these cardinal signs?

Accepted Answer

The combination of incontinence, a wide-based and irregular gait, and progressive dementia is classic for normal pressure hydrocephalus. Parkinson's disease typically presents with tremors and rigidity, while a basilar artery CVA would present with a sudden onset of symptoms. Progressive supranuclear palsy typically presents with early falls, vertical supranuclear gaze palsy and prominent axial rigidity.

Question 11

You are evaluating an elderly patient's complaint of a new onset of "hand shaking" when he drinks from a cup.The patient is euthyroid and does not drink alcohol.Which of the following signs indicate that this tremor is most likely an essential tremor rather than a Parkinson's tremor?

Accepted Answer

Essential tremors are usually mild to moderate in amplitude and occur only with movement/activity, while Parkinson's tremors are typically "pill rolling" in nature and occur at rest. Slowed movements and dyskinesia are more commonly associated with Parkinson's disease, and the patient being euthyroid and not drinking alcohol cannot reliably indicate one condition over another.

Question 12

An older male patient is experiencing acute onset of right-sided weakness,slurred speech,and confusion.What should the nurse practitioner do promptly?

Accepted Answer

Acute onset of right-sided weakness, slurred speech, and confusion are classic signs of a stroke, and prompt evaluation and transport to the hospital can potentially minimize the damage caused by the stroke. Administering aspirin by mouth, doing a thorough medication review, ordering an EKG, or administering O₂ by cannula would not be the priority in this situation.

Question 13

Which of the following assessments are commonly noted in a client with Parkinson's disease?

Accepted Answer

Micrographia (small handwriting) and bradykinesia (slowness of movement) are commonly noted in clients with Parkinson's disease. Macrographia refers to abnormally large handwriting and is not typical in Parkinson's disease. Exaggeration of rapid successive movements is seen in hyperkinetic disorders such as chorea or athetosis, which are not typically associated with Parkinson's disease. Increased arm swing is also not typically seen in Parkinson's disease and may actually decrease as the disease progresses.

Question 14

When assessing a patient who complains of a tremor,the nurse practitioner must differentiate essential tremor from the tremor of Parkinson's disease.Which of the following findings are consistent with essential tremor?

Accepted Answer

Essential tremor typically occurs with purposeful movements, such as writing or eating, and often improves with alcohol ingestion, unlike Parkinson's tremor, which occurs at rest.

Question 15

Which of the following assessment findings is commonly noted in a client with advanced Parkinson's disease?

Accepted Answer

Micrographia, or small, cramped handwriting, is a common manifestation of advanced Parkinson's disease due to the rigidity and bradykinesia (slowed movement) of the fingers and hands. Macrographia, or large handwriting, is not typically seen in Parkinson's disease. Ataxic gait, or an unsteady, wobbly walk, is more commonly associated with cerebellar disorders. Increased arm swing is not typically seen in advanced Parkinson's disease due to the increased rigidity of the limbs.

Question 16

An elderly patient has had a CVA in the anterior cerebral circulatory system (frontal lobe).What symptoms are most likely expressed?

Accepted Answer

CVA in the anterior cerebral circulatory system (frontal lobe) is commonly associated with disorders of behavior and cognition such as personality changes, apathy, decreased inhibition, and difficulty with planning and problem-solving. Neglect of body and difficulty organizing space is more commonly associated with lesions in the parietal lobe, while Wernicke's aphasia is associated with lesions in the temporal lobe. Bilateral motor and sensory problems are more commonly associated with lesions in the brainstem or spinal cord.

Question 17

Mr.Andrews experienced a brief onset of right-sided weakness,slurred speech,and confusion yesterday.The symptoms have resolved.What should the nurse practitioner do?

Accepted Answer

The symptoms described are suggestive of a transient ischemic attack (TIA), which is a warning sign for potential future strokes. Identifying and managing modifiable cardiovascular risk factors can help prevent future occurrences.

Question 18

In review of a nursing home patient's chart,the nurse practitioner discovers that the neurology consult identified that the client has a homonymous hemianopsia.Which of the following statements accurately describes these findings?

Accepted Answer

Homonymous hemianopsia is a type of visual field deficit in which there is loss of vision in either the right or left halves of the visual fields. It occurs as a result of a cerebral lesion affecting the area that processes visual information from both eyes on the same side of the brain.

Question 19

An elderly nursing home resident is maintained on phenytoin therapy for a history of a seizure disorder.In addition to periodic serum drug concentrations,which of the following are needed for annual evaluation?

Accepted Answer

The answer of An elderly nursing home resident is maintained...

Quiz 13: Central and Peripheral Nervous System Disorders