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APEA 3P EXAM Prep Neuro Questions with Correct
Answers and Explanations
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.
What recommendation should be made to an older adult who is diagnosed with mild dementia?
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 accident s 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
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 prevention. The patient is taking aspirin to prevent recurrent stroke. Research demonstrates that taking an aspirin daily can significantly reduce the risk of subsequent strokes and MI. Secondary prevention means that the intervention is performed to prevent another occurrence of the deleterious event. If she had never had a stroke but took aspirin daily for prevention of stroke, that would be primary
prevention. Taking aspirin at home during the course of having an MI is an example of tertiary prevention. There is no reference in the literature to quaternary prevention. An older adult patient with organic brain syndrome is at increased risk of abuse because she: lives in a nursing home. has multiple caregivers.
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.
A 68-year-old smoker with a history of well-controlled hypertension describes an event that occurred yesterday while mowing his lawn. He felt very dizzy and "passed out" for less than 1 minute. He awakened spontaneously. Today, he has no complaints and states that he feels fine. Initially, the NP should: perform a complete neurological and cardiac exam with auscultation of the carotid arteries. order a 12-lead ECG and carotid ultrasound, and perform a physical exam. order a CT of the brain, blood clotting studies, and cardiac enzymes. check blood pressure in three positions, order a 12-lead ECG, and schedule an exercise stress test. The event described is syncope. Syncope is a brief and sudden loss of consciousness that occurs with spontaneous recovery. This is a significant event but it is especially so in a smoker with hypertension. The assessment of this patient must start with an examination of the cardiac and neurological systems. Based on the findings and tentative diagnosis of syncope, coupled with the patient’s history of the event, other tests might be ordered to evaluate arrhythmias, stroke, transient ischemic attack, myocardial infarct, carotid stenosis, other vascular etiologies. A referral to specialty care is indicated after initial workup by the nurse practitioner. Which characteristic is true of tension headaches, but not of cluster headaches? Cluster headaches are always bilateral. Tension headaches are always bilateral. Cluster headaches always cause nausea. Tension headaches cause photosensitivity. Cluster headaches are always unilateral. The affected side produces a red, teary eye with nasal congestion on the affected side. Nausea and photosensitivity are common. Tension headaches are always bilateral with no nausea or photosensitivity associated with them. Which condition listed below does NOT impact an elder’s ability to eat?
Stroke Parkinson’s disease Dysphagia Hyperlipidemia
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, and glare during a headache cycle may prevent a subsequent headache from occurring. Cluster headaches are extremely painful headaches but are not as common as migraine or tension headaches. The headaches occur in cyclical patterns, hence the name “cluster.” The cycle lasts about 2-12 weeks. A single attack may last 30- 90 minutes, but it could last up to 3 hours. Scotoma refers to an area of diminished vision in the visual field. In patients who have cluster headaches, neuroimaging, like CT or MRI, typically demonstrates no abnormalities. Patients
own decisions. Her daughter requests a family conference with the nurse practitioner. Some important principles that need discussion currently, if not previously documented, are: bereavement support for the family, quality of life for the resident, and living will. health care proxy, living will, and hospice referral. withdrawing therapy, hospice referral, and managing symptoms. end of life decisions, quality of life, and advance directives. American Geriatrics Society stresses not only care of the patient but the care of the family as well. This includes meeting the current and future needs of the patient, family needs, and end-of-life issues with the living will. The living will is recognized as a valid advanced directive. Care includes developmental landmarks for the patient and family. A young male patient with a herniated disk reports bilateral sciatica and leg weakness. If he calls the NP with complaints of urinary incontinence, what should be suspected? Opioid overuse Medial or lateral herniation Rupture of the disc Cauda equina syndrome Cauda equina syndrome is a medical emergency. It is characterized by compression of the spinal cord. A common manifestation of this is bowel or bladder dysfunction. This may include incontinence or the inability to urinate or have a bowel movement. This patient needs immediate neurosurgical or orthopedic referral. The Snellen chart is used to assess: 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
