Chapter 13 KM CENTRAL AND PERIPHERAL NERVOUS SYSTEM DISORDERS Flashcards
____ 1. 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?
A.
Bilateral vision disturbance and/or diplopia
B.
Dysarthria and speech difficulties
C.
Disorders in behavior and in cognition
D.
Motor and sensory problems on both sides of the body
C.
Disorders in behavior and in cognition
____ 2. 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?
A.
The handwriting is not affected by the tremor
B.
The tremor occurs with purposeful movements
C.
The tremor occurs at rest
D.
The tremor gets worse with alcohol ingestion
B.
The tremor occurs with purposeful movements
3. Which of the following assessments are commonly noted in a client with Parkinson’s disease? A. Macrographia and bradycardia B. Micrographia and bradykinesia C. Exaggeration of rapid successive movements D. Increased arm swing
B.
Micrographia and bradykinesia
____
\_\_\_\_ 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? A. Lid lag and nystagmus B. Gingival hyperplasia and nystagmus C. Nystagmus and microcytic anemia D. Gingival hyperplasia and iron deficiency anemia
B.
Gingival hyperplasia and nystagmus
- 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?
A.
Complete blood count, liver function tests, and renal function tests
B.
Complete blood count, liver function tests, and platelet count
C.
Renal function and calculated creatinine clearance
D.
Serum albumin, liver function tests, and renal function tests
B.
Complete blood count, liver function tests, and platelet count
6. 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: A. Cerebellum B. Frontal lobe C. Temporal lobe D. Parietal lobe
C. Temporal Lobe
- An elderly patient has had a CVA in the anterior cerebral circulatory system (frontal lobe). What symptoms are most likely expressed?
A.
Neglect of body and difficulty organizing space
B.
Wernicke’s aphasia (difficulty understanding speech)
C.
Disorders of behavior and cognition
D.
Bilateral motor and sensory problem
C.
Disorders of behavior and cognition
8. The most common neurological cause of seizures in an older adult is: A. Alzheimer’s disease B. Multiple sclerosis C. Stroke D. Peripheral neuropathy
C. Stroke
- 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?
A.
It is characteristic of “pill rolling” and occurs at rest
B.
It is a moderate amplitude tremor that occurs only with movement/activity
C.
The tremor is also associated with slowed movements
D.
The tremor is accompanied by dyskinesia
. B.
It is a moderate amplitude tremor that occurs only with movement/activity
____ 10. 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?
A.
Assure the patient that he will not experience the symptoms again
B.
Identify modifiable cardiovascular risk factors
C.
Do a thorough medication review and a CT scan
D.
Order a stat EEG and administer O2 by mask
B.
Identify modifiable cardiovascular risk factors
- An older male patient is experiencing acute onset of right-sided weakness, slurred speech, and confusion. What should the nurse practitioner do promptly?
A.
Administer an aspirin by mouth
B.
Evaluate for stroke and arrange transport to the hospital right away
C.
Do a thorough medication review and stat blood sugar
D.
Order an EKG and administer O2 by cannula immediately
. B.
Evaluate for stroke and arrange transport to the hospital right away
\_\_\_\_ 12. An older adult female patient had a stroke. What symptoms are not usually expressed by patients who have had a vertebrobasilar stroke? A. Vertigo B. Ataxia C. Dysarthria D. Monocular blindness
. D.
Monocular blindness
- When assessing an elderly client who reports a tremor, which assessment findings would be most reliable in identifying Parkinson’s disease?
A.
Any presence of tremor
B.
Symptoms of slowed movement, unstable angina, and tremor
C.
Resting tremor, slow unsteady gait, and cogwheel resistance
D.
Cogwheel rigidity, bradykinesia, and amnesia
____
C.
Resting tremor, slow unsteady gait, and cogwheel resistance
____ 14. 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?
A.
Consult gastroenterologist for g-tube decision
B.
Consult speech pathologist for video fluoroscopy
C.
Provide a trial of foods of differing consistency
D.
Require that he is fed all his meals
C.
Provide a trial of foods of differing consistency
Which of the following assessment findings is commonly noted in a client with advanced Parkinson’s disease? A. Macrographia B. Micrographia C. Ataxic gait D. Increased arm swing
____
Micrographia
