Chapter22 Neuro

Question 1

Which assessment finding places an older patient at the greatest risk factor for the development of Alzheimers disease?

1. Age
2. Genetic predisposition
3. Environmental exposure
4. History of previous head injury

Answer 1

Correct Answer: 1

Rationale 1: Advanced age is the single greatest factor for the development of Alzheimers disease.
Reference: Page 619

Rationale 2: Genetic causes are responsible for fewer than 5% of the cases of Alzheimers disease.
Reference: Page 619

Rationale 3: Environmental exposure is not identified as a risk factor for the development of Alzheimers disease.
Reference: Page 619

Rationale 4: History of a previous head injury is considered a medical risk for the development of Alzheimers disease but advanced age is the single greatest risk factor for the development of the disorder.
Reference: Page 619

Question 2

Which treatment should the nurse prepare to provide to an older patient diagnosed with progressive dementia?

1. None
2. Vitamin E
3. Estrogen therapy
4. Gingko biloba extract

Answer 2

Correct Answer: 1

Rationale 1: There is no cure available at the present time for dementia. Treatments are directed at improving function and slowing the progression of the disease.
Reference: Page 621

Rationale 2: Vitamin E is an antioxidant and it is theorized that its use could help prevent or delay the development of progressive dementia.
Reference: Page 621

Rationale 3: Estrogen therapy is not used or recommended in the treatment of progressive dementia.
Reference: Page 621

Rationale 4: Ginkgo biloba is another antioxidant used for treatment of memory disorders. It is presumed to improve blood flow to the brain. Although many studies have been conducted using ginkgo biloba as prevention or treatment for memory disorders, none meet the stringent requirements of the double-blind study considered necessary to support the claims and its use is not recommended.
Reference: Page 621

Question 3

An older patient newly diagnosed with Alzheimers disease is prescribed galantamine (Razadyne). How will the nurse instruct the patient about this medication?

Standard Text: Select all that apply.

1. Take at bedtime.
2. Take the medication with food.
3. The dosage may be changed every 4 weeks.
4. Side effects of this medication are minimal.
5. Do not take the medication with an NSAID.

Answer 3

Correct Answer: 2,3,5

Rationale 1: This medication is not specifically to be given at bedtime.
Reference: Page 622

Rationale 2: This medication can cause gastrointestinal upset and should be taken with food.
Reference: Page 622

Rationale 3: This medication is titrated at 4-week intervals. The dosage may be changed every 4 weeks.
Reference: Page 622

Rationale 4: The side effects of this medication include gastrointestinal upset and bleeding, arrhythmias, urinary obstruction, somnolence, tremor, abdominal pain, and rhinitis.
Reference: Page 622

Rationale 5: This medication should be used with caution if also prescribed NSAIDs since this could increase the risk of gastrointestinal bleeding.
Reference: Page 622

Question 4

An older patient is diagnosed with dementia caused by Lewy bodies. What will the nurse most likely assess in this patient?

Standard Text: Select all that apply.

1. Tremor
2. Rigidity
3. Postural instability
4. Personality changes
5. Visual hallucinations

Answer 4

Correct Answer: 1,2,3,5

Rationale 1: Clinical symptoms of dementia caused by Lewy bodies include a tremor.
Reference: Page 618

Rationale 2: Clinical symptoms of dementia caused by Lewy bodies include rigidity.
Reference: Page 618

Rationale 3: Clinical symptoms of dementia caused by Lewy bodies include postural instability.
Reference: Page 618

Rationale 4: Personality changes are associated with dementia caused by Picks disease.
Reference: Page 618

Rationale 5: Clinical symptoms of dementia caused by Lewy bodies include visual hallucinations.
Reference: Page 618

Question 5

An older patient is diagnosed with early-mild Alzheimers disease. Which should be done at the time of diagnosis?

1. Discuss treatment options and wishes with the patient.
2. Identify a long-term care facility for immediate transfer.
3. Explain that this stage of the disorder can last up to 10 years.
4. Instruct family members to slowly improve the home environment for safety.

Answer 5

Correct Answer: 1

Rationale 1: Early diagnosis provides the family and the older person with the opportunity to discuss treatment options and wishes while the older person still has decision-making capacity.
Reference: Page 622

Rationale 2: It is not necessary to identify a long-term care facility for the older patient at this stage of the disorder.
Reference: Page 622

Rationale 3: There is no specific time interval for early-mild Alzheimers disease.
Reference: Page 622

Rationale 4: The family should prepare the home to avoid safety issues as soon as possible.
Reference: Page 622

Question 6

An older patient is being evaluated for dementia. What manifestations need to be present to diagnose this disorder?

Standard Text: Select all that apply.

1. Intermittent forgetfulness
2. Inability to manage finances
3. Misplacing personal belongings
4. Repetitive questions or conversations
5. Difficulty thinking of common words while speaking

Answer 6

Correct Answer: 2,3,4,5

Rationale 1: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Intermittent forgetfulness is not a cognitive symptom of any specific domain.
Reference: Pages 617-618

Rationale 2: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Inability to manage finances indicates impaired reasoning and handling of complex tasks.
Reference: Pages 617-618

Rationale 3: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Misplacing personal belongings indicates impaired ability to acquire and remember new information.
Reference: Pages 617-618

Rationale 4: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Repetitive questions or conversations indicate impaired ability to acquire and remember new information.
Reference: Pages 617-618

Rationale 5: The diagnosis of dementia must include the presence of cognitive or behavioral symptoms that involves a minimum of two domains. Difficulty thinking of common words while speaking indicates impaired language functions.
Reference: Pages 617-618

Question 7

An older patient with Alzheimers disease is demonstrating agnosia. Which intervention would be important to include in this patients plan of care?

1. List choices for the patient to select.
2. Provide deadlines for self-care activities.
3. Refrain from providing verbal instructions.
4. Remove inedible items from the environment.

Answer 7

orrect Answer: 4

Rationale 1: Listing choices for the patient to select will not help with agnosia, which is the inability to recognize objects.
Reference: Page 626

Rationale 2: Providing deadlines for self-care activities will not help with agnosia, which is the inability to recognize objects.
Reference: Page 626

Rationale 3: Verbal prompts decrease the chances of the older person becoming confused however it will not help with agnosia, which is the inability to recognize objects.
Reference: Page 626

Rationale 4: Agnosia is the inability to recognize objects and causes functional impairment and predisposes the patient to safety hazards such as eating inedible objects.
Reference: Page 626

Question 8

What should the nurse teach the family of an older patient with Alzheimers disease to help with spatial disorientation?

Standard Text: Select all that apply.

1. Use color to contrast objects and items.
2. Keep furniture in the same familiar place.
3. Fill the patients room with memorabilia.
4. Remove cues for exiting the home away from the doors.
5. Place family photos or recognizable familiar items in a prominent spot.

Answer 8

Correct Answer: 1,2,5

Rationale 1: The use of color to contrast objects and items is a form of a pop-up cue and helps with spatial disorientation.
Reference: Page 628

Rationale 2: Keeping furniture in the same familiar place provides landmarks and helps with spatial disorientation.
Reference: Page 628

Rationale 3: Filling the patients room with memorabilia could contribute to clutter and does not help with spatial disorientation.
Reference: Page 628

Rationale 4: Removing cues for exiting the home reduces the risk of elopement and does not help with spatial disorientation.
Reference: Page 628

Rationale 5: Placing family photos or familiar items in a prominent spot provides landmarks and helps with spatial disorientation.
Reference: Page 628

Question 9

An older patient with Alzheimers disease has wandered away from the home several times. What can the nurse suggest that the spouse do to reduce the patients risk for wandering?

Standard Text: Select all that apply.

1. Place car keys on a rack by the front door.
2. Install motion detectors on the door of the patients room.
3. Remove scatter rugs from the kitchen and bathroom areas.
4. Add slide bolt locks at the bottom of exit doors in the home.
5. Place emergency telephone numbers on the refrigerator door.

Answer 9

Correct Answer: 2,4

Rationale 1: Placing car keys on a rack by the front door would encourage the patient to wander.
Reference: Page 629

Rationale 2: Installing motion detectors on the door of the patients room would alert family members that the patient is mobile and could potentially wander from the home.
Reference: Page 629

Rationale 3: Removing scatter rugs from the kitchen and bathroom areas would reduce the risk of falling but will have no impact on the patients tendency to wander.
Reference: Page 629

Rationale 4: Adding slide bolt locks at the bottom of exit doors in the home provides a mechanical barrier to prevent the patient from wandering.
Reference: Page 629

Rationale 5: Placing emergency telephone numbers on the refrigerator door will have no impact on the patients tendency to wander.
Reference: Page 629

Question 10

After a neurologic assessment, the nurse determines that an older patient is exhibiting normal signs of aging. What did the nurse assess in this patient?

Standard Text: Select all that apply.

1. Slow movements
2. Intermittent hand tremor
3. Ataxia with position changes
4. Decreased sensation in the feet
5. Slight impairment of coordination

Answer 10

Correct Answer: 1,2,4,5

Rationale 1: Slower movements are a normal neurologic sign of aging.
Reference: Page 615

Rationale 2: Intermittent hand tremor is a normal neurologic sign of aging.
Reference: Page 615

Rationale 3: Ataxia with position changes is not a normal neurologic sign of aging.
Reference: Page 615

Rationale 4: Decreased sensation in the feet is a normal neurologic sign of aging.
Reference: Page 615

Rationale 5: Slight impairment of coordination is a normal neurologic sign of aging.
Reference: Page 615

Question 11

The nurse instructs an older patient with Parkinsons disease about carbidopa-levodopa (Sinemet). Which patient statement indicates that teaching has been effective?

1. I will take the medication with my meals.
2. I will sit up on the side of the bed before standing.
3. This medication will cure my Parkinsons disease in time.
4. This medication will not affect my blood pressure medications.

Answer 11

Correct Answer: 2

Rationale 1: To maximize absorption and facilitate crossing the bloodbrain barrier, carbidopa-levodopa should be taken on an empty stomach.
Reference: Page 635

Rationale 2: The older person may experience postural hypotension. The nurse needs to teach strategies to prevent falling, such as sitting on the side of the bed before standing.
Reference: Page 635

Rationale 3: There is no medication known to cure Parkinsons disease.
Reference: Page 635

Rationale 4: The older person may experience postural hypotension which could affect the patients blood pressure medication dosage.
Reference: Page 635

Question 12

The nurse suspects that an older patient is experiencing Parkinsons disease. What did the nurse observe in this patient?

Standard Text: Select all that apply.

1. Chorea
2. Tremor
3. Apraxia
4. Agnosia
5. Dystonia

Answer 12

Correct Answer: 1,2,5

Rationale 1: Chorea is involuntary twitching of the limbs or facial muscles which is an extrapyramidal manifestation of Parkinsons disease.
Reference: Page 634

Rationale 2: A tremor is an extrapyramidal manifestation of Parkinsons disease.
Reference: Page 634

Rationale 3: Apraxia is the inability to recognize speech and is a manifestation of dementia or Alzheimers disease.
Reference: Page 634

Rationale 4: Agnosia is the inability to recognize objects and is a manifestation of dementia or Alzheimers disease.
Reference: Page 634

Rationale 5: Dystonia is involuntary muscle contractions forcing unusual or painful positions and is an extrapyramidal manifestation of Parkinsons disease.
Reference: Page 634

Question 13

The nurse is preparing an educational session on stroke prevention for a group of senior citizens. What information would be important for the nurse to provide to these participants?

Standard Text: Select all that apply.

1. Stop smoking.
2. Limit exercise to once a week.
3. Maintain a healthy body weight.
4. Follow a low-sodium diet as prescribed.
5. Take blood pressure medication as prescribed.

Answer 13

Correct Answer: 1,3,4,5

Rationale 1: Healthy aging tips for stroke prevention include smoking cessation.
Reference: Page 637

Rationale 2: Healthy aging tips for stroke prevention include beginning or maintaining an exercise program. Exercise is helpful in stroke prevention.
Reference: Page 637

Rationale 3: Healthy aging tips for stroke prevention include losing weight if overweight.
Reference: Page 637

Rationale 4: Healthy aging tips for stroke prevention include ingesting below 2 to 3 grams of sodium each day.
Reference: Page 637

Rationale 5: Healthy aging tips for stroke prevention include reducing blood pressure to at least 140/90 mm Hg.
Reference: Page 637

Question 14

An older patient begins to experience status epilepticus. Which action will the nurse take to help this patient?

1. Measure vital signs.
2. Orient the patient between seizures.
3. Prevent chilling with warmed bed linens.
4. Ensure an intravenous access line is available.

Answer 14

Correct Answer: 4

Rationale 1: Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient. Vital signs can be assessed once the seizures have ceased.
Reference: Page 643

Rationale 2: Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient. The patient will most likely be unconscious.
Reference: Page 643

Rationale 3: Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient. Patient chilling is not of a high priority at this time.
Reference: Page 643

Rationale 4: Status epilepticus is a medical emergency which necessitates the establishment of an adequate airway, administration of oxygen, and administration of fluids and emergency medications. An intravenous access line is imperative for this patient.
Reference: Page 643

Question 15

The nurse suspects an older patient is having a grand mal seizure. What did the nurse observe in the patient?

1. Rhythmic jerking of the muscles
2. Rigid extremities lasting for several minutes
3. Brief loss of attention similar to daydreaming
4. Rigid extremities followed by rhythmic flexion

Answer 15

Correct Answer: 4

Rationale 1: Rhythmic jerking of the muscles is a myoclonic seizure.
Reference: Page 642

Rationale 2: Rigid extremities are a characteristic of a tonic seizure.
Reference: Page 642

Rationale 3: A brief loss of attention similar to daydreaming describes petit mal seizures which are more common in children.
Reference: Page 642

Rationale 4: A period of rigidity followed by rhythmic jerking or flexion of the extremities is characteristic of grand mal seizures.
Reference: Page 642

Question 16

An older patient is demonstrating signs of a brain attack. What will the nurse do to assess the degree of cerebral infarct?

1. Obtain a current cardiac rhythm strip.
2. Assess the patient using a stroke scale.
3. Prepare for an emergency electroencephalogram.
4. Obtain orders for immediate blood electrolyte analysis.

Answer 16

Correct Answer: 2

Rationale 1: Although an older patient with a cardiac arrhythmia is at increased risk for thromboembolism, obtaining a current cardiac rhythm strip will not assess the degree of cerebral infarct.
Reference: Page 636

Rationale 2: Usually, the National Institutes of Health (NIH) Stroke Scale is used to gauge the degree of cerebral infarction by determining level of consciousness.
Reference: Page 636

Rationale 3: An emergency electroencephalogram may or may not be used to diagnose the degree of cerebral infarct.
Reference: Page 636

Rationale 4: Blood electrolyte analysis will not help determine the degree of cerebral infarct.
Reference: Page 636

Question 17

The family of an older patient with Alzheimers disease does not want to discuss long-term care placement for at least a few years. How should the nurse respond to the family?

1. Long-term care placement is inevitable with this diagnosis.
2. It often takes a year for an individual with Alzheimers disease to be admitted.
3. Talking about it now gives you time to think about locations and make a decision.
4. By providing this information now, we will not need to address these concerns later.

Answer 17

Correct Answer: 3

Rationale 1: Placement in a long-term care facility may or may not occur with the patient. It is not a fate of all patients with this disease process.
Reference: Page 631

Rationale 2: There is no evidence to suggest that it takes a year for a patient with Alzheimers disease to be admitted to a long-term care facility.
Reference: Page 631

Rationale 3: By discussing placement issues as early as possible in the placement process, hopefully crisis and emergency placement can be avoided, allowing adequate time to investigate all options.
Reference: Page 631

Rationale 4: Nurses will need to provide reinforced education and referrals throughout the disease process, not just during this initial hospitalization.
Reference: Page 631

Question 18

An older patient with advanced Alzheimers disease is being treated for pneumonia. The daughter is not sure if resuscitation efforts should be a part of the plan of care. What information should the nurse provide to the daughter?

1. Resuscitation is often effective for older adults.
2. After resuscitation the patient will return to the same level of functioning.
3. As long as the resuscitation efforts are initiated quickly, the patient will survive.
4. Resuscitation for cardiac or respiratory arrest will have little probability of success.

Answer 18

Correct Answer: 4

Rationale 1: The patient with advanced Alzheimers disease has a reduced chance of successful resuscitation.
Reference: Page 632

Rationale 2: After successful resuscitation, the patient with dementia will often demonstrate a reduced level of functioning.
Reference: Page 632

Rationale 3: Certainly resuscitation is more successful if initiated quickly, but the patient in question will likely not survive such interventions.
Reference: Page 632

Rationale 4: Resuscitation for an unwitnessed cardiac arrest in the patient with advanced Alzheimers disease has a very low probability of restoring life.
Reference: Page 632

Question 19

An older patient with Alzheimers disease has a feeding tube. The family wants to know if the patient will ever be able to eat solid food again. What information should the nurse include when responding to this familys question?

1. The dietitian will decide if this can be done.
2. It depends upon the patients functional eating abilities.
3. This can be done but the feeding tube has to be removed first.
4. In the patient with dementia, the restoration of natural feeding is highly unlikely.

Answer 19

Correct Answer: 2

Rationale 1: The dietitian helps determine a feeding plan but does not determine if the patient will be able to eat solid food again. This is based upon the patients functional eating abilities.
Reference: Page 633

Rationale 2: Even older people with advanced Alzheimers disease can revert to natural feeding after tube feeding. An individualized care plan, based on the older persons target body weight and functional eating abilities, should be developed by an interdisciplinary team that includes a nurse, dietitian, and physician.
Reference: Page 633

Rationale 3: Natural feeding can begin with the tube in place until the older persons eating is reestablished.
Reference: Page 633

Rationale 4: Even older people with advanced Alzheimers disease can revert to natural feeding after tube feeding.
Reference: Page 633

Question 20

A care conference is being held with the family of an older patient in the late stages of Alzheimers disease. The family wants to know if a feeding tube should be placed. How should this question be answered?

1. Tube feeding will aid the patient to gain weight.
2. Tube feeding is associated with a reduced risk of aspiration.
3. Tube feeding reduces the discomfort associated with dehydration.
4. The absence of tube feeding promotes dehydration which reduces pain sensitivity.

Answer 20

Correct Answer: 4

Rationale 1: Tube feeding does not promote weight gain.
Reference: Page 634

Rationale 2: Tube feeding does not prevent aspiration.
Reference: Page 634

Rationale 3: Tube feeding does not increase comfort associated with dehydration.
Reference: Page 634

Rationale 4: Dehydration is beneficial during the dying process because it decreases the sensation of pain and prevents edema and excessive respiratory secretions.
Reference: Page 634

Question 21

The nurse is caring for an older patient who has been newly diagnosed with tonicclonic seizures. About which medication should the nurse prepare to instruct the patient?

1. Diazepam (Valium)
2. Phenytoin (Dilantin)
3. Clonazepam (Klonopin)
4. Valproic acid (Depakene)

Answer 21

Correct Answer: 2

Rationale 1: Diazepam (Valium) may be used in emergency seizure situations but is not routinely prescribed for tonicclonic seizures.
Reference: Page 642

Rationale 2: Phenytoin (Dilantin) is a medication prescribed for tonicclonic seizures.
Reference: Page 642

Rationale 3: Clonazepam (Klonopin) is prescribed for absence or myoclonic seizures.
Reference: Page 642

Rationale 4: Valproic acid (Depakene) is prescribed for absence or myoclonic seizures.
Reference: Page 642

Question 22

An older patient with mild Alzheimers disease abruptly stops taking the prescribed medication donepezil (Aricept). On which area should the nurse focus when assessing this patient?

1. Reflexes
2. Rest and sleep
3. Cognitive function
4. Cardiovascular function

Answer 22

Correct Answer: 3

Rationale 1: Abrupt cessation of donepezil (Aricept) does not affect reflexes.
Reference: Page 622

Rationale 2: Abrupt cessation of donepezil (Aricept) does not affect rest and sleep.
Reference: Page 622

Rationale 3: Abrupt cessation of donepezil (Aricept) is associated with a reduction in cognitive abilities.
Reference: Page 622

Rationale 4: Abrupt cessation of donepezil (Aricept) does not affect cardiovascular function.
Reference: Page 622

Question 23

The nurse is caring for an older patient with unstable blood glucose control from type 2 diabetes mellitus. On which potential neurologic problems should the nurse focus teaching with this patient?

Standard Text: Select all that apply.

1. Brain attack
2. Status epilepticus
3. Multiple sclerosis
4. Myasthenia gravis
5. Alzheimers disease

Answer 23

Correct Answer: 1,5

Rationale 1: Risk factors for a brain attack include diabetes mellitus.
Reference: Pages 619, 636

Rationale 2: There is no evidence to support that diabetes mellitus is a risk factor for status epilepticus.
Reference: Pages 619, 636

Rationale 3: There is no evidence to support that diabetes mellitus is a risk factor for multiple sclerosis.
Reference: Pages 619, 636

Rationale 4: There is no content to support that diabetes mellitus is a risk factor for myasthenia gravis.
Reference: Pages 619, 636

Rationale 5: Risk factors for Alzheimers disease include diabetes mellitus.
Reference: Pages 619, 636

Question 24

An older patient is prescribed gabapentin (Neurontin) for a seizure disorder. When instructing the patient on this medication, which common side effects should the nurse include?

Standard Text: Select all that apply.

1. Headache
2. Weakness
3. Irritability
4. Drowsiness
5. Weight gain

Answer 24

Correct Answer: 1,5

Rationale 1: Headache is a common side effect of gabapentin (Neurontin).
Reference: Page 643

Rationale 2: Weakness is a common side effect of levetiracetam (Keppra), valproic acid (Depakote), zonisamide (Zonegran), and pregabalin (Lyrica).
Reference: Page 643

Rationale 3: Irritability is a common side effect of levetiracetam (Keppra), valproic acid (Depakote), zonisamide (Zonegran), and pregabalin (Lyrica).
Reference: Page 643

Rationale 4: Drowsiness is a common side effect of levetiracetam (Keppra), valproic acid (Depakote), zonisamide (Zonegran), and pregabalin (Lyrica).
Reference: Page 643

Rationale 5: Weight gain is a common side effect of gabapentin (Neurontin).
Reference: Page 643

Question 25

An older patient with moderate stage dementia frequently cannot remember which room he is assigned in a long-term care facility. Which nursing intervention would help this patient?

1. Reorient the patient when it happens again.
2. Establish landmarks at the patients bedside.
3. Investigate placing the patient in a private room.
4. Place the patient in restraints to limit ambulation.

Answer 25

Correct Answer: 2

Rationale 1: Reorienting the patient does little to assist the patient in remaining independent.
Reference: Page 628

Rationale 2: Landmarks such as pictures and familiar belongings will promote the patients recognition of the correct room.
Reference: Page 628

Rationale 3: Placing the patient in a private room will serve to promote isolation and will be counterproductive.
Reference: Page 628

Rationale 4: Restraints should not be used for the patient with Alzheimers disease demonstrating confusion with room location. Restraints can worsen delirium and injure the older person.
Reference: Page 628