Delirium, Dementia, & Movement Disorders Flashcards
Dementia can be mixed, vascular, or Alzheimer-related, and it may have multiple contributing etiologies. Identify a potential cause that is not linked to prevention when identified as source.
Drinking too much alcohol
Creutzfeldt–Jakob disease
Emotional problem
Vitamin deficiency
Creutzfeldt–Jakob disease
Determine an element of care collaboration that the NP needs to order as referral when treating a patient with Parkinson’s disease.
Endocrinology, physical therapy, and neurology
Hospice, occupational therapy, and nutrition
Neuropsychiatry, physical therapy, and orthopedics
Occupational therapy, physical therapy, and nutrition consult
Occupational therapy, physical therapy, and nutrition consult
The 78-year-old patient reports of forgetfulness and often cannot recall where she placed her keys and cooking items. She seems quite alarmed today during her visit. The NP understands that the patient may need further workup. Determine what the NP should conduct or order.
Psychological referral
Referral after findings of 26 or higher on MoCA
MoCA
MRI with contrast
MoCA
Determine which patient’s statement about RLS indicates that her understanding about RLS is well-received from education in the clinic.
I can drink my nightly glass of wine with RLS and not worry.
I just need to talk to someone about my frequent crying, but treatment won’t be needed.
I drive for my job and should watch for sleepiness and needed rest before work.
I have a little bit of muscle spasm to worry about, and vitamins will help with that.
drive for my job and should watch for sleepiness and needed rest before work.
A 70-year-old female presents to the clinic for her annual exam. Determine the clinical exam finding that the nurse practitioner should give priority when considering treatment.
The patient begins to yell “Help!” and attempts to leave the exam room.
The patient has a slight tremor and generalized, unsteady hand movements.
The patient reports that she forgets things now and then.
The patient states that she would like to discuss safe sex options.
The patient begins to yell “Help!” and attempts to leave the exam room.
In the early stages of Parkinson’s disease, determine what the patient presenting to clinic may show.
Tremors while writing an intake form
Difficulty ambulating into the exam room
General tremors in both hands while resting on the exam table
Confusion with recall of medical history
General tremors in both hands while resting on the exam table
A 78-year-old male presents to the clinic with reports of nausea (not related to meals), frequent inability to sleep, and fatigue. There are no other reported symptoms. The clinician observes that the patient has a mild continuous headshake during the history of present illness. Identify a potential differential diagnosis to consider.
Pernicious anemia
Delirium
Restless leg syndrome
Alzheimer’s disease
Restless leg syndrome
Treatment of Willis–Ekbom disease is often difficult without the patient’s cooperation and compliance. Determine how the NP should disseminate scholarly education to patients with this disease.
Treatment of depression will eliminate the risk of suicide.
Suicide is not an identified risk, as long as depression is treated.
If the patient avoids alcohol consumption, the disease will be eliminated.
Suicide risk remains regardless of addressing insomnia and depression for patients with Willis–Ekbom disease.
Suicide risk remains regardless of addressing insomnia and depression for patients with Willis–Ekbom disease.
It is important for the NP to understand Alzheimer’s disease, if she will treat the disease in the clinic. Determine what documentation represents a true understanding.
The patient displays agitation, excitement, tremulousness, hallucinations, fantasies, and delusions.
This condition requires emergent medical treatment and is associated with a high mortality rate that is double that of other confused states.
In the frail elderly, this condition is an adverse sign that the patient may not recover quickly or may not recover from their previous condition.
Many patients may deny symptoms due to mentation decline, requiring family members to provide a real view of social interaction, memory loss, and clinical history.
Many patients may deny symptoms due to mentation decline, requiring family members to provide a real view of social interaction, memory loss, and clinical history.
The FNP in clinic is concerned about the difference and comparison of delirium and dementia while diagnosing his patients. Determine what he understands about DSM-5 criteria for diagnosing delirium.
The disturbances are not explained by another pre-existing, evolving, or established neurocognitive disorder, and they do not occur in the context of a severely reduced level of arousal.
The disturbance develops over a long duration of time (usually days to weeks), represents a change from baseline, and tends to fluctuate.
There is a disturbance in focus with the ability to sustain attention, with prompts and immediate feedback.
The patient has a positive MRI with plaques that is accompanied by hallucinations and wide ranges of behavior changes.
The disturbances are not explained by another pre-existing, evolving, or established neurocognitive disorder, and they do not occur in the context of a severely reduced level of arousal.
A 78-year-old male presents to the clinic with reports of nausea (not related to meals), frequent inability to sleep, and fatigue. There are no other reported symptoms. The clinician observes that the patient has a mild continuous headshake during the history of present illness. Identify a potential differential diagnosis to consider.
Alzheimer’s disease
Vascular dementia
Essential tremor
Delirium
Essential tremor
A 70-year-old female presents to the clinic for her annual exam. Determine the clinical exam finding that the nurse practitioner should give priority when considering treatment.
The patient begins to look for a snack in her bag and finds a pen to chew.
The patient reports that she forgets things now and then.
The patient states that she would like to discuss safe sex options.
The patient denies current issues and is appropriately dressed.
The patient begins to look for a snack in her bag and finds a pen to chew.
Identify the best treatment approach for a patient with new diagnosis of vascular dementia.
Research treatment protocols and have PT return in 2 weeks to discuss
Prescribe the patient lisinopril 10 mg PO daily
Prescribe lisinopril 50 mg PO daily
Stop current BP medications and prescribe a high-dose ace inhibitor
Prescribe the patient lisinopril 10 mg PO daily
Determine an element of care collaboration that the NP needs to order as referral when treating a patient with Parkinson’s disease.
Physical therapy and neuropsychiatry
Hospice, occupational therapy, and nutrition
Hospice, optometry, and orthopedics
Endocrinology, physical therapy, and neurology
Physical therapy and neuropsychiatry
Dementia can be mixed, vascular, or Alzheimer-related, and it may have multiple contributing etiologies. Identify a potential cause that is not linked to prevention when identified as source.
Drinking too much alcohol
Emotional problem
HIV-associated dementia
Vitamin deficiency
HIV-associated dementia
The FNP in clinic is concerned about the difference and comparison of delirium and dementia while diagnosing his patients. Determine what he understands about DSM-5 criteria for diagnosing delirium.
The patient has a positive MRI with plaques that is accompanied by hallucinations and wide ranges of behavior changes.
There is a disturbance in focus with the ability to sustain attention, with prompts and immediate feedback.
There is disturbance in attention (e.g., reduced ability to direct, focus, sustain, and shift attention) and awareness.
There is evidence from medical history to show true correlation in family history.
There is disturbance in attention (e.g., reduced ability to direct, focus, sustain, and shift attention) and awareness.
A family nurse practitioner is seeing a 76-year-old patient with an initial diagnosis of Parkinson’s disease today in clinic. Recommend what treatment is the most consistent with current evidence-based practice regarding Parkinson’s disease.
Levodopa is a treatment that was phased out for newer, more effective drugs.
The family should not treat Parkinson’s due to the age and side effects of medications.
For effective treatment, levodopa is routinely used.
The safest treatment is a combination of carbidopa and levodopa.
For effective treatment, levodopa is routinely used.
Identify a pattern of concern for the newly diagnosed but stable Alzheimer’s patient that would indicate a need for change in medication or collaborative treatment to be ordered by the NP.
A CEO with a designated parking spot who looks at his car and reports that his car is stolen
A CEO who loses his keys and is unable to find them
A physician with a busy clinic day who overlooks a waiting patient
A painter who loses his tracking book for customer orders
A CEO with a designated parking spot who looks at his car and reports that his car is stolen
The 78-year-old patient reports of forgetfulness and often cannot recall where she placed her keys and cooking items. She seems quite alarmed today during her visit. The NP understands that the patient may need further workup. Determine what the NP should conduct or order.
Psychological referral
CT with contrast
Referral after findings of 26 or higher on MoCA
MMSE
MMSE
The NP is considering collaborative care for patients who present with a neurodegenerative disease. Before a referral to a geneticist is written, the NP must first consider which diseases are known to have a genetic mutation, need for genetic follow-up, or hereditary association. Determine which of the patients the NP should refer.
An 80-year-old with Huntington’s disease
A 50-year-old with RLS
A 90-year-old with Parkinson’s disease
A 70-year-old with RLS
An 80-year-old with Huntington’s disease
In the early stages of Parkinson’s disease, determine what the patient presenting to clinic may show.
Confusion with recall of medical history
Generalized uncoordinated movements during the exam
Difficulty ambulating into the exam room
Headshake while listening to the practitioner
Headshake while listening to the practitioner
It is important for the NP to understand Alzheimer’s disease, if she will treat the disease in the clinic. Determine what documentation represents a true understanding.
In the frail elderly, this condition is an adverse sign that the patient may not recover quickly or may not recover from their previous condition.
The patient displays agitation, excitement, tremulousness, hallucinations, fantasies, and delusions.
This condition requires emergent medical treatment and is associated with a high mortality rate that is double that of other confused states.
Patients lose organization, multi-tasking, and motivation.
Patients lose organization, multi-tasking, and motivation.
An 89-year-old patient has had several years of inattention, difficulty with speech, impaired memory, and mobility. The patient now returns to the clinic with his family to review diagnostic tests. The patient is in no distress today but reports seeing hundreds of butterflies in the exam room. The NP can share the patient’s diagnosis with certainty after the radiologist reading indicates a finding of Lewy bodies and white matter on brain imagining. Identify the patient’s hallmark sign.
Possible mixed dementia
Normal signs of aged brain matter
Early stage dementia
Delirium with hallucinations
Possible mixed dementia
The FNP in clinic is concerned about the difference and comparison of delirium and dementia while diagnosing his patients. Determine what he understands about DSM-5 criteria for diagnosing delirium.
The patient has a positive MRI with plaques that is accompanied by hallucinations and wide ranges of behavior changes.
There is evidence from medical history to show true correlation in family history.
There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by a medical condition, substance intoxication or withdrawal, or medication side effects.
The disturbance develops over a long duration of time (usually days to weeks), represents a change from baseline, and tends to fluctuate.
here is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by a medical condition, substance intoxication or withdrawal, or medication side effects.
