Delirium, Dementia, & Movement Disorders

Question 1

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

Answer 1

Creutzfeldt–Jakob disease

Question 2

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

Answer 2

Occupational therapy, physical therapy, and nutrition consult

Question 3

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

Answer 3

MoCA

Question 4

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.

Answer 4

drive for my job and should watch for sleepiness and needed rest before work.

Question 5

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.

Answer 5

The patient begins to yell “Help!” and attempts to leave the exam room.

Question 6

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

Answer 6

General tremors in both hands while resting on the exam table

Question 7

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

Answer 7

Restless leg syndrome

Question 8

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.

Answer 8

Suicide risk remains regardless of addressing insomnia and depression for patients with Willis–Ekbom disease.

Question 9

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.

Answer 9

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.

Question 10

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.

Answer 10

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.

Question 11

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

Answer 11

Essential tremor

Question 12

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.

Answer 12

The patient begins to look for a snack in her bag and finds a pen to chew.

Question 13

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

Answer 13

Prescribe the patient lisinopril 10 mg PO daily

Question 14

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

Answer 14

Physical therapy and neuropsychiatry

Question 15

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

Answer 15

HIV-associated dementia

Question 16

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.

Answer 16

There is disturbance in attention (e.g., reduced ability to direct, focus, sustain, and shift attention) and awareness.

Question 17

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.

Answer 17

For effective treatment, levodopa is routinely used.

Question 18

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

Answer 18

A CEO with a designated parking spot who looks at his car and reports that his car is stolen

Question 19

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

Answer 19

MMSE

Question 20

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

Answer 20

An 80-year-old with Huntington’s disease

Question 21

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

Answer 21

Headshake while listening to the practitioner

Question 22

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.

Answer 22

Patients lose organization, multi-tasking, and motivation.

Question 23

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

Answer 23

Possible mixed dementia

Question 24

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.

Answer 24

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.

Question 25

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.

Emotional problem

Creutzfeldt–Jakob disease

Vitamin deficiency

Medication side effect

Answer 25

Creutzfeldt–Jakob disease

Question 26

A 66-year-old patient arrives to the clinic for review of his brain MRI and further discussion of treatment options because his symptoms of shuffling gait and rigid leg and arms began to worsen. The NP begins to explain her concern for Parkinson’s disease based on the MRI reading. Identify which of the following statements would be true for this patient.

There is an absence of the swallow tail sign on the MRI, so the patient has Parkinson’s.

The swallow tail sign is present on the MRI, so the patient has Parkinson’s.

Swallow tail is not a hallmark for Parkinson’s, so this is an inconclusive reading.

The MRI should be repeated to confirm the absence of the swallow tail sign.

Answer 26

There is an absence of the swallow tail sign on the MRI, so the patient has Parkinson’s.

Question 27

Mr. Lee, a 64-year-old male, presents to the clinic after an uneventful year for a routine exam. His HPI and ROS are negative, but he is concerned and wants to discuss a few additional items before the end of his visit. Recommend a symptom that would prompt an NP student to alter or initiate treatment for a patient with RLS.

The patient has switched his schedule to work the graveyard shift.

The patient is wondering if drinking nightly before bed a bad thing to do.

The patient has increased yellowing of the toenails and wet socks.

The patient has increased his activity and has generalized soreness.

Answer 27

The patient is wondering if drinking nightly before bed a bad thing to do.

Question 28

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 states that she would like to discuss safe sex options.

The patient exhibits a generalized tremor, uncontrolled at rest.

The patient has a slight tremor and generalized, unsteady hand movements.

The patient denies current issues and is appropriately dressed.

Answer 28

The patient exhibits a generalized tremor, uncontrolled at rest.

Question 29

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 physician with a busy clinic day who overlooks a waiting patient

A CEO who loses his keys and is unable to find them

A painter who loses his tracking book for customer orders

A physician who is now unable to organize his clinic day and overlooks waiting patients

Answer 29

A physician who is now unable to organize his clinic day and overlooks waiting patients

Question 30

Identify the best treatment approach for a patient with new diagnosis of vascular dementia.

Prescribe the patient lisinopril 10 mg PO daily

Research treatment protocols and have PT return in 2 weeks to discuss

Prescribe simvastatin 80 mg PO daily

Prescribe lisinopril 50 mg PO daily

Answer 30

Prescribe the patient lisinopril 10 mg PO daily

Question 31

A 75-year-old female reports to the clinic with her daughter with hope of finding a solution to the latest mood swings and volatile behavior. Yesterday, the mother threw a book at her daughter; today, she refused for several minutes to get in the car. There are no reports of injury and no recent change in medications. The NP reviews the medical record and can find no diagnosis to explain the recent behavior. Determine the next step in treatment.

The patient should be diagnosed with dementia and sent to a nursing home.

The patient should have a neuro focal exam with full blood work.

The patient should be sent to the ER for emergent treatment.

A complete history of present illness and appointment should be made for a longer visit.

Answer 31

The patient should have a neuro focal exam with full blood work.

Question 32

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.

If the patient avoids alcohol consumption, the disease will be eliminated.

Suicide is not an identified risk, as long as depression is treated.

This is not a disease linked to heredity.

There is a direct link to circulation and insulin resistance that contributes to this disease.

Answer 32

There is a direct link to circulation and insulin resistance that contributes to this disease.

Question 33

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.

Rasagiline, a MAO-B inhibitor, is commonly prescribed.

The family should not treat Parkinson’s due to the age and side effects of medications.

Levodopa is a treatment that was phased out for newer, more effective drugs.

The safest treatment is a combination of carbidopa and levodopa.

Answer 33

Rasagiline, a MAO-B inhibitor, is commonly prescribed.

Question 34

Determine an important fact that would correlate with Alzheimer’s disease education for patients with an initial diagnosis of the disease.

Treatment for Alzheimer’s is focused on reminding and re-orienting the patient to normal surroundings.

Everyone is at risk of Alzheimer disease.

Because it is usually associated with senile plaques, only the elderly can get this type of dementia.

There will be a slow steady progression of mental decline.

Answer 34

There will be a slow steady progression of mental decline.