APEA 3P EXAM Prep Neuro: Questions & Answers: Updated A+ Guide

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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, gav... e 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? (Ans- 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: (Ans- muscular rigidity. tremor. falling. bradykinesia. Approximately 70% of patients with Parkinson's disease have tremor as the presenting symptom. The tremor typically involves the hand but can involve the legs, jaw, lips, tongue. It seldom involves the head. Muscular rigidity and bradykinesia are two less common presenting signs. When should medications be initiated in a patient who is diagnosed with Parkinson's disease? (Ans- As soon as the disease is diagnosed When symptoms interfere with life's activities When nonpharmacologic measures have been exhausted After MRI and CT have ruled out stroke or tumor The medications used to treat patients who have Parkinson's disease do not prevent the progression of the disease. Therefore, it is not necessary to start medications until symptoms interfere with the patient's quality of life. Levodopa is often used initially at the lowest dose that helps a patient manage symptoms. It can be titrated upward as needed. Orthostatic hypotension is a common side effect of levodopa, so blood pressure should be monitored closely. A 72-year-old patient with history of polymyalgia rheumatica complains of new onset, unilateral headache and visual changes. Her neurologic exam is otherwise normal. Her CT results are WNL. ESR is 75 (Normal: 0-29). VS: BP 140/82, HR 67, RR 18, T 100. What is the most likely reason for her symptoms? (Ans- Transient ischemic attack Temporal arteritis Meningitis CVA Polymyalgia rheumatica (PMR) is a chronic inflammatory condition that produces morning stiffness in the neck, shoulders, and hips. Its peak incidence is 70-80 years old. PMR is commonly associated with temporal arteritis, also known as giant cell arteritis. Temporal arteritis is a chronic vasculitis of the medium and large vessels. Temporal arteritis is characterized by new onset unilateral temporal headache, abrupt onset of visual disturbances, elevated sedimentation rate, jaw claudication, and unexplained fever. This is best diagnosed by temporal artery biopsy. She should be referred to neurology for evaluation today. What recommendation should be made to an older adult who is diagnosed with mild dementia? (Ans- 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. [Show More]

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