APEA 3P EXAM PREP NEURO 2026
UPDATED QUESTIONS WITH
ANSWERS
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, gave 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? - Answer 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: - Answer 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? -
Answer 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
A 68-year-old smoker with a history of well-controlled hypertension describes an event that
occurred yesterday while mowing his lawn. He felt very dizzy and "passed out" for less than 1
minute. He awakened spontaneously. Today, he has no complaints and states that he feels fine.
Initially, the NP should: - Answer perform a complete neurological and cardiac exam with
auscultation of the carotid arteries.
order a 12-lead ECG and carotid ultrasound, and perform a physical exam.
order a CT of the brain, blood clotting studies, and cardiac enzymes.
1
,check blood pressure in three positions, order a 12-lead ECG, and schedule an exercise stress
test.
The event described is syncope. Syncope is a brief and sudden loss of consciousness that occurs
with spontaneous recovery. This is a significant event but it is especially so in a smoker with
hypertension. The assessment of this patient must start with an examination of the cardiac and
neurological systems. Based on the findings and tentative diagnosis of syncope, coupled with the
patient's history of the event, other tests might be ordered to evaluate arrhythmias, stroke,
transient ischemic attack, myocardial infarct, carotid stenosis, other vascular etiologies. A
referral to specialty care is indicated after initial workup by the nurse practitioner.
Which characteristic is true of tension headaches, but not of cluster headaches? - Answer Cluster
headaches are always bilateral.
Tension headaches are always bilateral.
Cluster headaches always cause nausea.
Tension headaches cause photosensitivity.
Cluster headaches are always unilateral. The affected side produces a red, teary eye with nasal
congestion on the affected side. Nausea and photosensitivity are common. Tension headaches are
always bilateral with no nausea or photosensitivity associated with them.
Which condition listed below does NOT impact an elder's ability to eat? - Answer Stroke
Parkinson's disease
Dysphagia
Hyperlipidemia
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? - Answer 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
2
, 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? -
Answer 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.
Dementia independently increases the risk of motor vehicle accidents if the patient drives. The
healthcare provider should discuss this with the patient and a family member if a family member
is present during the older adult's evaluation. Depending on the degree of impairment, the
healthcare provider could recommend stopping driving, or recommend that an assessment be
done. The assessment is usually completed by either an occupational or physical therapist or
someone trained to assess this.
A person with 20/60 vision: - Answer is legally blind.
will have difficulty reading a newspaper.
will be unable to see the big "E" on the eye chart.
has better vision than someone with 20/80 vision.
Using the Snellen nomenclature for describing visual acuity (example 20/80), the first number
represents the test distance. In most cases this is 20 feet. The second number represents the
distance at which the average eye can see the letters on a specific line of the chart. In other
words, the examinee can see at 20 feet what an average eye (20/20) can see at 80 feet. 20/80 is a
measure of distant vision, not near vision such as reading a newspaper. The big "E" represents
20/200 vision. 20/200 is considered legally blind by most standards.
A patient reports a history of transient ischemic attack (TIA) 6 months ago. His daily
medications are lisinopril, pravastatin, and metformin. After advising him to quit smoking, what
intervention is most important in helping to prevent stroke in him? - Answer Auscultation of
carotid arteries at each visit
Taking low dose aspirin daily
Assessing hemoglobin A1C every 3-6 months
Encouraging smoking cessation at each visit
Antiplatelet therapy, usually aspirin, inhibits the enzyme cyclooxygenase and reduces
thromboxane A2 production, which stimulates platelet aggregation. Thus, risk of ischemic stroke
is reduced. The dosage of aspirin needed to prevent an event is debatable. Most studies found
that 75-150 mg daily was as effective in preventing stroke as was higher doses. Lower doses of
aspirin are associated with less GI toxicity and fewer side effects.
A 75-year-old is diagnosed with essential tremor. What is the most commonly used medication
to treat this? - Answer Carbidopa
Long-acting propanolol
3
UPDATED QUESTIONS WITH
ANSWERS
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, gave 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? - Answer 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: - Answer 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? -
Answer 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
A 68-year-old smoker with a history of well-controlled hypertension describes an event that
occurred yesterday while mowing his lawn. He felt very dizzy and "passed out" for less than 1
minute. He awakened spontaneously. Today, he has no complaints and states that he feels fine.
Initially, the NP should: - Answer perform a complete neurological and cardiac exam with
auscultation of the carotid arteries.
order a 12-lead ECG and carotid ultrasound, and perform a physical exam.
order a CT of the brain, blood clotting studies, and cardiac enzymes.
1
,check blood pressure in three positions, order a 12-lead ECG, and schedule an exercise stress
test.
The event described is syncope. Syncope is a brief and sudden loss of consciousness that occurs
with spontaneous recovery. This is a significant event but it is especially so in a smoker with
hypertension. The assessment of this patient must start with an examination of the cardiac and
neurological systems. Based on the findings and tentative diagnosis of syncope, coupled with the
patient's history of the event, other tests might be ordered to evaluate arrhythmias, stroke,
transient ischemic attack, myocardial infarct, carotid stenosis, other vascular etiologies. A
referral to specialty care is indicated after initial workup by the nurse practitioner.
Which characteristic is true of tension headaches, but not of cluster headaches? - Answer Cluster
headaches are always bilateral.
Tension headaches are always bilateral.
Cluster headaches always cause nausea.
Tension headaches cause photosensitivity.
Cluster headaches are always unilateral. The affected side produces a red, teary eye with nasal
congestion on the affected side. Nausea and photosensitivity are common. Tension headaches are
always bilateral with no nausea or photosensitivity associated with them.
Which condition listed below does NOT impact an elder's ability to eat? - Answer Stroke
Parkinson's disease
Dysphagia
Hyperlipidemia
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? - Answer 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
2
, 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? -
Answer 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.
Dementia independently increases the risk of motor vehicle accidents if the patient drives. The
healthcare provider should discuss this with the patient and a family member if a family member
is present during the older adult's evaluation. Depending on the degree of impairment, the
healthcare provider could recommend stopping driving, or recommend that an assessment be
done. The assessment is usually completed by either an occupational or physical therapist or
someone trained to assess this.
A person with 20/60 vision: - Answer is legally blind.
will have difficulty reading a newspaper.
will be unable to see the big "E" on the eye chart.
has better vision than someone with 20/80 vision.
Using the Snellen nomenclature for describing visual acuity (example 20/80), the first number
represents the test distance. In most cases this is 20 feet. The second number represents the
distance at which the average eye can see the letters on a specific line of the chart. In other
words, the examinee can see at 20 feet what an average eye (20/20) can see at 80 feet. 20/80 is a
measure of distant vision, not near vision such as reading a newspaper. The big "E" represents
20/200 vision. 20/200 is considered legally blind by most standards.
A patient reports a history of transient ischemic attack (TIA) 6 months ago. His daily
medications are lisinopril, pravastatin, and metformin. After advising him to quit smoking, what
intervention is most important in helping to prevent stroke in him? - Answer Auscultation of
carotid arteries at each visit
Taking low dose aspirin daily
Assessing hemoglobin A1C every 3-6 months
Encouraging smoking cessation at each visit
Antiplatelet therapy, usually aspirin, inhibits the enzyme cyclooxygenase and reduces
thromboxane A2 production, which stimulates platelet aggregation. Thus, risk of ischemic stroke
is reduced. The dosage of aspirin needed to prevent an event is debatable. Most studies found
that 75-150 mg daily was as effective in preventing stroke as was higher doses. Lower doses of
aspirin are associated with less GI toxicity and fewer side effects.
A 75-year-old is diagnosed with essential tremor. What is the most commonly used medication
to treat this? - Answer Carbidopa
Long-acting propanolol
3
