NR 603 Week 1 Practice Test with 150 Questions and
Correct Answers/ NR 603 Advanced Clinical
Diagnosis and Practice Across the Lifespan Practicum
Week 1 Review – 150 Correctly Answered Questions
A 68-year-old female presents to the emergency department with signs and
symptoms of an acute ischemic stroke. The initial CT scan is normal. Her blood
pressure is 164/105. What is the most appropriate treatment for the blood pressure
of this patient?
A Atenolol PO
B Clonidine PO
C Close monitoring
D Labetolol IV
E Nicardipine IV
ANS:C - ANSWER-C Close monitoring
Aggressively lowering blood pressure may decrease blood flow to the ischemic
tissue, thus decreasing the chances of recovery or increasing the risk of further
infarction. In the setting of an acute ischemic stroke, blood pressure elevation
should be monitored closely, with some elevation expected. This elevation is
expected to decline without medication in the first few hours to days, but if
elevation continues to a systolic blood pressure greater than 220mmHg, or mean
arterial pressure greater than 120mmHg, medication is advised. Medications may
include intravenous labetolol or nicardipine, with close monitoring of the patient.
After the acute phase following a stroke, appropriate oral medications may be
considered for outpatient hypertension management.
1
,Which of the following medication classes has been shown to improve the short-
term rate of cognitive preservation in mild to moderate Alzheimer's dementia
patients?
A Acetylcholinesterase inhibitors
B Decarboxylase inhibitors
C Dopamine receptor agonists
D Monoamine oxidase inhibitor
E N-methyl-D-aspartate receptor antagonist
ANS:A - ANSWER-A Acetylcholinesterase inhibitors
Alzheimer's dementia is a chronic, progressive, neurodegenerative disorder.
Acetylcholinesterase inhibitors have been associated with a modest decrease of
cognitive decline and increased functioning. These medications increase the levels
of acetylcholine, a neurotransmitter, and increase cholinergic activity within the
affected brain regions. They have been approved for use in mild to moderate
Alzheimer's disease.
Memantine, an N-methyl-D-aspartate receptor antagonist, is indicated for use in
moderate to severe disease, has been associated with decreased destruction of
cholinergic neurons, and may slow cognitive decline. It is often added to
acetylcholinesterase inhibitor therapy for progressed disease, but may be first line
in a patient unable to tolerate the acetylcholinesterase inhibitor medications.
Decarboxylase inhibitor medications inhibit the metabolism of dopamine; one
example, carbidopa, is used in conjunction with L-dopa in the treatment of
Parkinson's disease.
Dopamine receptor agonists activate dopamine receptors in the absence of
dopamine, and are useful in conditions with low dopamine levels, such as
Parkinson's, prolactinomas, and restless leg syndrome.
2
, Selegiline, a monoamine oxidase inhibitor, is selective for monoamine oxidase-B
and inhibits catabolic dopamine breakdown, with a potential neuroprotective
effect. Use in moderately advanced Alzheimer's disease may slow progression, but
remains controversial.
A newborn baby boy is listless and febrile. He has diarrhea and vomiting as well.
There is no nuchal rigidity, however CSF examination confirms meningitis. He is
being treated with gentamicin and ampicillin.
Question
What is a common side effect he may experience?
Answer Choices
1 Rash
2 Constipation
3 Thrombocytopenia
4 Leukopenia
5 Elevated liver enzymes
ANS: 1 - ANSWER-rash
Explanation Skin rash is a common side effect of ampicillin. Rash occurs at a rate
of approximately 3-7%. Constipation is not a side effect of ampicillin. Diarrhea is a
side effect of ampicillin, rather than constipation. Thrombocytopenia, leukopenia,
and elevated liver enzymes can be seen but less frequently than a rash. References:
A 67-year-old man with an 80-pack/year smoking history and chronic bronchitis
presents 30 minutes after suffering what was described as a "seizure" by his wife.
According to his wife, this was his first seizure. During the seizure episode, the
patient did not lose consciousness, but was observed to have developed an
"involuntary jerking in his right arm and leg" that lasted about 5 minutes, with
right arm weakness immediately following this involuntary activity. On physical
exam, the patient appears drowsy, confused, and answers questions slowly. His
3
, right arm has objective weakness rated as 4/5; the remainder of the neurological
exam is normal.
Question Ico-delete Highlights
What aspect of this patient's presentation most closely identifies this event as a
simple focal seizure?
Answer Choices
1 Involuntary extremity jerking
2 Right arm weakness is noted
3 There was no impairment of consciousness
4 There is posticta - ANSWER-there was no impairment of consciousness
A 20-year-old college student describes his headaches as unilateral, a 5 out of 10
for pain, and with throbbing, associated with photophobia and often accompanied
by nausea and vomiting. He states that the headaches occur two to three times a
month and are associated with decreased sleep. He has taken OTC medication with
relief and is trying to stay on a sleep schedule. He denies any other neurologic
symptoms. Which of the following is the most appropriate next step for managing
this patient?
A Brain MRI
B Hydrocodone-acetaminophen tablets
C Physical therapy
D Topiramate
E Sumatriptan nasal spray
ANS: - ANSWER-Classic migraines often present with episodic, unilateral, and
throbbing headache pain, associated with photophobia and phonophobia. Nausea
and vomiting may also be involved. Management of migraines includes
nonpharmacologic therapies, such as healthy eating, sleep pattern stabilization,
caffeine avoidance, and stress relief. If nonpharmacologic therapies are not
sufficient, or if symptoms impact activities of daily living, pharmacologic
management is indicated. Medications are available for migraine sufferers and are
4
Correct Answers/ NR 603 Advanced Clinical
Diagnosis and Practice Across the Lifespan Practicum
Week 1 Review – 150 Correctly Answered Questions
A 68-year-old female presents to the emergency department with signs and
symptoms of an acute ischemic stroke. The initial CT scan is normal. Her blood
pressure is 164/105. What is the most appropriate treatment for the blood pressure
of this patient?
A Atenolol PO
B Clonidine PO
C Close monitoring
D Labetolol IV
E Nicardipine IV
ANS:C - ANSWER-C Close monitoring
Aggressively lowering blood pressure may decrease blood flow to the ischemic
tissue, thus decreasing the chances of recovery or increasing the risk of further
infarction. In the setting of an acute ischemic stroke, blood pressure elevation
should be monitored closely, with some elevation expected. This elevation is
expected to decline without medication in the first few hours to days, but if
elevation continues to a systolic blood pressure greater than 220mmHg, or mean
arterial pressure greater than 120mmHg, medication is advised. Medications may
include intravenous labetolol or nicardipine, with close monitoring of the patient.
After the acute phase following a stroke, appropriate oral medications may be
considered for outpatient hypertension management.
1
,Which of the following medication classes has been shown to improve the short-
term rate of cognitive preservation in mild to moderate Alzheimer's dementia
patients?
A Acetylcholinesterase inhibitors
B Decarboxylase inhibitors
C Dopamine receptor agonists
D Monoamine oxidase inhibitor
E N-methyl-D-aspartate receptor antagonist
ANS:A - ANSWER-A Acetylcholinesterase inhibitors
Alzheimer's dementia is a chronic, progressive, neurodegenerative disorder.
Acetylcholinesterase inhibitors have been associated with a modest decrease of
cognitive decline and increased functioning. These medications increase the levels
of acetylcholine, a neurotransmitter, and increase cholinergic activity within the
affected brain regions. They have been approved for use in mild to moderate
Alzheimer's disease.
Memantine, an N-methyl-D-aspartate receptor antagonist, is indicated for use in
moderate to severe disease, has been associated with decreased destruction of
cholinergic neurons, and may slow cognitive decline. It is often added to
acetylcholinesterase inhibitor therapy for progressed disease, but may be first line
in a patient unable to tolerate the acetylcholinesterase inhibitor medications.
Decarboxylase inhibitor medications inhibit the metabolism of dopamine; one
example, carbidopa, is used in conjunction with L-dopa in the treatment of
Parkinson's disease.
Dopamine receptor agonists activate dopamine receptors in the absence of
dopamine, and are useful in conditions with low dopamine levels, such as
Parkinson's, prolactinomas, and restless leg syndrome.
2
, Selegiline, a monoamine oxidase inhibitor, is selective for monoamine oxidase-B
and inhibits catabolic dopamine breakdown, with a potential neuroprotective
effect. Use in moderately advanced Alzheimer's disease may slow progression, but
remains controversial.
A newborn baby boy is listless and febrile. He has diarrhea and vomiting as well.
There is no nuchal rigidity, however CSF examination confirms meningitis. He is
being treated with gentamicin and ampicillin.
Question
What is a common side effect he may experience?
Answer Choices
1 Rash
2 Constipation
3 Thrombocytopenia
4 Leukopenia
5 Elevated liver enzymes
ANS: 1 - ANSWER-rash
Explanation Skin rash is a common side effect of ampicillin. Rash occurs at a rate
of approximately 3-7%. Constipation is not a side effect of ampicillin. Diarrhea is a
side effect of ampicillin, rather than constipation. Thrombocytopenia, leukopenia,
and elevated liver enzymes can be seen but less frequently than a rash. References:
A 67-year-old man with an 80-pack/year smoking history and chronic bronchitis
presents 30 minutes after suffering what was described as a "seizure" by his wife.
According to his wife, this was his first seizure. During the seizure episode, the
patient did not lose consciousness, but was observed to have developed an
"involuntary jerking in his right arm and leg" that lasted about 5 minutes, with
right arm weakness immediately following this involuntary activity. On physical
exam, the patient appears drowsy, confused, and answers questions slowly. His
3
, right arm has objective weakness rated as 4/5; the remainder of the neurological
exam is normal.
Question Ico-delete Highlights
What aspect of this patient's presentation most closely identifies this event as a
simple focal seizure?
Answer Choices
1 Involuntary extremity jerking
2 Right arm weakness is noted
3 There was no impairment of consciousness
4 There is posticta - ANSWER-there was no impairment of consciousness
A 20-year-old college student describes his headaches as unilateral, a 5 out of 10
for pain, and with throbbing, associated with photophobia and often accompanied
by nausea and vomiting. He states that the headaches occur two to three times a
month and are associated with decreased sleep. He has taken OTC medication with
relief and is trying to stay on a sleep schedule. He denies any other neurologic
symptoms. Which of the following is the most appropriate next step for managing
this patient?
A Brain MRI
B Hydrocodone-acetaminophen tablets
C Physical therapy
D Topiramate
E Sumatriptan nasal spray
ANS: - ANSWER-Classic migraines often present with episodic, unilateral, and
throbbing headache pain, associated with photophobia and phonophobia. Nausea
and vomiting may also be involved. Management of migraines includes
nonpharmacologic therapies, such as healthy eating, sleep pattern stabilization,
caffeine avoidance, and stress relief. If nonpharmacologic therapies are not
sufficient, or if symptoms impact activities of daily living, pharmacologic
management is indicated. Medications are available for migraine sufferers and are
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