APEA 3P EXAM Prep Neuro
Questions with Correct
Answers and Explanations
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?
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:
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?
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?
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?
, 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:
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?
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,
Questions with Correct
Answers and Explanations
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?
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:
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?
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?
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?
, 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:
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?
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,
