Chapter 22: The Neurologic System

Nurses who administer Sinemet as prescribed for the elderly should incorporate timing of the administration of Sinemet into the client's care plan and: 1. Give Sinemet 30 minutes after meals. 2. Give Sinemet 30 minutes before meals. 3. Give Sinemet 1 hour before meals. 4. Give Sinemet with meals, followed by a glass of water.

3. Give Sinemet 1 hour before meals.

Which of the following statements is accurate pertaining to frontotemporal dementia? Frontotemporal dementia: 1. Includes Lewy bodies, and is diagnosed on the basis of personality changes. 2. Is an abrupt onset dementia with abnormal reflexes and emotional instability. 3. Includes Pick's disease, and is diagnosed on the basis of personality changes and the presence of frontal brain atrophy. 4. Includes both Lewy and Pick's bodies inside nerve cells, and behavioral disinhibition.

3. Includes Pick's disease, and is diagnosed on the basis of personality changes and the presence of frontal brain atrophy.

A client with Alzheimer's disease (AD) frequently wanders during the night due to insomnia. Which of the following strategies may assist with modification? 1. Scheduled daytime naps 2. A cup of hot tea prior to bedtime 3. Comfortable bedding and a quiet environment 4. Brief exercise activity prior to bedtime

3. Comfortable bedding and a quiet environment

During assessment of an elderly client with history of seizure disorder the nurse would include specific questions regarding which of the following? Select all that apply. 1. Age of seizure onset 2. Frequency and types of attacks 3. Anti-seizure medication name, dosage, and frequency 4. Client's height

1. Age of seizure onset 2. Frequency and types of attacks 3. Anti-seizure medication name, dosage, and frequency

Which of the following drugs would the nurse anticipate being ordered for an elderly client with Parkinson's disease (PD)? 1. Carbidopa/Levodopa (Sinemet) 2. Memantine (Namenda) 3. Clopidogrel (Plavix) 4. Lioresal (Baclofen)

1. Carbidopa/Levodopa (Sinemet)

A 75-year-old female is diagnosed with early Alzheimer's disease (AD). Which of the following should the nurse incorporate in her plan of care for the client? Select all that apply. 1. Discussions with the patient about desired options and wishes 2. Providing information on available community services 3. Need to consider selection of a healthcare proxy 4. Need for inevitable placement in a nursing home

1. Discussions with the patient about desired options and wishes 2. Providing information on available community services 3. Need to consider selection of a healthcare proxy

Contraindications to thrombolytic therapy to treat an acute ischemic stroke include which of the following? Select all that apply. 1. Heparin use in the last 48 hours 2. History of intracranial hemorrhage 3. History of a Transient Ischemia Attack (TIA) in the past month 4. Blood pressure greater than 185/100 5. Blood pressure less than 120/80

1. Heparin use in the last 48 hours 2. History of intracranial hemorrhage 4. Blood pressure greater than 185/100

Cholinesterase inhibitor medications, such as donepezil (Aricept) and galatamine (Razadyne): 1. May slow the progression if taken in the early stages of Alzheimer's disease. 2. Eradicate a majority of the symptoms with Alzheimer's disease. 3. Should be taken on an empty stomach. 4. Are most effective in the late stages of Alzheimer's disease.

1. May slow the progression if taken in the early stages of Alzheimer's disease.

When planning client and family education regarding seizures, the nurse should include which of the following? Select all that apply. 1. Providing client and family with audiovisual aids for ongoing review. 2. Teaching how to identify and avoid precipitating factors for seizures. 3. Stressing the need to take medication as prescribed. 4. Instructing family member to place a spoon in the client's mouth during a seizure.

1. Providing client and family with audiovisual aids for ongoing review. 2. Teaching how to identify and avoid precipitating factors for seizures. 3. Stressing the need to take medication as prescribed.

A common and significant stressor and cause of agitation for a demented person is: 1. Television 2. Running water 3. Hand massage 4. Normal amplitude and tone of a human voice

1. Television

Parkinson's disease (PD) is referred to as an extrapyramidal syndrome because it manifests which of the following clinical symptoms? 1. Tremor, bradykinesia 2. Diarrhea, sweating 3. Constipation, hypotension 4. Somnolence and poor gait

1. Tremor, bradykinesia

Which of the following statements accurately describes Alzheimer's disease (AD)? Select all that apply. 1. The symptoms of AD, which include memory loss and altered cognition, are reversible if drug treatment is begun in the early stages. 2. Alzheimer's disease results from complex interactions between genetic and environmental factors. 3. Advanced age is the single greatest risk factor for development of AD. 4. The characteristic pathological changes of Alzheimer's disease are deposition of neurofibrillary tangles and plaques in brain tissue. 5. Atrophy of the frontotemporal lobe of the brain occurs in 80% of the cases.

2. Alzheimer's disease results from complex interactions between genetic and environmental factors. 3. Advanced age is the single greatest risk factor for development of AD. 4. The characteristic pathological changes of Alzheimer's disease are deposition of neurofibrillary tangles and plaques in brain tissue.

Question 20 The nurse determines that which one of the following statements is accurate? 1. Incidence of epilepsy decreases with advanced age. 2. Epilepsy is two or more unprovoked seizures. 3. People under 65 are twice as likely to develop new-onset epilepsy when compared to adult age groups over 75. 4. Antiepileptic medications act the same regardless of age category.

2. Epilepsy is two or more unprovoked seizures.

The nurse implements which of the following strategies to assist the client with Alzheimer's disease (AD) to participate in dressing? 1. Encourages the client to tie sneakers. 2. Lays out a jogging suit in the order in which patient should put it on. 3. Encourages the client to select and remove clothes from the closet. 4. Provides no verbal cues.

2. Lays out a jogging suit in the order in which patient should put it on.

The earliest symptom associated with Alzheimer's disease is which of the following? 1. Hallucinations 2. Short-term memory impairment 3. Behavioral disinhibition 4. Apraxia

2. Short-term memory impairment

The diagnostic measures used for clinical diagnosis in a person presenting with symptoms of Alzheimer's disease include which of the following? Select all that apply. 1. Abnormal MRI or CT scan findings of neuritic plaques and tangles. 2. Positive blood (serum) tests for beta-amyloid and tau proteins. 3. Patient history and physical examination. 4. Neuropsychological tests. 5. A dose of tacrine (Cognex) provides immediate improvement in memory.

3. Patient history and physical examination. 4. Neuropsychological tests.

A 70-year-old female presented to the emergency room with slurred speech and weakness of left upper and lower extremities, which started 30 minutes ago. Stat CT scan reveals evidence of acute ischemic stroke. Barring contraindication, which of the following treatment modalities should be considered? 1. Packed Red Blood Cells (PRBC) followed by furosemide (Lasix) 2. 25% albumin followed by 0.9% sodium chloride 3. Recombinant tissue plasminogen activator (rt-PA) 4. Heparin infusion alternating with Coumadin (Warfarin)

3. Recombinant tissue plasminogen activator (rt-PA)

The nurse is feeding a person with dementia, who spits out the food. The nurse's best immediate action to take is: 1. Stroke cheek and say "eat." 2. Stroke throat and say "swallow." 3. Stop, wait, and try with a bite of another food. 4. Hold head forward and slide spoon with food into side of mouth.

3. Stop, wait, and try with a bite of another food.

The nurse observes an elderly client exhibit stiffening of the muscles and loss of consciousness followed by a period of rhythmic jerking of the extremities. How should the nurse properly record this on the chart? 1. Client appears to have had a myoclonic seizure. 2. Client appears to have had an absence seizure. 3. Client appears to have experienced an atonic seizure. 4. Client appears to have had a tonic-clonic seizure.

4. Client appears to have had a tonic-clonic seizure. (Rationale: Tonic-clonic seizures have a duration of approximately 2 to 5 minutes and begin with a period of rigidity and stiffening of the muscles and loss of consciousness (tonic phase) followed by jerking of the extremities (clonic phase). Myoclonic seizures last only a few seconds and involve rhythmic jerking of a single muscle group. Absence seizures involve brief loss of attention with no loss of consciousness. In atonic seizure there is sudden loss of muscle tone and loss of postural control.)

The pathology of a stroke typically is not caused by which of the following? 1. Hemorrhage into the brain 2. An embolus or thrombus that occludes an artery 3. Rupture of an extracerebral artery causing subarachnoid hemorrhage 4. Damage to the cerebrum and myelin sheath

4. Damage to the cerebrum and myelin sheath