Neurologic Function

2. The nurse plans the care for the hospice client with end-stage Parkinson's disease. Which of the following symptoms should the nurse expect to incorporate into the nursing care plan? A) Bradykinesia B) Hemiparesis C) Hemiplegia D) Visual impairment

Ans: A Feedback: Bradykinesia (slow movement) must be incorporated in a plan of care for the client with end-stage Parkinson's disease. The others are not common findings with Parkinson's disease.

18. A nurse is evaluating an elderly client's lifestyle to determine the level of risk for neurovascular problems. Which of the following should the nurse identify to the client as the most significant lifestyle risk factor for neurovascular problems such as Parkinson's disease and stroke? A) Cigarette smoking B) Failure to use seat belts C) Sexually transmitted disease D) Alcohol and drug abuse

Ans: A Feedback: Cigarette smoking is a significant risk factor for neurovascular disease; the other choices, although they can lead to neurologic dysfunction, are not the most significant risk factors.

24. The nurse advises the 80-year-old patient not to sleep slumped in the recliner. The nurse explains that proper positioning of the head and neck can help prevent transient ischemic attacks (TIAs) in which of the following ways? A) Preventing impairment of cerebral blood flow B) Increasing neck muscle strength C) Maintaining blood pressure in a normal range D) Decreasing muscle tension

Ans: A Feedback: Hyperextension and flexion of the head can interfere with normal cerebral circulation, which may lead to TIAs; thus, proper positioning of the head and neck is important. Although other benefits are possible, they are not associated with avoiding TIAs.

16. Which of the following patients on a subacute geriatric medicine unit is likely at the highest risk for experiencing a cerebrovascular accident (CVA)? A) Mr. L, age 79, who has poorly controlled hypertension and smokes half a pack of cigarettes daily. B) Mrs. H, a 90-year-old woman, who has a diagnosis of vascular dementia. C) Mr. J, a 77-year-old man, who has experienced an upper GI bleed and required a transfusion of packed red blood cells. D) Mrs. N, age 83, who has had a recent fall resulting in a broken left wrist and hip.

Ans: A Feedback: Hypertension and smoking are significant risk factors for CVA. The other cited health problems are less closely associated with stroke.

20. The nurse initiates teaching for the client who takes levodopa (Larodopa). Which of the following should the nurse caution the patient to avoid? A) Foods high in vitamin A B) Anticholinergic drugs C) Foods high in vitamin B6 D) Passion flower herbs

Ans: C Feedback: Foods high in vitamin B6 counteract the effects of levodopa. None of the other choices are contraindicated.

4. The nurse monitors a group of older adults exercising at the wellness center. For which of the following new assessment findings should the nurse immediately call first responders? A) Inability to speak and imbalance B) Muscle spasms and pain C) Nausea and lethargy D) Tremor in the hands

Ans: A Feedback: New onset of inability to speak and imbalance strongly suggests a cerebrovascular accident or transient ischemic attack. The other symptoms described are symptoms of Parkinson's disease or diabetes that would not require a 911 call.

9. An 83-year-old resident of a nursing facility worked as a chef until retirement. The resident told the nurse "I am greatly disappointed that food just doesn't taste as good as it used to." Which of the following facts should underlie the response that then nurse chooses? A) The function of the cranial nerves mediating taste declines with age. B) Decreased taste sensitivity is indicative of periodontal disease or thrush. C) While hearing, sight, and smell diminish with the aging process, taste is normally unaffected. D) The neurological components of the sense of taste normally disappear by the ninth decade.

Ans: A Feedback: Some decline in the cranial nerves mediating taste is a normal, age-related change, though complete disappearance of taste would constitute a pathological finding. Some loss of taste acuity is not necessarily indicative of oral disease.

22. The nurse prepares the patient for a test to determine the cause of the cerebrovascular accident (CVA). For which test should the nurse teach the client and family? A) Carotid Doppler studies B) Visual acuity testing C) Arterial blood flow to weakened extremity D) Speech therapy evaluation

Ans: A Feedback: Those with arteriosclerosis are at risk for thrombus formation causing most CVAs. Carotid Doppler studies examine the blood flow to the brain and arteriosclerosis. The other choices evaluate the impact of cerebrovascular attacks.

21. Relatives brought an elderly relative to the health center because they noticed a new behavior in the elderly person. The nurse practitioner explained that the behavior they noticed was characteristic of Parkinson's disease. Which of the following symptoms was most likely noticed in their relative? A) Forced eyelid closure B) Faint tremor in the hands or feet C) Depression D) Difficulty in swallowing

Ans: B Feedback: A progressive, faint tremor is often an early sign of Parkinson's disease. Forced eyelid closure, dysphagia, and depression are likely later signs.

7. The nurse provides for the care of the client after a cerebrovascular accident with expressive aphasia. Which of the following interventions should be the priority intervention? A) Listen for the intent of the message and do not concentrate on the words. B) Devise a picture chart for the patient to point for requests. C) Encourage the client to speak when no one is around. D) Remind the patient that no improvement is expected.

Ans: B Feedback: Although listening for intent is appropriate, the high priority is to devise a method of communication that allows the patient to express requests or needs. Recovery continues for years and improvement can occur, albeit slowly.

8. During a health promotion seminar, a nurse is teaching a group of older adults at a senior center about some of the normal changes that accompany the aging process. Which of the following statements about the effects of aging on the nervous system is most accurate? A) "It's actually a myth that intellectual performance and verbal skills deteriorate in older adults." B) "Your brain actually becomes smaller as you age and this affects how quickly older adults react." C) "The brain's ability to assimilate new information decreases greatly after age 65." D) "While blood flow through the brain remains consistent across the life span, the electrical activity of the brain declines somewhat later in life."

Ans: B Feedback: Brain atrophy and loss of brain weight are considered normal, age-related changes. It is normal for some loss of verbal and intellectual skills to occur though the brain is still able to assimilate new information. Blood flow in the brain declines with age.

19. An autopsy shows that Lewy bodies were present in a patient's brain. Which of the following characteristics did the living patient probably exhibit? A) Hemiparesis B) Tremor C) Diplopia D) Aphasia

Ans: B Feedback: Lewy bodies are found in patients with Parkinson's disease. Choices A, C, and D are associated more with stroke.

27. Nurses should promote activities that reduce patients' risk of cerebrovascular accident (CVA). Which of the following is the most helpful activity to promote for reducing that risk? A) Maintaining physical activity B) Managing hypertension C) Maintaining adequate hydration D) Getting sufficient nutrition

Ans: B Feedback: Managing hypertension is the most important strategy. The other three choices, though less important, do tend to improve cerebral perfusion levels and general health.

11. During a health promotion class, a group of older adults asks the nurse to teach them measures that they can take to foster neurologic health. What should the nurse tell the group? A) "Neurological illnesses are generally the result of factors beyond your control." B) "Quitting smoking and maintaining a healthy body weight can cut your risk of neurological diseases." C) "The best protective measure for your neurological health is to avoid environmental toxins and eat a healthy diet." D) "The more mentally active you stay by continually reading and learning, the less your chance of developing neurological disease."

Ans: B Feedback: Many, but not all, neurologic illnesses exist for reasons beyond an individual's control. Smoking cessation and preventing obesity have been shown to have a preventative effect. Avoidance of toxins and maintaining mental activity are less significant preventative measures.

5. The nurse assesses the members of a senior center. For which of the following new findings should the nurse require immediate follow-up by the primary care provider? A) Blood pressure of 96/62 mm Hg B) Numbness of hands C) Urinary incontinence D) Opaque sclera

Ans: B Feedback: Numbness and tingling can be a subtle indication or neurologic problems. Blood pressure of 96/62 mm Hg is adequate for perfusion; the other findings can be followed up at a later date.

14. A 77-year-old patient has been brought to the emergency department by the daughter due to recent visual disturbances and unilateral weakness. The diagnostic workup has led the diagnosis of transient ischemic attacks (TIAs). Which of the following patient history most likely contributed to the patient's current health problem? A) The patient was treated for anemia 3 months ago. B) The woman is a smoker and takes antihypertensive medications. C) The woman has a history of recurrent deep vein thromboses. D) The woman was diagnosed with Parkinson's disease early this year.

Ans: B Feedback: Smoking and the use of antihypertensives are associated with TIAs. The other cited health issues are less often contributors to TIAs.

17. The son and daughter of an 80-year-old woman have expressed concern to the nurse that their mother has become impatient and irritable since her stroke earlier in the year. How should the nurse best respond to the children's concerns? A) "There is a new generation of medications that can help control outbursts with very few side effects." B) "This could be a sign that your mother is still experiencing transient ischemic attacks, so I will make sure to let her physician know." C) "This is not an uncommon consequence of a stroke that must be difficult for you to see, since it is uncharacteristic of her personality." D) "This is likely a temporarily response to the difficult changes that a stroke causes, and these behaviors will likely diminish with time."

Ans: C Feedback: Neurologic illnesses are often accompanied by profound and uncharacteristic behavioral changes, requiring understanding and patience. It would be inappropriate to direct the family toward medications or to tell the family that the changes will resolve. Such changes are not necessarily indicative of transient ischemic attacks.

13. A nurse who provides care in a long-term facility is working with a 78-year-old resident who has a diagnosis of Parkinson's disease. Which of the following aspects of the care the nurse provides should be reconsidered or modified? A) The nurse encourages the resident to continue to participate in the regular exercise programs at the facility. B) The nurse provides assistance with activities of daily living when necessary but encourages the resident to do what can be done independently. C) The nurse phrases questions and directions in a simple and understandable manner applicable to the client's decreased cognition. D) The nurse facilitates active and passive range of motion exercises on a regular basis.

Ans: C Feedback: Older adults with Parkinson's disease should not be assumed to have cognitive impairments. The other interventions are valid.

23. The nurse initiates teaching for the patient and family with newly diagnosed Parkinson's disease. In communicating with the patient and his family, which of the following should the nurse emphasize? A) Speech problems may affect the patient's expressive abilities. B) Emotional stability is maintained as the disease progresses. C) The disease progresses slowly, and therapy can minimize disability. D) Intellectual functioning is eventually impaired by this disease.

Ans: C Feedback: Patients with Parkinson's disease may appear to have intellectual problems because of difficulty with speech and emotion, but they do not lose their mental abilities.

10. During a neurologic evaluation, the nurse practitioner has asked an 83-year-old client to draw the face of the clock and then tell the nurse what time the clock reads. Which of the following assessment findings would be most indicative of expressive aphasia? A) The client appears unable to understand and follow the instruction. B) The client draws a person's face rather than the face of a clock. C) The client draws a clock but is unable to state the time. D) The client draws a clock with four hands rather than two.

Ans: C Feedback: The patient with expressive aphasia will be able to understand commands but will not be able to put symbols together into an intelligent speech form. This phenomenon is best demonstrated by answer C.

12. A 79-year-old male patient has a number of health problems, including Parkinson's disease. Which of the following signs and symptoms would the nurse attribute to the client's diagnosis of Parkinson's disease? (Select all that apply.) A) The patient's vision is gradually deteriorating. B) The patient experiences frequent, severe headaches. C) The patient moves slowly and has poor balance. D) The client shuffles when walking. E) The patient's face is less expressive than when healthy. F) The patient is emotionally unstable.

Ans: C, D, E, F Feedback: While visual disturbances and headaches are not closely associated with Parkinson's disease, the other cited signs and symptoms are associated with it.

29. A nurse is communicating with a family that includes an elder who has neurologic problems. What should the nurse suggest the family include in the home to lessen the likelihood of injury to the elder? A) Scatter rugs rather than wall-to-wall carpeting B) Soft, restful lighting in all areas C) Kitchen chairs with wheels for easy movement D) Smoke alarms with batteries that are replaced often

Ans: D Feedback: Dim lighting increases the possibility of falls as do loose scatter rugs and furniture with wheels. Smoke alarms are important in every home, but a fire can be especially dangerous to a patient who may respond slowly to danger.

15. A nurse is providing care for an 80-year-old patient who experienced an ischemic cerebrovascular accident (CVA) 3 weeks prior. Which of the following nursing actions is most likely to appropriately address the cognitive changes that have accompanied the patient's stroke? A) Discuss distant past events while avoiding discussions of recent events. B) Emphasize written rather than spoken communication on the part of both the patient and the nurse. C) Increase the volume of spoken communication as much as possible. D) Talk to the patient and give explanations while performing routine care tasks.

Ans: D Feedback: It is beneficial for post-CVA patients to be spoken to and have routine activities explained. While distant memory often remains more intact, it would not be appropriate for the nurse to avoid discussion of current or recent events. It would likely be inappropriate and/or unnecessary to forego spoken communication in favor of written communication. The nurse should speak clearly and distinctly but in not too high a volume.

25. Good nursing care of a patient who has had a cerebrovascular accident (CVA) can improve the patient's chance of survival and minimize the limitations that impair a full recovery. In the acute phase, nursing efforts should prioritize which of the following aims? A) Teach compensatory techniques for impaired communication. B) Talk to the patient during routine activities. C) Initiation of rehabilitation. D) Maintain a patent airway.

Ans: D Feedback: Maintaining a patent airway is an aim of nursing efforts for any patient who has had a CVA and would supersede the other noted interventions.

6. The nurse presents at a seminar on neurologic health issues in older adults. Which of the following data should the nurse include in the presentation? A) Neurological health is in the hands of God. B) Older adults are not at risk for sexually transmitted infections (STIs) that impact the neurologic system. C) Head and neck injuries can be avoided with the use of protective gear like seat belts. D) A low body mass index reduces the risk of neurovascular disease.

Ans: D Feedback: Maintaining weight and cholesterol levels within their ideal range, avoiding cigarette smoking, effectively managing stress, driving safely, and controlling infections can prevent some neurologic conditions. While using a seat belt reduces risk, it does not eliminate it. Any person who is sexually active is at risk for STIs, including the aged.

28. Promoting independence in an older patient with neurologic problems may take many forms. What advice to a patient's family would most help the patient achieve maximum levels of independence? A) Attend lectures on self-improvement. B) Prepare for personality changes in the patient. C) Complete tasks for the patient. D) Install self-help devices in the home.

Ans: D Feedback: Self-help devices can extend the time that older patients can live independently in the community and would likely be of greater utility than the other listed activities.

26. A patient recovering from a stroke at home seems to have a pleasant environment. Family members come in to talk with him, and he has his own familiar clothing and books in his room. A calendar shows the current date. A television and a radio are near his bed. No one disturbs him with the details of his condition. However, he seems depressed and anxious. A visiting nurse would most likely recommend which of the following? A) Encouraging reminiscence. B) Giving him antidepressant drugs. C) Redecorating his room. D) Giving him more information.

Ans: D Feedback: The environment should be simplified, consistent, and soothing. The patient needs to know the state of his health and what is being done to him.

3. The home care nurse plans the environment of the client with Parkinson's disease. Which of the following should the environment include? A) Brightly colored throw rugs B) Electric adjustable bed with side rails C) Weight training bench and weights D) Shower with nonslip surface and rails

Ans: D Feedback: Tub rails and nonslip tub surfaces are appropriate for clients with Parkinson's disease. While an adjustable bed may be useful, mobility equipment should be individually decided with input from the occupational and physical therapists.

1. The nurse assesses a client with Parkinson's disease. Which of the following symptoms are unexpected, requiring immediate follow-up? A) Drooling B) Hallucinations C) Hypoglycemia D) Tremors

C Feedback: Hypoglycemia is not an expected symptom from either Parkinson's disease or its treatment, and it would require immediate attention. The other symptoms relate to either Parkinson's disease or its treatment and no immediate follow-up is necessary.