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APEA QUESTIONS AND ANSWERS (NEUROLOGY)
The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as: alertness When assessing the patient’s sense of position, instruct the patient to first stand with his feet together and eyes open, then instruct him to close both eye for 30- 60 seconds. If he loses his balance with his eyes closed, this is: suggestive of ataxia related to dorsal column disease When comparing two sides of the body for symmetric sensation a symmetrical distal sensory loss would be suggestive of: polyneuropathy A female patient complains of weakness in her arm when combing her hair. This finding could be suggestive of which type of weakness pattern? Proximal Having the patient shrug his shoulders and elicit neck movements would be testing cranial nerve: XI It is imperative to assess for suicidality and bipolar disorder in patients suspected of experiencing: depression Which one of the following procedures should NOT be performed in a comatose patient? Dilate the pupils With the adult patient laying supine, the nurse practitioner flexes that patient’s leg at both the hip and the knee and the straightens the knee. Pain and increased resistance to extending the knee is noted. This is a positive: Kernig’s sign The part of the brain that controls most functions in the body and is responsible for breathing, heart rate, and articulate speech is the: brainstem The patient has his eyes closed and an area on his right leg is briefly touched by the nurse practitioner. The patient is instructed to open his eyes and point to the area that was touched. This is an example of the discriminative sensation known as: point localization What geriatric condition is characterized by normal alertness but progressive global deterioration of cognition in multiple domains? Alzheimer’s disease Which one of the following assesses pain, temperature, and sensation using the distal and proximal areas testing pattern? Test the sensation in the thumbs and little fingers An 8-month-old with a significant head lag would suggest the need for: a neurological evaluation A form of aphasia in which the speech is confluent, slow, with few words and laborious effort and inflection and articulation are impaired but words are meaningful, is termed: Broca’s aphasia
With the patient lying supine, the nurse practitioner places her hands behind the patient’s head while flexing the neck forward until his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is a positive: nuchal rigidity sign When assessing coordination of muscles movement, four areas of the nervous system function in a integrate way. These areas include the motor, cerebellar,
motor performance, and loss of muscle mass or weakness suggests: frailty Symmetric weakness of the proximal muscles of the legs suggests a: myopathy Aphasia refers to: the inability to produce or understand language The part of the peripheral nervous system that regulates muscle movement and response to the sensations of pain and touch is the: somatic nervous system
Assessment findings in an infant with increased intracranial pressure would include: drowsiness What is an example of a disease or condition that appears in a dermatomal pattern? Shingles Common physical findings in a young child with cerebral palsy include which one of the following? Presence of crossed or touching knees The part of the peripheral nervous system that controls involuntary actions is known as the: autonomic nervous system Ptosis of the left eye would be suggestive of damage to which cranial nerve? Cranial nerve III (CN III) A patient who is being evaluated for frequent headaches, mentions that the headache worsens with coughing, sneezing, or when changing positions. Increasing pain with these maneuvers may be suggestive of: a brain tumor An infant presents with an inappropriately increasing head circumference and hydrocephalus confirmed by CT scan. In addition to these findings, which one of the following would also be consistent with hydrocephalus? Tense, bulging fontanels A 40-year-old male presents with complaints of headaches. History revels headaches that occurred daily for about 4-6 weeks. He had relief for 6 months but now they are recurring. These are most likely: cluster headaches Assessing the neurological status of a child with a ventriculoperitoneal shunt should include: use of the Glasgow coma scale During this type of seizure activity, the patient appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. This type of seizure activity is referred to as a: focal seizure with impairment of consciousness Which of the following neurological assessment findings indicate the need for further evaluations? Weak and ineffective sucking movements To evaluate a patient’s response to light touch sensation, the nurse practitioner would as the patient to identify: a touch on the skin in response to touching the skin with a cotton wisp A patient is instructed to stand, close both eyes, and extend both arms forward with the palms facing upward for 20-30 seconds. If the forearm drifts downward, this would indicate: corticospinal tract lesion A term used to describe an increase in the muscular bulk with diminished strength is: pseudohypertrophy Most peripheral nerves contain afferent and efferent fibers. The term efferent refers to: motor nerve fibers The Glasgow coma scale assesses: motor response When observing the thenar atrophy of hands, a typical observation is: furrowing in the spaces between the metacarpals
During this type of seizure activity, the patient loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. This type of seizure activity is referred to as a: grand mal seizure Persistent blinking after glabellar tap and difficulty walking heel-to- toe are common in: Parkinson’s disease An indication that there is a malfunction of a ventriculoperitoneal (VP) shunt in an older child would be the presence of a: headache upon awakening When assessing anal reflexes, the nurse practitioner strokes the four quadrants of the anus with a cotton swab. A loss of anal reflex is noted. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Sacral 2, 3, and 4 The part of the brain that maintains homeostasis is the: hypothalamus Symptoms indicative of Shaken Baby Syndrome are related to: uncontrollable cerebral edema and hypoxia On examination of the adult patient, symptoms of flexed posture, tremor, rigidity, and shuffling gait are observed. These findings are consistent with: Parkinson’s disease The level of consciousness that refers to the patient that arouses from sleep only after painful stimuli is known as: stupor When upper motor neuron systems are damaged below the crossover of its tracts in the medulla, motor impairment develops on the same side. This term is: ipsilateral A form of aphasia where articulation is good, but sentences lack meaning is referred to as: Wernicke’s aphasia When upper motor neuron systems are damaged above the crossover tracts in the medulla, motor impairment develops on the opposite side. This term is: contralateral A sudden brief lapse on consciousness with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with: an absent seizure A patient is asked to visually follow a finger through the cardinal fields of gaze. Which cranial nerves are being assessed? III, IV, VI When a patient complains of severe headache that have worsened over the last few weeks, but she has no other symptoms, a most likely diagnosis would be: a tumor A form of aphasia in which the person has word-finding difficulties for speaking and writing is known as: anomic aphasia A neurologic assessment to evaluate neurologic input to the cerebellum is: Romberg test Symmetric weakness of the distal muscles of the legs suggests a: polyneuropathy
A patient presents with a history of a temperature of 102F, headache, and pink papules on the upper chest several hours ago. Petechiae and ecchymosis are noted on the trunk. These skin lesions may be indicative of: meningococcemia When assessing the cranial nerves, the nurse practitioner observes that the soft palate does not rise when the patient is instructed to say “ah”. This finding could be suggestive of a bilateral lesion in which cranial nerve? Cranial nerve X (CN X) A progressive disorder of the nervous system that affects movement is known as: Parkinson’s disease A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is: a tremor On examination of an eighteen-year-old which one of the following neurological signs would be helpful if meningitis is suspected? Loss of the anal reflex Bilateral weakness in the cranial nerve V (CN V) would be suggestive of a: bilateral hemispheric disease A form of aphasia in which the person has difficulty speaking and understanding words and is unable to read or write them is termed: global aphasia The term used to describe the impaired ability to adjust one’s body position is: bradykinesia When assessing coordination of muscles movement, four areas of the nervous system function in a integrate way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates position sense? Sensory system Involuntary movements of the body that are slower and more twist and writhing than choreiform movements, and have a larger amplitude are suggestive of: athetoid movements The part of the brain that coordinates all movement and helps maintain the body upright in space is the: cerebellum To evaluate a patient’s response to temperature sensation, the nurse practitioner would ask the patient to identify: an object as being hot or cold Ataxia, diplopia, and dysarthria can be symptoms associated with all of the following conditions except: polyneuropathy During this type of seizure activity, the patient experiences partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurological deficit is present during the postictal period. This type of seizure activity is referred to as a: focal seizure that becomes generalized A teenager is being assessed for possible acute marijuana usage and appears intoxicated. Findings consistent with marijuana intoxication could include: euphoria, talkativeness, and paranoia
Symptoms of a migraine headache can include throbbing, nausea or vomiting, duration of one day, and be unilateral and/or disabling. How many of these symptoms should be present to classify the headache as a migraine? Three of the five Uncontrolled electrical activity in the brain, which may produce minor physical signs, thought disturbances, or disturbed motor activity is: seizure When evaluative the sensory system, testing the spinothalamic tracts would include assessing sensations of: pain and temperature An ischemic stroke: an infarction of the central nervous system tissue that may be silent or symptomatic On physical exam, the soft palate does not rise, there is an absent gag reflex, and the patient complains of taste abnormalities. This requires further evaluation of the: glossopharyngeal nerve (IX) Involuntary rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue are known as: oral-facial dyskinesias The central nervous system extends from the medulla into the: spinal cord Anesthesia refers to: absence of touch sensation When eliciting deep tendon reflexes in the ankle, the nurse practitioner notes an abnormal reflex in the right ankle. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Sacral 1 When assessing the cranial nerves, the nurse practitioner uses the tongue blade to gently stimulate the back of the throat on each side. A unilateral absence of the gag reflex is noted. This finding could be suggestive of a unilateral lesion in which cranial nerve? Cranial nerve IX (CN IX) A patient is unable to identify the smell of an orange. The inability could reflex an abnormality in cranial nerves: I Dysphonia refers to: an impairment in volume of the voice Hyperesthesia refers to: increased sensitivity to touch An ambulatory child with spastic cerebral palsy needs a diet: high in calories Physical exam of a well two-week-old infant revels a little dimple with a small amount of hair just about the sacral area. This could be: spina bifida occulta The level of consciousness that refers to the patient who opens his eyes, looks at the person speaking to him but responds slowly and appears confused is known as: obtundation Discriminative sensations include all of the following except: deep tendon reflexes The most widely used tool available to assess for dementia in elderly patients is the: Mini Mental State Examination (MMSE) When trying to determine the level of consciousness in a patient whose level of consciousness if altered, a lethargic patient: appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then
falls asleep An example of distal weakness is: the right hand The term used to describe the absence or loss of control of voluntary muscle movements is: akinesia
While palpating the temporal and masseter muscles, the patient is asked to clench his teeth and move his jaw from side to side. This maneuver would be assessing which cranial nerve? Cranial nerve V (CN V)
Involuntary movements of the body that involve larger portions of the body, including the trunk resulting in grotesque, twisting postures are suggestive of: dystonic movements The part of the brain tissue that consists of neuronal axons that are coated with myelin is the: white matter When assessing an elderly patient for delirium, the recommended instrument with the best supportive data is the: Confusion Assessment Method (CAM) To identify sensory deficits comparing symmetric areas, the nurse practitioner would compare the sensation: in both arms A patient is noted as lying supine in an abnormal posture with the upper arms flexed tight to the sides with elbows, wrists, and fingers flexed. His legs are extended and internally rotated and his feet and plantar flexed. This position is consistent with: decorticate rigidity Which one of the following symptoms is not associated with bulbar symptoms? Dysesthesias To evaluate a patient’s response to pain sensation, the nurse practitioner would ask the patient to identify: pain as sharp or dull when the thumb is touched using the sharp end of a safety pin When assessing plantar reflexes, the nurse practitioner strokes the lateral aspect of the sole from the heel to the ball of the right foot. Absence of movement of the big toe is noted. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Lumbar 5 and sacral 1 The principal muscles involved when closing the mouth are innervated by which cranial nerve? Cranial nerve V (CN V) When evaluating the sensory system, testing the posterior columns tract would include assessing sensations of: position and vibration While assessing the cranial nerves, the nurse practitioner touches the cornea lightly with a wisp of cotton. This maneuver assesses which cranial nerve? Cranial nerve V (CN V) The inability to hop in place on each foot, could be suggestive of a: cerebellar dysfunction A transient ischemic attack is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemia, without acute infarction Hyperalgesia refers to: increased sensitivity to pain Sudden, brief, rapid jerks, involving the trunk or limbs may be consistent with: a myoclonic seizure Assessment of a 70-year-old’s ability to maintain personal safety would be most adversely affected by declining function in the: sensory perception system A patient presents with sweating, tremors, palpitations, hunger, and
Mini mental status exam helps to identify patients who have symptoms of: cognitive impairment A 70-year-old exhibits a unilateral resting tremor. This likely indicates: Parkinson’s disease Which of the following below does NOT contribute to the risk of falls in older adults? Decreased hearing What produces demyelination of the nerve cells in the brain and spinal cord is: multiple sclerosis What medications is NOT used for migraine prophylaxis? Triptans A 50-year-old patient reports acute pain in his lower back that started 2 weeks ago after working in his yard. The pain radiates into his right leg intermittently. He has been managing his pain with ibuprofen. There are no red flags in his history or on exam. When should consideration be given to imaging studies? At 4 weeks A 14-year-old male client reports dull anterior knee pain, exacerbated by kneeling. What is the likely etiology? Osgood- Schlatter disease A 65-year-old male is diagnosed with an initial episode of gout. It is likely that he: will have severe inflammation in a single joint Which patient below should be screened for osteoporosis? 60-year-old male with rheumatoid arthritis Which statement below is true regarding NSAIDs for low back pain? They are associated with more side effects than acetaminophen An 8-year-old has a painful limp. He reports his knee hurts medially. On exam he has pain with internal rotation of the hip. How should the NP manage this situation? the NP should order a hip x-ray, CBC and ESR A patient is at increased risk of osteopenia if she uses which form of birth control? Injectable progestin An adolescent athlete has sprained his ankle. What instruction should be given to him regarding activity? He should be able to walk pain-free be he start to run The drop arm test is used to assess patients with suspected: rotator cuff injury A 79-year old frail adult reports that she had a fall last week. She had no broken bone but is very core. In evaluating this adult, what question is most important to ask? Have you had other falls this year? Which criterion below is a criterion for Alzheimer’s disease? Impairment of function Which finding in a patient with migraine headache symptoms would compel the examiner to order an imagining study? Rapidly increasing intensity of headache Which finding below is typical in a patient who has Bell’s palsy? Unilateral numbness of the cheek
All of the following characteristics may be found in an older adult with dementia. Which one is common in a patient with Alzheimer’s disease, but uncommon in a patient with another type of dementia? Indifference A 70-year-old patient has intermittent back pain secondary to a bulging disc for more than 3 years. In the last year, it is constant (pain scale 2-3/10) and at times
CARDIAC
A heart rate of 100 – 180 beats per minute in an adult is considered: sinus tachycardia The external iliac lymph nodes drain lymphatic fluid from the following areas except the: gluteal region To assess aortic pulsations in patients with carotid obstruction, assess the pulse using the: brachial region The sacral lymph nodes receive lymphatic fluid from all the following except the: gluteal region The patient has had an internal pacemaker in place for five years. Pacemaker failure is being considered because over the past few days, the patient has been experiencing episodes of: hiccoughs In older adults, the presence of heart sounds S3 suggests: heart failure A patient described chest pain as persistent, sharp, and knife-like. These symptoms are more characteristic of: pericarditis In older adults, the presence of heart sound S4 suggests: hypertension A disparity between the brachial and femoral pulses in a 4-month-old could indicate: coarctation of the aorta The axillary lymph nodes drain lymphatic fluid from all of the following areas except the: anterior chest wall Tissue ischemia is usually observed when assessing a patient with peripheral artery disease (PAD). What other symptom could be assessed? Intermittent claudication Causes of orthostatic hypotension in older adults may include all of the following except: impaired visual acuity A finding suggestive of an inflamed lymph node would be one that is: tender and moveable On assessment, which one of the following symptoms would be noted as a compensatory response to chronic hypoxia? Hematocrit (HCT) of 55% The great saphenous vein enters the deep venous system by way of the: femoral vein A pediatric patient presents with erythema marginatum, chorea, and a heart murmur. These symptoms are consistent with: rheumatic heart disease Enlargement of which lymph nodes would be suggestive of metastasis from a thoracic or abdominal malignancy? Supraclavicular Presence of a heart murmur in a child would be considered organic if the child: was a 2-year-old with a congenital heart defect Heart sounds produced by a turbulence due to a temporary increase in blood flow in predisposing conditions, such as hyperthyroidism, is considered: a physiologic murmur
A patient complains of increased pain in the calf muscle and buttocks especially after walking or riding his bicycle. He states that the pain stops after he sits still for about 2-3 minutes. This condition may be associated with: intermittent claudication
