Nursing Final Exam Q&A on Neurological Disorders, Exams of Nursing

Download Nursing Final Exam Q&A on Neurological Disorders and more Exams Nursing in PDF only on Docsity! NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 Question 1 L. J. is a 55-year-old male who attended a funeral and found himself laughing during the service, but later that evening he was irritated with himself for what he had done. His wife said this was abnormal behavior and took him to his doctor to be evaluated. After L. J.’s MRI was reviewed, he was diagnosed with frontotemporal dementia. Which medication is recommended to help L. J. with his emotional outbursts? A . Memantine B . Escitalopram C . Donepezil D . Risperidone NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 Response Feedback: under Treatment subtitle: “The behavioral features are sometimes helped by SSRIs, and these are the best-studied treatments for these disorders.” Question 2 When can buprenorphine be initiated in a patient who is suffering from an opioid overdose? A . As soon as the patient is stabilized B . It should be administered as soon as you find the patient unconscious C . Right after naloxone is administered to prevent the patient from going back into opioid overdose D . When the patient is experiencing mild-to-moderate symptoms of withdrawal Response Feedback: “To avoid this problem, the initial buprenorphine dose should not be administered until the patient demonstrates mild-to-moderate symptoms of withdrawal.” Question 3 Of the following neurotransmitters, which one(s) are known to be severely disrupted in the disease Dementia with Lewy Bodies? I. Acetylcholine II. Glutamate III. Dopamine IV. GABA NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 patient will be thoroughly evaluated for the diagnosis of depression, what would you recommend as initial therapy? A . Amitriptyline B . Doxepin NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 C . Fluoxetine D . Bupropion Response Feedback: SSRIs are effective in treating depressive symptoms. Answer choices A & B are both TCAs and are advised against due to side effect profile and the fact this person is treatment naive (learned from previous exam) and answer choice D is contraindicated in a patient with seizures. Question 6 Which neurotransmitters are likely involved in the pathophysiology of withdrawal seizures? I. Serotonin II. Endorphins III. Glutamate IV. GABA V. Dopamine A . I and II B . II and V C . I and III D . III and IV Response Feedback: “Thus when an individual suddenly ceases alcohol use, the decrease in inhibitory effects in combination with fewer GABA receptors and increased glutamatergic discharge contributes to over-excitation and possible withdrawal seizures.” NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 Question 7 Which medication below should be routine for all suspected cases of alcohol intoxication and dependence? NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 I. Tau – tangles II. Beta-amyloid – tangles III. Tau – plaques IV. Beta-amyloid – plaques A . I and II B . II and III C . II and IV D . I and IV Question 10 T. K. is a 72-year-old female who has suffered many strokes in the past, likely due to uncontrolled hypertension and hyperlipidemia. She has now been diagnosed with vascular dementia due to memory loss and motor system slowing. What is the recommended treatment for T. K.? A . T. K. needs the drug donepezil to help with her memory loss only. B . T. K. needs the drug donepezil to help with her memory loss, but also needs her hypertension and hyperlipidemia controlled. C . T. K. needs the drug donepezil to help with her memory loss, but also needs her hypertension controlled. D . T. K. needs her hypertension controlled only Response Feedback: “Treatment for vascular dementia involves control of vascular risk factors (e.g., hypercholesterolemia, hypertension, inactivity, diabetes, excess alcohol use, cigarette smoking, hyperhomocysteinemia).” In NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 addition to treating these causes of CNS vascular disease, some literature indicates that symptomatic treatments (such as cholinesterase inhibitors or memantine) may be helpful for cognition. NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 Question 11 Which of the following alcohol screening tools lack sensitivity to detect hazardous/problem drinking? A . AUDIT B . AUDITC C . SASQ D . CAGE Response Feedback: “Compared to the SASQ or the AUDIT and AUDIT-C, the CAGE lacks sensitivity to detect hazardous/problem drinking.” Question 12 Which enzyme does disulfiram inhibit leading to a build-up of the ethanol metabolite acetaldehyde? A . Alcohol dehydrogenase B . Microsomal ethanol oxidizing enzyme C . Aldehyde dehydrogenase D . Aldehyde reductase Response Feedback: “Disulfiram inhibits acetaldehyde dehydrogenase leading to a buildup of the ethanol metabolite acetaldehyde” Question 13 Which of the following drugs in the treatment of Alzheimer’s Disease requires NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 will worsen their pain and disability and should be addressed in addition to treating the pain. Question 15 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 Choose the correct statement regarding an anti-ADHD medication and its respectful mechanism of action A . Methylphenidate – blocks reuptake of dopamine in the pre-synaptic neuron and promotes release of dopamine from their storage sites in the pre-synaptic neuron B . Amphetamines – blocks reuptake of norepinephrine and dopamine into presynaptic neurons C . Clonidine – blocks reuptake of dopamine in the pre-synaptic neuron and promotes release of dopamine from their storage sites in the pre-synaptic neuron D . Atomoxetine – acts by blocking the norepinephrine pump on the pre- synaptic membrane E . Guanfacine – blocks reuptake of norepinephrine and dopamine into presynaptic neurons Response Feedback: under atomoxetine subtitle: A & B are having their MOAs switched and C & E is completely incorrect since they are alpha-adrenergic agonists Question 16 Of the following neurotransmitters, which ones play a critical role in modulating attention in ADHD? I. Dopamine II. Epinephrine III. GABA IV. Norepinephrine NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 V. Glutamate A . II, III, and V B . II and IV NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 C . Focalin is the S-isomer D . There is no difference other than the formulations involved. Response Feedback: “The primarily active form of MPH appears to be the d-threo isomer, which is available in both immediate-release tablets (Focalin 2.5, 5, and 10 mg)” Question 20 The patient is a 16-year-old girl with a past history of substance use disorder. She has been known to abuse prescription opioids and smokes one pack of cigarettes every day. She has been in and out of recovery for the past year. During her last admission into a recovery center, she was diagnosed with ADHD, which may have contributed to her addictive personality. She presents to your clinic today to initiate pharmacotherapy for her new diagnosis. What would you recommend in this patient? Her current weight is 55 kg. A . Ritalin 10 mg twice daily B . Focalin 10 mg twice daily C . Daytrana 30 mg patch worn for 12 hours daily D . Atomoxetine 60 mg once daily Response Feedback: Ritalin and Focalin have abuse potential due to their short half-lives and multiple times a day dosing. Daytrana has the wrong instructions for the patch and still has an abuse potential due to being a stimulant (See table 10-1 for dosing instruction of the patch being worn for 9 hours but lasts 12 hours). Atomoxetine has the least abuse potential and appropriately dosed for patient’s weight. Page 110 in upper right column: “In these populations use of extended delivery stimulant preparations, which are more difficult to misuse, or non- NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 stimulants should be considered.” Question 21 Select the correct description of a somatoform disorder. NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 A . Somatization disorder – manifests as a pain syndrome with a significant loss of or alteration in physical function that mimics a physical disorder B . Conversion disorder – pain that causes significant impairment in occupation or social function, induces marked distress, or both C . Hypochondriasis – persistent belief that one has a serious illness, despite extensive medical evaluation D . Pain disorder – intentional production or feigning of physical symptoms Response Feedback: - Option A That description goes with conversion disorder. - Option B That description goes with pain disorder. - Option D That description goes with factitious disorder with physical symptoms. Question 22 FILL IN THE BLANK: is the main neurotransmitter behind reward systems in the brain, which usually leads to addiction when altered in any way. A . Norepinephri ne B . Serotonin C . Dopamine D . Acetylcholine Response Feedback: “Distribution of the endogenous reward systems in the brain is a common feature of drug abuse; most addictive drugs act by disrupting central nervous system (CNS) dopamine circuits.” - Table 16-1 as well all the drug types show alterations of dopamine pathways in some way Question 23 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 current physical symptoms.” Question 25 The experience of pain is ALWAYS subjective NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 A . True B . Fals e Response Feedback: “The experience of pain is always subjective.” Question 26 E. B., a 55-year-old female, is a patient at your clinic today who has a past medical history significant for breast cancer, hypertension, hepatic cirrhosis, type 2 diabetes, and a recent diagnosis of alcohol use disorder. She has no known drug allergies. She states she is ready to quit drinking but fears the cravings that it may bring. Which medication would you recommend for E. B. to begin? A . Naltrexone B . Acamprosate C . Any benzodiazepine D . Thiamine Response Feedback: “It is preferred for patients with liver damage since acamprosate is metabolized through the kidneys and not the liver” & Table 15-3 shows it reduces alcohol cravings; benzodiazepines are used in the acute setting if a patient is experiencing severe alcohol withdrawal that leads to seizures; thiamine is if a patient is admitted for alcohol intoxication. Question 27 Which of the following drugs is structurally similar to tramadol; thus, its opioid- mediated analgesia can be reversed by naloxone in mice? A . Venlafaxine NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 B . Ketorolac C . Duloxetine D . Gabapentin NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 Question 30 Which features are consistent with delirium? I. Acute onset II. Gradual onset III. Course of disease fluctuates IV. Course of diseases does not fluctuate V. Impaired attention VI. Normal attention A . II, IV, and VI B . I and III C . II and IV D . I, III, and V Response Feedback: “The onset of delirium is typically acute or subacute, the course often has marked fluctuations, and level of consciousness and attention are impaired.” Question 31 Of the axons involved in the transmission of pain, which one is thinly myelinated and conducts that first feeling of pain that is often felt as coming on as a sharp, rapid feeling? A . ß-∆ fibers NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 B . A-∆ fibers C . A-ß fibers D . C fibers NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 Response Feedback: “A-∆ fibers are 2 to 5 µcm in diameter and are thinly myelinated. They conduct “first pain,” which is immediate, rapid, and sharp with a velocity of 20 m/sec.” Question 32 Patient is a 10-year-old female with diagnosed ADHD who was started on Ritalin 5 mg twice a day over 2 months ago. She is still experiencing the triad of symptoms associated with ADHD (impaired attention, impulsivity, and excessive motor activity). Her mother reports that she is now having difficulty in falling asleep since starting the medication. She has been on no other anti-ADHD medications and the mother reports full compliance with medication regimen. What is the appropriate recommendation to make based on this scenario? A . Recommend psychotherapy in addition to current treatment B . Switch to low dose Focalin C . Add Clonidine D Switch to low-dose Adderall and titrate as appropriate in addition to psychotherapy Response Feedback: upper right column: “Consideration of another stimulant or ATMX is recommended when symptoms aren’t responsive or the patient experiences clinically significant side effects to initial medication. Given their pharmacodynamic differences, if an MPH product was initially selected, then moving to an amphetamine-based medication is appropriate.” - Choice A would be recommended if the patient had improvement in any of her symptoms, but the scenario makes it obvious she is not getting better, even after 2 months of therapy - Choice B is staying within the same stimulant class, therefore, would likely not see a big improvement in symptoms - Choice C is not considered first- NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 titration schedule to withdrawal the patient? I. Butalbital II. Lorazepam NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 III. Hydrocodone A . I only B . II only C . III only D . I and II Response Feedback: “Treatment should begin with an oral test dose of 200 mg of pentobarbital, a short-acting-barbiturate.” Question 36 Which of the following drugs is often used in the management of opioid addiction due to its ceiling effect? A . Buprenorphine B . Naloxone C . Clonidine D . Methadone Response Feedback: “Because of the ceiling effect seen with partial opiate agonists, there is no pharmacological benefit from doses higher than 32 mg/day.” Question 37 Which club drug is structurally similar to GABA? A . 3,4 – methylendedioxy- methamphetamine B . Ketamine NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 C . γ-hydroxybutyrate D . Ecstasy Response Feedback: under club drugs; Options A & D are the same drug NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 Y. R. is a 35-year-old woman who presents to your clinic today complaining of ankle pain. She said she was running the trail when she saw a snake. During a quick turn to run away from the snake, she twisted her ankle. Which of the following medications may be a good choice in helping Y. R. with her pain? A . Oxycodone B . Amitriptyline C . Ibuprofen D . Duloxetine Response Feedback: No specific page number, but ibuprofen would be the best choice since oxycodone isn’t recommended first-line (Box 17-1 on page 208) since no other medications have been trialed; TCAs and SNRIs wouldn’t be a good choice because the patient doesn’t show any signs of depression. Question 41 What should our treatment goal be with our patients when it comes to managing chronic pain? A . The goal is to make the pain go completely away. B . The goal is to make the patient feel numb so that the pain cannot be thought about. C . There are no specific treatment goals that we should discuss with our patients, just so they don’t get their expectations too high. D . The goal is to improve their function and to drop their pain scale to less than 5 out of 10. Response Feedback: “In general, treatment goals are reports of pain less than 5 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 out of 10 and an improvement in function.” Question 42 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 There are many different types of dementia. Which dementia is NOT a direct result of disrupted neurotransmitters, but a result of degeneration of different regions in the brain? Onset of the disease is typically before the age of 60, and very rare after the age of 75. A . Alzheimer’s Disease B . Dementia with Lewy Bodies C . Creutzfeldt-Jakob Disease D . Frontotemporal Dementias Response Feedback: under subtitle “Epidemiology and genetic risk factors” Question 43 A 59-year-old male has been admitted to the E. D. due to a methamphetamine overdose. The patient’s friend reported he ingested up to 2 grams because “he thought cops were coming to get him.” The patient’s vitals are all within normal limits, except his blood pressure is 180/110. What is the best recommendation to make at this time? A . Administer a beta-blocker like labetalol to help bring his blood pressure down B . Patient’s blood pressure is considered a hypertension urgency, but it is probably due to the drug overdose. No action is needed at this time until the drug has cleared his system. C . Blood pressure is not a concern right now, but supportive therapy should be provided in the incidence of respiratory depression. D . Administer an alpha-blocker like phentolamine to help bring his blood pressure down. NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 B . It does not undergo first-pass metabolism by the enzyme carboxylesterase in the liver. C . It can be cut up and sprinkled onto food so it can bypass first-pass metabolism in the liver. NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 D . It uses an osmotic releasing oral system technology to slowly deliver the drug to the enzyme carboxylesterase in order to make the drug last longer. Response Feedback: referring to MPH transdermal system (MTS; Daytrana): “Since the MPH is absorbed through the skin, it does not undergo first-pass metabolism by CES-1 in the liver, resulting in higher plasma MPH levels” Question 47 T. B. is a 55-year-old male who has diagnosed with type 2 diabetes 10+ years ago. He has since had complications from the disease and is suffering from severe neuropathy. On top of that, T. B. is struggling with his mental health and was recently told he could be depressed but he had refused treatment at that time. Besides getting his blood sugar under control, what medication(s) can we use that may be useful in helping T. B.? I. Nortriptyline II. Venlafaxine III. Duloxetine IV. Fluoxetine A . I, II, and III B . I and II C . II and III D . IV only Response Feedback: “Among the antidepressants these include the TCAs and SNRIs (duloxetine and venlafaxine).” - SSRIs – page 204: “There is little evidence to support the independent analgesic activity of SSRIs.” NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023 Question 48 NRS-6630/NURS-6630/NURS6630C/NURS6630F FINAL EXAM Q & AS 100%CORRECT ANSWERS 2023