, NURS 5461 MODULE 4 QUIZ
Adult Gerontology Primary Care
University of Texas at Arlington (UTA) 100-
Question Original Practice Quiz
2026/2027 Edition
Practice focus: Parkinson disease, essential tremor, multiple sclerosis, Guillain-Barre syndrome, myasthenia gravis,
seizures, headache syndromes, stroke red flags, peripheral neuropathy, spine syndromes, and neurologic medication safety
in older adults.
1. A 74-year-old has a resting tremor, bradykinesia, rigidity, and a shuffling gait. Which diagnosis is most
likely?
A) Cerebellar ataxia.
B) Parkinson disease.
C) Peripheral neuropathy.
D) Essential tremor.
Correct Answer: Parkinson disease.
Rationale:
Parkinson disease is defined clinically by bradykinesia plus resting tremor, rigidity, or postural instability. The classic tremor
occurs at rest and often decreases with purposeful movement. Essential tremor is typically action-related, while cerebellar
disease more often causes intention tremor and gait ataxia.
2. Which pathophysiologic change is central to Parkinson disease?
A) Destruction of anterior horn cells.
B) Demyelination of peripheral nerves.
C) Loss of dopaminergic neurons in the substantia nigra.
D) Autoimmune attack on acetylcholine receptors.
Correct Answer: Loss of dopaminergic neurons in the substantia nigra.
Rationale:
Parkinson disease results from progressive degeneration of dopaminergic neurons in the substantia nigra pars compacta.
Reduced dopamine alters basal-ganglia circuitry, producing bradykinesia, rigidity, and tremor. The other choices describe
motor-neuron, neuromuscular-junction, or peripheral demyelinating disorders.
3. Which tremor pattern most strongly supports essential tremor rather than Parkinson disease?
A) Unilateral resting tremor with bradykinesia.
B) Pill-rolling tremor that lessens with movement.
C) Bilateral action tremor that worsens with holding objects.
D) Rest tremor plus cogwheel rigidity.
Correct Answer: Bilateral action tremor that worsens with holding objects.
Rationale:
Essential tremor is most apparent with posture or action and often affects both hands. Parkinson tremor is typically present
at rest, asymmetric early, and accompanied by bradykinesia or rigidity. Family history and transient improvement with
alcohol can also support essential tremor.
4. A patient with Parkinson disease develops increasing 'off' periods despite regular levodopa-carbidopa
dosing. Which adjunct may extend levodopa effect?
A) A first-generation antihistamine.
B) A benzodiazepine used chronically for all symptoms.
C) A strong dopamine antagonist.
D) A COMT inhibitor such as entacapone.
NURS 5461 Module 4 Practice Quiz 1 2026/2027 Edition
, Correct Answer: A COMT inhibitor such as entacapone.
Rationale:
COMT inhibitors reduce peripheral levodopa breakdown and can prolong the clinical response, reducing wearing-off
periods. Dopamine antagonists may worsen parkinsonism. Sedating or anticholinergic drugs often increase falls, confusion,
and other geriatric adverse effects.
5. Why is metoclopramide generally avoided in a patient with Parkinson disease?
A) It blocks dopamine receptors and can worsen parkinsonian symptoms.
B) It causes excessive dopamine production.
C) It improves rigidity but worsens only constipation.
D) It permanently raises levodopa levels.
Correct Answer: It blocks dopamine receptors and can worsen parkinsonian symptoms.
Rationale:
Metoclopramide antagonizes central dopamine receptors and may worsen bradykinesia, rigidity, or tremor. Older adults with
Parkinson disease are especially vulnerable to extrapyramidal effects and tardive dyskinesia, so alternatives are generally
preferred when feasible.
6. Which nonmotor symptom is common in Parkinson disease?
A) Profound sensory loss in a stocking pattern.
B) Acute monocular blindness.
C) Hyperreflexia from corticospinal injury.
D) Constipation.
Correct Answer: Constipation.
Rationale:
Parkinson disease commonly includes nonmotor manifestations such as constipation, orthostatic hypotension, anosmia,
sleep disturbance, depression, cognitive change, and urinary symptoms. These may precede or complicate the motor
syndrome and should be incorporated into routine primary-care assessment.
7. A patient with Parkinson disease has recurrent falls when turning. Which intervention is most appropriate?
A) Eliminate all exercise.
B) Physical therapy with gait and balance training.
C) Long-term bed rest.
D) Routine benzodiazepine therapy.
Correct Answer: Physical therapy with gait and balance training.
Rationale:
Targeted physical therapy can improve gait, strength, turning strategies, and balance. Exercise also supports mobility and
functional independence. Sedatives and inactivity generally worsen fall risk and deconditioning in older adults.
8. Which feature best distinguishes drug-induced parkinsonism from idiopathic Parkinson disease?
A) Unilateral resting tremor as the usual first sign.
B) More symmetric onset after exposure to dopamine-blocking medication.
C) Prominent anosmia years before motor symptoms.
D) Classic levodopa response in every case.
Correct Answer: More symmetric onset after exposure to dopamine-blocking medication.
Rationale:
Drug-induced parkinsonism often begins symmetrically after exposure to dopamine antagonists such as certain
antipsychotics or antiemetics. Idiopathic Parkinson disease commonly starts asymmetrically and may include prodromal
nonmotor symptoms such as anosmia, REM sleep behavior disorder, or constipation.
9. An older adult has a tremor only when reaching for a target and the hand oscillation worsens near the
target. This is most consistent with:
NURS 5461 Module 4 Practice Quiz 2 2026/2027 Edition
Adult Gerontology Primary Care
University of Texas at Arlington (UTA) 100-
Question Original Practice Quiz
2026/2027 Edition
Practice focus: Parkinson disease, essential tremor, multiple sclerosis, Guillain-Barre syndrome, myasthenia gravis,
seizures, headache syndromes, stroke red flags, peripheral neuropathy, spine syndromes, and neurologic medication safety
in older adults.
1. A 74-year-old has a resting tremor, bradykinesia, rigidity, and a shuffling gait. Which diagnosis is most
likely?
A) Cerebellar ataxia.
B) Parkinson disease.
C) Peripheral neuropathy.
D) Essential tremor.
Correct Answer: Parkinson disease.
Rationale:
Parkinson disease is defined clinically by bradykinesia plus resting tremor, rigidity, or postural instability. The classic tremor
occurs at rest and often decreases with purposeful movement. Essential tremor is typically action-related, while cerebellar
disease more often causes intention tremor and gait ataxia.
2. Which pathophysiologic change is central to Parkinson disease?
A) Destruction of anterior horn cells.
B) Demyelination of peripheral nerves.
C) Loss of dopaminergic neurons in the substantia nigra.
D) Autoimmune attack on acetylcholine receptors.
Correct Answer: Loss of dopaminergic neurons in the substantia nigra.
Rationale:
Parkinson disease results from progressive degeneration of dopaminergic neurons in the substantia nigra pars compacta.
Reduced dopamine alters basal-ganglia circuitry, producing bradykinesia, rigidity, and tremor. The other choices describe
motor-neuron, neuromuscular-junction, or peripheral demyelinating disorders.
3. Which tremor pattern most strongly supports essential tremor rather than Parkinson disease?
A) Unilateral resting tremor with bradykinesia.
B) Pill-rolling tremor that lessens with movement.
C) Bilateral action tremor that worsens with holding objects.
D) Rest tremor plus cogwheel rigidity.
Correct Answer: Bilateral action tremor that worsens with holding objects.
Rationale:
Essential tremor is most apparent with posture or action and often affects both hands. Parkinson tremor is typically present
at rest, asymmetric early, and accompanied by bradykinesia or rigidity. Family history and transient improvement with
alcohol can also support essential tremor.
4. A patient with Parkinson disease develops increasing 'off' periods despite regular levodopa-carbidopa
dosing. Which adjunct may extend levodopa effect?
A) A first-generation antihistamine.
B) A benzodiazepine used chronically for all symptoms.
C) A strong dopamine antagonist.
D) A COMT inhibitor such as entacapone.
NURS 5461 Module 4 Practice Quiz 1 2026/2027 Edition
, Correct Answer: A COMT inhibitor such as entacapone.
Rationale:
COMT inhibitors reduce peripheral levodopa breakdown and can prolong the clinical response, reducing wearing-off
periods. Dopamine antagonists may worsen parkinsonism. Sedating or anticholinergic drugs often increase falls, confusion,
and other geriatric adverse effects.
5. Why is metoclopramide generally avoided in a patient with Parkinson disease?
A) It blocks dopamine receptors and can worsen parkinsonian symptoms.
B) It causes excessive dopamine production.
C) It improves rigidity but worsens only constipation.
D) It permanently raises levodopa levels.
Correct Answer: It blocks dopamine receptors and can worsen parkinsonian symptoms.
Rationale:
Metoclopramide antagonizes central dopamine receptors and may worsen bradykinesia, rigidity, or tremor. Older adults with
Parkinson disease are especially vulnerable to extrapyramidal effects and tardive dyskinesia, so alternatives are generally
preferred when feasible.
6. Which nonmotor symptom is common in Parkinson disease?
A) Profound sensory loss in a stocking pattern.
B) Acute monocular blindness.
C) Hyperreflexia from corticospinal injury.
D) Constipation.
Correct Answer: Constipation.
Rationale:
Parkinson disease commonly includes nonmotor manifestations such as constipation, orthostatic hypotension, anosmia,
sleep disturbance, depression, cognitive change, and urinary symptoms. These may precede or complicate the motor
syndrome and should be incorporated into routine primary-care assessment.
7. A patient with Parkinson disease has recurrent falls when turning. Which intervention is most appropriate?
A) Eliminate all exercise.
B) Physical therapy with gait and balance training.
C) Long-term bed rest.
D) Routine benzodiazepine therapy.
Correct Answer: Physical therapy with gait and balance training.
Rationale:
Targeted physical therapy can improve gait, strength, turning strategies, and balance. Exercise also supports mobility and
functional independence. Sedatives and inactivity generally worsen fall risk and deconditioning in older adults.
8. Which feature best distinguishes drug-induced parkinsonism from idiopathic Parkinson disease?
A) Unilateral resting tremor as the usual first sign.
B) More symmetric onset after exposure to dopamine-blocking medication.
C) Prominent anosmia years before motor symptoms.
D) Classic levodopa response in every case.
Correct Answer: More symmetric onset after exposure to dopamine-blocking medication.
Rationale:
Drug-induced parkinsonism often begins symmetrically after exposure to dopamine antagonists such as certain
antipsychotics or antiemetics. Idiopathic Parkinson disease commonly starts asymmetrically and may include prodromal
nonmotor symptoms such as anosmia, REM sleep behavior disorder, or constipation.
9. An older adult has a tremor only when reaching for a target and the hand oscillation worsens near the
target. This is most consistent with:
NURS 5461 Module 4 Practice Quiz 2 2026/2027 Edition
