Chronic Exam 4 Review 2025/2026 Latest Update With
Complete Solutions
Remember to review PowerPoints and to pay attention to the various charts and boxes mentioned from the text.
The following are the major areas of focus. Long-term management and patient teaching is a big focus on this test.
Medication management and education for that is also included for many of the conditions. Remember that you need a
good understanding of the pathophysiology and signs and symptoms of each condition in order to educate your patients.
So even if that is not specifically mentioned in the list below, it is in your best interest for the future to have a good
understanding of that. Also, medications for various conditions will show up again in the future, even if we are not
specifically asking about those on this test.
Age related changes to the Neuro system
Physiologic Change Nursing Implications
o Slower processing time o Provide adequate time to respond to questions
o Recent memory loss o Repetitions, written reminders, use alarms
o Decreased sensory perception o Watch where putting feet; wear good shoes. Change
positions often while in bed or chair (Q 1hr).
o Change in pain perception o Ask patient to describe nature and characteristics of pain
o Change in sleep patterns o Fall asleep earlier, wake earlier; More wakefulness at
night. Adjust schedule to sleep pattern. Interfere w/ ADLS?
o Altered balance/decrease in o Advise patient to move slowly; use handrails; assess the
coordination need for ambulatory aides. No multitasking
Parkinson’s disease – S/SX, Complications
• Signs and Symptoms
o Decline in dopamine production that affects motor abilities.
o 4 Cardinal Sx: tremor, muscle rigidity, bradykinesia (slow movement) or akinesia (no movement), &
postural instability.
o Stage 1 Initial – Unilateral limb involvement; minimal weakness; hand and arm trembling
o Stage 2 Mild – Bilateral limb involvement; masklike face (no facial expression); slow shuffling gait
o Stage 3 Moderate – Postural instability; increasing gate disturbance
o Stage 4 Severe – Akinesia; rigidity
o Stage 5 End – Complete ADL dependence
o Posture: stooped, flexed trunk, fingers abducted & flexed, wrist dorsiflexed.
o Gait: slow & shuffling; short, hesitant steps; propulsive gait (gets faster); difficulty stopping quickly
o Motor: bradykinesia, muscular rigidity (cogwheel, plastic, lead pipe), tremors, “pill-rolling”, mask-like face,
, difficulty chewing or swallowing, drooling, fatigue, reduced arm swing, micrographia (hand writing gets
smaller).
o Speech: Hypophonia (soft voice), low-pitched voice; Dysarthria (slurred speech); Echolalia (repetition of
what others say)
o Autonomic dysfunction: Orthro-hypo, excessive perspiration, oily skin, seborrhea, flushing, eyelid spasm,
bowel and bladder problems
o Psychosocial dysfunction: Emotionally liable (up and down emotions), depressed, paranoid, easily upset,
rapid mood swings, impaired cognition (dementia), delayed reaction time, sleep disturbances.
• Care of patients/Management
o Extra time to respond to questions (no open ended questions, yes or no questions instead) & perform
tasks; monitor pt ability to eat and swallow; High calorie/High protein; take meds on time, schedule apts
Complete Solutions
Remember to review PowerPoints and to pay attention to the various charts and boxes mentioned from the text.
The following are the major areas of focus. Long-term management and patient teaching is a big focus on this test.
Medication management and education for that is also included for many of the conditions. Remember that you need a
good understanding of the pathophysiology and signs and symptoms of each condition in order to educate your patients.
So even if that is not specifically mentioned in the list below, it is in your best interest for the future to have a good
understanding of that. Also, medications for various conditions will show up again in the future, even if we are not
specifically asking about those on this test.
Age related changes to the Neuro system
Physiologic Change Nursing Implications
o Slower processing time o Provide adequate time to respond to questions
o Recent memory loss o Repetitions, written reminders, use alarms
o Decreased sensory perception o Watch where putting feet; wear good shoes. Change
positions often while in bed or chair (Q 1hr).
o Change in pain perception o Ask patient to describe nature and characteristics of pain
o Change in sleep patterns o Fall asleep earlier, wake earlier; More wakefulness at
night. Adjust schedule to sleep pattern. Interfere w/ ADLS?
o Altered balance/decrease in o Advise patient to move slowly; use handrails; assess the
coordination need for ambulatory aides. No multitasking
Parkinson’s disease – S/SX, Complications
• Signs and Symptoms
o Decline in dopamine production that affects motor abilities.
o 4 Cardinal Sx: tremor, muscle rigidity, bradykinesia (slow movement) or akinesia (no movement), &
postural instability.
o Stage 1 Initial – Unilateral limb involvement; minimal weakness; hand and arm trembling
o Stage 2 Mild – Bilateral limb involvement; masklike face (no facial expression); slow shuffling gait
o Stage 3 Moderate – Postural instability; increasing gate disturbance
o Stage 4 Severe – Akinesia; rigidity
o Stage 5 End – Complete ADL dependence
o Posture: stooped, flexed trunk, fingers abducted & flexed, wrist dorsiflexed.
o Gait: slow & shuffling; short, hesitant steps; propulsive gait (gets faster); difficulty stopping quickly
o Motor: bradykinesia, muscular rigidity (cogwheel, plastic, lead pipe), tremors, “pill-rolling”, mask-like face,
, difficulty chewing or swallowing, drooling, fatigue, reduced arm swing, micrographia (hand writing gets
smaller).
o Speech: Hypophonia (soft voice), low-pitched voice; Dysarthria (slurred speech); Echolalia (repetition of
what others say)
o Autonomic dysfunction: Orthro-hypo, excessive perspiration, oily skin, seborrhea, flushing, eyelid spasm,
bowel and bladder problems
o Psychosocial dysfunction: Emotionally liable (up and down emotions), depressed, paranoid, easily upset,
rapid mood swings, impaired cognition (dementia), delayed reaction time, sleep disturbances.
• Care of patients/Management
o Extra time to respond to questions (no open ended questions, yes or no questions instead) & perform
tasks; monitor pt ability to eat and swallow; High calorie/High protein; take meds on time, schedule apts
