NUR 577 FINAL EXAM NEWEST VERSION 2023-2024
ACTUAL 310 QUESTION AND CORRECT DETAILED
ANSWERS RATED A GRADE.
1. A 56-year-old patient comes in for a routine well visit. He has a history of a
previous stroke and Type 2 Diabetes. Which of the following orders would be
appropriate for a patient with a previous stroke?
A. Initiate statin therapy
B. EEG
C. Warfarin therapy with an INR goal of 2-3
D. MRI✔✔ ANSWER✔✔A.
Patients with a history of an ASCVD should be started on statin therapy
regardless of current LDL. The question did not mention any other symptoms
that would warrant additional diagnostics. Warfarin therapy is only indicated
if AFIB would be the primary indication for anticoagulation after a stroke.
2. A 36-year-old female is being seen in your clinic for left sided facial
weakness. In your review of systems, the patient reports that "certain
sounds really bother me and my taste buds seem off". She also reports
temporal pain which has subsided. Your physical exam reveals no other
neurological deficits. Which of the following interventions would be most
appropriate?
A. Call 911 to activate emergency stroke protocols
B. Refer the patient to neurology
C. Order an MRI
,D. Prescribe a course of oral corticosteroids✔✔ ANSWER✔✔D.
Bell's Palsy commonly causes alterations in taste and hyperacusis. This
contrasts with stroke. Corticosteroids increase the chances of recovery
complete by 12-15% at nine to twelve months and are routinely prescribed.
The complaint of pain also suggests a possible viral infection such as herpes
simplex or varicella which has been implicated, in some cases, as a trigger
for facial palsy.
3. A 9-year-old female patient presents to your clinic with complaints of a
headache. The patients mother states the headache started two days ago
and she has been giving her children's Tylenol. The child states the pain is
bilateral and worsens when running or standing. The nurse practitioner
should:
A. Treat her for migraine prevention and start topiramate
B. Order a CT of her head
C. Educate the parent that children need at least 9 hours of sleep
D. Refer to a psychologist for cognitive behavioral therapy✔✔ ANSWER✔✔B.
Table 25-8 lists red flags for pediatric headaches. Headaches that worsen
with postural changes may indicate additional intracranial pathology and
should be further investigated. Depending on the urgency an MRI vs. CT
should be considered. A, C, & D are preventative measures for established
migraines or TTH.
4. You are educating the parents of a 16-year-old boy who has been newly
diagnosed with epileptic syndrome. Which statement is false?
A. Most states will grant a driver's license if the patient has been deemed
seizure free for 6-12 months by his physician.
,B. Clinical seizures that last 15 minutes are considered medical emergencies
C. Physical training such as weight training should be restricted due to safety
concerns.
D. Depression is a common comorbidity of epilepsy.✔✔ ANSWER✔✔C.
Physical activity that promote age appropriate socialization and normalcy are
highly recommended. The only activities that come with restrictions are
scuba diving, contact sports (may or may not be allowed depending on the
physician), and free climbing. Swimming is allowed, but preferably under
supervision.
5. A 25-year-old male presents to the clinic complaining of a severe,
throbbing headache for the past 2 days. The pain increases when exposed to
bright lights and is accompanied by nausea. He states the headache started
after working a 16-hour shift without resting. What type of headache is the
patient suffering from and what medication is appropriate for immediate
relief?
A. Migraine headache - Zolmitriptan 5mg PO one dose now, repeat after 2
hours if no relief
B. Migraine headache - Topiramate 50mg BID
C. Tension - Type Headache - Zolmitriptan 5mg PO one dose now, repeat
after 2 hours if no relief
D. Cluster headache - Sumatriptan 6mg SQ single dose✔✔ ANSWER✔✔A.
Migraine headaches can be unilateral and are often accompanied by nausea,
vomiting, and photophobia. These headaches can be triggered by lack of
sleep and stress. Zolmitriptan is often effective for immediate relief of
migraines. Topiramate is used as a prophylaxis for migraines. The patient's
, symptoms are not characteristic of a tension type or cluster headache.
Triptans are not recommended for tension type headaches.
6. A 63-year old male presents to clinic with complaints of tremors and
muscle spasms. The patient has a history of Parkinson's disease and has
been taking Levodopa 50mg TID. What is an appropriate treatment plan for
this patient?
A. Decrease the amount of levodopa the patient is taking per day.
B. Inform the patient that these side effects are common as Parkinson's
disease progresses and start the patient on amantadine.
C. Refer the patient to a neurologist for further evaluation.
D. Continue to monitor the patient for increase in tremors.✔✔
ANSWER✔✔B.
Levodopa-induced dyskinesias are common in later Parkinson's disease.
Dyskinesias can occur in the form of chorea, tremors, tics, and dystonia.
According to Papadakis and McPhee (2018), although levodopa-induced
dyskinesias are dose related, decreasing the dose can alter the therapeutic
benefit of the medication. The patient can begin taking amantadine or
levetiracetam to help decrease the dyskinesias.
7. An 11-year old presents to clinic with her mother complaining of severe
headaches and nausea when she wakes up in the morning. Headaches have
worsened over the past week. The patient states the headaches are worse
when she changes position and mostly towards the back of her head. As the
nurse practitioner, what is best treatment option for this patient?
ACTUAL 310 QUESTION AND CORRECT DETAILED
ANSWERS RATED A GRADE.
1. A 56-year-old patient comes in for a routine well visit. He has a history of a
previous stroke and Type 2 Diabetes. Which of the following orders would be
appropriate for a patient with a previous stroke?
A. Initiate statin therapy
B. EEG
C. Warfarin therapy with an INR goal of 2-3
D. MRI✔✔ ANSWER✔✔A.
Patients with a history of an ASCVD should be started on statin therapy
regardless of current LDL. The question did not mention any other symptoms
that would warrant additional diagnostics. Warfarin therapy is only indicated
if AFIB would be the primary indication for anticoagulation after a stroke.
2. A 36-year-old female is being seen in your clinic for left sided facial
weakness. In your review of systems, the patient reports that "certain
sounds really bother me and my taste buds seem off". She also reports
temporal pain which has subsided. Your physical exam reveals no other
neurological deficits. Which of the following interventions would be most
appropriate?
A. Call 911 to activate emergency stroke protocols
B. Refer the patient to neurology
C. Order an MRI
,D. Prescribe a course of oral corticosteroids✔✔ ANSWER✔✔D.
Bell's Palsy commonly causes alterations in taste and hyperacusis. This
contrasts with stroke. Corticosteroids increase the chances of recovery
complete by 12-15% at nine to twelve months and are routinely prescribed.
The complaint of pain also suggests a possible viral infection such as herpes
simplex or varicella which has been implicated, in some cases, as a trigger
for facial palsy.
3. A 9-year-old female patient presents to your clinic with complaints of a
headache. The patients mother states the headache started two days ago
and she has been giving her children's Tylenol. The child states the pain is
bilateral and worsens when running or standing. The nurse practitioner
should:
A. Treat her for migraine prevention and start topiramate
B. Order a CT of her head
C. Educate the parent that children need at least 9 hours of sleep
D. Refer to a psychologist for cognitive behavioral therapy✔✔ ANSWER✔✔B.
Table 25-8 lists red flags for pediatric headaches. Headaches that worsen
with postural changes may indicate additional intracranial pathology and
should be further investigated. Depending on the urgency an MRI vs. CT
should be considered. A, C, & D are preventative measures for established
migraines or TTH.
4. You are educating the parents of a 16-year-old boy who has been newly
diagnosed with epileptic syndrome. Which statement is false?
A. Most states will grant a driver's license if the patient has been deemed
seizure free for 6-12 months by his physician.
,B. Clinical seizures that last 15 minutes are considered medical emergencies
C. Physical training such as weight training should be restricted due to safety
concerns.
D. Depression is a common comorbidity of epilepsy.✔✔ ANSWER✔✔C.
Physical activity that promote age appropriate socialization and normalcy are
highly recommended. The only activities that come with restrictions are
scuba diving, contact sports (may or may not be allowed depending on the
physician), and free climbing. Swimming is allowed, but preferably under
supervision.
5. A 25-year-old male presents to the clinic complaining of a severe,
throbbing headache for the past 2 days. The pain increases when exposed to
bright lights and is accompanied by nausea. He states the headache started
after working a 16-hour shift without resting. What type of headache is the
patient suffering from and what medication is appropriate for immediate
relief?
A. Migraine headache - Zolmitriptan 5mg PO one dose now, repeat after 2
hours if no relief
B. Migraine headache - Topiramate 50mg BID
C. Tension - Type Headache - Zolmitriptan 5mg PO one dose now, repeat
after 2 hours if no relief
D. Cluster headache - Sumatriptan 6mg SQ single dose✔✔ ANSWER✔✔A.
Migraine headaches can be unilateral and are often accompanied by nausea,
vomiting, and photophobia. These headaches can be triggered by lack of
sleep and stress. Zolmitriptan is often effective for immediate relief of
migraines. Topiramate is used as a prophylaxis for migraines. The patient's
, symptoms are not characteristic of a tension type or cluster headache.
Triptans are not recommended for tension type headaches.
6. A 63-year old male presents to clinic with complaints of tremors and
muscle spasms. The patient has a history of Parkinson's disease and has
been taking Levodopa 50mg TID. What is an appropriate treatment plan for
this patient?
A. Decrease the amount of levodopa the patient is taking per day.
B. Inform the patient that these side effects are common as Parkinson's
disease progresses and start the patient on amantadine.
C. Refer the patient to a neurologist for further evaluation.
D. Continue to monitor the patient for increase in tremors.✔✔
ANSWER✔✔B.
Levodopa-induced dyskinesias are common in later Parkinson's disease.
Dyskinesias can occur in the form of chorea, tremors, tics, and dystonia.
According to Papadakis and McPhee (2018), although levodopa-induced
dyskinesias are dose related, decreasing the dose can alter the therapeutic
benefit of the medication. The patient can begin taking amantadine or
levetiracetam to help decrease the dyskinesias.
7. An 11-year old presents to clinic with her mother complaining of severe
headaches and nausea when she wakes up in the morning. Headaches have
worsened over the past week. The patient states the headaches are worse
when she changes position and mostly towards the back of her head. As the
nurse practitioner, what is best treatment option for this patient?
