NR 577 Week 6 Questions With Complete Solutions
FInal Exam 577
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.
FInal Exam 577
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.
