NR 603 Week 1 APEA Predictor Exam Review
Questions & Answers
NR 603 WEEK 1 APEA PREDICTOR EXAM REVIEW
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES 2024 LATEST UPDATE// ALREADRY
GRADED A+
A 75-year-old man is involved in a motor vehicle accident and strikes his forehead on the windshield. He
complains of neck pain and severe burning in his shoulders and arms. His physical examination reveals
weakness of his upper extremities. What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome ANS: B
Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more severe in the upper extremities
than in the lower extremities, and is more severe in the hands. There is typically hyperesthesia over the
shoulders and arms. Anterior cord syndrome presents with paraplegia or quadriplegia, loss of lateral
spinothalamic function with preservation of posterior column function. Brown-Séquard syndrome
consists of weakness and loss of posterior column function on one side of the body distal to the lesion
with contralateral loss of lateral spinothalamic function one to two levels below the lesion. Complete
cord transection would affect motor and sensory function distal to the lesion. Cauda equina syndrome
typically presents as low back pain with radiculopathy.
A 37-year-old man fell from a ladder as he finished hanging the Christmas lights on his house. The right
side of his head hit the alley cement, and he lost consciousness for about 1 minute; he woke up with a
headache, but he had no other complaints. A few hours later, the patient is brought to the emergency
room by his neighbor because of an intense headache, confusion, and left hand hemiparesis. On
examination, the patient has a bruise located over the right temporal region, mydriasis, and right
deviation of the right eye, papilledema, and left extensor plantar response. An emergency CT scan of the
head without contrast reveals a lens-shaped hyper-density under the right temporal bone with mass
effect and edema. What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
, NR 603 Week 1 APEA Predictor Exam Review
Questions & Answers
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis ANS: 1
Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the middle meningeal artery. Although a
lucid interval ranging from minutes to hours followed by altered mental status and focal deficits is
typical for epidural hematoma, this clinical picture is only encountered in up to 1/3 of the patients. The
collection of blood between the skull and dura mater causes an evident mass effect with ophthalmic
nerve palsy and the contralateral hemiparesis. Surgical evacuation of the clot via burr holes is the
treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging veins that connect the cerebrum to
the venous sinuses within the dura. This venous hemorrhage will result in a gradual increase of the
hematoma, with a progressive clinical picture over days or weeks. The CT scan will show a concave,
crescent-shaped hyper-density compared to the convex, lens-shaped hyper-density in epidural
hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most common is the congenital
berry aneurysm. The clinical picture is of a sudden, severe headache with meningeal irritation. A CT scan
will show blood in the subarachnoid space, and a lumbar puncture will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by hypertension complicated with
CharcotBouchard aneurysms. The blood accumulates into the brain substance and most commonly
involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal irritation dominate the
clinical picture. Lumbar puncture, indicated if there are no focal neurological signs on clinical
examination, will be the diagnostic procedure. The CT scan of the patient presented in this case is
characteristic for epidural hematoma, and there is no indication for a lumbar puncture.
A 31-year-old woman presents with a purpural rash covering her arms, legs, and abdomen. She also has
fever, chills, nausea, abdominal tenderness, tachycardia, and generalized myalgias. Prior to the
development of the rash, the patient noted that she had a headache, cough, and sore throat. Laboratory
studies were positive for Gram-negative diplococci in the blood, along with thrombocytopenia and an
elevation in PMNs. Urinalysis showed blood, protein, and casts. Vital signs are as follows: PB 92/66, P 96,
RR 14, T 39. The patient denies any foreign travel and does not have any sick contacts. However, she
does work part time as a nurse in a local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to the hospital and placed in
respiratory isolation. What major course of therapy should this patient receive?
Answer Choices
, NR 603 Week 1 APEA Predictor Exam Review
Questions & Answers
1 Steroids
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bactericidal/permeability-increasing protein
ANS:3
Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The preferred drug for active infection is
penicillin G. For those allergic to penicillin, chloramphenicol and cephalosporins (ie, cefotaxime,
cefuroxime) may be used as alternatives.
Patients will also receive supportive care, but antibiotic therapy must be initiated quickly if the patient is
to survive. Intensive care placement may be necessary if organ failure is imminent. Ventilatory support,
inotropic support, and IV fluids are necessary in some. If adrenal insufficiency occurs, corticosteroid
replacement may be considered. A central venous line helps to provide large amounts of volume
expanders and inotropic medications for adequate tissue perfusion.
Steroids have not been shown to play a major role in the treatment of meningococcemia. However, they
have been used in addition to antibiotic therapy. In the case of adrenal insufficiency, for example,
steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the patient suffers from a devastating
coagulopathy, blood or blood products may be replaced as necessary.
Bactericidal/permeability-increasing protein is a protein stored in the granules of neutrophils. It binds to
endotoxin in vitro and neutralizes it. This technique is experimental, and it is not used in everyday
treatment of meningococcemia.
In myasthenia gravis, weakness is a result of insufficient acetylcholine transmission at the
neuromuscular junction; however, weakness can also occur with overdosing of the cholinergic
medications used to treat myasthenia. What symptom helps differentiate a myasthenic crisis from a
cholinergic crisis?
Answer Choices
1 Respiratory failure
2 Bilateral ptosis
3 Muscle fasciculations
4 Diplopia
5 Normal muscle stretch reflexes
, NR 603 Week 1 APEA Predictor Exam Review
Questions & Answers
ANS: 3
Muscle Fasiculations
Signs of cholinergic overdosage include muscle fasciculation, rhinorrhea, lacrimation, salivation,
increased bronchial secretions, nausea, or diarrhea. The presence of any of these suggests that the
patient's weakness may be due to cholinergic crisis. The other signs are due to weakness and can occur
in either condition.
A 54-year-old man presents after having a generalized seizure. The patient is HIV positive, but he has
been unable to afford antiretroviral therapy since losing his job 2 years ago. Other than cachexia, the
physical exam is unremarkable. Upon further inquiry, the patient also notes that he has become
shorttempered and hypercritical; at times, he seems confused. An MRI of the brain is performed, and it
reveals several cortical ring-enhancing lesions.
Question
What is the most likely diagnosis?
Answer Choices
1 AIDS dementia complex
2 Cryptococcal meningitis
3 Cytomegalovirus encephalitis
4 Progressive multifocal leukoencephalopathy
5 Toxoplasma encephalitis ANS:5
Toxoplasma encephalitis
The patient's symptoms and MRI findings are most consistent with the diagnosis of toxoplasma
encephalitis. Toxoplasmosis is the most common cerebral mass lesion among HIV-positive patients.
Infection with the Toxoplasma gondii parasite is relatively common and usually asymptomatic.
Reactivation occurs in HIV positive patients due to failing cellular immunity, and it causes a multifocal
necrotizing encephalitis. Seizures may be the initial manifestation of central nervous system (CNS)
infection; other common clinical manifestations include focal neurologic deficits, such as impaired
speech and hemiparesis. Personality change, lethargy, headache, and confusion are also observed. The
MRI in patients with toxoplasma encephalitis characteristically reveals multiple, ring-enhancing lesions
with surrounding edema; these lesions usually occur bilaterally in the frontal and parietal cortices.
AIDS dementia complex describes a constellation of cognitive symptoms seen among HIV positive
patients. The condition occurs when HIV virus disseminates to the CNS. Within the CNS, the virus tends
to concentrate in the basal ganglia and subcortical regions. Symptoms include a constellation of
cognitive, behavioral, and motor disturbances that cause varying degrees of functional impairment.
Characteristic MRI findings include non-enhancing white matter, cerebral atrophy, and ventricular
enlargement. The diagnosis requires that other central nervous system infections, carcinoma, as well as
general medical conditions and substance abuse have been excluded.
Questions & Answers
NR 603 WEEK 1 APEA PREDICTOR EXAM REVIEW
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES 2024 LATEST UPDATE// ALREADRY
GRADED A+
A 75-year-old man is involved in a motor vehicle accident and strikes his forehead on the windshield. He
complains of neck pain and severe burning in his shoulders and arms. His physical examination reveals
weakness of his upper extremities. What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome ANS: B
Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more severe in the upper extremities
than in the lower extremities, and is more severe in the hands. There is typically hyperesthesia over the
shoulders and arms. Anterior cord syndrome presents with paraplegia or quadriplegia, loss of lateral
spinothalamic function with preservation of posterior column function. Brown-Séquard syndrome
consists of weakness and loss of posterior column function on one side of the body distal to the lesion
with contralateral loss of lateral spinothalamic function one to two levels below the lesion. Complete
cord transection would affect motor and sensory function distal to the lesion. Cauda equina syndrome
typically presents as low back pain with radiculopathy.
A 37-year-old man fell from a ladder as he finished hanging the Christmas lights on his house. The right
side of his head hit the alley cement, and he lost consciousness for about 1 minute; he woke up with a
headache, but he had no other complaints. A few hours later, the patient is brought to the emergency
room by his neighbor because of an intense headache, confusion, and left hand hemiparesis. On
examination, the patient has a bruise located over the right temporal region, mydriasis, and right
deviation of the right eye, papilledema, and left extensor plantar response. An emergency CT scan of the
head without contrast reveals a lens-shaped hyper-density under the right temporal bone with mass
effect and edema. What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
, NR 603 Week 1 APEA Predictor Exam Review
Questions & Answers
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis ANS: 1
Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the middle meningeal artery. Although a
lucid interval ranging from minutes to hours followed by altered mental status and focal deficits is
typical for epidural hematoma, this clinical picture is only encountered in up to 1/3 of the patients. The
collection of blood between the skull and dura mater causes an evident mass effect with ophthalmic
nerve palsy and the contralateral hemiparesis. Surgical evacuation of the clot via burr holes is the
treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging veins that connect the cerebrum to
the venous sinuses within the dura. This venous hemorrhage will result in a gradual increase of the
hematoma, with a progressive clinical picture over days or weeks. The CT scan will show a concave,
crescent-shaped hyper-density compared to the convex, lens-shaped hyper-density in epidural
hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most common is the congenital
berry aneurysm. The clinical picture is of a sudden, severe headache with meningeal irritation. A CT scan
will show blood in the subarachnoid space, and a lumbar puncture will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by hypertension complicated with
CharcotBouchard aneurysms. The blood accumulates into the brain substance and most commonly
involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal irritation dominate the
clinical picture. Lumbar puncture, indicated if there are no focal neurological signs on clinical
examination, will be the diagnostic procedure. The CT scan of the patient presented in this case is
characteristic for epidural hematoma, and there is no indication for a lumbar puncture.
A 31-year-old woman presents with a purpural rash covering her arms, legs, and abdomen. She also has
fever, chills, nausea, abdominal tenderness, tachycardia, and generalized myalgias. Prior to the
development of the rash, the patient noted that she had a headache, cough, and sore throat. Laboratory
studies were positive for Gram-negative diplococci in the blood, along with thrombocytopenia and an
elevation in PMNs. Urinalysis showed blood, protein, and casts. Vital signs are as follows: PB 92/66, P 96,
RR 14, T 39. The patient denies any foreign travel and does not have any sick contacts. However, she
does work part time as a nurse in a local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to the hospital and placed in
respiratory isolation. What major course of therapy should this patient receive?
Answer Choices
, NR 603 Week 1 APEA Predictor Exam Review
Questions & Answers
1 Steroids
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bactericidal/permeability-increasing protein
ANS:3
Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The preferred drug for active infection is
penicillin G. For those allergic to penicillin, chloramphenicol and cephalosporins (ie, cefotaxime,
cefuroxime) may be used as alternatives.
Patients will also receive supportive care, but antibiotic therapy must be initiated quickly if the patient is
to survive. Intensive care placement may be necessary if organ failure is imminent. Ventilatory support,
inotropic support, and IV fluids are necessary in some. If adrenal insufficiency occurs, corticosteroid
replacement may be considered. A central venous line helps to provide large amounts of volume
expanders and inotropic medications for adequate tissue perfusion.
Steroids have not been shown to play a major role in the treatment of meningococcemia. However, they
have been used in addition to antibiotic therapy. In the case of adrenal insufficiency, for example,
steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the patient suffers from a devastating
coagulopathy, blood or blood products may be replaced as necessary.
Bactericidal/permeability-increasing protein is a protein stored in the granules of neutrophils. It binds to
endotoxin in vitro and neutralizes it. This technique is experimental, and it is not used in everyday
treatment of meningococcemia.
In myasthenia gravis, weakness is a result of insufficient acetylcholine transmission at the
neuromuscular junction; however, weakness can also occur with overdosing of the cholinergic
medications used to treat myasthenia. What symptom helps differentiate a myasthenic crisis from a
cholinergic crisis?
Answer Choices
1 Respiratory failure
2 Bilateral ptosis
3 Muscle fasciculations
4 Diplopia
5 Normal muscle stretch reflexes
, NR 603 Week 1 APEA Predictor Exam Review
Questions & Answers
ANS: 3
Muscle Fasiculations
Signs of cholinergic overdosage include muscle fasciculation, rhinorrhea, lacrimation, salivation,
increased bronchial secretions, nausea, or diarrhea. The presence of any of these suggests that the
patient's weakness may be due to cholinergic crisis. The other signs are due to weakness and can occur
in either condition.
A 54-year-old man presents after having a generalized seizure. The patient is HIV positive, but he has
been unable to afford antiretroviral therapy since losing his job 2 years ago. Other than cachexia, the
physical exam is unremarkable. Upon further inquiry, the patient also notes that he has become
shorttempered and hypercritical; at times, he seems confused. An MRI of the brain is performed, and it
reveals several cortical ring-enhancing lesions.
Question
What is the most likely diagnosis?
Answer Choices
1 AIDS dementia complex
2 Cryptococcal meningitis
3 Cytomegalovirus encephalitis
4 Progressive multifocal leukoencephalopathy
5 Toxoplasma encephalitis ANS:5
Toxoplasma encephalitis
The patient's symptoms and MRI findings are most consistent with the diagnosis of toxoplasma
encephalitis. Toxoplasmosis is the most common cerebral mass lesion among HIV-positive patients.
Infection with the Toxoplasma gondii parasite is relatively common and usually asymptomatic.
Reactivation occurs in HIV positive patients due to failing cellular immunity, and it causes a multifocal
necrotizing encephalitis. Seizures may be the initial manifestation of central nervous system (CNS)
infection; other common clinical manifestations include focal neurologic deficits, such as impaired
speech and hemiparesis. Personality change, lethargy, headache, and confusion are also observed. The
MRI in patients with toxoplasma encephalitis characteristically reveals multiple, ring-enhancing lesions
with surrounding edema; these lesions usually occur bilaterally in the frontal and parietal cortices.
AIDS dementia complex describes a constellation of cognitive symptoms seen among HIV positive
patients. The condition occurs when HIV virus disseminates to the CNS. Within the CNS, the virus tends
to concentrate in the basal ganglia and subcortical regions. Symptoms include a constellation of
cognitive, behavioral, and motor disturbances that cause varying degrees of functional impairment.
Characteristic MRI findings include non-enhancing white matter, cerebral atrophy, and ventricular
enlargement. The diagnosis requires that other central nervous system infections, carcinoma, as well as
general medical conditions and substance abuse have been excluded.
