Nokea
A 63-year-old patient taking carbidopa/levodopa 25/100 mg four times a day for PD is experiencing end-of-dose wearing off. The best recommendation is to:
- A. Add tolcapone.
- B. Add entacapone.
- C. Consider deep-brain stimulation (DBS).
- D. Change carbidopa/levodopa to three times a day.
Correct Answer: B
Rationale: Entacapone, like tolcapone, is a COMT inhibitor that can help manage wearing-off symptoms by extending the duration of levodopa's effect.
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The home health nurse is caring for the client newly diagnosed with multiple sclerosis. Which client issue is of most importance?
- A. The client refuses to have a gastrostomy feeding.
- B. The client wants to discuss if she should tell her fiancé.
- C. The client tells the nurse life is not worth living anymore
- D. The client needs the flu and pneumonia vaccines.
Correct Answer: C
Rationale: Expressing feelings of hopelessness or suicidal ideation requires immediate intervention to ensure the client's safety and provide emotional support.
Executive Functions: involve problem-solving, planning, initiative, organising, and they monitor and inhibit complex behaviours. These functions are normally associated with which area of the brain?
- A. The neocortex.
- B. The corpus callosum.
- C. The cerebellum.
- D. The prefontal cortex.
Correct Answer: D
Rationale: The prefrontal cortex, located in the frontal lobe of the brain, is primarily responsible for executive functions such as problem-solving, planning, decision-making, and self-regulation. This brain region plays a critical role in coordinating complex cognitive processes and inhibiting inappropriate behaviors. Damage to the prefrontal cortex can result in significant impairments in executive functioning, leading to difficulties in managing daily tasks and adapting to new situations.
White matter refers to myelinated fibers in the:
- A. CNS
- B. PNS
- C. ANS
- D. SNS
Correct Answer: A
Rationale: White matter consists of myelinated axons found in the central nervous system (CNS). The PNS, ANS, and SNS contain myelinated fibers, but the term 'white matter' specifically refers to the CNS. Therefore, A is the correct answer.
The upper motor neuron impairment produces the following change of muscles tone:
- A. flaccidity
- B. spasticity
- C. "cog wheel" rigidity
- D. myoclonia
Correct Answer: B
Rationale: Spasticity is the correct answer because upper motor neuron lesions typically result in increased muscle tone due to the loss of inhibitory signals from the brain. This leads to hyperreflexia, clonus, and rigidity, which are hallmark signs of spasticity. The condition arises from damage to the corticospinal tract, which disrupts the balance of excitatory and inhibitory inputs to the motor neurons.
A young adult client complains of blurred vision and muscle spasms that come and go over the past several months. On what information from the client's history should the nurse focus to help identify this help problem?
- A. Family history of Parkinson disease
- B. Family history of epilepsy
- C. Is an immigrant from Germany
- D. Has been depressed
Correct Answer: C
Rationale: A family history of MS or related autoimmune conditions, as well as geographic factors (e.g., higher prevalence in northern latitudes), can provide clues to the diagnosis. Depression is common in MS but is not diagnostic.