Nokea
A 70-year-old patient taking carbidopa/levodopa 25/100 mg three times a day for PD is experiencing end-of-dose wearing off. The best next step is to:
- A. Add tolcapone.
- B. Consider surgery.
- C. Add trihexyphenidyl.
- D. Increase carbidopa/levodopa to four times daily.
Correct Answer: A
Rationale: Adding tolcapone, a COMT inhibitor, can help manage wearing-off symptoms by prolonging the effect of levodopa.
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The 45-year-old client is diagnosed with primary progressive multiple sclerosis and the nurse writes the nursing diagnosis 'anticipatory grieving related to progressive loss.' Which intervention should be implemented?
- A. Consult the physical therapist for assistive devices for mobility.
- B. Determine if the client has a legal power of attorney.
- C. Ask if the client would like to talk to the hospital chaplain.
- D. Discuss the client's wishes regarding end-of-life care.
Correct Answer: D
Rationale: Discussing end-of-life care is crucial for clients with progressive diseases like MS, as it helps them plan for the future and express their wishes.
The classic ketogenic diet is typically initiated with what macronutrient ratio?
- A. 4 g of fat to 1 g of protein and carbohydrate
- B. 4 g of carbohydrate to 1 g protein
- C. 4 g of protein to 1 g of carbohydrate
- D. 4 g of protein to 1 g of fat and carbohydrate
Correct Answer: A
Rationale: The classic ketogenic diet is initiated with a 4:1 ratio of fat to combined protein and carbohydrates. This high-fat, low-carbohydrate ratio is designed to induce ketosis, a metabolic state where the body uses fat as its primary energy source, which can help reduce seizures in epilepsy.
One criterion identified by the American College of Rheumatology for a diagnosis of fibromyalgia is
- A. Fiber atrophy found on muscle biopsy
- B. Elimination of all other causes of musculoskeletal pain
- C. The presence of the manifestations of chronic fatigue syndrome
- D. The elicitation of pain on palpation of at least 11 of 18 identified tender points
Correct Answer: D
Rationale: Tender points are diagnostic for fibromyalgia.
Regarding the speech centres
- A. Broca's area is on the left side in most left-handed people
- B. Broca's area is posterior
- C. Wernicke's area controls motor response
- D. Damage to Broca's area produces motor aphasia
Correct Answer: D
Rationale: Broca's area, located in the frontal lobe, is responsible for speech production. Damage to this area results in motor (expressive) aphasia, where patients understand language but cannot produce coherent speech.
When assessing cranial nerve XII (Hypoglossal nerve), the nurse should:
- A. Observe the patient's tongue for movement, symmetry, and strength.
- B. Measure the patient's blood pressure.
- C. Check the patient's visual acuity.
- D. Inspect the patient's skin for rashes.
Correct Answer: A
Rationale: Cranial nerve XII (Hypoglossal nerve) controls tongue movement. Observing the tongue for movement, symmetry, and strength assesses its function. Blood pressure, visual acuity, and skin inspection are unrelated.