Nokea
A 72-year-old patient with moderate-severe PD was placed on carbidopa/levodopa 25/100 mg three times a day by his primary care physician. He is complaining of nausea and stomach upset since starting the medication. The best recommendation is to:
- A. Increase the carbidopa/levodopa dose by 50%.
- B. Discontinue the medication and switch to rasagiline.
- C. Discontinue the medication and switch to a ropinirole.
- D. Recommend taking carbidopa/levodopa with a nonprotein snack.
Correct Answer: D
Rationale: Taking carbidopa/levodopa with a nonprotein snack can help reduce nausea, as protein can interfere with its absorption.
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The nurse is assisting as a neurosurgeon examines a patient who has a positive Babinski reflex. What assessment finding should the nurse expect to observe?
- A. The leg flexes when the patellar tendon is struck.
- B. The leg extends when the patellar tendon is struck.
- C. The big toe extends when the sole of the foot is stroked.
- D. Toes curl downward when the sole of the foot is stroked.
Correct Answer: C
Rationale: A positive Babinski reflex, indicative of neurological dysfunction, involves extension of the big toe and fanning of the other toes when the sole of the foot is stroked. Flexion or extension of the leg is associated with other reflexes. Recognizing a positive Babinski reflex is important for assessing upper motor neuron lesions.
Which technique does the nurse use to test the triceps reflex?
- A. Holds the knee in a slightly flexed position while he or she strokes the end of the foot with a dull object
- B. Hold the patient's relaxed forearm with the hand slightly pronated while striking the appropriate tendon with a reflex hammer
- C. Holds the patient's constricted arm with elbow flexed at a 90 degree angle, places a thumb over the elbow, and strikes the appropriate tendon
- D. Holds the patient's relaxed arm with elbow flexed at a 90 degree angle in one hand and strikes the appropriate tendon just above the elbow with either end of the reflex hammer
Correct Answer: D
Rationale: To test the triceps reflex, the nurse holds the patient's relaxed arm with the elbow flexed at a 90-degree angle and strikes the triceps tendon just above the elbow with a reflex hammer. This assesses the C7-C8 nerve roots.
In evolutionary terms, which is the oldest part of the brain?
- A. the limbic system
- B. the cortex
- C. the right hemisphere
- D. the brain stem
Correct Answer: D
Rationale: The brainstem is the oldest part of the brain in evolutionary terms, as it is responsible for basic life-sustaining functions such as breathing, heart rate, and blood pressure. It includes structures like the medulla oblongata, pons, and midbrain. The brainstem has been conserved throughout evolution and is present in all vertebrates, making it a fundamental component of the central nervous system. In contrast, the cortex and limbic system evolved later and are more developed in higher mammals.
A patient arrived in the ER with a head injury. She is unconscious. The physician and a fellow nurse are the only staff members near the patient. Her husband begins to criticize the attending physician and suggest that a different physician should care for this patient. What is the best response?
- A. Report the nurse to the attending physician.
- B. Call the nurse away from the patient and remind him that the patient can still hear even if unconscious.
- C. Ask the nurse why he has such feelings.
- D. Simply nod your head in agreement.
Correct Answer: B
Rationale: Unconscious patients can still perceive their surroundings; thus, maintaining professional communication is important.
True statements about EOG (electro-oculogram) include:
- A. the EOG light-peak to dark-trough ratio is reduced in central retinal vein occlusion
- B. the light peak of EOG is abnormal in Best's disease
- C. the EOG light rise is produced by depolarization of the basal membrane of the retinal pigment epithelium
- D. all above
Correct Answer: D
Rationale: The EOG light-peak to dark-trough ratio is reduced in retinal vein occlusion, the light peak is abnormal in Best's disease, and the light rise is due to RPE depolarization. All statements are true.