1. B - Damage to the third cranial nerve (oculomotor) may cause dilation of the pupil.
2. C - For the body to absorb calcium, pressure must be placed on the long bones. The tilt table places the patient in a standing position, which puts pressure on the long bones.
3. B - Huntington’s disease is a hereditary in which degeneration of the basal ganglia and cerebral cortex causes chronic progressive chorea (muscle twitching) and mental deterioration, ending in dementia.
4. A - Seizures may occur at any time following a head injury, but the onset of seizures specifically tends to occur 6 months to 2 years posttrauma.
5. B - Quadriplegia results from an injury to the spinal cord anywhere between levels C1 to C8. Injuries to the spinal cord at levels below C8 can cause lower level paralysis such as paraplegia.
6. C - The upper motor neuron originates in the cerebral cortex and terminates in the anterior horn cell in the spinal cord. Reflexes return following an injury, resulting in spastic paralysis.
7. A - The elasticity of the eye’s lens and the papillary light-reflex decline with age. Decreased tearing of the eyes also in normal in the elderly. Strabismus is an abnormal finding.
8. A - Physical changes associated with aging include decreased physical strength and endurance, decreased muscular coordination, decreased tolerance to cold, and a tendency to lose weight.
9. B - Psychogenic pain is related to emotional factors and has no anatomic or physiological explanation. Pain due to an amputation is called phantom pain, pain originating in the internal organs is visceral pain and originating in the central nervous system is central pain.
10. C - Major fears of elderly people include fear of physical and economic dependency as well as fear of chronic illness and fear of loneliness.
11. C - When a patient has had a cerebrovascular accident (CVA) in the left hemisphere of the brain, the paresis will be on the right side of the body. Because the pyramidal motor tracts cross over at the medulla oblongata, the right side of the body and the right side of the face will have paresis with left-hemisphere damage.
12. D - Aphasia describes the absence or impairment of speech when the patient can still communicate through gestures.
13. C - Long-term planning for a patient with aphasia would include consulting with the patient’s doctor concerning a speech therapy program. In Mr. Hilario’s case, it’s too soon to know whether his disability will be permanent. 14. D - Using gestures to accompany the spoken word will help the patient better understand the message being
communicated. Conversing slowly and giving directions one at a time will allow the patient time to understand what is being said.
15. A - Guillain, Barre’ syndrome is an acute, rapidly progressive, and potentially fatal form of poly neuritis that causes muscle weakness and mild distal sensory loss.
16. C - Patients with Guillain-Barre’ syndrome may suffer from progressive paralysis that includes the respiratory muscles and may requires intubation and mechanical ventilation during the acute phase of their disease. 17. C - Treatment of Guillain-Barre’ syndrome is supportive and includes intubation with mechanical ventilation,
nutritional supplementation, and rigorous attention to hygiene and skin care.
18. B - Hypotensive agents, steroids, and sedatives are utilized to prevent rupture of the aneurysm or to reduce bleeding if a cerebrovascular accident has occurred. Patients are typically kept on bed rest with a quiet room and no stimulants.
19. C - A brain aneurysm is a dilation of a cerebral artery, which is caused secondary to weakness in the vessel wall. The vessel may rupture and cause a subarachnoid bleed.
20. A - Signs of a brain aneurysm may include a headache, nuchal rigidity, and a stiff back and legs, progressing to altered consciousness and coma in severe cases.
21. C - During a seizure, the patient should be positioned on his side to prevent aspiration if he vomits. Padding the side rails prevents injury during generalized tonic-clonic seizures.
22. B - Because phenytoin (Dilantin) may cause hypertrophy of the gums, meticulous oral hygiene is required to reduce inflammation and prevent infection of the gums. Phenytoin doesn’t cause an increase in bacterial growth or plaque formation, nor does it cause bleeding of the gums.
23. C - An aura frequently precedes an epileptic seizure and may manifest as vague psychic discomfort or specific aromas. Patients experiencing auras aren’t having a CVA experiencing substance withdrawal, or hallucinating. 24. C - A simple focal seizure begins in one part of the cerebral cortex and remains localized, resulting in specific
isolated behaviors and brief lapses of attention.
25. B - The most common causes of spinal cord injury in teenagers and young adults are motor vehicle accidents, falls, and diving accidents. Arthritis conditions may occasionally cause spinal cord injury secondary to narrowing of the spinal canal in the elderly population.
26. C - In the early stages of spinal cord injury, patients experience a relative hypovolemi, with inflammation contributing to secondary injury to the damaged spinal cord region. Patients are treated with I.V. fluids and corticosteroids.
27. B - Learning to use mechanical aids is an early problem for a paraplegic. Most paraplegics are young adults and are accustomed to leading active, independent lives.
28. B - Spinal shock occurs in patients with complete transaction of the spinal cord. Impairment of the vasomotor mechanism (nerves having muscular control of the blood vessels walls) causes a drop in blood pressure and an increased heart rate.
29. A - Following a complete spinal cord transaction, all voluntary motor activity and sensation below the level of injury is lost. Variable loss of voluntary motor activity and sensation occurs following partial transaction of the spinal cord. 30. D - The patient is complaining of symptoms of autonomic dysreflexia, which consists of the triad of hypertension, bradycardia, and a headache. Major causes of autonomic dysreflexia include urinary bladder distention and fecal impaction.
31. A -The short span of 3 days after a spinal cord injury is too early to determine a male patient’s ability to have sexual intercourse.
32. D - Paraplegic patients can’t put pressure – which is necessary for calcium absorption – on their long bones. This causes the skeletal system to lose calcium, a situation that causes an increase in serum calcium levels and can cause renal calculi.
33. B - Rehabilitation should begin as soon as the patient is stabilized after a spinal cord injury. It can’t be left up to the patient, particularly because he may be depressed and uninterested in rehabilitation early recovery.
34. D - Cataracts are caused by clouding or opacity of the lens that leads to eventual loss of sight. Most patients have painless progressive vision loss, sometimes with increased glare from bright lights. Cataracts may occur in one eye or both eyes.
35. B - Typically, a patient with cataracts experiences a painless, gradual loss of vision. Although both eyes may develop cataracts, the cataracts usually develop at different rates.
36. D - Surgical removal of cataracts is performed when vision loss interferes with the patient’s functional status. Lubricants and miotic eyedrops don’t improve cataracts. Cataracts occur in many older adults but aren’t part of normal aging.
37. D - Surgery can restore about 95% of vision loss by removing the cataract. The procedure is generally performed under local anesthesia in an ambulatory surgical center, with patients returning hoe 2 to 3 hours postoperatively. 38. D - Patients must be careful to not increase intraocular pressure by bending, straining, lifting, or coughing. Bed rest
isn’t necessary. Alcohol and nicotine don’t directly affect recovery.
39. B - Intraocular infection and uveitis – together with vitreous prolapse and hyphema – are major complications of cataract surgery.
40. B - Due to presbycusis (sensorineural hearing loss), the ability to hear high-frequency sounds is lost first. 41. D - Meniere’s disease is a labyrinthine dysfunction. Manifestations include severe vertigo, tinnitus, and
sensorineural hearing loss.
42. D - During severe attack’s of Meniere’s disease, patients should rest in a position that minimizes their vertigo. Patients also should request assistance with activities to prevent injury from falls.
43. A - Bladder capacity decreases to 200 ml or less in postmenopausal women, causing urinary frequency. 44. C - Pelvic floor exercises (Kegel exercises) are the first appropriate intervention for stress incontinence. These
exercises are used to strengthen perianal and sphincter muscle control.
45. D - Because of the frequent need to urinate, the patient may limit social activities and suffer from isolation and lowered self-image.
46. B - Alzheimer’s disease is the most common cause of dementia in the elderly population. AIDS, brain tumors and vascular disease are all less common causes of progressive loss of mental function in elderly patients
47. B - During the middle stage of dementia, patients require constant supervision to ensure safety and are easily distracted during activities. Difficulties with concentration and learning are common in early dementia.
48. B - Care of the patient with Alzheimer’s disease is symptomatic and supportive including patient and family counseling and education. Treatment with lecithin and physostigmine hasn’t proven useful, and the use of physical restraints is ethically unacceptable.
49. B - Meals provides in a quite environment with minimal distractions are most helpful. Offering too many food choices, providing excessive stimulation at mealtimes, and strictly enforcing mealtimes can lead to anger and lack of cooperation in this patient population.
50. B - Families of patients with Alzheimer’s disease should be encouraged to plan ahead for progressive patient decline in functioning. This includes financial planning and nursing home or hospice applications.