NR603 Week 1 Quiz Paper

Question 1

Collaborating with specialists is an important part of primary care involving patients with neurologic injuries. It is important as an APN to know when to refer to a specialist and what the goal of the referral is: further information, diagnostic testing or treatment recommendations. Which of the following are accurate goals of referral of a patient for Neuropsychological testing?

· Monitor changes in cognition over time (document recovery or progression of symptoms)

· Marital counselling

· Monitor the results of Court ordered Drug testing

· Assist in different diagnosis and determination of severity of a condition

· Establish a baseline level of neuropsychological functioning

· Assist in identifying neurobehavioral or developmental disorders that may influence cognitive and behavioral functions (e.g. dyslexia, attention deficit hyperactivity disorder (ADHD), autism, spectrum disorders, mental retardation)

Question 2

Which of the following general guidelines is NOT recommended for treatment of a patient with traumatic brain injury (TBI):

· Allow extra time for patient arrival

· Speak quickly so that the patient will be motivated to stay in place

· Encourage the patient to keep a written notebook of notes from each session

· Hold sessions in a dim lighted room because they could be light sensitive

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Question 3

Reversible causes of delirium include:

· Depression, dementia, anesthesia

· Infection, electrolyte imbalance , medication effects

· BCD all have irreversible disease in their list

· Aesthesia, Parkinson’s Disease, alcohol withdrawal

Question 4

Which type of medication may be particularly dangerous when treating aggression in patients with traumatic brain injury (TBI) because it could cause paradoxical agitation?

· Propranolol

· Haloperidol

· Benzodiazepines

· Clonidine

Question 5

Common presenting symptoms of dementia include all of the following except:

· Abstract thinking increases

· Inability to find right words

· Depression

· Irritability

Question 6

Patients with any type of Traumatic Brain Injury (TBI) are at risk for developing which of the following sleep disorders:

· Hypersomnia

· Obstructive Sleep Apnea

· All the above

· Insomnia

Question 7

A pleasant 73 year old male presents to the clinic with his wife. His wife states that she has noted increased problems with his memory including forgetting to get some items on his grocery list and misplacing his car keys. You administer the MMSE in the office and he scores 24/30 which is the consistent with mild dementia per the scoring guidelines. Your best response to his wife is:

· The MMSE score alone is concerning for Dementia but the memory issues can be part of the normal brain function so we need to rule out organic causes before concluding a diagnosis of Dementia

· The MMSE score along with the memory issues are more concerning for head injury and so we will pursue a head CT to rule out TBI.

· The MMSE score alone is a strong indicator of Dementia and we can proceed with medication based on these results

· The MMSE score along with the memory issues you identified are very strong indicators of Dementia so we will begin first line treatment with Donepezil today

Question 8

Key early warning signs for Alzheimer’s disease include all of the following except:

· Memory loss

· Loss if initiative

· Increased fatigue

· Problem with language

Question 9

Which of the following is NOT an overlapping symptom of Post-Traumatic Stress Disorder (PTSD) and the Persistent Post Concussive Syndrome (PPCS):

· Dizziness

· Depression/Anxiety

· Irritability/Anger

· Insomnia

Question 10

Chris is a 28 year old marine who just returned from active duty from Iraq. He has been complaining of dizziness, extreme headaches and memory problems related to traumatic brain injury. His neurological injuries are most likely the effect of:

· Direct blunt trauma resulting in damage to underlying tissues

· Changes related to altitude and climate

· Diffuse axonal damage as the result of blast-induced injury

· Rotational Acceleration resulting in local injury