Week 4.

Bell’s palsy, Parkinson Disease, Alzheimer’s

Name: _______________________ Section: ___________ Date: ___________

Multiple Choice.

1. Bell’s palsy is a disorder of which cranial nerve?

A. Vagus (X)
B. Vestibulocochlear (VIII)
C. Trigeminal (V)
D. Facial (VII)

RATIONALE: D. Bell’s palsy is characterized by facial dysfunction, weakness, and paralysis.

Trigeminal neuralgia is a disorder of the trigeminal nerve and causes facial pain. Meniere’s
syndrome is a disorder of the vestibulocochlear nerve. Guillain-Barre syndrome is a disorder
of the vagus nerve.

2. Which clinical manifestation would be required to confirm the diagnosis of Parkinson​disease?

A. Tremors at rest and bradykinesia
B. Bradykinesia only
C. Rigidity only
D. Tremor at rest and flaccidity

RATIONALE: A. A diagnosis of Parkinson disease requires the presence of two of the three
cardinal​manifestations: tremor,​rigidity, and bradykinesia. Tremors at rest and bradykinesia
are two of the cardinal signs. Bradykinesia alone would not be diagnostic. Tremors at rest are
a cardinal​sign, but flaccidity is not. Rigidity is a cardinal​sign, but rigidity alone is not
diagnostic.

3. Which statement below is INCORRECT about Alzheimer’s disease?

A. It’s the 5th leading cause of death for adults over 65.
B. Alzheimer’s disease is more likely to develop in men rather than women.
C. Most patients typically start showing signs and symptoms of this disease after the age of 60.
D. Hispanics and African Americans are at higher risk for developing Alzheimer’s disease.

RATIONALE: B. Alzheimer’s disease is more likely to develop in WOMEN (not men) because
they tend to live longer. All the other statements are true regarding AD.

4. The client diagnosed with Parkinson's disease (PD) is being admitted with a fever and patchy
infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain
these assessment data?
A. Masklike facies and shuffling gait.
B. Difficulty swallowing and immobility.
C. Pill rolling of fingers and flat affect.
D. Lack of arm swing and bradykinesia.
 RATIONALE: B. Difficulty swallowing places the client at risk for aspiration. Immobility
predisposes the client to pneumonia. Both clinical manifestations place the client at risk for
pulmonary complications.

5. The exact cause of Alzheimer’s disease is not fully understood. However, what two changes in
the brain are found in a patient with this disease? Select all that apply:
A. Destruction of the myelin sheath on the neuron
B. Development of beta-amyloid plaques in between neurons
C. Destruction of dopaminergic neurons
D. Creation of neurofibrillary tangles within the neuron

RATIONALE: B and D. Beta-amyloid plaques and neurofibrillary tangles are found in a patient
with AD. Option A (destruction of the myelin sheath) happens in multiple sclerosis, and
option C (destruction of dopaminergic neurons) occurs in Parkinson’s disease.

6. When the nurse performs a neurologic assessment on Anne Jones, her pupils are dilated and
don’t respond to light.
A. glaucoma
B. damage to the lumbar spine
C. Bell’s palsy
D. damage to the third cranial nerve

RATIONALE: D. The third cranial nerve (oculomotor) is responsible for pupil constriction.
When there is damage to the nerve, the pupils remain dilated and don’t respond to light.
Glaucoma, lumbar spine injury, and Bell’s palsy won’t affect pupil constriction.

7. The client diagnosed with PD is being discharged on carbidopa/levodopa (Sinemet), an

antiparkinsonian drug. Which statement is the scientific rationale for combining these
medications?
A. There will be fewer side effects with this combination than with carbidopa alone.
B. Dopamine D requires the presence of both of these medications to work.
C. Carbidopa makes more levodopa available to the brain.
D. Carbidopa crosses the blood-brain barrier to treat Parkinson's disease.

RATIONALE: C. Carbidopa enhances the effects of levodopa by inhibiting decarboxylase in

the periphery, thereby making more levodopa available to the central nervous system.
Sinemet is the most effective treatment for PD.

8. A neuron is made up of a cell body which contains the nucleus. In addition, it has dendrites.
What is the function of the dendrite?
A. Give structure to the cell body and help keep the neuron functioning
B. To receive information for other nerves cells and take that information to the cell body
C. Take information it receives away from the cell body and to other dendrites of neurons
D. Release neurotransmitters at the synaptic junctions to relay messages
 RATIONALE: B. Dendrites receive information for other nerves cells and take that information
to the cell body.

9. Which symptom for a client with Parkinson disease​(PD) is due to the lack of automatic muscle​
movement?
A. Diminished voice volume
B. Reduced ability to swallow
C. Alterations in sleep pattern
D. Diminished physical mobility

RATIONALE: C. Alterations in sleep pattern may occur due to lack of automatic muscle
movement in a client with Parkinson disease. Reducing strenuous activities near​bedtime,
limiting intake of​caffeine, and providing a glass of milk before bedtime are all examples of
interventions that directly address issues with sleep pattern. Reduced ability to​swallow,
diminished voice​volume, and diminished physical mobility are all related to dysfunction of
voluntary muscle movement.

10. A male client with Bell’s palsy asks the nurse what has caused this problem. The nurse’s response
is based on an understanding that the cause is:
A. Primarily genetic in origin, triggered by exposure to neurotoxins
B. Unknown, but possibly includes long-term tissue malnutrition and cellular hypoxia
C. Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem
D. Primary genetic in origin, triggered by exposure to meningitis

RATIONALE: C. Bell’s palsy is a one-sided facial paralysis from compression of the facial
nerve. The exact cause is unknown, but may include vascular ischemia, infection, exposure
to viruses such as herpes zoster or herpes simplex, autoimmune disease, or a combination of
these factors.

11. Surrounding the neuron are cells that help protect its ability to function. Which cell type
provides safety to the neuron by removing dangerous material that could damage the neuron?
A. Microglia
B. Ependymal cells
C. Astrocytes
D. Oligodendrocyte

RATIONALE: A: microglia These cells play a role with inflammation that is found in
Alzheimer’s Disease.

12. The nurse is aware that Bell’s palsy affects which cranial nerve?
A. 3rd CN (Occulomotor)
B. 2nd CN (Optic)
C. 4th CN (Trochlear)
D. 7th CN (Facial)
 RATIONALE: D. Bells’ palsy is the paralysis of the motor component of the 7th cranial nerve,
resulting in facial sag, inability to close the eyelid or the mouth, drooling, flat nasolabial fold
and loss of taste on the affected side of the face.

13. The nurse caring for a client diagnosed with Parkinson's disease writes a problem of "impaired
nutrition." Which nursing intervention would be included in the plan of care?
A. Consult the occupational therapist for adaptive appliances for eating.
B. Request a low-fat, low-sodium diet from the dietary department.
C. Provide three (3) meals per day that include nuts and whole-grain breads.
D. Offer six (6) meals per day with a soft consistency.

RATIONALE: D. The client's energy levels will not sustain eating for long periods. Offering
frequent and easy-to-chew (soft) meals of small proportions is the preferred dietary plan.

14. Which type of therapy is used to manage problems with eating and​swallowing?
A. Physical
B. Occupational
C. Speech
D. Nutritional

RATIONALE: C. Speech therapy is used to manage problems with eating and swallowing.
Occupational therapy is used to maintain​self-care activities, not specifically eating and
swallowing. Physical therapy is used to improve coordination of balance and gait. There is no
nutritional therapy needed for a client with Parkinson disease.

15. Which finding in a patient with Alzheimer’s disease best describes the term agnosia?
A. The patient uses a fork to eat a bowl of soup.
B. The patient makes up a word to recall the name of an object.
C. The patient can’t recall their address.
D. The patient is unable to perform the movements needed to use their hair brush.

RATIONALE: A. Option b describes anomia, option c describes amnesia, option d describes

apraxia.

16. The charge nurse is making assignments. Which client should be assigned to the new graduate
nurse?
A. The client diagnosed with aseptic meningitis who is complaining of a headache and the light
bothering his eyes.
B. The client diagnosed with Parkinson's disease who fell during the night and is complaining of
difficulty walking.
C. The client diagnosed with a cerebrovascular accident whose vitals signs are P 60, R 14, and
BP 198/68.
D. The client diagnosed with a brain tumor who has a new complaint of seeing spots before the
eyes.
 RATIONALE: A. Headache and photophobia are expected clinical manifestations of
meningitis. The new graduate could care for this client.

17. The nurse has given the male client with Bell’s palsy instructions on preserving muscle tone in
the face and preventing denervation. The nurse determines that the client needs additional
information if the client states that he or she will:
A. Massage the face with a gentle upward motion
B. Exposure to cold and drafts
C. Perform facial exercises
D. Wrinkle the forehead, blow out the cheeks, and whistle

RATIONALE: B. Prevention of muscle atrophy with Bell’s palsy is accomplished with facial
massage, facial exercises, and electrical stimulation of the nerves. Exposure to cold or drafts
is avoided. Local application of heat to the face may improve blood flow and provide
comfort.

18. An older adult client with Parkinson disease uses a​walker, speaks in a slurred manner with poor​
articulation, but tries to speak louder to accommodate for this impairment. The client​states, "I
catch my daughter looking at me angrily​sometimes, but she​doesn't say​anything." Which
nursing diagnosis is the priority​?
A. Communication: Verbal, Impaired
B. Caregiver Role Strain
C. ​Falls, Risk for
D. Nutrition, Imbalanced: Less than Body Requirements

​ ATIONALE: B. The client is making accommodations for preventing falls by using a walker.
R
Being the primary​caregiver, the​client's daughter assists the client in feeding so imbalanced
nutrition is not a risk. The client is also practicing speech by speaking louder. It is the​
caregiver's role strain that is the major risk for this client.​

19. Alzheimer’s disease also affects the neurons found in the outside layer that surrounds the top of
the cerebrum. This area is made up of different lobes such as the frontal, parietal, temporal, and
occipital lobes. What is this area of the brain called?
A. Corpus callosum
B. Cerebral cortex
C. Amygdala
D. Cerebellum

RATIONALE: B: cerebral cortex It’s important to note that in advance cases of AD, the
cerebral cortex will shrink, leading to brain atrophy.

20. What is the average age when Parkinson disease first appears?
A. 25
B. 50
 C. 60
D. 75

RATIONALE: D. The average age when people get Parkinson disease is 70. It is rare among
people younger than 40, and the incidence rises with age. It is slightly more common in men
than in women, according to the NINDS.

21. Neurofibrillary tangles found in Alzheimer’s disease are made up of a protein called ________.
What is the role of these proteins?
A. Beta-amyloid; delivers nutrients to the neuron
B. Amyloid precursor protein; promotes neurotransmitter released at the synaptic junction
C. Tau; provides structural strength to microtubules in the neuron
D. Microglia; removes debris from outside the neuron

RATIONALE: C: Neurofibrillary tangles found in Alzheimer’s disease are made up of a protein

called Tau. Tau proteins provide structural strength to microtubules in the neuron.

22. The nurse is planning the care for a client diagnosed with Parkinson's disease. Which would be a
therapeutic goal of treatment for the disease process?
A. The client will experience periods of akinesia throughout the day.
B. The client will take the prescribed medications correctly.
C. The client will be able to enjoy a family outing with the spouse.
D. The client will be able to carry out activities of daily living.

RATIONALE: D. The major goal of treating PD is to maintain the ability to function. Clients
diagnosed with PD experience slow, jerky movements and have difficulty performing routine
daily tasks.

23. A patient was recently diagnosed with Mild Alzheimer’s (Early-stage Alzheimer’s disease). What
important educational topics should the nurse provide to this patient at this time? Select all that
apply:
A. Progression of the disease
B. Future planning
C. Surgical options
D. Medications

RATIONALE: A, B, and D. There are no surgical options for AD and no curative treatment at
this time. During this early-stage the patient is still able to function and be independent, but
this will not last too long (may be a couple of years…depends on the patient) until they will
need constant help. This is the time the nurse needs to tell the patient about the progression
of the disease (what to expect), medications available, and the need for future planning.

24. When teaching patients who are at risk for Bell's palsy because of previous herpes simplex
infection, which information should the nurse include?
 A. "You should call the doctor if pain or herpes lesions occur near the ear."
B. "Treatment of herpes with antiviral agents will prevent development of Bell's palsy."
C. "Medications to treat Bell's palsy work only if started before paralysis onset."
D. "You may be able to prevent Bell's palsy by doing facial exercises regularly."

Rationale: A. Pain or herpes lesions near the ear may indicate the onset of Bell's palsy and
rapid corticosteroid treatment may reduce the duration of Bell's palsy symptoms. Antiviral
therapy for herpes simplex does not reduce the risk for Bell's palsy. Corticosteroid therapy
will be most effective in reducing symptoms if started before paralysis is complete but will
still be somewhat effective when started later. Facial exercises do not prevent Bell's palsy.

25. The healthcare provider of an older adult client with advancing Parkinson disease suggested that
the client start an exercise regime. Which exercise should the nurse​recommend?
A. T'ai chi
B. Running
C. Weight lifting
D. Football

RATIONALE: A. For a client with Parkinson​disease, an exercise regime that promotes balance
and walking is the best.​So, the nurse may recommend​t'ai chi. Considering the​client's age,​
football, running, and weight lifting may be too strenuous.

26. During the evening hours you notice your patient with Moderate Alzheimer’s Disease (Middle
Stage) begins to experience an increase in confusion, agitations, and hallucinations. What
intervention below could the nurse implement to help decrease this occurrence?
A. Provide the patient with coffee at bedtime
B. Provide a relaxing and low noise environment in the evening
C. Use stimulating distractions at night
D. Limit patient’s contact with sunlight during the day

RATIONALE: B. Provide a relaxing and low noise environment in the evening This
phenomenon is known as Sundowner’s Syndrome. Patients with AD can experience this
during the evening hours. It can be triggered by exhaustion, low lighting (not experiencing
enough contact with sunlight during the day), sickness, and medications. The nurse should
promote a calm, relaxing environment and avoid stimulating activities that could cause
fatigue. Caffeine (coffee) can make Sundowning worst.

27. How is Parkinson disease treated?

A. Medicine
B. Surgery
C. Radiation
D. A and B
 RATIONALE: D. Parkinson has no cure. But the symptoms often can be improved with
medicine and sometimes with surgery. Treatment varies greatly from person to person. It
depends on whether the symptoms are mild, moderate, or severe. Levodopa is a medicine
that is often prescribed. It is converted to dopamine in the brain. It helps replace the
dopamine that the brain no longer makes. Some medicines act like dopamine in the brain.
Other medicines keep dopamine from being destroyed so more of it is available. It is
common for a person with Parkinson to take more than 1 medicine. Possible surgeries
include implanting neurostimulators, pallidotomy, and transplanting stem cells.

28. You’re providing education about testing for Alzheimer’s disease. Which tests below can a
patient have to check for beta-amyloid proteins in the brain? Select all that apply:
A. X-ray
B. Spinal tap
C. PET scan
D. MRI scan

RATIONALE: B and C. Currently, cerebrospinal fluid can be removed via a spinal tap to check
for these proteins along with an amyloid PET scan. Recently, a new blood test has been
created that can detected these proteins but may not be readily available for all patient at
this time.

29. How is Parkinson disease diagnosed?

A. With a blood test
B. With a neurological exam
C. With an X-ray
D. All of the above

RATIONALE: B. It's difficult to diagnose in the early stages. No test currently exists that can
diagnose Parkinson. Usually, a neurologist makes the diagnosis. They evaluate the symptoms
and how serious they are. They also assess the results of a neurological exam. The person
should also see a specialist in movement disorders to make sure the correct diagnosis is
made. A brain scan can help find out if the person has Parkinson or a disease with similar
symptoms. Sometimes medicines used to treat Parkinson are given to the person to see if
the symptoms improve.

30. The nurse is helping a patient with Moderate Alzheimer’s disease (Middle Stage) participate in a
task. When selecting a task for the patient, the nurse would want to make sure the task has?
A. Multiple steps
B. Clear simple directions
C. Critical thinking
D. Usage of multiple tools
 RATIONALE: B. clear simple directions. Patients with this stage of AD can follow directions
that are simple and clear. It is best to avoid tasks that require multiple steps, critical thinking,
and usage of multiple tools. This could confuse the patient and lead to outbursts of anger.

31. A patient with Bell's palsy refuses to eat while others are present because of embarrassment
about drooling. The best response by the nurse to the patient's behavior is to
A. Respect the patient's desire and arrange for privacy at mealtimes.
B. Offer the patient liquid nutritional supplements at frequent intervals.
C. Discuss the patient's concerns with visitors who arrive at mealtimes.
D. Teach the patient to chew food on the unaffected side of the mouth.

RATIONALE: A. The patient's desire for privacy should be respected to encourage adequate
nutrition and reduce patient embarrassment. Liquid supplements will reduce the patient's
enjoyment of the taste of food. It would be inappropriate for the nurse to discuss the
patient's embarrassment with visitors unless the patient wishes to share this information.
Chewing on the unaffected side of the mouth will enhance nutrition and enjoyment of food
but will not decrease the drooling.

32. An older adult client was diagnosed with Parkinson disease 3 months ago. Since the​diagnosis,
the client has not gone out of the house. Which statement by the nurse is most​appropriate?
A. "Tell your family to come and take you out of the​house."
B. "Can I ask why you​aren't going out of the​house?"
C. "You need to start getting​out."
D. ​"Getting out of the house will help you to feel less​depressed."

RATIONALE: B. Asking an​open-ended question and inquiring about the reason why the client
is not going out of the house will encourage the client to discuss and share information.
Advising the client about going​out, telling the client that they will feel better by going​out,
or involving the family will not encourage the client to discuss the reason behind staying at
home.

33. You’re providing education to a group of caregivers about wandering in Alzheimer’s disease. You
ask the participants to verbalize signs a family member with this disease may be experiencing
wandering. Which sign verbalized by a participant requires re-education?
A. The family member takes longer than expected to return from a place.
B. The family member repeatedly requests to visit an old acquaintance.
C. The family member refuses to leave their bedroom.
D. The family member has trouble finding rooms within the house.

RATIONALE: C. Options A, B, D are all signs the patient is at risk for wandering. Wandering
can lead the patient to become lost. Signs of wandering should be addressed and prevention
measures should be taken to help protect the safety of the patient.
34. The nurse researcher is working with clients diagnosed with Parkinson's disease. Which is an
example of an experimental therapy?
A. Sterotactic pallidotomy/thalamotomy.
B. Dopamine receptor agonist medication.
C. Physical therapy for muscle strengthening.
D. Fetal tissue transplantation.

RATIONALE: D. Fetal tissue transplantation has shown some success in PD, but it is an
experimental and highly controversial procedure.

35. A family member who is the caregiver for a patient with Moderate Alzheimer’s disease (Middle
Stage) asks for advice on safety measures that can be taken to keep the patient safe due to
wandering. Which option below is NOT an appropriate safety measure for the caregiver to take?
A. Display signs throughout the house to identify the rooms
B. Consider a GPS tracking device system for the patient
C. Encourage social interaction by taking the patient to a shopping mall
D. Obscure assess to exit doors and windows

RATIONALE: C. Encourage social interaction by taking the patient to shopping mall.

Wandering is experienced by many patients with AD. It tends to become worst during the
early evening. Triggers for wandering include being in stressful, crowded, unfamiliar areas
(avoid a shopping mall…they tend to be busy and unfamiliar for the patient), needs a basic
need met like a bathroom, trying to do a routine they have always done before, or restless
from inactivity (the patient needs regular exercise).

36. The client comes to the clinic and reports a sudden drooping of the left side of the face and
complains of pain in that area. The nurse notes that the client cannot wrinkle the forehead or
close the left eye. Which condition should the nurse suspect?
A. Bell's palsy.
B. Right-sided stroke.
C. Tetany.
D. Mononeuropathy.

RATIONALE: A. Bell's palsy, called facial paralysis, is a disorder of the 7th cranial nerve (facial
nerve) characterized by unilateral paralysis of facial muscles.

37. What is often the first symptom of Parkinson disease?

A. Headache
B. Nausea
C. Shaking of a hand or foot
D. Turning of the head

RATIONALE: C. About 7 in 10 people with Parkinson first have a slight tremor in a hand or
foot, according to the Parkinson Foundation. The tremor usually occurs when the muscles
 are at rest and relaxed. It usually appears on 1 side of the body. Later it may spread to the
other side of the body, often to a lesser degree.

38. The nurse is speaking to a patient with Moderate Alzheimer’s disease (Middle Stage). The
patient is sitting in the bedside chair and is about to eat breakfast. Which action by the nurse
demonstrates the nurse knows how to communicate with this patient correctly?
A. The nurse approaches the patient from behind to initiate conversation.
B. The nurse asks “Do you want orange juice with breakfast?”
C. The nurse leaves the TV on while talking with the patient.
D. The nurse stands over the patient while conversing with the patient.

RATIONALE: B. This option is correct because the nurse is using a closed-ended question
which requires a yes or no answer rather than an opened-ended like “what do you want to
drink with breakfast?”. This type of question requires more thought and can confuse the
patient. Option A is wrong because the nurse should approach the patient directly in the
front rather than behind (this could scare the patient and lead to an emotional outburst).
Option C is wrong because the nurse should eliminate outside noise so the patient can hear
and concentrate on the conversation. Option D is wrong because the nurse should
communicate on eye level rather than standing over the patient. The patient with AD may
feel intimated by this.

39. The nurse is admitting a client with the diagnosis of Parkinson's disease. Which assessment data
support this diagnosis?
A. Crackles in the upper lung fields and jugular vein distention.
B. Muscle weakness in the upper extremities and ptosis.
C. Exaggerated arm swinging and scanning speech.
D. Masklike facies and a shuffling gait.

RATIONALE: D. Masklike facies and a shuffling gait are two clinical manifestations of PD.

40. A caregiver reports that their family member with Alzheimer’s disease does not have interest in
eating. They request some advice on how to help their family member eat better. What
intervention below would be incorrect for the nurse to give?
A. Eat with the family member for meals
B. Keep the eating environment free from outside noise and well lit
C. Serve the family member a variety of food items on their plate
D. Select healthy but tasty soft finger foods

RATIONALE: C. A person with AD can become easily overwhelmed, especially by a full plate
of food. Therefore, it’s important to not overwhelm the patient with options, but to serve
them one food item at a time that they like.
41. The daughter of an older adult client with advancing Parkinson disease tells the nurse that they
need to dress their mother each​morning, because the mother is​"not fast​enough." Which is the
most appropriate response from the​nurse?
A. "It is important for you to get to work on​time."
B. "Can you let her dress​herself?
C. "It is best for you to let your mother dress herself for as long as she​can."
D. "That is really quite​normal."

RATIONALE: C. The nurse should tell the caregiver​that, by allowing independence in​
dressing, the client will have an improved sense of​well-being and lessened depression.
Asking​closed-ended questions or just remarking that it is normal will not support the​client's
needs.

42. A patient with Alzheimer’s disease is prescribed a cholinesterase inhibitor. Which of the
following medications below is NOT this type of medication?
A. Galantamine
B. Rivastigmine
C. Memantine
D. Donepezil

RATIONALE: C. Memantine This is a NMDA antagonist.

43. Which should be the nurse's first intervention with the client diagnosed with Bell's palsy?
A. Explain that this disorder will resolve within a month.
B. Tell the client to apply heat to the involved side of the face.
C. Encourage the client to eat a soft diet.
D. Teach the client to protect the affected eye from injury.

RATIONALE: D. Teaching the client to protect the eye is priority because the eye does not
close completely and the blink reflex is diminished, making the eye vulnerable to injury. The
client should wear an eye patch at night and wrap around sunglasses or goggles during the
day; he or she may also need artificial tears.

44. Select the statement below that best describes how Galantamine works to treat a patient with
Alzheimer’s disease.
A. “This medication decreases the amount of glutamate readily available at the receptor site.”
B. “Galantamine prevents the breakdown of acetylcholine.”
C. “This medication decreases the levels of acetylcholine in the brain.”
D. “Galantamine decrease beta-amyloid plaques in the brain.”

RATIONALE: B. Galantamine is a cholinesterase inhibitor and works to prevent the

breakdown of acetylcholine by inhibiting the enzyme cholinesterase.
45. The client diagnosed with Parkinson's disease is being discharged. Which statement made by the
significant other indicates an understanding of the discharge instructions?
A. "All of my spouse's emotions will slow down now just like his body movements."
B. "My spouse may experience hallucinations until the medication starts working."
C. "I will schedule appointments late in the morning after his morning bath."
D. "It is fine if we don't follow a strict medication schedule on weekends."

RATIONALE: C. Scheduling appointments late in the morning gives the client a chance to
complete ADLs without pressure and allows the medications time to give the best benefits.

46. A patient taking a cholinesterase inhibitor is experiencing nausea and diarrhea. These side
effects can be decreased by doing which of the following?
A. Administering the medication on an empty stomach
B. Administering the medication with meals
C. Administering the medication two hours before a meal
D. Administering the medication at bedtime

RATIONALE: B. This medication group can lead to GI upset. If this occurs, administering the
med with meals can help decrease this side effect.

47. Which is the main pathology of Parkinson disease that causes changes in muscular and sensory​
function?
A. Reduction of acetylcholine in the brain
B. Reduction of dopamine in the brain
C. Genetic predisposition
D. Presence of Lewy bodies

RATIONALE: B. The changes in muscular and sensory function in Parkinson disease​(PD) are
caused by a decreased amount of dopamine in the​brain, which in turn​increases, not​
reduces, the amount of acetylcholine. The presence of Lewy bodies​(abnormal aggregates of​
proteins) in the neurons is a characteristic of​PD, but it is unclear whether they are helpful or
harmful. Although there is a genetic link in approximately 15dash​25% of​cases, it is a risk
factor rather than a cause of PD manifestations.

48. A patient with Severe Alzheimer’s Disease is prescribed to take Memantine. Which statement
best describes how this medication works to treat this disease?
A. “It increases acetylcholine levels in the brain.”
B. “It prevents the enzyme cholinesterase from working.”
C. “It limits how glutamate can engage the NMDA receptor in the brain.”
D. “It decreases beta amyloid plaques in the brain.”

RATIONALE: C. Memantine is an NMDA receptor antagonist that limits how glutamate can
engage the NMDA receptor in the brain.
49. Parkinson disease is marked by a lack of which chemical in the brain?
A. Serotonin
B. GABA
C. Dopamine
D. Norepinephrine

RATIONALE: C. The brain-signaling chemical dopamine is one of many neurotransmitters in

the brain. It is made by cells in the brain stem. These cells release dopamine, which helps
control muscle movement. The shortage of dopamine is caused by the breakdown of
neurons in the area of the brain that controls movement. The breakdown of the neurons
does not stop and gets worse.

50. What medication is relatively new that is given by IV infusion that can help decrease beta
amyloid plaques in patients with Alzheimer’s disease?
A. Memantine
B. Galantamine
C. Donepezil
D. Aducanumab

RATIONALE: D. Aducanumab. Before a patient takes this medication their doctor may order
diagnostic testing to confirm plaques are present like spinal tap or amyloid PET scan. Side
effects are a potential brain bleed or swelling and will need brain scans periodically to
monitor the brain.

Prepared by: Dr. Jhonnifer A. Abarao,

DHCM, MAN, USRN, RN, LPT, CHA,

“Not all angels have wings … some have scrubs.” —Unknown