A patient with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep?
QUESTION 1. The unique clinical presentation of a three-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? (Points : 0.4)
“Have you ever given your child any honey or honey-containing products?”
“Is there any family history of neuromuscular diseases?”
“Has your baby ever been directly exposed to any chemical cleaning products?”
“Is there any mold in your home that you know of?”
Question 2. 2. A nurse practitioner is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. Which of the following pharmacologic therapies is most likely to benefit the woman? (Points : 0.4)
A drug that influences gamma-aminobutyric acid (GABA) levels
A selective serotonin reuptake inhibitor (SSRI)
An antipsychotic medication that blocks dopamine receptors
An epinephrine and norepinephrine supplement
Question 3. 3. A 51-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the patient’s history would not be considered to have contributed to his stroke? (Points : 0.4)
He was diagnosed with type 2 diabetes eight years ago
Elevated cholesterol
Blood pressure that is normally 120/80
The patient is an African American Male
History of sickle cell anemia
Question 4. 4. Following a motor vehicle accident three months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? (Points : 0.4)
“Your daughter has lost all her cognitive functions as well as all her basic reflexes.”
“Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”
“If you or the care team notice any spontaneous eye opening, then we will change our treatment plan.”
“Your daughter’s condition is an unfortunate combination of total loss of consciousness with continuation of all other normal brain functions.”
Question 5. 5. A patient with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in her chemical synapses? (Points : 0.4)
Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.
Communication between a neuron and the single neuron it is connected with will be facilitated.
The neurotransmitter will cross gap junctions more readily.
More serotonin molecules will cross the synaptic cleft and bond with postsynaptic receptors.
Question 6. 6. A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son’s increasingly frequent, severe headaches. Which of the nurse’s following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? (Points : 0.4)
“Does your son have a family history of migraines?”
“When your son has a headache, does he ever have nausea and vomiting as well?”
“Does your son have any food allergies that have been identified?”
“Is your son generally pain free during the intervals between headaches?”
Question 7. 7. A 60-year-old male patient with a long history of back pain has had little success with a variety of analgesic regimens that his nurse practitioner has prescribed. He has recently been diagnosed formally with a chronic pain disorder. Which of the following teaching points about chronic pain would his nurse practitioner most likely emphasize to the patient? (Points : 0.4)
“If your pain comes and goes, then we won’t characterize it as chronic, and it will require different treatment.”
“You need to remind yourself that this is a purely physical phenomenon that requires physical treatment.”
“Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about.”
“These pain signals your body is sending likely serve no real, useful, or protective function.”
Question 8. 8. Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep? (Points : 0.4)
The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping–waking cycles.
The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep.
The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep–wake cycle.
Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm.
Question 9. 9. Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? (Points : 0.4)
The inner layer (archilayer)
The middle layer (paleolayer)
The outer layer (neolayer)
The reticular formation
Question 10. 10. A patient with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep? (Points : 0.4)
“Fewer neurons in your brain are firing when you’re asleep, but they’re more synchronized than when you’re awake.”
“While you’re obviously less aware of stimuli when you’re asleep, your brain is actually more active when you’re asleep than when you’re awake.”
“There are four types of brain activity, and actually all of them occur at different stages of sleep.”
“Your brain alternates between periods of activity and periods of inactivity when you’re asleep, and these correspond to your eye movement.”
