A 31-year-old male client with excessive daytime sleepiness (EDS) has episodes in which he loses muscle tone but remains conscious. These episodes usually occur after he laughs. What should the PMHNP assess for?
Pseudobulbar affect
Secondary narcolepsy
Type 1 narcolepsy
Type 2 narcolepsy
The Correct Answer is C
Choice A reason: Pseudobulbar affect is characterized by sudden, uncontrollable episodes of laughing or crying that are disproportionate or unrelated to the situation. It does not involve loss of muscle tone or cataplexy and is typically associated with neurological conditions such as multiple sclerosis or traumatic brain injury.
Choice B reason: Secondary narcolepsy occurs due to identifiable causes such as brain injury, tumors, or infections affecting the hypothalamus. While it can present with excessive daytime sleepiness, cataplexy is not a defining feature unless hypocretin deficiency is present. The presence of cataplexy in this case points more specifically to Type 1 narcolepsy.
Choice C reason: Type 1 narcolepsy is characterized by excessive daytime sleepiness and cataplexy—sudden loss of muscle tone triggered by strong emotions such as laughter, while consciousness is preserved. This presentation is classic for Type 1 narcolepsy and is associated with low cerebrospinal fluid hypocretin levels.
Choice D reason: Type 2 narcolepsy also presents with excessive daytime sleepiness but lacks cataplexy. Since the patient experiences muscle tone loss triggered by laughter, Type 2 narcolepsy is ruled out.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: While testicular cancer is most common in men aged 15–35, limiting self-exams to this age range may miss cases in older men. Monthly self-exams are recommended starting at age 18 and continuing throughout adulthood.
Choice B reason: This age range excludes younger men who are at higher risk for testicular cancer. It is not consistent with preventive guidelines.
Choice C reason: Testicular cancer is less common in men over 45, and this age range does not reflect the peak incidence period.
Choice D reason: Monthly testicular self-exams are recommended for men aged 18 and older to promote early detection of testicular cancer, which has a high cure rate when caught early. Regular self-exams help men become familiar with their baseline anatomy and detect changes promptly.
Correct Answer is A
Explanation
Choice A reason: Minocycline is a tetracycline antibiotic and has not been established as a treatment for autonomic dysreflexia. While it has neuroprotective and anti-inflammatory properties in experimental models, it is not part of the clinical management protocol for autonomic dysreflexia.
Choice B reason: OnabotulinumtoxinA (Botox) has been used in patients with neurogenic bladder or spasticity, which can contribute to autonomic dysreflexia. It helps reduce bladder overactivity and prevent triggering episodes.
Choice C reason: Nifedipine, a calcium channel blocker, is commonly used to manage acute hypertension in autonomic dysreflexia. It reduces blood pressure quickly and is considered a first-line agent in emergent settings.
Choice D reason: Lidocaine may be used to suppress afferent stimuli during procedures such as catheterization, which can trigger autonomic dysreflexia. It helps block nociceptive input and prevent reflex sympathetic discharge.
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