The PMHNP is evaluating a 72-year-old patient with a history of ischemic stroke. The patient has difficulty finding words and trouble with activities such as brushing her teeth. Which part of her brain was most likely affected by the stroke?
Right hemisphere
Left hemisphere
Brainstem
Cerebellum
The Correct Answer is B
Choice A reason: The right hemisphere primarily governs spatial awareness, attention, and nonverbal processing. Difficulty with language and motor planning is less likely to result from right-sided lesions.
Choice B reason: The left hemisphere typically controls language and fine motor planning, especially in right-handed individuals. Difficulty with word-finding (aphasia) and daily activities (apraxia) suggests involvement of the left hemisphere, consistent with this patient’s deficits.
Choice C reason: The brainstem controls basic vital functions, cranial nerves, and motor/sensory pathways but is not the primary center for language or fine motor planning.
Choice D reason: The cerebellum coordinates movement, balance, and motor learning. Cerebellar lesions typically produce ataxia, dysmetria, and tremor, but not language deficits or apraxia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Attention deficit hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that are present across multiple settings and have existed since childhood. This patient’s symptoms are acute and situational, triggered by a recent stressor (grandfather’s illness), which makes ADHD less likely as the primary diagnosis.
Choice B reason: Adjustment disorder with mixed anxiety and mood is a stress-response syndrome that arises within three months of an identifiable stressor. The patient’s concentration problems, sadness, decreased energy, restlessness, and sleep difficulties are all temporally linked to the stressor of caring for a sick grandparent. This diagnosis fits the acute onset of emotional and behavioral changes in response to a significant life event.
Choice C reason: Separation anxiety disorder involves excessive fear or anxiety concerning separation from attachment figures. While the patient has concern for his grandfather, his anxiety is not rooted in separation from a primary attachment figure but rather in worry about the grandfather’s illness and responsibilities at home.
Choice D reason: Generalized anxiety disorder is characterized by excessive, uncontrollable worry about multiple areas of life for at least six months. The patient’s anxiety is specific to a recent stressor rather than pervasive across multiple domains, making GAD less likely.
Correct Answer is D
Explanation
Choice A reason: Nicotine use can cause stimulation and mild physical effects but is unlikely to produce sudden onset of facial tics or guttural sounds in this context.
Choice B reason: Atomoxetine, a non-stimulant ADHD medication, is less commonly associated with movement disorders or tics.
Choice C reason: Guanfacine is primarily sedating and generally does not precipitate new tics or stereotyped movements.
Choice D reason: Stimulant medications such as amphetamines (Adderall) can exacerbate or precipitate tics in children with ADHD. The temporal relationship between starting the new medication and the onset of tics strongly implicates amphetamine as the cause.
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