A 69-year-old patient has been admitted to an adult psychiatric ...

[B]

A 69-year-old patient has been admitted to an adult psychiatric unit because his wife thinks he is getting more and more confused. He laughs when he is found to be forgetful, saying I'm just getting old
 
  After the nurse completes a thorough neurologic assessment, which findings would be indicative of Alzheimer disease? Select all that apply.
  a.
  Occasionally forgetting names or appointments
  b.
  Difficulty performing familiar tasks, such as placing a telephone call
  c.
  Misplacing items, such as putting dish soap in the refrigerator
  d.
  Sometimes having trouble finding the right word
  e.
  Rapid mood swings, from calm to tears, for no apparent reason
  f.
  Getting lost in one's own neighborhood

Question 2

The nurse is assessing the neurologic status of a patient who has a late-stage brain tumor. With the reflex hammer, the nurse draws a light stroke up the lateral side of the sole of the foot and inward, across the ball of the foot. In response,
 
  the patient's toes fan out, and the big toe shows dorsiflexion. The nurse interprets this result as:
  a.
  Negative Babinski sign, which is normal for adults.
  b.
  Positive Babinski sign, which is abnormal for adults.
  c.
  Clonus, which is a hyperactive response.
  d.
  Achilles reflex, which is an expected response.

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Answer to Question 1

ANS: B, C, E, F
Difficulty performing familiar tasks, misplacing items, rapid mood swings, and getting lost in one's own neighborhood can be warning signs of Alzheimer disease. Occasionally forgetting names or appointments, and sometimes having trouble finding the right word are part of normal aging.

Answer to Question 2

ANS: B
Dorsiflexion of the big toe and fanning of all toes is a positive Babinski sign, also called up-going toes. This response occurs with upper motor neuron disease of the corticospinal (or pyramidal) tract and is an abnormal finding for adults.