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Nurse Practitioner:
doi: 10.1097/01.NPR.0000395035.61248.c5
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Gait disorder in older adults: Is it NPH?

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INSTRUCTIONS Gait disorder in older adults: Is it NPH?

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Gait disorder in older adults: Is it NPH?

General Purpose: To provide NPs with information about gait disorders and NPH in older adults. Learning Objectives: After reading the article and taking this test, the NP should be able to: 1. Explain the prevalence, etiology, pathophysiology, signs, and symptoms of NPH. 2. Identify diagnostic testing and management approaches for NPH.

1. NPH occurs when the amount of CSF is

a. lacking and causes diminished ventricular size.

b. excessive and causes enlargement of the brain's ventricular system.

c. normal but pressure in the brain is increased.

d. being reabsorbed, which alters brain pressure.

2. The number of people in the United States who have NPH is approximately

a. 75,000.

b. 150,000.

c. 375,000.

d. 500,000.

3. Diagnostic findings of NPH include

a. increased mean intraventricular pressure.

b. normal mean intracranial pressure.

c. mechanical obstruction of CSF.

d. ventricle size remains unchanged.

4. NPH may occur due to any of the following except

a. idiopathic changes.

b. meningitis.

c. subarachnoid bleed.

d. seizure disorders.

5. A significant relationship was found with severe gait disturbance with NPH and

a. hypercholesterolemia.

b. diabetes mellitus.

c. cerebrovascular disease.

d. systemic arterial hypertension.

6. The distinctive gait of patients with NPH includes

a. reduced velocity.

b. increased stride length.

c. heightened foot-to-floor clearance.

d. decreased foot angle with feet rotated inward.

7. Which correctly associates an assessment finding with its disease condition?

a. NPH gait—reciprocal arm swing is maintained when walking

b. Parkinson gait—feet rotated outward

c. NPH—easy to rise from seated position

d. Parkinson gait—feet seem to be stuck to floor

8. NPH cognitive impairment includes

a. difficulty with word formation.

b. inaccurate facts.

c. slow processing.

d. difficulty with simple tasks.

9. Early urinary symptoms accompanying NPH include

a. dysuria.

b. hematuria.

c. urinary frequency.

d. urinary tract infections.

10. The Folstein Mini-Mental State Examination evaluates

a. executive function.

b. mood disturbances.

c. visuospatial skills.

d. cognitive impairment.

11. MRI used for NPH diagnosis reveals

a. increased cerebral blood flow.

b. normal ventricle size.

c. CSF outflow obstruction.

d. increased CSF in the ventricles.

12. NPH treatment includes

a. lumbar puncture for CSF removal.

b. VP shunt.

c. central splenorenal (Warren) shunt.

d. transjugular intrahepatic portosystemic shunt.

13. Gradual elevation of the head after shunt insertion will help prevent

a. overshunting of CSF.

b. intracerebral hematoma.

c. infection.

d. seizure activity.

14. Following shunt insertion, significant improvement of symptoms occurs

a. immediately.

b. within the next few hours.

c. in 3 to 4 days.

d. over weeks and months.

15. After surgical shunting, NPH cognitive impairment symptoms will

a. remain unchanged.

b. possibly be reversed.

c. improve then regress quickly.

d. continue to decline steadily.

16. The most common complication of surgical shunting is

a. infection.

b. seizure activity.

c. shunt obstruction.

d. intracerebral hematoma.

17. Additional problems with NPH include all of the following except

a. writing skill decline.

b. fantastic confabulation.

c. awakening fluctuations.

d. paranoia.

18. Headaches relieved by reclining after a shunting procedure are due to

a. overshunting.

b. infection.

c. shunt obstruction.

d. surgical pain.

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