A nurse is assessing a patient who has had an ischemic stroke. The nurse hands the patient a comb, and the patient attempts to write with it. This inability to perform a previously learned action is known as:

1. A

   Dysarthria

2. B

   Aphasia

3. C

   Apraxia

4. D

   Homonymous hemianopsia

Appeared in: NORCET 1 - 2020

Explanation

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• Apraxia is a neurological disorder characterized by the inability to perform familiar, purposeful movements on command, despite having the desire and the physical ability to perform the movements.
• The scenario describes ideational apraxia, a specific type where the patient has lost the knowledge or idea of an object's function.
• The patient's attempt to write with a comb, rather than use it for their hair, is a classic clinical sign of this deficit following a stroke.
• This condition is not due to a lack of coordination, sensory loss, or failure to comprehend simple commands, but rather a breakdown in the conceptualization of the task.

Why Other Options Were Wrong

• Option A: Dysarthria is a motor speech disorder affecting the muscles used for speaking, causing slurred or slow speech. It does not involve the inability to use objects correctly.
• Option B: Aphasia is a language disorder affecting the ability to produce or understand spoken or written language. While a patient with apraxia may also have aphasia, the specific action of misusing an object defines apraxia.
• Option D: Homonymous hemianopsia is a visual field loss on the same side in both eyes. It is a sensory deficit, not a cognitive or motor planning deficit related to object use.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Neurological Deficits Post-Stroke: Apraxia to guide bedside assessment, documentation, and the next nursing action.
• Nurses must be able to differentiate between various neurological deficits to implement appropriate care and safety measures. For a patient with apraxia, the environment must be managed to prevent injury from the misuse of objects.
• Nursing interventions for apraxia include breaking down tasks into single, simple steps, using verbal cues and physical guidance, and providing adaptive equipment. It is crucial to maintain patient dignity and reduce frustration.
• What if? What if the patient could state that the object is a comb but still tried to write with it? This would further confirm ideational apraxia, as it shows the deficit is in understanding the object's use, not in object recognition or naming (which would be anomia, a form of aphasia).

How to Approach the Question

• First, identify the key action described in the clinical scenario. Here, it is a patient attempting to 'write with a comb'.
• Analyze the nature of this action. It represents a misuse of a common object, indicating a failure to understand the object's intended function, despite having the physical ability to hold it.
• Next, review the definitions of the four neurological terms provided as options.
• Compare the observed action to each definition. The action does not relate to speech articulation (Dysarthria), language processing (Aphasia), or vision (Homonymous hemianopsia).
• Conclude that the action perfectly matches the definition of Apraxia, which is the inability to perform a previously learned, purposeful action.

Concept Tested & Keywords

• Concept Tested: Neurological Deficits Post-Stroke: Apraxia
• Stem keywords: ischemic stroke, inability to perform a previously learned action, attempts to write with it, comb
• Lead-in keywords: known as
• Clinical cues: The key clinical cue is the misuse of a common object (comb) for an unrelated action (writing), which points to a deficit in understanding the object's function.

Question ID

QSLFf8vCYA3GuDMbMPrEdT

Copy ID

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 3340-3342

E6 Medicine Harrison 22e Part 1 p. 244-246