chapter 22
The spouse of a patient who is newly diagnosed with Alzheimer's disease asks the nurse if medications will prevent the need for nursing home care. Which response by the nurse is correct? a. "Drugs to treat Alzheimer's disease may slow the progression of memory loss." b. "Drugs may be effective to stop the progression of the disease if they are initiated early in the disease." c. "Medications to treat Alzheimer's disease are effective for treating core symptoms of the disease." d. "Medications for Alzheimer's disease are effective in reducing cognitive impairment."
ANS: A Alzheimer's disease is a disease in which symptoms progress relentlessly from mild to moderate to severe. Medications have not been clearly effective and do not stop the disease progression, although they may slow loss of memory and cognition and prolong independent function. There is no indication that available drugs stop disease progression if begun early in the course of the disease. There is no clearly effective therapy for core symptoms, but associated symptoms such as incontinence and depression may be treated.
An older adult patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil [Aricept] 10 mg once daily for 6 months. The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What will the nurse tell the spouse? a. The dose can be increased, because the patient has been taking the drug for longer than 3 months. b. The dose can be increased to twice daily dosing instead of once daily dosing. c. The increase in symptoms is the result of hepatotoxicity from the medication's side effects. d. The patient must take the drug for longer than 1 year before the dose can be increased.
ANS: A Donepezil is given for mild, moderate, and severe AD, and dosing may be increased, although it must be titrated up slowly. For patients with moderate to severe AD who have taken 10 mg once daily for at least 3 months, the dose can be increased to 23 mg once daily. Donepezil is not given twice daily. Donepezil does not cause hepatotoxicity; hepatotoxicity occurs with tacrine, the first acetylcholinesterase (AChE) inhibitor, which now is rarely used. Dosing is increased after 3 months, not 1 year.
A patient is worried about the risk of developing Alzheimer's disease, because both parents had the disease. The nurse will tell this patient that known risk factors include what? (Select all that apply.) a. Advanced age b. Alcoholism c. Family history d. Gender e. Obesity
ANS: A, C The major known risk factor for AD is advancing age; the only other known risk factor is a family history of AD. Alcoholism, gender, and obesity are not known risk factors.
A nurse is teaching a group of nursing students about the use of memantine [Namenda] for Alzheimer's disease. Which statement by a student indicates understanding of the teaching? a. "Memantine is indicated for patients with mild to moderate Alzheimer's disease." b. "Memantine modulates the effects of glutamate to alter calcium influx into neurons." c. "Memantine prevents calcium from leaving neurons, which improves their function." d. "Memantine and donepezil combined may stop progression of Alzheimer's disease."
ANS: B Memantine modulates the effects of glutamate, which is involved in calcium influx into neuronal cells. Memantine is used for patients with moderate to severe AD. Memantine does not prevent calcium from leaving cells; it only affects the influx of calcium. In studies, although the effects of memantine and donepezil appear to be synergistic or may confer independent benefits, they only demonstrate improvement in cognitive function and not a stop in disease progression.
The spouse of a patient with Alzheimer's disease asks a nurse for more information about the rivastigmine [Exelon] transdermal patch that is being used. Which statement by the spouse indicates a need for further explanation? a. "Doses are lower but more steady with the transdermal patch." b. "Reduced side effects occur with the transdermal patch." c. "We only need to change the patch every 2 weeks." d. "We should remove the old patch before applying the new one."
ANS: C The rivastigmine transdermal patch needs to be changed daily. Sites used should not be reused for 14 days. Transdermal dosing provides lower, steady levels of the drug. Intensity of side effects is lower with the transdermal patch. The old patch must be removed prior to applying the new patch to prevent toxicity.
A nurse is caring for an older adult man who has Alzheimer's disease (AD). The patient's daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her? a. Female gender is known to increase the risk. b. Genetic testing can provide a definitive measure of the risk. c. Patients with the apolipoprotein E2 gene (apoE2) are more likely to develop the disease. d. Advancing age and family history are known risk factors. ?
ANS: D Advancing age and a positive family history are the only two known risk factors. Female gender is not a known risk; the increased incidence among females may be the result of women living longer than men. No definitive genetic tests are available. The presence of apoE2 seems to be protective.
A nurse is caring for an older adult patient who has Alzheimer's disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse? a. Confusion and memory impairment b. Dizziness and headache c. Nausea, vomiting, and diarrhea d. Slowed heart rate and lightheadedness
ANS: D Cardiovascular effects of cholinesterase inhibitor drugs are uncommon but cause the most concern. Bradycardia and fainting can occur when cholinergic receptors in the heart are activated. Confusion and memory impairment are signs of the disease and are not side effects of the drug. Dizziness, headache, nausea, vomiting, and diarrhea are all expected adverse effects, and although uncomfortable, they do not present an increased risk to the patient.
A patient will begin taking a cholinesterase inhibitor for early Alzheimer's disease. The nurse is teaching the patient's spouse about the medication. Which statement by the spouse indicates a need for further teaching? a. "Gastrointestinal symptoms are common with this medication." b. "People taking this drug should not take antihistamines." c. "This drug helps neurons that aren't already damaged to function better." d. "This drug significantly slows the progression of the disease."
ANS: D Cholinesterase inhibitors produce modest improvements in cognition, behavior, and function and may slightly delay disease progression; they do not have a major impact on delaying progression of the disease. Gastrointestinal symptoms are common side effects. Drugs that block cholinergic receptors, including antihistamines, can reduce therapeutic effects and should be avoided. Cholinesterase inhibitors do not affect neurons already damaged, but they do improve function in those not yet affected.
A nurse is preparing to administer memantine [Nemanda] to a patient and notes a slight elevation in the patient's creatinine clearance level. What will the nurse expect the provider to order for this patient? a. Adding sodium bicarbonate to the patient's drug regimen b. Continuing the memantine as ordered c. Discontinuing the memantine d. Reducing the dose of memantine
ANS: D Patients with severe renal impairment may require a dosage reduction. Adding sodium bicarbonate would alkalinize the urine and increase memantine levels, causing toxicity. It is not necessary to discontinue or decrease the dose of the memantine with mild or moderate renal impairment.
An older adult patient with Alzheimer's disease is admitted to the hospital. The patient's spouse reports that the patient is often confused and gets lost walking to the store, which is three blocks from their home. That evening, the nurse observes the patient pacing the hall and screaming. What will the nurse do? a. Notify the provider of this patient's worsening symptoms. b. Prepare the patient's spouse for impending death from Alzheimer's disease. c. Request an increase in the medication dose to treat the exacerbation in symptoms. d. Tell the spouse that this is an expected progression of the disease.
ANS: D This patient is showing signs of the natural progression of AD. Behavior problems such as these occur in 70% to 90% of patients with AD as the disease progresses. There is no need to notify the provider to report these symptoms, because they are expected. The time from onset of symptoms to death usually is 4 to 8 years, but it may be as long as 20 years; this progression does not represent the final stages. Medications are not effective for preventing disease progression, and their effects on memory and cognition are modest, so requesting an increase in the drug dose would not help in this situation.