chapter 19 pharmacology

The client with Alzheimer's disease has a difficult time making choices when it comes to meals. Which are things the caregiver can do to promote appetite in the client with Alzheimer's who is not experiencing nausea and vomiting? Select all that apply.

Offer foods easy to chew. Offer small frequent meals. Offer 6 to 8 glasses of water

The provider just finished talking to a client's family about Alzheimer's disease. One member asks what an amyloid plaque is. What is the most appropriate response from the nurse?

"It is a tangle of protein in nerve tissue that impairs neurotransmission, which results in dementia symptoms."

The caregiver of client describes the client as having Alzheimer's disease (AD) for 10 years and is currently in the late stage of the disease. The caregiver asks the nurse if the client can go back on the medication donepezil. Which response by the nurse is appropriate?

"The drugs are best used early as they slow the progression of AD."

The nurse is educating the caregiver of a client with Alzheimer's disease on the correct way to apply the exelon transdermal patch. What should the nurse tell the caregiver about placement of this medication?

"The site should be where the client is not able to remove the patch."

A nurse is talking to a group of families from the local nursing home about Alzheimer's disease (AD). The nurse shares that approximately how many people in the United States are diagnosed with AD?

5.4 million

A client is being evaluated for decline in cognitive function. The client's wife asks the nurse to explain the term "dementia" to her. The nurse bases her response on the knowledge that dementia is which of the following?

A primary brain pathology

A nursing instructor is preparing a presentation on the etiology of Alzheimer's disease. When discussing the role of neurotransmitters in the course of the disease, which would the instructor emphasize?

Acetylcholine

A nursing student is conducting a class presentation about cholinesterase inhibitors. Which would the student identify as the primary indication for use?

Alzheimer disease

The nursing instructor is teaching the students about degenerative diseases that affect both the musculoskeletal and neurologic systems. The student correctly identifies the disease that is a progressive deterioration of emotional, physical, and cognitive abilities as which?

Alzheimer's

The nursing instructor is teaching the students about degenerative diseases that affect both the musculoskeletal and neurologic systems. The student correctly identifies the disease that is a progressive deterioration of emotional, physical, and cognitive abilities as which?

Alzheimer's.

A new resident has just been admitted to the long-term care facility. When reviewing the client's medication record, the nurse observes that the client is currently taking donepezil. What should the nurse include in the resident's plan of care?

Assess the client's orientation each shift.

A client with dementia of Alzheimer disease is prescribed memantine. Before administering the drug to the client, which would the nurse observe while obtaining the client's health history?

Behavior patterns

A cholinesterase inhibitor is prescribed for a client showing signs of dementia. The nurse knows that which statement regarding cholinesterase inhibitors is correct?

Cholinesterase inhibitors cause adverse gastrointestinal effects, including nausea and diarrhea.

A client with Alzheimer's disease will take donepezil (Aricept). What must the client's family or caregiver be taught to do? Select all that apply.

Keep all medical appointments. Report adverse effects such as severe vomiting and dehydration. Devise a method to ensure that medication is taken every day.

The cholinesterase inhibitors act to increase the level of acetylcholine in the central nervous system by inhibiting its breakdown. A newer group of drugs, NMDA receptor antagonists such as memantine (Namenda), is thought to work by which mechanisms?

Decreasing the excitability of neurotransmission caused by excess of the amino acid glutamate in the CNS

The nuring instructor is teaching students about Alzheimer's disease. The instructor informs the students that clients with this illness experience problems with memory and thinking. The reason that this happens is which?

Degeneration of cholinergic pathways

A nurse is explaining the difference between delirium and dementia to a client's son. The client is 72-years-old who is being treated for a kidney infection with IV antibiotics in a hospital. Prior to the hospitalization the client was working three days per week as a mechanical engineer. Today, when the son arrived, the client was hearing, seeing, and talking about angels. Which statements is correct?

Delirium is temporary and is brought on by an illness or chemical imbalance.

The nurse can distinguish delirium from dementia by knowing which of the following?

Dementia has a gradual onset and is progressive in course.

Which medication would the nurse expect to administer orally once a day to a client with AD?

Donepezil

Which medication is used in mild to moderate dementia of AD and Parkinson's disease?

Exelon

Cholinesterase inhibitors should not be administered to clients in which stage of Alzheimer's disease?

Late

A man is being admitted to an Alzheimer's unit. The family tells the nurse that they can no longer care for the client at home now that he is incontinent of urine and needs help with bathing and feeding. This cltient is in which stage of Alzheimer's?

Late stage

A daughter brings her mother, who has Alzheimer's disease, to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month. When assessing the client, the nurse would be alert for the possibility of which side effect?

Gastrointestinal distress

A client asks the nurse about any herbal products that can help with memory problems. Which would the nurse suggest?

Ginkgo

The herbal preparation ginkgo has long been thought to enhance memory, and thus might be used by some clients with Alzheimer's disease to support memory. The nurse knows that which statements regarding ginkgo is correct?

Ginkgo must be used with caution in clients who are taking anticoagulant drugs.

The nurse is preparing a teaching plan for a client who is taking rivastigmine. What precaution should the nurse teach the client and family to minimize the risk of adverse GI effects?

Having small, frequent meals

A nurse is caring for a client who is taking rivastigmine. The client's nursing care plan will prioritize which nursing diagnosis?

Imbalanced Nutrition: Less Than Body Requirements related to decreased desire to eat secondary to nausea and vomiting from drug therapy

Which of the following Alzheimer's disease symptoms is treated with cholinesterase inhibitors?

Mild to moderate dementia

Imbalanced Nutrition: Less Than Body Requirements is a common nursing diagnosis for clients prescribed cholinesterase inhibitors. The client's daughter asks the nurse why this is common. The nurse knows that which is a common side effect of cholinesterase inhibitors?

Nausea and vomiting

A client with Alzheimer's disease is being treated with the medication Exelon. The nurse knows that this drug is also used to treat which disorder?

Parkinson's disease

When planning care for a newly diagnosed client with Alzheimer's disease, the nurse should focus on which?

Providing a safe, structured environment

A nursing student is preparing a care plan and is choosing a nursing diagnosis for her client with Alzheimer's disease. The client is taking Exelon. Which would be an appropriate nursing diagnosis for this client?

Risk for Injury related to dizziness and fatigue

The nurse is assessing a client with early signs of dementia. The nurse asks the client what he ate for breakfast that morning. The purpose of this question is to determine what?

Recent memory

A client with Alzheimer's disease will take donepezil (Aricept). This client has heard that Alzheimer's disease involves loss of acetylcholine in the cerebral cortex and asks the nurse, "How does donepezil work?" The nurse will explain that donepezil does which?

Reduces inactivation of acetylcholine

A client with Alzheimer's disease has difficulty swallowing tablets and capsules. The nurse knows that transdermal patches are available for which medication?

Rivastigmine (Exelon)

A nurse and client are discussing adverse effects of drugs used to manage the dementia of Alzheimer's disease. The nurse knows that hepatotoxicity is a risk, especially with which?

Tacrine (Cognex)

The nursing instructor is teaching a student about the drugs used for Alzheimer's disease. Even though cholinesterase inhibitors do not cure the disease, the instructor informs the student that they do help to slow the progression. The instructor then asks the student, "When a drug is stopped due to side effects, what happens to the client?" The student's best response would be:

The client loses any benefit they have received from the drug.

A family calls the nurse with concerns that grandpa will not come to the table to eat when all four kids are home. The client is losing weight and getting more confused. What suggestions could the nurse make for this family?

Weight loss and difficulty swallowing are often signs of worsening AD. Keep grandpa's mealtime calm and offer easily chewed foods of different consistency and flavor.

A client has been diagnosed with early-stage Alzheimer's disease. No history of other medical problems. The nurse can anticipate which other drugs may be ordered in addition to the cholinesterase inhibitors? Check all that apply.

antipsychotics antidepressants anti-anxiety medications

An 83-year-old client has a diagnosis of moderate Alzheimer's disease. The client's physician recently prescribed oral rivastigmine, but the client was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should do which?

apply the patch to the client's back to reduce the chance that he will remove it.

A client is diagnosed with early-stage Alzheimer's disease. The nurse will anticipate that the client will be given a(n):

cholinesterase inhibitor.

A client with Alzheimer's disease is taking Exelon along with an anticholinergic drug to decrease the amount of secretions. What should the nurse be concerned about?

decreased effectiveness of the anticholinergic

How does concurrent administration of anticholinergic drugs affect the effects of donepezil?

decreases the efficacy of donepezil

A nursing student correctly identifies which of the following herbs to be the "king of herbs," especially because of its abilities to improve energy and mental performance.

ginseng

A client asks the nurse if taking ginseng will improve the client's memory. The nurse informs the client that it is safe to take as long as the client does not suffer from:

high blood pressure.

An older adult client has been diagnosed with early-stage Alzheimer's disease and has begun treatment with donepezil. When providing health education to the client and the client's spouse, the nurse should identify what goal of treatment?

improvement of cognition and function

The client in the final stage of Alzheimer's disease tends to suffer from weight loss and eating problems. This is primarily due to:

inability to swallow.

Cholinesterase inhibitors act to increase the levels of acetylcholine in the central nervous system by which of the following mechanisms?

inhibiting acetylcholine's breakdown

A client taking rivastigmine reports to the clinic nurse that she has been having gastrointestinal problems since she started the medication. The nurse will advise the client to do which?

take the medication with food.