Alzheimer's Disease
A nurse is teaching an older adult client's family about the causes of mental impairment. The nurse sees that the teaching has been effective when the family says which of the following? 1) "Dementia is an acute process and develops suddenly." 2) "Sundowning is a common problem of dementia." 3) "Alzheimer's disease (AD) is a reversible neurologic illness." 4) "Delirium progressively affects cognitive function and is a chronic process."
"Sundowning is a common problem of dementia." A common problem in clients with dementia is sundowning syndrome, in which an older adult habitually becomes confused, restless, and agitated after dark.
A client with Alzheimer's disease is prescribed donepezil hydrochloride. When teaching the client and family about this drug, which of the following would the nurse include? "This drug will help to stop the disease from getting worse." "Once it becomes effective, you can stop the drug." "The drug helps to control the symptoms of the disease." "The client need to take this drug for the rest of his or her life."
"The drug helps to control the symptoms of the disease."
In clients with Alzheimer's disease, neurotransmission is reduced, neurons are lost, and the hippocampal neurons degenerate. Which neurotransmitter is most involved in cognitive functioning? Acetylcholine Epinephrine Serotonin Norepinephrine
Acetylcholine Acetylcholine is involved in cognitive functioning. Epinephrine, serotonin, and norepinephrine are not as involved in cognitive functioning.
The nurse is providing information about how to care for clients during a bioterrorism attack. The nurse knows that which drug will be administered in the case of a sarin attack? Donepezil Neostigmine Bethanechol Atropine
Atropine
Which would be most important to have readily available for a client who is receiving an indirect-acting cholinergic agonist and develops a severe reaction? Naloxone Phentolamine Edrophonium Atropine
Atropine should be readily available to counteract the severe effects of an indirect-acting cholinergic agonist.
The client has been diagnosed with urinary retention. The nurse expects the client to receive which medication for this condition? Ambenonium Bethanechol Benadryl Guanidine
Bethanechol is the only medication listed that is used to treat urinary retention.
A client has vascular neurocognitive disorder. When teaching the family about the cause of this disorder, which would the nurse expect to integrate into the explanation? Blood flow in the vessels to the brain are blocked. Fragments mix with molecules to make plaques in the brain. Acetylcholine production is decreased. Strands of protein are tangled together.
Blood flow in the vessels to the brain are blocked. Vascular neurocognitive disorder, also called multi-infarct dementia, is caused by conditions that block or reduce blood flow to the brain.
A nurse administering donepezil (Aricept) to a client should monitor the client for signs of GI bleeding if which medications are initiated? (Select all that apply.) Meperidine (Demerol) Ibuprofen (Motrin) Oxycodone (OxyContin) Acetaminophen (Tylenol) Naproxen (Naprosyn)
Naproxen (Naprosyn) Ibuprofen (Motrin)
A nurse is preparing a presentation for a group of families who are providing care to their older adult parents. One of the family members asks the nurse, "How common is Alzheimer's disease?" The nurse responds by telling the group that after age 65, the prevalence of Alzheimer's disease: triples every year. decreases by 10 for every year. doubles every 5 years. declines but the rate is unknown.
doubles every 5 years.
The nurse is caring for a client who is receiving neostigmine for the treatment of myasthenia gravis. The nurse is aware that a potential complication of the treatment is cholinergic crisis, which is characterized by which event? 1) excessive stimulation of the parasympathetic nervous system 2) excessive stimulation of the sympathetic nervous system 3) hypertension and respiratory failure 4) stronger skeletal muscle contractions
excessive stimulation of the parasympathetic nervous system A cholinergic crisis is characterized by excessive stimulation of the parasympathetic nervous system. If early symptoms are not treated, hypotension and respiratory failure may occur. At high doses, anticholinesterase drugs weaken, rather than strengthen, skeletal muscle contraction because excessive amounts of acetylcholine accumulate at motor endplates and reduce nerve impulse transmission to muscle tissue.
The health care provider is preparing to administer edrophonium to confirm myasthenia gravis in a 47-year-old male client. What other drug must be available when edrophonium is administered?
Atropine Edrophonium is a cholinergic agonist administered by a provider to diagnose myasthenia gravis. Use of this drug requires that an antidote, typically atropine, be on hand in case of cholinergic overdose.
A client experiences an overdose of a cholinergic drug. Which medication would the nurse anticipate that the client will receive as a reversal agent? Atropine Dopamine Epinephrine Norepinephrine
Atropine Atropine is considered an antidote for a cholinergic drug overdose.
A client has experienced a gradual flattening of affect, confusion, and withdrawal and has been diagnosed with Alzheimer's disease. Which additional findings would the nurse most likely assess? 1) Tremors, unsteady gait, and transient paresthesias 2) Uncharacteristic use of illicit substances and alcohol 3) Personality change, wandering, and inability to perform purposeful movements 4) Transient blindness, slurred speech, and weakness
Personality change, wandering, and inability to perform purposeful movements
A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by Converting liquid foods to a gelatin texture Cutting the client's food into small pieces Serving hot foods at a warm temperature Placing one food at a time in front of the client during meals
Placing one food at a time in front of the client during meals Offering one food at a time helps to prevent the client from playing with food.
A client is in the mild stage of dementia due to Alzheimer's disease. Which intervention would be most appropriate? 1) Offering nourishing finger foods to help maintain the client's nutritional status 2) Providing emotional support and gentle reminders 3) Advocating for the client to be transitioned to a care home 4) Suggesting new activities for the client and family to do together
Providing emotional support and gentle reminders
A nurse is monitoring a patient with Alzheimer's disease for initiation of therapy. In which patient is the administration of donepezil contraindicated? A patient with bronchitis A patient with asthma A patient with beriberi A patient with amnesia
A patient with asthma
In clients with Alzheimer's disease, neurotransmission is reduced, neurons are lost, and the hippocampal neurons degenerate. Which neurotransmitter is most involved in cognitive functioning? Acetylcholine Epinephrine Serotonin Norepinephrine
Acetylcholine
A client is diagnosed with Alzheimer's disease. While assessing the client, the nurse notes that the client has trouble identifying objects such as a key and spoon. The nurse would document this as what? Aphasia Agnosia Apraxia Disturbance of executive function
Agnosia failure to recognize or identify objects despite intact sensory function
Decreased acetylcholine levels are characteristic of what disorder? Alzheimer's disease. multiple sclerosis. Huntington's disease. Parkinson's disease.
Alzheimer's disease.
When assessing a client for possible adverse effects of direct-acting cholinergic agents, what might the nurse find? Tachycardia Hypertension Constipation Urinary urgency
Urinary urgency Adverse effects associated with direct-acting cholinergic agents include urinary urgency, bradycardia, hypotension, and diarrhea.
A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to 1) Allow the mother to smoke cigarettes outside on the porch without supervision. 2) Ensure that the mother does not have access to car keys or drive an automobile. 3) Turn off lights at night so that the mother differentiates night and day. 4) Encourage the mother to take responsibility for cooking and cleaning the house.
Ensure that the mother does not have access to car keys or drive an automobile.
The geriatrician has prescribed an 80-year-old client donepezil in order to treat the client's dementia, Alzheimer's type. Which teaching points should the nurse provide to the client's spouse about the new medication? 1) "Donepezil won't cure your spouse's dementia of Alzheimer's type, but it has the potential to slow down the progression of the disease." 2) "It's important to closely follow the administration schedule for this drug if it is to make your spouse recover." 3) "This won't result in any improvements to the client's symptoms of dementia of Alzheimer's type, but it will make the client much more compliant and easier to manage." 4) "Donepezil will help your spouse sleep much better at night and stay awake during the day."
"Donepezil won't cure your spouse's dementia of Alzheimer's type, but it has the potential to slow down the progression of the disease." Cholinesterase inhibitors such as donepezil cannot cure dementia, Alzheimer's type, but they can slow the progression of the disease and can stabilize symptoms. The drug does not directly affect sleep patterns.
A family of a patient with Alzheimer's disease asks the nurse what causes this condition? Which response by the nurse would be most appropriate? 1) "The numerous drugs that he was taking contributed to his current confusion." 2) "A specific gene is involved in the development of this disorder." 3) "Evidence shows that there are changes in nerve cells and brain chemicals." 4) "This condition is most likely due to a stroke that the patient didn't realize he had."
"Evidence shows that there are changes in nerve cells and brain chemicals." Specific neuropathologic and biochemical changes are found in patients with Alzheimer's disease. These include neurofibrillary tangles and neuritic plaques as well as altered neurotransmitter function, specifically acetylcholine.
A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds: "What precipitates the outbursts?" "You need to remain calm during the outbursts." "Play quiet music that your grandmother may like." "Start rubbing her shoulders and her back."
"What precipitates the outbursts?" A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive.
The nurse is providing education to a client who has been prescribed an anticholinesterase drug. What caution would the nurse include in the teaching? 1) Anticholinesterase drugs need to be started at a very high dose and titrated to effect. 2) Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration. 3) Anticholinesterase drugs should be taken on an empty stomach to decrease the risk of gastric distress and ulceration. 4) Anticholinesterase drugs should be taken at bedtime to prevent nausea.
Anticholinesterase drugs should be taken with food or milk to decrease the risk of gastric distress and ulceration.
A client diagnosed with Alzheimer's disease has an alteration in language ability. This alteration would be documented as what? Agnosia Apraxia Aphasia Akinesia
Aphasia is an alteration in language ability.
A client being treated for myasthenia gravis is receiving neostigmine. When the client's pulse drops to 50 after the administration, which medication should be administered to treat the bradycardia? Pseudoephedrine Atropine Propranolol Bethanechol
Atropine
A client has been receiving bethanechol for 1 week. One hour after the dose is administered, the client develops sweating, flushing, abdominal cramps, and nausea. The nurse prepares to intervene for what condition? Myasthenic crisis Cholinergic overdose Anaphylactic reaction Pulmonary edema
Cholinergic overdose A client who suffers cholinergic overdose will experience sweating, flushing, abdominal cramps, and nausea. An accurate diagnosis may be determined from timing in relation to medication. Signs and symptoms having an onset within approximately 1 hour after a dose of anticholinesterase drug are likely to be caused by cholinergic crisis.
The client has been prescribed a cholinergic medication. Which nursing diagnosis is common for clients taking a cholinergic medication? Constipation related to medication side effect Sleep disturbance related to medication side effect Body image disturbance related to weight gain Diarrhea related to medication side effect
Diarrhea related to medication side effect Diarrhea is a common side effect/nursing diagnosis when taking a cholinergic medication.
A female client had surgery 24 hours ago to repair a hernia. The nurse finds that the client has not had a bowel movement since the day before the surgery. She is experiencing abdominal distention, and during auscultation the nurse notes an absence of bowel sounds. Further examination and testing reveal a paralytic ileus. The provider orders bethanechol. The nurse is aware that bethanechol is included in which drug classification? Direct-acting cholinergic drug Indirect-acting cholinergic drug Indirect-acting anticholinergic medication Anticholinergic medication
Direct-acting cholinergic drug
The client is to receive an IV cholinergic medication. When the nurse administers the drug what reaction will the nurse anticipate? Increase in heart rate Decrease in heart rate Increase in anxiety Decrease in anxiety
Decrease in heart rate Cholinergic drugs decrease, not increase, heart rate. They do not usually have any effect on anxiety.
The nursing 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 Regeneration of cholinergic pathways Increased level of acetylcholine Lack of neural destruction
Degeneration of cholinergic pathways Acetylcholine is the transmitter in the cholinergic neuropathway. People with early Alzheimer's disease experience degeneration of these cholinergic neuropathways. As a result, the client has problems with memory and thinking. The cholinesterase inhibitors act to increase the level of acetylcholine in the central nervous system by inhibiting its breakdown and slowing neural destruction.
A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? Distract the client with a familiar object or music. Document the inability to assess vital signs due to client's agitation. Continue taking the vital signs. Place the client in a secluded room until calm.
Distract the client with a familiar object or music. The nurse should try to calm the patient by using distraction with a familiar object or music. Continuing to take the vital signs will cause further agitation and possible harm to the client or nurse.
A client with Alzheimer disease (AD) is forgetful and has started to lose interest in social activities. Which treatment routine would be beneficial for the client? Donepezil Vitamin D High protein diet Memantine
Donepezil
Which agent would be most appropriate to administer to a client with Alzheimer's disease? Pyridostigmine Neostigmine Ambenonium Donepezil
Donepezil
A client is prescribed donepezil. The nurse would expect to administer this drug at which frequency?
Donepezil has a 70-hour half-life and is usually given in a once-a-day dosing.
A nurse is caring for a client who is taking rivastigmine. The client's nursing care plan will prioritize which nursing diagnosis? 1) Imbalanced Nutrition: More Than Body Requirements related to increased appetite and secondary to the drug therapy 2) Imbalanced Nutrition: Less Than Body Requirements related to decreased desire to eat secondary to nausea and vomiting from drug therapy 3) Risk for Fluid and Electrolyte Imbalance and Hyperglycemia related to adverse effects of medication 4) Risk for Injury related to extrapyramidal symptoms
Imbalanced Nutrition: Less Than Body Requirements related to decreased desire to eat secondary to nausea and vomiting from drug therapy
The pharmacology instructor is discussing the drug therapy for Alzheimer's disease with a group of nursing students and states that indirect-acting cholinergic drugs do what to improve symptoms?
Improve cholinergic neurotransmission to the brain
The nurse administered donepezil (Aricept) to a patient. What is the therapeutic response the nurse expects to assess? Decreased urination Increased red blood cell count Decreased heart rate Improved memory
Improved memory Aricept is given daily to patients with senile dementia, Alzheimer type (SDAT), to decrease the symptoms of dementia.
A male client is diagnosed with hepatitis C and myasthenia gravis. His prescriptions include neostigmine. The nurse is concerned because the client may experience which possible problem? Increased absorption of the medication Increased adverse effects Increased resistance to the medication Decreased absorption of the medication
Increased adverse effects The hepatic metabolism of neostigmine and pyridostigmine may be impaired by liver disease, resulting in increased adverse effects.
A nurse's aide has rung the call light for assistance while providing a client's twice-weekly bath because the client became agitated and aggressive while being undressed. Knowing that the client has a diagnosis of Alzheimer's disease and is prone to agitation, which measure may help in preventing this client's agitation? 1) Reminding the client multiple times that he or she will be soon having a bath 2) Decreasing the frequency of the client's baths from two times to one time per week 3) Reinforcing the facility's zero-tolerance policy for aggressive behavior 4) Providing all of the client's daily medications early on the day of a scheduled bath
Reminding the client multiple times that he or she will be soon having a bath Adequately preparing a client for a task can sometimes prevent episodes of agitation or aggression.
A group of students are reviewing the drugs that are available for treating Alzheimer's disease. The students demonstrate understanding of the information when they identify which drug as appropriate for treatment? Rivastigmine Cevimeline Edrophonium Pyridostigmine
Rivastigmine Rivastigmine is used to treat Alzheimer's disease. Cevimeline is used to treat dry mouth associated with Sjogren syndrome. Edrophonium is used to diagnose myasthenia gravis. Pyridostigmine is used to manage myasthenia gravis.
The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer disease. What intervention will be implemented to slow cognitive decline? antioxidant therapy psychotherapy cholinesterase inhibitors lipid-lowering agents
cholinesterase inhibitors Cognitive function in Alzheimer disease can be enhanced by the use of medications to slow progression and improve depression, agitation, or sleep disorders. The cholinesterase inhibitors have been shown to be effective in slowing the progression of the disease by potentiating the action of available ACh and inhibiting acetylcholinesterase.
The nurse is caring for a client who is receiving an indirect-acting cholinergic medication and knows it is indicated as a treatment for myasthenia gravis as well as which other condition? Musculoskeletal cancer Alzheimer's disease Muscular dystrophy Cerebrovascular dementia
Alzheimer's disease
The nurse is caring for a client with dementia. The client's brain images show atrophy of cerebral neurons and enlargement of the third and fourth ventricles. What is the cause of dementia in this client? Parkinson's disease Alzheimer's disease Vascular dementia Picks's disease
Alzheimer's disease
A nurse is caring for a 49-year-old client who has been taking bethanechol for treatment of neurogenic bladder. After one week, the client develops sweating, heavy salivation, and bronchospasm. What would the nurse suspect is happening with this client? Pulmonary edema Myasthenic crisis Anaphylactic reaction Cholinergic crisis
Cholinergic crisis Overdose of cholinergic agonists can lead to cholinergic crisis. Symptoms of cholinergic crisis are those associated with excessive stimulation of the parasympathetic nervous system, including increased sweating, salivation, gastric secretions, and respiratory secretions.
A female client is taking cholinergic medication to control bladder retention. She presents to the emergency department with confusion, shortness of breath, and an apical pulse of 42 beats per minute and irregular. What action would the nurse expect the health care provider to take? 1) Discontinue the cholinergic medication secondary to the diagnosis of bradycardia. 2) Decrease the cholinergic medication to alleviate the symptom of confusion. 3) Increase the cholinergic medication to increase cardiac contractility. 4) Increase the cholinergic medication to increase oxygenation to the heart through vasodilation.
Discontinue the cholinergic medication secondary to the diagnosis of bradycardia. People with coronary artery disease should not take cholinergics because they can result in bradycardia, vasodilation, and hypotension.
A nurse is conducting a medication resolution of a new resident of a care facility and notes that the woman has been taking neostigmine. The nurse should recognize that the woman may have a history of what health problem? Multiple sclerosis Alzheimer disease Parkinson disease Myasthenia gravis
Myasthenia gravis The most significant indication for neostigmine therapy is myasthenia gravis. Other clinical indications include urinary retention and paralytic ileus
A pathologist is examining the brain of a recently deceased client who was thought to have developed Alzheimer disease shortly before death. Which pathology finding would confirm the diagnosis? absence of any visible gross changes ventricular volume decrease cortical atrophy in the temporal lobes degeneration of the basal ganglia
cortical atrophy in the temporal lobes Alzheimer disease is characterized by cortical atrophy and loss of neurons, particularly in the parietal and temporal lobes.
The nurse documents that a client diagnosed with dementia of the Alzheimer's type is exhibiting agnosia when the client is observed being unable to ... identify a picture of a car. button a blouse. find words to describe the client's daughter's appearance. open juice and insert a straw into the container.
identify a picture of a car. Agnosia is the failure to recognize or identify objects despite intact sensory function