Nokea
A client has just been diagnosed with mild Alzheimer's disease. A family member asks what medications are used for treatment. The nurse knows that which of the following medications are the ones most used for mild to moderate Alzheimer's disease? (Select all that apply.)
- A. Haloperidol (Haldol)
- B. Donepezil (Aricept)
- C. Rivastigmine (Exelon)
- D. Nonsteroidal antiinflammatory drugs
Correct Answer: B
Rationale: The correct answer is B: Donepezil (Aricept). Donepezil is a cholinesterase inhibitor commonly used to treat mild to moderate Alzheimer's disease by improving cognitive function. It is considered a first-line medication for Alzheimer's. Haloperidol (A) is an antipsychotic drug and not used for Alzheimer's treatment. Rivastigmine (C) is another cholinesterase inhibitor like donepezil, but it is more commonly used for moderate to severe Alzheimer's. Nonsteroidal anti-inflammatory drugs (D) are not typically used for Alzheimer's treatment. In summary, Donepezil is the preferred medication for mild to moderate Alzheimer's due to its effectiveness in improving cognitive symptoms.
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A patient tells the nurse, 'I can't go to any unit meetings because when I get in that room, everyone can hear my thoughts.' The nurse can correctly assess this symptom as:
- A. concrete thinking.
- B. loose associations.
- C. thought broadcasting.
- D. auditory hallucinations.
Correct Answer: C
Rationale: The correct answer is C: thought broadcasting. This is when a person believes that others can hear their thoughts. In this scenario, the patient's belief that everyone in the unit meetings can hear their thoughts aligns with the symptom of thought broadcasting. It is a common manifestation of certain psychiatric disorders like schizophrenia.
Choice A, concrete thinking, refers to literal thinking without abstract reasoning and is not applicable in this context. Choice B, loose associations, involves disorganized and illogical thought patterns, which are not evident in the patient's statement. Choice D, auditory hallucinations, refers to hearing voices when no external stimulus is present, which is different from the patient's belief that others can hear their thoughts.
The nurse is to perform a complete assessment of a client in her home, using the Mini-Mental State Examination as one component. When the nurse arrives, the client is seated at the table with her husband, the TV is on, and several grandchildren are visiting. The client's husband says, 'Let's get on with this business.' The client is quiet, but her hands are gripped tightly, and she is staring at the ceiling. The best action for the nurse to take would be to:
- A. Explain to the husband that accurate data will be sought, and ask him to stay with the grandchildren in another room
- B. Explain the importance of the testing process and make an appointment for another day when the environment can be better controlled
- C. Not perform the test during the assessment (because it will not be valid) and rely on observations and reports from the family
- D. Ask the husband to make an appointment to bring his wife to the clinic for testing
Correct Answer: B
Rationale: The correct answer is B because conducting a Mini-Mental State Examination (MMSE) in a distracting environment with the client exhibiting signs of distress would likely yield inaccurate results. By explaining the importance of the testing process and rescheduling for a quieter day, the nurse ensures a more accurate assessment. This allows for a controlled environment conducive to obtaining reliable data.
Choice A is incorrect because simply moving the husband and grandchildren to another room may not eliminate distractions or address the client's distress, potentially still impacting the accuracy of the assessment.
Choice C is incorrect as relying solely on observations and reports from the family may not provide a comprehensive assessment of the client's cognitive function, as the MMSE is a standardized tool designed for objective evaluation.
Choice D is incorrect as it does not address the immediate issue of conducting the assessment in a more suitable environment and may disrupt the client's routine by requiring a clinic visit.
The Omnibus Budget Reconciliation Act (OBRA) provides standards of care for which of the following:
- A. Very young
- B. Older adults
- C. Those who have certain intellectual communication difficulties
- D. Those without medical insurance
Correct Answer: B
Rationale: OBRA provides regulations for proper assessment of the elderly (B); for this reason, registered nurses have to provide the initial physical assessment.
An elderly client was well until 12 hours ago, when she reported to her family that during the evening she saw strange faces peering in her windows and in the middle of the night awakened to see a man standing at the foot of her bed. She admits to being very frightened. She is presently pacing and somewhat agitated in the examining room. The client's family reports that the client has recently been to the doctor, who made some medication changes, although they are unsure what the changes were. Which nursing intervention should the nurse implement at the time of this client's admission?
- A. Interact with the client on an adult to child level.
- B. Place the client in a safe, nonstimulating environment.
- C. Ask client why she thinks someone would be trying to frighten her.
- D. Explain to the family that the client will be restrained for her own good.
Correct Answer: B
Rationale: The correct answer is B: Place the client in a safe, nonstimulating environment. This is the most appropriate nursing intervention because the client is experiencing hallucinations and agitation, which could be due to the recent medication changes. Placing the client in a safe, calm environment can help reduce stimulation and provide a sense of security. This intervention addresses the client's immediate needs by ensuring her safety and promoting a sense of comfort.
Incorrect answers:
A: Interact with the client on an adult to child level - This is not appropriate as it does not address the client's current state of distress and could potentially worsen the situation.
C: Ask client why she thinks someone would be trying to frighten her - This is not the priority at this time, as the client is experiencing hallucinations and agitation that need to be managed first.
D: Explain to the family that the client will be restrained for her own good - Restraints should only be used as a last resort and should not be considered
According to statistical research data, which of these children currently being followed by the pediatric nurse practitioner is at the greatest risk for fatal abuse?
- A. A child who is 2 years old and has cerebral palsy
- B. A child who is 5 years old and has measles
- C. A child who is 8 years old and has appendicitis
- D. A child who is 11 years old and has a fractured humerus
Correct Answer: A
Rationale: The correct answer is A because young children with disabilities, like cerebral palsy, are at the highest risk for fatal abuse based on statistical research. These children may be more vulnerable due to their dependency on caregivers and communication challenges. Choice B is incorrect as measles, although serious, is not associated with fatal abuse. Choice C is incorrect as appendicitis is a medical condition and not a risk factor for abuse. Choice D is incorrect as a fractured humerus, while concerning, does not indicate a higher risk for fatal abuse compared to a child with cerebral palsy.