Nokea
A client is receiving donepezil. When reviewing the client's medication history, the nurse determines that the client is at increased risk for GI bleeding if the client is also taking which drug?
- A. Naproxen (Naprosyn)
- B. Oxycodone (OxyContin)
- C. Acetaminophen (Tylenol)
- D. Ibuprofen (Motrin)
- E. Meperidine (Demerol)
Correct Answer: A,D
Rationale: Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, in combination with donepezil place the client at an increased risk for GI bleeding. Oxycodone, acetaminophen, and meperidine do not increase the client's risk.
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A client asks the nurse about using the herb ginkgo to improve his memory and thinking. Which of the following would the nurse need to integrate into the response about this herb?
- A. There is scientific proof that this herb is effective.
- B. The effects may take at a minimum 4 weeks to occur.
- C. Mild GI discomfort and headache may occur with the herb.
- D. The herb needs to be taken at least four times a day to be effective.
- E. The herb if taken in large doses rarely leads to problems.
Correct Answer: B,C
Rationale: Conflicting research both supports and disputes ginkgo's ability to enhance memory. The effects of ginkgo may not be evident until after 4 to 24 weeks of treatment. The most common adverse reactions include mild GI discomfort, headache, and rash.
After teaching the caregiver of a client prescribed transdermal rivastigmine, the nurse determines that the teaching was successful when the caregiver states which of the following?
- A. I'll apply a new patch every other day.
- B. The patch should be placed on a hairless area.
- C. I'll make sure to put the patch where he can see it.
- D. I can use the same spot once or twice a week.
Correct Answer: B
Rationale: Rivastigmine patches are changed on a daily basis and rotated to a clean, dry, and hairless area. Because the patient is experiencing dementia, the site for application should be where the patient is not able to pick at or remove the patch. The upper or lower portions of the back are recommended for patch administration. Because the same site should not be used more than once every 2 weeks, the caregiver should be instructed to make a chart of the back and indicate where patches have been applied during the last 14 days.
The caregiver of a client diagnosed with AD asks the nurse about the prescribed therapy with rivastigmune and about how the drug works. The nurse would integrate knowledge of which action in the response to the caregiver?
- A. Increases the level of acetylcholine in the CNS
- B. Decreases the level of neurotoxins in the brain
- C. Increases the level of cholinesterase in the blood
- D. Increases the level of adenosine triphosphate in the blood
Correct Answer: A
Rationale: Administration of cholinesterase inhibitors results in an increase in the level of acetylcholine in the CNS. Administration of cholinesterase inhibitors does not decrease the neurotoxins in the brain or increase the level of adenosine triphosphate in the blood. Cholinesterase inhibitors inhibit and do not increase the level of cholinesterase in the blood.
A client with AD receiving a cholinesterase inhibitor has a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements. Which of the following would be most appropriate?
- A. Provide nutritious meals three times a day.
- B. Give foods that have the same consistency.
- C. Encourage careful chewing.
- D. Encourage visitors during mealtime.
Correct Answer: C
Rationale: The nurse should encourage chewing action when feeding. The nurse need not provide nutritious meals three times a day; instead, frequent small nutritious meals would be more beneficial. Offering foods of different consistency and flavor is important in case the patient can handle one form better than another. The nurse should not encourage visitors during mealtime; mealtime should be simple and calm.
The nurse suspects that a client has consumed an excessive dose of ginkgo based on assessment of which of the following?
- A. Constipation
- B. Diarrhea
- C. Vomiting
- D. Restlessness
- E. Drowsiness
Correct Answer: B,C,D
Rationale: A client who takes an excessive dose of ginkgo may exhibit the following adverse reactions: diarrhea, nausea, vomiting, and restlessness.