Nokea
After administering rivastigmine to a client with AD, the nurse would continue to assess the client for which of the following adverse effects?
- A. Anorexia and nausea
- B. Cardiovascular dysfunction
- C. Diabetes mellitus
- D. Hypertension
Correct Answer: A
Rationale: The adverse effects associated with the administration of cholinesterase inhibitors include anorexia and nausea. Cardiovascular dysfunction, diabetes mellitus, and hypertension are not adverse effects associated with the administration of cholinesterase inhibitors.
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When describing the action of cholinesterase inhibitors to a class of nursing students, the instructor would include which of the following about their action?
- A. The drugs decrease the level of acetylcholine in the CNS.
- B. They inhibit the breakdown of acetylcholine.
- C. The drugs slow neural destruction.
- D. They stop neural breakdown.
- E. The drugs increase excitatory neurotransmitters in the CNS.
Correct Answer: B,C
Rationale: Cholinesterase inhibitors act to increase the level of acetylcholine in the CNS by inhibiting its breakdown and slowing neural destruction.
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.
A group of nursing students are reviewing the stages of AD. They demonstrate understanding of the information when they identify which of the following as characteristic of preclinical AD?
- A. Client's changes in thinking are readily evident to family members.
- B. The client may exhibit moderate levels of anxiety.
- C. The ability to function is significantly limited.
- D. There are no cognitive changes noted.
Correct Answer: D
Rationale: Preclinical AD is characterized by no changes in cognitive or functional ability. With mild cognitive impairment, the changes in thinking are noticeable to the client and family members, and the person may experience mild to moderate anxiety. In dementia due to AD, memory, thinking, and behavior limit the person's ability to function.
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 nurse should advise clients taking which medications to avoid the use of ginkgo?
- A. Selective serotonin reuptake inhibitors
- B. Monoamine oxidase inhibitors
- C. NSAIDs
- D. Nonsalicylates
- E. Anticholinergics
Correct Answer: A,B
Rationale: Ginkgo is contraindicated in clients taking SSRI or MAOI antidepressants, because of the risk of a toxic reaction. Cholinesterase inhibitors interact with anticholinergics. Ginkgo does not interact with NSAIDs or nonsalicylates.