Roach's Introductory Clinical Pharmacology 11th Edition - Cholinesterase Inhibitors

Roach's Introductory Clinical Pharmacology 11th Edition - Cholinesterase Inhibitors Related

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The daughter of a client with AD who is receiving cholinesterase inhibitor therapy tells the nurse that her father has been getting more and more clumsy lately, saying, 'He's almost fallen several times and he often gets out of bed at night. That's when I'm most concerned that he will fall.' The daughter reports that his appetite is fair and that he takes his medication as prescribed. When developing the client's plan of care, the nurse would identify which nursing diagnosis as the priority?

  • A. Imbalanced Nutrition: Less Than Body Requirements
  • B. Risk for Injury
  • C. Ineffective Self Health Management
  • D. Deficient Knowledge: drug therapy
Correct Answer: B

Rationale: Based on the daughter's report, the client is at high risk for injury and this would be the priority. Imbalanced nutrition might be appropriate based on the daughter's report that her father's appetite is fair. However, additional information is needed to determine if this nursing diagnosis would be more of a priority than the risk for injury. The client is receiving his medication as prescribed, so ineffective self health management is not a concern. There is no evidence to suggest that there is a lack of knowledge about the drug therapy.

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For a client who is receiving a cholinesterase inhibitor, which of the following can the nurse recommend to the client's caregiver to decrease the client's risk for injury?

  • A. Observe frequent drug holidays.
  • B. Encourage the use of assistive devices.
  • C. Keep the bed in a low position.
  • D. Use night lights.
  • E. Decrease drug dose if mobility worsens.
Correct Answer: B,C,D

Rationale: To minimize the client's risk for injury, the nurse should encourage using assistive devices and keeping the bed in a low position, using night lights, and frequent monitoring by the caregiver.

A review of a client's history reveals that the client takes ginkgo. Which of the following would the nurse assess for in the client as a common adverse reaction?

  • A. Hyperglycemia
  • B. Headache
  • C. Hypotension
  • D. Rash
  • E. GI discomfort
Correct Answer: B,D,E

Rationale: The most common adverse reactions associated with ginkgo include mild GI discomfort, headache, and rash.

A client taking which of the following medications will see a decrease in effectiveness if rivastigmine (Exclon) is initiated?

  • A. Benztropine (Cogentin)
  • B. Quetiapine (Seroquel)
  • C. Glycopyrrolate (Robinul)
  • D. Theophylline (Theo-Dur)
  • E. Tiotropium (Spiriva)
Correct Answer: A,C,E

Rationale: A client taking anticholinergic medications, like benztropine, glycopyrrolate, and tiotropium, will see a decrease in effectiveness if rivastigmine (Exelon) is initiated.

After teaching a group of nursing students about confusion and how it differs from dementia, the instructor determines that the teaching was successful when the students identify which of the following about delirium?

  • A. The onset occurred suddenly.
  • B. Memory is significantly impaired.
  • C. Sensory impairment occurs.
  • D. Environmental changes are needed for safety.
Correct Answer: A,C

Rationale: Delirium occurs suddenly, affects the senses, and is reversible when the cause is found. In contrast, dementia occurs slowly, affects memory and judgment, and is not reversible, often requiring a change in the environment to maintain safety.

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.

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