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The nurse is administering donepezil (Aricept) to a client with stage 1 Alzheimer's disease. Based on this drug's mechanism of action, the nurse will seek evidence of improvement in the client's:
- A. Ability to remember
- B. Ability to tolerate stress
- C. Social behaviors
- D. Delusions and hallucinations
Correct Answer: A
Rationale: The correct answer is A: Ability to remember. Donepezil is a cholinesterase inhibitor that works by increasing levels of acetylcholine in the brain, which helps improve cognitive function, particularly memory. Therefore, the nurse should seek evidence of improvement in the client's ability to remember.
Choice B: Ability to tolerate stress is incorrect because donepezil does not directly impact stress tolerance.
Choice C: Social behaviors is incorrect as donepezil primarily targets memory and cognitive function, not social behaviors.
Choice D: Delusions and hallucinations is incorrect because donepezil does not specifically address these symptoms, which are more commonly associated with psychosis rather than Alzheimer's disease.
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A patient with schizophrenia begins to talk about creatures called 'volmers' hiding in the warehouse where he works and undoing his work each night. The term 'volmers' most likely represents:
- A. a neologism.
- B. clanging.
- C. anhedonia.
- D. alogia.
Correct Answer: A
Rationale: The correct answer is A: a neologism. In schizophrenia, patients often create new words (neologisms) that have no meaning outside of their delusional context. The term 'volmers' is a made-up word by the patient, indicating a loss of touch with reality. Clanging (B) is a speech pattern characterized by rhyming or punning words, not creating new words. Anhedonia (C) refers to the inability to experience pleasure, unrelated to creating new words. Alogia (D) is a decrease in speech or thought productivity, not related to inventing new words. In this case, the patient's use of 'volmers' is indicative of a neologism associated with schizophrenia.
While the nurse at the personality disorders clinic is interviewing a patient, the patient constantly scans the environment and frequently interrupts to ask what the nurse means by certain words or phrases. The nurse notes that the patient is very sensitive to the nurse's nonverbal behavior. His responses are often argumentative, sarcastic, and hostile. He suggests that he is being hospitalized 'so they can exploit me.' The patient's behaviors are most consistent with the clinical picture of:
- A. paranoid personality disorder.
- B. histrionic personality disorder.
- C. avoidant personality disorder.
- D. narcissistic personality disorder.
Correct Answer: A
Rationale: The correct answer is A: paranoid personality disorder. The patient's behaviors align with the diagnostic criteria for paranoid personality disorder, characterized by suspicion, distrust, sensitivity to criticism, and interpreting benign interactions as threatening. The patient's constant scanning of the environment, interrupting to clarify meanings, being sensitive to nonverbal cues, and displaying argumentative and hostile responses are all indicative of paranoid traits. Additionally, the belief that hospitalization is for exploitation is consistent with paranoid beliefs.
Choices B, C, and D can be ruled out:
B: Histrionic personality disorder is characterized by attention-seeking behavior, emotional instability, and dramatic expression. The patient's behaviors are not suggestive of seeking attention or being overly dramatic.
C: Avoidant personality disorder is marked by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. The patient's behaviors are more indicative of suspiciousness rather than avoidance.
D: Narcissistic personality disorder involves grandiosity, need for admiration, and lack of
A core feature of all abnormal behavior is that it is
- A. culturally absolute
- B. learned
- C. maladaptive
- D. dependent on age
Correct Answer: C
Rationale: Maladaptive behavior, impairing function or causing distress, is a universal hallmark of abnormality.
The medication donepezil (Aricept) frequently is used to treat the early-stage symptoms of Alzheimer's disease. When administering this particular medication, the nurse should be especially alert to assess the client for:
- A. Weight changes
- B. Tremors
- C. Increased sweating
- D. Alterations in blood pressure
Correct Answer: D
Rationale: The correct answer is D: Alterations in blood pressure. Donepezil can cause changes in blood pressure as a side effect. Nurses should monitor for orthostatic hypotension and changes in blood pressure to prevent adverse effects. Weight changes (A), tremors (B), and increased sweating (C) are not commonly associated with donepezil and are less likely to be significant concerns when administering this medication for Alzheimer's disease.
A patient admitted to the eating disorders unit has yellow skin, the extremities are cold, and the heart rate is 42 bpm. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient is quiet during the assessment saying only, "I will not eat until I lose enough weight to look thin."Â Select the best initial nursing diagnosis.
- A. Anxiety related to fear of weight gain
- B. Disturbed body image related to weight loss
- C. Ineffective coping related to lack of conflict resolution skills
- D. Imbalanced nutrition: less than body requirements related to self-starvation
Correct Answer: D
Rationale: The correct initial nursing diagnosis is D: Imbalanced nutrition: less than body requirements related to self-starvation. The patient's presentation of yellow skin, cold extremities, bradycardia, low weight, and refusal to eat indicate severe malnutrition due to self-starvation. The key indicators are the physical signs of malnutrition and the patient's statement about not eating until they lose enough weight. Options A and B do not address the primary issue of malnutrition and self-starvation. Option C focuses on coping skills, which is not the priority in this case. Therefore, option D is the best initial nursing diagnosis to address the patient's life-threatening condition of malnutrition.