Nokea
The nurse is caring for a client who has experienced readmission to the behavioral health unit for an exacerbation of schizophrenia. Which assessment question asked by the nurse identifies a possible cause for the return?
- A. Do you take a generic form of your medications?
- B. When was your last dose of medication?
- C. Are you having any side effects of the medication?
- D. Can you afford to purchase your medication?
Correct Answer: B
Rationale: The nurse is correct to identify that noncompliance with drug therapy is the leading cause of the return of disease symptoms and the need for short-term hospitalization. Asking when the client's last dose of medication was opens communication for when the medication was last administered. If it was not at the prescribed time, the conversation allows the nurse to probe why. Taking a generic medication does not change the effectiveness. Asking if the client can afford the medication or if the medication causes side effects does not directly address the question of noncompliance.
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The nurse is caring for a client diagnosed with delirium. What does the nurse know to be true of delirium?
- A. It is incurable.
- B. It is a sudden, transient state.
- C. It has a gradual onset.
- D. It is considered permanent.
Correct Answer: B
Rationale: Delirium is a sudden, transient state of confusion. The period of confusion depends on the cause of the delirium. Treating the underlying medical condition usually restores mental function.
The nurse is caring for a client with Alzheimer disease. When discussing neuron damage, which statement best represents the cause of neuron death?
- A. Neurons die from a lack of oxygen.
- B. Neurons die from microtubule disintegration.
- C. Neurons die from an elevated neurotransmitter level.
- D. Neurons die from diminished blood flow.
Correct Answer: B
Rationale: Alzheimer disease includes mutated genes that disrupt the processing of the amyloid precursor protein following a series of steps in which neuron degeneration occurs. The nurse is correct to identify that neurons die from microtubule disintegration. Oxygen level, blood flow, and an elevated neurotransmitter level are not responsible for neuron death.
The nurse is relating medication classifications for Alzheimer type dementia to the pathophysiology of the disease process. Which neurotransmitter do most the medications on the market currently impact?
- A. Dopamine
- B. Acetylcholine
- C. Norepinephrine
- D. Epinephrine
Correct Answer: B
Rationale: Current drugs approved for treatment of dementia of the Alzheimer type include cholinesterase inhibitors, which increase acetylcholine by inhibiting cholinesterase, the enzyme that degrades it. When these drugs, tacrine (Cognex), donepezil (Aricept), or rivastigmine (Exelon), are administered in the early to middle stages of Alzheimer disease, some clients improve. Only memantine (Namenda) has a different mechanism of action.
Which of the following is an outcome of the drug memantine (Namenda) in clients with advanced stages of Alzheimer disease?
- A. Less depression
- B. Increased brain excitability
- C. Lessens symptoms
- D. Decreased brain excitability
Correct Answer: C
Rationale: Clients in advanced stages of Alzheimer disease have fewer symptoms when taking memantine than others who were given a placebo.
The nurse is instructing the parents of a 21-year-old with schizophrenia who hears voices. Which response by the parent to the child validates that the parent understands the discharge teaching?
- A. The parent states 'Does the person speaking have a name?'
- B. The parent states 'The person speaking to you is bad, but you are good.'
- C. The parent states 'The voice is not real. We have talked about this before.'
- D. The parent states 'I do not hear the voices, but what are they telling you?'
Correct Answer: D
Rationale: The parent is most correct to state not hearing the voices but then asking the client to share what the voices are saying. By identifying the content of the hallucinations, the parent can determine the safety of the client or if others are in jeopardy. Also, the parent is correct to call the auditory hallucinations by the term 'the voices.'