Nokea
Which condition would require the nurse to cautiously monitor a client who is receiving donepezil?
- A. Hyperthyroidism
- B. Seizure disorder
- C. Renal disease
- D. Asthma
- E. GI bleeding
Correct Answer: B,C,D,E
Rationale: Cholinesterase inhibitors, like donepezil, are used cautiously in clients with renal or hepatic disease, bladder obstruction, seizure disorder, sick sinus syndrome, GI bleeding, history of ulcer disease, and asthma.
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After teaching a group of nursing students about cholinesterase inhibitors, the instructor determines that additional teaching is needed when the students identify which drug as an example?
- A. Rivastigmine
- B. Donepezil
- C. Memantine
- D. Galantamine
Correct Answer: C
Rationale: Memantine is an example of an NMDA receptor antagonist. Rivastigmine, donepezil, and galantamine are cholinesterase inhibitors.
A nurse is reviewing the action of memantine. The nurse understands that this drug addresses which of the following?
- A. Acetylcholine
- B. Glutamate
- C. Serotonin
- D. Dopamine
Correct Answer: B
Rationale: Memantine, an NMDA receptor antagonist, is thought to work by decreasing the excitability of neurotransmission caused by an excess of the amino acid glutamate in the CNS.
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.
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.
When reviewing a client's medical record, which condition would the nurse identify as contraindicating the use of donepezil?
- A. Bronchitis
- B. Asthma
- C. Vitamin deficiency
- D. Anmesia
Correct Answer: B
Rationale: The administration of donepezil is contraindicated in clients with asthma. The drug is not contraindicated in clients with bronchitis, beriberi, or amnesia.