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Which information should be shared with the client diagnosed with stage I Alzheimer's disease who is prescribed donepezil (Aricept), a cholinesterase inhibitor?
- A. The client must continue taking this medication forever to maintain function.
- B. The drug may delay the progression of the disease, but it does not cure it.
- C. A serum drug level must be obtained monthly to evaluate for toxicity.
- D. If the client develops any muscle aches, the HCP should be notified.
Correct Answer: B
Rationale: Donepezil delays Alzheimer’s progression but does not cure it (B). Lifelong use (A) is not mandatory, serum levels (C) are not routine, and muscle aches (D) are not a primary concern.
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The nurse is caring for several clients. Which client would the nurse assess first after receiving the shift report?
- A. The 22-year-old male client diagnosed with a concussion who is complaining someone is waking him up every two (2) hours.
- B. The 36-year-old female client admitted with complaints of left-sided weakness who is scheduled for a magnetic resonance imaging (MRI) scan.
- C. The 45-year-old client admitted with blunt trauma to the head after a motorcycle accident who has a Glasgow Coma Scale (GCS) score of 6.
- D. The 62-year-old client diagnosed with a cerebrovascular accident (CVA) who has expressive aphasia.
Correct Answer: C
Rationale: A GCS score of 6 (C) indicates severe neurological impairment, requiring immediate assessment for potential life-threatening conditions. Waking every 2 hours (A) is standard for concussion, left-sided weakness (B) is concerning but less acute, and expressive aphasia (D) is stable.
The client, who had a stroke, follows the nurse’s instructions without problems, but an attempt to verbally respond to the nurse’s question was garbled. The nurse should identify that the client has which type of aphasia?
- A. Receptive aphasia
- B. Global aphasia
- C. Expressive aphasia
- D. Anomic aphasia
Correct Answer: C
Rationale: With receptive aphasia (Wernicke’s aphasia or fluent aphasia) the client would hear the voice but would be unable to comprehend the meaning of the message. Global aphasia is a combination of receptive and expressive aphasia. The client would have difficulty speaking and understanding words and would not be able to read or write. The nurse should identify that the client has expressive aphasia (Broca’s aphasia or non-fluent aphasia). The client is able to comprehend and responds appropriately. The client may attempt to speak but has difficulty communicating with the correct words. With anomic aphasia, the client would have word-finding difficulties; this client does not verbalize.
Which nursing intervention is most appropriate after the lumbar puncture has been performed?
- A. Keep the client in a side-lying position.
- B. Assist the client into a sitting position.
- C. Withhold food and fluids for 1 hour.
- D. Keep the client flat for several hours.
Correct Answer: D
Rationale: Keeping the client flat for several hours post-lumbar puncture reduces the risk of cerebrospinal fluid leakage and subsequent headache.
The nurse identifies the concept of intracranial regulation disturbance in a client diagnosed with Parkinson’s Disease. Which priority intervention should the nurse implement?
- A. Keep the bed low and call light in reach.
- B. Provide a regular diet of three (3) meals per day.
- C. Obtain an order for home health to see the client.
- D. Perform the Braden scale skin assessment.
Correct Answer: A
Rationale: Parkinson’s increases fall risk due to bradykinesia and rigidity. Keeping the bed low and call light in reach (A) prioritizes safety. Diet (B), home health (C), and skin assessment (D) are secondary.
The client has right homonymous hemianopia following an ischemic stroke. The nurse asks the NA to help the client with meals knowing that this problem may result in which client response?
- A. Tendency to fall to the contralateral side
- B. Eating food on only half of the plate
- C. Using the silverware inappropriately
- D. Choking when swallowing any liquids
Correct Answer: B
Rationale: Tendency to fall to the contralateral side would be a concern if the client were weak or paralyzed. Homonymous hemianopia (hemianopsia) is a visual field abnormality that results in blindness in half of the visual field in the same side of both eyes. It results from damage to the optic tract or occipital lobe. Using the silverware inappropriately is a concern if the client has agnosia. Choking when swallowing any liquids is a concern if the client has dysphagia.