Which medication classification is given to counteract extrapyramidal symptoms (EPS)?
- A. Antidepressants
- B. Antianxiety
- C. Anticholinergics
- D. Anticonvulsants
Correct Answer: C
Rationale: Anticholinergic drugs such as Artane and Cogentin are given to prevent or relieve EPS. Antidepressants, antianxiety, and anticonvulsant medications are not given to counteract EPS.
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The nurse is caring for a client who is concerned about having the beginning symptoms of Alzheimer disease. Which question is helpful in determining risk factors?
- A. Has your house been tested for high radon levels?
- B. Do you have any family with Alzheimer disease?
- C. How many times a week do you eat red meat?
- D. At which time of day do you experience most symptoms?
Correct Answer: B
Rationale: The nurse asks the client about the family health history. The nurse is correct to understand that if the client has a first-degree relative with Alzheimer's disease, the client's risk for the disease doubles. The other options are not helpful in determining risk factors.
Which family-centered nursing diagnosis is a priority for Alzheimer disease clients who have a spouse providing care?
- A. Altered Health Maintenance
- B. Fatigue
- C. Caregiver Fatigue
- D. Grief
Correct Answer: C
Rationale: A priority family-centered nursing diagnosis related to a spouse who is providing care is Caregiver Fatigue. The nurse determines family-specific interventions that can assist the spouse or family in care for themselves while caring for the client. Altered Health Maintenance is a client diagnosis. Fatigue and Grief are also potential diagnoses but not as high a priority as Caregiver Fatigue.
A family brings a parent to the physician's office to discuss the parent's decline in cognitive status. The family states that the parent is forgetful and needs reminders to be able to live alone. Following assessment, which stage of Alzheimer disease does the nurse anticipate?
- A. Preclinical
- B. Post clinical
- C. Mild cognitive impairment
- D. Alzheimer dementia
Correct Answer: C
Rationale: The nurse is most correct to anticipate that the client will be diagnosed at the mild cognitive impairment stage of Alzheimer disease. At this stage, the client has noticeable memory problems, however, the memory loss is not serious enough to interfere with independent living.
The nurse is teaching the family of clients with Alzheimer disease about the disease process. The nurse is using a picture of the brain and highlighting which structures?
- A. Neurotransmitters and cell receptors
- B. Neurofibrillary tangles and amyloid plaques
- C. Brain tissue and receptor sites
- D. Blood vessels with valves
Correct Answer: B
Rationale: The nurse is most correct to instruct the families on neurofibrillary tangles and amyloid plaques. These are characteristic in clients with Alzheimer disease. The other options may have some effect related to the disease but are not characteristic.
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.'
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