Question 1

A patient will begin taking a cholinesterase inhibitor for early Alzheimer's disease. The nurse is teaching the patient's spouse about the medication. Which statement by the spouse indicates a need for further teaching?

A) "Gastrointestinal symptoms are common with this medication."
B) "People taking this drug should not take antihistamines."
C) "This drug helps neurons that aren't already damaged to function better."
D) "This drug significantly slows the progression of the disease."

"This drug significantly slows the progression of the disease."

Accepted Answer

Cholinesterase inhibitors produce modest improvements in cognition, behavior, and function and may slightly delay disease progression; they do not have a major impact on delaying progression of the disease. Gastrointestinal symptoms are common side effects. Drugs that block cholinergic receptors, including antihistamines, can reduce therapeutic effects and should be avoided. Cholinesterase inhibitors do not affect neurons already damaged, but they do improve function in those not yet affected.

Question 2

A nurse is caring for an older adult patient who has Alzheimer's disease. The patient is taking a cholinesterase inhibitor drug. Which side effects would concern the nurse?&#10;A) Confusion and memory impairment&#10;B) Dizziness and headache&#10;C) Nausea, vomiting, and diarrhea&#10;D) Slowed heart rate and lightheadedness

Accepted Answer

Cardiovascular effects of cholinesterase inhibitor drugs are uncommon but cause the most concern. Bradycardia and fainting can occur when cholinergic receptors in the heart are activated. Confusion and memory impairment are signs of the disease and are not side effects of the drug. Dizziness, headache, nausea, vomiting, and diarrhea are all expected adverse effects, and although uncomfortable, they do not present an increased risk to the patient.

Question 3

A patient is worried about the risk of developing Alzheimer's disease, because both parents had the disease. The nurse will tell this patient that known risk factors include what? (Select all that apply.)

A) Advanced age
B) Alcoholism
C) Family history
D) Gender
E) Obesity

Advanced age
Family history

Accepted Answer

The major known risk factor for AD is advancing age; the only other known risk factor is a family history of AD. Alcoholism, gender, and obesity are not known risk factors.

Question 4

An older adult patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil (Aricept) 10 mg once daily for 6 months. The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be increased. What will the nurse tell the spouse?

A) The dose can be increased, because the patient has been taking the drug for longer than 3 months.
B) The dose can be increased to twice daily dosing instead of once daily dosing.
C) The increase in symptoms is the result of hepatotoxicity from the medication's side effects.
D) The patient must take the drug for longer than 1 year before the dose can be increased.

Accepted Answer

Donepezil is given for mild, moderate, and severe AD, and dosing may be increased, although it must be titrated up slowly. For patients with moderate to severe AD who have taken 10 mg once daily for at least 3 months, the dose can be increased to 23 mg once daily. Donepezil is not given twice daily. Donepezil does not cause hepatotoxicity; hepatotoxicity occurs with tacrine, the first acetylcholinesterase (AChE) inhibitor, which now is rarely used. Dosing is increased after 3 months, not 1 year.

Question 5

The spouse of a patient with Alzheimer's disease asks a nurse for more information about the rivastigmine (Exelon) transdermal patch that is being used. Which statement by the spouse indicates a need for further explanation?

A) "Doses are lower but more steady with the transdermal patch."
B) "Reduced side effects occur with the transdermal patch."
C) "We only need to change the patch every 2 weeks."
D) "We should remove the old patch before applying the new one."

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Accepted Answer

The rivastigmine transdermal patch needs to be changed daily. Sites used should not be reused for 14 days. Transdermal dosing provides lower, steady levels of the drug. Intensity of side effects is lower with the transdermal patch. The old patch must be removed prior to applying the new patch to prevent toxicity.

Question 6

A nurse is teaching a group of nursing students about the use of memantine (Namenda) for Alzheimer's disease. Which statement by a student indicates understanding of the teaching?&#10;A) &#34;Memantine is indicated for patients with mild to moderate Alzheimer's disease.&#34;&#10;B) &#34;Memantine modulates the effects of glutamate to alter calcium influx into neurons.&#34;&#10;C) &#34;Memantine prevents calcium from leaving neurons, which improves their function.&#34;&#10;D) &#34;When used with donepezil, memantine increases the amount of calcium in neuronal cells.&#34;

Accepted Answer

Memantine modulates the effects of glutamate, which is involved in calcium influx into neuronal cells. Memantine is used for patients with moderate to severe AD. Memantine does not prevent calcium from leaving cells; it only affects the influx of calcium. Although the effects of memantine and donepezil appear to be synergistic, the result is not always an increase in the amount of calcium in the cells.

Question 7

A nurse is caring for an older adult man who has Alzheimer's disease (AD). The patient's daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her?

A) Family history and female gender are both known to increase the risk.
B) Genetic testing can provide a definitive measure of the risk.
C) Patients with the apolipoprotein E₂ gene (ApoE₂) are more likely to develop the disease.
D) Some biologic markers can be measured, but none is known to increase the risk.

Accepted Answer

Although several genes, proteins, and neurologic changes are associated with the presence of Alzheimer's disease, none has been shown to have a direct causative link. Advancing age and a positive family history are the only two known risk factors. Female gender is not a known risk; the increased incidence among females may be the result of women living longer than men. No definitive genetic tests are available. The presence of ApoE₂ seems to be protective.

Question 8

The spouse of a patient who acts confused and forgetful wants to know if there is a test to determine whether the patient has Alzheimer's disease. Which response by the nurse is correct?&#10;A) &#34;A diagnosis is made by administering medications and observing for potential improvement in symptoms.&#34;&#10;B) &#34;The diagnosis is based on a patient's age, family history, serum apolipoproteins, and genetic testing.&#34;&#10;C) &#34;Magnetic resonance imaging to demonstrate brain atrophy is the definitive test to determine Alzheimer's disease.&#34;&#10;D) &#34;Proposed diagnostic criteria include measures of cognitive function and the presence of one known biomarker.&#34;

Accepted Answer

In 2010 an international group of AD experts proposed revising diagnostic criteria to add the presence of at least one AD biomarker to current measures of cognitive function after a patient has been observed to have episodic memory impairment. The diagnosis currently is made by observing memory impairment and then measuring cognitive function. Most medications used for AD do not demonstrate sustained or unequivocal improvement, so they would not be useful for diagnostic purposes. The patient's age and family history are risk factors. The serum ApoE level and genetic testing are not used to diagnose AD. Magnetic resonance imaging (MRI) can measure one brain marker of AD; however, brain atrophy has several different causes and is not definitive.

Question 9

An older adult patient with Alzheimer's disease is admitted to the hospital. The patient's spouse reports that the patient is often confused and gets lost walking to the store, which is 3 blocks from their home. That evening, the nurse observes the patient pacing the hall and screaming. What will the nurse do?

A) Notify the provider of this patient's worsening symptoms.
B) Prepare the patient's spouse for impending death from Alzheimer's disease.
C) Request an increase in the medication dose to treat the exacerbation in symptoms.
D) Tell the spouse that this is an expected progression of the disease.

Accepted Answer

This patient is showing signs of the natural progression of AD. Behavior problems such as these occur in 70% to 90% of patients with AD as the disease progresses. There is no need to notify the provider to report these symptoms, because they are expected. The time from onset of symptoms to death usually is 4 to 8 years, but it may be as long as 20 years; this progression does not represent the final stages. Medications are not effective for preventing disease progression, and their effects on memory and cognition are modest, so requesting an increase in the drug dose would not help in this situation.

Deck 22: Alzheimers Disease