PrepU Alzheimer Disease & Dementia

Question 1

Exelon is used to treat mild to moderate dementia diseases such as Alzheimer’s disease and ?

Answer 1

Parkinson’s disease:
It is a cholinesterase inhibitor used cautiously with ct. with renal/hepatic disease, bladder obstruction, seizure disorders, sick sinus syndrome, GI bleeding and asthma.

Question 2

The nurse administered neostigmine to a client with myasthenia gravis. The nurse is doubling the dose that the client was taking at home. Three hours later, the nurse is assessing the client and notes the following symptoms: nausea with vomiting, diarrhea, and sweating. What does the nurse interpret these symptoms to be?

Answer 2

Cholinergic crisis: provider needs to notified immediately. : -idiosyncratic reaction. The fact that the dosage was increased would result in a cholinergic crisis.

Question 3

When describing parasympathetic nervous system, which substance would the nursing instructor discuss as being responsible for transmission of nerve impulses?

Answer 3

Acetylcholine

Question 4

A nurse caring for a client receiving bethanechol for urinary retention should advise the client that voiding usually occurs how long after oral admin?

Answer 4

30-90 minutes after an oral dose. 2-4 hours means the medication will not work; 12-24 hours indicates insertion of a catheter may be needed to relieve pressure exerted on the bladder.

Question 5

The nurse documents that a client diagnosed with dementia of the Alzheimer’s type is exhibiting agnosia when the client is observed being unable to:
a. remember the word to describe what she had for breakfast
b. open a juice container
c. identify a picture of a car

Answer 5

C.
Apraxia: inability to carry out motor activities
Aphasia: language disturbance

Question 6

Which would be MOST important to have readily available for a client who is receiving an indirect-acting cholinergic agonist and develops a severe reaction?
A. Naloxone
B. Atropine
C. Edrophonium
D. Phentolamine

Answer 6

B.
-Edrophonium = antidote for nondepolarizing neuromuscular junction (NMJ) blockers.
-Phentolamine = treatment for extravasation of intravenous norepinephrine or dopamine
-Naloxone = narcotic overdose reversing agent

Question 7

What are some resources for family members of ct. with Alzheimer disease who are concerned about their wandering away at night?

Answer 7

Alzheimer’s Association “MedicAlert + Safe Return” program

Question 8

A nurse is reviewing the med. history of several clients. One of the clients is receiving a direct-acting cholinergic drug. The nurse would identify which drug?
a. pyridostigmine
b. ambenonium
c. bethanechol
d. guanidine

Answer 8

C. acts like the neurotransmitter acetylcholine.
-All other choices are indirect-acting muscle stimulants.

Question 9

Clients with Alzheimer’s disease experience problems with memory and thinking. The reason this happens is degeneration of what?

Answer 9

cholinergic pathways

Question 10

Which agent would be used to counteract a severe reaction occurring with the use of neostigmine?
A. Naloxone
B. Edrophonium
C. Atropine
D. Phentolamine

Answer 10

C: Neostigmine is an indirect acting cholinergic agonist.

Question 11

A client diagnosed with Alzheimer’s disease will likely be administered which medication?

Answer 11

Donepezil: mild-moderate.
-Bethanechol produces smooth muscle contractions.
-Neostigmine treats myasthenia gravis
-Physostigmines is an antidote for overdose of anticholinergic drugs

Question 12

A client diagnosed with myasthenia gravis is prescribed pyridostigmine. How does this drug produce its therapeutic effect?

Answer 12

Stimulates the parasympathetic nervous system

Question 13

Ct receiving neostigmine for treatment of myasthenia gravis has a potential risk of experiencing cholinergic crisis, characterized by excessive stimulation of the —— nervous system.

Answer 13

Parasympathetic. If early symptoms aren’t treated, hypotension and resp. failure may occur. At high doses, anticholinesterase drugs weaken, rather than strengthen, skeletal muscle contraction because excessive amounts of acetylcholine accumulate at motor endplates and reduce nerve impulse transmission to muscle tissue.

Question 14

After age 65, the prevalence of Alzheimer’s disease increases by how much every 5 years?

Answer 14

Doubles

Question 15

A patient taking Exelon may experience what side effects?

Answer 15

dizziness and fatigue, which can contribute to falls and injuries. May also lose weight.

Question 16

The nurse is caring for a client with asthmatic bronchitis and understands that cholinergic medications are contraindicated because this classification of medication may cause?

Answer 16

Bronchoconstriction; may also increase resp. secretions.

Question 17

Donepezil HCL is a cholinesterase inhibiter which means that it does what?

Answer 17

Increases levels of acetylcholine in CNS

Question 18

A ct. with Alzheimer’s disease can foster socialization needs. What guidelines will help best meet these needs?

Answer 18

1. Visits, letters, and phone calls are encouraged.
2. Visits should be brief and nonstressful, limiting visitors to one or two at a time to reduce overstimulation.

Question 19

How many times a day is donepezil taken?

Answer 19

Once a day (70 hour half-life)

Question 20

How often are medications like galantamine and rivastigmine taken?

Answer 20

twice a day

Question 21

How often is tacrine taken?

Answer 21

4 times a day

Question 22

What technique can help a ct. with Alzheimer’s to have better eating success?

Answer 22

Offering one food at a time. Familiar and appealing foods are preferred.

Question 23

Indirect-acting cholinergic drugs do what to improve symptoms?

Answer 23

Improves cholinergic neurotransmission to the brain

Question 24

What caution would a nurse provide to a ct. during education for a prescribed anticholinesterase drug (how should the drug be taken)?

Answer 24

Take with food or milk to decrease risk of gastric distress and ulceration.
Take at bedtime to prevent risk of dizziness and vertigo.

Question 25

The nurse receives a report of a 75-y.o. ct recovering from surgery. During the shift, the nurse notes that the client is forgetful and restless. Several times, the client calls the nurse the name of the ct.’s child. The nurse interprets this behavior as?

Answer 25

Delirium- characterized by rapid onset of cognitive dysfunction and disruption in consciousness; most common psychiatric syndrome in general hospitals, occurring in up to 50% of older adult patients.
Associated with increased morbidity and mortality both during and after hospitalization

Question 26

A client has been receiving bethanechol for 1 week. One hour after the dose is administered, the client develops sweating, flushing, abdominal crams, and nausea. The nurse prepares to intervene for what condition?

Answer 26

Cholinergic overdose: sweating, flushing, abdominal cramps and nausea.
Onset within 1 hour after a dose of anticholinesterase drugs are likely to cause cholinergic crisis
-3 hours plus after a drug dose = myasthenic crisis.

Question 27

A client worried about taking a new cholinergic medication wants to know what body system most side effects occur within:

Answer 27

gastrointestinal system

Question 28

A client is diagnosed with urinary retention The nurse expects the client to receive which medication for this condition?

Answer 28

Bethanechol

Question 29

Ambenonium and guanidine are used to treat what condition?

Answer 29

Myasthenia gravis

Question 30

A client with myasthenia gravis is having difficulty swallowing and adhering to a routine schedule Which agent would be most appropriate?
A. pyridostigmine
B. Ambenonium
C. Rivastigmine
D. neostigmine

Answer 30

A. Available in oral and parental forms. Has longer half life than neostigmine and can be given less frequently.
-Ambenonium = oral for only
-Rivastigmine = Alzheirmer’s disease med.

Question 31

Which type of drug is a direct-acting cholinergic drug?

Answer 31

Bethanechol

Question 32

A female patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has also been taking nonsteroidal anti-inflammatory drugs Which interaction should the nurse monitor for?

Answer 32

-Increase risk for GI bleed:

Question 33

Interaction of theophylline with cholinesterase inhibitors cause increased risk of what type of toxicity?

Answer 33

-theophylline toxicity

Question 33

Interaction of anticholinergics with cholinesterase inhibitors can have what interaction?

Answer 33

Decreased effectiveness of anticholinergics

Question 34

A client with advanced-stage Alzheimer’s disease is seen by a health care provider who prescribes a newer drug that is not a cholinesterase inhibitor. This drug is a N-methyl-D-asparate (NMDA) receptor antagonist. This drug is better known as?

Answer 34

Namenda: Decreases excitability of neurotransmission caused by excess of amino acid glutamate in the CNS. NOT used in late-stage Alzheimer’s disease.

Question 35

The client is to receive an IV cholinergic medication. When the nurse administers the drug what reaction will the nurse anticipate?
A. Decrease in heart rate
B. Increase in anxiety
C. Decrease in anxiety
D. Increase in heart rate

Answer 35

A:

Question 36

A client is receiving galantamine as treatment of Alzheimer’s disease. The nurse would instruct the client and his family about which possible adverse effects? SATA
A. hypertension
B. blurred vision
C. urinary urgency
D. constipation
E. flushing

Answer 36

B, C, E

Question 37

A nurse is caring for a client who is taking rivastigmine. The client’s nursing care plan will prioritize which nursing diagnosis?
A. imbalanced nutrition: more than body requirements related to increase appetite and secondary to the drug therapy
B. Risk for injury related to extrapyramidal symptoms
C. Imbalanced nutrition: less than body requirements related to decreased desire to eat secondary to nausea and vomiting from drug therapy
D. risk for fluid and electrolyte imbalance and hyperglycemia related to adverse effects of medication

Answer 37

C.
-Olanzapine poses risk for imbalanced nutrition for more than body requirements related to increased appetite and secondary to olanzapine use for for fluid and electrolyte imbalance and hyperglycemia related to adverse effects of medication.
-use of haloperidol poses risk for injury related to extrapyramidal symptoms