NGR6172 Exam 1 Questions With Complete Solutions
110. An older adult patient with Alzheimer 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 three
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 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.
ANS: D
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.
111. A nurse is preparing to administer memantine [Nemenda]
to a patient and notes a slight elevation in the patient's creatinine
,clearance level. What will the nurse expect the provider to order
for this patient?
a. Adding sodium bicarbonate to the patient's drug regimen
b. Continuing the memantine as ordered
c. Discontinuing the memantine
d. Reducing the dose of memantine
ANS: D
Patients with severe renal impairment may require a dosage
reduction. Adding sodium bicarbonate would alkalinize the
urine and increase memantine levels, causing toxicity. It is not
necessary to discontinue or decrease the dose of the memantine
with mild or moderate renal impairment.
112. The spouse of a patient with Alzheimer 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."
ANS: C
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.
,113. A patient is worried about the risk of developing Alzheimer
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
ANS: A,C
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.
114. A nurse is teaching a group of nursing students about the
use of memantine [Namenda] for Alzheimer disease. Which
statement by a student indicates understanding of the teaching?
a. "Memantine is indicated for patients with mild to moderate
Alzheimer disease."
b. "Memantine modulates the effects of glutamate to alter
calcium influx into neurons."
c. "Memantine prevents calcium from leaving neurons, which
improves their function."
d. "Memantine and donepezil combined may stop progression of
Alzheimer disease."
ANS: B
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. In studies, although the effects of memantine and
donepezil appear to be synergistic or may confer independent
benefits, they only demonstrate improvement in cognitive
function and not a stop in disease progression.
115. 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.
ANS: A
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
110. An older adult patient with Alzheimer 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 three
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 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.
ANS: D
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.
111. A nurse is preparing to administer memantine [Nemenda]
to a patient and notes a slight elevation in the patient's creatinine
,clearance level. What will the nurse expect the provider to order
for this patient?
a. Adding sodium bicarbonate to the patient's drug regimen
b. Continuing the memantine as ordered
c. Discontinuing the memantine
d. Reducing the dose of memantine
ANS: D
Patients with severe renal impairment may require a dosage
reduction. Adding sodium bicarbonate would alkalinize the
urine and increase memantine levels, causing toxicity. It is not
necessary to discontinue or decrease the dose of the memantine
with mild or moderate renal impairment.
112. The spouse of a patient with Alzheimer 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."
ANS: C
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.
,113. A patient is worried about the risk of developing Alzheimer
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
ANS: A,C
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.
114. A nurse is teaching a group of nursing students about the
use of memantine [Namenda] for Alzheimer disease. Which
statement by a student indicates understanding of the teaching?
a. "Memantine is indicated for patients with mild to moderate
Alzheimer disease."
b. "Memantine modulates the effects of glutamate to alter
calcium influx into neurons."
c. "Memantine prevents calcium from leaving neurons, which
improves their function."
d. "Memantine and donepezil combined may stop progression of
Alzheimer disease."
ANS: B
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. In studies, although the effects of memantine and
donepezil appear to be synergistic or may confer independent
benefits, they only demonstrate improvement in cognitive
function and not a stop in disease progression.
115. 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.
ANS: A
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
