HESI RN Week 4 Questions

HESI RN Week 4 Questions A 70-year-old man comes to the office because he has progressive difficulty speaking. The patient's family states that over the past 2 years he has gradually been speaking less. Another physician prescribed propranolol for anxiety related to his work as a museum docent, discussing art with tour groups. His difficulty continued, and in the last year, his responsibilities at work have been shifted. His family thinks he understands most of what is said to him, but he answers questions in 1- or 2-word phrases, typically just nouns and verbs. His memory seems to be relatively spared, and he performs many chores around the house, including cleaning and helping with cooking. The patient is partially independent in ADLs. However, because of his language difficulties, he cannot safely leave the house alone. More recently, he has acted inappropriately toward family members, and they are concerned about what he might do in public if he is alone. History includes hypertension, anxiety, and anemia. There is no history of drug or alcohol abuse. Physical examination is consistent with the history provided by the family. Laboratory findings include macrocytic anemia with a low level of vitamin B12. Levels of homocysteine, methylmalonic acid, and thyrotropin are normal. Renal function and hepatic synthetic function are intact. There is no evidence of prior stroke on MRI of the brain. Which one of the following is the most likely cause of the patient's cognitive impairment? (A) Lewy body dementia (B) Vascular dementia (C) Alzheimer disease (D) Frontotemporal dementia - Frontotemporal dementia Which one of the following statements about therapy for patients with agitated dementia is true? (A) Second-generation antipsychotic agents are associated with a 5- to 6-fold increased risk of death compared with first-generation antipsychotics. (B) Second-generation antipsychotic agents are associated with a 1.5-fold increased risk of death compared with placebo. (C) First-generation antipsychotic agents are associated with a lower risk of death than secondgeneration antipsychotic agents and are therefore the treatment of choice for psychosis with agitation in older patients. (D) Sedating antidepressants have a lower risk of death than either first- or second-generation antipsychotic agents and are therefore the treatment of choice for psychosis with agitation in older patients. - Second-generation antipsychotic agents are associated with a 1.5-fold increased risk of death compared with placebo A 76-year-old man comes to the office for his annual appointment. He is accompanied by his wife, who reports that the patient has been taking his antihypertensive medicine irregularly, is increasingly irritable, and no longer expresses interest in activities that they used to enjoy. She also notes that he has started to gamble impulsively and is losing a lot of money in poker games with friends. She says that he ignores her protests because he tends to be domineering and selfabsorbed. The patient counters that he enjoys the games but loses money because his friends cheat. He insists that he takes his medication regularly and claims that he is only irritable aroundhis wife and that she never raised concerns about his medication adherence with him. The patient seems unusually suspicious and mistrusting when asked for information about his daily routine, and he angrily leaves the office during a memory screen.