ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 72 : Caring for Clients With Dementia and Thought Disorders Questions
Question 1 of 5
Which of the following nursing diagnoses would be of highest priority for a client diagnosed with advanced Alzheimer disease?
Correct Answer: D
Rationale: When identifying a priority, select the diagnosis that could be the most harmful. The nurse is most correct to select Aspiration Risk as the highest priority. Aspiration can potentially cause pneumonia. Memory Impairment and Chronic Confusion are manageable with appropriate supervision. Impaired Verbal Communication is an obstacle in expressing thoughts and feelings.
Question 2 of 5
The nurse is providing community education regarding Alzheimer disease. Which client scenario is best for the client with progressing Alzheimer symptoms?
Correct Answer: D
Rationale: The best client scenario allows the client to remain in the familiar environment of the client's home while maintaining safety. Home health nurses and nurse aides can aid families in managing client care. Transferring clients to the behavioral health unit, to a personal care home, or a dementia unit all take the client from the home setting, which can be confusing.
Question 3 of 5
The nurse is relating medication classifications for Alzheimer type dementia to the pathophysiology of the disease process. Which neurotransmitter do most the medications on the market currently impact?
Correct Answer: B
Rationale: Current drugs approved for treatment of dementia of the Alzheimer type include cholinesterase inhibitors, which increase acetylcholine by inhibiting cholinesterase, the enzyme that degrades it. When these drugs, tacrine (Cognex), donepezil (Aricept), or rivastigmine (Exelon), are administered in the early to middle stages of Alzheimer disease, some clients improve. Only memantine (Namenda) has a different mechanism of action.
Question 4 of 5
The nurse is caring for a client in the mild cognitive impairment stage of Alzheimer disease. When reviewing the client's medication regimen, which medication does the nurse identify as having a neuroprotective property?
Correct Answer: A
Rationale: The neuroprotective drugs are the newest medications on the market. The newest drug, Namenda, contains memantine, which is a neuroprotective. The other medications are not Alzheimer medications that diminish dementia.
Question 5 of 5
Which family-centered nursing diagnosis is a priority for Alzheimer disease clients who have a spouse providing care?
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.