Chapter 22: Drugs for Alzheimer’s Disease

Chapter 22: Drugs for Alzheimer’s Disease

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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.	Female gender is 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.	Advancing age and family history are known risk factors.

 

 

ANS:  D

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.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 191-192

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

2. The spouse of a patient who is newly diagnosed with Alzheimer’s disease asks the nurse if medications will prevent the need for nursing home care. Which response by the nurse is correct?

a.	“Drugs to treat Alzheimer’s disease may slow the progression of memory loss.”
b.	“Drugs may be effective to stop the progression of the disease if they are initiated early in the disease.”
c.	“Medications to treat Alzheimer’s disease are effective for treating core symptoms of the disease.”
d.	“Medications for Alzheimer’s disease are effective in reducing cognitive impairment.”

 

 

ANS:  A

Alzheimer’s disease is a disease in which symptoms progress relentlessly from mild to moderate to severe. Medications have not been clearly effective and do not stop the disease progression, although they may slow loss of memory and cognition and prolong independent function. There is no indication that available drugs stop disease progression if begun early in the course of the disease. There is no clearly effective therapy for core symptoms, but associated symptoms such as incontinence and depression may be treated.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 191-192

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

3. 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 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’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.

 

 

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.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 192-193

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

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.

 

 

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 now is rarely used. Dosing is increased after 3 months, not 1 year.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 193-194

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies