Gerontological Nursing, 4e (Tabloski) Chapter 22 The Neurologic System

Gerontological Nursing, 4e (Tabloski) Chapter 22 The Neurologic System 1) Which assessment finding places an older patient at the greatest risk factor for the development of Alzheimer's disease? 1. Age 2. Genetic predisposition 3. Environmental exposure 4. History of previous head injury Answer: 1 Explanation: 1. Advanced age is the single greatest factor for the development of Alzheimer's disease. 2. Genetic causes are responsible for fewer than 5% of the cases of Alzheimer's disease. 3. Environmental exposure is not identified as a risk factor for the development of Alzheimer's disease. 4. History of a previous head injury is considered a medical risk for the development of Alzheimer's disease but advanced age is the single greatest risk factor for the development of the disorder. Page Ref: 619 Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nurs/Integ Conc.: Nursing Process: Assessment Learning Outcome: 2. Identify progressive dementias. 2) An older client is being evaluated for delirium. Of the following, which is not a manifestation typically used to make a diagnosis of this disorder? 1. Unable to physically swallow when asked to 2. Unable to remember who visited earlier in the day 3. Unable to sleep at night, but able to sleep through the day 4. Unable to maintain attention Answer: 1 Explanation: 1. Delirium is a disturbance in mental abilities. The physical ability of swallowing is not affected by delirium. 2. Short-term memory impairment such as being unable to remember who visited earlier in the day is a symptom of delirium. 3. Sleep-wake cycle disturbance, such as being able to sleep through the day but not at night, is a symptom of delirium. 4. Not being able to maintain attention is an impairment that is a symptom of delirium. Page Ref: 589 Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nurs/Integ Conc.: Nursing Process: Implementation Learning Outcome: 2. Identify progressive dementias and other neurologic illnesses such as Parkinson's disease. 1 Copyright © 2019 Pearson Education, Inc. 3) An older patient newly diagnosed with Alzheimer's disease is prescribed galantamine (Razadyne). How will the nurse instruct the patient about this medication? Select all that apply. 1. Take at bedtime. 2. Take the medication with food. 3. The dosage may be changed every 4 weeks. 4. Side effects of this medication are minimal. 5. Do not take the medication with an NSAID. Answer: 2, 3, 5 Explanation: 1. This medication is not specifically to be given at bedtime. 2. This medication can cause gastrointestinal upset and should be taken with food. 3. This medication is titrated at 4-week intervals. The dosage may be changed every 4 weeks. 4. The side effects of this medication include gastrointestinal upset and bleeding, arrhythmias, urinary obstruction, somnolence, tremor, abdominal pain, and rhinitis. 5. This medication should be used with caution if also prescribed NSAIDs since this could increase the risk of gastrointestinal bleeding. Page Ref: 622 Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies Nurs/Integ Conc.: Nursing Process: Implementation Learning Outcome: 4. Apply a contextual model to direct behavioral and pharmacological interventions for behavioral symptoms of Alzheimer's disease. 4) An older client is diagnosed with dementia caused by Lewy bodies. What will the nurse most likely assess in this client? Select all that apply. 1. Tremor 2. Rigidity 3. Postural instability 4. Sleep apnea 5. Visual hallucinations Answer: 1, 2, 3, 5 Explanation: 1. Clinical symptoms of dementia caused by Lewy bodies include a tremor. 2. Clinical symptoms of dementia caused by Lewy bodies include rigidity. 3. Clinical symptoms of dementia caused by Lewy bodies include postural instability. 4. Sleep apnea is not a clinical symptom of dementia caused by Lewy bodies. 5. Clinical symptoms of dementia caused by Lewy bodies include visual hallucinations. Page Ref: 618 Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation Nurs/Integ Conc.: Nursing Process: Assessment Learning Outcome: 2. Identify progressive dementias. 2 Copyright © 2019 Pearson Education, Inc. 5) An older patient is diagnosed with early-mild Alzheimer's disease. Which should be done at the time of diagnosis? 1. Discuss treatment options and wishes with the patient. 2. Identify a long-term care facility for immediate transfer. 3. Explain that this stage of the disorder can last up to 10 years. 4. Instruct family members to slowly improve the home environment for safety. Answer: 1 Explanation: 1. Early diagnosis provides the family and the older person with the opportunity to discuss treatment options and wishes while the older person still has decision-making capacity. 2. It is not necessary to identify a long-term care facility for the older patient at this stage of the disorder. 3. There is no specific time interval for early-mild Alzheimer's disease. 4. The family should prepare the home to avoid safety issues as soon as possible. Page Ref: 622 Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential Nurs/Integ Conc.: Nursing Process: Implementation Learning Outcome: 3. Recognize the stages of Alzheimer's disease and implications for nursing care.