An older adult is admitted to the emergency department after working outside during extremely high temperatures. The client is lethargic and diagnosed with heat stroke. Which intervention should the nurse implement?

Choice A reason: Cognitive enhancers like donepezil or memantine are prescribed based on Alzheimer’s disease stage. Cholinesterase inhibitors are effective in mild-to-moderate stages, enhancing acetylcholine levels to improve cognition. Memantine, an NMDA receptor antagonist, is used in moderate-to-severe stages to regulate glutamate activity, slowing cognitive decline. This statement is accurate, as treatment is tailored to symptom severity.

Choice B reason: Cognitive enhancers are not equally effective in all Alzheimer’s stages. Cholinesterase inhibitors benefit mild-to-moderate cases, while memantine is used in severe stages. Their efficacy diminishes in advanced disease due to extensive neuronal loss, making this statement inaccurate, as stage-specific prescribing is critical for therapeutic benefit.

Choice C reason: Medications for anxiety and depression, like SSRIs, remain helpful in Alzheimer’s to manage behavioral symptoms, even with cognitive enhancers. These drugs address mood disorders, which often coexist, improving quality of life. This statement is inaccurate, as combination therapy is common and beneficial in managing neuropsychiatric symptoms.

Choice D reason: Cognitive enhancers are not used for seizure management. Anticonvulsants like levetiracetam manage seizures, which may occur in Alzheimer’s due to neuronal excitability. Cognitive enhancers target cognitive decline via cholinergic or glutamatergic pathways, not seizure control, making this statement inaccurate and unrelated to their pharmacological role.

Choice A reason: Lithium toxicity is a concern but not inevitable. It occurs with levels above 1.5 mEq/L, often due to dehydration or drug interactions, common in trauma settings. However, routine monitoring of levels is a more immediate nursing priority than assuming toxicity, as early detection prevents severe outcomes like seizures or renal damage.

Choice B reason: Lithium is primarily excreted by the kidneys, not metabolized by the liver. Liver function tests are not indicated for lithium monitoring, as it does not undergo hepatic metabolism. This statement is inaccurate, as renal function tests are critical to assess lithium clearance and prevent toxicity in trauma patients.

Choice C reason: Stress does not directly increase lithium requirements. Trauma-related dehydration or renal impairment can elevate lithium levels, risking toxicity, but this is due to reduced clearance, not increased need. This statement is inaccurate, as dosing adjustments should be based on serum levels, not stress alone.

Choice D reason: Lithium has a narrow therapeutic range (0.6-1.2 mEq/L), and trauma-related factors like dehydration or medications can alter levels, risking toxicity or subtherapeutic effects. Regular serum level monitoring is critical, especially in acute settings, to ensure safety and efficacy, making this statement accurate and a priority nursing concern.