During a home visit, the nurse assesses a client with Alzheimer's Di’ease who recently started a new prescription for rivastigmine. The caregiver reports that the client seems to be thinking more clearly but is not sleeping well at night. Which action should the nurse take?

Instruct the caregiver to withhold the medication until the dosage can be decreased to ensure the client's sa’ety.

Notify the healthcare provider that the dosage of the medication may need to be increased to manage the client's in’omnia.

Advise the caregiver that the purpose of the medication is to promote sleep, so a change in medication may be needed.

Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started.

Answer and Explanation

The Correct Answer is D

A) Instruct the caregiver to withhold the medication until the dosage can be decreased to ensure the client's sa’ety: Withholding the medication without consulting the healthcare provider may not be appropriate, especially if the client is experiencing improvements in cognitive function. The insomnia may be a temporary side effect that could resolve with continued use or adjustment of the dosage.

B) Notify the healthcare provider that the dosage of the medication may need to be increased to manage the client's in’omnia: Increasing the dosage of rivastigmine to manage insomnia may not be the most appropriate action. It's es’ential to assess the client further and explore other interventions before considering a dosage adjustment.

C) Advise the caregiver that the purpose of the medication is to promote sleep, so a change in medication may be needed: Rivastigmine is not typically used to promote sleep. It is a cholinesterase inhibitor used to treat cognitive symptoms associated with Alzheimer's di’ease. Therefore, advising a change in medication solely based on the client's in’omnia is not appropriate.

D) Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started: Rivastigmine and other cholinesterase inhibitors may cause insomnia, especially when therapy is initiated. Educating the caregiver about this common side effect helps manage expectations and provides reassurance that the insomnia may improve over time as the client's bo’y adjusts to the medication.

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Correct Answer is A

Explanation

A) Asking the client to describe how she takes the medication is the most appropriate initial response by the nurse. “Heartburn” reported after taking risedronate raises concerns about potential esophageal irritation or gastroesophageal reflux disease (GERD) exacerbation. Understanding the client’s administration technique (e.g., whether she takes the medication with a full glass of water and remains upright for at least 30 minutes afterward) can help identify potential causes of the reported symptoms.

B) While suggesting the use of an antacid two hours after the medication may provide symptomatic relief, it does not address the underlying issue of potential esophageal irritation or GERD exacerbation related to risedronate administration. Moreover, if the client’s symptoms are due to esophageal irritation, using an antacid may mask the symptoms without addressing the cause.

C) Reminding the client to take the medication with plenty of water is a standard recommendation for bisphosphonate administration to minimize the risk of esophageal irritation and ensure proper drug absorption. However, since the client is already experiencing “heartburn,” further assessment of the client’s medication administration technique is warranted before providing this reminder.

D) Advising the client to go to the nearest emergency department is not appropriate at this stage, as the reported symptom of “heartburn” does not suggest an immediate life-threatening emergency. However, if the client experiences severe chest pain, difficulty swallowing, or signs of a severe allergic reaction (e.g., swelling of the face or throat, difficulty breathing), emergency medical attention would be necessary.

Therefore, the nurse should first assess the client’s medication administration technique to determine if improper administration may be contributing to the reported symptoms. Based on this assessment, appropriate interventions can be provided to address potential esophageal irritation or GERD exacerbation.

A. Obtain another transdermal patch and position it on the client’s left upper chest. B. Withhold further doses of nitroglycerin until contacting the healthcare provider. C. Leave the patch in place and administer a PRN dose of sublingual nitroglycerin. D. Reassure the client that the patch will begin to take effect within a few minutes.

Correct Answer is C

Explanation

A) Applying another transdermal patch is not recommended without healthcare provider approval. Doubling the dose of nitroglycerin could increase the risk of hypotension and other adverse effects.

B) Withholding further doses of nitroglycerin without healthcare provider guidance may lead to inadequate control of angina symptoms. However, in this scenario, the client has already received a dose of transdermal nitroglycerin, so withholding further doses may not be appropriate if the client’s symptoms persist.

C) Leaving the patch in place and administering a sublingual dose of nitroglycerin is the correct action in this situation. Sublingual nitroglycerin provides rapid relief of angina symptoms by dilating blood vessels and improving myocardial oxygen supply. The transdermal patch may not have reached therapeutic levels yet, but the sublingual form can provide more immediate relief.

D) While it’s important to reassure the client, especially during an episode of chest pain, relying solely on the transdermal patch to take effect may not provide timely relief. Administering sublingual nitroglycerin allows for faster absorption and symptom relief.

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During a home visit, the nurse assesses a client with Alzheimer's Di’ease who recently started a new prescription for rivastigmine. The caregiver reports that the client seems to be thinking more clearly but is not sleeping well at night. Which action should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A female client with osteoporosis has been taking a weekly dose of oral risedronate for several weeks. The client calls the clinic nurse to report increasing “heartburn.” How should the nurse respond?

Correct Answer is A

Explanation

A client with a history of angina reports the onset of chest pain. The nurse determines that the heart rate is 104 beats/minute and the blood pressure is 138/86 mm Hg. A transdermal nitroglycerin patch was applied 30 minutes ago to the right upper chest. Which action should the nurse take?

Correct Answer is C

Explanation

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