Rivastigmine, a cholinesterase inhibitor, is prescribed for a female patient with early-stage Alzheimer’s Disease.
The patient’s daughter tells the nurse that she plans to start administering the drug when her mother’s symptoms worsen, hoping to avoid nursing home placement.
How should the nurse respond?

Affirm the decision to use the medication when the symptoms start to worsen.

Explain that the drug should be used early in the disease process.

Assess the patient’s current mental status before deciding to support the decision.

Confirm that the daughter is aware of the progressive nature of the disease.

w should the nurse respond?

Answer and Explanation

The Correct Answer is B

Choice A rationale

While it’s understandable that the patient’s daughter wants to delay the use of medication until her mother’s symptoms worsen, this approach may not be beneficial. Rivastigmine, a cholinesterase inhibitor, is used to treat mild to moderate dementia caused by Alzheimer’s or Parkinson’s disease. It is not a cure for Alzheimer’s or Parkinson’s disease, but it can help manage the symptoms. Waiting until the symptoms worsen may not provide the desired benefits and could potentially lead to a faster progression of the disease.

Choice B rationale

Rivastigmine is most effective when used early in the disease process. It works by increasing the concentration of acetylcholine, a neurotransmitter, through reversible inhibition of its hydrolysis by cholinesterase. This can help improve the function of nerve cells in the brain and can slow the progression of symptoms in patients with Alzheimer’s disease. Therefore, starting the medication early can help manage the symptoms and potentially slow the progression of the disease.

Choice C rationale

While assessing the patient’s current mental status is an important part of care, it should not be the sole factor in deciding when to start medication. The decision to start medication should be based on a comprehensive evaluation of the patient’s condition, including the stage of the disease, the patient’s overall health, and the potential benefits and risks of the medication.

Choice D rationale

While it’s important for the daughter to understand the progressive nature of Alzheimer’s disease, this understanding alone does not determine when to start medication. The decision to start medication should be based on a comprehensive evaluation of the patient’s condition and the potential benefits and risks of the medication.

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Correct Answer is C

Explanation

Choice A rationale

While changes in stool color and character can be indicative of various health conditions, they are not the best indicators of a patient’s therapeutic response to lactulose in the context of hepatic encephalopathy.

Choice B rationale

Fingerstick glucose monitoring is important in managing conditions like diabetes, but it does not provide the best information to evaluate a patient’s therapeutic response to lactulose in the context of hepatic encephalopathy.

Choice C rationale

Lactulose is used in the management of hepatic encephalopathy, a condition that can occur in patients with severe liver disease. It works by reducing the absorption of ammonia in the gut, which is a toxin that can accumulate in the blood in patients with liver dysfunction. Therefore, monitoring serum electrolytes and ammonia levels can help evaluate the effectiveness of lactulose therapy.

Choice D rationale

While monitoring serum hepatic enzymes can provide valuable information about liver function, it does not provide the best information to evaluate a patient’s therapeutic response to lactulose in the context of hepatic encephalopathy.

A. Administer glucagon intramuscularly. B. Measure the client’s vital signs. C. Obtain a fingerstick blood glucose. D. Perform a neurological exam.

Correct Answer is C

Explanation

Choice A rationale

Administering glucagon intramuscularly is typically done in response to severe hypoglycemia, not for symptoms of confusion and blurred vision which are side effects of glipizide. Glucagon works by triggering the liver to release stored glucose into the bloodstream, which would not be beneficial in this case as the client’s symptoms suggest hypoglycemia, not hyperglycemia.

Choice B rationale

While measuring the client’s vital signs is an important part of overall patient assessment, it does not directly address the client’s immediate issue of confusion and blurred vision after receiving a dose of glipizide.

Choice C rationale

Obtaining a fingerstick blood glucose level is the most appropriate action. The client’s symptoms of confusion and blurred vision are common side effects of glipizide, which is used to lower blood sugar levels in people with type 2 diabetes. These symptoms may indicate that the client’s blood sugar level is too low (hypoglycemia). Checking the blood glucose level will provide immediate information about the client’s current blood sugar level and guide further interventions.

Choice D rationale

Performing a neurological exam is not the most appropriate immediate response. While confusion and blurred vision can be symptoms of neurological issues, in this context, they are likely related to the client’s recent dose of glipizide.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient with hepatic encephalopathy is receiving lactulose.Which assessment provides the nurse with the best information to evaluate the patient’s therapeutic response to the drug?

Correct Answer is C

Explanation

A client reports confusion and blurred vision after receiving a dose of glipizide. What should the nurse do?

Correct Answer is C

Explanation

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