Which of the following nursing strategies would be most appropriate when caring for an individual who is delusional?

Choice A Reason:

Prevents the breakdown of acetylcholine.

Galantamine is an acetylcholinesterase inhibitor, which means it works by preventing the breakdown of acetylcholine in the brain. Acetylcholine is a neurotransmitter that is important for memory and learning. By inhibiting the enzyme that breaks down acetylcholine, galantamine increases the levels of acetylcholine available in the brain, which can help improve cognitive function in patients with Alzheimer’s disease1. This mechanism of action is crucial because it directly addresses the cholinergic deficit observed in Alzheimer’s disease.

Choice B Reason:

Decreases amyloid plaques in the brain.

This statement is incorrect. Galantamine does not work by decreasing amyloid plaques in the brain. Amyloid plaques are one of the pathological hallmarks of Alzheimer’s disease, but galantamine’s primary mechanism of action is related to acetylcholine metabolism. Other treatments and research efforts focus on targeting amyloid plaques, but this is not the function of galantamine.

Choice C Reason:

Increases acetylcholine levels in the brain.

While this statement is partially correct, it is not as precise as the correct answer. Galantamine increases acetylcholine levels indirectly by preventing its breakdown rather than directly increasing its production. The distinction is important because the therapeutic approach involves inhibiting the enzyme acetylcholinesterase, which breaks down acetylcholine, thereby increasing its availability.

Choice D Reason:

Limits neurotransmitter engagement of NMDA receptors.

This statement is incorrect. Limiting neurotransmitter engagement of NMDA receptors is the mechanism of action for a different class of Alzheimer’s medications, such as memantine. Galantamine does not affect NMDA receptors; instead, it enhances cholinergic function by inhibiting acetylcholinesterase and potentiating nicotinic receptors.

Choice A Reason:

Ask the client direct questions about the hallucinations.

This response is the most appropriate because it allows the nurse to assess the content and nature of the hallucinations directly. By understanding what the client is experiencing, the nurse can better evaluate the risk of harm to the client or others and develop an appropriate care plan. Direct questioning helps in identifying whether the hallucinations are commanding the client to perform harmful actions, which is crucial for ensuring safety. This approach aligns with therapeutic communication techniques that emphasize understanding the client’s experience and providing appropriate interventions.

Choice B Reason:

Act as if the hallucinations are real.

This response is not appropriate because it can reinforce the client’s delusions and hallucinations, making it harder for them to distinguish between reality and their hallucinations. It is important for the nurse to maintain a reality-based approach while being empathetic and supportive. Acknowledging the client’s feelings without validating the hallucinations helps in maintaining a therapeutic environment.

Choice C Reason:

Instruct the client to argue with the voices.

Instructing the client to argue with the voices is not recommended as it can increase the client’s distress and confusion. Instead, the nurse should help the client develop coping strategies to manage the hallucinations, such as distraction techniques or reality testing. Encouraging the client to engage in a confrontation with their hallucinations can exacerbate their symptoms and is not a therapeutic approach.

Choice D Reason:

Explain to the client that the hallucinations will subside soon.

This response is not appropriate because it provides false reassurance. Hallucinations may not subside quickly, and the client needs realistic support and coping strategies to manage their symptoms. Providing false hope can undermine the client’s trust in the nurse and the treatment process. Instead, the nurse should focus on helping the client manage their symptoms effectively.