Review Practice Exercise 2

Drugs Used for Degenerative Diseases of the Nervous System > Pharmacology

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Practice Exercise 2

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Total Questions : 5

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Question 1:

The nurse has initiated teaching for a family member of a patient with Alzheimer’s disease. The nurse realizes more teaching is needed if the family member makes which statement?

A. As the disease gets worse, the memory loss will get worse. B. There are several theories about the cause of the disease. C. Personality changes and hostility may occur. D. It may take several medications to cure the disease.

Answer and Explanation

Choice A:

As the disease gets worse, the memory loss will get worseAlzheimer’s disease is marked by progressive memory impairment, worsening as the disease advances.

Choice B:

There are several theories about the cause of the diseaseProposed causes include genetic factors, amyloid plaques, neurofibrillary tangles, and neurotransmitter imbalances.

Choice C:

Personality changes and hostility may occur
Behavioral changes, including irritability, aggression, and mood swings, are common as the disease progresses

Choice D:

It may take several medications to cure the diseaseThis statement reflects a misunderstanding, since Alzheimer’s disease cannot be cured. Medications only slow symptom progression and improve quality of life but do not reverse or eliminate the disease. Believing there is a cure may lead to false hope and frustration, making this a teaching priority for the nurse

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Question 2:

A patient is taking rivastigmine (Exelon). The nurse should teach the patient and family which information about rivastigmine?

A. That hepatotoxicity may occur B. That the initial dose is 6 mg t.i.d. C. That GI distress is a common side effect D. That weight gain may be a side effect

Answer and Explanation

Choice A:

That hepatotoxicity may occurRivastigmine does not carry a risk of hepatotoxicity. This adverse effect is linked to other cholinesterase inhibitors such as tacrine, not rivastigmine.

Choice B:

That the initial dose is 6 mg t.i.d.Rivastigmine should be started at A.5 mg twice daily, with gradual titration. Starting at 6 mg three times daily would be unsafe and increase the risk of severe side effects.

Choice C:

That GI distress is a common side effectRivastigmine often causes nausea, vomiting, diarrhea, and decreased appetite due to increased cholinergic stimulation in the digestive tract. These effects are most pronounced during initiation or dose escalation. Administering the drug with food may help reduce discomfort.

Choice D:

That weight gain may be a side effect
Rivastigmine is more often associated with weight loss, not weight gain, due to appetite suppression and GI distress.

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Question 3:

A patient is taking rivastigmine (Exelon) to improve cognitive function. What should the nurse teach the patient/ family member to do? Select all that apply

A. Rise slowly to avoid dizziness. B. Remove obstacles from pathways to avoid injury. C. Closely follow the drug dosing schedule. D. Have frequent checks for hypertension. E. Receive regular liver function tests.

Answer and Explanation

Choice A:

Rise slowly to avoid dizzinessRivastigmine can cause orthostatic hypotension and dizziness, increasing the risk of falls. Patients should be instructed to change positions slowly to reduce this risk.

Choice B:

Remove obstacles from pathways to avoid injuryCognitive decline combined with dizziness places patients at high fall risk. Keeping walkways clear and using safety measures in the home environment helps prevent accidents.

Choice C:

Closely follow the drug dosing scheduleRivastigmine requires strict adherence to the prescribed dosing schedule to maintain steady therapeutic levels and minimize side effects. Skipping or doubling doses can increase adverse effects or reduce drug effectiveness.

Choice D:

Have frequent checks for hypertensionRivastigmine is more commonly associated with hypotension, not hypertension. Monitoring for dizziness and low blood pressure is more relevant.

Choice E:

Receive regular liver function testsRivastigmine does not cause hepatotoxicity. Liver function monitoring was necessary with older agents like tacrine, but not with rivastigmine.

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Question 4:

Which of the following are major disadvantages to the use of tacrine? Select all that apply

A. It must be administered four times per day. B. It causes weight gain. C. It may cause vision difficulties. D. It may cause serious hepatic damage. E. It may be purchased over the counter.

Answer and Explanation

Choice A:

It must be administered four times per day.Tacrine requires frequent dosing (QID), which decreases adherence and makes it impractical for many clients, especially elderly patients with cognitive impairment who may struggle with complex regimens.

Choice B:

It causes weight gain.Tacrine is not associated with weight gain; common side effects are more often related to the gastrointestinal system (e.g., nausea, vomiting, diarrhea).

Choice C:

It may cause vision difficulties.Tacrine does not directly cause vision changes or ocular complications. This option may confuse it with other neuro or ophthalmic medications.

Choice D:

It may cause serious hepatic damage.One of the most serious adverse effects of tacrine is hepatotoxicity, requiring frequent monitoring of liver function tests (LFTs). This risk led to its decline in use compared to newer cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine), which have safer profiles.

Choice E:

It may be purchased over the counter.Tacrine is a prescription-only drug due to its risks and need for monitoring. It is not available over the counter.

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Question 5:

A patient with Alzheimer’s disease is prescribed both rivastigmine and memantine. What is the primary rationale for this combination therapy?

A. To completely cure Alzheimer’s disease. B. To reduce excitotoxic neuronal damage while enhancing neurotransmission. C. To prevent cardiovascular side effects such as bradycardia and hypotension. D. To immediately reverse cognitive deficits and memory loss.

Answer and Explanation

Choice A:

To completely cure Alzheimer’s diseaseThere is currently no cure for Alzheimer’s disease; medications slow progression and manage symptoms, but do not eliminate the disease.

Choice B:

To reduce excitotoxic neuronal damage while enhancing neurotransmissionRivastigmine enhances cholinergic signaling, improving memory, attention, and cognition. Memantine blocks excessive NMDA receptor activity, preventing neuronal damage from glutamate excitotoxicity. Together, they target both neurotransmitter deficits and neurodegeneration, providing synergistic benefits in Alzheimer’s disease management.

Choice C:

To prevent cardiovascular side effects such as bradycardia and hypotensionCardiovascular effects are possible adverse reactions of cholinesterase inhibitors but are not the primary reason for this combination therapy.

Choice D:

To immediately reverse cognitive deficits and memory loss
These medications improve cognition gradually; they do not produce immediate reversal of deficits.

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Practice Exercise 2

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