A patient has been taking a progestin-only, or minipill, OC for 3 ...

[nautica902]

A patient has been taking a progestin-only, or minipill, OC for 3 months and reports spotting and irregular menstrual cycles. The nurse will:
 
  a. question the patient about any possible missed doses of the pill.
  b. reassure the patient that this is normal with this form of contraception.
  c. recommend that she take a pregnancy test to rule out pregnancy.
  d. suggest that she use a backup form of contraception until these symptoms re-solve.

Question 2

An older adult patient has confusion, memory loss, and disorientation in familiar surroundings. The patient has been taking donepezil Aricept 10 mg once daily for 6 months.
 
  The patient's symptoms have begun to worsen, and the patient's spouse asks if the medication dose can be in-creased. What will the nurse tell the spouse? a. The dose can be increased, because the patient has been taking the drug for longer than 3 months.
  b. The dose can be increased to twice daily dosing instead of once daily dosing.
  c. The increase in symptoms is the result of hepatotoxicity from the medication's side effects.
  d. The patient must take the drug for longer than 1 year before the dose can be in-creased.

[srodz]

Answer to Question 1

B
Patients taking the progestin-only OC may expect irregular bleeding, including spotting and ir-regular periods. This symptom does not indicate lack of compliance with the regimen. A preg-nancy test is not indicated. It is not necessary to use a backup form of contraception.

Answer to Question 2

A
Donepezil is given for mild, moderate, and severe AD, and dosing may be increased, although it must be titrated up slowly. For patients with moderate to severe AD who have taken 10 mg once daily for at least 3 months, the dose can be increased to 23 mg once daily. Donepezil is not given twice daily. Donepezil does not cause hepatotoxicity; hepatotoxicity occurs with tacrine, the first acetylcholinesteras e (AChE) inhibitor, which now is rarely used. Dosing is increased after 3 months, not 1 year.