An elderly patient with dementia exhibits hostility and ...

[jerry coleman]

An elderly patient with dementia exhibits hostility and uncooperativeness. The primary care NP prescribes clozapine (Clozaril) and should counsel the family about:
 
  a. a decreased risk of extrapyramidal symptoms.
  b. improved cognitive function.
  c. the need for long-term use of the medication.
  d. a possible increased risk of heart disease and stroke.

Question 2

A patient who has severe arthritis and who takes nonsteroidal antiinflammatory drugs (NSAIDs) daily develops a duodenal ulcer.
 
  The patient has tried a cyclooxygenase-2 selective NSAID in the past and states that it is not as effective as the current NSAID. The primary care nurse practitioner (NP) should: a. prescribe cimetidine (Tagamet).
  b. prescribe omeprazole (Prilosec).
  c. teach the patient about a bland diet.
  d. change the NSAID to a corticosteroid.

[sailorcrescent]

Answer to Question 1

D
Antipsychotics are useful in treating some psychiatric symptoms of dementia and help to improve quality of life in many patients. They do not improve cognitive function, however. They increase the risk of extrapyramidal symptoms and should be used only on a short-term basis. They increase the risk of heart disease and stroke.

Answer to Question 2

B
Patients with NSAID-induced ulcer should discontinue the NSAID if possible and use an acid suppressant. This patient has severe arthritis and so cannot discontinue the NSAID. In a situation such as this, a PPI is indicated. Cimetidine is a histamine-2 blocker, which would be a second-line choice, but cimetidine has many serious side effects. Bland diets are not effective in treating ulcers. Corticosteroids are not indicated.

[jerry coleman]

Excellent

[softEldritch]

Gracias!