How can a visiting nurse best ensure proper care for a patient ...

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How can a visiting nurse best ensure proper care for a patient when she is not present but can be reached by a telephone or pager?
 
  A) Instruct that all the family's questions should be filtered through the primary caregiver.
  B) Provide detailed written instructions for all procedures.
  C) Train the patient carefully in all procedures.
  D) Train all caregivers carefully in all procedures.

Question 2

An older patient with Alzheimer's disease is experiencing increasing episodes of agitation and wandering. The patient has been prescribed risperidone (Risperdal), an atypical antipsychotic. Why should the nurse question this medication order?
 
  A) Physical restraints should be trialed before using an antipsychotic medication
  B) It is inappropriate to use antipsychotics to manage the behavior of patients with dementia
  C) The sensory changes that accompany antipsychotic use exacerbate the symptoms of dementia
  D) Atypical antipsychotics are preferable to traditional sedatives for the treatment of agitation and delirium

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Answer to Question 1

B
Feedback:
Patients and caregivers can usually follow instructions well when a nurse is present, but the stress of illness and caregiving can make it easy to forget instructions later, especially if a procedure involves several steps or has changed from a recent procedure. Written instructions make it possible for a patient or caregiver to review procedures; if there is still confusion, the nurse can be called for advice.

Answer to Question 2

B
Feedback:
Atypical antipsychotics should not be used for the treatment of dementia-related behavioral disturbances. They do not exacerbate the symptoms of dementia but rather increase the risk of cerebrovascular adverse events and mortality. The use of physical restraints may or may not be indicated for this patient.

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