D118 Unit 6 Study Guide

Grace J.
January 3, 2026January 3, 2026
D118, MSN, Western Governors University

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Western Governors University

D118 Adult Primary Care for the Advanced Practice Nurse

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Date

Discuss the Treatment for a Patient With Alzheimer’s Disease Who Is Experiencing Depression

Depression is a common neuropsychiatric complication in patients with Alzheimer’s disease and can exacerbate cognitive decline, increase functional disability, and heighten caregiver stress. Managing depression in this population requires careful pharmacologic choice due to the risks of polypharmacy and increased drug sensitivity in older adults.

What is the preferred medication for treating depression in Alzheimer’s disease?
Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line treatment for depression among Alzheimer’s patients. These agents are favored because of their safer side-effect profiles and minimal interaction with other medications. Commonly prescribed SSRIs include sertraline and citalopram, both shown to improve mood, anxiety, and emotional instability.

What nonpharmacologic strategies complement medication treatment?
Non-drug interventions should support pharmacotherapy and may involve establishing consistent daily routines, educating caregivers, cognitive stimulation activities, and providing psychosocial support. If depression remains resistant to treatment, consultation with psychiatric or geriatric mental health specialists is advisable.

What Is the Treatment for Guillain-Barré Syndrome?

Guillain-Barré syndrome (GBS) is an acute autoimmune neuropathy characterized by rapid muscle weakness and potential respiratory failure, requiring urgent intervention to reduce complications.

The standard treatment involves intravenous immunoglobulin (IVIG), which works by neutralizing pathogenic antibodies attacking the peripheral nerves. Plasma exchange (plasmapheresis) serves as an effective alternative and is useful when IVIG is contraindicated.

What supportive care is essential in GBS?
Comprehensive supportive care includes close respiratory monitoring, prevention of complications like deep vein thrombosis, and initiation of physical rehabilitation to optimize recovery.

What Is Ankylosing Spondylitis and How Does It Relate to Seronegative Spondyloarthropathies?

Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily targeting the axial skeleton, especially the sacroiliac joints and spine. It is classified under seronegative spondyloarthropathies, a group of disorders sharing clinical, genetic, and radiographic characteristics.

These diseases are typically negative for rheumatoid factor and are strongly linked to the HLA-B27 gene. Other conditions in this category include reactive arthritis, psoriatic arthritis, enteropathic arthritis (associated with inflammatory bowel disease), and undifferentiated spondyloarthritis.

Early detection and management are crucial to prevent irreversible spinal fusion and loss of mobility.

What Are the Common Laboratory Findings Associated With Paget Disease of Bone?

Paget disease of bone involves abnormal remodeling that produces structurally compromised and misshapen bones. Laboratory tests aid in diagnosis and disease activity monitoring.

Laboratory Test	Typical Finding	Clinical Significance
Alkaline phosphatase (ALP)	Elevated	Indicates increased bone turnover
Serum calcium	Usually normal	Elevation seen only with immobilization
Phosphorus	Normal	Helps exclude other bone disorders

The most frequent abnormality is an elevated serum ALP, reflecting heightened osteoblastic activity. Bone-specific ALP and urinary hydroxyproline can offer further diagnostic detail.

Discuss the Diagnosis, Treatment, and Referral for a Patient With Infectious Arthritis

Infectious arthritis is an emergency condition marked by rapid joint destruction if untreated. Symptoms include acute joint pain, swelling, redness, fever, and reduced joint movement, with the knee being the most commonly affected joint.

Diagnosis starts with a thorough clinical history and examination, followed by joint aspiration—the gold standard for confirming infection through synovial fluid analysis (Gram stain, culture, cell count). Imaging such as X-rays or MRI can assess joint damage.

Treatment necessitates prompt, targeted antibiotic therapy guided by culture results and aggressive joint drainage via needle aspiration, arthroscopy, or surgery if required. Referral to orthopedics or infectious disease specialists is often essential.

What Are the Common Manifestations of Osteoarthritis and What Is the Treatment Plan?

Osteoarthritis (OA) is a degenerative joint disease marked by progressive cartilage loss. Patients usually report gradual onset of joint pain and stiffness, exacerbated by prolonged activity or inactivity.

Clinical signs include crepitus, limited range of motion, joint swelling, and bony deformities, frequently affecting weight-bearing joints such as knees and hips.

Treatment goals focus on symptom relief and functional enhancement. Acetaminophen is the first-line medication for mild OA pain, while NSAIDs are reserved for moderate pain. Intra-articular hyaluronic acid injections may benefit mild to moderate cases. Lifestyle interventions like weight control and physical therapy are vital components.

What Medications and Dosages Are Appropriate in Treating Osteoporosis?

Pharmacologic management of osteoporosis aims to lower fracture risk by improving bone density. Oral bisphosphonates are the mainstay treatment and must be taken properly—on an empty stomach with plain water, with the patient remaining upright for 30 minutes afterward. Ibandronate specifically requires a 60-minute interval before eating.

Raloxifene, a selective estrogen receptor modulator, is approved for preventing and treating postmenopausal osteoporosis at a dose of 60 mg daily.

Differentiate the Types of Dementia

Dementia refers to a set of disorders involving progressive cognitive decline. Alzheimer’s disease and vascular dementia are the most common types.

Type of Dementia	Pathophysiology	Key Features
Alzheimer’s disease	Amyloid plaques and neurofibrillary tangles	Gradual memory loss, cortical atrophy
Vascular dementia	Cerebral ischemia and infarcts	Stepwise cognitive decline, focal neurologic deficits
Lewy body dementia	Lewy body protein deposits	Visual hallucinations, fluctuating cognition

Discuss the Treatment for Gout

Gout is an inflammatory arthritis caused by deposition of monosodium urate crystals. Diagnosis is ideally confirmed by synovial fluid microscopy revealing intracellular urate crystals.

Acute attacks are managed with NSAIDs or oral corticosteroids; corticosteroids are preferred for patients with renal issues, anticoagulation, or liver disease. Initiating anti-inflammatory therapy early (within 24–48 hours) is crucial for symptom resolution.

What Are the Common Manifestations of Rheumatoid Arthritis and the Treatment Plan?

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by symmetric inflammation of multiple joints. Patients often report morning stiffness lasting over an hour, along with fatigue and weight loss.

Initial joint involvement typically includes small joints in the hands and feet. Early use of disease-modifying antirheumatic drugs (DMARDs), often combined with biologics, NSAIDs, and glucocorticoids, is essential to control inflammation and prevent joint damage.

What Medication Is Appropriate for Dyskinesia in an Alzheimer’s Patient?

In Alzheimer’s patients experiencing tardive dyskinesia, anticholinergic drugs like benztropine should be avoided due to potential cognitive decline. Management involves stopping the offending agent, switching to an atypical antipsychotic with lower dyskinesia risk, and referring to psychiatric specialists if symptoms persist.

What Medications Are Considered for Insomnia in a Patient With Fibromyalgia?

Sleep disturbances are common in fibromyalgia. Medications such as trazodone and zolpidem may assist with falling and staying asleep, although they do not significantly enhance restorative slow-wave sleep. Emphasizing nonpharmacologic sleep hygiene practices remains critical.

Define Migraine and Describe Its Signs and Symptoms

Migraine is a chronic neurovascular disorder characterized by episodic headaches with or without aura. The more common migraine without aura presents as unilateral, pulsating pain lasting from 4 to 72 hours, often accompanied by nausea, sensitivity to light (photophobia), and sound (phonophobia).

Migraine with aura includes transient neurological symptoms such as visual disturbances or sensory changes before the headache onset. Prodromal symptoms like fatigue, irritability, and food cravings can appear days before the attack.

What Are the Common Manifestations of Meningitis, How Is It Diagnosed, and What Is the Treatment Plan?

Acute bacterial meningitis typically presents with fever, headache, and neck stiffness, though older adults may show atypical signs like confusion or altered consciousness.

Diagnosis relies on prompt laboratory testing, including blood cultures and lumbar puncture for cerebrospinal fluid analysis. Empiric antimicrobial therapy should be started immediately, with vancomycin often included to address resistant strains.

References

American College of Rheumatology. (2020). Guidelines for the management of rheumatoid arthritis. https://www.rheumatology.org

Harrison, T. R., & Fauci, A. S. (2022). Harrison’s principles of internal medicine (21st ed.). McGraw-Hill Education.