MSN Exam for Alzheimer’s Disease

39) As the manager in a long-term-care (LTC) facility, you are in charge of developing a standard plan of care for residents with Alzheimer’s disease. Which of these nursing tasks is best to delegate to the LPN team leaders working in the facility?

1. Check for improvement in resident memory after medication therapy is initiated.
2. Use the Mini-Mental State Examination to assess residents every 6 months.
3. Assist residents to toilet every 2 hours to decrease risk for urinary intolerance.
4. Develop individualized activity plans after consulting with residents and family.

40) The nurse would expect a client with early Alzheimer’s disease to have problems with:

1. Balancing a checkbook.
2. Self-care measures.
3. Relating to family members.
4. Remembering his own name

1. B. Apraxia . Apraxia is the inability to use objects appropriately. Agnosia is loss of sensory comprehension, anomia is the inability to find words, and aphasia is the inability to speak or understand .
2. C. Placing simple signs to indicate the location of the bedroom, bathroom, and so on. Placing simple signs that indicate the location of rooms where the client sleeps, eats, and bathes will help the client be more independent. Providing mirrors and pictures is not recommended with the client who has Alzheimer’s disease because mirrors and pictures tend to cause agitation, and alternating healthcare workers confuses the client.
3. C. Sundowning . Increased confusion at night is known as “sundowning” syndrome. This increased confusion occurs when the sun begins to set and continues during the night.
4. A. 85 and older
5. C. Shallow of labile effect 
6. C. “I’ll get you some juice and toast. Would you like something else?”. The client who is confused might forget that he ate earlier. Don’t argue with the client. Simply get him something to eat that will satisfy him until lunch.
7. B. Failing to recognize familiar objects . In stage III of Alzheimer’s disease, the client develops agnosia, or failure to recognize familiar objects.
8. C. remains in a safe and secure environment. Safety is a priority consideration as the client’s cognitive ability deteriorates.. receiving adequate nutrition and hydration is appropriate interventions because the client’s cognitive impairment can affect the client’s ability to attend to his nutritional needs, but it is not the priority Patient is allowed to reminisce but it is not the priority. The client in the moderate stage of Alzheimer’s disease will have difficulty in performing activities independently
9. C. We have safety bars installed in the bathroom and have 24 hour alarms on the doors. We have safety bars installed in the bathroom and have 24 hour alarms on the doors. Ensuring safety of the client with increasing memory loss is a priority of home care. Note all options are correct statements. However, safety is most important to reinforce.
10. D. All of the above. Alzheimer’s sufferers also can’t learn new information and tend to repeat themselves.
11. A. Acetylcholine. A relative deficiency of acetylcholine is associated with this disorder. The drugs used in the early stages of Alzheimer’s disease will act to increase available acetylcholine in the brain. The remaining neurotransmitters have not been implicated in Alzheimer’s disease.
12. C. that it sneaks up on a person over time 
13. B. Impaired communication. Initially, memory impairment may be the only cognitive deficit in a client with Alzheimer’s disease. During the early stage of this disease, subtle personality changes may also be present. However, other than occasional irritable outbursts and lack of spontaneity, the client is usually cooperative and exhibits socially appropriate behavior. Signs of advancement to the middle stage of Alzheimer’s disease include exacerbated cognitive impairment with obvious personality changes and impaired communication, such as inappropriate conversation, actions, and responses. During the late stage, the client can’t perform self-care activities and may become mute.
14. B. Diabetes mellitus 
15. B. Dementia. It is a collection of symptoms characterized by decreasing intellectual and social abilities.
16. C. Reduce environmental stimuli to redirect the client’s attention. The client with Alzheimer’s disease can have frequent episode of labile mood, which can best be handled by decreasing a stimulating environment and redirecting the client’s attention. An over stimulating environment may cause the labile mood, which will be difficult for the client to understand. The client with Alzheimer’s disease loses the cognitive ability to respond to either humor or logic. The client lacks any insight into his or her own behavior and therefore will be unaware of any causative factors.
17. D. Alzheimer’s disease . Alzheimer;s disease, sometimes known as senile dementia of the Alzheimer’s type or primary degenerative dementia, is an insidious; progressive, irreversible, and degenerative disease of the brain whose etiology is still unknown. Parkinson’s disease is a neurologic disorder caused by lesions in the extrapyramidial system and manifested by tremors, muscle rigidity, hypokinesis, dysphagia, and dysphonia. Multiple sclerosis, a progressive, degenerative disease involving demyelination of the nerve fibers, usually begins in young adulthood and is marked by periods of remission and exacerbation. Amyotrophic lateral sclerosis, a disease marked by progressive degeneration of the neurons, eventually results in atrophy of all the muscles; including those necessary for respiration.
18. B. “Do you hurt? (pause) “Do you hurt?” . When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions.Those that the client can answer with “yes” or “no”
19. B. “Do you hurt? (pause) “Do you hurt?” When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions.Those that the client can answer with “yes” or “no” whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension.
20. D. D. All of the above. No single test identifies Alzheimer’s. Lab tests help rule out other disorders that may produce similar symptoms. Neurological and mental-status tests reveal cognitive-function deficits.
21. B. two to twenty years 
22. D. plaques and tangles
23. A. stay with the client and encourage him to eat. Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimer’s disease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesn’t ensure adequate nutritional intake.
24. B. Recommend family members bring pictures to the patient’s room. Stimulation in the form of pictures may decrease signs of confusion.
25. D. Nausea . Nausea and gastrointestinal upset are very common in clients taking acetlcholinesterase inhibitors such as Exelon. Other side effects include liver toxicity, dizziness, unsteadiness, and clumsiness. The client might already be experiencing urinary incontinence or headaches, but they are not necessarily associated; and the client with Alzheimer’s disease is already confused.
26. D. all of the above 
27. D. Alzheimer’s disease 
28. B. sundowning 
29. B. Age . Although some studies have shown an association between certain modifiable lifestyle factors and a reduced risk for Alzheimer’s disease, the National Institutes of Health says that age is the strongest known risk factor where most people receive the diagnosis after age 60. An early onset familial form can also occur, although it is rare.
30. D. Simplify the environment to eliminate the need to make chores 
31. C. Remain calm and talk quietly to the client. Maintaining a calm approach when intervening with an agitated client is extremely important. Telling the client firmly that it is time to get dressed may increase his agitation, especially if the nurse touches him. Restraints are a last resort to ensure client safety and are inappropriate in this situation. Sedation should be avoided, if possible, because it will interfere with CNS functioning and may contribute to the client’s confusion.
32. B. Alzheimer’s disease . Alzheimer’s disease is the most common cause of dementia in the elderly population. AIDS, brain tumors and vascular disease are all less common causes of progressive loss of mental function in elderly patients.
33. B. Caregiver Role Strain related to continuous need for providing care. The husband’s statement about lack of sleep and anxiety over whether the patient is receiving the correct medications are behaviors that support this diagnosis. There is no evidence that the patient’s cardiac output is decreased. The husband’s statements about how he monitors the patient and his concern with medication administration indicate that the Risk for Ineffective Therapeutic Regimen Management and falls are not priorities at this time. Focus: Prioritization
34. C. Many cells die . Nerve cells change in certain parts of the brain, which causes brain cells to die. The loss of cells impairs thinking and judgment.
35. A. Vascular dementia has more abrupt onset . Vascular dementia differs from Alzheimer’s disease in that it has a more abrupt onset and runs a highly variable course. Personally change is common in Alzheimer’s disease. The duration of delirium is usually brief. The inability to carry out motor activities is common in Alzheimer’s disease.
36. B. Providing emotional support and individual counseling. Clients in the first stage of Alzheimer’s disease are aware that something is happening to them and may become overwhelmed and frightened. Therefore, nursing care typically focuses on providing emotional support and individual counseling. The other options are appropriate during the second stage of Alzheimer’s disease, when the client needs continuous monitoring to prevent minor illnesses from progressing into major problems and when maintaining adequate nutrition may become a challenge. During this stage, offering nourishing finger foods helps clients to feed themselves and maintain adequate nutrition.
37. B. Talk to the family member and explain that what she/he has said is not appropriate for the client . This response is the most direct and immediate. This is a case of potential need for advocacy and patient’s rights.
38. C. Establish and maintain a routine. Establishing and maintaining a routine is essential to decreasing extraneous stimuli. The client should participate in daily care as much as possible. Attempting to reason with such clients isn’t successful, because they can’t participate in abstract thinking.
39. A. Check for improvement in resident memory after medication therapy is initiated. LPN education and team leader responsibilities include checking for the therapeutic and adverse effects of medications. Changes in the residents’ memory would be communicated to the RN supervisor, who is responsible for overseeing the plan of care for each resident. Assessment for changes on the Mini-Mental State Examination and developing the plan of care are RN responsibilities. Assisting residents with personal care and hygiene would be delegated to nursing assistants working the LTC facility. Focus: Delegation
40. A. Balancing a checkbook. In the early stage of Alzheimer’s disease, complex tasks (such as balancing a checkbook) would be the first cognitive deficit to occur. The loss of self-care ability, problems with relating to family members, and difficulty remembering one’s own name are all areas of cognitive decline that occur later in the disease process.