MSN Exam for Alzheimer’s Disease

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1) The client with Alzheimer’s disease is being assisted with activities of daily living when the nurse notes that the client uses her toothbrush to brush her hair. The nurse is aware that the client is exhibiting:

  1. Agnosia
  2. Apraxia
  3. Anomia
  4. Aphasia

2) A client with Alzheimer’s disease is awaiting placement in a skilled nursing facility. Which long-term plans would be most therapeutic for the client?

  1. Placing mirrors in several locations in the home
  2. Placing a picture of herself in her bedroom
  3. Placing simple signs to indicate the location of the bedroom, bathroom, and so on
  4. Alternating healthcare workers to prevent boredom

3) The client with dementia is experiencing confusion late in the afternoon and before bedtime. The nurse is aware that the client is experiencing what is known as:

  1. Chronic fatigue syndrome
  2. Normal aging
  3. Sundowning
  4. Delusions

4) Which age group has the highest rate of Alzheimer’s cases reported?

  1. 85 and older
  2. 74 to 84
  3. 65 to 74
  4. 55 to 65

5) A 75 year old client is admitted to the hospital with the diagnosis of dementia of the Alzheimer’s type and depression. The symptom that is unrelated to depression would be?

  1. Apathetic response to the environment
  2. “I don’t know” answer to questions
  3. Shallow of labile effect
  4. Neglect of personal hygiene

6) The client with confusion says to the nurse, “I haven’t had anything to eat all day long. When are they going to bring breakfast?” The nurse saw the client in the day room eating breakfast with other clients 30 minutes before this conversation. Which response would be best for the nurse to make?

  1. “You know you had breakfast 30 minutes ago.”
  2. “I am so sorry that they didn’t get you breakfast. I’ll report it to the charge nurse.”
  3. “I’ll get you some juice and toast. Would you like something else?”
  4. “You will have to wait a while; lunch will be here in a little while.”

7) The nurse is caring for a client with stage III Alzheimer’s disease. A characteristic of this stage is:

  1. Memory loss
  2. Failing to recognize familiar objects
  3. Wandering at night
  4. Failing to communicate

8) The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client:

  1. receives adequate nutrition and hydration
  2. will reminisce to decrease isolation
  3. remains in a safe and secure environment
  4. independently performs self care

9) During the evaluation of the quality of home care for a client with Alzheimer’s disease, the priority for the nurse is to reinforce which statement by a family member?

  1. At least 2 full meals a day is eaten.
  2. We go to a group discussion every week at our community center.
  3. We have safety bars installed in the bathroom and have 24 hour alarms on the doors.
  4. The medication is not a problem to have it taken 3 times a day.

10) Signs of Alzheimer’s include which of these symptoms?

  1. Loss of memory
  2. Increase in irritability
  3. Restlessness
  4. All of the above

11) Which neurotransmitter has been implicated in the development of Alzheimer’s disease?

  1. Acetylcholine
  2. Dopamine
  3. Epinephrine
  4. Serotonin

12) Alzheimer’s is an INSIDIOUS disease. This means:

  1. that it is terminal
  2. that is can be cured
  3. that it sneaks up on a person over time
  4. that it only affects the elderly
  5. none of the above

13) Edward, a 66 year old client with slight memory impairment and poor concentration is diagnosed with primary degenerative dementia of the Alzheimer’s type. Early signs of this dementia include subtle personality changes and withdrawal from social interactions. To assess for progression to the middle stage of Alzheimer’s disease, the nurse should observe the client for:

  1. Occasional irritable outbursts.
  2. Impaired communication.
  3. Lack of spontaneity.
  4. Inability to perform self-care activities.

14) Which of the following is not directly related with Alzheimer’s disease?

  1. Senile plaques
  2. Diabetes mellitus
  3. Tangles
  4. Dementia

15) Alzheimer’s is the most common form of which of these?

  1. Malnutrition
  2. Dementia
  3. Fatigue
  4. Psychosis

16) Which nursing intervention is most appropriate for a client with Alzheimer’s disease who has frequent episodes emotional lability?

  1. Attempt humor to alter the client mood.
  2. Explore reasons for the client’s altered mood.
  3. Reduce environmental stimuli to redirect the client’s attention.
  4. Use logic to point out reality aspects.

17) Which of the following is the most common cause of dementia among elderly persons?

  1. Parkinson’s disease
  2. Multiple sclerosis
  3. Amyotrophic lateral sclerosis (Lou Gerhig’s disease)
  4. Alzheimer’s disease

18) Rosana is in the second stage of Alzheimer’s disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?

  1. “Where is your pain located?”
  2. “Do you hurt? (pause) “Do you hurt?”
  3. “Can you describe your pain?”
  4. “Where do you hurt?”

19) Rosana is in the second stage of Alzheimer’s disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?

  1. “Where is your pain located?”
  2. “Do you hurt? (pause) “Do you hurt?”
  3. “Can you describe your pain?”
  4. “Where do you hurt?”

20) How is Alzheimer’s diagnosed?

  1. Mental-status tests
  2. Blood tests
  3. Neurological tests
  4. All of the above

21) The usual span of years that Alzheimer’s may progress in the patient is:

  1. three to five years
  2. two to twenty years
  3. fifty to sixty years
  4. 6 months to one year
  5. eight to ten years

22) Scientists believe that _________________ develop in the brain of an Alzheimer’s patient, and may be a cause of the disease.

  1. cholesterols
  2. tumors
  3. ruptured blood vessels
  4. plaques and tangles

23) To encourage adequate nutritional intake for a female client with Alzheimer’s disease, the nurse should:

  1. stay with the client and encourage him to eat.
  2. help the client fill out his menu.
  3. give the client privacy during meals.
  4. fill out the menu for the client.

24) A 93 year-old female with a history of Alzheimer’s Disease gets admitted to an Alzheimer’s unit. The patient has exhibited signs of increased confusion and limited stability with gait. Moreover, the patient is refusing to use a w/c. Which of the following is the most appropriate course of action for the nurse?

  1. Recommend the patient remain in her room at all times.
  2. Recommend family members bring pictures to the patient’s room.
  3. Recommend a speech therapy consult to the doctor.
  4. Recommend the patient attempt to walk pushing the w/c for safety.

25) The doctor has prescribed Exelon (rivastigmine) for the client with Alzheimer’s disease. Which side effect is most often associated with this drug?

  1. Urinary incontinence
  2. Headaches
  3. Confusion
  4. Nausea

26) A patient with Stage One Alzheimers might exhibit these behaviors:

  1. forgetting names
  2. missing appointments
  3. getting lost while driving
  4. all of the above
  5. none of the above

27) Which of the following diseases has not been directly linked with Bell’s palsy?

  1. AIDS
  2. Diabetes
  3. Lyme disease
  4. Alzheimer’s disease

28) The symptom of dementia that involved a more confused state after dark is called:

  1. dark retreat
  2. sundowning
  3. agitation
  4. dark reaction

29) Which of these is the strongest risk factor for developing the Alzheimer’s disease?

  1. Heredity
  2. Age
  3. Exposure to toxins
  4. None of the above

30) The priority of care for a client with Alzheimer’s disease is

  1. Help client develop coping mechanism
  2. Encourage to learn new hobbies and interest
  3. Provide him stimulating environment
  4. Simplify the environment to eliminate the need to make chores

31) An elderly client with Alzheimer’s disease becomes agitated and combative when a nurse approaches to help with morning care. The most appropriate nursing intervention in this situation would be to:

  1. Tell the client family that it is time to get dressed.
  2. Obtain assistance to restrain the client for safety.
  3. Remain calm and talk quietly to the client.
  4. Call the doctor and request an order for sedation.

32) Thomas Elison is a 79 year old man who is admitted with diagnosis of dementia. The doctor orders a series of laboratory tests to determine whether Mr. Elison’s dementia is treatable. The nurse understands that the most common cause of dementia in this population is:

  1. AIDS
  2. Alzheimer’s disease
  3. Brain tumors
  4. Vascular disease

33) A patient who has been admitted to the medical unit with new-onset angina also has a diagnosis of Alzheimer’s disease. Her husband tells you that he rarely gets a good night’s sleep because he needs to be sure she does not wander during the night. He insists on checking each of the medications you give her to be sure they are the same as the ones she takes at home. Based on this information, which nursing diagnosis is most appropriate for this patient?

  1. Decreased Cardiac Output related to poor myocardial contractility
  2. Caregiver Role Strain related to continuous need for providing care
  3. Ineffective Therapeutic Regimen Management related to poor patient memory
  4. Risk for Falls related to patient wandering behavior during the night

34) Physiologically, what happens to the brain as Alzheimer’s progresses?

  1. Tissue swells
  2. Fluid collects
  3. Many cells die
  4. Brain-stem atrophies

35) The nurse is aware that the following ways in vascular dementia different from Alzheimer’s disease is:

  1. Vascular dementia has more abrupt onset
  2. The duration of vascular dementia is usually brief
  3. Personality change is common in vascular dementia
  4. The inability to perform motor activities occurs in vascular dementia

36) A 65 years old client is in the first stage of Alzheimer’s disease. Nurse Patricia should plan to focus this client’s care on:

  1. Offering nourishing finger foods to help maintain the client’s nutritional status.
  2. Providing emotional support and individual counseling.
  3. Monitoring the client to prevent minor illnesses from turning into major problems.
  4. Suggesting new activities for the client and family to do together.

37) A nurse caring to a client with Alzheimer’s disease overheard a family member say to the client, “if you pee one more time, I won’t give you any more food and drinks”. What initial action is best for the nurse to take?

  1. Take no action because it is the family member saying that to the client
  2. Talk to the family member and explain that what she/he has said is not appropriate for the client
  3. Give the family member the number for an Elder Abuse Hot line
  4. Document what the family member has said

38) Alzheimer’s disease is the secondary diagnosis of a client admitted with myocardial infarction. Which nursing intervention should appear on this client’s plan of care?

  1. Perform activities of daily living for the client to decease frustration.
  2. Provide a stimulating environment.
  3. Establish and maintain a routine.
  4. Try to reason with the client as much as possible.

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
Answers and Rationales
  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.

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