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MSN Exam for Alzheimer’s Disease (PM)
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Question 1
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:
A
Sundowning
B
Delusions
C
Chronic fatigue syndrome
D
Normal aging
Question 1 Explanation:
Increased confusion at night is known as "sundowning" syndrome. This increased confusion occurs when the sun begins to set and continues during the night.
Question 2
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?
A
“Where do you hurt?”
B
“Do you hurt? (pause) “Do you hurt?”
C
“Can you describe your pain?”
D
“Where is your pain located?”
Question 2 Explanation:
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”
Question 3
The nurse is caring for a client with stage III Alzheimer’s disease. A characteristic of this stage is:
A
Wandering at night
B
Failing to recognize familiar objects
C
Memory loss
D
Failing to communicate
Question 3 Explanation:
In stage III of Alzheimer’s disease, the client develops agnosia, or failure to recognize familiar objects. Answer A is incorrect because it appears in stage I. Answer C is incorrect because it appears in stage II. Answer D is incorrect because it appears in stage IV.
Question 4
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?
A
"I’ll get you some juice and toast. Would you like something else?"
B
"You will have to wait a while; lunch will be here in a little while."
C
"I am so sorry that they didn’t get you breakfast. I’ll report it to the charge nurse."
D
"You know you had breakfast 30 minutes ago."
Question 4 Explanation:
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.
Question 5
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:
A
Impaired communication.
B
Occasional irritable outbursts.
C
Lack of spontaneity.
D
Inability to perform self-care activities.
Question 5 Explanation:
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.
Question 6
The nurse would expect a client with early Alzheimer’s disease to have problems with:
A
Self-care measures.
B
Remembering his own name
C
Relating to family members.
D
Balancing a checkbook.
Question 6 Explanation:
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.
Question 7
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?
A
Provide a stimulating environment.
B
Establish and maintain a routine.
C
Perform activities of daily living for the client to decease frustration.
D
Try to reason with the client as much as possible.
Question 7 Explanation:
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.
Question 8
Which of these is the strongest risk factor for developing the Alzheimer's disease?
A
Heredity
B
None of the above
C
Exposure to toxins
D
Age
Question 8 Explanation:
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.
Question 9
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?
A
Take no action because it is the family member saying that to the client
B
Give the family member the number for an Elder Abuse Hot line
C
Document what the family member has said
D
Talk to the family member and explain that what she/he has said is not appropriate for the client
Question 9 Explanation:
This response is the most direct and immediate. This is a case of potential need for advocacy and patient’s rights.
Question 10
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?
A
The medication is not a problem to have it taken 3 times a day.
B
We have safety bars installed in the bathroom and have 24 hour alarms on the doors.
C
At least 2 full meals a day is eaten.
D
We go to a group discussion every week at our community center.
Question 10 Explanation:
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.
Question 11
Signs of Alzheimer's include which of these symptoms?
A
Loss of memory
B
Increase in irritability
C
Restlessness
D
All of the above
Question 11 Explanation:
Alzheimer's sufferers also can't learn new information and tend to repeat themselves.
Question 12
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?
A
Use the Mini-Mental State Examination to assess residents every 6 months.
B
Check for improvement in resident memory after medication therapy is initiated.
C
Assist residents to toilet every 2 hours to decrease risk for urinary intolerance.
D
Develop individualized activity plans after consulting with residents and family.
Question 12 Explanation:
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
Question 13
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:
A
Suggesting new activities for the client and family to do together.
B
Monitoring the client to prevent minor illnesses from turning into major problems.
C
Offering nourishing finger foods to help maintain the client's nutritional status.
D
Providing emotional support and individual counseling.
Question 13 Explanation:
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.
Question 14
Alzheimer's is an INSIDIOUS disease. This means:
A
that it is terminal
B
that it only affects the elderly
C
that it sneaks up on a person over time
D
that is can be cured
E
none of the above
Question 15
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?
A
Ineffective Therapeutic Regimen Management related to poor patient memory
B
Risk for Falls related to patient wandering behavior during the night
C
Decreased Cardiac Output related to poor myocardial contractility
D
Caregiver Role Strain related to continuous need for providing care
Question 15 Explanation:
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
Question 16
Which neurotransmitter has been implicated in the development of Alzheimer’s disease?
A
Dopamine
B
Epinephrine
C
Acetylcholine
D
Serotonin
Question 16 Explanation:
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.
Question 17
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:
A
Aphasia
B
Apraxia
C
Agnosia
D
Anomia
Question 17 Explanation:
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 .
Question 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?
A
“Do you hurt? (pause) “Do you hurt?”
B
“Where do you hurt?”
C
“Where is your pain located?”
D
“Can you describe your pain?”
Question 18 Explanation:
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.
Question 19
The doctor has prescribed Exelon (rivastigmine) for the client with Alzheimer’s disease. Which side effect is most often associated with this drug?
A
Headaches
B
Nausea
C
Confusion
D
Urinary incontinence
Question 19 Explanation:
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.
Question 20
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:
A
Tell the client family that it is time to get dressed.
B
Obtain assistance to restrain the client for safety.
C
Remain calm and talk quietly to the client.
D
Call the doctor and request an order for sedation.
Question 20 Explanation:
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.
Question 21
A patient with Stage One Alzheimers might exhibit these behaviors:
A
getting lost while driving
B
missing appointments
C
all of the above
D
forgetting names
E
none of the above
Question 22
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?
A
Placing simple signs to indicate the location of the bedroom, bathroom, and so on
B
Placing a picture of herself in her bedroom
C
Alternating healthcare workers to prevent boredom
D
Placing mirrors in several locations in the home
Question 22 Explanation:
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.
Question 23
Scientists believe that _________________ develop in the brain of an Alzheimer's patient, and may be a cause of the disease.
A
ruptured blood vessels
B
tumors
C
cholesterols
D
plaques and tangles
Question 24
Which of the following diseases has not been directly linked with Bell's palsy?
A
Diabetes
B
Lyme disease
C
Alzheimer's disease
D
AIDS
Question 25
The priority of care for a client with Alzheimer’s disease is
A
Simplify the environment to eliminate the need to make chores
B
Provide him stimulating environment
C
Help client develop coping mechanism
D
Encourage to learn new hobbies and interest
Question 26
How is Alzheimer's diagnosed?
A
All of the above
B
Mental-status tests
C
Neurological tests
D
Blood tests
Question 26 Explanation:
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.
Question 27
Which of the following is not directly related with Alzheimer's disease?
A
Tangles
B
Dementia
C
Diabetes mellitus
D
Senile plaques
Question 28
Which nursing intervention is most appropriate for a client with Alzheimer’s disease who has frequent episodes emotional lability?
A
Use logic to point out reality aspects.
B
Attempt humor to alter the client mood.
C
Explore reasons for the client’s altered mood.
D
Reduce environmental stimuli to redirect the client’s attention.
Question 28 Explanation:
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.
Question 29
The nurse is aware that the following ways in vascular dementia different from Alzheimer’s disease is:
A
The duration of vascular dementia is usually brief
B
The inability to perform motor activities occurs in vascular dementia
C
Personality change is common in vascular dementia
D
Vascular dementia has more abrupt onset
Question 29 Explanation:
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.
Question 30
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:
A
Alzheimer’s disease
B
Brain tumors
C
Vascular disease
D
AIDS
Question 30 Explanation:
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.
Question 31
The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client:
A
remains in a safe and secure environment
B
will reminisce to decrease isolation
C
receives adequate nutrition and hydration
D
independently performs self care
Question 31 Explanation:
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
Question 32
To encourage adequate nutritional intake for a female client with Alzheimer’s disease, the nurse should:
A
help the client fill out his menu.
B
stay with the client and encourage him to eat.
C
give the client privacy during meals.
D
fill out the menu for the client.
Question 32 Explanation:
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.
Question 33
The symptom of dementia that involved a more confused state after dark is called:
A
dark reaction
B
dark retreat
C
sundowning
D
agitation
Question 34
Which of the following is the most common cause of dementia among elderly persons?
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.
Question 35
Physiologically, what happens to the brain as Alzheimer's progresses?
A
Fluid collects
B
Many cells die
C
Tissue swells
D
Brain-stem atrophies
Question 35 Explanation:
Nerve cells change in certain parts of the brain, which causes brain cells to die. The loss of cells impairs thinking and judgment.
Question 36
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?
A
Recommend family members bring pictures to the patient’s room.
B
Recommend the patient remain in her room at all times.
C
Recommend the patient attempt to walk pushing the w/c for safety.
D
Recommend a speech therapy consult to the doctor.
Question 36 Explanation:
Stimulation in the form of pictures may decrease signs of confusion.
Question 37
Which age group has the highest rate of Alzheimer's cases reported?
A
55 to 65
B
85 and older
C
65 to 74
D
74 to 84
Question 38
Alzheimer's is the most common form of which of these?
A
Malnutrition
B
Dementia
C
Psychosis
D
Fatigue
Question 38 Explanation:
It is a collection of symptoms characterized by decreasing intellectual and social abilities.
Question 39
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?
A
“I don’t know” answer to questions
B
Shallow of labile effect
C
Apathetic response to the environment
D
Neglect of personal hygiene
Question 40
The usual span of years that Alzheimer's may progress in the patient is:
A
three to five years
B
fifty to sixty years
C
two to twenty years
D
6 months to one year
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MSN Exam for Alzheimer’s Disease (EM)
Choose the letter of the correct answer. You got 40 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed MSN Exam for Alzheimer’s Disease (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
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?
A
“Do you hurt? (pause) “Do you hurt?”
B
“Can you describe your pain?”
C
“Where is your pain located?”
D
“Where do you hurt?”
Question 1 Explanation:
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”
Question 2
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:
A
Sundowning
B
Normal aging
C
Chronic fatigue syndrome
D
Delusions
Question 2 Explanation:
Increased confusion at night is known as "sundowning" syndrome. This increased confusion occurs when the sun begins to set and continues during the night.
Question 3
Which of these is the strongest risk factor for developing the Alzheimer's disease?
A
None of the above
B
Exposure to toxins
C
Age
D
Heredity
Question 3 Explanation:
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.
Question 4
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?
A
Perform activities of daily living for the client to decease frustration.
B
Provide a stimulating environment.
C
Try to reason with the client as much as possible.
D
Establish and maintain a routine.
Question 4 Explanation:
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.
Question 5
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?
A
"I am so sorry that they didn’t get you breakfast. I’ll report it to the charge nurse."
B
"You know you had breakfast 30 minutes ago."
C
"I’ll get you some juice and toast. Would you like something else?"
D
"You will have to wait a while; lunch will be here in a little while."
Question 5 Explanation:
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.
Question 6
The nurse is aware that the following ways in vascular dementia different from Alzheimer’s disease is:
A
Vascular dementia has more abrupt onset
B
Personality change is common in vascular dementia
C
The duration of vascular dementia is usually brief
D
The inability to perform motor activities occurs in vascular dementia
Question 6 Explanation:
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.
Question 7
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?
A
We go to a group discussion every week at our community center.
B
At least 2 full meals a day is eaten.
C
The medication is not a problem to have it taken 3 times a day.
D
We have safety bars installed in the bathroom and have 24 hour alarms on the doors.
Question 7 Explanation:
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.
Question 8
A patient with Stage One Alzheimers might exhibit these behaviors:
A
getting lost while driving
B
missing appointments
C
all of the above
D
none of the above
E
forgetting names
Question 9
Physiologically, what happens to the brain as Alzheimer's progresses?
A
Tissue swells
B
Brain-stem atrophies
C
Many cells die
D
Fluid collects
Question 9 Explanation:
Nerve cells change in certain parts of the brain, which causes brain cells to die. The loss of cells impairs thinking and judgment.
Question 10
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:
A
Alzheimer’s disease
B
Vascular disease
C
Brain tumors
D
AIDS
Question 10 Explanation:
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.
Question 11
Which age group has the highest rate of Alzheimer's cases reported?
A
55 to 65
B
65 to 74
C
74 to 84
D
85 and older
Question 12
Alzheimer's is an INSIDIOUS disease. This means:
A
that it only affects the elderly
B
that it sneaks up on a person over time
C
that is can be cured
D
none of the above
E
that it is terminal
Question 13
How is Alzheimer's diagnosed?
A
Blood tests
B
Neurological tests
C
Mental-status tests
D
All of the above
Question 13 Explanation:
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.
Question 14
Which of the following is not directly related with Alzheimer's disease?
A
Tangles
B
Dementia
C
Diabetes mellitus
D
Senile plaques
Question 15
Which nursing intervention is most appropriate for a client with Alzheimer’s disease who has frequent episodes emotional lability?
A
Reduce environmental stimuli to redirect the client’s attention.
B
Attempt humor to alter the client mood.
C
Explore reasons for the client’s altered mood.
D
Use logic to point out reality aspects.
Question 15 Explanation:
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.
Question 16
The doctor has prescribed Exelon (rivastigmine) for the client with Alzheimer’s disease. Which side effect is most often associated with this drug?
A
Headaches
B
Confusion
C
Nausea
D
Urinary incontinence
Question 16 Explanation:
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.
Question 17
The nurse would expect a client with early Alzheimer’s disease to have problems with:
A
Balancing a checkbook.
B
Remembering his own name
C
Self-care measures.
D
Relating to family members.
Question 17 Explanation:
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.
Question 18
The priority of care for a client with Alzheimer’s disease is
A
Encourage to learn new hobbies and interest
B
Simplify the environment to eliminate the need to make chores
C
Help client develop coping mechanism
D
Provide him stimulating environment
Question 19
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:
A
Tell the client family that it is time to get dressed.
B
Remain calm and talk quietly to the client.
C
Obtain assistance to restrain the client for safety.
D
Call the doctor and request an order for sedation.
Question 19 Explanation:
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.
Question 20
The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client:
A
independently performs self care
B
will reminisce to decrease isolation
C
receives adequate nutrition and hydration
D
remains in a safe and secure environment
Question 20 Explanation:
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
Question 21
Which neurotransmitter has been implicated in the development of Alzheimer’s disease?
A
Epinephrine
B
Dopamine
C
Acetylcholine
D
Serotonin
Question 21 Explanation:
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.
Question 22
The nurse is caring for a client with stage III Alzheimer’s disease. A characteristic of this stage is:
A
Memory loss
B
Failing to communicate
C
Failing to recognize familiar objects
D
Wandering at night
Question 22 Explanation:
In stage III of Alzheimer’s disease, the client develops agnosia, or failure to recognize familiar objects. Answer A is incorrect because it appears in stage I. Answer C is incorrect because it appears in stage II. Answer D is incorrect because it appears in stage IV.
Question 23
To encourage adequate nutritional intake for a female client with Alzheimer’s disease, the nurse should:
A
help the client fill out his menu.
B
stay with the client and encourage him to eat.
C
fill out the menu for the client.
D
give the client privacy during meals.
Question 23 Explanation:
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.
Question 24
The symptom of dementia that involved a more confused state after dark is called:
A
dark reaction
B
dark retreat
C
agitation
D
sundowning
Question 25
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?
A
Recommend family members bring pictures to the patient’s room.
B
Recommend the patient attempt to walk pushing the w/c for safety.
C
Recommend a speech therapy consult to the doctor.
D
Recommend the patient remain in her room at all times.
Question 25 Explanation:
Stimulation in the form of pictures may decrease signs of confusion.
Question 26
Which of the following is the most common cause of dementia among elderly persons?
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.
Question 27
Signs of Alzheimer's include which of these symptoms?
A
All of the above
B
Increase in irritability
C
Loss of memory
D
Restlessness
Question 27 Explanation:
Alzheimer's sufferers also can't learn new information and tend to repeat themselves.
Question 28
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:
A
Agnosia
B
Anomia
C
Apraxia
D
Aphasia
Question 28 Explanation:
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 .
Question 29
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?
A
Apathetic response to the environment
B
“I don’t know” answer to questions
C
Shallow of labile effect
D
Neglect of personal hygiene
Question 30
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?
A
Assist residents to toilet every 2 hours to decrease risk for urinary intolerance.
B
Check for improvement in resident memory after medication therapy is initiated.
C
Develop individualized activity plans after consulting with residents and family.
D
Use the Mini-Mental State Examination to assess residents every 6 months.
Question 30 Explanation:
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
Question 31
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?
A
“Do you hurt? (pause) “Do you hurt?”
B
“Where is your pain located?”
C
“Can you describe your pain?”
D
“Where do you hurt?”
Question 31 Explanation:
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.
Question 32
Scientists believe that _________________ develop in the brain of an Alzheimer's patient, and may be a cause of the disease.
A
ruptured blood vessels
B
cholesterols
C
plaques and tangles
D
tumors
Question 33
Alzheimer's is the most common form of which of these?
A
Psychosis
B
Fatigue
C
Malnutrition
D
Dementia
Question 33 Explanation:
It is a collection of symptoms characterized by decreasing intellectual and social abilities.
Question 34
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?
A
Take no action because it is the family member saying that to the client
B
Give the family member the number for an Elder Abuse Hot line
C
Talk to the family member and explain that what she/he has said is not appropriate for the client
D
Document what the family member has said
Question 34 Explanation:
This response is the most direct and immediate. This is a case of potential need for advocacy and patient’s rights.
Question 35
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:
A
Suggesting new activities for the client and family to do together.
B
Providing emotional support and individual counseling.
C
Offering nourishing finger foods to help maintain the client's nutritional status.
D
Monitoring the client to prevent minor illnesses from turning into major problems.
Question 35 Explanation:
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.
Question 36
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?
A
Placing simple signs to indicate the location of the bedroom, bathroom, and so on
B
Placing a picture of herself in her bedroom
C
Placing mirrors in several locations in the home
D
Alternating healthcare workers to prevent boredom
Question 36 Explanation:
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.
Question 37
Which of the following diseases has not been directly linked with Bell's palsy?
A
Lyme disease
B
AIDS
C
Diabetes
D
Alzheimer's disease
Question 38
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?
A
Caregiver Role Strain related to continuous need for providing care
B
Decreased Cardiac Output related to poor myocardial contractility
C
Risk for Falls related to patient wandering behavior during the night
D
Ineffective Therapeutic Regimen Management related to poor patient memory
Question 38 Explanation:
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
Question 39
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:
A
Occasional irritable outbursts.
B
Lack of spontaneity.
C
Impaired communication.
D
Inability to perform self-care activities.
Question 39 Explanation:
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.
Question 40
The usual span of years that Alzheimer's may progress in the patient is:
A
two to twenty years
B
three to five years
C
6 months to one year
D
fifty to sixty years
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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:
Agnosia
Apraxia
Anomia
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?
Placing mirrors in several locations in the home
Placing a picture of herself in her bedroom
Placing simple signs to indicate the location of the bedroom, bathroom, and so on
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:
Chronic fatigue syndrome
Normal aging
Sundowning
Delusions
4) Which age group has the highest rate of Alzheimer’s cases reported?
85 and older
74 to 84
65 to 74
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?
Apathetic response to the environment
“I don’t know” answer to questions
Shallow of labile effect
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?
“You know you had breakfast 30 minutes ago.”
“I am so sorry that they didn’t get you breakfast. I’ll report it to the charge nurse.”
“I’ll get you some juice and toast. Would you like something else?”
“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:
Memory loss
Failing to recognize familiar objects
Wandering at night
Failing to communicate
8) The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client:
receives adequate nutrition and hydration
will reminisce to decrease isolation
remains in a safe and secure environment
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?
At least 2 full meals a day is eaten.
We go to a group discussion every week at our community center.
We have safety bars installed in the bathroom and have 24 hour alarms on the doors.
The medication is not a problem to have it taken 3 times a day.
10) Signs of Alzheimer’s include which of these symptoms?
Loss of memory
Increase in irritability
Restlessness
All of the above
11) Which neurotransmitter has been implicated in the development of Alzheimer’s disease?
Acetylcholine
Dopamine
Epinephrine
Serotonin
12) Alzheimer’s is an INSIDIOUS disease. This means:
that it is terminal
that is can be cured
that it sneaks up on a person over time
that it only affects the elderly
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:
Occasional irritable outbursts.
Impaired communication.
Lack of spontaneity.
Inability to perform self-care activities.
14) Which of the following is not directly related with Alzheimer’s disease?
Senile plaques
Diabetes mellitus
Tangles
Dementia
15) Alzheimer’s is the most common form of which of these?
Malnutrition
Dementia
Fatigue
Psychosis
16) Which nursing intervention is most appropriate for a client with Alzheimer’s disease who has frequent episodes emotional lability?
Attempt humor to alter the client mood.
Explore reasons for the client’s altered mood.
Reduce environmental stimuli to redirect the client’s attention.
Use logic to point out reality aspects.
17) Which of the following is the most common cause of dementia among elderly persons?
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?
“Where is your pain located?”
“Do you hurt? (pause) “Do you hurt?”
“Can you describe your pain?”
“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?
“Where is your pain located?”
“Do you hurt? (pause) “Do you hurt?”
“Can you describe your pain?”
“Where do you hurt?”
20) How is Alzheimer’s diagnosed?
Mental-status tests
Blood tests
Neurological tests
All of the above
21) The usual span of years that Alzheimer’s may progress in the patient is:
three to five years
two to twenty years
fifty to sixty years
6 months to one year
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.
cholesterols
tumors
ruptured blood vessels
plaques and tangles
23) To encourage adequate nutritional intake for a female client with Alzheimer’s disease, the nurse should:
stay with the client and encourage him to eat.
help the client fill out his menu.
give the client privacy during meals.
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?
Recommend the patient remain in her room at all times.
Recommend family members bring pictures to the patient’s room.
Recommend a speech therapy consult to the doctor.
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?
Urinary incontinence
Headaches
Confusion
Nausea
26) A patient with Stage One Alzheimers might exhibit these behaviors:
forgetting names
missing appointments
getting lost while driving
all of the above
none of the above
27) Which of the following diseases has not been directly linked with Bell’s palsy?
AIDS
Diabetes
Lyme disease
Alzheimer’s disease
28) The symptom of dementia that involved a more confused state after dark is called:
dark retreat
sundowning
agitation
dark reaction
29) Which of these is the strongest risk factor for developing the Alzheimer’s disease?
Heredity
Age
Exposure to toxins
None of the above
30) The priority of care for a client with Alzheimer’s disease is
Help client develop coping mechanism
Encourage to learn new hobbies and interest
Provide him stimulating environment
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:
Tell the client family that it is time to get dressed.
Obtain assistance to restrain the client for safety.
Remain calm and talk quietly to the client.
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:
AIDS
Alzheimer’s disease
Brain tumors
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?
Decreased Cardiac Output related to poor myocardial contractility
Caregiver Role Strain related to continuous need for providing care
Ineffective Therapeutic Regimen Management related to poor patient memory
Risk for Falls related to patient wandering behavior during the night
34) Physiologically, what happens to the brain as Alzheimer’s progresses?
Tissue swells
Fluid collects
Many cells die
Brain-stem atrophies
35) The nurse is aware that the following ways in vascular dementia different from Alzheimer’s disease is:
Vascular dementia has more abrupt onset
The duration of vascular dementia is usually brief
Personality change is common in vascular dementia
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:
Offering nourishing finger foods to help maintain the client’s nutritional status.
Providing emotional support and individual counseling.
Monitoring the client to prevent minor illnesses from turning into major problems.
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?
Take no action because it is the family member saying that to the client
Talk to the family member and explain that what she/he has said is not appropriate for the client
Give the family member the number for an Elder Abuse Hot line
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?
Perform activities of daily living for the client to decease frustration.
Provide a stimulating environment.
Establish and maintain a routine.
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?
Check for improvement in resident memory after medication therapy is initiated.
Use the Mini-Mental State Examination to assess residents every 6 months.
Assist residents to toilet every 2 hours to decrease risk for urinary intolerance.
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:
Balancing a checkbook.
Self-care measures.
Relating to family members.
Remembering his own name
Answers and Rationales
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 .
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.
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.
A. 85 and older
C. Shallow of labile effect
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.
B. Failing to recognize familiar objects . In stage III of Alzheimer’s disease, the client develops agnosia, or failure to recognize familiar objects.
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
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.
D. All of the above. Alzheimer’s sufferers also can’t learn new information and tend to repeat themselves.
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.
C. that it sneaks up on a person over time
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.
B. Diabetes mellitus
B. Dementia. It is a collection of symptoms characterized by decreasing intellectual and social abilities.
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.
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.
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”
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.
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.
B. two to twenty years
D. plaques and tangles
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.
B. Recommend family members bring pictures to the patient’s room. Stimulation in the form of pictures may decrease signs of confusion.
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.
D. all of the above
D. Alzheimer’s disease
B. sundowning
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.
D. Simplify the environment to eliminate the need to make chores
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.
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.
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
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.
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.
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.
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.
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.
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
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.