1.
The nurse would expect a client with early Alzheimer’s disease to have problems with:
Correct Answer
A. Balancing a checkbook.
Explanation
In the early stage of Alzheimer’s disease, complex tasks (such as balancing a checkbook) would be the first cognitive deficit. The loss of self-care ability, problems relating to family members, and difficulty remembering one’s name are all areas of cognitive decline that occur later in the disease process.
2.
Which nursing intervention is most appropriate for a client with Alzheimer’s disease who has frequent episodes of emotional lability?
Correct Answer
C. Reduce environmental stimuli to redirect the client’s attention.
Explanation
The client with Alzheimer’s disease can have frequent episodes of labile mood, which can best be handled by decreasing a stimulating environment and redirecting the client’s attention. An over-stimulating climate may cause a 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 their behavior and, therefore, will be unaware of any causative factors.
3.
Which neurotransmitter has been implicated in the development of Alzheimer’s disease?
Correct Answer
A. Acetylcholine
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.
4.
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:
Correct Answer
C. Remain calm and talk quietly to the client.
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.
5.
A 65-year-old client is in the first stage of Alzheimer's disease. Nurse Patricia should plan to focus this client's care on:
Correct Answer
B. Providing emotional support and individual counseling.
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.
6.
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:
Correct Answer
B. Impaired communication.
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, besides 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 noticeable 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.
7.
The nurse is aware of the following ways in which vascular dementia is different from Alzheimer’s disease:
Correct Answer
A. Vascular dementia has a more abrupt onset
Explanation
Vascular dementia differs from Alzheimer’s disease in that it has a more abrupt onset and runs a highly variable course. Personality 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.
8.
Rosana is in the second stage of Alzheimer’s disease and appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?
Correct Answer
B. “Do you hurt? (pause) “Do you hurt?”
Explanation
When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions. The client should be able to answer with a “yes” or “no” whenever possible to avoid requiring the client to make choices. Repeating the question aids comprehension.
9.
To encourage adequate nutritional intake for a female client with Alzheimer’s disease, the nurse should:
Correct Answer
A. Stay with the client and encourage him to eat.
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.
10.
Which of the following is not directly related with Alzheimer's disease?
Correct Answer
B. Diabetes mellitus
Explanation
Diabetes mellitus is not directly related to Alzheimer's disease. While both conditions can occur in the same individual, they are separate diseases with different underlying mechanisms. Alzheimer's disease is characterized by the presence of senile plaques and tangles in the brain, which lead to cognitive decline and dementia. Diabetes mellitus, on the other hand, is a metabolic disorder that affects the body's ability to regulate blood sugar levels. Although there is some evidence linking diabetes to an increased risk of developing Alzheimer's disease, the two conditions are not directly related.
11.
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?
Correct Answer
C. We have safety bars installed in the bathroom and have 24 hour alarms on the doors.
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.
12.
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?
Correct Answer
B. Talk to the family member and explain that what she/he has said is not appropriate for the client
Explanation
This response is the most direct and immediate. This is a case of potential need for advocacy and patient’s rights.
13.
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:
Correct Answer
B. Apraxia
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 .
14.
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:
Correct Answer
C. Sundowning
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.
15.
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?
Correct Answer
C. "I’ll get you some juice and toast. Would you like something else?"
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.
16.
The doctor has prescribed Exelon (rivastigmine) for the client with Alzheimer’s disease. Which side effect is most often associated with this drug?
Correct Answer
D. Nausea
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.
17.
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?
Correct Answer
B. Recommend family members bring pictures to the patient’s room.
Explanation
Stimulation in the form of pictures may decrease signs of confusion.
18.
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?
Correct Answer
C. Establish and maintain a routine.
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.
19.
The nurse is caring for a client with stage III Alzheimer’s disease. A characteristic of this stage is:
Correct Answer
B. Failing to recognize familiar objects
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.
20.
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:
Correct Answer
B. Alzheimer’s disease
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.
21.
Which of the following diseases has not been directly linked with Bell's palsy?
Correct Answer
D. Alzheimer's disease
Explanation
Bell's palsy is a condition characterized by sudden weakness or paralysis of the facial muscles. It is typically caused by inflammation or damage to the facial nerve. While diseases such as AIDS, diabetes, and Lyme disease have been directly linked to Bell's palsy, there is currently no direct link between Alzheimer's disease and Bell's palsy. Alzheimer's disease is a progressive brain disorder that primarily affects memory and cognitive function, and it does not typically cause facial paralysis.
22.
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?
Correct Answer
A. Check for improvement in resident memory after medication therapy is initiated.
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
23.
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?
Correct Answer
B. Caregiver Role Strain related to continuous need for providing care
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
24.
The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client:
Correct Answer
C. Remains in a safe and secure environment
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
25.
Which of the following is the most common cause of dementia among elderly persons?
Correct Answer
D. Alzheimer’s disease
Explanation
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.
26.
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?
Correct Answer
B. “Do you hurt? (pause) “Do you hurt?”
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”
27.
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?
Correct Answer
C. Placing simple signs to indicate the location of the bedroom, bathroom, and so on
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.
28.
The priority of care for a client with Alzheimer’s disease is
Correct Answer
D. Simplify the environment to eliminate the need to make chores
Explanation
Simplifying the environment for a client with Alzheimer's disease helps to reduce confusion and frustration. By eliminating the need to make chores, the client can focus on their daily activities without feeling overwhelmed. This approach promotes a sense of calmness and enhances their ability to function independently.
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?
Correct Answer
C. Shallow of labile effect
Explanation
The symptom of shallow or labile effect is unrelated to depression. Shallow effect refers to a lack of emotional depth or intensity in one's expressions or reactions, while labile effect refers to rapid and unpredictable shifts in emotional states. These symptoms are more commonly associated with certain types of dementia, such as Alzheimer's disease, rather than depression. Depression, on the other hand, is typically characterized by symptoms such as apathetic response to the environment, "I don't know" answers to questions, and neglect of personal hygiene.
30.
A patient with Stage One Alzheimers might exhibit these behaviors:
Correct Answer
D. All of the above
Explanation
A patient with Stage One Alzheimer's might exhibit all of the above behaviors. Forgetting names is a common symptom of Alzheimer's as it affects the individual's ability to recall information. Missing appointments can occur due to memory lapses and difficulty in organizing and keeping track of time. Getting lost while driving is another possible behavior as Alzheimer's can impair spatial awareness and navigation skills. Therefore, all of these behaviors can be seen in a patient with Stage One Alzheimer's.
31.
Scientists believe that _________________ develop in the brain of an Alzheimer's patient, and may be a cause of the disease.
Correct Answer
D. Plaques and tangles
Explanation
Plaques and tangles are believed to develop in the brain of an Alzheimer's patient and may be a cause of the disease. These plaques are formed by the accumulation of beta-amyloid protein, while tangles are twisted fibers of tau protein. Both plaques and tangles disrupt communication between brain cells and lead to the death of neurons, resulting in the cognitive decline and memory loss characteristic of Alzheimer's disease.
32.
The symptom of dementia that involved a more confused state after dark is called:
Correct Answer
B. Sundowning
Explanation
Sundowning is a symptom of dementia characterized by increased confusion and agitation that occurs later in the day, typically in the late afternoon or evening. It is believed to be triggered by the disruption of the internal body clock, leading to a mismatch between the individual's sleep-wake cycle and the external environment. This phenomenon can result in heightened restlessness, anxiety, and disorientation, making it particularly challenging for caregivers to manage.
33.
Alzheimer's is an INSIDIOUS disease. This means:
Correct Answer
C. That it sneaks up on a person over time
Explanation
The correct answer is that Alzheimer's is an insidious disease because it sneaks up on a person over time. This means that the disease progresses slowly and gradually, often without obvious symptoms in the early stages. It may start with mild memory loss or confusion and gradually worsen over months or years. This gradual onset can make it difficult to detect and diagnose the disease early on, leading to delayed treatment and management.
34.
The usual span of years that Alzheimer's may progress in the patient is:
Correct Answer
B. Two to twenty years
Explanation
Alzheimer's disease is a progressive neurodegenerative disorder that affects the brain, leading to memory loss and cognitive decline. The progression of the disease varies from person to person, but on average, it can span from two to twenty years. This wide range is due to the fact that Alzheimer's progresses at different rates in different individuals. Factors such as age, overall health, and the stage at which the disease is diagnosed can also influence the rate of progression. Therefore, it is important to note that while some individuals may experience a relatively rapid decline within a few years, others may have a slower progression over a couple of decades.
35.
Alzheimer's is the most common form of which of these?
Correct Answer
B. Dementia
Explanation
It is a collection of symptoms characterized by decreasing intellectual and social abilities.
36.
How is Alzheimer's diagnosed?
Correct Answer
D. D. All of the above
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.
37.
Physiologically, what happens to the brain as Alzheimer's progresses?
Correct Answer
C. Many cells die
Explanation
Nerve cells change in certain parts of the brain, which causes brain cells to die. The loss of cells impairs thinking and judgment.
38.
Which of these is the strongest risk factor for developing the Alzheimer's disease?
Correct Answer
B. Age
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.
39.
Signs of Alzheimer's include which of these symptoms?
Correct Answer
D. All of the above
Explanation
Alzheimer's sufferers also can't learn new information and tend to repeat themselves.
40.
Which age group has the highest rate of Alzheimer's cases reported?
Correct Answer
A. 85 and older
Explanation
The age group of 85 and older has the highest rate of Alzheimer's cases reported. This is because Alzheimer's disease is more common among older individuals, and as age increases, the risk of developing the disease also increases. Therefore, it is expected that the highest rate of cases would be found in the oldest age group.