Question 1

Donepezil (Aricept)has been prescribed for a patient with Alzheimer disease (AD).Which statement indicates that the patient and spouse understand teaching about the medication?

Accepted Answer

Donepezil (Aricept)is used in the management of AD.It has been shown to elevate acetylcholine levels in the brain and will slow the progression of the condition.The medication should be taken with meals to reduce gastrointestinal distress.

Question 2

The nurse is aware that the older adult is at risk for drug-induced delirium.Which age-related change contributes to this risk?

Accepted Answer

Slower renal and liver clearance of drugs allows the drugs to accumulate in the system of the older adult.

Question 3

The nurse differentiates vascular dementia from Alzheimer dementia.Which causative factor is responsible for vascular dementia?

Accepted Answer

Vascular dementia occurs from brain tissue becoming hypoxic and necrotic in local areas due to small emboli.The deficits may be intellectual or loss of sensory function.

Question 4

The nurse is caring for a patient with acquired immune deficiency syndrome (AIDS)dementia complex (ADC).Which factor places this patient at particular risk for injury?

Accepted Answer

Peripheral neuropathy results in numbness and muscle weakness that may contribute to falls and thermal skin injuries.

Question 5

The nurse is caring for a patient with Alzheimer disease (AD)who wakes up moaning and frightened in the middle of the night.She begs that her husband's coffin be removed from her room.How should the nurse respond?

Accepted Answer

Turning the light on helps reorient the patient.Distraction of going to the bathroom and identifying the dresser assist with reorientation after a frightening illusion.The other options would lead to greater confusion.

Question 6

The nurse notes that the newly admitted patient with Alzheimer disease (AD)has significant anomia.Which intervention is most appropriate for this problem?

Accepted Answer

Anomia is the inability to recall a word.Waiting for the patient to remember the word or be able to substitute another is more supportive than supplying the word for him.

Question 7

The home health nurse is counseling a family who will be caring for a relative with moderate-stage Alzheimer disease (AD).Which information is most important to include?

Accepted Answer

A consistent routine-eating,resting,medication,hygiene-are all beneficial to the demented patient.Different caregivers and distracting environmental objects increase confusion.

Question 8

The CNA approaches the older adult in the long-term care facility and says,"Oh,look! Your pretty dress is icky with food spots! Let's change your clothes,sweetie." The nurse identifies that the CNA is using which type of communication?

Accepted Answer

Elderspeak is a way of communicating with older adults that is infantile,oversimplistic,oversolicitous,and demeaning.It serves no therapeutic purpose.

Question 9

The patient with Alzheimer's disease (AD)has been on donepezil (Aricept)for several weeks.In which situation would the nurse suspect an overdose?

Accepted Answer

Inability to grasp the glass indicates muscle weakness,a cardinal indicator of overdose of Aricept.Other overdose signs are hypotension,nausea and vomiting,and bradycardia.Appetite changes are not consistent with the use of this medication.

Question 10

Postmortem brain examinations of Alzheimer disease (AD)patients reveal which type of finding(s)?

Accepted Answer

Tangled nerve cells and abnormal buildup of protein in the brain have been found on postmortem brain examinations of people who have AD.

Question 11

An exhausted daughter is the sole caregiver to a patient with moderate Alzheimer disease (AD).She asks the nurse what respite care entails.Which statement indicates that the caregiver understands the nurse's response?

Accepted Answer

Respite care is placing the patient temporarily in a long-term care facility (usually for no longer than a month)to give the family respite from the responsibility of 24/7 care.

Question 12

How should the nurse speak when communicating with a patient with moderate Alzheimer dementia?

Accepted Answer

Clarity is essential when communicating with a patient with Alzheimer dementia.Placing self directly in front of the patient and using pictures or symbols is helpful.

Question 13

A recently licensed nurse is orienting to the Alzheimer disease (AD)care unit.The nurse is caring for a patient who is transitioning from oral rivastigmine (Exelon)to the medication patch.Which action indicates an accurate understanding of the medication?

Accepted Answer

Rivastigmine (Exelon)is used to manage AD by elevating acetylcholine.The medication is available orally and transdermally.The patch should be applied 24 hours after the last oral dosage is given.The sites for application of the drug patches should be rotated.

Question 14

The nurse is caring for a patient who has dementia and has been getting up out of bed at night.What action by the nurse is most therapeutic?

Accepted Answer

The patient poses a significant risk for falls and needs provisions to increase safety.Placing the mattress on the floor decreases the risk of injury from falling from a larger height.Moving the patient closer to the nurse's station does not offer protection or ensure that the patient will be seen or heard.The use of side rails can be considered a restraint and it can present an additional safety hazard.Restraints are to be the last option when caring for patients.

Question 15

Which percentage of the population that is 85 years of age and older has some stage of Alzheimer disease (AD)?

Accepted Answer

AD is the most common degenerative disease of the brain.Approximately 5.3 million Americans have AD (Alzheimer Association,2010),and there is no known cause or cure.AD typically affects people over 65 years of age,but can also strike younger people.The 85-year-old and over age group is currently the fastest-growing age group in the United States.It is estimated that 50% of this age group have AD.

Question 16

The nurse is assisting the patient with middle-stage Alzheimer's disease (AD)with dressing.Which action is most appropriate?

Accepted Answer

Coaching the patient to dress himself helps preserve dignity and function.Selecting clothes and dressing the patient does not allow the patient to actively participate in any way.Asking the patient what he wants to wear and telling him to choose a shirt could increase confusion and indecision.

Question 17

An 85-year-old man is admitted to the hospital with gastroenteritis and dehydration.He receives a dose of meclizine hydrochloride,an anticholinergic,for vomiting.He begins to hallucinate and talk to his wife,who has been dead for 10 years.Which explanation best describes this behavior?

Accepted Answer

Anticholinergic drugs can cause sudden confusion in older adults.There is nothing in the history that suggests that the behavior would be related to AD or any other dementia as dementias progress slowly.Dehydration would increase the effect of the anticholinergic.

Question 18

In which situation should the nurse document that the patient with AD exhibited agnosia?

Accepted Answer

Agnosia is the inability to recognize an object and use it as intended.Expressive aphasia is difficulty in expressing oneself.Alexia is the inability to recognize the written language.Apraxia is the inability to do an activity despite having the motor function to accomplish it.

Question 19

Memory lapses seen in early stages of Alzheimer disease (AD)are related to the pathophysiology of which condition?

Accepted Answer

Loss of neurons in the frontal and temporal lobes results in atrophy and the many signs of AD,memory deficits being one of the earliest.

Question 20

The nurse is caring for a patient with moderate Alzheimer disease (AD)in a long-term care facility who "sundowns." The nurse understands that which action would be most beneficial for this patient?

Accepted Answer

Sundowning occurs when a patient is completely oriented during the day but becomes disoriented and confused during the evening and night hours.Planning interactive activities when the resident is not confused is beneficial.Exercise programs at night would add to agitation and confusion.Sedatives also frequently cause confusion.Lights should be left on to assist with reorientation should the resident wake up at night.

Quiz 47: Care of Patients with Cognitive Disorders

Donepezil (Aricept) has been prescribed for a patient with Alzheimer disease (AD) .Which statement indicates that the patient and spouse understand teaching about the medication?

The nurse is aware that the older adult is at risk for drug-induced delirium.Which age-related change contributes to this risk?

The nurse differentiates vascular dementia from Alzheimer dementia.Which causative factor is responsible for vascular dementia?

The nurse is caring for a patient with acquired immune deficiency syndrome (AIDS) dementia complex (ADC) .Which factor places this patient at particular risk for injury?

The nurse is caring for a patient with Alzheimer disease (AD) who wakes up moaning and frightened in the middle of the night.She begs that her husband's coffin be removed from her room.How should the nurse respond?

The nurse notes that the newly admitted patient with Alzheimer disease (AD) has significant anomia.Which intervention is most appropriate for this problem?

The home health nurse is counseling a family who will be caring for a relative with moderate-stage Alzheimer disease (AD) .Which information is most important to include?

The CNA approaches the older adult in the long-term care facility and says,"Oh,look! Your pretty dress is icky with food spots! Let's change your clothes,sweetie." The nurse identifies that the CNA is using which type of communication?

The patient with Alzheimer's disease (AD) has been on donepezil (Aricept) for several weeks.In which situation would the nurse suspect an overdose?

Postmortem brain examinations of Alzheimer disease (AD) patients reveal which type of finding(s) ?

An exhausted daughter is the sole caregiver to a patient with moderate Alzheimer disease (AD) .She asks the nurse what respite care entails.Which statement indicates that the caregiver understands the nurse's response?

How should the nurse speak when communicating with a patient with moderate Alzheimer dementia?

A recently licensed nurse is orienting to the Alzheimer disease (AD) care unit.The nurse is caring for a patient who is transitioning from oral rivastigmine (Exelon) to the medication patch.Which action indicates an accurate understanding of the medication?

The nurse is caring for a patient who has dementia and has been getting up out of bed at night.What action by the nurse is most therapeutic?

Which percentage of the population that is 85 years of age and older has some stage of Alzheimer disease (AD) ?

The nurse is assisting the patient with middle-stage Alzheimer's disease (AD) with dressing.Which action is most appropriate?

An 85-year-old man is admitted to the hospital with gastroenteritis and dehydration.He receives a dose of meclizine hydrochloride,an anticholinergic,for vomiting.He begins to hallucinate and talk to his wife,who has been dead for 10 years.Which explanation best describes this behavior?

In which situation should the nurse document that the patient with AD exhibited agnosia?

Memory lapses seen in early stages of Alzheimer disease (AD) are related to the pathophysiology of which condition?

The nurse is caring for a patient with moderate Alzheimer disease (AD) in a long-term care facility who "sundowns." The nurse understands that which action would be most beneficial for this patient?