M.23-1: Dynamic Study Module Alzheimer Disease

A patient diagnosed with Alzheimer disease (AD) has mild cognitive impairment. The patient's husband asks the nurse what therapies are appropriate. Which reply should the nurse provide? "Sticking to a routine is important with this type of cognitive decline." "It is important to start medication right away." "It is time to consult hospice for end-of-life care." "Your wife will need to enter a nursing home."

"Sticking to a routine is important with this type of cognitive decline." Mild cognitive decline is treated with behavioral therapies such as routine and reality orientation. Pharmacologic therapy is introduced with progression to moderate and severe Alzheimer disease. End-of-life care will apply in severe Alzheimer disease. Placement in a nursing facility may be needed in later stages of Alzheimer disease.

A patient with a history of Alzheimer disease (AD) is admitted for gastrointestinal bleeding. Which medication in the patient's profile would the nurse expect the healthcare provider to discontinue? Acetylcholinesterase inhibitor Antipsychotic Antidepressant N-Methyl-D-aspartate (NMDA) receptor antagonist

Acetylcholinesterase inhibitor The acetylcholinesterase inhibitors have a major adverse effect of gastrointestinal bleeding. Therefore, the nurse would expect the healthcare provider to discontinue the medication. The antipsychotic, antidepressant, and the NMDA receptor antagonist do not have this side effect.

Which psychological factors should the nurse assess for in a client to determine the risk for development of Alzheimer disease​ (AD)? (Select all that​ apply.) A. Depression B. Schizophrenia C. Sleep disorders D. Bipolar disorder E. Elevated stress levels

A. Depression C. Sleep disorders D. Bipolar disorder

The nurse is caring for a patient with cognitive impairment who is in the middle stage of Alzheimer disease. The patient is exhibiting resistance to bathing. How should the nurse gain the patient's cooperation in bathing? Allow the patient to decide what body part will be bathed first. Encourage sitting in the shower. Explain that all patients must bathe today. Recognize that the patient cannot make decisions in middle Alzheimer disease.

Allow the patient to decide what body part will be bathed first. The patient with cognitive impairment from Alzheimer disease is frustrated and anxious. They can make simple decisions and should be allowed to have as much control as possible in their healthcare.

The nurse is talking with the adult child of a patient with newly diagnosed Alzheimer disease (AD). The person asks if there is a blood test available to determine the chances of acquiring the disease. Which test would the nurse recommend to the person? Bio markers Thyroid stimulating hormone Complete blood count Serum B12 and folate level

Biomarkers Biomarkers are a newer way of testing for the risk of developing AD as passed on from a parent. Thyroid stimulating hormone, complete blood counts, and serum B12 and folate levels would be performed on the person with increased confusion to rule out other metabolic causes of AD.

patient with Alzheimer disease (AD) was started on an N-Methyl-D-aspartate (NMDA) receptor antagonist for the treatment of moderate AD. The patient returns 3 months later for a follow-up appointment. Which assessment finding indicates a need for immediate healthcare provider notification? Blood pressure 180/90 mmHg Bowel movements 3-4 days/week Stomach upset with medication Occasional fatigue

Blood pressure 180/90 mmHg NMDA receptor antagonists can cause increased blood pressure. Therefore, the BP reading of 180/90 mmHg indicates a high reading and the healthcare provider should be notified immediately. Bowel movements three to four times a week may be normal for this patient. The nurse would need to gather more information first. If the patient has stomach upset with the medication, it can be taken with food. Occasional fatigue is normal and does not warrant immediate healthcare provider notification.

A patient in the last stage of Alzheimer disease (AD) is combative and confused. Which intervention planned by the nurse indicates a need for the nurse manager to intervene? Employment of physical restraints Use of continued reorientation Use of a low, locked safety bed Application of bed and chair alarms

Employment of physical restraints Chemical and physical restraints should be last resorts, so if the nurse is planning to incorporate the use of restraints this requires immediate intervention by the nurse manager. Using continued reorientation; a low, locked, safety bed; and bed/chair alarms promotes safety without restraints.

The nurse is teaching a group of unlicensed assistive personnel​ (UAPs) about caring for clients with Alzheimer disease​ (AD). Which statement by a UAP provides an accurate description of​ AD? A. ​"Alzheimer disease involves dyskinetic movements from disordered tonicity of​ muscles." B. ​"Alzheimer disease is a progressive deterioration of brain​ function." C. ​"Alzheimer disease is a temporary state of mental confusion and fluctuating​ consciousness." D. ​"Alzheimer disease is an exaggerated feeling of physical and mental​ well-being."

​ B. ​"Alzheimer disease is a progressive deterioration of brain​ function." Rationale: Alzheimer disease is a type of dementia that causes progressive deterioration of brain function. Euphoria is an exaggerated feeling of physical and mental​ well-being. Dystonia describes dyskinetic movements caused by disordered tonicity of muscle. Delirium is a temporary state of mental confusion and fluctuating consciousness.

The nurse working in a​ long-term care facility develops a plan of care for a client with stage 2 Alzheimer disease​ (AD) and a nursing diagnosis of ​Memory, Impaired. The client becomes agitated easily. Which intervention would be appropriate for the nurse to​ include? A. Challenge the​ client's responses. B. Ask the client one question at a time. C. Avoid making eye contact. D. Speak in a loud monosyllabic tone.

​B. Ask the client one question at a time. Rationale: When communicating with the client who has impaired​ memory, it is best to ask only one question at a time and preferably yes or no questions. The nurse should make eye contact with the​ client, but never challenge the​ client's responses because this can increase agitation. The nurse should speak in a calm and reassuring tone so as to not frighten the client.​ (NANDA-I ©2014)

A patient previously diagnosed as having stage 2 Alzheimer disease (AD) is brought to the healthcare provider by their daughter. The daughter expresses concerns that her father's AD seems to be getting worse. Which changes should the nurse assess in the patient to help determine if the AD has progressed to the next stage? Inability to identify immediate family Knowledge deficit of recent events Losing everyday objects such as keys and glasses Inability to remember names when introduced to new people

Inability to identify immediate family An inability to recognize close family members is a manifestation of stage 3 AD and would be an indication that the patient's AD has progressed. An inability to remember names when introduced to new people is a sign of stage 1 AD. A knowledge deficit of recent events is a manifestation of stage 1 AD. Losing everyday objects such as keys and glasses is also a sign of stage 1 AD.

The nurse is talking with the adult child of a parent with a new diagnosis of stage I Alzheimer disease (AD). The family is having increased difficulty keeping the patient on task. Which nursing intervention would be most appropriate to help with this issue? Maintain a daily schedule for the patient. Provide family photos with their names. Consult a dietitian to address food preferences. Place locks and alarms on house entrances and exits.

Maintain a daily schedule for the patient atients with AD work well with maintaining the same daily routine. Therefore, the nurse would recommend the family provide the patient with a daily schedule. Family photos with names would help with recognition of others. The patient is in the early stage of AD and nutritional counseling is not needed. Locks and alarms on house entrances and exits provide safety, not continuity.

Which outcome is the nurse least likely to expect for a patient diagnosed with Alzheimer disease (AD)? Maintains previous level of functioning Maintains adequate nutrition Maintains an adequate balance of activity and rest Maintains an adequate fluid and electrolyte balance

Maintains previous level of functioning AD is a chronic progressive disease. The patient will never return to a previous level of functioning. The expected outcomes for patients with AD are that the patients will remain free from injury, maintain an adequate balance of activity and rest, maintain adequate nutrition, maintain an adequate fluid and electrolyte balance, and maintain an optimal level of functioning, if possible.

he nurse is explaining the early pathophysiological changes occurring with Alzheimer disease (AD). Which statement by the nurse is accurate? "AD causes deposits of insoluble material in the memory and cognition areas of the brain early in the disease." "AD causes deposits of insoluble material that accelerate neuron impulses early in the disease." "In AD, the neurons secrete a substance that causes the growth of abnormal neurons." "In AD, there are deposits of a fat-soluble material in the speech areas of the brain, caused by poor circulation, early in the disease."

"AD causes deposits of insoluble material in the memory and cognition areas of the brain early in the disease." The earliest areas affected by AD are the memory and cognition areas of the brain. Insoluble deposits consisting of beta-amyloid material collect in these areas of the brain. The cause of the deposits is unknown. Patients with vascular dementia caused by circulation issues in the brain are prone to AD. Deposits made of insoluble beta-amyloid material interfere with, not accelerate, neuron impulses. These deposits form in the spaces between the neurons in the brain. Normally, a protein substance called tau holds the microtubules together so that neurons can receive nutrients. When tau no longer holds the cellular structure together, the neurons die from lack of nutrients. The neurons are no longer in communication, and brain function is lost. The neurons do not secrete a substance that causes abnormal neurons.

A patient with suspected Alzheimer disease (AD) has numerous tests scheduled. The patient asks the nurse why there are so many tests ordered. Which response by the nurse is the most appropriate? "Alzheimer disease is diagnosed in part by ruling out other diseases that affect memory." "The tests are used to identify which gene is causing Alzheimer disease." "The tests are necessary to determine what is causing Alzheimer disease." "There is a number of diagnostic tests that are needed to accurately diagnose Alzheimer disease."

"Alzheimer disease is diagnosed in part by ruling out other diseases that affect memory." AD cannot be definitively diagnosed without examining a piece of brain tissue. This is done at autopsy. AD is diagnosed by excluding other disorders. There are screening tools that identify cognition issues, but do not necessarily diagnose AD. The other statements are not appropriate or accurate.

he nurse is working with the family of a patient diagnosed with Alzheimer disease (AD). Which question should the nurse ask to determine if the patient has had a recent functional decline? "Have you noticed if the patient's ability to cook meals in the last month has differed?" "Have you noticed if the patient has been taking the prescribed medications for AD?" "Have you noticed when the patient begins to experience the symptoms of sundowning?" "Have you noticed the patient needing to look at scrapbooks and photo albums more often?"

"Have you noticed if the patient's ability to cook meals in the last month has differed?" The nurse is assessing for recent changes and this would include asking about changes in the ability to prepare meals. Assessing for medication compliance does not indicate a change in memory. Sundowning usually occurs around the same time in the evening and does not indicate worsening of the disease. The patient spending more time looking at scrapbooks and photo albums does not indicate worsening of the disease.

The nurse is conducting an admission assessment for a patient diagnosed with late-stage Alzheimer disease (AD). Which statement by the patient's spouse indicates a need for further teaching regarding the progression of the disease? Answer "I feel tired all the time and I often feel guilty and angry. I need to better organize my time so that I can get everything done each day." "I feel bad that I can no longer provide all the care my husband needs. I wish I could continue to be his caregiver. It's just too much for me." "I am having a hard time transitioning from being my husband's caregiver to being his advocate. I feel so bad that I have to move him out of our home." "My husband doesn't recognize me anymore. I am so grateful that the caregivers come to our home. He seems so peaceful."

"I feel tired all the time and I often feel guilty and angry. I need to better organize my time so that I can get everything done each day." A patient in the final stage of AD requires total and intensive around-the-clock support and care for all functions of daily living. It can be extremely difficult for a spouse caregiver to maintain their own physical and emotional health while attempting to meet the care needs of a spouse with end-stage AD. This balance is crucial. A statement by the spouse caregiver that they need to use their time more effectively indicates that they are unaware of the need for support. It indicates that the caregiver does not realize that it is time to seriously consider moving the husband to a care facility or getting help with care in the home. The caregiver must adjust from being the person who provides all hands-on care to being an advocate. It is critical that the spouse caregiver recognize when they are no longer able to provide total care.

The nurse is providing home care instruction for a patient recently diagnosed with Alzheimer disease (AD). Which statement by the patient indicates the need for further instruction? "I will restrict my fluid intake because it is known to cause symptoms to worsen." "I will monitor my diet and eat foods that are nutritious." "I will make sure my wife asks for assistance if my care becomes overwhelming." "There are community resources that can help me and my family as the disease progresses."

"I will restrict my fluid intake because it is known to cause symptoms to worsen." The patient would show a need for further teaching by stating that they would need to restrict fluid intake; fluid intake does not affect AD. All other statements indicate appropriate understanding of the teaching provided.

The family of a patient diagnosed with Alzheimer disease (AD) reports that the patient becomes confused and combative in the evenings and sometimes wanders. The nurse explains the concept of sundowning. Which information should the nurse provide the family? "It is important to keep doors locked and alarmed at night to keep the patient from leaving the home." "When a patient with Alzheimer disease (AD) begins sundowning, it is time for nursing home placement." "Your parent may need to be treated with antidepressants to control the incidence of sundowning." "Sundowning in patients with Alzheimer disease (AD) reflects that the patient is in the last stages of the disease."

"It is important to keep doors locked and alarmed at night to keep the patient from leaving the home." When a patient with Alzheimer disease (AD) experiences sundowning, they have increased confusion, and they may be combative and wander. Therefore, safety is most important, and it is advisable to place a good lock and alarm system on doors. Sundowning does not arbitrarily mean that the patient requires nursing home placement or antidepressants. Sundowning happens in stages 2 and 3 of Alzheimer disease (AD), but does not indicate the end stages of the disease.

The family of a patient newly diagnosed with Alzheimer disease (AD) asks the nurse what caused this to occur because there is no family history. How should the nurse respond? "Many theories exist about the cause of AD, but the most prominent is the brain's inability to process a specific protein." "Alzheimer disease (AD) frequently runs in families. Maybe you have a distant relative who had the disease." "Alzheimer disease (AD) often happens as a result of multiple cerebral vascular accidents that damage brain tissue." "Many patients who develop Alzheimer disease (AD) have a long history of alcohol abuse."

"Many theories exist about the cause of AD, but the most prominent is the brain's inability to process a specific protein." Research shows that the brain of people with AD cannot properly process the amyloid precursor protein, leading to amyloid plaque buildup. It can occur in a person with no family history of the disease. It is unrelated to cerebral vascular accidents and alcohol abuse.

The family of a 40-year-old patient with a diagnosis of stage 1 Alzheimer disease (AD) asks the nurse how long the disease usually lasts. How should the nurse respond? "Patients diagnosed with AD younger in life can live up to two decades." "You should have your loved one begin to get their affairs in order." "Your family member may not have many years left because they are in the first stage." "Those with early-onset AD tend to progress through the disease stages faster."

"Patients diagnosed with AD younger in life can live up to two decades." People who experience early-onset AD can tend to survive up to two decades after diagnosis. As a result, the patient would not need to get their affairs in order at this point. Those diagnosed later in life tend to survive 4-8 years after diagnosis and progress through the stages faster.

A patient asks the nurse about taking gingko biloba, resveratrol, and omega-3 fatty acids as over-the-counter treatments to slow the progression of AD. How should the nurse respond? "Research shows that these supplements have no effect on the progression of AD." "These antioxidants have been proven to prevent the progression of AD." "I would take one of each herbal supplement to try and slow the progression of AD." "Herbal therapies in combination with healing touch help slow the progression of AD."

"Research shows that these supplements have no effect on the progression of AD." Research has shown that there is no impact on AD progression from taking these supplements. They may actually be detrimental and interfere with other prescription medication. Healing therapies can provide comfort and relieve symptoms of AD, but they are not related to over-the-counter supplements.

The nurse is teaching a group of adults about risk factors for the development of Alzheimer disease (AD). Which participant statement indicates a need for further teaching? "Smoking and a sedentary lifestyle are not risk factors for the development of Alzheimer disease." "Risk factors for the onset of Alzheimer disease include cardiovascular diseases such as obesity and hyperlipidemia." "People with lower levels of formal education may be at a higher risk for developing Alzheimer disease." "Someone who has sustained a traumatic brain injury (TBI) has an increased risk for Alzheimer disease."

"Smoking and a sedentary lifestyle are not risk factors for the development of Alzheimer disease." The participant who states that smoking and sedentary lifestyle are not risk factors is incorrect and this indicates a need for further teaching. Cardiovascular diseases such as hypertension, hyperlipidemia, diabetes mellitus, and obesity increase a person's risk for Alzheimer disease (AD). People with lower educational levels may not be cognitively challenged and are at higher risk for AD. TBIs place a person at risk for AD.

A patient is brought to the clinic by family because of increased forgetfulness and concern that the patient may have Alzheimer disease (AD). The nurse notices the patient is dressed in a t-shirt and shorts when it is 25°F (−3.9°C) outside. Which question should the nurse ask the patient first? "What is your name and the month, date, and year?" "Are you cold with the clothes you are currently wearing?" "What made you decide to wear the clothes you have on today?" "Do you know why your family brought you here today?"

"What is your name and the month, date, and year?" The family is concerned that the patient has increased memory loss and is wearing clothing that is inappropriate for the season. The nurse would need to determine the patient's level of orientation, so name and date would be asked first. The nurse would not ask if the patient is cold because that does not determine mental status. Asking the patient why they are wearing the clothes they have on would not provide information as to the current mental status. The nurse would ask the patient why they were brought in today to determine the patient's perception, but it would not be the first question asked.

The nurse is teaching the family about how to include validation therapy when communicating with the patient with Alzheimer disease (AD) who is wandering the house and crying out for their spouse. Which statement by a family member indicates the correct way to use validation therapy? "You are looking for your spouse. Is there something you need from them?" "You are remembering the way things used to be before you had Alzheimer disease." "Do you remember? You are home with family in your house. You are safe." "You seem to be restless today. Let's go outside and take a short walk."

"You are looking for your spouse. Is there something you need from them?" Validation therapy involves searching for meaning in the emotions the patient is displaying. Reminiscence therapy involves reflecting on past events. This patient is upset and is looking for something. Reality orientation involves bringing the patient back to reality by explaining where they are and that they are safe. Exercise is used as a form of relaxation, but is not related to validation therapy.

the nurse is caring for a client with stage 2 moderate Alzheimer disease. Which collaborative colleague in healthcare should the nurse anticipate working with for optimal care of this​ client? (Select all that​ apply.) A. Hospice B. Dietitian C. Speech therapist D. Physical therapist E. Occupational therapist

B. Dietitian C. Speech therapist D. Physical therapist E. Occupational therapist Rationale: In moderate Alzheimer​ disease, it is appropriate for the client to receive physical​ therapy, occupational​ therapy, speech​ therapy, and guidance from the dietitian. Hospice is applicable in stage 3 severe Alzheimer disease.

The home health nurse is caring for a patient with Alzheimer disease (AD) and their family. The husband states that his wife is having difficulty with time and place orientation. Which intervention is most appropriate for the patient? The use of clocks and calendars The importance of fluid intake The use of community resources The importance of adequate sleep

The use of clocks and calendars While all of these interventions are appropriate for patients diagnosed with dementia or Alzheimer disease, the only intervention that addresses orientation of time or place is the use of clocks and calendars.

The family members of a patient with Alzheimer disease (AD) ask the nurse what they can do to help the person recognize them. Which intervention is most appropriate for the nurse to suggest? Go through scrapbooks and photo albums frequently. Redirect the patient to activities that will validate needs. Administer an N-Methyl-D-aspartate (NMDA) receptor antagonist as prescribed. Place clocks in every room with a schedule of tasks.

Go through scrapbooks and photo albums frequently. The nurse is suggesting the use of reminiscence therapy by reviewing scrapbooks and photo albums in order to recognize people and retain memories. Validation therapy is used to assist a person with AD to remember what current needs are. Medications help with memory, but are not specific to recognizing people. Placing clocks in every room with a schedule of tasks is considered reality orientation therapy.

he nurse in a long-term care facility is providing care for a patient who is receiving an acetylcholinesterase inhibitor for Alzheimer disease (AD). Which adverse reaction to the medication should the nurse report to the healthcare provider? Guaiac positive stool Decreased appetite Tachycardia Hypertension

Guaiac positive stool Acetylcholinesterase inhibitors are associated with gastrointestinal bleeding. Blood in the stool would require notification to the healthcare provider. Tachycardia is a sign of early compensation for a decrease in intravascular fluid and could result from gastrointestinal bleeding; however, bradycardia is an adverse effect of acetylcholinesterase inhibitors and should be reported. Hypotension also could indicate a loss of intravascular fluid. A decrease in appetite is a mild side effect of the medication and would likely not be reported unless it worsened.

The family brings in an older adult to the clinic for an annual physical in the summer. The family reports the patient is acting oddly and has been forgetting to pay bills and keep appointments. Which assessment finding would lead the healthcare provider to test for Alzheimer disease (AD)? Patient wearing a thick sweater and overcoat Patient reporting burning and pain with urination Patient recently beginning a new medication for depression Patient reporting flulike symptoms for the past 1-2 weeks

Patient wearing a thick sweater and overcoat Signs of AD include dressing inappropriately, an inability to perform self-care, and/or difficulty paying attention during the interview. Therefore, the inappropriate dress for the season would indicate changes in mental status. The patient reporting pain and burning with urination could indicate a urinary tract infection (UTI), which can cause alterations in electrolyte balance and mental status.

The nurse is teaching the family members of a patient with stage 2 Alzheimer disease (AD) about safety. Which assessment finding by the nurse indicates a high safety risk? The patient continues to drive. The patient has a medical alert system. The family administers all medications. The family supervises meal preparation.

The patient continues to drive. Patients in the second stage of AD should not be driving because confusion can increase the risk for motor vehicle accidents. Use of a medical alert system indicates that the family is ensuring safety. When the family administers all medications and supervises meal preparation, this ensures patient safety.

The family of a client with Alzheimer disease​ (AD) report that they can no longer manage the care in their home and are planning​ long-term care placement. Which information should the nurse provide the family to decrease the risk of relocation​ syndrome? (Select all that​ apply.) A. Bring pictures from home. B. Retain the same structure. C. Refrain from visiting for 1dash 2 weeks. D. Administer medication at different times. E. Use a daily schedule to remind the client of tasks.

​A. Bring pictures from home. B. Retain the same structure. E. Use a daily schedule to remind the client of tasks. Rationale: Ways the nurse can help minimize the effects of relocation​ syndrome, which can occur when a client with AD is moved to another care​ facility, include bringing pictures from home and retaining as close to the same structure as possible. The client should be provided a daily schedule to remind the client of what happens at what time. Family should be encouraged to visit and be a part of the​ client's routine. Medications should be administered as they have been prescribed and not varied

Which information should the nurse include when providing teaching at a community center about ways to prevent Alzheimer disease​ (AD)? (Select all that​ apply.) A. Consume a heart healthy diet. B. Refrain from consuming alcohol. C. Keep mentally active with puzzles. D. Get tested annually for Alzheimer disease. E. Take N​-methyl-D-aspartate ​(NMDA) receptor antagonists.

​A. Consume a heart healthy diet. C. Keep mentally active with puzzles. Rationale: Clients who are trying to prevent the onset of Alzheimer disease​ (AD) should consume a heart healthy​ (Mediterranean) diet because the foods in this diet have antioxidants and prevent the formation of amyloid plaques. Clients should keep mentally active by doing puzzles and playing games. It is believed that alcohol can be consumed in moderation to prevent AD. An individual should not routinely take NMDA receptor antagonists to prevent​ AD, and there is not a test that can be performed to diagnose AD.

A nurse on the​ medical-surgical unit has identified safety as a priority problem for a client who is in the late stages of Alzheimer disease​ (AD). The client is awake at night and tends to wander. Which priority intervention should the nurse use in the care of this​ client? (Select all that​ apply.) A. Keep a nightlight on in the room. B. Place a vest restraint on the client. C. Place nonskid slippers on the client. D. Keep the​ client's room free of clutter. E. Take the client to the bathroom every 2 hours.

​A. Keep a nightlight on in the room. C. Place nonskid slippers on the client. D. Keep the​ client's room free of clutter. E. Take the client to the bathroom every 2 hours. Rationale: Appropriate nursing interventions for this client to enhance safety include placing nonskid slippers on the​ client, keeping the​ client's room free of​ clutter, placing a nightlight in the​ client's room, and taking the client to the bathroom every 2 hours. Restraints are a last resort and should not be used unless absolutely necessary.

The home health nurse is caring for a client with a lower extremity venous stasis ulcer. Which clinical manifestations would lead the nurse to suspect the client has Alzheimer disease​ (AD)? (Select all that​ apply.) A. Looking for misplaced car keys B. Inability to tell time with a clock C. Evening and nighttime confusion D. Reporting the use of a day planner E. Taking walks up and down the street

​A. Looking for misplaced car keys B. Inability to tell time with a clock C. Evening and nighttime confusion Rationale: Clients with AD may frequently lose items such as car keys and important items. They will also eventually lose the cognitive ability to tell time and be disoriented to place and time. Evening and nighttime​ confusion, called​ sundowning, is a frequent occurrence in clients with AD. Many people use a day planner or calendar to remember important appointments and events. Taking walks up and down the street is a form of exercise. As long as the client knows where he is and how to find his way​ home, this does not indicate AD.

The nurse is teaching a group of adults at a health fair about modifiable risk factors for the onset of Alzheimer disease​ (AD). Which risk factor should the nurse​ include? (Select all that​ apply.) A. Obesity B. Hypertension C. Type 1 diabetes D. Sedentary lifestyle E. Traumatic brain injury

​A. Obesity D. Sedentary lifestyle Rationale: Modifiable risk factors are those that the client can control. This would include controlling weight​ (obesity) and increasing movement​ (sedentary lifestyle). Hypertension and type 1 diabetes can be​ controlled, but not eliminated. A traumatic brain injury cannot be modified.

A nurse is providing information about acetylcholinesterase inhibitors for the spouse of a client diagnosed with Alzheimer disease​ (AD). Which item will the nurse include in the teaching​ session? (Select all that​ apply.) A. Observe the client for improvement in manifestations. B. Notify the healthcare provider if manifestations worsen. C. The medication must be administered 1 hour before meals. D. Do not stop the medication without consulting the healthcare provider. E. Cholinesterase inhibitors will stop the progression of Alzheimer disease.

​A. Observe the client for improvement in manifestations. B. Notify the healthcare provider if manifestations worsen. D. Do not stop the medication without consulting the healthcare provider. Rationale: Appropriate teaching points to include are to not stop the medication without consulting with the healthcare​ provider, to observe for​ improvement, and to notify the healthcare provider if conditions worsen. The medication does not need to be administered 1 hour before a meal. The nurse would not include the teaching point that the medication will stop the progression of AD.

The nurse is providing teaching to a client recently diagnosed with Alzheimer disease. The​ client's daughter wants to know which services the Alzheimer Association offers. Which activity should the nurse include in the​ response? (Select all that​ apply.) A. Support B. Education C. Treatment D. Legal referrals E. Caregiver respite guidance

​A. Support B. Education D. Legal referrals E. Caregiver respite guidance Rationale: The Alzheimer Association provides​ education, support, legal​ referrals, and caregiver respite guidance. It does not provide direct treatment.

The family of a client with Alzheimer disease​ (AD) reports the client is losing weight and having difficulty remembering how to use utensils. Which intervention should the nurse include in the plan of care for this​ client? (Select all that​ apply.) A. Use finger foods. B. Initiate tube feedings. C. Begin total parenteral nutrition. D. Refer the client to a registered dietician. E. Provide liquid supplements such as Ensure or Boost.

​A. Use finger foods. D. Refer the client to a registered dietician. E. Provide liquid supplements such as Ensure or Boost. Rationale: The client with AD may eventually forget how to use utensils for eating and begin to lose weight. Appropriate interventions for the nurse to include would be to incorporate finger foods into the diet. A registered dietician would be able to develop a meal plan for the client. Liquid supplements such as Ensure or Boost would provide a concentrated source of calories and can be used without utensils.

The nurse is discussing the care of a client with Alzheimer disease​ (AD) with the family. The family reports the client has frequent mood swings and becomes combative. Which intervention should the nurse expect the healthcare provider to​ prescribe? A. Implement behavioral interventions. B. Administer selective serotonin reuptake inhibitor​ (SSRI) antidepressants. C. Increase acetylcholinesterase inhibitor dose. D. Utilize physical and chemical restraints.

​B. Administer selective serotonin reuptake inhibitor​ (SSRI) antidepressants. Rationale: Clients with AD will experience frequent mood swings and may become combative. Research shows success in decreasing mood swings with the use of SSRI antidepressants. Increasing the acetylcholinesterase inhibitor dose will not change the​ client's mood. Behavioral interventions may be​ effective, but do not last long. Physical and chemical restraints should be a last resort.

The nurse is caring for a client with stage 3 Alzheimer disease​ (AD) who has become bedridden and requires​ 24-hour care. The family is exhausted and requests assistance. Which intervention would the nurse​ suggest? A. Acetylcholinesterase inhibitor B. Hospice services C. Respite care D. Antipsychotic medication

​C. Respite care Rationale: Respite care is important for the family of a client with AD because the care is exhausting and demanding. Respite care can provide the family a short break to refresh and take care of themselves. Hospice services are for clients with a terminal illness. Hospice may eventually be beneficial for this client and​ family, but there is no information that the client meets hospice criteria yet. An acetylcholinesterase​ (AChE) inhibitor is used to slow the disease progression. This client is in the third and final stage of AD and would likely not derive benefit from this medication. Antipsychotic medication can help calm the client but does not provide relief from the demands of​ 24-hour client care. A healthcare provider must prescribe medications.

A client has been diagnosed with stage 1 Alzheimer disease​ (AD). Which activity should the nurse describe as helpful for the client when meeting with the​ spouse? A. Doing a crossword puzzle each day B. Interacting in group activities C. Writing reminders for appointments D. Driving a car locally

​C. Writing reminders for appointments Rationale: A person with stage 1 AD may need to use assistive devices such as calendars and written instructions to remember important events and appointments. Driving may be dangerous depending on the​ client's mental status. Group activities may be overwhelming for a client with AD and can increase confusion and combativeness. Doing a daily crossword puzzle can stimulate the​ mind, slowing the progression of AD.

Which statement by a family member of a client with Alzheimer disease​ (AD) indicates an understanding of the​ disease? A. ​"Clients with AD have remissions and exacerbations of the​ disease." B. ​"Clients with AD frequently have sexually transmitted​ infections." C. ​"Clients with AD can only be definitively diagnosed with an​ autopsy." D. Clients with AD show rapid improvement in mental status with​ medication."

​C. ​"Clients with AD can only be definitively diagnosed with an​ autopsy." Rationale: Due to the neurofibrillary​ tangles, amyloid plaques can only be noted during an autopsy.​ Therefore, AD can only be diagnosed with an autopsy. Sexually transmitted infections can be a cause of delirium and​ confusion, but they do not cause AD. AD is a progressive deterioration of mental status. The client does not experience remissions and exacerbations. Medication will slow the progression of the disease but does not produce a rapid improvement in mental status.

The nurse is working with a client newly diagnosed with Alzheimer disease​ (AD). The family member asks about the cause of this disease. Which statement explains the etiology of AD to the family​ member? A. ​"Most cases of AD have a genetic basis. These are considered familial and happen to older​ adults." B. ​"Do not worry. Your chances of acquiring the disease are minimal since the genetic mutation skips a​ generation." C. ​"Many theories exist about the cause of AD. One theory is the brain cannot process a specific​ protein." D. ​"Alzheimer disease can be caused by​ infections, new​ medications, and cardiopulmonary​ diseases."

​C. ​"Many theories exist about the cause of AD. One theory is the brain cannot process a specific​ protein." Rationale: Many theories do exist about the cause of AD. This includes the​ cholinergic, amyloid, and tau hypotheses. The amyloid hypothesis is the most accepted one at this point and is based on the brain being unable to process a certain protein called amyloid precursor protein. Familial AD occurs in​ younger, not​ older, adults.​ Infections, new​ medications, and cardiopulmonary diseases can cause delirium or temporary​ confusion, not AD. There is no evidence that AD skips a generation.

A client with a family history of Alzheimer disease​ (AD) asks the nurse how to decrease the risk of developing the disease. How should the nurse​ respond? A. ​"You can take​ over-the-counter gingko biloba to improve​ memory." B. ​"You should decrease intake of alcoholic beverages to decrease the​ risk." C. ​"You should maintain a healthy lifestyle with diet and​ exercise." D. ​"You cannot decrease your risk because this disease is in your​ genetics."

​C. ​"You should maintain a healthy lifestyle with diet and​ exercise." Rationale: The best way to decrease this​ person's risk for acquiring AD is to maintain a healthy lifestyle. This includes diet and exercise. The nurse would not inform the client there is no way to decrease the risk of developing AD since it runs in the family because this is inaccurate.​ Over-the-counter herbal supplements such as gingko biloba and other complementary health approaches have not been proven to help slow the onset of AD. Moderate alcohol consumption is appropriate to decrease the risk.

he nurse is working with a client who presents with​ confusion, losing important​ items, and inappropriate behavior. Which assessment should the nurse anticipate to assist with diagnosis of Alzheimer disease​ (AD)? (Select all that​ apply.) A. Borg scale B. Braden scale C. ​SF-36 health survey D. Presence of dementia E. Mental status examination

​D. Presence of dementia E. Mental status examination Rationale: The presence of​ dementia, a mental status​ examination, and the Alzheimer Disease Assessment Scale are used to diagnose AD. The Borg scale is used to measure perceived exertion during exercise. The​ SF-36 health​ survey, a measure of health status and quality of​ life, is not used to diagnose AD. The Braden scale is used to assess the risk for developing a pressure ulcer.

The nurse is caring for a client with stage 2 Alzheimer disease​ (AD) who is unable to remember how to get dressed. Which nursing intervention would assist the client to maintain​ independence? A. Play a video of a person dressing herself. B. Provide assistance with each step of dressing. C. Give the client pictures of each step to follow. D. Tell the client each step and allow her to perform it.

​D. Tell the client each step and allow her to perform it. Rationale: To maintain independence as much as​ possible, the nurse should tell the client each step to perform and allow the client to do the task. Playing a video or giving the client pictures may be overwhelming. Providing assistance with each step promotes dependence.