HESI Neurocognitive Disorder (Alzheimer's Disease)
Harry describes Esther's current behaviors, which include increasing memory loss, frequent wandering, inability to perform self-care when she is feeling highly stressed, urinary incontinence, and limited ability to maintain a conversation. He asks the nurse what to expect next. Question 17 of 33 Which is the best response by the nurse?
"Every person responds differently to the disease, but it is likely that her ability to function will continue to decline." This response provides accurate information and an opportunity for further client teaching and emotional support.
What is the best response by the nurse
"The healthcare provider is looking for changes in the brain that are consistent with Alzheimer's disease or for other conditions that can cause Esther's symptoms." Although there are no diagnostic tests that provide a definitive differential diagnosis of Alzheimer's disease, several imaging tests provide data that show changes consistent with AD. Other problems that cause dementia may also be found via neuroimaging tests.
Esther's husband states, "I know this disease will worsen. Shouldn't we wait to use this medication until Esther really needs it?" Question 9 of 33 How should the nurse respond?
"This medication provides the most benefit to persons with early-stage Alzheimer's disease, so it is important to start it right away."
What is the best response by the nurse? Harry reports that Esther frequently makes statements that are inaccurate, but he is reluctant to correct her too often, because she told him that it makes her feel stupid. Question 14 of 33 What is the best response by the nurse?
"You are right to balance her feelings with the need to promote reality." Reality orientation is an important tool for the client with early-stage Alzheimer's disease; however, as the disease progresses, reality orientation often causes the client to become agitated. It is important to recognize the feelings and emotions of the client with Alzheimer's disease.
Harry cares for Esther in their home with the help of the home health care team until her Alzheimer's disease progresses to the point at which she is completely bedridden and is no longer able to perform any self-care measures. Harry notifies the nurse that he plans to place Esther in a long-term care facility. While speaking with the nurse, Harry states, "I think she would be better off if she died, but I feel so guilty for even thinking that." Question 32 of 33 Which response is best for the nurse to provide?
"You have many conflicting emotions right now." This response restates Harry's feelings and provides the opportunity for him to continue to share his concerns.
How many tablets...
0.5
Caregiver Role Strain The nurse recognizes that Harry is experiencing caregiver role strain and develops a plan of care for him. Question 20 of 33 Which questions are most important to ask Harry before developing the plan of care?
A. "How are your children coping with Esther's disease?" This will provide useful information to ascertain whether the children are helping Harry or whether their response is adding to his stress; however, the nurse should involve the children in the conversation to teach the family about the need to provide respite for their father. B. "What do you find most stressful in your daily life?" This question will elicit information concerning the caregiver's perceptions about the stress in his life, which is the most important information for the nurse to obtain. D. "How much time do you spend taking care of yourself?" This will provide useful information on the extent of caregiver support Harry will need. E. "What activities do you attend outside your home?" This will provide useful information that will help in the nurse's discussion with Harry. The nurse will need to discuss the activities with Harry to ascertain whether these activities are providing respite for him. For example, is he visiting with friends for a couple of hours or is he going to the pharmacy or grocery shopping? The latter are task-oriented and do not provide respite.
When the nurse is assessing Esther's cognitive function, which questions are appropriate to include in the mental status exam?
A. Ask E to list three different types of fruits, colors, and animals. E. Give E a photo of a circle and ask her to fill in the times of the clock. F. Ask E what she would do if she smelled gas in the house.
Which information indicates possible serious side effects of trazodone (Desyrel)
A. Esther is also taking MAOIs. MAOIs and trazodone (Desyrel) are antidepressants that cannot be used in conjunction with each other. There must be a 2-week period without MAOIs before trazadone (Desyrel) is administered. B. Esther is complaining of perineal pain. A rare and painful side-effect of trazodone (Desyrel) is persistent engorgement of the clitoris in women or engorgement of the penis, called priaprism, in men. E. Esther has a history of cardiac disease. Trazadone (Desyrel) may exacerbate coronary problems, and the HCP needs to know this history prior to prescribing trazadone (Desyrel).
The nurse provides teaching to Harry to help reduce Esther's urinary incontinence. Which actions are most important for Harry to initiate? SELECT ALL
A. Keep a commode at the bedside. This may be useful in establishing a routine to promote continence, and it will provide easy access for nocturia. C. Take Esther to the bathroom every 2 hours. Continence may be promoted if the client with Alzheimer's disease is taken to the bathroom on a regular schedule of at least every 2 hours during the day. D. Ask Esther if she needs to use the bathroom after meals. This may be useful because it is likely to help establish a pattern that promotes continence. E. Establish a toileting schedule at the same time daily. This is a useful way to promote continence; toileting at the time of arising in the morning, after meals, and before bedtime is a good way to establishing this schedule.
The nurse is concerned that Esther will develop sundowning syndrome. Which instructions should be included when teaching Harry some appropriate measures to reduce this problem?
A. Provide Esther with a relaxing backrub at bedtime. Touch, as well as other relaxation techniques, is useful in reducing the nocturnal confusion referred to as sundowning syndrome. B. Keep some light on in the bedroom at night. Maintaining some light in the room after dark is useful in reducing the nocturnal confusion referred to as sundowning syndrome. E. Provide a calm atmosphere during the day. A calm atmosphere during the day is useful in reducing the nocturnal confusion referred to as sundowning syndrome.
To promote the well-being of a group of clients with Alzheimer's disease, which goals are important for the nurse manager of an adult care center to include in the plan of care?
A. Provide forms of moderate sensory stimulation B. Ensure opportunities for physical activity C. Maintain a calm, consistent environment E. Incorporate pet therapy Provide forms of moderate sensory stimulation. Music and art therapy, as well as other forms of sensory stimulation, may be a part of the care for clients with Alzheimer's disease, but it is essential to avoid over-stimulation to reduce confusion. Ensure opportunities for physical activity. Promoting physical mobility is an important goal. Maintain a calm, consistent environment. To reduce confusion and maintain function as long as possible, it is most important that the nurse control the environment of clients with Alzheimer's disease. Control of the environment will prevent over-stimulation and will ensure a consistent routine. Both are essential to managing the behavior of clients with Alzheimer's disease who are easily agitated. Incorporate pet therapy. Pet therapy is another form of sensory stimulation that may calm clients with Alzheimer's disease.
While the nurse is talking with Esther and securing the IV site with a Kerlix gauze dressing, the charge nurse enters the room assessing the client's behavior and says, "I will prepare medication to calm her." Question 26 of 33 What is the best response by the nurse?
A."Esther needs to be calmed down immediately. her husband is upset" B. The medication will prevent E from harming herself. C. We may not need to administer a medication. let me try to calm her E. Esther says her hip hurts; she has a prescription for pain med. Esther needs to be calmed down immediately. Her husband is upset." The use of an antianxiety medication, such as oxazepam (Serax), represents an appropriate medication when used as prescribed to manage anxiety that is manifested as agitation, especially if the behavior is unsafe, like pulling out the IV line. Chemical restraints, usually antipsychotics, are drugs given for the specific purpose of inhibiting a certain behavior or movement. "The medication will prevent Esther from harming herself." The use of an antianxiety medication prescribed for anxious and agitated behavior in the client with Alzheimer's disease represents an appropriate medication, when used as prescribed to manage unsafe behavior, like pulling out the IV line. Chemical restraints, usually antipsychotics, are drugs given for the specific purpose of inhibiting a certain behavior or movement. "We may not need to administer a medication. Let me try to calm her." This is an assertive response that promotes client advocacy and prevents unnecessary chemical restraint. "Esther says her hip hurts; she has a prescription for pain medication." Assessing the client's complaint of pain is appropriate because clients with Alzheimer's disease may not be able to ask for pain medication. Administering the appropriate prescribed pain medication may alleviate Esther's pain and diminish her anxiety and agitation. Administering appropriate prescribed medication based on an assessment of the client's overall condition or symptoms, for example, sleeping medication for insomnia, antianxiety medication to calm an anxious client, or analgesics for pain management, is not considered a chemical restraint.
Which task can be delegated to the licensed LPN
Administer the first scheduled dose of the prescribed oral antibiotic. This action is within the scope of practice of the LPN. Calculate Esther's intake and output for the shift. This action is within the scope of practice of the LPN.
The nurse recognizes that caregivers need respite from the constant care demands of loved ones with Alzheimer's disease. Question 21 of 33 Which option provides the best respite for Harry?
Adult day care for Esther. While Esther is still ambulatory, she can spend several hours a day at an adult day care facility, which would provide Harry with respite from the constant demands of caring for Esther.
Disease Progression Harry calls the nurse some time later and reports that Esther's behavior is deteriorating more quickly than he was expecting. He states, "It's only been 2 years since all this started. I thought this disease progressed very slowly. Am I doing something wrong?" Question 16 of 33 The nurse's response should be based on which understanding about Alzheimer's disease?
Alzheimer's disease is a chronic disease that can progress with no set sequence and that has a typical lifespan of 5 to 20 years. This most correctly describes the course of Alzheimer's disease.
Which understanding by the nurse regarding Alzheimer's disease is accurate?
Changes in behavior and personality often occur in early Alzheimer's disease - Subtle changes in behavior and personality, which would easily be recognized by a loved one, occur even in early Alzheimer's disease.
Which question is best to ask Esther and her husband to elicit information about possible risk factors for Alzheimer's disease?
Does anyone in your family have AD - There seems to be a genetic predisposition to the development of Alzheimer's disease for many individuals. Genetic testing may be useful for the differential diagnosis because four genes are currently associated with the disease. In addition, information about previous head trauma, exposure to toxic or metal waste, or any viral illnesses should be elicited when the nurse obtains Esther's history.
The nurse obtains the following assessment data: T 96.8° F (36° C), HR 98 beats/min, R 22 breaths/min, BP 74/44 mmHg, O 2 saturation 96%. Question 29 of 33 After the nurse assists Esther to the bed, which nursing action has the highest priority?
Educate unlicensed staff about the need for Esther to rise slowly and ensure close monitoring of Esther. Esther is experiencing postural hypotension secondary to her initial dose of the anti-anxiety medication. The priority nursing action is to provide patient safety. Postural hypotension is a common side effect that occurs when a client, who is taking anti-anxiety medication, stands up too quickly from a lying or sitting position.
One morning a week, Harry participates in a caregiver support group. He finds that sharing his frustrations and concerns with other people experiencing the same situation provides comfort and support, as well as some useful caregiver tips. One male member of the support group jokes about the problems he has taking care of his spouse. Question 22 of 33 How should the nurse facilitator respond to this participant's joking behavior?
Encourage all group members to use humor as a coping mechanism. Humor can serve as an effective coping mechanism for the caregiver of a client with Alzheimer's disease.
Two hours later, the UAP reports to the nurse that Esther is sitting in a chair and finally seems ready to settle down for the night. The UAP reports that Esther is weak, drowsy, and diaphoretic. Question 28 of 33 What action should the nurse take?
Evaluate Esther's vital signs before transferring her to her bed. Esther may be experiencing an adverse effect of the medication, and she should be assessed before further action is initiated.
Which example represents the forgetfulness typical of Alzheimer's disease?
Forgetting to serve dinner after preparing the meal.
Distorted Thought Processes The nurse identifies "distorted thought processes" as a priority problem for Esther. Focusing on this problem, the nurse provides client teaching to Esther's husband, Harry. The nurse instructs Harry about measures to promote cognitive restructuring. Question 13 of 33 Which intervention should the nurse include in the client and family teaching?
Help Esther to recognize the strong emotions that she is feeling. The goal of cognitive restructuring in the client with early-stage Alzheimer's disease is to challenge the client to alter distorted thought patterns and view the world more realistically. One technique is to help the client recognize emotions such as anger, fear, and anxiety.
Medication Therapy Since the lab test results are normal, and neuroimaging tests are consistent with Alzheimer's disease, the nurse develops a plan of care for Esther and her husband that is consistent with the medical diagnosis of Alzheimer's disease. Esther receives prescriptions for trazodone (Desire) and donepezil (Aricept).How should the nurse explain the therapeutic effect of donepezil (Aricept) to the couple?
Improves thinking and functioning abilities. Donepezil (Aricept), classified as an acetylcholinesterase inhibitor, is used in Alzheimer's disease to delay the onset of cognitive decline.
This exam includes which component
Judgment - Evaluation of cognitive function includes assessment of attention, concentration, judgment, perception, learning, memory, communication, language, and speed of processing information.
Esther's husband calls the nurse 2 months later and gives her an update on Esther's condition. Question 11 of 33 Which information indicates the trazodone (Desyrel) is having the desired effect?
Mary sleeps through the night Trazodone (Desyrel) is an antidepressant often used to improve sleep in the client with Alzheimer's disease.
How should the nurse explain this information to Esther and her husband
Normal lab test results help rule out other causes of the symptoms There are many causes of dementia, especially in the older client. Lab tests help rule out treatable causes before a diagnosis of Alzheimer's disease is established.
The nurse also advises Harry that there will come a time when Ester will be unable to recognize the bathroom and he will need to help her to prevent toileting accidents. Question 15 of 33 Which technique is most useful in helping a client with Alzheimer's disease recognize the bathroom?
Place a picture of a toilet on the bathroom door Picture recognition is a useful tool in helping the client with Alzheimer's disease locate the bathroom.
A client at the care center with late-stage Alzheimer's disease becomes distraught when staff members attempt to reorient him to reality. Immediately after lunch, he starts yelling in a loud voice that he is hungry and wants his lunch. Question 24 of 33 What action should the nurse implement?
Provide a snack that the client can eat. Responding to the client's reality is referred to as validation therapy and is a useful intervention to reduce client agitation, especially in the later stages of Alzheimer's disease.
Esther becomes agitated at home and the home health nurse notes that Esther's temperature is elevated. Harry takes Esther to the HCP where she is diagnosed with urosepsis. Esther is admitted to the Medical Center for IV antibiotics. By the second day of hospitalization, Esther's behavior becomes increasingly agitated. While the nurse is administering a dose of antibiotics, Esther attempts to climb out of bed and demonstrates hostile, belligerent behavior toward the nurse. Question 25 of 33 What action should the nurse implement first?
Redirect Esther's attention to holding a stuffed animal. The nurse should first attempt to calm Esther by redirecting her attention or distracting her from the source of the anxiety.
Harry begins to cry. What initial intervention should the nurse implement?
Remain seated next to Harry while he is crying. The nurse should remain with Harry and allow him to cry and then offer additional support and options.
Because Esther will be taking donepezil (Aricept), the nurse schedules her for lab tests in 6 months. Question 10 of 33 Which lab tests should be scheduled?
Serum liver enzymes Liver toxicity is a significant side effect of acetylcholinesterase inhibitors, so liver function tests should be monitored regularly.
After being discharged from the Medical Center, Esther is visited by the home health RN every other week, a home health LPN twice a week, and a home health aide three times a week. Esther's condition gradually worsens. Question 31 of 33 Which member of the home care team should be assigned to revise Esther's plan of care to reflect her changing condition?
The home health nurse who visit every other week. Revision of the plan of care is best performed by the RN who visits the client. It should be based on the nurse's assessment, as well as reports from the LPN and home health aide.
