Stages of Alzheimer's Disease

A nurse is preparing an in-service session about Alzheimer's disease for a group of newly licensed nurses. Which of the following findings should the nurse include as an early manifestation in the progression of the disease? A. Forgetting material that was just read B. Losing the ability to feel emotions C. Experiencing changes in physical abilities such as swallowing D. Having difficulty controlling the bladder

Correct Answer: A Rational: Forgetting material that has just been read is a sign of mild Alzheimer's and is an early manifestation of the disease. Mild memory impairment includes recent memory. Gradually, deterioration progresses to include both recent and remote memory.

A nurse is administering intermittent IV antibiotic therapy for a client who has Alzheimer's disease. The client repeatedly attempts to remove the IV access line during the medication administration. Which of the following actions should the nurse take? A. Assign an assistive personnel to remain with the client during the medication administration. B. Call the provider and request a prescription for an oral antibiotic. C. Give the client a PRN sedative 30 min before the IV medication is scheduled. D. Place bilateral wrist restraints on the client during the antibiotic infusion.

Correct Answer: A Rational: The nurse should assign an AP to remain with the client to prevent the client from removing the IV access line during antibiotic treatment. This practice is the least restrictive and is within the AP's range of function.

A nurse is teaching the family of a client who has Alzheimer's disease about donepezil. Which of the following statements should the nurse include in the teaching? A. "Donepezil can improve cognitive functioning during the earlier stages of the disease." B. "Donepezil cures the disease process if started at the first recognition of dementia." C. "Donepezil provides long-term reversal of memory loss in the last phase of the disease." D. "Donepezil accelerates the breakdown of acetylcholine within the client's brain."

Correct Answer: A Rational: The nurse should inform the family that donepezil is used to treat the manifestations of mild to severe Alzheimer's disease. Although donepezil does not prevent the progression of Alzheimer's disease, it is intended to prolong the client's ability to function in the early stages of the disease.

A nurse is caring for a client who has Alzheimer's disease and becomes agitated while refusing morning hygiene care. Which of the following actions should the nurse take? A. Talk to the client from 2 arm-lengths away B. Obtain assistance to restrain the client for safety C. Firmly state to the client that morning care will be performed D. Call the provider to request a prescription for an antipsychotic medication

Correct Answer: A Rational: The nurse should talk calmly and quietly to the client to decrease agitation. The nurse should remain 1 to 2 arm-lengths away to provide a sense of personal space and maintain safety if the client becomes aggressive.

A nurse is caring for a client who has moderate Alzheimer's disease. Which of the following actions should the nurse take? A. Add gestures when speaking with the client B. Ask open-ended questions C. Limit visitors to 3 at a time D. Use different words if the client does not understand a statement

Correct Answer: A Rational: The nurse should use gestures when speaking with the client to increase the client's understanding of the conversation.

A nurse is caring for a client who takes warfarin to treat chronic atrial fibrillation and has early manifestations of Alzheimer's disease. The client's partner asks the nurse if the client would benefit from taking ginkgo biloba. Which of the following responses should the nurse make? A. "Ginkgo biloba will likely interfere with the effectiveness of his other medications." B. "You should ask his provider if ginkgo biloba is safe." C. "Ginkgo biloba is most effective in the later stages of Alzheimer's disease." D. "People who have Alzheimer's disease should adhere to the medication regimen their provider prescribes."

Correct Answer: A Rational:Ginkgo biloba may delay the mental deterioration of Alzheimer's disease if taken in the early stages. Research has not demonstrated this, however. More importantly, ginkgo biloba increase the client's risk of bleeding when taken with warfarin.

When administering a mental status examination to a patient, the nurse suspects depression when the patient responds with a. "I don't know." b. "Is that the right answer?" c. "Wait, let me think about that." d. "Who are those people over there?"

Correct Answer: A Rationale: Answers such as "I don't know" are more typical of depression. The response "Who are those people over there?" is more typical of the distraction seen in a patient with delirium. The remaining two answers are more typical of a patient with dementia.

The nurse has identified the nursing diagnosis of disturbed thought processes related to effects of dementia for a patient with late-stage Alzheimer's disease (AD). An appropriate intervention for this problem is to a. maintain a consistent daily routine for the patient's care. b. encourage the patient to discuss events from the past. c. reorient the patient to the date and time every few hours. d. provide the patient with current newspapers and magazines.

Correct Answer: A Rationale: Providing a consistent routine will decrease anxiety and confusion for the patient. In late-stage AD, the patient will not remember events from the past. Reorientation to time and place will not be helpful to the patient with late-stage AD. The patient with late-stage AD will not be able to read.

Risperidone (Risperdal) is prescribed for an outpatient with moderate Alzheimer's disease (AD). Which information obtained by the nurse at the next clinic appointment indicates that the medication is effective? a. The patient has less agitation. b. The patient is dressed appropriately. c. The patient is able to swallow a pill. d. The patient's speech is clearer.

Correct Answer: A Rationale: Risperidone is an antipsychotic used to treat the agitation, aggression, and behavioral problems associated with AD. The other improvements might occur with cholinesterase inhibitors.

A nurse is teaching about taking donepezil with a client who was recently diagnosed with early Alzheimer's disease. Which of the following instructions should the nurse include in the teaching? A. "You should chew the medication thoroughly prior to swallowing." B. "You should take this medication late in the evening." C. "You should take this medication with food." D. "If you miss taking a dose for a day, take 2 doses the following day."

Correct Answer: B Rational: The nurse should instruct the client to take donepezil late in the evening, just before going to bed.

A home health nurse is providing teaching for the family of a client who has moderate Alzheimer's disease. The family plans to care for the client in the home. Which of the following recommendations should the nurse include in the teaching? A. Place nonskid throw rugs over smooth floors B. Install locks at the tops of exterior doors C. Provide clothing that has zippers instead of buttons D. Encourage the client to take frequent naps during the day

Correct Answer: B Rational: The nurse should instruct the family that the client is at an increased risk for wandering and getting lost. A safety intervention to decrease the risk for wandering is to install locks at the tops of exterior doors since the client who has moderate Alzheimer's disease loses the ability to reach and look upward.

A family member of a patient with possible Alzheimer's disease asks the nurse the purpose of the Mini-Mental State Examination (MMSE). Which response by the nurse is appropriate? a. The MMSE helps in establishing the diagnosis of Alzheimer's disease (AD). b. The MMSE is useful in determining the degree of mental impairment. c. The MMSE determines the choice of the most appropriate treatment. d. The MMSE aids in differentiating acute delirium from chronic dementia.

Correct Answer: B Rationale: The MMSE establishes the degree of mental impairment at the time it is given. It does not establish a diagnosis of AD but when given repeatedly over time may help to determine the progression of AD. The choice of treatment is made on the basis of multiple data, not just the MMSE. The MMSE may be abnormal with either delirium or dementia and is not useful in determining which condition the patient has.

When teaching the spouse of a patient who is being evaluated for Alzheimer's disease (AD) about the disorder, the nurse explains that a. the most important risk factor for AD is a family history of the disorder. b. a diagnosis of AD can be made only when other causes of dementia have been ruled out. c. new drugs have been shown to reverse AD dramatically in some patients. d. the presence of brain atrophy detected by MRI confirms the diagnosis of AD in patients with dementia.

Correct Answer: B Rationale: The diagnosis of AD is one of exclusion. Age is the most important risk factor for development of AD. Drugs can slow the deterioration but do not dramatically reverse the effects of AD. Brain atrophy is a common finding in AD, but it can occur in other diseases as well.

A nurse is providing support for a client who is grieving the loss of her mother who died from Alzheimer's disease. Which of the following statements should the nurse make? A. "I know how you're feeling. I recently lost my father." B. "It must be very difficult for you to deal with your mother's death." C. "Hopefully, knowing your mother is in a better place provides you with some comfort." D. "I want you to let me know what I can do to help you cope with your mother's death."

Correct Answer: B\ Rational: The nurse should use therapeutic communication when supporting a client who is grieving. This statement focuses the conversation on the client by acknowledging her grief and encourages further communication.

A home health nurse is speaking with the caregiver of a client who has Alzheimer's disease. The caregiver asks the nurse why the client becomes disoriented, confused, and often combative later in the day. Which of the following conditions should the nurse plan to report to the provider? A. Electrolyte imbalance B. Hypothyroidism C. Sundowning D. Adverse effect of medication

Correct Answer: C Rational: Sundowning, an increase in confusion beginning in the afternoon and lasting into the night, is a common manifestation of Alzheimer's disease. The client can become confused, aggressive, agitated, and obsessive, leading to severe disorientation.

A nurse is speaking to a community group about the diagnosis and treatment of clients who have Alzheimer's disease. The nurse should conclude that the group requires further teaching when a member identifies which of the following findings as a manifestation of Alzheimer's disease? A. Impaired judgment B. Sudden confusion C. Personality change D. Remote memory loss

Correct Answer: C Rational: The nurse should clarify that a client who has Alzheimer's disease is expected to exhibit confusion that develops slowly over months. Clients who have delirium exhibit sudden confusion.

A nurse at a long-term care facility is planning care for a client who has Alzheimer's disease and wanders at night. Which of the following interventions should the nurse include in the plan? A. Place the client in wrist restraints at night. B. Request a prescription for a psychotropic medication. C. Assign the client to a room closer to the nurse's station. D. Keep the television on at night.

Correct Answer: C Rational: The nurse should place the client who wanders in a room that allows close observation. The nurse should provide a safe place to walk for clients who wander and supervision when ambulating.

A home-health patient with Alzheimer's disease (AD) and mild dementia has a new prescription for donepezil (Aricept). Which nursing action will be most effective in ensuring compliance with the medication? a. Setting the medications up weekly in a medication box b. Calling the patient daily with a reminder to take the medication c. Having the patient's spouse administer the medication d. Posting reminders to take the medications in the patient's house

Correct Answer: C Rationale: Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the Aricept. The other nursing actions will not be as effective in ensuring that the patient takes the medications.

When assessing a patient with Alzheimer's disease (AD) who is being admitted to a long-term care facility, the nurse learns that the patient has had several episodes of wandering away from home. Which nursing action will the nurse include in the plan of care? a. Ask the patient why the wandering episodes have occurred. b. Reorient the patient to the new living situation several times daily. c. Place the patient in a room close to the nurses' station. d. Have the family bring in familiar items from the patient's home.

Correct Answer: C Rationale: Patients at risk for problems with safety require close supervision. Placing the patient near the nurse's station will allow nursing staff to observe the patient more closely. Use of "why" questions is frustrating for the patient with AD, who are unable to understand clearly or verbalize the reason for wandering behaviors. Because of the patient's short-term memory loss, reorientation will not help to prevent wandering behavior. Because the patient had wandering behavior at home, familiar objects will not prevent wandering.

A patient with Alzheimer's disease (AD) is hospitalized with a urinary tract infection. The spouse tells the nurse, "I am just exhausted from the constant care and worry. We don't have any children and we can't afford a nursing home. I don't know what to do." The most appropriate nursing diagnosis for the spouse is a. anxiety related to limited financial resources. b. ineffective health maintenance related to stress. c. caregiver role strain related to limited resources for caregiving. d. social isolation related to unrelieved caregiving responsibilities.

Correct Answer: C Rationale: The spouse's statements are most consistent with caregiver role strain. The other diagnoses each address one aspect of the spouse's problem, but caregiver-role strain related to limited resources for caregiving addresses all the information the nurse has about this situation.

A nurse is providing teaching to the family of a client who has stage II Alzheimer's disease (AD). Which of the following pieces of information should the nurse include in the teaching? A. Place abstract pictures on the wall in the client's room B. Provide music for the client using headphones C. Reorient the client to reality frequently D. Limit choices offered to the client

Correct Answer: D Rational: Choices should be limited for a client who has stage II AD to reduce confusion and frustration.

A nurse is caring for a client who has Alzheimer's disease and a new prescription for donepezil. Which of the following actions should the nurse take? A. Monitor the client's liver function while taking this medication B. Increase the dosage of this medication every 72 hr C. Offer the client a PRN NSAID while taking this medication D. Administer the medication at bedtime

Correct Answer: D Rational: Donepezil is used to treat the manifestations of mild to moderate Alzheimer's disease. The nurse should administer this medication at bedtime to reduce the risk of injury due to bradycardia and syncope.

A nurse is assessing a client who has Stage 4 Alzheimer's disease. Which of the following findings should the nurse expect? A. The client requires assistance with eating. B. The client independently manages personal finances. C. The client has bladder incontinence. D. The client is able to identify the names of family members.

Correct Answer: D Rational: The nurse should expect this client who has Stage 4 Alzheimer's disease to recognize and identify family members. Clients who have Alzheimer's disease maintain this ability until Stage 6

Difficulty coming up with the right word or name

Mild

Forgetfulness beyond what is seen in a normal patient

Mild

Loss of initiative and interest

Mild

May forget recent events, names, and objects

Mild

May no longer be able to solve simple math problems

Mild

Short-term memory impairment (especially for new learnings)

Mild

Agitation and restlessness

Moderate

Behavioral probelms

Moderate

Behavioral problems

Moderate

Delusions/ hallucinations/paranioa

Moderate

May have episodes of incontinence

Moderate

May have trouble sleeping

Moderate

May lack judgment, begin to wander and get lost

Moderate

May need help getting dressed

Moderate

Memory loss and confusion becomes more obvious

Moderate

More trouble organizing and planning

Moderate

More trouble organizing, planning, and following directions

Moderate

Trouble recognizing family members, and friends

Moderate

Immobility

Severe

Incontinence

Severe

Little memory, and is unable to process any new information

Severe

Little memory, unable to process any new information

Severe

May have problems eating and swallowing

Severe

May not be able to talk

Severe

May not be able to walk or sit up with out help

Severe

Often needs help with daily needs

Severe

Require around-the clock assistance with daily personal care

Severe

Severe impairment of all cognitive functions

Severe

Unable to perform self-care activities

Severe

slowly loses ability to plan and organize

mild