Chapter 39

The nurse observed the client was late stage Alzheimer's disease eat breakfast. After the client states, " I am hungry and want breakfast." What is the nurses best response? A. "I see you are still hungry. I will get you some toast." B. "you ate your breakfast 30 minutes ago." C. "it appears you're confused this morning." D. "your family will be here soon. Let's get you dressed."

A Use a validation therapy with clients who have late stage Alzheimer disease involves acknowledgment of the clients feelings and concerns. This technique has proved more effective in later stages of the disease because reality orientation only increases agitation. The other statements do not validate the clients concerns.

A nurse teaches assistive personnel about how to care for a client with Parkinson disease. Which statement will the nurse include as part of this teaching? A. Allow the client to be as independent as possible with activities B. Assist the client with frequent and meticulous oral care C. Assess the clients ability to eat and swallow but for each meal D. Schedule appointments early in the morning to ensure rust in the afternoon

A Clients with Parkinson's disease do not move as quickly and can have functional problems. The client would be encouraged to be as independent as possible and provided time to perform activities without rushing. Although oral care is important for all clients, instructing the UAP to provide frequent and meticulous oral care is not a priority for this client. The statement would be a priority of the client was immune compromised or NPO. The nurse would assess the clients ability to eat and swallow, this would not be delegated. Appointments and activities would not be scheduled early in the morning because this may cause the client to be rushed and discourage the client from wanting to participate in activities of daily living ..

The nurse is teaching a family caregiver about how best to communicate with a client who has been diagnosed with Alzheimer's disease. Which statement by the caregiver indicates a need for further teaching? A. I will avoid communicating with a client to prevent agitation B. I should use simple, short sentences and one step instructions C. I can try to use gestures or pictures to communicate with the client D. I will limit the number of choices I provide for the client

A Communication with a client is important to provide cognitive stimulation. Using short simple sentences, using gestures and pictures, and limiting choices provided for the client will help promote communication

The nurse assesses a client who has Parkinson's disease. Which signs and symptoms would the nurse recognize as a key feature of this disease? Select all that apply A. Flexed trunk B. Long, extended steps C. Slow movements D. Uncontrolled drooling E. Tachycardia

A, C, D Key features of Parkinson disease include a flexed trunk, slow and hesitant steps, bradykinesia, and uncontrolled drooling. Tachycardia is not a key feature of this disease

A nurse teaches the spouse of a client who has Alzheimer's disease. Which statements should the nurse include in this teaching related to caregiver stress reduction? Select all that apply A. Establish advanced directives early B. Trust that family and friends will help C. Set aside time each day to be away from the client D. Use discipline to correct inappropriate behaviors E. Secret respite care periodically for longer periods of time

A, C, D To reduce caregiver stress, the spouse should be encouraged to establish advance directives early, set aside time each day for rest or recreation away from the client, seek recite care periodically for longer periods of time, use humor with a client, and explore alternative care settings and resources. Family and friends may not be available to help. A structured environment will assist the client with Alzheimer's but discipline will not correct inappropriate behaviors and not reduce caregiver stress.

The nurse is caring for a client who has Alzheimer's disease. The clients wife states, I am having trouble managing his behaviors at home. Which questions with the nurse asked to assess potential causes of the clients behavioral problems? Select all that apply A. Does your husband bathe and dress himself independently? B. Do you weigh your husband each morning around the same time? C. Does his behavior become worse around large crowds? D. Does your husband eat healthy foods including fruits and vegetables? E. Do you have a clock and calendar in the bedroom and kitchen?

A, C, E To minimize behavior problems, the nurse would encourage the patient to be as independent as possible with ADLs, minimize excessive stimulation, and assist patient to remain oriented. The nurse would assess these activities by asking if the patient is independent with bathing and dressing, if behavior worsens around crowds, and if the clock and single date calendar are readily available. Diet and weight are not related to the management of behavioral problems for a patient with Alzheimer disease.

The nurse is caring for a client in late stage Alzheimer's disease. Which assessment findings will the nurse anticipate? Select all that apply A. Immobile B. Has difficulty driving C. Wandering D. ADL dependent E. Incontinent F. Possible seizures

A, D, E, F The client in late stage Alzheimer's disease is totally bedridden and immobile, and therefore cannot ambulate to wander or drive. The client is in continent and ADL dependent

The nurse cares for a client with middle stage (moderate) Alzheimer disease. The clients caregiver states, " she is always wandering us. What can I do to manage this restless behavior?" What is the nurses best response? A. "this is a sign of fatigue. The client would benefit from a daily nap." B. "engage the client in scheduled activities throughout the day." C. "it sounds like this is difficult for you. I will consult the social worker." D. "The provider can prescribe a mild sedative for restlessness"

B Several strategies may be used to cope with restlessness and wandering. One strategy is to engage the client in structured activities. Another is to take the client for frequent walks. Daily naps and a mild sedative will not be effective in the management of restless behavior. Consulting the social worker does not address the caregivers concern.

A client with early stage Alzheimer's disease is admitted to the hospital with chest pain. Which nursing action is most appropriate to manage this clients dementia? A. Provide animal assisted therapy as needed B. Ensure a structured and consistent environment C. Assist the client with activities of daily living (ADLS) D. Use validation therapy when communicating with the client

B The client who has early Alzheimer's disease does not require assistance with ADLs or validation therapy. While animal assisted therapy may be helpful, some healthcare agencies do not allow this intervention. Therefore, the most appropriate action is to provide a structured inconsistent environment while the client is hospitalized to prevent worsening of the clients symptoms.

The nurse teaches assistive personnel (AP) about how to care for a client with early stage Alzheimer's disease. Which statement with the nurse include? A. If she is confused, play along and pretend that everything is okay B. Remove the clock from her room so that she doesn't get confused C. Re-orient the client to the day, time, and environment with each contact D. Use validation therapy to recognize and acknowledge the clients concerns

C Clients who have early stage Alzheimer disease would be re-oriented frequently to person, place, and time. The assistive personnel would re-orient the client and not encourage the clients delusions. The room should have a clock and whiteboard with the current date written on it. Validation therapy is used with late stage Alzheimer's disease

The nurse is teaching the daughter of a client who has middle stage Alzheimer disease. The daughter asks, " Will the sertraline my mother is taking improve her dementia?" How would the nurse respond about the purpose of the drug? A. "It will allow your mother to live independently for several more years." B. " it is used to hold the advancement of Alzheimer disease but will not curate." C. "It will not improve her dementia but can help control emotional responses." D. "It is used improve short term memory but will not improve problem-solving."

C Drug therapy is not effective for treating dementia are holding the advancement of Alzheimer disease. However, certain psychoactive drugs may help suppress emotional disturbances and manage depression, psychosis, or anxiety. Drug therapy will not allow the client with middle stage dementia to safely live independently.

A client diagnosed with Parkinson's disease will be starting ropinirole for symptom control. Which statement by the client indicates a need for further teaching? A. The stroke should help decrease my tremors and help me move better B. I need to change position slowly to prevent dizziness or falls C. I should take the drug at the same time each day for the best effect D. I know the drug will probably help me prevent constipation

D Although Ropinirole is it dopamine agonist and mimics dopamine to promote movement, it does not work to prevent constipation. This class of drugs can cause orthostatic hypotension and should be taken at the same time every day.

The nurse prepares to discharge a client with early to moderate Alzheimer's disease. Which statement to maintain client safety with the nurse include in the discharge teaching for the caregiver? A. Provide periods of exercise and rest for the client B. Place a padded throw rug at the bedside C. Provide a highly stimulating environment D. Install safety locks on all outside doors

D Clients with early to moderate Alzheimer disease have a tendency to wander, especially at night. If possible, alarms would be installed on all outside doors to alert family members of the client leaves. At a minimum, all outside door should have safety locks installed to prevent a client from going outdoors on supervised. The client would be allowed to exercise within his or her limits, but this action does not ensure his or her safety. Throw rugs are a slip and fall hazard and would be removed. A highly stimulating environment would likely increase the clients confusion.

The primary healthcare provider prescribed Donepezil for a client diagnosed with early stage Alzheimer disease. What teaching about the struggle the nurse provide for the clients family caregiver? A. Monitor the clients temperature because the drug can cause a low-grade fever B. Observed a client for nausea and vomiting to determine drug tolerance C. Donepezil Will prevent the clients dementia from progressing as usual D. Report any client dizziness or falls because the drug can cause bradycardia

D Donepezil is a Cholinesterase inhibitor that may temporarily slow cognitive decline for some clients but does not alter the course of the disease. The family caregiver would want to monitor the clients heart rate and report any incidents of dizziness or falls because the drug can cause bradycardia. It does not typically cause fever or nausea/vomiting

After teaching the wife of a client who has Parkinson's disease, the nurse assesses the wise understanding. Which statement by the clients wife indicates that she correctly understands changes associated with this disease? A. His mask like face makes it difficult to communicate, so I will use a whiteboard B. He should not socialize outside of the house due to uncontrollable drooling C. This disease is associated with anxiety causing increased perspiration D. He may have trouble chewing so I will offer bite-size portions

D Because chewing and swallowing can be problematic, small frequent meals any supplement or better for meeting the clients nutritional needs. A mask like this and Julie are common in clients with Parkinson's disease. The client would be encouraged to continue to socialize and communicate as normally as possible. The wife should understand of the clients mask like this can be misinterpreted and additional time if you need it for the client to communicate with her or others. Excessive perspiration is also common in clients of Parkinson's disease and is associated with the autonomic nervous system's response.

The nurse plans care for a client with Parkinson's disease. Which intervention with the nurse include in this clients plan of care? A. Restrain the client to prevent falling. B. Ensure that the client uses incentive spirometry. C. Teach the client pursed lip breathing techniques. D. Keep the head of the bed at 30° or greater.

D Elevation of the head of the bed will prevent aspiration. The other options will not prevent aspiration, which is the greatest respiratory complication of Parkinson's disease, nor do these interventions of Russ any of the complications of Parkinson's disease. Purse lip breathing increases exhalation of carbon dioxide, incentive spirometry expands the lungs. The client should not be your strain to prevent falls. Other less restrictive intervention should be used to maintain client safety