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Alzheimers
Text Mode Text version of the exam
1) The client with Alzheimers disease is being assisted with activities of daily living when the nurse
notes that the client uses her toothbrush to brush her hair. The nurse is aware that the client is
exhibiting:
Agnosia
Apraxia
Anomia
Aphasia
2) A client with Alzheimers disease is awaiting placement in a skilled nursing facility. Which long-term
plans would be most therapeutic for the client?
Placing mirrors in several locations in the home
Placing a picture of herself in her bedroom
Placing simple signs to indicate the location of the bedroom, bathroom, and so on
Alternating healthcare workers to prevent boredom
3) The client with dementia is experiencing confusion late in the afternoon and before bedtime. The
nurse is aware that the client is experiencing what is known as:
Chronic fatigue syndrome
Normal aging
Sundowning
Delusions
4) Which age group has the highest rate of Alzheimers cases reported?
85 and older
74 to 84
65 to 74
55 to 65
5) A 75 year old client is admitted to the hospital with the diagnosis of dementia of the Alzheimers type
and depression. The symptom that is unrelated to depression would be?
Apathetic response to the environment
I dont know answer to questions
Shallow of labile effect
Neglect of personal hygiene
6) The client with confusion says to the nurse, I havent had anything to eat all day long. When are they
going to bring breakfast? The nurse saw the client in the day room eating breakfast with other clients
30 minutes before this conversation. Which response would be best for the nurse to make?
You know you had breakfast 30 minutes ago.
I am so sorry that they didnt get you breakfast. Ill report it to the charge nurse.
Ill get you some juice and toast. Would you like something else?
You will have to wait a while; lunch will be here in a little while.
7) The nurse is caring for a client with stage III Alzheimers disease. A characteristic of this stage is:
Memory loss
Failing to recognize familiar objects
Wandering at night
Failing to communicate
8) The primary nursing intervention in working with a client with moderate stage dementia is ensuring
that the client:
receives adequate nutrition and hydration
will reminisce to decrease isolation
remains in a safe and secure environment

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independently performs self care

9) During the evaluation of the quality of home care for a client with Alzheimers disease, the priority for
the nurse is to reinforce which statement by a family member?
At least 2 full meals a day is eaten.
We go to a group discussion every week at our community center.
We have safety bars installed in the bathroom and have 24 hour alarms on the
doors.
The medication is not a problem to have it taken 3 times a day.
10) Signs of Alzheimers include which of these symptoms?
Loss of memory
Increase in irritability
Restlessness
All of the above
11) Which neurotransmitter has been implicated in the development of Alzheimers disease?
Acetylcholine
Dopamine
Epinephrine
Serotonin
12) Alzheimers is an INSIDIOUS disease. This means:
that it is terminal
that is can be cured
that it sneaks up on a person over time
that it only affects the elderly
none of the above
13) Edward, a 66 year old client with slight memory impairment and poor concentration is diagnosed
with primary degenerative dementia of the Alzheimers type. Early signs of this dementia include subtle
personality changes and withdrawal from social interactions. To assess for progression to the middle
stage of Alzheimers disease, the nurse should observe the client for:
Occasional irritable outbursts.
Impaired communication.
Lack of spontaneity.
Inability to perform self-care activities.
14) Which of the following is not directly related with Alzheimers disease?
Senile plaques
Diabetes mellitus
Tangles
Dementia
15) Alzheimers is the most common form of which of these?
Malnutrition
Dementia
Fatigue
Psychosis
16) Which nursing intervention is most appropriate for a client with Alzheimers disease who has
frequent episodes emotional lability?
Attempt humor to alter the client mood.
Explore reasons for the clients altered mood.
Reduce environmental stimuli to redirect the clients attention.
Use logic to point out reality aspects.
17) Which of the following is the most common cause of dementia among elderly persons?

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Parkinsons disease
Multiple sclerosis
Amyotrophic lateral sclerosis (Lou Gerhigs disease)
Alzheimers disease
18) Rosana is in the second stage of Alzheimers disease who appears to be in pain. Which question by
Nurse Jenny would best elicit information about the pain?
Where is your pain located?
Do you hurt? (pause) Do you hurt?
Can you describe your pain?
Where do you hurt?
19) Rosana is in the second stage of Alzheimers disease who appears to be in pain. Which question by
Nurse Jenny would best elicit information about the pain?
Where is your pain located?
Do you hurt? (pause) Do you hurt?
Can you describe your pain?
Where do you hurt?
20) How is Alzheimers diagnosed?
Mental-status tests
Blood tests
Neurological tests
All of the above
21) The usual span of years that Alzheimers may progress in the patient is:
three to five years
two to twenty years
fifty to sixty years
6 months to one year
eight to ten years
22) Scientists believe that _________________ develop in the brain of an Alzheimers patient, and may
be a cause of the disease.
cholesterols
tumors
ruptured blood vessels
plaques and tangles
23) To encourage adequate nutritional intake for a female client with Alzheimers disease, the nurse
should:
stay with the client and encourage him to eat.
help the client fill out his menu.
give the client privacy during meals.
fill out the menu for the client.
24) A 93 year-old female with a history of Alzheimers Disease gets admitted to an Alzheimers unit. The
patient has exhibited signs of increased confusion and limited stability with gait. Moreover, the patient is
refusing to use a w/c. Which of the following is the most appropriate course of action for the nurse?
Recommend the patient remain in her room at all times.
Recommend family members bring pictures to the patients room.
Recommend a speech therapy consult to the doctor.
Recommend the patient attempt to walk pushing the w/c for safety.
25) The doctor has prescribed Exelon (rivastigmine) for the client with Alzheimers disease. Which side
effect is most often associated with this drug?
Urinary incontinence

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Headaches
Confusion
Nausea
26) A patient with Stage One Alzheimers might exhibit these behaviors:
forgetting names
missing appointments
getting lost while driving
all of the above
none of the above
27) Which of the following diseases has not been directly linked with Bells palsy?
AIDS
Diabetes
Lyme disease
Alzheimers disease
28) The symptom of dementia that involved a more confused state after dark is called:
dark retreat
sundowning
agitation
dark reaction
29) Which of these is the strongest risk factor for developing the Alzheimers disease?
Heredity
Age
Exposure to toxins
None of the above
30) The priority of care for a client with Alzheimers disease is
Help client develop coping mechanism
Encourage to learn new hobbies and interest
Provide him stimulating environment
Simplify the environment to eliminate the need to make chores
31) An elderly client with Alzheimers disease becomes agitated and combative when a nurse
approaches to help with morning care. The most appropriate nursing intervention in this situation would
be to:
Tell the client family that it is time to get dressed.
Obtain assistance to restrain the client for safety.
Remain calm and talk quietly to the client.
Call the doctor and request an order for sedation.
32) Thomas Elison is a 79 year old man who is admitted with diagnosis of dementia. The doctor orders
a series of laboratory tests to determine whether Mr. Elisons dementia is treatable. The nurse
understands that the most common cause of dementia in this population is:
AIDS
Alzheimers disease
Brain tumors
Vascular disease
33) A patient who has been admitted to the medical unit with new-onset angina also has a diagnosis of
Alzheimers disease. Her husband tells you that he rarely gets a good nights sleep because he needs
to be sure she does not wander during the night. He insists on checking each of the medications you
give her to be sure they are the same as the ones she takes at home. Based on this information, which
nursing diagnosis is most appropriate for this patient?
Decreased Cardiac Output related to poor myocardial contractility

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Caregiver Role Strain related to continuous need for providing care

Ineffective Therapeutic Regimen Management related to poor patient memory
Risk for Falls related to patient wandering behavior during the night
34) Physiologically, what happens to the brain as Alzheimers progresses?
Tissue swells
Fluid collects
Many cells die
Brain-stem atrophies
35) The nurse is aware that the following ways in vascular dementia different from Alzheimers disease
is:
Vascular dementia has more abrupt onset
The duration of vascular dementia is usually brief
Personality change is common in vascular dementia
The inability to perform motor activities occurs in vascular dementia
36) A 65 years old client is in the first stage of Alzheimers disease. Nurse Patricia should plan to focus
this clients care on:
Offering nourishing finger foods to help maintain the clients nutritional status.
Providing emotional support and individual counseling.
Monitoring the client to prevent minor illnesses from turning into major problems.
Suggesting new activities for the client and family to do together.
37) A nurse caring to a client with Alzheimers disease overheard a family member say to the client, if
you pee one more time, I wont give you any more food and drinks. What initial action is best for the
nurse to take?
Take no action because it is the family member saying that to the client
Talk to the family member and explain that what she/he has said is not appropriate
for the client
Give the family member the number for an Elder Abuse Hot line
Document what the family member has said
38) Alzheimers disease is the secondary diagnosis of a client admitted with myocardial infarction.
Which nursing intervention should appear on this clients plan of care?
Perform activities of daily living for the client to decease frustration.
Provide a stimulating environment.
Establish and maintain a routine.
Try to reason with the client as much as possible.
39) As the manager in a long-term-care (LTC) facility, you are in charge of developing a standard plan of
care for residents with Alzheimers disease. Which of these nursing tasks is best to delegate to the LPN
team leaders working in the facility?
Check for improvement in resident memory after medication therapy is initiated.
Use the Mini-Mental State Examination to assess residents every 6 months.
Assist residents to toilet every 2 hours to decrease risk for urinary intolerance.
Develop individualized activity plans after consulting with residents and family.
40) The nurse would expect a client with early Alzheimers disease to have problems with:
Balancing a checkbook.
Self-care measures.
Relating to family members.
Remembering his own name
Answers and Rationales

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B. Apraxia . Apraxia is the inability to use objects appropriately. Agnosia is loss of

sensory comprehension, anomia is the inability to find words, and aphasia is the inability to
speak or understand .
C. Placing simple signs to indicate the location of the bedroom,
bathroom, and so on. Placing simple signs that indicate the location of rooms where the
client sleeps, eats, and bathes will help the client be more independent. Providing mirrors
and pictures is not recommended with the client who has Alzheimers disease because
mirrors and pictures tend to cause agitation, and alternating healthcare workers confuses
the client.
C. Sundowning . Increased confusion at night is known as sundowning
syndrome. This increased confusion occurs when the sun begins to set and continues
during the night.
A. 85 and older
C. Shallow of labile effect
C. Ill get you some juice and toast. Would you like something
else?. The client who is confused might forget that he ate earlier. Dont argue with the
client. Simply get him something to eat that will satisfy him until lunch.
B. Failing to recognize familiar objects . In stage III of Alzheimers disease, the
client develops agnosia, or failure to recognize familiar objects.
C. remains in a safe and secure environment. Safety is a priority
consideration as the clients cognitive ability deteriorates.. receiving adequate nutrition
and hydration is appropriate interventions because the clients cognitive impairment can
affect the clients ability to attend to his nutritional needs, but it is not the priority Patient
is allowed to reminisce but it is not the priority. The client in the moderate stage of
Alzheimers disease will have difficulty in performing activities independently
C. We have safety bars installed in the bathroom and have 24 hour
alarms on the doors. We have safety bars installed in the bathroom and have 24 hour
alarms on the doors. Ensuring safety of the client with increasing memory loss is a priority
of home care. Note all options are correct statements. However, safety is most important
to reinforce.
D. All of the above. Alzheimers sufferers also cant learn new information and
tend to repeat themselves.
A. Acetylcholine. A relative deficiency of acetylcholine is associated with this
disorder. The drugs used in the early stages of Alzheimers disease will act to increase
available acetylcholine in the brain. The remaining neurotransmitters have not been
implicated in Alzheimers disease.
C. that it sneaks up on a person over time
B. Impaired communication. Initially, memory impairment may be the only
cognitive deficit in a client with Alzheimers disease. During the early stage of this disease,
subtle personality changes may also be present. However, other than occasional irritable
outbursts and lack of spontaneity, the client is usually cooperative and exhibits socially
appropriate behavior. Signs of advancement to the middle stage of Alzheimers disease
include exacerbated cognitive impairment with obvious personality changes and impaired
communication, such as inappropriate conversation, actions, and responses. During the
late stage, the client cant perform self-care activities and may become mute.
B. Diabetes mellitus
B. Dementia. It is a collection of symptoms characterized by decreasing
intellectual and social abilities.

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C. Reduce environmental stimuli to redirect the clients attention. The

client with Alzheimers disease can have frequent episode of labile mood, which can best
be handled by decreasing a stimulating environment and redirecting the clients attention.
An over stimulating environment may cause the labile mood, which will be difficult for the
client to understand. The client with Alzheimers disease loses the cognitive ability to
respond to either humor or logic. The client lacks any insight into his or her own behavior
and therefore will be unaware of any causative factors.
D. Alzheimers disease . Alzheimer;s disease, sometimes known as senile
dementia of the Alzheimers type or primary degenerative dementia, is an insidious;
progressive, irreversible, and degenerative disease of the brain whose etiology is still
unknown. Parkinsons disease is a neurologic disorder caused by lesions in the
extrapyramidial system and manifested by tremors, muscle rigidity, hypokinesis,
dysphagia, and dysphonia. Multiple sclerosis, a progressive, degenerative disease involving
demyelination of the nerve fibers, usually begins in young adulthood and is marked by
periods of remission and exacerbation. Amyotrophic lateral sclerosis, a disease marked by
progressive degeneration of the neurons, eventually results in atrophy of all the muscles;
including those necessary for respiration.
B. Do you hurt? (pause) Do you hurt? . When speaking to a client with
Alzheimers disease, the nurse should use close-ended questions.Those that the client can
answer with yes or no
B. Do you hurt? (pause) Do you hurt? When speaking to a client with
Alzheimers disease, the nurse should use close-ended questions.Those that the client can
answer with yes or no whenever possible and avoid questions that require the client to
make choices. Repeating the question aids comprehension.
D. D. All of the above. No single test identifies Alzheimers. Lab tests help rule
out other disorders that may produce similar symptoms. Neurological and mental-status
tests reveal cognitive-function deficits.
B. two to twenty years
D. plaques and tangles
A. stay with the client and encourage him to eat. Staying with the client and
encouraging him to feed himself will ensure adequate food intake. A client with Alzheimers
disease can forget how to eat. Allowing privacy during meals, filling out the menu, or
helping the client to complete the menu doesnt ensure adequate nutritional intake.
B. Recommend family members bring pictures to the patients
room. Stimulation in the form of pictures may decrease signs of confusion.
D. Nausea . Nausea and gastrointestinal upset are very common in clients taking
acetlcholinesterase inhibitors such as Exelon. Other side effects include liver toxicity,
dizziness, unsteadiness, and clumsiness. The client might already be experiencing urinary
incontinence or headaches, but they are not necessarily associated; and the client with
Alzheimers disease is already confused.
D. all of the above
D. Alzheimers disease
B. sundowning
B. Age . Although some studies have shown an association between certain
modifiable lifestyle factors and a reduced risk for Alzheimers disease, the National
Institutes of Health says that age is the strongest known risk factor where most people
receive the diagnosis after age 60. An early onset familial form can also occur, although it
is rare.

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D. Simplify the environment to eliminate the need to make chores

C. Remain calm and talk quietly to the client. Maintaining a calm approach
when intervening with an agitated client is extremely important. Telling the client firmly
that it is time to get dressed may increase his agitation, especially if the nurse touches
him. Restraints are a last resort to ensure client safety and are inappropriate in this
situation. Sedation should be avoided, if possible, because it will interfere with CNS
functioning and may contribute to the clients confusion.
B. Alzheimers disease . Alzheimers disease is the most common cause of
dementia in the elderly population. AIDS, brain tumors and vascular disease are all less
common causes of progressive loss of mental function in elderly patients.
B. Caregiver Role Strain related to continuous need for providing
care. The husbands statement about lack of sleep and anxiety over whether the patient is
receiving the correct medications are behaviors that support this diagnosis. There is no
evidence that the patients cardiac output is decreased. The husbands statements about
how he monitors the patient and his concern with medication administration indicate that
the Risk for Ineffective Therapeutic Regimen Management and falls are not priorities at this
time. Focus: Prioritization
C. Many cells die . Nerve cells change in certain parts of the brain, which causes
brain cells to die. The loss of cells impairs thinking and judgment.
A. Vascular dementia has more abrupt onset . Vascular dementia differs from
Alzheimers disease in that it has a more abrupt onset and runs a highly variable course.
Personally change is common in Alzheimers disease. The duration of delirium is usually
brief. The inability to carry out motor activities is common in Alzheimers disease.
B. Providing emotional support and individual counseling. Clients in the
first stage of Alzheimers disease are aware that something is happening to them and may
become overwhelmed and frightened. Therefore, nursing care typically focuses on
providing emotional support and individual counseling. The other options are appropriate
during the second stage of Alzheimers disease, when the client needs continuous
monitoring to prevent minor illnesses from progressing into major problems and when
maintaining adequate nutrition may become a challenge. During this stage, offering
nourishing finger foods helps clients to feed themselves and maintain adequate nutrition.
B. Talk to the family member and explain that what she/he has said is not
appropriate for the client . This response is the most direct and immediate. This is a
case of potential need for advocacy and patients rights.
C. Establish and maintain a routine. Establishing and maintaining a routine is
essential to decreasing extraneous stimuli. The client should participate in daily care as
much as possible. Attempting to reason with such clients isnt successful, because they
cant participate in abstract thinking.
A. Check for improvement in resident memory after medication therapy is
initiated. LPN education and team leader responsibilities include checking for the
therapeutic and adverse effects of medications. Changes in the residents memory would
be communicated to the RN supervisor, who is responsible for overseeing the plan of care
for each resident. Assessment for changes on the Mini-Mental State Examination and
developing the plan of care are RN responsibilities. Assisting residents with personal care
and hygiene would be delegated to nursing assistants working the LTC facility. Focus:
Delegation
A. Balancing a checkbook. In the early stage of Alzheimers disease, complex
tasks (such as balancing a checkbook) would be the first cognitive deficit to occur. The loss

of self-care ability, problems with relating to family members, and difficulty remembering
ones own name are all areas of cognitive decline that occur later in the disease process.