A nurse is caring for a client who has Alzheimer's disease.
Which of the following findings should the nurse expect?

Altered level of consciousness.

Rapid mood swings.

Excessive motor activity.

Failure to recognize familiar objects.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

An altered level of consciousness is a common finding in clients with Alzheimer's disease. This may range from mild confusion to severe cognitive impairment. It is caused by the degeneration of brain cells and affects memory, thinking, and behavior.

Choice B rationale:

Rapid mood swings are not specific to Alzheimer's disease. While mood changes can occur, they are not typically characterized by rapid swings. Mood disturbances may include depression, apathy, or irritability, but these symptoms are not unique to Alzheimer's disease.

Choice C rationale:

Excessive motor activity is not a typical finding in clients with Alzheimer's disease. Instead, clients often experience a decline in motor skills and coordination as the disease progresses. Restlessness or agitation might occur, but excessive motor activity is not a characteristic feature.

Choice D rationale:

Failure to recognize familiar objects, people, or places is a common symptom of Alzheimer's disease. This is due to the damage and loss of nerve cells in the brain. As the disease advances, clients may have difficulty recognizing even close family members or their own reflection in the mirror.

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Correct Answer is C

Explanation

The correct answer is Choice C.

Choice A rationale: Eating a meal prior to postural drainage is not recommended.Postural drainage uses gravity to help clear mucus from the lungs, and having a full stomach can cause discomfort and potentially lead to vomiting 1.

Choice B rationale: Pancrelipase is a medication that replaces digestive enzymes produced by the pancreas.Most people with cystic fibrosis benefit from taking pancrelipase to aid their digestion 2. However, it is not specifically required prior to postural drainage.

Choice C rationale: Using an albuterol inhaler prior to postural drainage is beneficial.Albuterol is a bronchodilator that helps open the airways, making it easier to clear mucus from the lungs 3 4. This is why it’s recommended to use prior to postural drainage.

Choice D rationale: While maintaining good oral hygiene is important for overall health, it is not specifically required prior to postural drainage

A. Maintain the irrigation solution rate. B. Replace the indwelling urinary catheter. C. Perform the Credé's maneuver. D. Warm the irrigation solution.

Correct Answer is A

Explanation

Choice A rationale:

Maintaining the irrigation solution rate is appropriate in this situation. Pink-tinged urine in the drainage bag indicates the presence of blood, which is expected after a transurethral resection of the prostate. However, if the bleeding becomes excessive, the healthcare provider should be notified. Adjusting the irrigation solution rate might be necessary based on the provider's orders, but abruptly changing the rate without medical direction could lead to complications.

Choice B rationale:

Replacing the indwelling urinary catheter is not necessary solely based on the presence of pink-tinged urine. It is essential to assess the patient's overall condition and the extent of bleeding before considering catheter replacement. Catheter replacement without a valid reason can increase the risk of infection and discomfort for the patient.

Choice C rationale:

Performing the Credé's maneuver involves manual compression of the bladder to assist with urine elimination. This maneuver is not indicated in this situation and could potentially cause harm or disrupt the continuous bladder irrigation. It is essential to follow evidence-based practices and avoid interventions that are not appropriate for the patient's condition.

Choice D rationale:

Warming the irrigation solution is not relevant to the situation described. The presence of pink-tinged urine suggests bleeding, which requires careful monitoring and appropriate medical intervention. Warming the solution does not address the underlying cause of the bleeding and should not be the nurse's primary concern in this scenario.

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A nurse is caring for a client who has Alzheimer's disease.Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for an adolescent client who has cystic fibrosis. Which of the following actions should the nurse instruct the client to take prior to initiating postural drainage?

Correct Answer is C

Explanation

A nurse is assessing a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate 4 hr ago.The nurse notes pink-tinged urine in the drainage bag.Which of the following actions should the nurse take?

Correct Answer is A

Explanation

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A nurse is caring for a client who has Alzheimer's disease.
Which of the following findings should the nurse expect?