Review Practice Excercise 3

Dementia And Alzheimer’s Disease > Mental Health

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Practice Excercise 3

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Total Questions : 6

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Question 1:

A nurse is assessing an older adult with the diagnosis of dementia. Which manifestations are expected in this client? Select all that apply.

A. Resistance to change. B. Inability to recognize familiar objects. C. Preoccupation with personal appearance. D. Inability to concentrate on new activities or interests. E. Tendency to dwell on the past and ignore the present.

Answer and Explanation

Choice A:

Resistance to change is nonspecific and can occur in normal aging, anxiety, or personality traits. While routine dependence may appear, it is not diagnostic. Dementia requires objective cognitive decline with functional impairment—memory, language, praxis, or executive dysfunction—beyond mere preference rigidity.

Choice B:

Inability to recognize familiar objects reflects agnosia, a cortical perceptual deficit common in dementia, especially Alzheimer-type, due to temporo-occipital association cortex dysfunction. Patients misidentify or cannot use familiar items despite intact primary sensation, aligning with progressive neurocognitive disorder pathophysiology.

Choice C:

Preoccupation with personal appearance is atypical; dementia more often shows apathy, neglect of grooming, or reduced insight. Hyperfocus on appearance suggests anxiety, body dysmorphic tendencies, or hypomania rather than neurodegenerative decline characterized by memory impairment and instrumental ADL deterioration.

Choice D:

Difficulty concentrating on new activities is vague. Dementia features impaired new learning and episodic memory, but “inability to concentrate” lacks specificity and overlaps with depression, delirium, or anxiety. Diagnostic weight rests on objective deficits—aphasia, apraxia, agnosia—with functional consequences, not isolated attentional complaints.

Choice E:

Dwelling on the past with present neglect may reflect preserved remote memory with impaired recent memory, but it is not a defining manifestation. Reminiscence can be adaptive or cultural. Dementia diagnosis hinges on measurable cognitive decline across domains and impaired daily functioning, not narrative focus.

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Question 2:

A client says to the nurse: “I read an article about Alzheimer’s and it said the disease is hereditary. My mother has Alzheimer’s disease. Does that mean I’ll get it when I’m old?” The nurse bases her response on the knowledge that which factor is not associated with increased incidence of NCD due to Alzheimer’s disease?

A. Multiple small strokes. B. Family history of Alzheimer’s disease. C. Head trauma. D. Advanced age.

Answer and Explanation

Choice A:

Multiple small strokes contribute to vascular neurocognitive disorder by causing cumulative brain infarcts. These are not a recognized risk factor for Alzheimer’s disease, so they do not increase its incidence.

Choice B:

Family history of Alzheimer’s disease is a significant risk factor due to genetic predisposition, particularly in early-onset forms.

Choice C:

Head trauma increases the risk of Alzheimer’s disease by accelerating amyloid deposition and neuronal injury, contributing to neurodegeneration.

Choice D:

Advanced age is the strongest risk factor; incidence rises sharply after age 65, with prevalence increasing dramatically in older populations.

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Question 3:

A nurse is providing care for several clients who have a diagnosis of dementia. The nurse should adopt a common approach of care because these clients need to:

A. Relate in a consistent manner to staff. B. Learn that the staff cannot be manipulated. C. Accept controls that are concrete and fairly applied. D. Have sameness and consistency in their environment.

Answer and Explanation

Choice A:

Relating consistently to staff is supportive but secondary. The primary therapeutic need is environmental stability, as cognitive decline makes adaptation difficult. Staff consistency helps but does not address the core deficit of disorientation.

Choice B:

Learning that staff cannot be manipulated assumes intact reasoning and insight. Dementia clients lack the cognitive ability for such learning due to impaired executive function and memory, making this rationale inappropriate.

Choice C:

Accepting controls that are concrete and fairly applied emphasizes discipline rather than therapeutic support. Dementia care focuses on minimizing stressors and maintaining orientation, not enforcing behavioral controls, which may increase agitation.

Choice D:

Sameness and consistency in the environment are essential because dementia impairs the ability to process new information and adapt to change. A stable environment minimizes confusion, reduces agitation, and enhances safety by reinforcing familiar cues and routines that support residual cognitive function.

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Question 4:

A 76-year-old client is admitted to a long-term-care facility with a diagnosis of Alzheimer’s-type dementia. The client has been wearing the same dirty clothes for several days, and the nurse contacts the family to bring in clean clothing. Which intervention would best prevent further regression in the client’s personal hygiene?

A. Encouraging the client to perform as much self-care as possible. B. Making the client assume responsibility for physical care. C. Assigning a staff member to take over the client’s physical care. D. Accepting the client’s desire to go without bathing.

Answer and Explanation

Choice A:

Encouraging the client to perform as much self-care as possible maintains independence and prevents further decline in functional abilities. Preserving autonomy supports self-esteem, reduces learned helplessness, and aligns with rehabilitation principles in dementia care. This approach maximizes retained skills while providing assistance only when necessary.

Choice B:

Making the client assume responsibility for physical care is unrealistic because dementia impairs judgment and memory. Forcing responsibility may increase frustration and agitation, as clients lack the cognitive capacity to consistently manage hygiene independently.

Choice C:

Assigning a staff member to take over physical care fosters dependency and accelerates regression. Over-assistance diminishes opportunities for practice of retained abilities, leading to faster decline in activities of daily living and loss of autonomy.

Choice D:

Accepting the client’s desire to go without bathing neglects basic physiological needs and compromises health. Poor hygiene increases risk of infection, skin breakdown, and social isolation. Maslow’s hierarchy prioritizes physical care needs, making this option unsafe and inappropriate.

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Question 5:

A nurse is planning care for a client who has a diagnosis of dementia. Which intervention should the nurse identify as the top priority for this client?

A. Providing foods that are easy to eat. B. Providing the opportunity for rest and sleep. C. Keeping the incontinent client clean and dry. D. Creating a safe environment.

Answer and Explanation

Choice A:

Providing foods that are easy to eat supports nutrition but is not the top priority. While important, nutritional needs come after ensuring safety, as injury or accidents pose immediate threats to survival.

Choice B:

Providing rest and sleep promotes comfort and reduces agitation, but it does not address the immediate risk of harm. Sleep hygiene is supportive but secondary to environmental safety.

Choice C:

Keeping the incontinent client clean and dry maintains skin integrity and dignity, but it is not the highest priority. Hygiene needs are important but do not outweigh the immediate risk of injury from unsafe surroundings.

Choice D:

Creating a safe environment is the priority because dementia clients are prone to wandering, falls, and accidents due to impaired judgment and orientation. Safety interventions—secured areas, removal of hazards, supervision—directly prevent injury and preserve life, aligning with Maslow’s physiological and safety needs.

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Question 6:

A nurse is planning care for a client who has a diagnosis of dementia. Which intervention should the nurse identify as the top priority for this client?

A. Providing foods that are easy to eat. B. Providing the opportunity for rest and sleep. C. Keeping the incontinent client clean and dry. D. Creating a safe environment.

Answer and Explanation

Choice A:

Choice B:

Providing rest and sleep promotes comfort and reduces agitation, but it does not address the immediate risk of harm. Sleep hygiene is supportive but secondary to environmental safety.

Choice C:

Choice D:

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Practice Excercise 3

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