Review Practice Exercise 5

Dementia And Alzheimer’s Disease > Mental Health

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Practice Exercise 5

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Total Questions : 5

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Question 1:

A nurse is caring for a client diagnosed with Alzheimer’s disease who is prescribed cholinergic medications. Why do these medications help the client?

A. Cholinergics increase acetylcholine in the brain. B. Parasympathetic stimulation helps the client to function at a higher level. C. Sympathetic stimulation is inhibited when cholinergic medications are used. D. The vasodilation caused by cholinergics increases the amount of oxygen available.

Answer and Explanation

Choice A:

Cholinergics increase acetylcholine in the brain by inhibiting acetylcholinesterase, the enzyme responsible for breakdown. This enhances synaptic transmission in cortical and hippocampal regions, improving memory and attention. Although not curative, this mechanism temporarily slows decline and supports functional independence.

Choice B:

Parasympathetic stimulation does not directly improve cognition. The therapeutic effect is specifically related to acetylcholine enhancement in the brain, not systemic parasympathetic activity such as bradycardia or increased secretions.

Choice C:

Sympathetic inhibition is not the mechanism of action. Cholinergic drugs act centrally to increase acetylcholine, not to suppress sympathetic nervous system activity. Autonomic effects are side effects, not therapeutic benefits.

Choice D:

Vasodilation and increased oxygen availability are not the primary therapeutic mechanism. Cognitive improvement is due to enhanced neurotransmission, not vascular changes. Cerebral perfusion is not significantly altered by cholinesterase inhibitors.

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Question 2:

A nurse is teaching a client and family about the characteristics of dementia of the Alzheimer type. What characteristic should the nurse include?

A. Periodic exacerbations. B. Aggressive acting-out behavior. C. Hypoxia of selected areas of brain tissue. D. Areas of brain destruction called senile plaques.

Answer and Explanation

Choice A:

Periodic exacerbations are more characteristic of conditions with fluctuating courses, such as delirium or multiple sclerosis. Alzheimer’s disease is progressive and irreversible, with steady decline rather than episodic worsening and recovery.

Choice B:

Aggressive acting-out behavior may occur in some clients due to frustration or disorientation, but it is not a defining characteristic. The hallmark features are cognitive decline and neuropathological changes, not behavioral aggression.

Choice C:

Hypoxia of selected brain tissue is not the primary mechanism in Alzheimer’s disease. While hypoxia can cause cognitive impairment, Alzheimer’s pathology is specifically linked to amyloid plaques and neurofibrillary tangles, not vascular hypoxia.

Choice D:

Senile plaques are areas of brain destruction formed by abnormal beta-amyloid deposits. These plaques interfere with synaptic transmission, trigger neuroinflammation, and contribute to neuronal death. Their presence, along with neurofibrillary tangles, defines the neuropathology of Alzheimer’s disease and explains the progressive cognitive decline.

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Question 3:

A nurse is reviewing medications indicated for improvement in cognitive functioning in mild to moderate Alzheimer’s disease. Which medications are appropriate? Select all that apply.

A. Donepezil (Aricept). B. Rivastigmine (Exelon). C. Risperidone (Risperdal). D. Sertraline (Zoloft). E. Galantamine (Razadyne).

Answer and Explanation

Choice A:

Donepezil (Aricept) is a cholinesterase inhibitor that prevents acetylcholine breakdown, improving synaptic transmission and enhancing cognition in mild to moderate Alzheimer’s disease.

Choice B:

Rivastigmine (Exelon) inhibits both acetylcholinesterase and butyrylcholinesterase, increasing acetylcholine levels and improving memory, attention, and daily functioning.

Choice C:

Risperidone (Risperdal) is an antipsychotic used for behavioral disturbances in dementia (agitation, aggression), not for improving cognitive function.

Choice D:

Sertraline (Zoloft) is an SSRI antidepressant indicated for depression or anxiety; it does not directly enhance cognition in Alzheimer’s disease.

Choice E:

Galantamine (Razadyne) is another cholinesterase inhibitor that enhances cholinergic transmission and can modestly improve cognitive performance and behavioral symptoms.

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Question 4:

A client has a nursing diagnosis of disturbed sleep patterns related to increased anxiety as evidenced by an inability to fall asleep. Which short-term outcome is appropriate for this client?

A. The client will use one coping skill before bedtime to assist in falling asleep. B. The client will sleep 6 to 8 hours a night and report a feeling of being rested. C. The client will ask for prescribed PRN medication to assist with falling asleep by day 2. D. The client will verbalize his or her level of anxiety as less than a 3/10.

Answer and Explanation

Choice A:

Using one coping skill before bedtime is a specific, measurable, and realistic short-term outcome that directly addresses the client’s inability to fall asleep caused by anxiety. It focuses on an immediate, achievable intervention.

Choice B:

Sleeping 6–8 hours and feeling rested is a long-term goal, not a short-term, immediately achievable outcome, and may not be realistic without first addressing anxiety.

Choice C:

Asking for PRN medication is dependent on nurse/administered interventions and is not a measure of the client’s own active coping or skill use; it is intervention-focused, not outcome-focused.

Choice D:

Verbalizing anxiety less than 3/10 is a cognitive outcome, which may take longer and does not directly measure the short-term goal of falling asleep.

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Question 5:

A client diagnosed with primary dementia has a nursing diagnosis of altered thought process related to disorientation and confusion. Which nursing intervention should be implemented first?

A. Use tranquilizing medications and soft restraints B. Continually orient client to reality and surroundings C. Assess client’s level of disorientation and confusion D. Remove potentially harmful objects from the client’s room

Answer and Explanation

Choice A:

Using tranquilizers or restraints first is inappropriate; these interventions are last-resort measures and may worsen confusion or agitation if applied without prior assessment and justification.

Choice B:

Continual orientation is important, but its effectiveness depends on knowing the client’s current cognitive status; orientation strategies without assessment may be ineffective or frustrating.

Choice C:

Assessing the client’s disorientation and confusion provides critical baseline data to determine severity, triggers, and risks. Without assessment, interventions may be inappropriate or unsafe, and care cannot be tailored effectively to the client’s cognitive abilities.

Choice D:

Removing harmful objects improves safety, but prioritization requires knowing the client’s specific behaviors and level of risk, which comes from a proper assessment first.

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Practice Exercise 5

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