Review Practice Exercise 6

Dementia And Alzheimer’s Disease > Mental Health

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Practice Exercise 6

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Total Questions : 5

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Question 1:

A nurse is assessing a client with dementia. Which clinical manifestations are expected? Select all that apply.

A. Agitation. B. Pessimism. C. Short attention span. D. Disordered reasoning. E. Impaired motor activities.

Answer and Explanation

Choice A:

Agitation is common due to confusion, disorientation, and frustration with cognitive decline. Neurochemical changes and impaired coping mechanisms contribute to restlessness and irritability, often worsening in unfamiliar environments.

Choice B:

Pessimism is not a defining manifestation of dementia. While mood changes such as depression can coexist, pessimism alone is not a diagnostic feature. Dementia is primarily characterized by cognitive and functional decline rather than personality outlook.

Choice C:

Short attention span occurs because dementia impairs concentration and the ability to sustain focus. Cortical degeneration disrupts attentional networks, leading to distractibility and difficulty completing tasks.

Choice D:

Disordered reasoning reflects impaired executive function. Clients struggle with problem-solving, judgment, and logical thought due to frontal lobe involvement, making decision-making unreliable and unsafe.

Choice E:

Impaired motor activities result from apraxia, a cortical deficit where purposeful movement is disrupted despite intact motor strength. Clients may be unable to perform familiar tasks such as dressing or feeding themselves.

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Question 2:

A client in the early dementia stage of Alzheimer’s disease is admitted to a long-term care facility. Which activities must the nurse initiate? Select all that apply.

A. Weigh the client once a week. B. Have specialized rehabilitation equipment available. C. Keep the client in pajamas and robe most of the day. D. Establish a schedule with periods of rest after activities. E. Review the client’s weekly budget and use of community resources. F. Set up a plan for weekly entertainment through a senior citizens group.

Answer and Explanation

Choice A:

Weekly weighing is important because dementia clients may forget meals, have altered appetite, or experience weight loss. Monitoring ensures nutritional status is maintained and allows early intervention for malnutrition or dehydration.

Choice B:

Specialized rehabilitation equipment is not necessary in early dementia. The focus is on cognitive support and routine, not advanced physical rehabilitation, as motor strength is usually preserved at this stage.

Choice C:

Keeping the client in pajamas fosters dependency and disorientation. Normal clothing supports dignity, orientation to time of day, and maintenance of self-care abilities, which are essential in early dementia.

Choice D:

Establishing a schedule with rest periods supports energy conservation and reduces agitation. Structured routines provide orientation cues, minimize confusion, and balance activity with rest, which is critical in early dementia care.

Choice E:

Reviewing budgets and community resources requires intact executive function, which is impaired in dementia. Expecting financial management is unrealistic and may cause frustration or errors, making this intervention inappropriate.

Choice F:

Weekly social entertainment through senior groups promotes stimulation, reduces isolation, and maintains social skills. Engagement in structured activities helps preserve cognitive function and emotional well-being, slowing decline in early stages.

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Question 3:

A nurse is writing a plan of care for a client diagnosed with dementia. Which of the following are secondary prevention interventions? Select all that apply.

A. Reinforce speech with nonverbal techniques by pointing to and touching items. B. Keep surroundings simple by reducing clutter. C. Offer family ethics consultation or hospice assistance if appropriate. D. Place a large, visible clock and calendar in the client’s room. E. Talk to family members about genetic predisposition regarding dementia.

Answer and Explanation

Choice A:

Reinforcing speech with nonverbal techniques supports communication when verbal ability declines. This intervention reduces frustration and confusion, helping preserve cognitive interaction and slowing deterioration of functional abilities, which is consistent with secondary prevention.

Choice B:

Keeping surroundings simple by reducing clutter minimizes environmental stressors that worsen disorientation. A simplified environment enhances orientation and safety, preventing further confusion and behavioral disturbances, aligning with secondary prevention strategies.

Choice C:

Offering family ethics consultation or hospice assistance is a tertiary prevention measure. It addresses advanced disease stages by focusing on comfort, end-of-life decisions, and quality of life rather than slowing progression.

Choice D:

Placing a large, visible clock and calendar provides external cues that reinforce orientation to time and place. This intervention reduces disorientation and supports memory recall, helping stabilize cognitive decline rather than allowing worsening confusion.

Choice E:

Talking to family members about genetic predisposition is a primary prevention measure. It involves education and risk awareness before disease onset, not interventions for clients already diagnosed with dementia.

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Question 4:

A nurse is working with clients with late-stage Alzheimer’s dementia. Which is a priority intervention?

A. Assist the client to consume fluids and food to prevent electrolyte imbalance. B. Reorient the client to place and time frequently to reduce confusion and fear. C. Encourage the client to participate in their own activities of daily living to promote self-esteem. D. Assist with ambulation to avoid injury from falls.

Answer and Explanation

Choice A:

Late-stage Alzheimer’s commonly causes impaired swallowing and reduced intake, leading to dehydration and electrolyte imbalance that precipitate delirium, cardiac instability, and renal dysfunction. Prioritizing fluids and food addresses physiological survival needs first and reduces aspiration risk with supervised feeding and texture modification.

Choice B:

Frequent reorientation is minimally effective in late-stage disease due to profound memory encoding deficits. Over-reorientation can heighten agitation and distress; supportive validation and environmental cues are preferable, but they do not supersede immediate physiological needs like hydration and nutrition.

Choice C:

Encouraging independent ADLs supports dignity earlier in the course, but late-stage patients have severe apraxia and dependence. Pushing independence may increase fatigue, frustration, and unsafe attempts, while failing to address urgent risks from inadequate intake and metabolic derangements.

Choice D:

Fall prevention is important, yet ambulation assistance is secondary when dysphagia and dehydration threaten acute medical instability. If the patient is weak or hypotensive from poor intake, ambulation may increase fall and syncope risk; stabilize fluids and nutrition first, then implement mobility safety.

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Question 5:

A client is in the hospital with a diagnosis of vascular neurocognitive disorder (NCD). In explaining this disorder to the client’s family, which statement by the nurse is correct?

A. “The client will probably live longer than if his disorder was of the Alzheimer’s type.” B. “Vascular NCD shows step-wise progression. This is why the client sometimes seems okay.” C. “Vascular NCD is caused by plaques and tangles that form in the brain.” D. “The cause of vascular NCD is unknown.”

Answer and Explanation

Choice A:

Survival is variable and depends on comorbidities; vascular NCD does not consistently result in longer survival than Alzheimer’s disease.

Choice B:

The step-wise progression refers to the characteristic pattern of vascular NCD, where cognitive function may remain stable for weeks or months, then suddenly decline after additional cerebrovascular insults. This explains why the client sometimes appears relatively normal between episodes.

Choice C:

Plaques and tangles are characteristic of Alzheimer’s disease, not vascular NCD, which is caused by ischemic or hemorrhagic brain injury.

Choice D:

The cause of vascular NCD is well understood—it results from cerebrovascular disease, not an unknown etiology.

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Practice Exercise 6

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