CHAPTER

60 Nursing Management: Alzheimer’s

Disease, Dementia, and Delirium

1. What manifestations of cognitive impairment are primarily characteristic of delirium (select all that apply)?
a. Reduced awareness
b. Impaired judgments
c. Words difficult to find
d. Sleep/wake cycle reversed
e. Distorted thinking and perception
f. Insidious onset with prolonged duration

2. Which statement accurately describes dementia?

a. Overproduction of β-amyloid protein causes all dementias.
b. Dementia resulting from neurodegenerative causes can be prevented.
c. Dementia caused by hepatic or renal encephalopathy cannot be reversed.
d. Vascular dementia can be diagnosed by brain lesions identified with neuroimaging.

3. A patient with Alzheimer’s disease (AD) dementia has manifestations of depression. The nurse knows that treatment
of the patient with antidepressants will most likely do what?
a. Improve cognitive function
b. Not alter the course of either condition
c. Cause interactions with the drugs used to treat the dementia
d. Be contraindicated because of the central nervous system (CNS)–depressant effect of antidepressants

4. For what purpose would the nurse use the Mini-Mental State Examination to evaluate a patient with cognitive
impairment?
a. It is a good tool to determine the etiology of dementia.
b. It is a good tool to evaluate mood and thought processes.
c. It can help to document the degree of cognitive impairment in delirium and dementia.
d. It is useful for initial evaluation of mental status but additional tools are needed to evaluate changes in cognition
over time.

5. During assessment of a patient with dementia, the nurse determines that the condition is potentially reversible when
finding out what about the patient?
a. Has long-standing abuse of alcohol
b. Has a history of Parkinson’s disease
c. Recently developed symptoms of hypothyroidism
d. Was infected with human immunodeficiency virus (HIV) 10 years ago

6. The husband of a patient is complaining that his wife’s memory has been decreasing lately. When asked for
examples of her memory loss, the husband says that she is forgetting the neighbors’ names and forgot their
granddaughter’s birthday. What kind of loss does the nurse recognize this to be?
a. Delirium
b. Memory loss in AD
c. Normal forgetfulness
d. Memory loss in mild cognitive impairment

7. The wife of a patient who is manifesting deterioration in memory asks the nurse whether her husband has AD.
The nurse explains that a diagnosis of AD is usually made when what happens?
a. A urine test indicates elevated levels of isoprostanes
b. All other possible causes of dementia have been eliminated
c. Blood analysis reveals increased amounts of β-amyloid protein
d. A computed tomography (CT) scan of the brain indicates brain atrophy
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 Chapter 60 Nursing Management: Alzheimer’s Disease, Dementia, and Delirium 271

8. The newly admitted patient has moderate AD. What does the nurse know this patient will need help with?
a. Eating
b. Walking
c. Dressing
d. Self-care activities

9. What is one focus of collaborative care of patients with AD?

a. Replacement of deficient acetylcholine in the brain
b. Drug therapy for cognitive problems and undesirable behaviors
c. The use of memory-enhancing techniques to delay disease progression
d. Prevention of other chronic diseases that hasten the progression of AD

10. The patient is receiving donepezil (Aricept), lorazepam (Ativan), risperidone (Risperdal), and sertraline (Zoloft) for
the management of AD. What benzodiazepine medication is being used to help manage this patient’s behavior?
a. Sertraline (Zoloft)
b. Donepezil (Aricept)
c. Lorazepam (Ativan)
d. Risperidone (Risperdal)

11. What N-methyl-d-aspartate (NMDA) receptor antagonist is frequently used for a patient with AD who is
experiencing decreased memory and cognition?
a. Trazodone (Desyrel)
b. Olanzapine (Zyprexa)
c. Rivastigmine (Exelon)
d. Memantine (Namenda)

12. A patient with AD in a long-term care facility is wandering the halls very agitated, asking for her “mommy” and
crying. What is the best response by the nurse?
a. Ask the patient, “Why are you behaving this way?”
b. Tell the patient, “Let’s go get a snack in the kitchen.”
c. Ask the patient, “Wouldn’t you like to lie down now?”
d. Tell the patient, “Just take some deep breaths and calm down.”

13. The sister of a patient with AD asks the nurse whether prevention of the disease is possible. In responding, the nurse
explains that there is no known way to prevent AD but there are ways to keep the brain healthy. What is included in
the ways to keep the brain healthy (select all that apply)?
a. Avoid trauma to the brain.
b. Recognize and treat depression early.
c. Avoid social gatherings to avoid infections.
d. Do not overtax the brain by trying to learn new skills.
e. Daily wine intake will increase circulation to the brain.
f. Exercise regularly to decrease the risk for cognitive decline.

14. The son of a patient with early-onset AD asks if he will get AD. What should the nurse tell this man about the
genetics of AD?
a. The risk of early-onset AD for the children of parents with it is about 50%.
b. Women get AD more often than men do, so his chances of getting AD are slim.
c. The blood test for the ApoE gene to identify this type of AD can predict who will develop it.
d. This type of AD is not as complex as regular AD, so he does not need to worry about getting AD.

15. A patient with moderate AD has a nursing diagnosis of impaired memory related to effects of dementia. What is an
appropriate nursing intervention for this patient?
a. Post clocks and calendars in the patient’s environment.
b. Establish and consistently follow a daily schedule with the patient.
c. Monitor the patient’s activities to maintain a safe patient environment.
d. Stimulate thought processes by asking the patient questions about recent activities.

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272 Chapter 60 Nursing Management: Alzheimer’s Disease, Dementia, and Delirium

16. The family caregiver for a patient with AD expresses an inability to make decisions, concentrate, or sleep. The nurse
determines what about the caregiver?
a. The caregiver is also developing signs of AD.
b. The caregiver is manifesting symptoms of caregiver role strain.
c. The caregiver needs a period of respite from care of the patient.
d. The caregiver should ask other family members to participate in the patient’s care.

17. The wife of a man with moderate AD has a nursing diagnosis of social isolation related to diminishing social
relationships and behavioral problems of the patient with AD. What is a nursing intervention that would be
appropriate to provide respite care and allow the wife to have satisfactory contact with significant others?
a. Help the wife to arrange for adult day care for the patient.
b. Encourage permanent placement of the patient in the Alzheimer’s unit of a long-term care facility.
c. Refer the wife to a home health agency to arrange daily home nursing visits to assist with the patient’s care.
d. Arrange for hospitalization of the patient for 3 or 4 days so that the wife can visit out-of-town friends and
relatives.

18. The health care provider is trying to differentiate the diagnosis of the patient between dementia and dementia with
Lewy bodies (DLB). What observations by the nurse support a diagnosis of DLB (select all that apply)?
a. Tremors
b. Fluctuating cognitive ability
c. Disturbed behavior, sleep, and personality
d. Symptoms of pneumonia, including congested lung sounds
e. Bradykinesia, rigidity, and postural instability without tremor

19. Delegation Decision: The RN in charge at a long-term care facility could delegate which activities to unlicensed
assistive personnel (UAP) (select all that apply)?
a. Assist the patient with eating.
b. Provide personal hygiene and skin care.
c. Check the environment for safety hazards.
d. Assist the patient to the bathroom at regular intervals.
e. Monitor for skin breakdown and swallowing difficulties.

20. A 72-year-old woman is hospitalized in the intensive care unit (ICU) with pneumonia resulting from chronic
obstructive pulmonary disease (COPD). She has a fever, productive cough, and adventitious breath sounds
throughout her lungs. In the past 24 hours her fluid intake was 1000 mL and her urine output was 700 mL. She was
diagnosed with early-stage AD 6 months ago but has been able to maintain her activities of daily living (ADLs) with
supervision. Identify at least six risk factors for the development of delirium in this patient.
a.
b.
c.
d.
e.
f.

21. A 68-year-old man is admitted to the emergency department with multiple blunt trauma following a one-vehicle car
accident. He is restless; disoriented to person, place, and time; and agitated. He resists attempts at examination and
calls out the name “Janice.” Why should the nurse suspect delirium rather than dementia in this patient?
a. The fact that he wouldn’t have been allowed to drive if he had dementia
b. His hyperactive behavior, which differentiates his condition from the hypoactive behavior of dementia
c. The report of emergency personnel that he was noncommunicative when they arrived at the accident scene
d. The report of his family that although he has heart disease and is “very hard of hearing,” this behavior is
unlike him

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 Chapter 60 Nursing Management: Alzheimer’s Disease, Dementia, and Delirium 273

22. What should be included in the management of a patient with delirium?

a. The use of restraints to protect the patient from injury
b. The use of short-acting benzodiazepines to sedate the patient
c. Identification and treatment of underlying causes when possible
d. Administration of high doses of an antipsychotic drug such as haloperidol (Haldol)

23. When caring for a patient in the severe stage of AD, what diversion or distraction activities would be appropriate?
a. Watching TV
b. Playing games
c. Books to read
d. Mobiles or dangling ribbons

CASE STUDY
Alzheimer’s Disease
Patient Profile
G.D. is a 79-year-old man whose wife noticed that he has become increasingly forgetful over the past 3 years. Recently
he was diagnosed with AD.

Subjective Data
• Wanders out of the house at night
• States that he “sees things that aren’t there”
• Is able to dress, bathe, and feed himself
• Has trouble figuring out how to use his electric razor
• His wife is distressed about his cognitive decline
• His wife says that she is depressed and cannot watch him at night and get rest herself

Objective Data
• CT scan: Moderate cerebral atrophy

Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What pathophysiologic changes are associated with AD?
2. How is a diagnosis of AD made?
3. What progression of symptoms should G.D.’s wife be told to expect over the course of the disease?
4. What suggestions can the nurse make to relieve some of the stress on the wife?
5. What community resources might be available to G.D. and his wife?
6. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses for G.D.? Are
there any collaborative problems?
7. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses for G.D.’s
wife? Are there any collaborative problems?

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.