A nurse is meeting with the caregivers of a client who has Alzheimer's disease who is at risk for wandering. Which of the following are manifestations that put the client at risk for wandering that the nurse should educate their caregivers about?
Confusion
Distress
Agitation
Depression
Distraction
Correct Answer : A,C,E
A. Confusion: Individuals with Alzheimer's disease often experience confusion due to memory loss, disorientation, and difficulty processing information. Confusion can contribute to wandering behavior as the individual may become lost or disoriented in familiar surroundings, leading them to wander in search of familiar people or places.
C. Agitation: Agitation, characterized by restlessness, pacing, or irritability, is commonly observed in individuals with Alzheimer's disease. Agitation can be triggered by various factors such as environmental stimuli, changes in routine, or unmet needs. It can escalate and prompt wandering behavior as the individual seeks to alleviate discomfort or agitation.
E. Distraction: Individuals with Alzheimer's disease may easily become distracted by environmental stimuli or sensory cues, which can lead to wandering behavior. Distraction can impair the individual's ability to maintain attention to their surroundings, increasing the likelihood of wandering episodes.
The following options are not directly associated with wandering behavior in individuals with Alzheimer's disease:
B. Distress: While distress may be experienced by individuals with Alzheimer's disease due to various factors such as confusion, agitation, or environmental changes, it is not a specific manifestation that puts the client at risk for wandering. Distress may exacerbate wandering behavior in some cases but is not a primary risk factor.
D. Depression: Depression is a common comorbidity in individuals with Alzheimer's disease and can contribute to overall behavioral changes and functional decline. However, depression alone is not a direct manifestation that puts the client at risk for wandering. Wandering behavior is more closely associated with cognitive impairment, agitation, and environmental factors rather than depression.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "I notice the ringing when I'm not concentrating on something." This statement suggests that the client notices the tinnitus but does not imply a significant impact on their well-being. It indicates that the tinnitus occurs when the client is not focused on tasks, which may not necessarily affect their overall functioning or well-being.
B. "I am still able to complete my work in a timely manner." This statement indicates that the client can still function adequately in their work despite experiencing tinnitus. While this may suggest some level of coping, it does not directly address the impact of tinnitus on the client's overall well-being.
C. "The ringing in my ears is distracting." This is the correct answer. This statement indicates that the tinnitus is distracting to the client, which suggests that it may affect their concentration, focus, or overall quality of life. The distraction caused by tinnitus can significantly impact daily activities and well-being.
D. "Hopefully a treatment for this ringing in my ears will help." While this statement acknowledges the presence of tinnitus and the desire for treatment, it does not directly address the impact of tinnitus on the client's well-being. It focuses more on the hope for relief through treatment rather than the current impact on their quality of life.
Correct Answer is ["A","B","C","D","E"]
Explanation
A. Weight loss:
Weight loss can occur in individuals with dementia due to various factors, including decreased appetite, difficulty eating or swallowing, and increased energy expenditure.
Monitoring weight regularly can help detect changes in nutritional status and identify potential health concerns, such as malnutrition or dehydration.
B. Decreased mobility:
Individuals with dementia may experience a decline in mobility and functional abilities as the disease progresses.
Monitoring changes in mobility, such as difficulty walking, transferring, or performing activities of daily living, is important for assessing functional decline and implementing appropriate interventions to maintain mobility and prevent complications such as falls.
C. Increased physical activity:
While dementia can lead to decreased physical activity in some individuals, others may exhibit increased restlessness or wandering behaviors.
Monitoring changes in physical activity levels can help identify agitation, restlessness, or wandering behaviors that may require intervention to ensure the safety and well-being of the individual with dementia.
D. Unkempt appearance:
Individuals with dementia may neglect personal hygiene and grooming tasks, leading to an unkempt appearance.
Monitoring changes in appearance, such as poor personal hygiene, disheveled clothing, or neglect of grooming habits, can indicate difficulties with self-care and may necessitate assistance or supervision to maintain hygiene and appearance.
E. Constipation:
Constipation is a common gastrointestinal symptom in individuals with dementia, often due to factors such as reduced fluid intake, decreased physical activity, and side effects of medications.
Monitoring bowel habits and addressing constipation promptly can help prevent discomfort, complications such as fecal impaction, and maintain overall gastrointestinal health in individuals with dementia.
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