A nurse is visiting a client who has Alzheimer's disease in their home. The client's spouse states that the client gets increasingly agitated and restless in the evening hours and can sometimes be difficult to calm down. Which of the following behaviors does the nurse recognize that the client is experiencing?

Relocation stress syndrome

Wandering

Sundowning

Depression

Answer and Explanation

The Correct Answer is C

A. Relocation stress syndrome: Relocation stress syndrome refers to the physical and psychological symptoms experienced by individuals when they are moved from one environment to another, such as transitioning to a new residence or healthcare facility. While relocation stress syndrome can cause agitation and confusion in individuals with Alzheimer's disease, the scenario provided does not indicate a recent relocation.

B. Wandering: Wandering is a common behavior observed in individuals with dementia, where they aimlessly roam or wander in their environment. While wandering may be associated with agitation and restlessness, the scenario does not describe the client physically moving around or attempting to leave their home.

C. Sundowning: Sundowning refers to a phenomenon commonly observed in individuals with Alzheimer's disease or other forms of dementia, where they experience increased agitation, confusion, and restlessness in the late afternoon or early evening hours. Sundowning behaviors can include pacing, agitation, anxiety, irritability, confusion, and difficulty sleeping. The exact cause of sundowning is not fully understood but may be related to factors such as fatigue, sensory overload, hormonal imbalances, or disruptions in the sleep-wake cycle. Managing sundowning behaviors often involves creating a calming environment, maintaining a consistent daily routine, minimizing stimuli in the evening, and providing reassurance and comfort to the individual.

D. Depression: Depression can occur in individuals with Alzheimer's disease and may present with symptoms such as sadness, hopelessness, loss of interest in activities, changes in appetite or sleep patterns, and difficulty concentrating. However, the scenario primarily describes agitation and restlessness in the evening hours, which is characteristic of sundowning rather than depression.

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Correct Answer is A

Explanation

A. "I need to walk slowly as I lose my balance often": This statement indicates a potential safety concern related to balance issues while walking. Loss of balance can increase the risk of falls, especially in individuals with peripheral artery disease (PAD) who may already have compromised circulation and reduced sensation in their legs. The nurse should report this statement to the provider for further evaluation and intervention to prevent falls and promote safety.

B. "I don't go out much because of the pain in my legs" : While this statement suggests that the client experiences pain in their legs, it does not directly indicate a safety concern that requires immediate reporting to the provider. Pain management strategies may be discussed with the provider to address this issue.

C. "It makes me sad that I can't keep up with my grandchildren" : While this statement reflects emotional distress related to the client's inability to participate fully in activities with their grandchildren, it does not indicate a specific safety concern that requires reporting to the provider. However, addressing the client's emotional well-being is important for overall holistic care.

D. "I have a small-healed area on my spine that is painful" : This statement describes a painful area on the client's spine but does not directly relate to potential safety concerns associated with PAD. The nurse may further assess this issue and include it in the client's overall assessment, but it does not require immediate reporting to the provider for safety concerns related to PAD.

A. Myopia B. Vertigo C. Photophobia D. Presbycusis

Correct Answer is B

Explanation

A. Myopia: Myopia refers to nearsightedness, which is caused by refractive errors in the eye and is not associated with Meniere's disease. Myopia results in difficulty seeing distant objects clearly.

B. Vertigo: Vertigo is a hallmark symptom of Meniere's disease and is caused by an excessive accumulation of endolymph fluid in the inner ear. Vertigo presents as a sensation of spinning or dizziness, often accompanied by nausea, vomiting, and imbalance.

C. Photophobia: Photophobia refers to sensitivity to light, which can be associated with various eye conditions but is not a typical manifestation of Meniere's disease. Photophobia may occur in conditions such as migraine headaches or certain eye infections.

D. Presbycusis: Presbycusis refers to age-related hearing loss, which typically occurs gradually over time and is not directly associated with Meniere's disease. Meniere's disease is characterized by sudden episodes of vertigo, hearing loss, tinnitus, and a sensation of fullness or pressure in the ear.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has peripheral artery disease for potential safety concerns. Which of the following client statements should the nurse report to the provider?

Correct Answer is A

Explanation

A nurse is caring for a client who has Meniere’s disease. The nurse identifies that which of the following manifestations is caused by an excessive accumulation of endolymph fluid?

Correct Answer is B

Explanation

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