AUTONOMIC DYSREFLEXIA

1. Which patient below is at MOST risk for developing a condition called autonomic dysreflexia?

A. A 24-year-old male patient with a traumatic brain injury.

B. A 15-year-old female patient with a spinal cord injury at C7.

C. A 35-year-old male patient with a spinal cord injury at L6.

D. A 42-year-old male patient recovering from a hemorrhagic stroke.

The answer is B. Patients who are at MOST risk for developing autonomic dysreflexia are patients
who’ve experienced a spinal cord injury at T6 or higher…this includes C7. L6 is below T6, and
traumatic brain injury and hemorrhagic stroke does not increase a patient risk of AD.

2. Your patient, who has a spinal cord injury at T3, states they are experiencing a throbbing
headache. What is your NEXT nursing action?

A. Perform a bladder scan

B. Perform a rectal digital examination

C. Assess the patient’s blood pressure

D. Administer a PRN medication to alleviate pain and provide a dark, calm environment.
The answer is C. This is the nurse’s NEXT action. The patient is at risk for developing autonomic
dysreflexia because of their spinal cord injury at T3 (remember patients who have a SCI at T6 or
higher are at MOST risk). If a patient with this type of injury states they have a headache, the nurse
should NEXT assess the patient’s blood pressure. If it is elevated, the nurse would take measures to
check the bladder (a bladder issue is the most common cause of AD), bowel, and skin for
breakdown.

3. You’re performing a head-to-toe assessment on a patient with a spinal cord injury at T6. The
patient is restless, sweaty, and extremely flushed. You assess the patient’s blood pressure and heart
rate. The patient’s blood pressure is 140/98 and heart rate is 52. You look at the patient’s chart and
find that their baseline blood pressure is 106/76 and heart rate is 72. What action should the nurse
take FIRST?

A. Reassess the patient’s blood pressure.

B. Check the patient’s blood glucose.

C. Position the patient at 90 degrees and lower the legs.

D. Provide cooling blankets for the patient.

The answer is C. Based on the patient findings and how the patient has a spinal cord injury at T6,
they are experiencing autonomic dysreflexia. Patients with this condition may have a blood pressure
that is 20-40 mmHg higher than their baseline and may experience bradycardia (heart rate less than
60). The FIRST action the nurse should take when AD is suspected is to position the patient at 90
degree (high Fowler’s) and lower the legs. This will allow gravity to cause the blood to pool in the
lower extremities and help decrease the blood pressure. Then the nurse should try to find the cause
of the autonomic dysreflexia, which could be a full bladder, impacted bowel, or skin break down.

4. You’re providing an in-service to a group of new nurse graduates on the causes of autonomic
dysreflexia. Select all the most common causes you will discuss during the in-service:

A. Hypoglycemia

B. Distended bladder

C. Sacral pressure injury

D. Fecal impaction

E. Urinary tract infection

The answers are B, C, D, and E. Anything that can cause an irritating stimulus below the site of the
spinal injury (T6 or higher) can lead to autonomic dysreflexia, which causes an exaggerated
sympathetic reflex response and the parasympathetic system is unable to oppose it. This will lead to
severe hypertension. The most common cause of AD is a bladder issue (full/distended bladder,
urinary tract infection etc). Other common causes are due to a bowel issue like fecal impaction or
skin break down (pressure injury/ulcer, cut, infection etc.).

5. After taking all the necessary steps for a patient who has developed autonomic dysreflexia, what
should the nurse assess FIRST as a possible cause of this condition?

A. Skin break down

B. Blood glucose

C. Possible bladder irritant

D. Last bowel movement

The answer is C. A bladder issue is usually the most common cause of AD. If this isn’t the issue the
nurse should assess the bowel and then the skin for break down.

6. The physician orders Nitropaste for a patient who has developed autonomic dysreflexia. Which
finding would require the nurse to hold the ordered dose of Nitropaste and notify the physician?

A. The patient’s blood pressure is 130/80.

B. The patient reports a throbbing headache.

C. The patient’s lower extremities are pale and cool.

D. The patient states they took Sildenafil 12 hours ago.

The answer is D. A patient should not receive a dose of Nitropaste if they have taken a
phosphodiesterase inhibitor within the past 24 hours (Sildenafil or Tadalafil). This will cause major
vasodilation and severe hypotension that will not respond to medication. Another medication should
be used. All the other findings are expected with autonomic dysreflexia.
7. A patient is receiving treatment for a complete spinal cord injury at T4. As the nurse you know to
educate the patient on the signs and symptoms of autonomic dysreflexia. What signs and symptoms
will you educate the patient about? Select all that apply:

A. Headache

B. Low blood glucose

C. Sweating

D. Flushed below site of injury

E. Pale and cool above site of injury

F. Hypertension

G. Slow heart rate

H. Stuffy nose

The answers are A, C, F, G and H. All of these are signs and symptoms of autonomic dysreflexia.
The patient will have flushing above site of injury due to vasodilation from parasympathetic activity,
BUT will be pale and cool below site of injury due to vasoconstriction occurring below the site of
injury for the sympathetic response reflex.

8. What is the BEST position for a patient experiencing autonomic dysreflexia?

A. High Fowler’s with legs lowered

B. Low Fowler’s with legs lowered

C. Semi-Fowler’s with legs at heart level

D. Prone

The answer is A. The patient should be in high Fowler’s (90 degrees) with the legs lowered. This
will allow gravity to cause blood to pool in the lower extremities and help decrease blood pressure.

9. In autonomic dysreflexia, the nurse would expect what finding below the site of the spinal cord
injury?

A. Flushed lower body

B. Pale and cool lower extremities

C. Low blood pressure

D. Absent reflexes

The answer is B. The lower extremities would be cool and pale due to vasconstriction caused by the
exaggerated reflex response of the sympathetic nervous system from an irritating stimulus. The
sympathetic reflex can NOT be unopposed by the parasympathetic nervous system due to the spinal
injury, which is blocking the nerve impulse. The areas found ABOVE the site of injury would be
flushed due to vasodilation from parasympathetic stimulation.

10. Which statements are TRUE about autonomic dysreflexia? Select all that apply:
A. “Autonomic dysreflexia is an exaggerated reflex response by the parasympathetic nervous system
that results in severe hypertension due to a spinal cord injury.”

B. “Autonomic dysreflexia causes a slow heart rate and severe hypertension.”

C. “Autonomic dysreflexia is less likely to occur in a patient who has experienced a lumbar injury.”

D. “The first-line of treatment for autonomic dysreflexia is an antihypertensive medication.”

The answers are B and C. Option A is false, it should say: Autonomic dysreflexia is an exaggerated
reflex response by the SYMPATHETIC (NOT parasympathetic) nervous system that results in
severe hypertension due to a spinal cord injury. Option D is false because medications are used only
if the blood pressure is not decreasing or the cause cannot be determined.

11. The nurse is about to assess for bowel impaction in a patient who has developed autonomic
dysreflexia. The nurse makes it priority to?A. Avoid using lubricants

B. Stimulate the bowel with rectal manipulation

C. Slowly administer a saline solution prior to assessment

D. Instill an anesthetic jelly prior to assessment

The answer is D. To avoid increasing autonomic dysreflexia symptoms by increasing the

sympathetic reflex due to an irritating stimulus, the nurse should instill an anesthetic jelly before
assessing the rectum for hardened stool. This is also important prior to catheterization to check the
bladder for urine.
PARKINSON’S DISEASE

1. As the nurse you know that Parkinson’s Disease tends to affect the _____________ of the
midbrain, which leads to the depletion of the neurotransmitter ________________.

A. red nucleus, acetylcholine

B. leminisci, norepinephrine

C. substantia nigra, dopamine

D. tectum nigra, dopamine

The answer is C.

2. True or False: Parkinson’s Disease most commonly affects patients in young adulthood, and there
is currently no cure for the disease.

The answer is FALSE. Parkinson’s Disease most commonly affects patients in OLDER adulthood
(60 or older), and there is currently no cure for the disease.

3. You’re caring for a patient with Parkinson’s Disease that has tremors. Select the option that is
INCORRECT about tremors experienced in this disease:

A. The tremors are most likely to occur with purposeful movements.

B. A common term used to describe the tremors in the hands and fingers is called “pill-rolling”.

C. Tremors are one of the most common signs and symptoms in Parkinson’s Disease.

D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.

The answer is A. This option is the only one that is INCORRECT. Tremors in Parkinson’s Disease
tend to occurs at rest and will actually improve with movement.

4. While assessing a patient with Parkinson’s Disease, you note the patient’s arms slightly jerk as
you passively move them toward the patient’s body. This is known as:

A. Lead Pipe Rigidity

B. Cogwheel Rigidity

C. Pronate Rigidity

D. Flexor Rigidity

The answer is B. This is known as cogwheel rigidity, and occurs when the arms are passively
moved, which will cause them to jerk slightly.
5. A patient with Parkinson’s Disease has slow movements that affects their swallowing, facial
expressions, and ability to coordinate movements. As the nurse you will document the patient has:

A. Akinesia

B. “Freeze up” tremors

C. Bradykinesia

D. Pill-rolling

The answer is C. This is known as bradykinesia.

6. You’re providing free education to a local community group about the signs and symptoms of
Parkinson’s Disease. Select all the signs and symptoms a patient could experience with this disease:

A. Increased Salivation

B. Loss of smell

C. Constipation

D. Tremors with purposeful movement

E. Shuffling of gait
F. Freezing of extremities

G. Euphoria

H. Coordination issues

The answers are B, C, E, F, H. These are all signs and symptoms experienced with PD (they vary
among patients). There is NOT increased salivation (although drooling occurs…this is due to the
decreased ability to swallow. There are tremors at REST (not movement) along with depression
rather the euphoria.

7. You’re providing diet education to a patient with Parkinson’s Disease. Which statement below
demonstrates the patient understood your teaching? Select all that apply:

A. “I will limit foods high in fiber like fruits and vegetables in my diet.”

B. “I will be sure to drink 2 Liter of fluid per day.”

C. “It is very common for me to experience diarrhea with this disease.”

D. “I will avoid taking Carbidopa/Levodopa with a protein rich meal.”

The answers are B and D. Constipation (not diarrhea) is a common symptom with Parkinson’s
Disease. Therefore, the patient should be vigilant about preventing constipation by EATING foods
high in fiber like fruits/vegetable and drinking 2 L of fluid per day (unless contraindicated). In
addition, diet teaching should be included with the medication Carbidopa/Levodopa. The patient
should NOT take this medication with a protein rich meal because levodopa competes with protein
in the small intestine (hence decreasing it absorption).

8. A patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and
swallowing. Which meal option below is the best for this patient?

A. Scrambled eggs with a side of cottage cheese

B. Grilled cheese with apple slices

C. Baked chicken with bacon slices

D. Tacos with refried beans

The answer is A. The patient should have a diet of soft foods that are easy to swallow and chew.
Option A is the only option that meets that specification.

9. As the home health nurse you are helping a patient with Parkinson’s Disease get dressed. What
item gathered by the patient to wear should NOT be worn?

A. Velcro pants

B. Pull over sweatshirt

C. Non-slip socks

D. Rubber sole shoes

The answer is D. Rubber sole shoes can make walking difficulty, especially when the patient has a
shuffling gait because these type of shoes tend to stick to the floor and can cause the patient to trip. It
is best to wear low heel, smooth soles (not slick or hard).

10. A spouse of a husband who has Parkinson’s Disease explains to you that her husband
experiences episodes while walking where he freezes and can’t move. She asks what can be done to
help with these types of episodes to prevent injury. Select all the options that are correct:

A. Have the husband try to change direction of movement by moving in the opposite direction when
the freeze ups occur.

B. Use a cane with a laser point while walking.

C. Have the husband try to push through the freeze ups.

D. Encourage the husband to consciously lift the legs while walking (as with marching).

The answers are A, B, D. These are correct teaching points on how to deal with freeze ups in
Parkinson’s Disease.
11. A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that
which statement is incorrect about this medication:

A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when
beginning treatment with this medication.

B. Body fluids can turn a dark color and stain clothes.

C. This medication is most commonly prescribed with a vitamin B6 supplement.

D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the
brain. Hence, levodopa is able to enter the brain.

The answer is C. All the other options are CORRECT about this medication. However, the patient
should avoid foods and supplements high in vitamin B 6 because it decreases the effectiveness of
this medication.

12. You’re patient with Parkinson’s Disease has been taking Carbidopa/Levodopa for several years.
The patient reports that his signs and symptoms actually become worse before the next dose of
medication is due. As the nurse, you know what medication can be prescribed with this medication
to help decrease this for happening?

A. Anticholinergic (Benztropine)

B. Dopamine agonists (Ropinirole)

C. COMT Inhibitor (Entacapone)

D: Beta blockers (Metoprolol)

The answer is C. Entacapone “Comtan” (is a catechol-O-methyltransferase inhibitors) and is used

with levodopa/carbidopa to prevent the “wearing off” of the drug before the next dose is due. It
blocks the COMT enzyme that will break down the levodopa in the blood to allow it to last longer.

13. While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it
priority to teach the patient about what side effect?

A. Drowsiness

B. Dry mouth

C. Coughing

D. Dark sweat or saliva

The answer is A. This medication is known to cause sudden drowsiness that can cause a person to
randomly fall asleep. Therefore, it is PRIORITY to teach the patient to not take this medication
when they be driving or operating machinery etc…to prevent injury.
14. A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this
medication before and is due to take the first dose at 1000. What statement by the patient requires
you to hold the dose and notify the physician?

A. “I forgot to tell the doctor I take eye drops for my glaucoma.”

B. “I had a PET scan last week.”

C. “I take aspirin once day.”

D. “My hands are experiencing tremors at rest.”

The answer is A. This medication is contraindicated for patients with glaucoma.

15. A patient is taking Rasagiline “Azilect” for treatment of Parkinson’s Disease. What foods do the
patient want to limit in their diet? Select all that apply:

A. Liver

B. Aged Cheese

C. Sweetbread

D. Beer
E. Fermented foods

F. Shellfish

The answers are B, D, and E. Rasagiline “Azilect” is a MAO Inhibitor Type B (Monoamine Oxidase
Inhibitor). The patient should avoid foods high in tyramine which can cause a hypertensive crisis.
This includes: aged cheese, smoked/cured meats, fermented food, beer.

GBS

1. True or False: Guillain-Barré Syndrome occurs when the body’s immune system attacks the
myelin sheath on the nerves in the central nervous system.

FALSE: Guillain-Barré Syndrome is an autoimmune neuro condition where the immune system
attacks the nerves in the PERIPHERAL NERVOUS SYSTEM and cranial nerves. This condition
does NOT occur in the central nervous system (CNS).

2. During nursing report you learn that the patient you will be caring for has Guillain-Barré
Syndrome. As the nurse you know that this disease tends to present with:

A. signs and symptoms that are unilateral and descending that start in the lower extremities

B. signs and symptoms that are symmetrical and ascending that start in the upper extremities

C. signs and symptoms that are asymmetrical and ascending that start in the upper extremities
D. signs and symptoms that are symmetrical and ascending that start in the lower extremities

The answer is D. GBS signs and symptoms will most likely start in the lower extremities (ex: feet),
be symmetrical, and will gradually spread upward (ascending) to the head. There are various forms
of Guillain-Barré Syndrome. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is
the most common type in the U.S. and this is how this syndrome tends to present.

3. You’re assessing a patient’s health history for risk factors associated with developing Guillain-
Barré Syndrome. Select all the risk factors below:

A. Recent upper respiratory infection

B. Patient’s age: 3 years old

C. Positive stool culture Campylobacter Jejuni

D. Hyperthermia

E. Epstein-Barr

F. Diabetes

G. Myasthenia Gravis
The answers are: A, C, and E. Risk factors for developing Guillain-Barré Syndrome include:
experiencing upper respiratory infection, GI infection (especially from Campylobacter Jejuni),
Epstein-Barr infection, HIV/AIDS, vaccination (flu or swine flu) etc.

4. A 25 year-old presents to the ER with unexplained paralysis from the hips downward. The patient
explains that a few days ago her feet were feeling weird and she had trouble walking and now she is
unable to move her lower extremities. The patient reports suffering an illness about 2 weeks ago, but
has no other health history. The physician suspects Guillain-Barré Syndrome and orders some
diagnostic tests. Which finding below during your assessment requires immediate nursing action?

A. The patient reports a headache.

B. The patient has a weak cough.

C. The patient has absent reflexes in the lower extremities.

D. The patient reports paresthesia in the upper extremities.

The answer is B. The patient’s signs and symptoms in this scenario are typical with Guillain-Barré
Syndrome. The syndrome tends to start in the lower extremities (with paresthesia that will progress
to paralysis) and migrate upward. The respiratory system can be affected leading to respiratory
failure. Therefore, the nurse should assess for any signs and symptoms that the respiratory system
may be compromised (ex: weak cough, shortness of breath, dyspnea…patient says it is hard to
breath etc.). The nurse should immediately report this to the MD because the patient may need
mechanical ventilation. Absent reflexes is common in GBS and paresthesia can extend to the upper
extremities as the syndrome progresses. A headache is not common.

5. A patient with Guillain-Barré Syndrome has a feeding tube for nutrition. Before starting the
scheduled feeding, it is essential the nurse? Select all that apply:

A. Assesses for bowel sounds

B. Keeps the head of bed less than 30′ degrees

C. Checks for gastric residual

D. Weighs the patient

The answers are A and C. Some patients who experience GBS will need a feeding tube because they
are no longer able to swallow safely due to paralysis of the cranial nerves that help with swallowing.
GBS can lead to a decrease in gastric motility and paralytic ileus. Therefore, before starting a
scheduled feeding the nurse should always assess for bowel sounds and check gastric residual.

6. You’re educating a patient about treatment options for Guillain-Barré Syndrome. Which statement
by the patient requires you to re-educate the patient about treatment?

A. “Treatments available for this syndrome do not cure the condition but helps speed up recovery
time.”
B. “Plasmapheresis or immunoglobin therapies are treatment options available for this syndrome but
are most effective when given within 4 weeks of the onset of symptoms.”

C. “When I start plasmapheresis treatment a machine will filter my blood to remove the antibodies
from my plasma that are attacking the myelin sheath.”

D. “Immunoglobulin therapy is where IV immunoglobulin from a donor is given to a patient to stop

the antibodies that are damaging the nerves.

The answer is B. This statement is incorrect. Plasmapheresis and immunoglobin therapies are
treatment options available for GBS, BUT they are only really effective when given within 2 weeks
from the onset of symptoms (not 4 weeks).

7. Which tests below can be ordered to help the physician diagnose Guillain-Barré Syndrome? Select
all that apply:

A. Edrophonium Test

B. Sweat Test

C. Lumbar puncture

D. Electromyography
E. Nerve Conduction Studies

The answers are C, D, and E. These are the tests that can be ordered to help the MD determine if the
patient is experiencing GBS.

8. You’re teaching a group of nursing students about Guillain-Barré Syndrome and how it can affect
the autonomic nervous system. Which signs and symptoms verbalized by the students demonstrate
they understood the autonomic involvement of this syndrome? Select all that apply:

A. Altered body temperature regulation

B. Inability to move facial muscles

C. Cardiac dysrhythmias

D. Orthostatic hypotension

E. Bladder distension

The answers are A, C, D, and E. All these are some signs and symptoms that can present in severe
cases of GBS when the autonomic nervous system is involved.

9. You’re about to send a patient for a lumbar puncture to help rule out Guillain-Barré Syndrome.
Before sending the patient you will have the patient?
A. Clean the back with antiseptic

B. Drink contrast dye

C. Void

D. Wash their hair

The answer is C. The patient will need to void and empty the bladder before going for a LP. This
will help decrease the chances of the bladder becoming punctured during the procedure.

10. Your patient is back from having a lumbar puncture. Select all the correct nursing interventions
for this patient? Select all that apply:

A. Place the patient in lateral recumbent position.

B. Keep the patient flat.

C. Remind the patient to refrain from eating or drinking for 4 hours.

D. Encourage the patient to consume liquids regularly.

The answers are B and D. The patient will need to stay flat after the procedure for a prescribed
amount of time to prevent a headache, and the nurse will need to encourage the patient to drink
fluids regularly to help replace the fluid lost during the lumbar puncture.
11. The patient’s lumbar puncture results are back. Which finding below correlates with Guillain-
Barré Syndrome?

A. high glucose with normal white blood cells

B. high protein with normal white blood cells

C. high protein with low white blood cells

D. low protein with high white blood cells

The answer is B.

ALZHEIMERS DISEASE

1. Which statement below is INCORRECT about Alzheimer’s disease?

A. It’s the 5th leading cause of death for adults over 65.
B. Alzheimer’s disease is more likely to develop in men rather than women.
C. Most patients typically start showing signs and symptoms of this disease after the age of 60.
D. Hispanics and African Americans are at higher risk for developing Alzheimer’s disease.

The answer is B. Alzheimer’s disease is more likely to develop in WOMEN (not men) because they
tend to live longer. All the other statements are true regarding AD.
2. The exact cause of Alzheimer’s disease is not fully understood. However, what two changes in the
brain are found in a patient with this disease? Select all that apply:

A. Destruction of the myelin sheath on the neuron

B. Development of beta-amyloid plaques in between neurons
C. Destruction of dopaminergic neurons
D. Creation of neurofibrillary tangles within the neuron

The answers are B and D. Beta-amyloid plaques and neurofibrillary tangles are found in a patient
with AD. Option A (destruction of the myelin sheath) happens in multiple sclerosis, and option C
(destruction of dopaminergic neurons) occurs in Parkinson’s disease.

3. A neuron is made up of a cell body which contains the nucleus. In addition, it has dendrites. What
is the function of the dendrite?

A. Give structure to the cell body and help keep the neuron functioning
B. To receive information for other nerves cells and take that information to the cell body
C. Take information it receives away from the cell body and to other dendrites of neurons
D. Release neurotransmitters at the synaptic junctions to relay messages

The answer is B. Dendrites receive information for other nerves cells and take that information to the
cell body.
4. True or False: The axon of a neuron takes information it receives away from the cell body and to
other dendrites of neurons.

True
False

The answer is true. This is the function of an axon.

5. Surrounding the neuron are cells that help protect its ability to function. Which cell type provides
safety to the neuron by removing dangerous material that could damage the neuron?

A. Microglia
B. Ependymal cells
C. Astrocytes
D. Oligodendrocyte

The answer is A: microglia These cells play a role with inflammation that is found in Alzheimer’s
Disease.

6. In Alzheimer’s disease, what protein is responsible for creating amyloid beta peptides which
develop into plaques?

A. Tau proteins
B. Postsynaptic proteins (PSP)
C. Amyloid precursor proteins (APP)
 D. Beta-synuclein

The answer is C: Amyloid precursor proteins (APP) are responsible for creating amyloid beta
peptides. These small peptides form together and create plaques outside the neuron called beta-
amyloid plaques (this impedes neuron communication and causes death of the neuron).

7. Neurofibrillary tangles found in Alzheimer’s disease are made up of a protein called ________.
What is the role of these proteins?

A. Beta-amyloid; delivers nutrients to the neuron

B. Amyloid precursor protein; promotes neurotransmitter released at the synaptic junction
C. Tau; provides structural strength to microtubules in the neuron
D. Microglia; removes debris from outside the neuron

The answer is C: Neurofibrillary tangles found in Alzheimer’s disease are made up of a protein
called Tau. Tau proteins provide structural strength to microtubules in the neuron.

8. In early stages of Alzheimer’s disease, the hippocampus is affected. This part of the brain is
responsible for what function(s)? Select all that apply:

A. Learning
B. Navigation
C. Memory
D. Language
E. Planning
The answers are: A, B, and C. The hippocampus tends to be affected first in AD. This structure is
important for being able to learn new things, recall memories (especially recent ones), and
navigation (due to its function with spatial memory). This structure is affected early on, and this is
why patients start to have memory problems and can get lost easily (losing function of spatial
memory).

9. Alzheimer’s disease also affects the neurons found in the outside layer that surrounds the top of
the cerebrum. This area is made up of different lobes such as the frontal, parietal, temporal, and
occipital lobes. What is this area of the brain called?

A. Corpus callosum
B. Cerebral cortex
C. Amygdala
D. Cerebellum

The answer is B: cerebral cortex It’s important to note that in advance cases of AD, the cerebral
cortex will shrink, leading to brain atrophy.

10. A patient with Alzheimer’s disease is having trouble performing the movements needed to use
their toothbrush for mouth care. This is described as?

A. Aphasia
B. Apraxia
C. Anomia
 D. Agnosia

The answer is B: apraxia. There are different forms of apraxia that can affect speech, movement, and
so forth. This example is describing “limb-kinetic” apraxia. In this scenario, the patient can’t
perform the movements with their hands needed to brush the teeth.

11. Which finding in a patient with Alzheimer’s disease best describes the term agnosia?

A. The patient uses a fork to eat a bowl of soup.

B. The patient makes up a word to recall the name of an object.
C. The patient can’t recall their address.
D. The patient is unable to perform the movements needed to use their hair brush.

The answer is A. Option b describes anomia, option c describes amnesia, option d describes apraxia.

12. You’re helping a patient with hygiene. The patient is having trouble asking you for a particular
bathing item. The patient wants the soap bar but makes up a name for the item. This is known as
what?

A. Amnesia
B. Agnosia
C. Anomia
D. Aphasia

The answer is C: Anomia

13. A patient was recently diagnosed with Mild Alzheimer’s (Early-stage Alzheimer’s disease).
What important educational topics should the nurse provide to this patient at this time? Select all that
apply:

A. Progression of the disease

B. Future planning
C. Surgical options
D. Medications

The answers are A, B, and D. There are no surgical options for AD and no curative treatment at this
time. During this early-stage the patient is still able to function and be independent, but this will not
last too long (may be a couple of years…depends on the patient) until they will need constant help.
This is the time the nurse needs to tell the patient about the progression of the disease (what to
expect), medications available, and the need for future planning.

14. A patient is starting to experience memory changes that are subtle but doesn’t affect their ability
to function. For example, they are forgetting recent commitments and new people they’ve met or
recent conversations. The patient reports feeling like “something just isn’t right”. This describes
what stage of Alzheimer’s disease?

A. Preclinical Alzheimer’s Disease

B. Mild Alzheimer’s Disease (early-stage)
C. Mild Cognitive Impairment
D. Moderate Alzheimer’s Disease (Middle Stage)
The answer is C: Mild Cognitive Impairment

15. Select all the correct options below that best describe the Moderate Alzheimer’s Disease (Middle
Stage) of AD?

A. Longest stage
B. Patient is able to function (move around, talk etc.)
C. Patient is confused to the point they need supervision
D. Experiences mood swings
E. May wander
F. Stage last a couple of years
G. When most patients are diagnosed
H. Communication is minimal
I. Caregiver fatigue is experienced

The answers are: A, B, C, D, E, I. This is the longest stage that is very hard for the caregivers
(family members etc.). Many caregivers, at some point, will experience fatigue and stress during this
stage. The discussion of respite care for the caregiver should be discussed (this will help provide a
temporary break for the caregiver). The patient is very active during this stage, but has confusion and
impaired judgement. They must be supervised. In addition, they may have episode of mood swings,
hallucinations, and wander, which may lead them to get lost or injured.

16. The nurse is providing routine care for a patient with Severe Alzheimer’s disease (late stage).
The patient has no motor activities or language communication abilities. What are some nursing
interventions the nurse can implement to promote patient interaction and communication? Select all
that apply.

A. Limit interaction to verbal communication

B. Use touch when appropriate
C. Incorporate nonverbal communication
D. Have music and imagery available during the day
E. Identify yourself to the side of the patient rather than directly in front

The answers are B, C, and D. Communication and interaction is still very essential in the late-stage
of Alzheimer’s disease. Even though the patient may not be able to speak or move around,
communication and interaction are vitally important for providing quality patient care and a loving
environment for the patient. The nurse should try to incorporate nonverbal communication as much
as possible like facial expression and body gestures. This is because even though the patient may not
understand the words spoken, they may understand the nonverbal communication. Touch should be
used when needed to reassurance or let the patient know you care along with soft music and other
tools to provide a calm, interactive environment.

17. During the evening hours you notice your patient with Moderate Alzheimer’s Disease (Middle
Stage) begins to experience an increase in confusion, agitations, and hallucinations. What
intervention below could the nurse implement to help decrease this occurrence?

A. Provide the patient with coffee at bedtime

B. Provide a relaxing and low noise environment in the evening
C. Use stimulating distractions at night
 D. Limit patient’s contact with sunlight during the day

The answer is B: Provide a relaxing and low noise environment in the evening This phenomenon is
known as Sundowner’s Syndrome. Patients with AD can experience this during the evening hours. It
can be triggered by exhaustion, low lighting (not experiencing enough contact with sunlight during
the day), sickness, and medications. The nurse should promote a calm, relaxing environment and
avoid stimulating activities that could cause fatigue. Caffeine (coffee) can make Sundowning worst.

18. You’re providing education about testing for Alzheimer’s disease. Which tests below can a
patient have to check for beta-amyloid proteins in the brain? Select all that apply:

A. X-ray
B. Spinal tap
C. PET scan
D. MRI scan

The answers are B and C. Currently, cerebrospinal fluid can be removed via a spinal tap to check for
these proteins along with an amyloid PET scan. Recently, a new blood test has been created that can
detected these proteins but may not be readily available for all patient at this time.

19. A patient is concerned about developing Alzheimer’s disease because their mother had the
disease. What statement below could the nurse provide to the patient about genetic testing for
Alzheimer’s disease? Select all that apply:
 A. Genetic testing is readily available at most doctor offices for this disease and should be
discussed with the physician.
B. A genetic test is available that assesses for ApoE-4 (Apolipoprotein E).
C. Genetic testing is not routinely ordered but for research purposes.
D. A positive genetic testing result means you will develop the disease.

The correct answers are B and C.

20. The nurse is helping a patient with Moderate Alzheimer’s disease (Middle Stage) participate in a
task. When selecting a task for the patient, the nurse would want to make sure the task has?

A. Multiple steps
B. Clear simple directions
C. Critical thinking
D. Usage of multiple tools

The answer is B: clear simple directions. Patients with this stage of AD can follow directions that are
simple and clear. It is best to avoid tasks that require multiple steps, critical thinking, and usage of
multiple tools. This could confuse the patient and lead to outbursts of anger.

21. You’re providing education to a group of caregivers about wandering in Alzheimer’s disease.
You ask the participants to verbalize signs a family member with this disease may be experiencing
wandering. Which sign verbalized by a participant requires re-education?

A. The family member takes longer than expected to return from a place.
 B. The family member repeatedly requests to visit an old acquaintance.
C. The family member refuses to leave their bedroom.
D. The family member has trouble finding rooms within the house.

The answer is C. Options A, B, D are all signs the patient is at risk for wandering. Wandering can
lead the patient to become lost. Signs of wandering should be addressed and prevention measures
should be taken to help protect the safety of the patient.

22. A family member who is the caregiver for a patient with Moderate Alzheimer’s disease (Middle
Stage) asks for advice on safety measures that can be taken to keep the patient safe due to
wandering. Which option below is NOT an appropriate safety measure for the caregiver to take?

A. Display signs throughout the house to identify the rooms

B. Consider a GPS tracking device system for the patient
C. Encourage social interaction by taking the patient to a shopping mall
D. Obscure assess to exit doors and windows

The answer is C: Encourage social interaction by taking the patient to shopping mall. Wandering is
experienced by many patients with AD. It tends to become worst during the early evening. Triggers
for wandering include being in stressful, crowded, unfamiliar areas (avoid a shopping mall…they
tend to be busy and unfamiliar for the patient), needs a basic need met like a bathroom, trying to do a
routine they have always done before, or restless from inactivity (the patient needs regular exercise).
23. The nurse is speaking to a patient with Moderate Alzheimer’s disease (Middle Stage). The
patient is sitting in the bedside chair and is about to eat breakfast. Which action by the nurse
demonstrates the nurse knows how to communicate with this patient correctly?

A. The nurse approaches the patient from behind to initiate conversation.

B. The nurse asks “Do you want orange juice with breakfast?”
C. The nurse leaves the TV on while talking with the patient.
D. The nurse stands over the patient while conversing with the patient.

The answer is B. This option is correct because the nurse is using a closed-ended question which
requires a yes or no answer rather than an opened-ended like “what do you want to drink with
breakfast?”. This type of question requires more thought and can confuse the patient. Option A is
wrong because the nurse should approach the patient directly in the front rather than behind (this
could scare the patient and lead to an emotional outburst). Option C is wrong because the nurse
should eliminate outside noise so the patient can hear and concentrate on the conversation. Option D
is wrong because the nurse should communicate on eye level rather than standing over the patient.
The patient with AD may feel intimated by this.

24. A caregiver reports that their family member with Alzheimer’s disease does not have interest in
eating. They request some advice on how to help their family member eat better. What intervention
below would be incorrect for the nurse to give?

A. Eat with the family member for meals

B. Keep the eating environment free from outside noise and well lit
C. Serve the family member a variety of food items on their plate
 D. Select healthy but tasty soft finger foods

The answer is C. A person with AD can become easily overwhelmed, especially by a full plate of
food. Therefore, it’s important to not overwhelm the patient with options, but to serve them one food
item at a time that they like.

25. A patient with Alzheimer’s disease is prescribed a cholinesterase inhibitor. Which of the
following medications below is NOT this type of medication?

A. Galantamine
B. Rivastigmine
C. Memantine
D. Donepezil

The answer is C: Memantine This is a NMDA antagonist.

26. Select the statement below that best describes how Galantamine works to treat a patient with
Alzheimer’s disease.

A. “This medication decreases the amount of glutamate readily available at the receptor site.”
B. “Galantamine prevents the breakdown of acetylcholine.”
C. “This medication decreases the levels of acetylcholine in the brain.”
D. “Galantamine decrease beta-amyloid plaques in the brain.”
The answer is B. Galantamine is a cholinesterase inhibitor and works to prevent the breakdown of
acetylcholine by inhibiting the enzyme cholinesterase.

27. A patient taking a cholinesterase inhibitor is experiencing nausea and diarrhea. These side effects
can be decreased by doing which of the following?

A. Administering the medication on an empty stomach

B. Administering the medication with meals
C. Administering the medication two hours before a meal
D. Administering the medication at bedtime

The answer is B. This medication group can lead to GI upset. If this occurs, administering the med
with meals can help decrease this side effect.

28. A patient with Severe Alzheimer’s Disease is prescribed to take Memantine. Which statement
best describes how this medication works to treat this disease?

A. “It increases acetylcholine levels in the brain.”

B. “It prevents the enzyme cholinesterase from working.”
C. “It limits how glutamate can engage the NMDA receptor in the brain.”
D. “It decreases beta amyloid plaques in the brain.”

The answer is C. Memantine is an NMDA receptor antagonist that limits how glutamate can engage
the NMDA receptor in the brain.
29. What medication is relatively new that is given by IV infusion that can help decrease beta
amyloid plaques in patients with Alzheimer’s disease?

A. Memantine
B. Galantamine
C. Donepezil
D. Aducanumab

The answer is D. Aducanumab. Before a patient takes this medication their doctor may order
diagnostic testing to confirm plaques are present like spinal tap or amyloid PET scan. Side effects
are a potential brain bleed or swelling and will need brain scans periodically to monitor the brain.