NUR 2755 MDC IV Exam 1 – (2027) Actual
Questions & Answers (Rasmussen) 100%
Guarantee Pass
1. A nurse is caring for a client with Alzheimer's disease who is in the moderate
stage. Which finding is MOST consistent with this stage of the disease?
A) Complete dependence on ADLs and loss of verbal skills
B) Disorientation to time, place, and event with difficulty handling finances
C) Forgetting names and misplacing household objects
D) Loss of mobility and development of tremors
*B) Disorientation to time, place, and event with difficulty handling finances *
Rationale: In the moderate stage of Alzheimer's disease, clients demonstrate disorientation
to time, place, and events, along with difficulty handling money or finances. They may also
be depressed or agitated and have visuospatial deficits. The mild stage includes forgetting
names and misplacing objects (Option C). The severe stage includes complete ADL
dependence, loss of mobility, and verbal skills (Option A) .
2. The nurse is providing safety education to the family of a client with Alzheimer's
disease. Which instruction is MOST important?
A) "Encourage the client to drive independently to maintain autonomy."
B) "Remove throw rugs and dangerous objects from the environment."
C) "Keep the environment unstructured to promote flexibility."
D) "Allow the client to use the stove unattended."
*B) "Remove throw rugs and dangerous objects from the environment." *
Rationale: Safety is the priority for clients with Alzheimer's disease. The nurse should
instruct the family to remove throw rugs and dangerous objects to prevent falls and injury.
Clients with Alzheimer's should not drive (Option A) due to safety risks. A structured,
,consistent environment (Option C) reduces confusion. Stoves should not be used
unattended (Option D) due to fire risk .
3. A client with Alzheimer's disease is wandering into other clients' rooms. What is
the nurse's best initial intervention?
A) Apply physical restraints
B) Redirect the client to a safe, supervised activity
C) Administer a sedative medication
D) Lock the client in their room
*B) Redirect the client to a safe, supervised activity *
Rationale: The nurse should first redirect the client to a safe, supervised activity such as a
walk or structured task. Restraints (Option A) and sedation (Option C) are last resorts.
Locking the client in their room (Option D) is a form of false imprisonment. Validation and
redirection are the least restrictive and most therapeutic interventions .
4. A client with Alzheimer's disease is prescribed donepezil. The nurse should
include which instruction in the teaching?
A) "This medication will cure your Alzheimer's disease."
B) "This medication may help slow the progression of symptoms."
C) "You should stop taking this medication if you feel better."
D) "This medication works immediately to improve memory."
*B) "This medication may help slow the progression of symptoms." *
Rationale: Cholinesterase inhibitors like donepezil may help slow the progression of
symptoms but do not cure Alzheimer's disease. They take time to show effects and should
not be stopped abruptly .
,5. A client with Alzheimer's disease is experiencing "sundowning" (increased
confusion and agitation in the late afternoon/evening). Which intervention should
the nurse implement?
A) Increase environmental stimulation
B) Keep the client awake during the day
C) Maintain a calm environment and consistent routine
D) Administer a sedative without an order
*C) Maintain a calm environment and consistent routine *
Rationale: A calm environment and consistent routine help reduce sundowning. Increasing
stimulation (Option A) can worsen agitation. Keeping the client awake during the day
(Option B) may increase fatigue. Sedatives (Option D) require an order and should be used
cautiously .
6. A client with Alzheimer's disease becomes agitated during bathing. What is the
nurse's best response?
A) Continue the bath forcefully to complete the task
B) Stop the bath, provide a calm environment, and try again later
C) Ask a family member to hold the client still
D) Use restraints to complete the bath
*B) Stop the bath, provide a calm environment, and try again later *
Rationale: The nurse should stop the bath and try again later when the client is calmer.
This reduces agitation and respects the client's dignity. Forcing the bath (Option A) or
using restraints (Option D) increases distress and is unsafe .
7. The nurse is performing a Mini-Mental State Examination (MMSE) on a client.
Which area does the MMSE assess?
A) Physical strength
B) Cognitive function (orientation, memory, attention, language)
, C) Emotional stability
D) Respiratory function
*B) Cognitive function (orientation, memory, attention, language) *
Rationale: The MMSE assesses cognitive function, including orientation to time and place,
memory, attention, and language. It is used to screen for dementia and track cognitive
decline .
8. Which clinical manifestation is MOST characteristic of Alzheimer's disease in the
early stage?
A) Inability to recognize family members
B) Short-term memory loss and difficulty finding words
C) Complete dependence on care
D) Loss of bowel and bladder control
*B) Short-term memory loss and difficulty finding words *
Rationale: Early-stage Alzheimer's disease is characterized by short-term memory loss
(forgetting recent conversations or events) and difficulty finding the right words. Inability
to recognize family members, complete ADL dependence, and loss of bowel/bladder
control are seen in moderate to severe stages .
9. The nurse is caring for a client with dementia who is at risk for falls. Which
intervention should the nurse prioritize?
A) Keep the bed in the highest position
B) Keep the bed in the lowest position with side rails up
C) Use a bed alarm and perform frequent rounding
D) Apply physical restraints
*C) Use a bed alarm and perform frequent rounding *
Rationale: The nurse should use a bed alarm and perform frequent rounding to prevent
falls. The bed should be in the lowest position (Option B), not the highest (Option A). Side
Questions & Answers (Rasmussen) 100%
Guarantee Pass
1. A nurse is caring for a client with Alzheimer's disease who is in the moderate
stage. Which finding is MOST consistent with this stage of the disease?
A) Complete dependence on ADLs and loss of verbal skills
B) Disorientation to time, place, and event with difficulty handling finances
C) Forgetting names and misplacing household objects
D) Loss of mobility and development of tremors
*B) Disorientation to time, place, and event with difficulty handling finances *
Rationale: In the moderate stage of Alzheimer's disease, clients demonstrate disorientation
to time, place, and events, along with difficulty handling money or finances. They may also
be depressed or agitated and have visuospatial deficits. The mild stage includes forgetting
names and misplacing objects (Option C). The severe stage includes complete ADL
dependence, loss of mobility, and verbal skills (Option A) .
2. The nurse is providing safety education to the family of a client with Alzheimer's
disease. Which instruction is MOST important?
A) "Encourage the client to drive independently to maintain autonomy."
B) "Remove throw rugs and dangerous objects from the environment."
C) "Keep the environment unstructured to promote flexibility."
D) "Allow the client to use the stove unattended."
*B) "Remove throw rugs and dangerous objects from the environment." *
Rationale: Safety is the priority for clients with Alzheimer's disease. The nurse should
instruct the family to remove throw rugs and dangerous objects to prevent falls and injury.
Clients with Alzheimer's should not drive (Option A) due to safety risks. A structured,
,consistent environment (Option C) reduces confusion. Stoves should not be used
unattended (Option D) due to fire risk .
3. A client with Alzheimer's disease is wandering into other clients' rooms. What is
the nurse's best initial intervention?
A) Apply physical restraints
B) Redirect the client to a safe, supervised activity
C) Administer a sedative medication
D) Lock the client in their room
*B) Redirect the client to a safe, supervised activity *
Rationale: The nurse should first redirect the client to a safe, supervised activity such as a
walk or structured task. Restraints (Option A) and sedation (Option C) are last resorts.
Locking the client in their room (Option D) is a form of false imprisonment. Validation and
redirection are the least restrictive and most therapeutic interventions .
4. A client with Alzheimer's disease is prescribed donepezil. The nurse should
include which instruction in the teaching?
A) "This medication will cure your Alzheimer's disease."
B) "This medication may help slow the progression of symptoms."
C) "You should stop taking this medication if you feel better."
D) "This medication works immediately to improve memory."
*B) "This medication may help slow the progression of symptoms." *
Rationale: Cholinesterase inhibitors like donepezil may help slow the progression of
symptoms but do not cure Alzheimer's disease. They take time to show effects and should
not be stopped abruptly .
,5. A client with Alzheimer's disease is experiencing "sundowning" (increased
confusion and agitation in the late afternoon/evening). Which intervention should
the nurse implement?
A) Increase environmental stimulation
B) Keep the client awake during the day
C) Maintain a calm environment and consistent routine
D) Administer a sedative without an order
*C) Maintain a calm environment and consistent routine *
Rationale: A calm environment and consistent routine help reduce sundowning. Increasing
stimulation (Option A) can worsen agitation. Keeping the client awake during the day
(Option B) may increase fatigue. Sedatives (Option D) require an order and should be used
cautiously .
6. A client with Alzheimer's disease becomes agitated during bathing. What is the
nurse's best response?
A) Continue the bath forcefully to complete the task
B) Stop the bath, provide a calm environment, and try again later
C) Ask a family member to hold the client still
D) Use restraints to complete the bath
*B) Stop the bath, provide a calm environment, and try again later *
Rationale: The nurse should stop the bath and try again later when the client is calmer.
This reduces agitation and respects the client's dignity. Forcing the bath (Option A) or
using restraints (Option D) increases distress and is unsafe .
7. The nurse is performing a Mini-Mental State Examination (MMSE) on a client.
Which area does the MMSE assess?
A) Physical strength
B) Cognitive function (orientation, memory, attention, language)
, C) Emotional stability
D) Respiratory function
*B) Cognitive function (orientation, memory, attention, language) *
Rationale: The MMSE assesses cognitive function, including orientation to time and place,
memory, attention, and language. It is used to screen for dementia and track cognitive
decline .
8. Which clinical manifestation is MOST characteristic of Alzheimer's disease in the
early stage?
A) Inability to recognize family members
B) Short-term memory loss and difficulty finding words
C) Complete dependence on care
D) Loss of bowel and bladder control
*B) Short-term memory loss and difficulty finding words *
Rationale: Early-stage Alzheimer's disease is characterized by short-term memory loss
(forgetting recent conversations or events) and difficulty finding the right words. Inability
to recognize family members, complete ADL dependence, and loss of bowel/bladder
control are seen in moderate to severe stages .
9. The nurse is caring for a client with dementia who is at risk for falls. Which
intervention should the nurse prioritize?
A) Keep the bed in the highest position
B) Keep the bed in the lowest position with side rails up
C) Use a bed alarm and perform frequent rounding
D) Apply physical restraints
*C) Use a bed alarm and perform frequent rounding *
Rationale: The nurse should use a bed alarm and perform frequent rounding to prevent
falls. The bed should be in the lowest position (Option B), not the highest (Option A). Side
