Alzheimer’s Disease/Major Neurocognitive Disorder (29 Questions)

1. You are caring for Mrs. Thérèse Marchand, a patient with a neurocognitive disorder who is currently hospitalized in a long-term care unit. Her husband, Mr. Paul Marchand, is her legal representative and both of them signed the consent form for her annual influenza vaccination during the admission process.

During your morning medication rounds, you enter Mrs. Marchand’s room to administer the vaccine. She appears alert and cooperative but firmly refuses to receive the injection, stating: “No, I don’t want that needle.” You reassure her and decide to return later.

You come back 20 minutes later, and she continues to refuse the vaccination, stating again: “I said no.”

Question:
What is the most appropriate nursing action at this point? *
2.1 Mr. Fernand Leblanc, an 82-year-old patient with Alzheimer’s disease (Major Neurocognitive Disorder), is brought to the emergency department by his wife, Mrs. Cécile Leblanc, who is also his legal representative and primary caregiver.

Upon arrival, she tells you, “He’s been agitated for three days, and his behavior is getting harder to manage.” Before entering the room, you overhear Mrs. Leblanc shouting, “I am tired!” Moments later, as you walk into the room, she quickly apologizes and explains: “I haven’t slept for three nights… He keeps waking me up.”

Mr. Leblanc appears calm but disoriented. You observe no signs of physical harm or injury on either of them.

Question:
What do you suspect is happening in this situation? *
2.2 A few days after being transferred to the short-stay geriatric unit, Mr. Gérard Leblanc is stable and under observation. His wife, Mme Cécile Leblanc, visits daily but appears exhausted. She confides in you and says, “I haven’t been sleeping well. I still feel like I need to be there for him all the time… What if something happens while I’m away?”

Question:
What is the best response to provide Mme Leblanc?w *
2.3 Mr. Leblanc becomes increasingly agitated during your shift while Mme Cécile Leblanc is away on respite.

He enters another patient’s room and refuses to leave. He raises his voice, appears disoriented, and is visibly angry when asked to return to his room. The other patient is distressed and asks for help.

Medical Orders:
*Haldol 0.5 mg PO PRN q8h for agitation
*Ensure 1.5 bottles daily with meals
*Tylenol 325 mg PO PRN q4h for pain
*Routine vital signs every shift

Question:
What is your priority intervention? *
3. You are caring for Mme. Lucie Tremblay, an 84-year-old long-term care resident with moderate Alzheimer’s disease. She has been stable on her routine medications, including donepezil (Aricept).

This evening, during your rounds, you find Mme. Tremblay restless and agitated, pacing back and forth in the hallway, trying to open the exit door, and mumbling incoherently. She seems more confused than usual and keeps asking for her late husband. Her PRN lorazepam (Ativan) is still available.

Question:
What is the nurse's initial action? *
4.1 Mr. Henri Dubois, an 82-year-old man diagnosed with a major neurocognitive disorder (dementia), has been refusing hygiene care for the past several days in the long-term care facility.

Despite several strategies, including:
*Changing the nursing assistant assigned to him,
*Providing care with two staff members, and
*Adjusting the timing of his bath,

Mr. Dubois continues to resist care, often becoming verbally aggressive and swearing at staff.

Team members are growing frustrated and concerned about the impact on his hygiene and well-being.

Question:
What is the most appropriate next action by the nurse? *
4.2 Despite all previous interventions, Mr. Henri Dubois, continues to refuse hygiene care.

The care team has already:
*Assigned different staff members to increase comfort and trust.
*Modified bathing times to match his mood and routine.
*Provided care in pairs to ensure safety.
*Attempted verbal de-escalation using calm, reassuring communication.
*Held an interdisciplinary meeting to explore further strategies.
*Offered hygiene alternatives like sponge baths and grooming in small steps.
*Informed the facility manager, who authorized care protocols in line with legal guidelines.

However, Mr. Dubois has persistently refused all hygiene efforts.

Now, other residents in the unit have begun to complain of foul odor, and staff are concerned about the risk of skin breakdown, infection, and social isolation for Mr. Dubois.

Question:
What is your next appropriate nursing action? *
5.1 Mrs. Chan, 90 years old, was admitted with pneumonia that is being treated with intravenous antibiotics. Her medical record indicates mild Alzheimer’s-type major neurocognitive disorder (NCD).

This morning, the orderly suggests to Mrs. Chan that she get up. She insists on staying in bed because she says she is too weak to get up and go to the toilet. The orderly puts incontinence briefs on her so that she would be comfortable.

Four days after her admission, Mrs. Chan’s respiratory condition has improved but she has urinary incontinence. At meals, she has a few mouthfuls of her main dish as well as a serving of liquid protein. She drinks an average of 600 mL of water a day. She gets about with the orderly’s help. She says to you, in tears: “I don’t like this diaper.”

Question:
What information will you give Mrs. Chan about the course of her clinical condition? *
5.2 What other intervention will you plan to provide clinical follow-up for Mrs. Chan? *
6.1 Mr. Émile Bouchard, a 77-year-old man with a diagnosis of major neurocognitive disorder (moderate stage), has been living in an intermediate care facility for the past 6 months. He requires assistance with most of his daily activities, including wound care for a chronic pressure ulcer.

During your afternoon rounds, you enter his room to perform a routine dressing change. Upon entering, you find Mr. Bouchard engaging in a masturbatory act while seated in his chair.

Question:
What is your best nursing intervention in this situation? *
6.2 The following morning, you enter Mr. Émile Bouchard’s room again to check on his wound and hygiene. Once again, he is engaging in a masturbatory act. The licensed practical nurse (LPN) informs you that this behavior has been occurring daily, especially in the mornings. It is always done in the privacy of his room, and he does not exhibit this behavior in public spaces.

Some new staff members have expressed discomfort, and there is concern about how to manage this behavior respectfully and professionally.

Question:
What is your best action in this situation? *
7. Mr. Albert Desjardins, 87 years old, lives in a long-term care facility. He has moderate-stage Alzheimer’s dementia. Before retirement, he was a furniture mover, and after retiring, he regularly participated in a local walking club. For the past week, Mr. Desjardins has been waking up in the middle of the night or very early in the morning. He has been observed shuffling through the hallways, entering other residents’ rooms, and rearranging chairs and small tables. His actions have caused complaints and sleep disturbances among other residents.

Question:
What is the most appropriate intervention to help reduce these behaviors? *
8.1 Mme. Suzanne Gauthier, 82 years old, has moderate dementia and was admitted to the hospital for pneumonia. Her husband holds power of attorney for medical decisions. During your medication round, Mme. Gauthier categorically refuses to take her prescribed oral antibiotics. You explain their purpose clearly, but she remains firm in her refusal. You attempt to contact her husband to inform him and possibly help with consent, but he is not answering his phone.

Question:
What is the most appropriate nursing action at this time? *
8.2 Mme. Suzanne Gauthier, 82 years old, has moderate dementia and was admitted to the hospital for pneumonia. Her husband holds power of attorney for medical decisions. During your medication round, Mme. Gauthier categorically refuses to take her prescribed oral antibiotics. You explain their purpose clearly, but she remains firm in her refusal. You attempt to contact her husband to inform him and possibly help with consent, but he is not answering his phone.

Question:
What is the most appropriate nursing action at this time? *
9. You are working the evening shift in a long-term care facility. Mme Lefebvre, an 84-year-old resident with moderate Alzheimer’s disease, is usually calm. However, tonight during hygiene care, she becomes physically aggressive, pushing your hands away and shouting, "Get out! Don't touch me! You are trying to hurt me!" She is visibly distressed and clutching her blouse.

Question:
What is the most appropriate initial nursing intervention? *
10. M. Gagnon, a 79-year-old male with vascular dementia, approaches the nursing station at 15:00. He is wearing his hat and coat. He looks anxious and tells you, "I have to leave right now. My mother is waiting for me to come home for supper. She will be worried sick if I am late." You know that his mother passed away 20 years ago.

Question:
Using the principles of Validation Therapy, what is the best response? *
11. Mme Dubois, 88 years old, has a history of mild Lewy Body Dementia. She is usually alert and able to feed herself. Today, the orderly reports that Mme Dubois is very drowsy, confused, mumbled her speech during breakfast, and has been incontinent of urine three times, which is new for her.

Question:
What is your priority nursing assessment? *
12. M. Tremblay, 75 years old with frontotemporal dementia, has lost 3 kg in the last month. During lunchtime, you observe that he sits at the table staring at his tray. When he picks up his spoon, he tries to eat the soup with the handle, becomes frustrated, throws the spoon, and stops eating.

Question:
Which intervention is best suited to improve his nutritional intake? *
13. Mme Caron, 81 years old with Alzheimer’s, is trying to tell you that she is in pain. She suffers from expressive aphasia. She points to her hip, grimaces, and says, "The… the thing… ouch… the car…". She is becoming visibly frustrated that she cannot find the words.

Question:
How should you facilitate communication with Mme Caron? *
14. M. Poirier, 72 years old, was recently diagnosed with early-stage Alzheimer’s. The physician prescribes Donepezil (Aricept) 5 mg PO daily. You are providing discharge teaching to M. Poirier and his daughter.

Question:
Which potential side effect should you emphasize as a priority to monitor at home? *
15. Mme Fortin brings her husband, who has advanced dementia, to the clinic. Mme Fortin looks disheveled, has dark circles under her eyes, and starts crying during the interview. She says, "He doesn't sleep at night, he wanders, and he doesn't recognize me anymore. I haven't slept in three days. I feel like I'm going to snap."

Question:
What is your priority intervention for Mme Fortin? *
16. M. Cloutier, a resident in the memory care unit, typically functions well during the day. However, every day around 16:30, as the sun sets, he becomes agitated, paces the hallways, pulls at the curtains, and demands to see his boss.

Question:
Which non-pharmacological intervention is most effective for managing Sundowning? *
17. Mme Roy, 85 years old with moderate dementia, has an infection.
Medical Order: Antibiotic PO twice daily.

When you approach her with the pill, she clamps her mouth shut and turns her head away, pushing your hand. You try three times over 15 minutes with encouragement, but she refuses. She does not have a legal representative present.

Question:
What is the appropriate ethical action? *
18. M. Lambert, 92 years old, is in the end stages of Alzheimer’s disease. He is bedbound and non-verbal. During lunch, he coughs frequently when given thin liquids. The family is concerned about him "starving."
Medical Order: Diet as tolerated.

Question:
What is the safest feeding technique to recommend to the family? *
19. Mme Lavallée, 89 years old, has severe Alzheimer’s disease and is non-verbal. For the past two shifts, she has been resisting care, grimacing when moved, and refusing to eat. Her vital signs show a heart rate of 110 bpm and BP of 150/90 mmHg. She usually has a calm demeanor.

Question:
Since the patient cannot self-report, what is the most reliable method to assess if she is experiencing pain? *
20. M. Bastien, 68 years old, was recently admitted to the unit with Frontotemporal Dementia (FTD). While in the dining room, he begins making loud, sexually explicit comments to a female resident and attempts to touch her leg under the table. The female resident looks terrified.

Question:
What is the appropriate immediate nursing intervention? *
21. You enter the room of Mme Morel, a 77-year-old patient with vascular dementia. You find her standing at the sink holding a disposable razor. She is lifting it towards her mouth as if she intends to brush her teeth with it.

Question:
This behavior is an example of which cognitive deficit, and what is your action? *
22. M. Desjardins, 82 years old, is mobile but severely confused. He spends most of his day standing by the unit's exit door, shaking the handle and yelling, "I need to go to work!" This behavior agitates other residents. He has managed to slip out once before.

Question:
Which environmental modification is most recommended to reduce his attempts to exit? *
23. Mme St-Pierre, 85 years old, becomes combative whenever the nursing assistants attempt to take her to the central shower room. She screams, shivers, and strikes out. The family insists she must be bathed.

Question:
What is the most appropriate strategy to ensure hygiene while respecting the patient's condition? *