An older man has Alzheimer disease, and his wife says he is up and wandering around the house at ...

Answer to #1

A
Regular exercise can help increase the duration of sleep during the night. Adding a new medica-tion to the existing pharmacotherapy can increase adverse drug interactions and complicate the problem; the existing therapeutic regimen can be already contributing to the problem. Adminis-tering a hypnotic medication is the therapy of last resort and can be ineffective. The nurse avoids recommending the use of restraints; restraint use is associated with an increased incidence of in-jury and accidents. In addition, restraints can be an ineffective therapy and can contribute to hos-tility and combativeness. Excessive napping during the day may be contributing to the problem.

Answer to #2

D

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A Incorrect. Restraints have been shown not to increase safety and may contribute to morbidity and mortality.
B Incorrect. Even if a fall does not cause injury, it can contribute to fear of falling, inhibiting activities of daily living.
C Incorrect. The get-up-and-go test, in which the person rises from a straight-backed chair, walks 10 feet, returns, and sits down, assesses balance and gait.
D Correct. Adjusting bed height to match the length of the resident's lower leg and marking the path from bed to toilet with bright fluorescent tape are some of many possible interventions to improve residents' safety.

Answer to #3

B
All of these physical problems, as well as arthritis, can contribute to sleep disorders. It takes older adults more time to fall asleep, and older adults are awakened throughout the night more fre-quently than younger people. Benzodiazepines should not be used to induce sleep; these sub-stances are highly addictive, and if their administration is suddenly withdrawn, then rebound in-somnia can occur. In addition, older adults who take benzodiazepines for sleeping are more likely to experience a hangover after waking that can increase the risk of accidents and injuries. In addition to alleviating depression that causes sleep disorders, SSRIs can have a stimulating effect that, in itself, interferes with the sleep cycle.

Answer to #4

A

Feedback
A Correct. A thoughtful nurse respects and supports the resident's boundaries.
B Incorrect. Even if this were true, the resident's grief process and personal space should be respected.
C Incorrect. The resident's behavior can be understood as a healthy defense of personal space.
D Incorrect. This is probably the nurse assistant's rationale, but the assistant should realize that the resident is entitled to personal use of personal space.

Answer to #5

B
The mere presence of other people, without significant personal exchange, does not prevent or alleviate loneliness.
Loneliness is evidence of the capacity to love. Hostile behavior can be a sign of loneliness. Pets can provide comfort, touch, affection, and an opportunity to care for another being.

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