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Advance care planning and anticipatory decision making in patients with Alzheimer disease

doi: 10.1097/01.NPR.0000534861.40262.08
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INSTRUCTIONS Advance care planning and anticipatory decision making in patients with Alzheimer disease


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Lippincott Professional Development will award 1.0 contact hour for this continuing nursing education activity.

Lippincott Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.0 contact hour. Lippincott Professional Development is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida CE Broker #50-1223.

Advance care planning and anticipatory decision making in patients with Alzheimer disease

Purpose: To provide information that will assist patients with AD and their caregivers in decision making. Learning Objectives/Outcomes: After completing this continuing-education activity, you should be able to: 1. Distinguish the AD trajectory and difficulties patients and caregivers experience with decision making. 2. Specify the NP's role in advance care planning and anticipatory decision making.

  1. For patients older than 65, a cognitive status assessment should be done at annual wellness visits and should begin with a
    1. Memory Impairment Screen test.
    2. structured cognitive assessment such as the Mini-Cog.
    3. conversation about patient concerns with confusion or memory loss.
  2. The primary clinical manifestation of AD is
    1. cognitive decline.
    2. personality changes.
    3. mood instability.
  3. One early sign of cognitive decline is
    1. difficulty with organization and planning.
    2. difficulty learning new information.
    3. lack of judgment.
  4. Behavioral symptoms manifest with the progression of AD and exhibit as all of the following except
    1. aggression.
    2. hallucinations.
    3. mania.
  5. The AD trajectory is
    1. predictable.
    2. medically complex.
    3. straightforward and certain.
  6. A goal of anticipatory decision making is to make decisions
    1. that are well thought out.
    2. quickly in times of uncertainty.
    3. that patients would have made when they were able.
  7. An early and timely AD diagnosis
    1. ensures readiness to participate in decision making.
    2. facilitates development of coping strategies.
    3. results in patient distress and caregiver guilt.
  8. Hamann and colleagues found that patients with early-stage AD
    1. preferred to remain autonomous in making decisions.
    2. tended to defer decisions to close family members.
    3. trusted healthcare providers with direct decision making.
  9. The authors suggest that engaging patients in decision making early in the AD trajectory is vital to
    1. guide caregivers to assume decision-making responsibility.
    2. slow the progression of symptoms.
    3. maintaining autonomy as cognitive decline progresses.
  10. In the event that the patient is not ready for education and decision making, what intervention is recommended?
    1. education of caregivers instead of the patient
    2. identification of an alternate decision maker
    3. support, guidance, and counseling strategies
  11. The process of ACP anticipates potential decisions, preparing the patient and caregiver, thereby managing or preventing
    1. uncertainty.
    2. mistakes.
    3. any changes to the plan.
  12. During which stage of the AD trajectory does the caregiver provide collaborative support in decision making?
    1. early
    2. mid
    3. late
  13. The period of unilateral support with surrogate decision making is necessary in order to
    1. ease the burden on caregivers.
    2. reduce harm.
    3. ensure adherence to treatment.
  14. A systematic review by Robinson and colleagues suggested that ACP as an intervention strategy in later stages of the disease
    1. increased safety and autonomy.
    2. significantly improved quality of life.
    3. had limited effectiveness.
  15. Dening and colleagues stressed the importance of ACP
    1. during the late stage of the disease.
    2. at a predetermined point in time.
    3. prior to the point when cognitive decline interferes with decision making.
  16. Essential to ACP education is the acknowledgment that
    1. patients seek support and develop coping strategies.
    2. final decisions are made early and once.
    3. goals of care do not change over time.
  17. The CPT code G0505 has been approved by the CMS for the
    1. treatment of complications arising from AD.
    2. first 30 minutes of face-to-face AD discussions.
    3. creation of a comprehensive care plan.


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