An 82-year-old patient with moderate Alzheimer dementia beco… | MyMerci
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NCLEX-RNBCC
Question
An 82-year-old patient with moderate Alzheimer dementia becomes increasingly agitated, restless, and disoriented every evening between 1700 and 2000. Which non-pharmacological intervention should the nurse implement first?
1Discourage family visits during the evening hours to minimize overstimulation and help reduce the intensity of the patient's sundowning symptoms in the late afternoon.
2Raise all four bed rails on the patient's bed at the first sign of evening restlessness to prevent falls and ensure safety.
3Maintain consistent daytime activity, limit daytime napping, and increase ambient light in the late afternoon by opening blinds and turning on bright lighting before sundown.✓ Correct answer
4Play soft, calming music and reduce noise in the patient's room during the early evening to help minimize agitation.
Explanation
Sundowning is the late-afternoon-to-evening worsening of agitation/disorientation in dementia. The best first-line approach is non-pharmacological: maintain a consistent daytime routine, limit daytime napping, and increase ambient light before sundown to reinforce circadian cues. Choice 3 reflects these evidence-based strategies. Choice 1 (discouraging family visits) removes a potential source of comfort and orientation. Choice 2 (raising all four bed rails) is a physical restraint that can increase agitation and injury risk and is not recommended as a first-line measure. Choice 4 (providing music and reducing noise) is a non-pharmacological comfort measure but is less effective than light therapy and does not address circadian rhythm disruption, making it a lower priority than the combination in choice 3.
Sundowning is the second-most-tested NCLEX dementia topic after wandering. The exam reliably rewards: bright light, structured routine, simplified environment, redirection, and family involvement. Benzodiazepines and restraints are the predictable distractors.
Clinical scenario
82-year-old with moderate Alzheimer dementia exhibits sundowning: increasing agitation, restlessness, and disorientation each evening between 1700 and 2000. The patient is on no scheduled antipsychotic and the family is asking what they can do at home.
Key concepts
Sundowning — Late-afternoon-to-evening agitation, disorientation, and restlessness in patients with dementia.
Bright-light therapy — Increased ambient lighting in late afternoon to reinforce circadian rhythm and reduce evening confusion.
Beers criteria — AGS list of potentially inappropriate medications in older adults; flags benzodiazepines and many antipsychotics.