# 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?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372904&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: BCC

## 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?

## Option

1. Administer the prn lorazepam now to prevent further escalation.
2. Maintain 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**
3. Restrict family visitors during evening hours to reduce overstimulation.
4. Apply soft wrist restraints at the first sign of restlessness to prevent falls.

**Correct answer: 2**

## Explanation

Sundowning is the late-afternoon-to-evening worsening of agitation/disorientation in dementia. Evidence-based first-line interventions are NON-pharmacological: maintain a consistent daytime routine, discourage long naps, and increase ambient light before sundown to reinforce circadian cues. Lorazepam (1) increases delirium risk in older adults (Beers criteria); restricting family (3) removes a calming presence; and restraints (4) escalate agitation and increase injury and delirium risk and should never be the first response.

## In-depth explanation

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.

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