# Situation: An 80-year-old woman with moderate Alzheimer disease is admitted to the medical ward for dehydration. She lives with her daughter. Her medications are donepezil 10 mg at bedtime and metoprolol 50 mg twice daily for hypertension. Her daughter asks how to keep her safe at home, because she has tried to walk out of the house at night. Which measure should the nurse recommend?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630427  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: An 80-year-old woman with moderate Alzheimer disease is admitted to the medical ward for dehydration. She lives with her daughter. Her medications are donepezil 10 mg at bedtime and metoprolol 50 mg twice daily for hypertension.

Her daughter asks how to keep her safe at home, because she has tried to walk out of the house at night. Which measure should the nurse recommend?

## 보기

1. Fit an identification bracelet and alarm the outside doors **✔ 정답**
2. Allow short walks alone to the corner store during the day
3. Use a vest restraint on her chair in the evening
4. Lock her bedroom door from the outside from bedtime to morning

**정답: 1**

## 해설

Wandering is managed with an identification bracelet, door alarms, supervision, and a safe home, and the client is never encouraged to go out alone. Locking a person in a room and physical restraints are unsafe, restrict freedom, and increase agitation and injury.

## 심화 해설

The measure to recommend
Her mother has tried to walk out of the house at night. Wandering is managed with an identification bracelet, door alarms, supervision, and a safe home, and the client is never encouraged to go out alone. Fitting an identification bracelet and alarming the outside doors is the measure the nurse recommends. These steps allow the family to respond quickly when she tries to leave and help others return her safely if she does get out.

Why wandering is dangerous and how to manage it
In moderate dementia, impaired memory, disorientation, and poor judgment mean a person may leave home and be unable to find the way back. Night-time wandering is especially dangerous because of darkness, traffic, weather, and the chance that no one notices she is gone. Effective management combines prevention (a calm routine, adequate daytime activity, meeting needs such as toileting or hunger), detection (door alarms, motion sensors, bells on doors), and identification (a bracelet with her name and the caregiver's contact details). The goal is safety while preserving dignity and freedom of movement within a secure environment.

| Measure | Safe? | Reason |
| --- | --- | --- |
| ID bracelet and door alarms | Yes | Allows a safe response to wandering |
| Short walks alone to the store | No | She cannot reliably find her way back |
| Vest restraint in the evening | No | Increases agitation, falls, and injury |
| Lock bedroom door from outside | No | A restraint; unsafe in fire or emergency |

Why the other measures are wrong
Allowing short walks alone is unsafe for a client with moderate dementia who already wanders. Locking a person in a room and using physical restraints are unsafe, restrict freedom, and increase agitation and injury. A vest restraint can cause falls, strangulation, skin injury, and severe distress. Locking the bedroom door from the outside is itself a form of restraint and could trap her during a fire or other emergency.

Supporting the caregiver
The nurse also suggests keeping a recent photograph available, informing neighbors, placing visual cues or covers on doors, ensuring adequate daytime activity and a calm evening, and connecting the daughter with dementia support services and respite care to reduce caregiver strain.

Exam takeaway
Key point For wandering, choose identification, alarms, supervision, and environmental safety. Restraints, locked rooms, and unsupervised outings are always wrong.

## 임상 시나리오

Home Safety for Wandering in DementiaDetect, identify, and supervise
A client with moderate dementia who walks out at night needs supervision and a safe home. An identification bracelet helps others return her safely, and door alarms alert the family when she tries to leave.

Calm routines, daytime activity, and meeting basic needs such as toileting can also reduce night-time wandering.

CautionPhysical restraints and locking her in a room increase agitation and injury and are unsafe in a fire. Never allow unsupervised outings.

## 핵심 개념

- **Wandering** — Aimless or purposeful moving about by a person with dementia, often with risk of getting lost.
- **Door alarm** — A device that sounds when a door is opened, alerting caregivers that a person is leaving.
- **Physical restraint** — A device or method that restricts a person's movement, which increases agitation and injury in dementia.
- **Respite care** — Short-term care that gives family caregivers a break from caregiving duties.

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