Ch 39 - Neurocognitive Disorders

The caregiver of a client with Alzheimer disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm the them down. The nurse educates the caregiver to use distraction techniques. When evaluating the effectiveness of the education, which statement by the caregiver demonstrates an understanding of distraction?

"Come over here and help me choose a game to play."

The adult child of a client with dementia has been the primary caregiver for 5 months. The adult child expresses to the nurse, "At times it is so overwhelming! I feel I do not have a life anymore!" Which is the most therapeutic response by the nurse?

"Here is the number of a caregivers' support group. Will you talk with others in the same situation?"

A client with delirium states to the nurse while pointing to an electrical cord on the floor, "Please get that snake out of my room. I hate snakes!" Which is the best response by the nurse?

"I don't see a snake in your room but there is an electrical cord here."

A family member is the primary caregiver to a client with dementia who states, "This is so overwhelming. I want to do the right thing but I have no life." Which statement by the nurse would be most appropriate?

"Spending some time relaxing and doing what you like to do will help you manage the demands of caregiving."

The nurse is preparing to set a client with dementia up for breakfast and gives the client a washcloth to clean their face and hands. The client looks at the washcloth without knowing what to do with it. Which is the best response by the nurse?

"This is a washcloth so you can wash your face and hands."

What is the primary sign of delirium?

An altered level of consciousness

The nurse is caring for an assigned group of clients. Which client does the nurse identify is at the highest risk for the development of delirium and will be closely monitored?

An older adult client with sepsis from a urinary tract infection

A 35-year-old client is delirious after being lost in the woods for several days and becoming severely dehydrated. At 9 p.m. the client tells the nurse to get the client's clothes because the client has to get home to the client's family. Which response by the nurse is most therapeutic?

"You're in the hospital. You did not drink for several days, but you're getting better now."

An older client has recently finished treatment for a urinary tract infection (UTI) and has now developed changes in behavior resulting in decreased cognition. Which priority intervention(s) should the nurse perform? Select all that apply.

-Contact the health care provider. -Maintain adequate hydration. -Obtain a repeat urine culture.

A group of student nurses are reviewing diagnostic criteria for the clinical diagnosis of Alzheimer disease (AD). Which finding(s) indicates that a client may have AD? Select all that apply.

-unable to identify a pen -unable to verbally communicate -inability to use a telephone

Which type of therapy encompasses thinking about or relating personally significant past experiences?

Reminiscence therapy

An older client transferred from a nursing home presents to the emergency department in an agitated state. The nurse is unable to obtain a coherent response to any questions posed. What is the best nursing action?

Review medication profile record.

In clients with Alzheimer's disease, neurotransmission is reduced, neurons are lost, and the hippocampal neurons degenerate. Which neurotransmitter is most involved in cognitive functioning?

Acetylcholine

A client is being evaluated for decline in cognitive function. The client's wife asks the nurse to explain the term dementia to her. The nurse bases her response on the knowledge that dementia is which of the following?

A primary brain pathology

After teaching a group of nursing students about delirium, the instructor determines a need for additional teaching when the students identify which as a primary goal of nursing care?

Achievement of self-esteem needs

A client with dementia is unable to recognize ordinary objects, such as a pen or notebook. The nurse recognizes this symptom as ...

Agnosia

A client diagnosed with Alzheimer's disease has an alteration in language ability. This alteration would be documented as what?

Aphasia

A client has been diagnosed with dementia and is exhibiting several cognitive disturbances. Which of the following terms is used to describe the inability to execute motor functioning despite intact motor abilities?

Apraxia

Which of the following drug classifications is avoided due to the fact that they may worsen delirium?

Benzodiazepines

A client has vascular neurocognitive disorder. When teaching the family about the cause of this disorder, which would the nurse expect to integrate into the explanation?

Blood flow in the vessels to the brain are blocked.

The nurse can distinguish delirium from dementia by knowing which of the following?

Dementia has a gradual onset and is progressive in course.

A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client is restless, approaches the nurse, and states, "I'm going to take a walk outside. I'll be back in about 10 minutes." Which is the most appropriate nursing action?

Designate a staff member to accompany the client on the walk.

Changes that are found during the mental status examination of a client diagnosed with delirium include what?

Difficulty focusing

The spouse caregiver of a client with dementia tells the nurse that the client has been agitated lately. The spouse states, "I don't know how to handle this. The client was always such a gentle person!" Which interventions should the nurse suggest?

Distract the client with family photos and discuss the events pictured.

A client with Alzheimer's disease is confused and mumbling incoherently and rambling. To help redirect the client's attention, the nurse should encourage the client to ...

Fold towels

When describing the dementia associated with Huntington disease, a nurse understands that the problems involving behavior and attention arise from a disruption in which lobe of the brain?

Frontal

A nurse is providing education to the care provider of a cognitively impaired client who is prescribed a cholinesterase inhibitor. Which information about medication side effects should the nurse be sure to include?

Gastrointestinal (GI) symptoms

A nurse is caring for a client receiving an acetylcholinesterase inhibitor (AChEI) for treatment of dementia. What is the primary side effect of AChEIs?

Gastrointestinal distress

Which is the primary treatment for delirium?

Identify and treat any causal or contributing medical conditions

The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. The nurse recognizes that this activity is likely to do which of the following?

Increase frustration

Delirium can be differentiated from many other cognitive disorders in which way?

It has a rapid onset and is highly treatable if diagnosed quickly.

A client has been diagnosed with delirium. Which of the following is the priority intervention for a client diagnosed with delirium?

Maintenance of safety

The most effective intervention for clients with delirium is which of the following?

Managing environmental stimuli

The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which of the following interventions should the nurse implement first?

Move the client to a quieter area during these times.

A group of nursing students is reviewing information about delirium and its causes. The students demonstrate a need for additional review when they identify which as a cause of this medical condition?

Oxidative stress

The client has advanced Alzheimer's disease and becomes confused at mealtimes. The client has agnosia, apraxia, and disturbed executive functioning. Which is the most appropriate nursing intervention?

Provide the client with a tray, opening containers for the client.

The nurse is caring for an older adult client that is diagnosed with dementia. Continuing assessment reveals that the client's condition is progressing significantly. Which is a priority when providing care?

Providing safety interventions to prevent injury

The nurse is assessing a client with early signs of dementia. The nurse asks the client what he ate for breakfast that morning. The purpose of this question is to determine which of the following?

Recent memory

A nurse's aide has rung the call light for assistance while providing a client's twice-weekly bath because the client became agitated and aggressive while being undressed. Knowing that the client has a diagnosis of Alzheimer's disease and is prone to agitation, which measure may help in preventing this client's agitation?

Reminding the client multiple times that he or she will be soon having a bath

Which nursing diagnosis would be the priority for the client experiencing acute delirium?

Risk for injury related to confusion and cognitive deficits

A client is diagnosed with dementia that has progressed significantly. Which would be the priority for this client?

Safety

The nurse is providing care to a client with dementia who has difficulty using utensils. Which approach is most appropriate for the nurse to implement to assist in meeting adequate dietary intake?

Serve meals in small, bite-size pieces and cut before serving.

The nurse receives a report that a 75-year-old client is recovering from surgery. During the shift, the nurse notes that the client is forgetful and restless. Several times, the client calls the nurse the name of the client's daughter. The nurse interprets this behavior as what?

Signs of delirium

The client is 42 years old, married, and has two children, ages 16 and 18. The client is also caring for the client's parent, who is in the late stages of Alzheimer's disease. The nurse would want to assess the client for what?

Signs of stress

A client with dementia gets angry and begins to yell at the nurse during mealtime in the dining area. Which is the best action by the nurse?

Step away from the client for 5 to 10 minutes and then return.

The client has early Alzheimer's disease. When asked about family history, the client relates that the client has two children who are both grown and who visit the client around the holidays each year. The nurse subsequently discovers that the client has one child who is currently assigned overseas and who has not been home for 2 years. Which would best describe the client's behavior?

The client is confabulating, most likely to cover for memory deficit.

During morning care, an unlicensed assistive personnel (UAP) asks a client with dementia, "How was your night?" The client replies, "It was lovely. My spouse and I went out to dinner and to a movie." The nurse, who overhears this conversation, would make which assessment regarding the client?

The client is using confabulation.

A 65-year-old has been admitted to the intensive care unit following surgical resection of the bowel. The client has developed a fever. Which additional signs indicate the client has developed delirium?

The client removes the client's surgical bandage and begins picking at the sheets.

The diagnosis of delirium is supported when the nurse notes what about the client?

The client reports seeing "hundreds of bugs" and is not always oriented to time and place

The nurse is creating a plan of care for a client experiencing delirium. Which outcome assigned will be a priority for the nurse to evaluate?

The client will be safe in their environment and free from injury.

The nurse is performing an assessment for a client brought in by a family member who states they think the client has dementia. When evaluating the assessment data, which finding indicates that the client may likely have delirium and not dementia?

The family member said the client started to forget people's names.

The nurse preparing an educational program on dementia should include which information?

The onset of symptoms of dementia is gradual

A nurse has been working with clients with Alzheimer disease for almost 6 months. The nurse expresses frustration to the nurse manager because the same instructions have to be given to clients several times a day. Which suggestion would be most appropriate for the manager to make?

Try to stay supportive and meet the clients' needs at the current moment.

To manage voiding issues, such as incontinence, male clients diagnosed with dementia would best be managed by what?

Use of disposable, adult diapers

Which type of hallucination most commonly occurs in clients diagnosed with dementia?

Visual

An older adult with no significant medical history is admitted to the hospital through the emergency department after hitting the client's head during a fall and fracturing the humerus. The client does not require surgery and will probably be discharged the following day. Should the nurse be concerned about delirium?

Yes, because of the head injury and medication

A caregiver of a client with dementia brings the client to the clinic for an evaluation. During the visit, the caregiver states, "Sometimes, out of the clear blue, he'll come into the kitchen while we're eating breakfast without any clothes on. It's really upsetting to me and the family." The nurse interprets this behavior as:

disinhibition.

The nurse documents that a client diagnosed with dementia of the Alzheimer's type is exhibiting agnosia when the client is observed being unable to ...

identify a picture of a car.

The nurse cares for a client with dementia. Which action determines whether the client has agnosia?

showing the client a pencil and asking the client to name the object

Which client behavior should the nurse attempt to change when managing a client's tendency to wander and pace at night?

take a nap mid-afternoon and before dinner

The nurse should consider the intervention referred to as "going along with" when managing the care of which client?

the older widower who is worried about his wife not being able to visit because of the snow