dementia delirium questions

A client with Alzheimer's disease has a nursing diagnosis of risk for injury related to memory loss, wandering, and disorientation. Which nursing intervention should appear in this client's care plan to prevent injury?

Remove hazards from the environment.

A client diagnosed with Alzheimer's disease says, "I'm so afraid. Where am I? Where is my family?" How should the nurse respond?

"You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is 1 hour from now."

The nurse understands that numerous comorbidities can contribute to the development of dementia. Which client may be at risk for dementia?

A 49-year-old client whose human immunodeficiency virus (HIV) has progressed to acquired immunodeficiency syndrome (AIDS)

C. Assess environmental triggers and potential unmet needs.

A client diagnosed with a neurocognitive disorder is exhibiting behavioral problems on a daily basis. At change of shift, the clients behavior escalates from pacing to screaming and flailing. Initially, which action should a nurse implement in this situation? A. Consult the psychologist regarding behavior-modification techniques. B. Medicate the client with prn antianxiety medications. C. Assess environmental triggers and potential unmet needs. D. Anticipate the behavior and restrain when pacing begins.

D. Late stage

A client diagnosed with neurocognitive disorder due to Alzheimers disease can no longer ambulate, does not recognize family members, and communicates with agitated behaviors and incoherent verbalizations. The nurse recognizes these symptoms as indicative of which stage of the illness? A. Confabulation stage B. Early stage C. Middle stage D. Late stage

D. Assist with bathing and toileting

A client diagnosed with neurocognitive disorder due to Alzheimers disease has impairments of memory and judgment and is incapable of performing activities of daily living. Which nursing intervention should take priority? A. Present evidence of objective reality to improve cognition B. Design a bulletin board to represent the current season C. Label the clients room with name and number D. Assist with bathing and toileting

C. Risk for injury

A client diagnosed with neurocognitive disorder due to Alzheimers disease is disoriented and ataxic, and he wanders. Which is the priority nursing diagnosis? A. Disturbed thought processes B. Self-care deficit C. Risk for injury D. Altered health-care maintenance

A. Schedule structured daily routines.

A client diagnosed with neurocognitive disorder exhibits progressive memory loss, diminished cognitive functioning, and verbal aggression upon experiencing frustration. Which nursing intervention is most appropriate? A. Schedule structured daily routines. B. Minimize environmental lighting. C. Organize a group activity to present reality. D. Explain the consequences for aggressive behaviors.

D. The client smokes one pack of cigarettes per day.

A client diagnosed with vascular dementia is discharged to home under the care of his wife. Which information should cause the nurse to question the clients safety? A. His wife works from home in telecommunication. B. The client has worked the night shift his entire career. C. His wife has minimal family support. D. The client smokes one pack of cigarettes per day.

C. Neurocognitive disorder

A client is experiencing progressive changes in memory that have interfered with personal, social, and occupational functioning. The client exhibits poor judgment and has a short attention span. A nurse should recognize these as classic signs of which condition? A. Mania B. Delirium C. Neurocognitive disorder D. Parkinsonism

C. Promote dignity by providing comfort, safety, and self-care measures.

A client is in the late stage of Alzheimers disease. To address the clients symptoms, which nursing intervention should take priority? A. Improve cognitive status by encouraging involvement in social activities. B. Decrease social isolation by providing group therapies. C. Promote dignity by providing comfort, safety, and self-care measures. D. Facilitate communication by providing assistive devices.

B. Vascular neurocognitive disorder

A client with a history of cerebrovascular accident (CVA) is brought to an emergency department experiencing memory problems, confusion, and disorientation. On the basis of this clients assessment data, which diagnosis would the nurse expect the physician to assign? A. Medication-induced delirium B. Vascular neurocognitive disorder C. Altered thought processes D. Alzheimers disease

A. Taking multiple medications may lead to adverse interactions or toxicity.

A geriatric nurse is teaching student nurses about the risk factors for development of delirium in older adults. Which student statement indicates that learning has occurred? A. Taking multiple medications may lead to adverse interactions or toxicity. B. Age-related cognitive changes may lead to alterations in mental status. C. Lack of rigorous exercise may lead to decreased cerebral blood flow. D. Decreased social interaction may lead to profound isolation and psychosis.

Parkinson's disease is thought to be caused by which neural change?

A loss of neurons at the basal ganglia

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

Aphasia

A client with dementia is having difficulty finding the words that the client wants to use. When the client could not remember the name of the client's shoes, he referred to them as, "the things you put on your feet." What is the name for this condition?

Aphasia

Which term is used to describe the inability to execute motor functioning, despite intact motor abilities?

Apraxia

When conducting a nursing assessment of a client experiencing moderate cognitive dysfunction, the nurse can best prepare for an effective interview by ensuring what?

Asking a family member to be present during the assessment

C. At twilight

At what time during a 24-hour period should a nurse expect clients with Alzheimers disease to exhibit more pronounced symptoms? A. When they first awaken B. In the middle of the night C. At twilight D. After taking medications

A nursing instructor is preparing a presentation on the etiology of Alzheimer's disease. When discussing the role of neurotransmitters in the course of the disease, which of the following would the instructor most likely emphasize? A) Serotonin B) Acetylcholine C) Dopamine D) Norepinephrine

B) Acetylcholine

When assessing a client with dementia, the nurse identifies that the client is experiencing hallucinations. Based on the nurse's understanding of this disorder, which type of hallucination would the nurse expect as most common? A) Auditory B) Visual C) Gustatory D) Olfactory

B) Visual

Which of the following would the nurse do when providing care to a patient with delirium? A. Keep the environment brightly lit B. Carefully supervise the patient C. Withhold fluids D. Apply restraints

B. Carefully supervise the patient

A 68-year-old patient who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the patient is experiencing delirium rather than dementia? a. The patient was oriented and alert when admitted. b. The patient's speech is fragmented and incoherent. c. The patient is oriented to person but disoriented to place and time. d. The patient has a history of increasing confusion over several years.

ANS: A-The patient was oriented and alert when admitted The onset of delirium occurs acutely. The degree of disorientation does not differentiate between delirium and dementia. Increasing confusion for several years is consistent with dementia. Fragmented and incoherent speech may occur with either delirium or dementia.

Which action will help the nurse determine whether a new patient's confusion is caused by dementia or delirium? a. Administer the Mini-Mental Status Exam. b. Use the Confusion Assessment Method tool. c. Determine whether there is a family history of dementia. d. Obtain a list of the medications that the patient usually takes.

ANS: B The Confusion Assessment Method tool has been extensively tested in assessing delirium.

A patient who has severe Alzheimer's disease (AD) is being admitted to the hospital for surgery. Which intervention will the nurse include in the plan of care? a. Encourage the patient to discuss events from the past. b. Maintain a consistent daily routine for the patient's care. c. Reorient the patient to the date and time every 2 to 3 hours. d. Provide the patient with current newspapers and magazines.

ANS: B Providing a consistent routine will decrease anxiety and confusion for the patient.

The nurse is administering a mental status examination to a 48-year-old patient who has hypertension. The nurse suspects depression when the patient responds to the nurse's questions with a. "Is that right?" b. "I don't know." c. "Wait, let me think about that." d. "Who are those people over there?"

ANS: B-"I don't know." Answers such as "I don't know" are more typical of depression than dementia. The response "Who are those people over there?" is more typical of the distraction seen in a patient with delirium. The remaining two answers are more typical of a patient with mild to moderate dementia.

Which nursing action will be most effective in ensuring daily medication compliance for a patient with mild dementia? a. Setting the medications up monthly in a medication box b. Having the patient's family member administer the medication c. Posting reminders to take the medications in the patient's house d. Calling the patient weekly with a reminder to take the medication

ANS: B-Having the patient's family member administer the medication Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the drug.

Which intervention will the nurse include in the plan of care for a patient with moderate dementia who had an appendectomy 2 days ago? a. Provide complete personal hygiene care for the patient. b. Remind the patient frequently about being in the hospital. c. Reposition the patient frequently to avoid skin breakdown. d. Place suction at the bedside to decrease the risk for aspiration.

ANS: B-Remind the patient frequently about being in the hospital. The patient with moderate dementia will have problems with short- and long-term memory and will need reminding about the hospitalization. The other interventions would be used for a patient with severe dementia, who would have difficulty with swallowing, self-care, and immobility.

A 56-year-old patient in the outpatient clinic is diagnosed with mild cognitive impairment (MCI).Which action will the nurse include in the plan of care? a. Suggest a move into an assisted living facility. b. Schedule the patient for more frequent appointments. c. Ask family members to supervise the patient's daily activities. d. Discuss the preventive use of acetylcholinesterase medications.

ANS: B-Schedule the patient for more frequent appointments

A 68-year-old patient is diagnosed with moderate dementia after multiple strokes. During assessment of the patient, the nurse would expect to find a. excessive nighttime sleepiness. b. difficulty eating and swallowing. c. loss of recent and long-term memory. d. fluctuating ability to perform simple tasks.

ANS: C Loss of both recent and long-term memory is characteristic of moderate dementia

A patient is being evaluated for Alzheimer's disease (AD). The nurse explains to the patient's adult children that a. the most important risk factor for AD is a family history of the disorder. b. new drugs have been shown to reverse AD dramatically in some patients. c. a diagnosis of AD is made only after other causes of dementia are ruled out. d. the presence of brain atrophy detected by magnetic resonance imaging (MRI) will confirm the diagnosis of AD.

ANS: C The diagnosis of AD is usually one of exclusion. Age is the most important risk factor for development of AD

A 71-year-old patient with Alzheimer's disease (AD) who is being admitted to a long-term care facility has had several episodes of wandering away from home. Which action will the nurse include in the plan of care? a. Reorient the patient several times daily. b. Have the family bring in familiar items. c. Place the patient in a room close to the nurses' station. d. Ask the patient why the wandering episodes have occurred.

ANS: C-Place the patient in a room close to the nurses' station. Patients at risk for problems with safety require close supervision. Placing the patient near the nurse's station will allow nursing staff to observe the patient more closely

When administering a mental status examination to a patient with delirium, the nurse should a. wait until the patient is well-rested. b. administer an anxiolytic medication. c. choose a place without distracting stimuli. d. reorient the patient during the examination.

ANS: C-choose a place without distracting stimuli. Because overstimulation by environmental factors can distract the patient from the task of answering the nurse's questions, these stimuli should be avoided. The nurse will not wait to give the examination because action to correct the delirium should occur as soon as possible. Reorienting the patient is not appropriate during the examination. Antianxiety medications may increase the patient's delirium.

A 72-year-old female patient is brought to the clinic by the patient's spouse, who reports that she is unable to solve common problems around the house. To obtain information about the patient's current mental status, which question should the nurse ask the patient? a. "Are you sad?" b. "How is your self-image?" c. "Where were you were born?" d. "What did you eat for breakfast?"

ANS: D-"What did you eat for breakfast?" This question tests the patient's short-term memory, which is decreased in the mild stage of Alzheimer's disease or dementia

The nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. The most appropriate action by the nurse is to a. secure the patient in bed using a soft chest restraint. b. ask the health care provider to order an antipsychotic drug. c. instruct family members to remain with the patient and prevent injury. d. assign unlicensed assistive personnel (UAP) to stay with the patient and offer reorientation.

ANS: D-assign unlicensed assistive personnel (UAP) to stay with the patient and offer reorientation.

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.

D. Sertraline (Zoloft)

An older client has recently moved to a nursing home. The client has trouble concentrating and socially isolates. A physician believes the client would benefit from medication therapy. Which medication should the nurse expect the physician to prescribe? A. Haloperidol (Haldol) B. Donepezil (Aricept) C. Diazepam (Valium) D. Sertraline (Zoloft)

When administering a mental status examination to a patient, the nurse suspects depression when the patient responds with a. "I don't know." b. "Is that the right answer?" c. "Wait, let me think about that." d. "Who are those people over there?"

Correct Answer: A Rationale: Answers such as "I don't know" are more typical of depression. The response "Who are those people over there?" is more typical of the distraction seen in a patient with delirium. The remaining two answers are more typical of a patient with dementia.

The nurse has identified the nursing diagnosis of disturbed thought processes related to effects of dementia for a patient with late-stage Alzheimer's disease (AD). An appropriate intervention for this problem is to a. maintain a consistent daily routine for the patient's care. b. encourage the patient to discuss events from the past. c. reorient the patient to the date and time every few hours. d. provide the patient with current newspapers and magazines.

Correct Answer: A Rationale: Providing a consistent routine will decrease anxiety and confusion for the patient. In late-stage AD, the patient will not remember events from the past. Reorientation to time and place will not be helpful to the patient with late-stage AD. The patient with late-stage AD will not be able to read. Cognitive Level: Application Text Reference: p. 1571 Nursing Process: Planning NCLEX: Physiological Integrity

Risperidone (Risperdal) is prescribed for an outpatient with moderate Alzheimer's disease (AD). Which information obtained by the nurse at the next clinic appointment indicates that the medication is effective? a. The patient has less agitation. b. The patient is dressed appropriately. c. The patient is able to swallow a pill. d. The patient's speech is clearer.

Correct Answer: A Rationale: Risperidone is an antipsychotic used to treat the agitation, aggression, and behavioral problems associated with AD. The other improvements might occur with cholinesterase inhibitors. Cognitive Level: Application Text Reference: p. 1568 Nursing Process: Evaluation NCLEX: Physiological Integrity

When developing a plan of care for a hospitalized patient with moderate dementia, which intervention will the nurse include? a. Reminding the patient frequently about being in the hospital b. Placing suction at the bedside to decrease the risk for aspiration c. Providing complete personal hygiene care for the patient d. Repositioning the patient frequently to avoid skin breakdown

Correct Answer: A Rationale: The patient with moderate dementia will have problems with short- and long-term memory and will need reminding about the hospitalization. The other interventions would be used for a patient with severe dementia, who would have difficulty with swallowing, self-care, and immobility. Cognitive Level: Application Text Reference: p. 1563 Nursing Process: Planning NCLEX: Physiological Integrity

A nurse is providing care to a client with Alzheimer's disease who is exhibiting suspiciousness and delusional thinking. Which of the following would be most important for the nurse to do with this client? A) Tell the client that he is experiencing delusions. B) Confront the client about his distorted thinking. C) Correct the client's interpretation of the situation. D) Determine the trigger for the distorted thinking.

D) Determine the trigger for the distorted thinking.

An older adult client is brought to the emergency department after ingesting an unknown substance. The client, who appears to have dementia, has tremors, ataxia of the upper and lower extremities, depression, and confusion. The nurse suspects ingestion of which of the following? A)Lead B)Aluminum C)Manganese D)Mercury

D)Mercury

An 80-year-old is brought to the clinic by the client's spouse. The client has a history of peripheral vascular disease and type 2 diabetes. The spouse states that the client hasn't seemed to be normal for the preceding few days, noting that the client has been lethargic and mildly confused at times and has been incontinent of urine. The spouse reports that the client's blood glucose levels have been elevated. The nurse considers which as the most likely explanation for the client's change in mental status?

Delirium related to underlying medical problem

Medications for Neurocognitive disorders

Delirium: Avoid Benzos Alzheimers: Cholinesterase inhibitors Donepezil (Aricept), Galantamine (Razadyne) delay the decline in cognitive functioning but do not improve cognitive function after it has declined. Start as soon as diagnosis made. N-Methyl-D-Aspartic Acid Antagonists Memantine (Nameda) Blocks toxic effects of excess glutamate and regulates glutamate activation

A client with Alzheimer's disease in the intensive treatment unit repeatedly tries to go into other clients' rooms to nap during the day. The most appropriate nursing intervention for this client is what?

Escorting the client to the client's room for napping

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

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 an 84-year-old suffering from delirium. The client has been in a nursing home for the past 2 years but recently is becoming combative and has become a threat to staff. Which medication would the client most likely receive for these symptoms?

Haloperidol

A client with amnestic disorder is being evaluated for dementia. Which is a diagnostic characteristic of amnestic disorder?

History and physical examination indicative of memory impairment

A nurse is preparing a presentation for a group of staff nurses about neurocognitive disorders. When describing vascular neuorocognitive disorder, the nurse would identify which as posing the greatest risk for this disorder?

Hypertension

Which is a metabolic cause of delirium?

Hypoglycemia

Which is the primary treatment for delirium?

Identify and treat any causal or contributing medical conditions

Which is the priority when caring for a client with delirium?

Identifying the cause

A nurse is caring for a client with delirium. The client sees a thermometer on the nurse's table and shouts, "Don't stab me!" and cowers. Which feature of delirium is this client exhibiting?

Illusion

Cognitive disorders are characterized by what?

Impaired attention, memory, and abstract thinking

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 is diagnosed with dementia related to Parkinson's disease. While at a doctor's visit, a cholinesterase inhibitor is prescribed for the client. The nurse knows that this type of medication would be prescribed for the client to do what?

Slow deterioration of memory and function

The psychiatric nurse documents that the cognitively impaired client is exhibiting "confabulation" when observed doing what?

Telling other clients that the client "was a dairy farmer" when the client actually ran a small grocery store

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.

A 59-year-old has just been diagnosed with early-stage dementia. The client is experiencing mild forgetfulness but can function normally. The client lives with a spouse and adult child, who is a single parent of two. When planning care for this family, which of the goals should the nurse identify as a priority?

The client will discuss emotional response to diagnosis.

A client was admitted to an inpatient unit with a diagnosis of dementia. A nursing assessment and interview of the client would include what?

Intellectual ability, health history, and self-care ability

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

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

The client with dementia often cannot clearly communicate physical needs. Which intervention should the nurse teach the caregiver to address common physical problems?

Keep a record of bowel movements.

After teaching a group of nursing students about drugs used to treat Alzheimer's disease, the instructor determines that additional teaching is needed when the group identifies which as a N-methyl-D-aspartic acid (NMDA) receptor antagonist?

Memantine

A client with a medical diagnosis of dementia of Alzheimer's type has been increasingly agitated in recent days. As a result, the nurse has identified the nursing diagnosis of "risk for injury related to agitation and confusion" and an outcome of "the client will remain free from injury." What intervention should the nurse use in order to facilitate this outcome?

Monitor amount of environmental stimulation and adjust as needed.

While reviewing the medical record of a client with moderate dementia of the Alzheimer type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type?

N-methyl-D-aspartate (NMDA) receptor antagonist

A client has experienced a gradual flattening of affect, confusion, and withdrawal and has been diagnosed with Alzheimer's disease. The nurse assesses which additional characteristics of this disorder?

Personality change, wandering, and inability to perform purposeful movements

A client with dementia becomes extremely agitated shortly after being admitted to the psychiatric unit. The nurse is reluctant to use physical restraints to control the client. What is a likely reason the nurse has this reluctance?

Physical restraints may increase the client's agitation.

A older adult client develops delirium secondary to an infection. Which would be the most likely cause?

Pneumonia

Which is an infection-related cause of delirium?

Pneumonia

The geriatrician has prescribed an 80-year-old client donepezil in order to treat the client's dementia, Alzheimer's type. Which teaching points should the nurse provide to the client's spouse about the new medication?

"Donepezil won't cure your spouse's dementia of Alzheimer's type, but it has the potential to slow down the progression of the disease."

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

The diagnosis of delirium is supported when the nurse notes which in the client?

The is convinced that the client sees "hundreds" of bugs and is not always oriented to time and place

A group of friends have arrived at the hospital to visit a client recently diagnosed with delirium. The nurse tells the friends they can visit with the client one at a time. What is the likely reason for the nurse to give this instruction?

The nurse wants to prevent increasing the client's confusion.

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

The onset of symptoms of dementia is gradual

A nurse is caring for a client with delirium. The nurse assesses the client's activities of daily living on a daily basis. What is the most likely reason for assessing these so frequently?

To assess for fluctuation in the client's capabilities

A nurse is studying the medical chart of a client with delirium. The nurse finds that the client was given haloperidol. What would be the most likely reason for administering this drug to the client?

To decrease agitation

The nurse is working with the family of a client who is newly diagnosed with Alzheimer's type dementia. Which suggestion would be effective for assisting the family members in daily orienting of their family member when the client returns home?

Use daily newspapers, calendars, and a set routine.

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.

Which of the following statements by the caregiver of a client newly diagnosed with dementia requires further intervention by the nurse? a. "I will remind Mother of things she has forgotten." b. "I will keep Mother busy with favorite activities as long as she can participate." c. "I will try to find new and different things to do every day." d. "I will encourage Mother to talk about her friends and family."

c. "I will try to find new and different things to do every day."

What is the greatest benefit support groups provide to the caregivers of clients diagnosed with dementia?

provides interaction with those with similar concerns

A client was admitted to the intensive care unit after a motor vehicle accident. The client sustained a right parietal injury, resulting in an acute confusional state or delirium. The client reports that there are "bugs crawling around" on the arms. The nurse understands this as:

tactile hallucinations from delirium.

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

What is the primary sign of delirium?

An altered level of consciousness

A 73-year-old client has been brought to the emergency department by the client's adult children due to abrupt and uncharacteristic changes in behavior, including impairments of memory and judgment. The subsequent history and diagnostic testing have resulted in a diagnosis of delirium. Which teaching point about the client's diagnosis should the nurse provide to the family?

"If the underlying cause of delirium is identified and treated, most people return to their previous level of functioning."

The nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate?

"The client's diagnosis is primarily based on the rapid onset of the change in consciousness."

An 80-year-old client with Alzheimer's disease is prescribed donepezil. Which teaching points should the nurse provide to the client's spouse about the new medication?

"The drug won't cure the client's Alzheimer's, but it has the potential to slow down the progression of the disease."

Dementia Nursing Interventions

-provide safe environment -assist with ADLs -use simple, direct statements -maintain health, hygiene, rest -routine activities

A. This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the AD.

A nursing instructor is teaching about donepezil (Aricept). A student asks, How does this work? Will this cure Alzheimers disease (AD)? Which is the appropriate instructor reply? A. This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the AD. B. This medication encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease. C. This medication delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the AD. D. This medication encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease.

The nurse is caring for a client diagnosed with delirium who has been brought for treatment by his son. While taking the client's history, which question would be most appropriate for the nurse to ask the client's son? A)"Has your father taken any medications recently?" B)"Are you aware of your father falling or injuring his head in any way?" C)"Has your father had a recent stroke?" D)"Has your father experienced any major losses recently?"

A) "Has your father taken any medications recently?"

A client is admitted to the hospital with dementia related to Parkinson's disease. The client is being treated for a fractured tibia from a recent fall. The nurse should assess the client's history for use of which type of medication? A) Anticholinergics B) Dopamine agonists C) Anxiolytics D) Benzodiazepines

A) Anticholinergics

A group of nursing students is reviewing information about delirium and dementia. The students demonstrate a need for additional review when they identify which of the following as characteristics of dementia? A) Fluctuating changes within a 24-hour period B) Possible hallucinations C) Normal psychomotor activity D) Globally impaired cognition

A) Fluctuating changes within a 24-hour period

A client with Alzheimer's disease is admitted to the acute care facility for treatment of an infection. Assessment reveals that the client is anxious. When developing the client's plan of care, which of the following would be least appropriate to include? A) Frequently provide reality orientation. B) Simplify the client's routines. C) Limit the number of choices to be made. D) Establish predictable routines.

A) Frequently provide reality orientation.

A daughter brings her mother, who has Alzheimer's disease, to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month. When assessing the client, the nurse would be alert for the possibility of which side effect? A) Gastrointestinal distress B) Mild headache C)Muscle tics D) Blurred vision

A) Gastrointestinal distress

A client is brought to the emergency department by his wife. The wife states that over the past few hours, the client has become disoriented and confused. "He didn't know where he was and didn't seem to recognize me or be able to carry on a coherent conversation." The nurse suspects delirium. When reviewing the client's medication history with the wife, use of which of the following would alert the nurse to a potential cause? Select all that apply. A) Propranolol B) Acetaminophen C) Diphenhydramine D) Verapamil E) Quinidine

A) Propranolol C) Diphenhydramine E) Quinidine

While the nurse is caring for a hospitalized client in the advanced stages of Alzheimer's disease, the client begins to have a catastrophic reaction to feeding himself. Which of the following should the nurse do first? A) Remain calm and reassuring. B) Restrain the client temporarily. C) Draw the curtains to darken the room. D) Offer to feed the client.

A) Remain calm and reassuring.

After teaching a group of nursing students about Alzheimer's disease and appropriate nursing care, the instructor determines that the teaching was successful when the students identify which of the following as the foundation for providing care to the client and family? A) Therapeutic relationship B) Medication therapy C) Injury prevention D) Functional independence

A) Therapeutic relationship

As part of a follow-up home visit to an 80-year-old client who has had surgery, the nurse discusses the client's risk for delirium with his family members. Which of the following would the nurse include as placing the client at increased risk? Select all that apply. A)Urinary tract infection B)Hypertension C)Acute stress D)Bone fractures E)Dehydration F)Electrolyte balance

A)Urinary tract infection C)Acute stress D)Bone fractures E)Dehydration

C. Neurocognitive disorder does not develop suddenly.

After 1 week of continuous mental confusion, an elderly African American client is admitted with a preliminary diagnosis of major neurocognitive disorder due to Alzheimers disease. What should cause the nurse to question this diagnosis? A. Neurocognitive disorder does not typically occur in African American clients. B. The symptoms presented are more indicative of Parkinsonism. C. Neurocognitive disorder does not develop suddenly. D. There has been no T3 or T4 level evaluation ordered.

A client is diagnosed with Alzheimer's disease. While assessing the client, the nurse notes that the client has trouble identifying objects such as a key and spoon. The nurse would document this as what?

Agnosia

A nurse is assessing a client diagnosed with Alzheimer's disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing for what?

Agnosia

When assessing a client with dementia, the nurse notes that the client is having difficulty identifying common items, such as a ball or book. The nurse interprets this finding as what?

Agnosia

The nurse is caring for a client with dementia. The client's brain images show atrophy of cerebral neurons and enlargement of the third and fourth ventricles. What is the cause of dementia in this client?

Alzheimer's disease

A nurse is assessing a client diagnosed with Alzheimer's disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing for which of the following? A) Aphasia B) Apraxia C) Agnosia D) Executive functioning

C) Agnosia

The nurse makes a home visit to a family caring for a client with Alzheimer's disease. The client's wife tells the nurse that she hasn't been out of the house for more than 2 weeks because her sister has been unable to help her care for the client. Which nursing diagnosis would the nurse identify as the priority? A) Ineffective Family Coping related to care of a client with Alzheimer's disease B) Risk for Activity Intolerance related to Alzheimer's disease C) Caregiver Role Strain related to social isolation D) Powerlessness related to seclusion and long-term care of client

C) Caregiver Role Strain related to social isolation

A nurse is talking with the husband of a female client diagnosed with Alzheimer's disease. During the conversation, the husband tells the nurse that "she often begins to scream and curse for no apparent reason". The nurse interprets this as which of the following? A) Hypersexuality B) Disinhibition C) Hypervocalization D) Apathy

C) Hypervocalization

While reviewing the medical record of a client with moderate dementia of the Alzheimer type, the nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type? A) Atypical antipsychotic B) Cholinesterase inhibitor C) NMDA receptor antagonist D) Benzodiazepine

C) NMDA receptor antagonist

The nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate? A)"Basically, this diagnosis is based on the client's inability to talk normally." B)"Your report of gradually developing confusion over time was the basis for the diagnosis." C)"His diagnosis is primarily based on the rapid onset of his change in consciousness." D)"The client's exposure to an infectious agent led us to determine the diagnosis."

C)"His diagnosis is primarily based on the rapid onset of his change in consciousness."

An adolescent client is seen in the emergency department with symptoms of dementia, tremors, and ataxia. The client had been sniffing glue with a friend. The nurse suspects the client's symptoms were caused by poisoning with which of the following? A)Mercury B)Lead C)Toluene D)Arsenic

C)Toluene

A family member of a patient with possible Alzheimer's disease asks the nurse the purpose of the Mini-Mental State Examination (MMSE). Which response by the nurse is appropriate? a. The MMSE helps in establishing the diagnosis of Alzheimer's disease (AD). b. The MMSE is useful in determining the degree of mental impairment. c. The MMSE determines the choice of the most appropriate treatment. d. The MMSE aids in differentiating acute delirium from chronic dementia.

Correct Answer: B Rationale: The MMSE establishes the degree of mental impairment at the time it is given. It does not establish a diagnosis of AD but when given repeatedly over time may help to determine the progression of AD. The choice of treatment is made on the basis of multiple data, not just the MMSE. The MMSE may be abnormal with either delirium or dementia and is not useful in determining which condition the patient has. Cognitive Level: Application Text Reference: p. 1563 Nursing Process: Implementation NCLEX: Physiological Integrity

When teaching the spouse of a patient who is being evaluated for Alzheimer's disease (AD) about the disorder, the nurse explains that a. the most important risk factor for AD is a family history of the disorder. b. a diagnosis of AD can be made only when other causes of dementia have been ruled out. c. new drugs have been shown to reverse AD dramatically in some patients. d. the presence of brain atrophy detected by MRI confirms the diagnosis of AD in patients with dementia.

Correct Answer: B Rationale: The diagnosis of AD is one of exclusion. Age is the most important risk factor for development of AD. Drugs can slow the deterioration but do not dramatically reverse the effects of AD. Brain atrophy is a common finding in AD, but it can occur in other diseases as well. Cognitive Level: Comprehension Text Reference: p. 1568 Nursing Process: Implementation NCLEX: Physiological Integrity

During the morning change-of-shift report at the long-term care facility, the nurse learns that the patient with dementia has had sundowning. Which nursing action should the nurse take while caring for the patient? a. Move the patient to a quieter room at night. b. Open the blinds in the patient's room and provide frequent activities. c. Have the patient take a brief mid-morning nap. d. Provide hourly orientation to time of day.

Correct Answer: B Rationale: The most likely cause of sundowning is a disruption in circadian rhythms and keeping the patient active and in daylight will help to reestablish a more normal circadian pattern. Moving the patient to a different room might increase confusion. Taking a nap will interfere with nighttime sleep. Hourly orientation will not be helpful in a patient with memory difficulties. Cognitive Level: Application Text Reference: p. 1573 Nursing Process: Implementation NCLEX: Safe and Effective Care Environment

To protect a patient from injury during an episode of delirium, the most appropriate action by the nurse is to a. have a close family member remain with the patient and provide reassurance. b. assign a staff member to stay with the patient and offer frequent reorientation. c. ask the health care provider about ordering an antipsychotic drug. d. secure the patient in bed with a soft chest restraint.

Correct Answer: B Rationale: The priority goal is to protect the patient from harm, and a staff member will be most experienced in providing safe care. Visits by family members are helpful in reorienting the patient, but families should not be responsible for protecting patients from injury. Antipsychotic medications may be ordered, but only if other measures are not effective because these medications have multiple side effects. Restraints are sometimes used but tend to increase agitation and disorientation. Cognitive Level: Application Text Reference: p. 1577 Nursing Process: Implementation NCLEX: Physiological Integrity

3. When administering a mental status examination to a patient with delirium, the nurse should a. give the examination when the patient is well-rested. b. reorient the patient as needed during the examination. c. choose a place without distracting environmental stimuli. d. medicate the patient first to reduce anxiety.

Correct Answer: C Rationale: Because overstimulation by environmental factors can distract the patient from the task of answering the nurse's questions, these stimuli should be avoided. The nurse will not wait to give the examination because action to correct the delirium should occur as soon as possible. Reorienting the patient is not appropriate during the examination. Antianxiety medications may increase the patient's delirium. Cognitive Level: Application Text Reference: pp. 1562, 1576-1577 Nursing Process: Implementation NCLEX: Physiological Integrity

A home-health patient with Alzheimer's disease (AD) and mild dementia has a new prescription for donepezil (Aricept). Which nursing action will be most effective in ensuring compliance with the medication? a. Setting the medications up weekly in a medication box b. Calling the patient daily with a reminder to take the medication c. Having the patient's spouse administer the medication d. Posting reminders to take the medications in the patient's house

Correct Answer: C Rationale: Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the Aricept. The other nursing actions will not be as effective in ensuring that the patient takes the medications. Cognitive Level: Application Text Reference: pp. 1563, 1567 Nursing Process: Implementation NCLEX: Physiological Integrity

A long-term care patient with moderate dementia develops increased restlessness and agitation. The nurse's initial action should be to a. administer the PRN dose of lorazepam (Ativan). b. reorient the patient to time and place. c. assess the patient for anything that might be causing discomfort. d. have a nursing assistant stay with the patient to ensure safety.

Correct Answer: C Rationale: Increased motor activity in a patient with dementia is frequently the patient's only way of responding to factors like pain, so the nurse's initial action should be to assess the patient for any precipitating factors. Administration of sedative drugs may be indicated, but this should not be done until assessment for precipitating factors has been completed and any of these factors have been addressed. Reorientation is unlikely to be helpful for the patient with moderate dementia. Assigning a nursing assistant to stay with the patient may also be necessary, but any physical changes that may be causing the agitation should be addressed first. Cognitive Level: Application Text Reference: p. 1573 Nursing Process: Implementation NCLEX: Physiological Integrity

A son brings his mother to the clinic for an evaluation. The son's mother has moderate Alzheimer's disease without delirium. The nurse assesses the client for which of the following as the priority? A) Hearing deficits B) Mania C) Strange verbalizations D) Catastrophic reactions

D) Catastrophic reactions

Coexisting dementia and depression are identified in a patient with Parkinson's disease. The nurse anticipates that the greatest improvement in the patient's condition will occur with administration of a. antipsychotic drugs. b. anticholinergic agents. c. dopaminergic agents and antidepressant drugs. d. selective serotonin reuptake inhibitor (SSRI) agents.

Correct Answer: C Rationale: Parkinson's disease and depression are both potentially reversible conditions, and the patient's symptoms that are caused by these two conditions will improve with appropriate treatment. Anticholinergic agents are likely to worsen the patient's condition because they will block the effect of acetylcholine at the synaptic cleft. There is no indication that the patient needs an antipsychotic agent at this time. A selective serotonin reuptake inhibitor (SSRI) may be effective for the depression, but it does not address the patient's other conditions. Cognitive Level: Application Text Reference: p. 1563 Nursing Process: Planning NCLEX: Physiological Integrity

When assessing a patient with Alzheimer's disease (AD) who is being admitted to a long-term care facility, the nurse learns that the patient has had several episodes of wandering away from home. Which nursing action will the nurse include in the plan of care? a. Ask the patient why the wandering episodes have occurred. b. Reorient the patient to the new living situation several times daily. c. Place the patient in a room close to the nurses' station. d. Have the family bring in familiar items from the patient's home.

Correct Answer: C Rationale: Patients at risk for problems with safety require close supervision. Placing the patient near the nurse's station will allow nursing staff to observe the patient more closely. Use of "why" questions is frustrating for the patient with AD, who are unable to understand clearly or verbalize the reason for wandering behaviors. Because of the patient's short-term memory loss, reorientation will not help to prevent wandering behavior. Because the patient had wandering behavior at home, familiar objects will not prevent wandering. Cognitive Level: Application Text Reference: p. 1573 Nursing Process: Planning NCLEX: Safe and Effective Care Environment

A patient with Alzheimer's disease (AD) is hospitalized with a urinary tract infection. The spouse tells the nurse, "I am just exhausted from the constant care and worry. We don't have any children and we can't afford a nursing home. I don't know what to do." The most appropriate nursing diagnosis for the spouse is a. anxiety related to limited financial resources. b. ineffective health maintenance related to stress. c. caregiver role strain related to limited resources for caregiving. d. social isolation related to unrelieved caregiving responsibilities.

Correct Answer: C Rationale: The spouse's statements are most consistent with caregiver role strain. The other diagnoses each address one aspect of the spouse's problem, but caregiver-role strain related to limited resources for caregiving addresses all the information the nurse has about this situation. Cognitive Level: Application Text Reference: pp. 1574-1575 Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

A 62-year-old patient is brought to the clinic by a family member who is concerned about the patient's increasing sleep disturbances and inability to solve common problems. To obtain information about the patient's current mental status, which question should the nurse ask the patient? a. "Where were you were born?" b. "Do have any feelings of sadness?" c. "What day of the week is it today?" d. "How positive is your self-image?"

Correct Answer: C Rationale: This question tests the patient's orientation to time, which is decreased in early Alzheimer's disease (AD) or dementia. Asking the patient about birthplace tests for remote memory, which is intact in the early stages. Questions about the patient's emotions and self-image are helpful in assessing emotional status, but they are not as helpful in assessing mental state. Cognitive Level: Application Text Reference: pp. 1564, 1567 Nursing Process: Assessment NCLEX: Physiological Integrity

A 71-year-old patient is diagnosed with moderate dementia as a result of multiple strokes. During assessment of the patient, the nurse would expect to find a. excessive nighttime sleepiness. b. variable ability to perform simple tasks. c. difficulty eating and swallowing. d. loss of recent and long-term memory.

Correct Answer: D Rationale: Loss of both recent and long-term memory is characteristic of moderate dementia. Patients with dementia have frequent nighttime awakening. Dementia is progressive, and the patient's ability to perform tasks would not have periods of improvement. Difficulty eating and swallowing is characteristic of severe dementia. Cognitive Level: Application Text Reference: pp. 1562-1563 Nursing Process: Assessment NCLEX: Physiological Integrity

A 72-year-old patient hospitalized with pneumonia is disoriented and confused 2 days after admission. Which assessment information obtained by the nurse about the patient indicates that the patient is experiencing delirium rather than dementia? a. The patient is disoriented to place and time but oriented to person. b. The patient has a history of increasing confusion over several years. c. The patient's speech is fragmented and incoherent. d. The patient was oriented and alert when admitted.

Correct Answer: D Rationale: The onset of delirium occurs acutely. The degree of disorientation does not differentiate between delirium and dementia. Increasing confusion for several years is consistent with dementia. Fragmented and incoherent speech may occur with either delirium or dementia. Cognitive Level: Application Text Reference: p. 1562 Nursing Process: Assessment NCLEX: Physiological Integrity

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

Difficulty focusing

Which is the hallmark of beginning mild dementia?

Forgetfulness

Which is the priority intervention for a client diagnosed with delirium?

Maintenance of safety

A client is exhibiting signs of mild delirium such as occasional confusion about why the client is in the hospital and what day of the week it is. When developing a care plan, the nurse identifies several strategies to improve the client's cognitive function. Which intervention will be helpful to the client?

Make up a daily calendar with the date and the times of scheduled activities.

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 client is 79 years old and has been diagnosed with dementia. Continuing assessment reveals that the client's condition is progressing significantly. Which would be the priority when providing care?

Safety

Which would be the priority goal for a client with dementia?

Safety

Which can be identified as a hallmark symptom of dementia?

Short-term memory loss

An 82-year-old client with a diagnosis of vascular dementia has been admitted to the geriatric psychiatry unit of the hospital. In planning the care of this client, which outcome should the nurse prioritize?

The client will remain free from injury.

Which type of hallucination is most commonly seen in clients diagnosed with delirium?

Visual

B. Neurocognitive disorders involve impairment of abstract thinking and judgment, whereas amnestic disorders do not.

Which symptom should a nurse identify that would differentiate clients diagnosed with neurocognitive disorders from clients diagnosed with amnesic disorders? A. Neurocognitive disorders involve disorientation that develops suddenly, whereas amnestic disorders develop more slowly. B. Neurocognitive disorders involve impairment of abstract thinking and judgment, whereas amnestic disorders do not. C. Neurocognitive disorders include the symptom of confabulation, whereas amnestic disorders do not. D. Both neurocognitive disorders and profound amnesia typically share the symptom of disorientation to place, time, and self.

C. Altered task performance

Which symptom should a nurse identify that would differentiate clients diagnosed with neurocognitive disorders from clients with pseudodementia (depression)? A. Altered sleep B. Impaired attention and concentration C. Altered task performance D. Impaired psychomotor activity

Which of the following interventions is most appropriate in helping a client with early-stage dementia complete activities of daily living (ADLs)? a. Allow enough time for the client to complete ADLs as independently as possible. b. Provide the client with a written list of all the steps needed to complete ADLs. c. Plan to provide step-by-step prompting to complete the ADLs. d. Tell the client to finish ADLs before breakfast or the nursing assistant will do them

a. Allow enough time for the client to complete ADLs as independently as possible.

A client with dementia has been admitted to a long-term care facility. Which of the following nursing interventions will help the client to maintain optimal cognitive function? a. Discuss pictures of children and grandchildren with the client. b. Do word games or crossword puzzles with the client. c. Provide the client with a written list of daily activities. d. Watch and discuss the evening news with the client.

a. Discuss pictures of children and grandchildren with the client.