Exam #3 Dementia

The nurse is providing care for an 82-year-old client whose signs and symptoms of Parkinson disease have worsened over the past several months. The client reports no longer being able to do as many things as in the past. Based on this statement, what issue is of most concern to the client? A. Neurologic deficits B. Loss of independence C. Age-related changes D. Tremors and decreased mobility

B. Loss of independence Rationale: This client's statement places a priority on a loss of independence, not specific symptoms. This is undoubtedly a result of the neurologic changes associated with the disease, but this is not the focus of the statement. This is a disease process, not an age-related physiologic change.

The nurse caring for a client diagnosed with Parkinson's disease has helped prepare a plan of care that would include which goal? A. Promoting effective communication B. Controlling diarrhea C. Preventing optic nerve damage D. Managing choreiform movements

A. Promoting effective communication Rationale: The goals for the client may include improving functional mobility, maintaining independence in ADLs, achieving adequate bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive coping mechanisms. Constipation would be more likely than diarrhea. Parkinson disease does not affect the optic nerve. Choreiform movements are related to Huntington disease.

After a sudden decline in cognition, a 77-year-old client who has been diagnosed with vascular dementia is receiving care at home. To reduce this client's risk of future infarcts, which action should the nurse most strongly encourage? A. Activity limitation and falls reduction efforts B. Adequate nutrition and fluid intake C. Rigorous control of the client's blood pressure and serum lipid levels D. Use of mobility aids to promote independence

C. Rigorous control of the client's blood pressure and serum lipid levels

The nurse administered donepezil (Aricept) to a patient. Which finding indicates that the medication is therapeutic? The patient is awake The patient has urinated The patient has increased cognition The patient is relaxed

The patient has increased cognition.

The nurse assesses which patient as being at the highest risk for poisoning related to mixing garden chemicals? a. The patient who has Parkinson disease with hand tremors b. The patient who has low vision or uses magnifying glasses c. The patient who has hearing impairment or wears hearing aid d. The patient who has osteoarthritis or using a wheeled walker

a. The patient who has Parkinson disease with hand tremors The patient with hand tremors is at greatest risk because of the potential for inaccurate mixing and spillage.

When the demented resident in a long-term care facility becomes combative when being prepared for a bath in the shower, the nurse should: a. call for assistance to complete the shower. b. say, I understand you don't want a shower, so Ill give you a sponge bath. c. medicate the patient with a sedative and complete the bath when the patient is more cooperative. d. say, Okay. Its your right to remain dirty.

b. say, I understand you don't want a shower, so Ill give you a sponge bath. Focusing on feelings or offering an alternative is helpful with a combative demented patient. Arguing serves no purpose other than to make the resident more upset.

The nurse is providing education to a client with early-stage Alzheimer's disease (AD) and the family members. The client has been prescribed donepezil hydrochloride. What should the nurse explain to the client and family about this drug? A. It slows the progression of AD. B. It cures AD in a small minority of clients. C. It removes the client's insight that they have AD. D. It eliminates the physical effects of AD and other dementias.

A. It slows the progression of AD.

The nurse is caring for an 88-year-old client who is recovering from an iliac-femoral bypass graft. The client is day 2 postoperative and has been mentally intact, as per baseline. When the nurse assesses the client, it is clear that the client is confused and has been experiencing disturbed sleep patterns and impaired psychomotor skills. Which complication should the nurse suspect? A. Postoperative delirium B. Postoperative dementia C. Senile dementia D. Senile confusion

A. Postoperative delirium Rationale: Postoperative delirium, characterized by confusion, perceptual and cognitive deficits, altered attention levels, disturbed sleep patterns, and impaired psychomotor skills, is a significant problem for older adults. Dementia does not have a sudden onset. Senile confusion is not a recognized health problem.

A 76-year-old client with Parkinson disease has been admitted with aspiration pneumonia and constipation. Which nursing intervention would help both diagnoses? A. Sitting upright for meals B. Good oral hygiene C. Prolonged laxative usage D. Increase dietary fat

A. Sitting upright for meals Rationale: Sitting upright for meals is beneficial to both problems. It decreases risk from further aspiration and increases motility. Good oral hygiene promotes gastrointestinal health. Prolonged laxative use and increased dietary fat are not recommended for either condition.

The nurse is planning the care of a client with Parkinson disease. The nurse should be aware that treatment will focus on what pathophysiologic phenomenon? A. Premature degradation of acetylcholine B. Decreased availability of dopamine C. Insufficient synthesis of epinephrine D. Delayed reuptake of serotonin

B. Decreased availability of dopamine Rationale: Parkinson disease develops from decreased availability of dopamine, not acetylcholine, epinephrine, or serotonin.

A client is receiving ongoing nursing care for the treatment of Parkinson disease. When assessing this client's gait, which finding is most closely associated with this health problem? A. Spastic hemiparesis gait B. Shuffling gait C. Rapid gait D. Steppage gait

B. Shuffling gait Rationale: A variety of neurologic conditions are associated with abnormal gaits, such as a spastic hemiparesis gait (stroke), steppage gait (lower motor neuron disease), and shuffling gait (Parkinson disease). A rapid gait is not associated with Parkinson disease.

The nurse is writing a care plan for a client who has been diagnosed with angina pectoris. The client describes herself as being "distressed" and "shocked" by the new diagnosis. What nursing diagnosis is most clearly suggested by the client's statement? A. Spiritual distress related to change in health status B. Acute confusion related to prognosis for recovery C. Anxiety related to cardiac symptoms D. Deficient knowledge related to treatment of angina pectoris

C. Anxiety related to cardiac symptoms Rationale: Although further assessment is warranted, it is not unlikely that the client is experiencing anxiety. In clients with CAD, this often relates to the threat of sudden death. There is no evidence of confusion (i.e., delirium or dementia) and there may or may not be a spiritual element to the client's concerns. Similarly, it is not clear that a lack of knowledge or information is the root of the client's anxiety.

A home health nurse makes a home visit to a 90-year-old client who has cardiovascular disease. During the visit the nurse observes that the client has begun exhibiting subtle and unprecedented signs of confusion and agitation. What should the home health nurse do? A. Increase the frequency of the client's home care. B. Have a family member check in on the client in the evening. C. Arrange for the client to see their primary care provider. D. Refer the client to an adult day program.

C. Arrange for the client to see their primary care provider.

The nurse is discharging home a client who had a stroke. The client has a flaccid right arm and leg and is experiencing urinary incontinence. The nurse makes a referral to a home health nurse because of an awareness of what common client response to a change in body image? A. Confusion B. Uncertainty C. Depression D. Disassociation

C. Depression Rationale: Depression is a common and serious problem in the client who has had a stroke. It can result from a profound disruption in his or her life and changes in total function, leaving the client with a loss of independence. The nurse needs to encourage the client to verbalize feelings to assess the effect of the stroke on self-esteem. Confusion, uncertainty, and disassociation are not the most common client response to a change in body image, although each can occur in some clients.

The nurse is caring for an older adult client in the postanesthesia care unit. The client begins to awaken and responds to their name, but is confused, restless, and agitated. Which principle should guide the nurse's subsequent assessment? A. Postoperative confusion in older adults is an indication of impaired oxygenation or possibly a stroke during surgery. B. Confusion, restlessness, and agitation are expected postoperative findings in older adults, and they will diminish in time. C. Postoperative confusion is common in the older adult client, but it could also indicate a significant blood loss. D. Confusion, restlessness, and agitation indicate an underlying cognitive deficit such as dementia.

C. Postoperative confusion is common in the older adult client, but it could also indicate a significant blood loss.

A 50-year-old client presents at the clinic with recent episodes of forgetfulness. The client reports that a parent had some kind of illness in which the parent had to be institutionalized at age 42 and passed away at age 45. The client states that the parent forgot who their children were when the parent was institutionalized. Based on this information, what should the nurse suspect? A. Huntington disease B. Schizophrenia C. Cerebrovascular disease D. Alzheimer disease

D. Alzheimer disease

The nurse is caring for a client with dementia who has a fractured femur secondary to a fall. Which approach should the nurse take in regard to pain management with this client? A. Assume that a client with dementia does not feel pain. B. Document that the client is not in pain if the client is sleeping. C. Assess vital signs to determine if the client is in pain. D. Assume that a fracture is painful and the client is in pain.

D. Assume that a fracture is painful and the client is in pain. Rationale: When assessing a nonverbal or uncommunicative client for pain, such as the client with dementia, consider whether the client has a condition that is typically painful and treat the client accordingly. A client with dementia can feel pain even if the client is unable to verbalize pain. Being asleep is not an indicator that the client does not have pain. While vital signs may change with pain, they are the least sensitive indicators of pain.

The nurse is admitting a 52-year-old father of four into hospice care. The client has a diagnosis of Parkinson disease, which is progressing rapidly. The client has made clear his preference to receive care at home. What intervention should the nurse prioritize in the plan of care? A. Aggressively continuing to fight the disease process B. Moving the client to a long-term care facility when it becomes necessary C. Including the children in planning their father's care D. Supporting the client's and family's values and choices

D. Supporting the client's and family's values and choices Rationale: Nurses need to develop skill and comfort in assessing clients' and families' responses to serious illness and planning interventions that support their values and choices throughout the continuum of care. To be admitted to hospice care, the client must have come to terms with the fact that he is dying. The scenario states that the client wants to be cared for at home, not in a long-term care setting. The children may be able to participate in their father's care, but they should not be assigned responsibility for planning it.

A 78-year-old patient was admitted with dehydration. The nurse assesses and documents observations that support a finding of dementia. Which of the following observations are related to dementia? (Select all that apply.) a. Forgetting what she ate for lunch today b. Crying frequently when alone c. Inability to find her way back to her room from the dayroom d. Being impatient with the nursing staff for not closing her door e. Repeatedly asking to call her son

a. Forgetting what she ate for lunch today c. Inability to find her way back to her room from the dayroom d. Being impatient with the nursing staff for not closing her door e. Repeatedly asking to call her son Common manifestations of dementia include repeated questions and statements, forgetting to pay bills or take medications, increasing problems with orientation, and geographic disorientation. Other symptoms of AD include pervasive forgetfulness and memory loss, language deterioration, impaired ability to mentally manipulate visual information, poor judgment, confusion, restlessness, and mood swings. Personality changes may include apathy or loss of interest in previously enjoyed activities. Crying is not a classic sign of dementia, although depression often accompanies dementia and this could be a sign of depression.

An 80-year-old patient who is experiencing symptoms of depression and anxiety is reluctant to comply with the prescribed treatment plan. The nurse initially addresses the issue with the patient by asking: a. How do you feel about how others view your mental health problem? b. Are you concerned about paying for your psychiatric medications? c. Did you know that depression is common among people your age? d. Do you have any questions about your the mental health treatment plan?

a. How do you feel about how others view your mental health problem? Older adults are often reluctant to seek care from a mental health professional because they grew up during a period when a strong stigma was attached to mental illness, mental hospitals, and mental treatment. The other questions do not open a discussion.

A home care nurse is visiting a patient with moderate cognitive impairment from Alzheimer disease. The patients partner expresses concern about difficulty getting the patient to eat properly. The nurse suggests which of the following? (Select all that apply.) a. Serving meals at the same time each day b. Offering liquids in place of solid foods when possible c. Offering a calorie-dense snack at bedtime d. Cutting food into bite-sized pieces that will fit into the patients hand e. Asking the patent to identify favorite foods

a. Serving meals at the same time each day c. Offering a calorie-dense snack at bedtime d. Cutting food into bite-sized pieces that will fit into the patients hand Rational: It is important to support the ongoing nutrition of individuals with dementia because they may experience decreased hunger and ability to taste food. People who demonstrate symptoms of moderate to severe cognitive impairment may benefit from having meals in the same place at the same time each day. Small, frequent, nutritionally dense meals and snacks should be provided. During later stages of dementia, individuals may need to be reminded to open the mouth and chew. Food should be soft and cut in small pieces. Liquids do not need to be substituted for solid food. The patient may not be able to identify favorite foods, and asking may cause frustration.

The nurse is caring for an older adult patient admitted to the hospital. What assessment findings place the patient at risk for developing delirium during the hospitalization? (Select all that apply.) a. The patient takes medications to manage several chronic illnesses. b. The patient has a history of urinary tract infections. c. The patient is in cancer remission. d. The patient has recently been eating poorly. e. The patient experienced a mild heart attack 2 years ago.

a. The patient takes medications to manage several chronic illnesses. b. The patient has a history of urinary tract infections. d. The patient has recently been eating poorly. Rational: The risk factors for delirium include advanced age, central nervous system diseases, infection, polypharmacy, hypoalbuminemia, electrolyte imbalances, trauma history, gastrointestinal or genitourinary disorders, cardiopulmonary disorders, and sensory changes. These factors can lead to physiologic imbalances increasing the risk for confusion. Cancer remission and a heart attack 2 years prior does not increase the patient's risk.

An 89-year-old diagnosed with dementia was until recently responding well to cognitive cueing techniques. The nurse shows an understanding of dementia when sharing with staff that: a. We will implement new interventions that address the diseases progression. b. Its important that we frequently recue the patient to improve her quality of life. c. The patients family needs to be made aware of this decline. d. This poor response to cueing is likely a result of advanced aging.

a. We will implement new interventions that address the disease progression. Rational: Positive responses to selected interventions may continue for a time but may decline as the disease progresses, which results in the need to reevaluate strategies. The nursing staff cannot evaluate the patient's quality of life; only the patient can, and this patient is not capable. The family should be informed but that is not related to understanding dementia. The change in response is the result of advancing disease, not age.

The nurse can help a demented person maintain orientation by . (Select all that apply.) a. consistently calling the patient by name, usually the first name b. referring the patient to a calendar to note special events c. reminding the patient about the time of day by pointing to the clock d. calmly taking the patient to an appointment without explanation e. reminding the patient of her or his whereabouts frequently

a. consistently calling the patient by name, usually the first name b. referring the patient to a calendar to note special events c. reminding the patient about the time of day by pointing to the clock e. reminding the patient of her or his whereabouts frequently Demented persons need a simple explanation of all procedures involved in their care. All other options are helpful in maintaining orientation for a demented patient.

The nurse reading the history of a newly admitted 88-year-old man with dementia sees that this resident is prone to catastrophic reactions. The nurse understands that this person will: a. demonstrate excessive emotional reactions. b. become combative with little stimulus. c. suddenly display self-destructive behaviors. d. openly expose himself or make sexual advances.

a. demonstrate excessive emotional reactions. Catastrophic reactions are reactions that are excessively emotional.

To best advocate for an older adult patient being prescribed medication to control newly observed signs of confusion and aggressive behavior, the nurse: a. initiates an assessment to determine possible underlying causes of the behavior. b. contacts family to inform them of the new medication therapy being planned. c. discusses possible nonpharmaceutical treatments with the physician. d. documents a detailed description of the behaviors before administering the drugs.

a. initiates an assessment to determine possible underlying causes of the behavior. In this population, such symptoms may be mistakenly assumed to be a result of normal aging, so prescription medications may be ordered for anxiety, depression, aggressive and disruptive behavior, or paranoid-type behavior, without assessing the reasons for the behavior. If an underlying cause of the behavior is found, it can be treated, thereby eliminating the problem. The other actions do not demonstrate advocacy.

The nurse interprets a patient's behavior changes as being characteristic of delirium because: a. the onset of the behavior was rapid. b. there is no change in the level of consciousness. c. of the absence of disorientation. d. of the absence of hallucinations.

a. the onset of the behavior was rapid. Rational: Delirium comes on suddenly and is accompanied by a change in the level of consciousness, disorientation, and hallucinations.

The nurse is aware that conditions that can cause delirium in the older adult include: a. uncontrolled pain. b. death of a loved one. c. relocation to a long-term care facility. d. altered sleep patterns.

a. uncontrolled pain. Rational: Delirium results from physiological influences such as uncontrolled pain, metabolic disturbances, or drug toxicity.

A nurse is caring for an older patient diagnosed with acute depression. What action by the nurse is most important to help prevent delirium in this patient? a. Reorienting the patient to the day, time and place frequently b. Being physically present to help the patient with eating meals c. Providing the patient with opportunities to discuss depression d. Administering antidepressive medication as prescribed

b. Being physically present to help the patient with eating meals Rational: Depressed older adults may neglect eating or caring for a chronic medical condition, predisposing them to the development of delirium resulting from hypoalbuminemia and possibly electrolyte imbalances. The other actions will not prevent delirium.

The nurse recognizes a cardinal indicator that the patient with stage 1 dementia has deteriorated to stage 2 by the presence of: a. inability to communicate. b. incontinent episodes. c. total dependency. d. forgetfulness.

b. incontinent episodes. Incontinent episodes are indicative of stage 2 dementia.

The nurse is caring for an older adult patient who was admitted with a stage 3 pressure ulcer on the left heel and who also has a history of Parkinson disease and chronic renal failure. To minimize the patients risk of developing an iatrogenic illness, the nurse: a. uses sterile technique when changing the heels dressings. b. reviews all the patients medications for possible adverse reactions. c. instructs the patient to call for assistance when needing to go to the bathroom. d. assists the patient in choosing the appropriate foods from the daily menu.

b. reviews all the patients medications for possible adverse reactions. Adverse drug reactions frequently precipitate hospitalizations and, although often unreported, are among the most common iatrogenic events in the acute care setting. The hospital staff needs to get an accurate drug history of a patient, be aware of pharmacokinetic and pharmacodynamic changes related to aging, and have a working understanding of drug-disease, drug-drug, and drug-food interactions in older adults. Nurses should be particularly aware of drugs that may be high risk when used in older adults. The other actions are important for patient safety, but the more frequent cause of iatrogenic problems is related to medication use.

The nurse caring for an older adult patient recovering from cardiac surgery recognizes that it is most appropriate to assess this patient for mental health problems because: a. cardiac surgery often results in anxiety-related issues. b. untreated depression can contribute to the patients morbidity risks. c. many in this age cohort have undiagnosed depression. d. hospitalization is both anxiety and depression inducing.

b. untreated depression can contribute to the patients morbidity risks. Depression can and should be treated when it occurs with other illnesses because untreated depression can delay recovery from or worsen the outcome of the other illnesses. Cardiac illness is associated with depression, but not necessarily with anxiety issues. It is true that depression in the older population is underdiagnosed. Hospitalization can lead to depression. But the main reason to assess for depression is because of its effects on other health conditions.

An incapacitated older adult with dementia is brought to the emergency department by a rescue squad after falling and breaking an arm. When the patients children arrive, they are adamantly against the patient having any medical care and insist that prayer will heal the broken arm. What action by the nurse is most appropriate? a. Allow the family to pray with the patient then escort them to the waiting room. b. Call security to keep the family from interfering with medical care. c. Check facility policies and contact the hospital social worker. d. Call the police who can force the family to accept medical care.

c. Check facility policies and contact the hospital social worker.

The nurse suggests to a family caring for a member with early Alzheimer disease in their home that they investigate the services of an adult day care center. What is a major benefit of adult day care centers? a. It takes the patient out on recreational outings. b. It can provide daily hygiene. c. It expands social interaction. d. It is free to the public.

c. It expands social interaction. Rational: Adult day care centers are open a large part of the day and offer several modalities to enhance social interaction and also give the family respite.

The nurse can provide continuity for the demented patient in a general hospital by: a. keeping the patient in the room. b. reducing environmental stimuli such as the TV or radio. c. assigning the same personnel every day for care. d. attaching a bed alarm to the patient.

c. assigning the same personnel every day for care. Assigning the same personnel helps the demented patient have continuity of care

An 84-year-old female resident with dementia in an extended care facility rapidly paces the halls and the common areas from right after breakfast to bedtime. The nurse should include in the plan of care to: a. restrain the resident from pacing. b. apply a bracelet that sounds an alarm if the resident leaves the building. c. encourage rest by asking her to sit and have a glass of juice or a snack. d. pace with her and engage her in conversations.

c. encourage rest by asking her to sit and have a glass of juice or a snack. Encourage rest periods during the day by offering a snack or juice. Pacers should not be restrained from pacing. An alarm bracelet is not necessary if no attempt to leave the building is made. Pacing with her does not result in rest periods.

The nurse is caring for a 78-year-old with a history of chronic depression. The patient currently reports persistent left shoulder pain since having a fall a year ago. To best address the patients pain, the nurse initially determines: a. if the patient is still at risk for falls. b. the severity of the shoulder injury. c. how effectively depression is being managed. d. the patients ability to effectively cope with pain.

c. how effectively depression is being managed. Persistent depression affects a persons ability to cope with the pain, so it must be treated. The nurse should also assess fall risk but that is secondary to determining why the pain has lasted so long and if the patient is able to cope.

When assessing an older patient displaying symptoms of delirium, the nurse focuses the assessment on: a. the degree and duration of the symptoms. b. the amount of self-care deficiency the symptoms cause. c. identifying processes that commonly result in the symptoms. d. physiologic dysfunction resulting from the symptoms.

c. identifying processes that commonly result in the symptoms. Rational: The treatment of delirium entails the identification and treatment of the underlying cause. The nurse should assess this factor as the priority. The other assessments are of lesser priority.

A 73-year-old patient diagnosed with vascular dementia is admitted for exacerbation of asthma. The patient has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior. The nurse's initial response is to: a. identify the patient as being at high risk for falls. b. monitor the patient for signs of benzodiazepine withdrawal. c. notify the admitting physician immediately. d. place the patient on strict intake and output.

c. notify the admitting physician immediately. Rational: Benzodiazepines should be reserved for acute situations and not used for the long-term management of troubling behaviors. Long-term use can precipitate withdrawal if use is stopped and can possibly cause seizures. The nurse should notify the physician immediately so that plans for safely discontinuing the drug can be made.

The most appropriate intervention added to the nursing care plan for a person with Parkinson disease with a nursing diagnosis of Nutrition, less than body requirements related to difficulty swallowing, would be to: a. feed the patient at each meal. b. place the patient in a semi-Fowler position for mealtime. c. offer a thick, high-nutrition shake as a snack. d. encourage the patient to drink a sip of water after each bite of solid food.

c. offer a thick, high-nutrition shake as a snack.

When unsure about how to address older patients with advanced stage Alzheimer disease, the nurse recognizes that it is best to address the patient by: a. a pet name, because the patients are not likely to respond to their given names. b. the first name, to foster a friendly, relaxed atmosphere. c. the full name, to show respect for the patients as individuals. d. a childhood nickname, because long-term memory will likely still be intact.

c. the full name, to show respect for the patients as individuals. Rational: Nurses should address all older patients by their full name, including Mr. Mrs., or Miss, to show respect, unless the patient specifically requests being called something else.

The nurse at a nursing home wants to help decrease the risk of Alzheimer's disease in the residents. Which should the nurse do to implement this goal? a. Keep the curtains open in their rooms. b. Offer beads for them to string on yarn. c. Show movies that the residents choose. d. Assist residents with ambulation to meals.

d. Assist residents with ambulation to meals. Rational: Engaging in physical activity and social interaction are associated with a lower risk for Alzheimer disease. Keeping the curtains open can make a residents room more pleasant but is likely to be counterproductive in lowering the risk; brightening the room can entice the resident to stay in the room and decrease social interaction. Stringing beads is a passive and sedentary activity and therefore unlikely to decrease the risk for Alzheimer's disease; physical activity is associated with a lower risk for Alzheimer's disease. Watching movies is a sedentary but not a mentally stimulating activity for an adult with a normal intelligence.

The adult child of a patient diagnosed with Alzheimer disease has shared that he feels so sad that he is not able to carry on a social conversation with the patient anymore because of her loss of memory. The nurse suggests: a. keeping conversations short while focusing on things that happened in the past. b. concentrating on doing things his mother enjoys rather than focusing on talking. c. participating in support groups that offer suggestions for communication. d. allowing his mother to pick the topic and then simply being with her in her world.

d. allowing his mother to pick the topic and then simply being with her in her world. Rational: Family members must have a realistic understanding of the cognitive limitations of their loved ones and learn to communicate within those limits in order to remain emotionally connected with their family member. The patient may be better able to relate to past memories for a time.

6. An 80-year-old patient is exhibiting signs of dementia representative of Alzheimer disease (AD). The nurse supports that possibility when determining that the patient: a. experienced a gastric resection several years ago. b. traveled often to third world countries. c. was employed as a steelworker for 40 years. d. has a history of viral encephalitis.

d. has a history of viral encephalitis. Rational: Viral illness such as herpes zoster, herpes simplex, or viral encephalitis is believed to be a possible risk factor for AD. However, advancing age is the primary risk factor. The other options are not related.

An 80-year-old patient is exhibiting signs of dementia representative of Alzheimer disease (AD). The nurse supports that possibility when determining that the patient: a. experienced a gastric resection several years ago. b. traveled often to third world countries. c. was employed as a steelworker for 40 years. d. has a history of viral encephalitis.

d. has a history of viral encephalitis. Rational: Viral illness such as herpes zoster, herpes simplex, or viral encephalitis is believed to be a possible risk factor for AD. However, advancing age is the primary risk factor. The other options are not related.

The nurse clarifies that perception differs from cognition in that perception refers mainly to: a. intellect. b. memory. c. judgment. d. interpretation.

d. interpretation Rational: Perception refers mainly to the ability to interpret situations in the environment.

An older patient is anxious about an upcoming diagnostic test and requests something to calm the nerves. To best address the patients need, the nurse prepares to administer a PRN dose of: a. clonazepam (Klonopin). b. diazepam (Valium). c. chlordiazepoxide (Librium). d. lorazepam (Ativan).

d. lorazepam (Ativan).

The son of a patient with possible Alzheimer disease (AD) asks the nurse if there is a diagnostic test that can confirm the diagnosis. The nurse responds that: a. an electroencephalogram is often very useful in diagnosing AD. b. a positron emission tomography (PET) scan is a cheap but dependable tool. c. magnetic resonance imaging (MRI) is often ordered for that purpose. d. postmortem autopsy is the only definitive diagnostic tool.

d. postmortem autopsy is the only definitive diagnostic tool. Rational: Autopsy remains the gold standard and only definitive method for the diagnosis of AD.

When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to: a. place printed labels on important items, such as the telephone. b. place a clock and calendar in the patient's immediate environment. c. use hand gestures instead of verbal communication to demonstrate meaning. d. show the patient a picture of a toothbrush when it is time for oral hygiene.

d. show the patient a picture of a toothbrush when it is time for oral hygiene. Rational: Reality orientation supports failing memory in early stages of dementia and preserves independent functioning for a longer duration. Although written messages and signs may become meaningless to individuals with advancing dementia, pictures often evoke a response. The other options are not part of this strategy.

the nurse is caring for an older adult with cognitive impairment. What are common pain behaviors in cognitively impaired older adults that should be documented?

grimacing, crying, increased wandering and noisy breathing