Chapter 59, Dementia and Delirium

What score range on the Mini-Cog test indicates a positive screen for dementia?

The Mini-Cog test is used as a brief assessment tool for cognitive impairment. 0 to 2 is a positive screen for dementia. 3 and above is a negative screen for dementia.

The nurse identifies that a patient with delirium is at risk for injury. Which interventions would be included in the patient's plan of care to address the safety concerns? Select all that apply. 1 Place a calendar within view. 2 Obtain a prescription for restraints. 3 Make sure the television is on at all times. 4 Keep the overhead lights on during the day. 5 Reorient the patient to person, place, and time as necessary.

1. / 5. This helps orient the patient person, place, and time (situation) NOT 3 / 4 Potentially overstimulate the patient 2. Restraints should be avoided

Which manifestations is the nurse likely to document when performing a physical assessment on a patient with dementia with Lewy bodies? Select all that apply. 1 Rigidity 2 Dementia 3 Physical growth delays 4 Bradykinesia 5 Postural instability 6 Mild to moderate intellectual disability

1. 2. 4. 5. Lewy bodies are clumps of protein that can form in the brain and cortex (Researchers don't know exactly why these deposits form) NOT 3. 6. Seen in Down syndrome

Which drug therapy would be prescribed for a patient diagnosed with Alzheimer's disease? Select all that apply. 1 Donepezil 2 Rivastigmine 3 Memantine 4 Haloperidol 5 Risperidone

1. 2. cholinesterase inhibitors 3. protects the brain's nerve cells against excessive amounts of glutamate, which is released in large amounts by cells damaged in AD NOT 4. 5. antipsychotic drugs that are not indicated for the treatment of AD; however, they can be used with caution for treating behavioral problems associated with the disease

Which findings would the nurse identify as supporting a diagnosis of dementia in a patient with behavioral changes? Select all that apply. 1 Loss of memory 2 Early awakening from sleep 3 Hyperactive body movements 4 Difficulty with normal conversation 5 Changes developing over the last few days

1. 4. Dementia is often diagnosed when two or more brain functions, such as memory loss or language skills, are significantly impaired. NOT 2. Associated with depression 3. associated with either dementia or delirium 5. manifestations of delirium

A patient with disorganized, distorted thinking and slow or accelerated incoherent speech is demonstrating which cognitive problem? 1 Delirium 2 Dementia 3 Depression 4 Alzheimer's disease

1. Dementia is characterized by difficulty with abstract thinking and judgment (in addition to disorganized, distorted thinking and slow or accelerated incoherent speech)

Which observation would the nurse identify as a possible beginning sign of delirium in a hospitalized patient? 1 Pain level of 5 2 Awake at 3:00 a.m. 3 Drop in BP 4 Reports of being hungry

2. Early manifestations of delirium include insomnia. Being awake at 3:00 a.m. could indicate this early warning sign. NOT 1. 3. 4. Pain, hypotension, and increased hunger are not identified as manifestations of delirium.

Which issue is the leading risk factor for delirium? 1 Age 2 Dementia 3 Sleep deprivation 4 Serious medical illness

2. The leading risk factor for delirium is dementia NOT 3. Sleep deprivation has been linked to delirium, though it is not the leading risk factor 4. may be a symptom of a serious medical illness 1. Many risk factors that can lead to delirium are more common in older patients, and older adults are more susceptible to drug-induced delirium, but age in and of itself is not a risk factor

Which drug on the medication administration record would the nurse administer to a patient with Alzheimer's disease who is experiencing sleep disturbances? 1 Fluoxetine 2 Zolpidem 3 Clonazepam 4 Memantine

2. hypnotic drug used to treat sleep disturbances that are often associated with AD NOT 1. Depression (SSRI) 3. used to treat behavioral problems such as aggression, disinhibition, and agitation that occur with AD 4. protects the nerve cells against excess amounts of glutamate, which is released in large amounts by damaged cells in patients with AD

A nurse in a long-term care facility is caring for a patient with Alzheimer's disease. The patient, who is usually cooperative and calm, is agitated and refusing care from the nursing assistant. Which action would the nurse do first? 1 Notify the health care provider and obtain a medication to treat the agitation. 2 Notify the patient's family and ask if someone could come and sit with the patient. 3 Perform a physical assessment, including monitoring vital signs and signs of pain. 4 Ask the nursing assistant to distract the patient with an activity.

3. Initially, the nurse should assess the patient's physical status to determine whether the patient is experiencing some physical ailment. Consider that the patient's dementia limits the ability to express needs. NOT 2. Precipitating factors causing the behavior change should be thoroughly investigated before asking a family member to sit with the patient or administering medication to control agitation 4. Acceptable, but not done first

Which collaborative treatment would be prescribed for an adult patient who is diagnosed with mild cognitive impairment (MCI)? 1 Donepezil 2 Rivastigmine 3 Continued monitoring 4 Placement in assisted living

3. MCI is marked by symptoms of memory problems severe enough to be noticed and measured, but not compromising a person's independence; therefore placement in assisted living is not anticipated. NOT 1 / 2 little evidence that cholinesterase inhibitors, such as donepezil and rivastigmine, affect progression to dementia or cognitive test scores in people with MCI

Which disorder can cause dementia and is considered ventricular? 1 Head injury 2 Brain tumor 3 Hydrocephalus 4 Hepatic encephalopathy

3. a potentially reversible ventricular disorder that can cause dementia NOT 1. also a potentially reversible condition that can cause dementia. However, this is not a ventricular disorder 2. can also cause dementia but is not a ventricular disorder 4. a systemic disease that can cause dementia

Which medication is appropriate for the nurse to administer when the patient who is diagnosed with Alzheimer's disease (AD) is experiencing agitation and physical aggression? 1 Zolpidem 2 Sertraline 3 Haloperidol 4 Galantamine

3. an antipsychotic drug, is often prescribed PRN for the agitation and physical aggression that can occur in a patient who is diagnosed with AD. NOT 1. used to treat sleep disturbances. 2. SSRI used for the depression that can occur with AD 4. cholinesterase inhibitor, is used to treat decrease memory and cognition

Early onset AD is associated with various mutations to:

PSEN1, PSEN2 gene, and the APP gene. The presence of the ApoE-2 allele is associated with a lower risk of AD. Late-onset AD is associated with the presence of the ApoE-4 allele.

When providing community health care teaching regarding the early warning signs of Alzheimer's disease, which key signs would the nurse advise family members to report? Select all that apply. 1 Misplacing car keys 2 Losing sense of time 3 Difficulty performing familiar tasks 4 Problems with performing basic calculations 5 Becoming lost in a usually familiar environment

All but 1. NOT 1. Misplacing car keys is a normal frustrating event for many people.

Which tools will be used to diagnose Alzheimer's disease (AD)? Select all that apply. 1 Drug therapy 2 Thyroid function tests 3 Brain imaging tests 4 Behavioral modification 5 Psychologic evaluation

NOT 1. therapy not diagnostic

Which complications are associated with dementia with Lewy bodies? Select all that apply. 1 Renal calculi 2 Impaired mobility 3 Impaired nutrition 4 Pulmonary edema 5 Difficulty swallowing

Nursing care for a patient with dementia with Lewy bodies relates to management of the dementia and of problems related to dysphagia and immobility (2.3.5.) NOT 1.4. not health problems associated with dementia with Lewy bodies

Which information is correct about the association between Alzheimer's disease (AD), dementia, and diabetes mellitus? Select all that apply. 1 Elevated blood glucose levels contribute to oxidative stress. 2 Insulin resistance may encourage the development of brain plaques. 3 Supplemental insulin alters arterial lining, encouraging atherosclerotic changes. 4 Uncontrolled glucose levels reduce the oxygen-carrying capacity of red blood cells. 5 Elevated glucose and cholesterol levels potentiate the development of atherosclerosis.

1. High blood glucose produces oxygen-containing molecules that can damage cells in a process known as oxidative stress. 2. Insulin resistance, which causes high blood glucose and in some cases leads to type 2 diabetes, may interfere with the body's ability to break down amyloid, a protein that forms brain plaques in AD. 5. contributes to vascular dementia NOT 3. not identified as encouraging atherosclerotic changes 4. do not reduce the oxygen-carrying capacity of RBC

The nurse would assess a patient with Alzheimer's disease who has increased vocalization and agitation for which issue? 1 Pain 2 Glaucoma 3 Lack of sleep 4 Schizophrenia

1. Patients with AD have cognitive impairment that may affect their oral and written language. As a result, AD patients may have difficulty expressing physical complaints, including pain. You should observe for signs of pain, such as increased vocalization, agitation, withdrawal, and changes in function.

Which factors would the nurse consider risk factors for developing Alzheimer's disease? Select all that apply. 1 Aging 2 Viral infection 3 Family history 4 Diabetes mellitus 5 IBS

1. greatest risk factor for AD 3. found to run in families; those with a 1st degree relative with dementia are more likely to develop the disease. Those who have more than one first-degree relative with dementia are at even higher risk of developing the disease. 4. DM affects the vascular supply of the brain in many ways. (Cerebral hypoxia caused by compromised vascular supply may cause neurodegenerative changes in the brain, leading to dementia and Alzheimer's disease) NOT 2. 5. do not cause degenerative changes in the brain

After reviewing assessment data, the nurse adds interventions to a patient's plan of care to address the risk for developing delirium. Which findings would cause the nurse to make these additions? Select all that apply. 1 Age 84 2 Left foot wound 3 Chronic renal failure 4 Macular degeneration 5 Previous hip replacement

1. groups at risk include those with advanced age 2. severe acute illness such as a foot wound 3. chronic renal disease 4. visual impairment such as macular degeneration NOT 5. do not contribute to the development of delirium

Which is a key characteristic of delirium? 1 Occurs abruptly 2 Difficulty using words 3 Frequent night awakenings 4 Lasts an average of eight years

1. key distinction of delirium is that it occurs abruptly NOT 2. / 3. patient with dementia, not delirium, experiences difficulty using words and frequent night awakenings 4. AD, not delirium, lasts an average of eight years.

A patient in the intensive care unit begins to exhibit signs of delirium. The nurse identifies that which factors may have contributed to the acute onset of symptoms? Select all that apply. 1 Hard of hearing 2 Sleep deprivation 3 Indwelling urinary catheter 4 IV fluid administration 5 Anesthesia for surgery

1.2. Sleep deprivation and sensory limitations may contribute to the development of delirium 5. NOT 3.4. not identified as precipitating factors for delirium.

When reviewing the health history of a patient with dementia, which causes of the patient's dementia would the nurse identify as possibly being reversible? Select all that apply. 1 Alcoholism 2 Hypothyroidism 3 Parkinson's disease 4 Anticholinergic drug use 5 Hydrocephalus

2. 4. 5. NOT 1. 3. Not reversible

An older patient who takes haloperidol for delirium is exhibiting extrapyramidal effects. Which action would the nurse take? 1 Hold the next scheduled dose of haloperidol. 2 Instruct the patient on how to control the adverse body movements. 3 Discuss the use of a benzodiazepine with the health care provider. 4 Position the patient in a chair in an area with increased environmental stimuli.

3. can be used in conjunction with antipsychotics to reduce extrapyramidal side effects NOT 1. More information is required before deciding to hold the next dose 2. not under voluntary control; therefore coaching to control body movements will be unsuccessful 4. could exacerbate the delirium.

Which methods are used to diagnose the preclinical stage of Alzheimer's disease? Select all that apply. 1 Electrocardiogram 2 Thyroid function tests 3 Serum creatinine test 4 Cerebrospinal fluid (CSF) analysis 5 Positron emission tomography (PET) scan

4. 5. some people, amyloid buildup can be detected with PET scan and CSF analysis NOT 1. determines the cardiac activity 2. does not cause Alzheimer's disease, so thyroid tests are not appropriate 3. indicative of renal functioning and are therefore not useful in detecting Alzheimer's disease

A patient seeks medical attention because of cognitive impairment and is diagnosed with Alzheimer's disease. Which finding forms the basis for the diagnosis? 1 Brain imaging shows atrophy of the brain. 2 Presence of the gene ApoE-4 shows up on genetic testing. 3 CT shows vascular brain lesion. 4 Cognitive impairment with etiologies other than Alzheimer's disease has been ruled out.

4. Testing is done to rule out all possible known causes. If no cause is found for the change in mental status, then the diagnosis of Alzheimer's disease is made based on exclusion NOT 1. found with aging and may be present with normal cognitive functioning 2. only a risk factor gene for late onset Alzheimer's disease (after age 60) 3. Vascular brain lesions such as infarcts of the brain occur with vascular dementia

Which statement by the nurse is accurate when explaining vascular dementia to a patient's family? 1 "It is caused by low blood pressure." 2 "It is caused by another chronic disease." 3 "It is reversible with medication treatment." 4 "It occurs after a single stroke or multiple strokes."

4. Vascular conditions are the 2nd most common cause of dementia and may be caused by a single stroke (infarct) or by multiple strokes. NOT 1. risk factor for dementia 2. 3. not identified as being reversible or caused by another chronic disease

Which medication helps to improve memory and cognition in patients with Alzheimer's disease? 1 Sertraline 2 Trazodone 3 Haloperidol 4 Rivastigmine

4. inhibits cholinesterase (used to treat decreased memory and cognition associated with AD) NOT 1. treat depression associated with AD 2. treat behavioral problems such as agitation and aggression that can be caused by AD 3. may help with sleep problems associated with AD

Dementia

A neurocognitive disorder characterized by dysfunction or loss of memory, orientation, attention, language, judgment, and reason

"DELERIUM" Mnemonic

D- Dementia, Dehydration E-electrolyte abnormality L-Lung, Liver, Heart, Kidney, Brain I-Infection R-Rx I-Injury, immobility U-Untreated Pain M-Metabolic Disorder

Patients who are diagnosed with early onset AD should:

Encourage their adult children to be genetically tested for the disease process. The children of any patient diagnosed with early onset AD have a 50% risk for AD. Early onset AD is rare, and it is often associated with a more rapid disease course. While proper treatment may slow the progression of AD, it will continue to advance and is fatal. Most patients die from AD within four to eight years of diagnosis. If a person tests positive for the apolipoprotein E-4 (ApoE-4) allele, it does not mean that the person will develop AD.

Which assessment findings support the diagnosis of frontotemporal lobar degeneration (FTLD)? Select all that apply. 1 Erratic behavior 2 Altered memory 3 Sleep disturbances 4 Difficulty with speech 5 Inconsistent motor function

Everything but 5. Motor function changes are not identified as a manifestation of FTLD.

The adult child of an older patient states, "Since the discharge from the hospital two days ago, my parent won't eat and is confused." Which issue would the nurse suspect is occurring with the patient? Delirium or Dementia

In most patients, delirium usually develops over a two- to three-day period. Early manifestations of delirium include loss of appetite and confusion. Loss of appetite and confusion are not indications of an infection. Dementia has a slow, insidious onset. The described manifestations are not indicative of psychosis.

Phenytoin and carbamazepine

anticonvulsant medications used to treat seizures