prepU 39 Neurocognitive disorders mental health 243 CSN

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

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

"I don't see a snake in your room but there is an electrical cord here." Explanation: In a matter-of-fact manner, give the client factual feedback on misperceptions, delusions, or hallucinations such as "that is an electrical cord" and convey that others do not share their interpretations such as "I don't see a snake in your room." The client can feel validated for their feelings while recognizing that their perceptions are not shared by others. The nurse should not go along with the illusion or attempt to argue with the client.

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

Apraxia

An adult child brings their parent, who has Alzheimer disease, to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month. When assessing the client, a nurse would be alert for the possibility of which side effect?

nausea diarrhea vomiting Explanation: The most frequent side effects from cholinesterase inhibitors include gastrointestinal distress, such as nausea, vomiting, and diarrhea. Other side effects include constipation, ataxia, insomnia, and skin rashes.

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

provides interaction with those with similar concerns

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

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

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

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

The adult child of a client with dementia asks the nurse if the client will ever be able to live independently again. Which is the most appropriate response by the nurse?

"Symptoms of dementia gradually get worse. The client will not be independent again."

A client with moderate Alzheimer disease is prescribed memantine and donepezil. Which statement does the nurse include when teaching the client's family member about this medication?

"The efficacy of the medication can decrease over time." Explanation: Memantine and donepezil (Namzaric) is a N-methyl-D-aspartate (NMDA) receptor antagonist and cholinesterase inhibitor used to treat moderate to severe dementia of the Alzheimer type in clients stabilized on 10 mg of donepezil hydrochloride once daily. The nurse should let the family know that the efficacy of Namzaric can decrease over time. The client should not discontinue any additional dementia medications. If a dose is missed, do not double up on the next dose. Headache, diarrhea, and dizziness can occur with Namzaric; however, these are expected and not life threatening.

The nurse is talking with an older adult client who is experiencing confusion while being treated for a urinary tract infection in the hospital. The client states to the nurse, "I feel like I am losing my mind." Which statement made by the nurse would be most appropriate?

"This is upsetting right now, but your confusion will clear as you get better." Explanation: The client is aware of the confusion that indicates the client is experiencing delirium from the medical condition of the urinary tract infection. Validating the client's feelings by acknowledging that this is upsetting to the client and providing information that it will clear is the most therapeutic response to the client. Although telling the client that you understand, no information is being relayed to the client about the condition.

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

Reminiscence therapy

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

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

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

A primary brain pathology Explanation: Dementia results from primary brain pathology that usually is irreversible, chronic, and progressive. The prognosis depends on whether the cause can be identified and the condition reversed.

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

Acetylcholine Explanation: Acetylcholine is involved in cognitive functioning.

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

Achievement of self-esteem needs

A client 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

The nurse is performing an admission assessment for a client who is suspected of having dementia. Which finding would the nurse most likely document as a subjective finding?

Answers by the client and family to questions about emotional changes Explanation: Answers to question posed to the client or family about emotional changes would be documented as subjective findings.

A nurse is reviewing a journal article about Huntington's disease and the role of genetics. The nurse demonstrates understanding of the information by identifying which type of genetic transmission as being seen in this condition?

Autosomal dominant Explanation: Huntington's disease is a progressive, genetically transmitted autosomal dominant disorder characterized by choreiform movements and mental abnormalities.

During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium?

Belief that a water pitcher is another object Explanation: Clients with delirium have difficulty paying attention and are easily distracted; are often disoriented to place and time, but rarely to person; experience sudden mood swings that may range from fear to euphoria; and may have sensory disturbances such as illusions, misinterpretations, or hallucinations (they may believe a water pitcher is another object).

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

Benzodiazepines Explanation: Sedatives and benzodiazepines are avoided because they may worsen delirium.

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. Explanation: Vascular neurocognitive disorder, also called multi-infarct dementia, is caused by conditions that block or reduce blood flow to the brain.

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

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

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

Dementia has a gradual onset and is progressive in course. Explanation: Delirium has a sudden onset and the underlying cause is treatable; by contrast, dementia has a gradual onset and is progressive rather than treatable.

A nurse is providing care to a client diagnosed with delirium. When developing the client's plan of care, the nurse would identify which goals as the priority?

Correction of the underlying physiologic alteration Explanation: Resolution of confusion is the primary goal; however, the nursing care provided makes important contributions to all four of these outcomes. The end result of delirium may be full recovery, incomplete recovery, incomplete recovery with some residual cognitive impairment, or a downward course leading to death.

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

Designate a staff member to accompany the client on the walk. Explanation: The principal means of dealing with restless patients is to have an adequate number of staff (or caregivers in the home setting) to provide supervision, as well as electronically controlled exits. The nurse teaches clients to request assistance for activities, such as getting out of bed or going to the bathroom. If clients cannot request assistance, they require close supervision to prevent them from attempting activities they cannot perform safely alone. The nurse responds promptly to calls from clients for assistance and checks clients at frequent intervals.

A client diagnosed with Alzheimer's disease (AD) has decided that he is more comfortable naked than in clothes. This would be documented as which of the following?

Disinhibition Explanation: Disinhibition is a frustrating symptom of AD. Disinhibition is acting on thoughts and feelings without exercising appropriate social judgment.

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

Distract the client with family photos and discuss the events pictured. Explanation: At times, there may seem to be no way to resolve the emotional frustration, agitation, or outbursts of the client who is angry with the environment and those in it. The caregiver might find it beneficial to redirect or distract the client. This can be done by asking to see a client's personal items, such as photographs, and then talking about the family members and life events illustrated by the photographs in the book.

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

Frontal Explanation: The dementia syndrome of Huntington disease is characterized by insidious changes in behavior and personality. Typically, the dementia is frontal, which means that the person demonstrates prominent behavioral problems and disruption of attention.

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 Explanation: All four of the commonly prescribed cholinesterase inhibitors have the possibility of producing GI symptoms.

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

Gastrointestinal distress Explanation: The primary side effect of these medications is gastrointestinal distress, including nausea, vomiting, and diarrhea.

The adult child of a client with dementia asks the nurse how to respond when the client repeatedly states they had a busy day at work but the client has not worked in over 20 years. Which is the best guidance that the nurse could offer?

Go along with the client's thought of it having been a busy day, but do not refer to the client's work.

Cognitive disorders are characterized by what?

Impaired attention, memory, and abstract thinking

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

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

A client with dementia is having difficulty clearly communicating about physical needs. When teaching the caregiver about ways to assist the client in meeting physical needs, which instruction would the nurse most likely include?

Keep a record of bowel movements. Explanation: Adequate nutrition, bowel and bladder function are important physical needs. Maintenance of nutrition and hydration are essential nursing interventions. The patient's weight, oral intake, and hydration status should be monitored carefully. Poor food and fluid intake can result in bowel and bladder problems. Constipation or impaction from insufficient bulk or water can have serious consequences if not treated promptly. The client may be unable to articulate feelings of fullness; caregivers should keep a record of the regularity of bowel movements. Overstimulation should be avoided. Keeping a record of emotional outbursts is unrelated to the client's physical needs.

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

Managing environmental stimuli

Which of these is a N-methyl-D-aspartic acid (NMDA) receptor antagonist?

Memantine Explanation: Memantine is a NMDA receptor antagonist that has been shown to improve cognition and activities of daily living in clients with moderate to severe symptoms of dementia.

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

Oxidative stress Explanation: Oxidative stress is associated with dementia. The etiology of delirium is complex and multifaceted. Delirium is associated with medications, infections, fluid and electrolyte imbalance, metabolic disturbances, or hypoxia or ischemia.

The nurse manager in an long-term care facility is managing the environment to give optimal care to clients with dementia. Which will the nurse include when improving the living environment?

Plan for the same staff to provide care to individuals as much as possible.

A nurse is developing the plan of care for a client with dementia who is demonstrating problems with judgment and decision making. The nurse would identify which area as the priority for this client?

Protecting from injury

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

Provide the client with a tray, opening containers for the client. Explanation: The ability of clients to care for themselves decreases as the severity of the cognitive order increases. Caregivers can help by enhancing the client's environment to facilitate his or her limited ability to perform activities of daily living and instrumental activities of daily living and by fulfilling unmet client needs.

A client is in the mild stage of dementia due to Alzheimer's disease. Which intervention would be most appropriate?

Providing emotional support and gentle reminders

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

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

Review medication profile record. Explanation: At the present time, additional information is needed to determine whether the older client is experiencing delirium or dementia; therefore, the priority would be to review the medication profile record to see if any prescribed medications are causing delirium. Although the client is agitated, there is insufficient evidence for the use of restraints and using them could cause the confusion to worsen. Making sure that all side rails are up is a form of a restraint. Sedating the client with medication may eventually be needed. but it is not the priority action. The nurse must identify the cause of confusion and agitation prior to using medications.

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

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

Step away from the client for 5 to 10 minutes and then return. Explanation: Time-away involves leaving clients for a short period and then returning to them to reengage in interaction. The nurse can leave the client for about 5 or 10 minutes and then return without referring to the previous outburst. The client may have little or no memory of the incident and may be pleased to see the nurse on return.

The nurse is performing a history and physical assessment for a client in the clinic with moderate dementia. When asking questions, the client gets agitated and asks the nurse why are all of these questions being asked. Which is the best action(s) for the nurse to take to obtain the data needed? Select all that apply.

Take frequent breaks during the interview process. Provide simple explanations to the client as often as required. Give the client ample time to answer the questions asked. Ask simple questions instead of compound questions.

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. Explanation: The client may have some difficulty recalling events or knowledge that the client formerly knew to be fact. Because of the inability to recall recent events, the client may be confabulating, or filling in memory gaps with fabricated or imagined data.

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

The client is using confabulation. Explanation: In mild and moderate dementia, clients may make up answers to fill in memory gaps (confabulation). It is a defensive tactic to protect self-esteem and prevent others from noticing memory loss. The client's response was not given facetiously, so it cannot be assessed as an attempt at humor. Perseveration refers to repeating a word or phrase over and over, and delirium is a less likely cause because the client has a known diagnosis of dementia.

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

The client removes the client's surgical bandage and begins picking at the sheets. Explanation: Features of delirium may include a reduced level of consciousness, a disrupted sleep-wake cycle, and an abnormality of psychomotor behavior. The hospitalized client with delirium will try to remove intravenous lines and other tubes, "pick" at the air or the bed sheet, and try to climb over side rails or the end of the bed.

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

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

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

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

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

Use of disposable, adult diapers

A client has contacted the care provider because of concerns for the client's 55-year-old spouse, who suddenly became very forgetful in recent days. Most recently, the spouse became lost while driving to the spouse's home of 30 years and temporarily forgot the client's adult child's name. The client also had a temporary slurring of speech lasting about a minute. Diagnostic testing has ruled out delirium and the spouse had been previously healthy. Which would the nurse most likely suspect?

Vascular neurocognitive disorder Explanation: The behavior changes that result from vascular neurocognitive disorder are similar to those found in Alzheimer's disease, such as memory loss, depression, emotional lability or emotional incontinence (including inappropriate laughing or crying), wandering or getting lost in familiar places, bladder or bowel incontinence, difficulty following instructions, gait changes such as small shuffling steps, and problems handling daily activities (e.g., money management). However, these symptoms usually begin more suddenly rather than developing slowly, as is the case in Alzheimer's disease.

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

Visual

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

Yes, because of the head injury and medication

The nurse is creating a plan of care for a client with moderate dementia. When assigning interventions to the plan of care, which will promote socialization and provide a safe and secure environment for the client?

an activity with the nurse

Plaques

are also found in the brains of clients with Alzheimer's disease. Proteins mix together to form plaques. The more plaques present, the more signs of degeneration are also found in affected clients.

Tangles

are found in clients with Alzheimer's disease, when proteins intended to provide stability in neurons are tangled together.

Family members bring an older client, recently diagnosed with Alzheimer disease, to the clinic stating they need placement in a facility for their loved one. Which finding would support further assistance in care giving for this client?

client wandering off

The nurse cares for an older adult client with a neurocognitive disorder affecting executive function. Which assessment finding is most likely?

difficulty planning daily activities Explanation: Neurocognitive disorders are based on deficits in attention, executive function, learning and memory, language, perceptual-motor, and social cognition deficits. Planning, decision-making, and working memory can all be affected by executive function deficits.

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

disinhibition.

The nurse is caring for a 78-year-old female client with a history of Alzheimer disease, hypertension, hyperlipidemia, and type 2 diabetes admitted with a drug-induced acute kidney injury. The client currently is prescribed the Alzheimer medication galantamine. Which medication on the client's current medication list should the nurse alert the health care provider about?

ibuprofen

The nurse is caring for a 78-year-old female client with a history of Alzheimer disease, hypertension, hyperlipidemia, and type 2 diabetes admitted with a drug-induced acute kidney injury. The client currently is prescribed the Alzheimer medication galantamine. Which medication on the client's current medication list should the nurse alert the health care provider about?

ibuprofen Explanation: Ibuprofen should be used with caution with galantamine (Razadyne). If the client presents with a drug-induced kidney injury, a medication that may interact or cause adverse reactions should be discontinued. In this case, the medication is the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen. Acetaminophen, metoprolol, and atorvastatin are appropriate medications for this client and do not interact with the information given in the scenario.

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

identify a picture of a car.

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

increase frustration

Neurocognitive disorder with Lewy bodies

is associated with progressive cognitive decline with visual hallucination, rapid eye movement sleep disorder, and spontaneous Parkinsonism.

Frontotemporal neurocognitive disorder

is associated with progressive development of behavioral and personality change and/or language impairment.

The onset of Alzheimer's disease

is most likely after the age of 65.

Decreased acetylcholine production

is thought to be a cause of Alzheimer's disease, with less of the enzyme needed to produce acetylcholine found in the brains of affected clients.

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