Chapter 24: Cognitive Disorders PREPU
Delirium can be differentiated from many other cognitive disorders in which way?
It has a rapid onset and is highly treatable if diagnosed quickly.
Which nursing diagnosis would be the priority for the client experiencing acute delirium?
Risk for injury related to confusion and cognitive deficits
A nurse is caring for a client diagnosed with delirium who has been brought for treatment by the client's adult child. While taking the client's history, which question would be most appropriate for the nurse to ask the client's adult child?
"Has your parent taken any medications recently?"
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."
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."
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."
Parkinson's disease is thought to be caused by which neural change?
A loss of neurons at the basal ganglia
Which would not be considered a primary goal of nursing care for a client with delirium?
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
What is the primary sign of delirium?
An altered level of consciousness
When giving tacrine to an elderly client, the nurse must be aware of what information?
Because the liver is most vulnerable to tacrine, liver function tests must be done periodically.
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.
A group of nurses is reviewing information about delirium and dementia. The nurses demonstrate a need for additional review when they identify which as a characteristic of dementia?
Fluctuating changes within a 24-hour period
A nurse is providing education to the care provider of a cognitively impaired client who is prescribed a cholinesterase inhibitor. Which information about medication side effects should the nurse be sure to include?
Gastrointestinal (GI) symptoms
A nurse is caring for a client 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
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
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.
Maintain adequate hydration. Contact the health care provider. Obtain a repeat urine culture.
Which of these is a N-methyl-D-aspartic acid (NMDA) receptor antagonist?
Memantine
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 group of nursing students is reviewing information about delirium and its causes. The students demonstrate a need for additional review when they identify which as a cause of this medical condition?
Oxidative stress
The client has advanced Alzheimer's disease and becomes confused at mealtimes. The client has agnosia, apraxia, and disturbed executive functioning. Which is the most appropriate nursing intervention?
Provide the client with a tray, opening containers for the client.
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 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?
Reminding the client multiple times that he or she will be soon having a bath
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 nurse is assessing a client who is diagnosed with delirium. Which presenting sign in the client indicates to the nurse that the client may have a diagnosis of dementia?
Remote memory loss
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.
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
A client is diagnosed with dementia related to Parkinson's disease. While at a clinic visit, a cholinesterase inhibitor is prescribed for the client. The nurse knows that this type of medication would be prescribed for the client to achieve which goal?
Slow deterioration of memory and function
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.
The nurse asks a client to pretend the client is brushing the client's teeth. The client is unable to perform the action. Upon examination, the nurse finds that the client possesses intact motor abilities. What can this problem be documented as?
The client may have apraxia.
Major goals for the nursing care of clients with dementia should include what?
The client will be safe, be physiologically stable, and have infrequent episodes of agitation.
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.
To manage voiding issues, such as incontinence, male clients diagnosed with dementia would best be managed by what?
Use of disposable, adult diapers
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
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.
When assessing a client with dementia, a 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?
Visual
Which type of hallucination is most commonly seen in clients diagnosed with delirium?
Visual
Which type of hallucination most commonly occurs in clients diagnosed with dementia?
Visual
An older adult with no significant medical history is admitted to the hospital through the emergency department after hitting the client's head during a fall and fracturing the humerus. The client does not require surgery and will probably be discharged the following day. Should the nurse be concerned about delirium?
Yes, because of the head injury and medication
Which is a metabolic cause of delirium?
hypoglycemia
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.
What is the initial intervention the nurse should implement when helping a client diagnosed with dementia deal with paranoid delusions?
observe the client in order to identify the triggers for the delusions
Which is an infection-related cause of delirium?
pneumonia
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