Mental Health Prep U Exam 2 Chapter 24

Which is a metabolic cause of delirium?

Hypoglycemia

Which medication is not known to cause delirium?

Loop diuretics

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

Memantine

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

Visual

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

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 is diagnosed with dementia that has progressed significantly. Which would be the priority for this client?

safety

Which medication used to treat dementia requires a liver function test every 1 to 2 weeks?

tacrine

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

A group of student nurses are reviewing diagnostic criteria for the clinical diagnosis of Alzheimer disease (AD). Which finding(s) indicates that a client may have AD? Select all that apply. abnormal chemistry profile intact remote memory unable to identify a pen unable to verbally communicate inability to use a telephone

unable to identify a pen unable to verbally communicate inability to use a telephone

The nurse is reviewing the medication profile for an older client who is being evaluated for possible dementia. Which medication(s) could impair the client's cognitive status? Select all that apply. warfarin digoxin acetaminophen theophylline cimetidine

warfarin digoxin theophylline cimetidine

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 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?"

The nurse assesses a client who has received a tentative diagnosis of delirium and explains 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 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."

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)

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

A loss of neurons at the basal ganglia

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

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

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

What is the primary sign of delirium?

An altered level of consciousness

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

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

Aphasia

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

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.

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. Stop the prescribed antibiotic therapy. Contact the health care provider. Maintain adequate hydration. Obtain an order for sedation. Obtain a repeat urine culture.

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

When working with the family of an older adult client recently diagnosed with vascular dementia, the nurse's primary educational concern is to what?

Discuss the speed of progression of the disease's symptoms

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.

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 group of nurses is reviewing information about delirium and dementia. The nurses demonstrate a need for additional review when they identify which sign as a characteristic of dementia?

Fluctuating changes within a 24-hour period

A client with Alzheimer's disease is admitted to an acute care facility for treatment of an infection. Assessment reveals that the client is anxious. When developing the client's plan of care, which would be least appropriate for a nurse to include?

Frequently provide reality orientation

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 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 the primary treatment for delirium?

Identify and treat any causal or contributing medical conditions

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

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.

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.

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 diagnosed 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

A client has experienced a gradual flattening of affect, confusion, and withdrawal and has been diagnosed with Alzheimer's disease. Which additional findings would the nurse most likely assess?

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.

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

Pneumonia

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 care 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 dementia of Alzheimer's type 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 nursing diagnosis would be the priority for the client experiencing acute delirium?

Risk for injury related to confusion and cognitive deficits

Which can be identified as a hallmark symptom of dementia?

Short-term memory loss

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 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 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 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

A client diagnosed with dementia has been prescribed memantine and donepezil by the health care provider. Which information does the nurse include when providing education to the family?

The capsule can be opened and contents sprinkled over food.

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 is assessing a client with aphasia and notes the client may be exhibiting echolalia during their conversation. What signs does the nurse observe that leads to this conclusion?

The client may echo whatever is heard.

The nurse is interviewing a 50-year-old with a suspected cognitive disorder. The client has a long history of alcoholism. When the nurse asks if the client is employed, the client replies that the client is currently employed as a conductor on a national railway system. The client's spouse takes the nurse aside and informs the nurse that the client hasn't worked for several years and never worked for the railway. The nurse attributes the client's answer to which explanation?

The client may have Korsakoff's syndrome.

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 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.

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.

The diagnosis of delirium is supported when the nurse notes what about the client?

The client reports seeing "hundreds of bugs" and is not always oriented to time and place

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.

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.

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.

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

The onset of symptoms of dementia is gradual

After educating a group of nurses on Alzheimer's disease and appropriate nursing care, the group leader determines that the education was successful when the nurses identify which as the foundation for providing care to the client and family?

Therapeutic relationship

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.

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 in the client's 50s has contacted the care provider because of concerns for the client's spouse, who has suddenly begun behaving uncharacteristically in recent days. Most recently, the spouse became lost while driving to the spouse's home of 30 years and temporarily forgot the name of the spouse's child. Diagnostic testing has ruled out delirium and the spouse had been previously healthy. What is the most likely cause of the spouse's cognitive changes?

Vascular dementia

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

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

Directed by evidence-based practice, the psychiatric nurse minimizes the milieu's dementia-induced aggressive behavior by:

adhering to a predictable dressing 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.

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