MH Prep U Ch. 24

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? A. Blood flow in the vessels to the brain are blocked. B. Fragments mix with molecules to make plaques in the brain. C. Strands of protein are tangled together. D. Acetylcholine production is decreased.

A. Blood flow in the vessels to the brain are blocked.

When working with the family of an older adult client recently diagnosed with vascular dementia, the nurse's primary educational concern is to what? A. Discuss the speed of progression of the disease's symptoms B. Determine ways to minimize caregiver stress C. Explain the onset can be related to exposure to infection D. Explain the medication therapy the client has been prescribed

A. Discuss the speed of progression of the disease's symptoms

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? A. Frequently provide reality orientation B. Limit the number of choices to be made C. Establish predictable routines D. Simplify the client's routines

A. Frequently provide reality orientation

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? A. The client may have agnosia. B. The client may have apraxia. C. The client may have aphasia. D. The client may have disturbed executive function.

B. The client may have apraxia.

Which would not be considered a primary goal of nursing care for a client with delirium? A. Management of confusion B. Protection from injury C. Achievement of self-esteem needs D. Meeting physiological and psychological needs

C. Achievement of self-esteem needs

An older adult client develops delirium secondary to an infection. Which would be the most likely cause? A. Appendicitis B. Cellulitis C. Pneumonia D. Low platelet count

C. Pneumonia

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? A. Client's ability to perform arithmetic problems to determine cortical function B. Results of testing the client's ability to remember unrelated words and recent events C. Assessment of the client's level of consciousness D. Answers by the client and family to questions about emotional changes

D. Answers by the client and family to questions about emotional changes

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? A. Give the client a sedative when the client begins to get agitated. B. Distract the client by turning on the television or watching a video. C. Leave the client in a safe place in the house and go to another area until the client calms down. D. Distract the client with family photos and discuss the events pictured.

D. Distract the client with family photos and discuss the events pictured.

Which of these is a N-methyl-D-aspartic acid (NMDA) receptor antagonist? A. Galantamine B. Rivastigmine C. Donepezil D. Memantine

D. Memantine

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? A. "Has your parent taken any medications recently?" B. "Are you aware of your parent falling or injuring the head in any way?" C. "Has your parent experienced any major losses recently?" D. "Has your parent had a recent stroke?"

A. "Has your parent taken any medications recently?"

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? A. Acetylcholine B. Epinephrine C. Norepinephrine D. Serotonin

A. 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? A. Achievement of self-esteem needs B. Addressing physiological and psychological needs C. Management of confusion D. Protection from injury

A. Achievement of self-esteem needs

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? A. Hypertension B. Heart disease C. Hyperlipidemia D. Diabetes

A. Hypertension

Which is a metabolic cause of delirium? A. Hypoglycemia B. Encephalitis C. Alcohol Intoxication D. Meningitis

A. Hypoglycemia

Delirium can be differentiated from many other cognitive disorders in which way? A. It has a rapid onset and is highly treatable if diagnosed quickly. B. It is much less responsive to pharmacologic treatment than the other disorders. C. It has as a slow onset, but if caught early it can be treated with medications. D. It is characterized by a period of disorganization and confusion.

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

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

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

Which nursing diagnosis would be the priority for the client experiencing acute delirium? A. Risk for injury related to confusion and cognitive deficits B. Acute confusion related to delirium of known/unknown etiology C. Risk for self-mutilation related to confusion and cognitive deficits D. Fall precautions related to acute confusion

A. Risk for injury related to confusion and cognitive deficits

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? A. The capsule can be opened and contents sprinkled over food. B. Each medication can be given separately. C. The effects of the drug become stronger over time. D. The medication should be given in the morning.

A. The capsule can be opened and contents sprinkled over food.

Major goals for the nursing care of clients with dementia should include what? A. The client will be safe, be physiologically stable, and have infrequent episodes of agitation. B. The client will be safe and eat appropriately. C. The client will be physically stable, maintain normal body weight, and be safe. D. The client will have no self-harm behaviors and maintain sleep and appetite.

A. 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? A. The client will remain free from injury. B. The client will demonstrate decreased agitation. C. The client will identify life areas that require alterations due to illness. D. The client will demonstrate increased feelings of self-worth.

A. 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? A. Use of disposable, adult diapers B. Indwelling catheters C. Condom catheter D. Intermittent catheterization

A. 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? A. Vascular dementia B. Dementia with Lewy bodies (DLB) C. Dementia of Alzheimer's type (DAT) D. Wernicke's encephalopathy

A. Vascular dementia

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? A. "The client's exposure to an infectious agent led us to determine the diagnosis." B. "The client's diagnosis is primarily based on the rapid onset of the change in consciousness." C. "Your report of gradually developing confusion over time was the basis for the diagnosis." D. "Basically, this diagnosis is based on the client's inability to talk normally."

B. "The client's diagnosis is primarily based on the rapid onset of the change in consciousness."

The nurse understands that numerous comorbidities can contribute to the development of dementia. Which client may be at risk for dementia? A. A 30-year-old client with schizophrenia who has been admitted to the hospital because of psychogenic polydipsia B. A 49-year-old client whose human immunodeficiency virus (HIV) has progressed to acquired immunodeficiency syndrome (AIDS) C. A 69-year-old client whose lung cancer has metastasized to the bones and liver D. An 87-year-old resident of a long-term care facility who has developed a urinary tract infection (UTI)

B. A 49-year-old client whose human immunodeficiency virus (HIV) has progressed to acquired immunodeficiency syndrome (AIDS)

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? A. Aphasia B. Agnosia C. Apraxia D. Disturbance of executive function

B. Agnosia

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? A. Apraxia B. Agnosia C. Disturbance of executive function D. Aphasia

B. 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? A. Picks's disease B. Alzheimer's disease C. Vascular dementia D. Parkinson's disease

B. Alzheimer's disease

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? A. Bruising B. Gastrointestinal (GI) symptoms C. Syncope D. Skin rashes

B. Gastrointestinal (GI) symptoms

Which is the primary treatment for delirium? A. Maintain intravenous fluid administration B. Identify and treat any causal or contributing medical conditions C. Apply physical restraints D. Provide adequate nutritional food and fluid intake

B. Identify and treat any causal or contributing medical conditions

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? A. Give acetaminophen if the client appears uncomfortable. B. Keep a record of bowel movements. C. Ensure environmental noise for stimulation. D. Keep a record of emotional outbursts.

B. Keep a record of bowel movements.

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? A. Tremors, unsteady gait, and transient paresthesias B. Personality change, wandering, and inability to perform purposeful movements C. Transient blindness, slurred speech, and weakness D. Uncharacteristic use of illicit substances and alcohol

B. 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? A. Physical restraints may potentially become fatal for the client. B. Physical restraints may increase the client's agitation. C. Physical restraints may not be of any use in controlling the client. D. Physical restraints may cause injury to the client.

B. Physical restraints may increase the client's agitation.

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? A. Irrelevant speech B. Remote memory loss C. Impaired consciousness D. Visual hallucinations

B. Remote 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? A. Decrease combative behaviors and hallucinations B. Slow deterioration of memory and function C. Increase the number of neurons in the brain D. Decrease tremors associated with Parkinson's disease

B. Slow deterioration of memory and function

Which client behavior should the nurse attempt to change when managing a client's tendency to wander and pace at night? A. request a bedtime snack of milk and cookies B. take a nap mid-afternoon and before dinner C. insist on having the curtains left open at night D. watch television after dinner

B. take a nap mid-afternoon and before dinner

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? A. "Your family is fine. You need to take care of yourself now." B. "It's time to sleep now; you can see your family in the morning." C. "You're in the hospital. You did not drink for several days, but you're getting better now." D. "We don't have your clothes; they are at home. You'll be going home when you recover."

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

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? A. Ask the client what the client would like from the buffet and give the client finger foods. B. Provide the client with a tray but encourage the client to open the client's own packages. C. Provide the client with a tray, opening containers for the client. D. Have the client eat in the client's room to avoid distractions while eating.

C. Provide the client with a tray, opening containers for the client.

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? A. Reinforcing the facility's zero-tolerance policy for aggressive behavior B. Decreasing the frequency of the client's baths from two times to one time per week C. Reminding the client multiple times that he or she will be soon having a bath D. Providing all of the client's daily medications early on the day of a scheduled bath

C. 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? A. Make sure all side rails are up. B. Place the client in restraints to maintain safety. C. Review medication profile record. D. Sedate the client with medication.

C. Review medication profile record.

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? A. Signs of early Alzheimer's disease B. Normal, given the client's age C. Signs of delirium D. Normal for the first postoperative day

C. 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? A. Likelihood to engage in elder abuse B. Early signs of Alzheimer's disease C. Signs of stress D. Signs of dominance

C. Signs of stress

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? A. The client is confused about the client's children and needs refocusing. B. The client is showing signs of agnosia in that the client is unable to name the client's children. C. The client is confabulating, most likely to cover for memory deficit. D. The client demonstrates aphasia when discussing the client's children.

C. The client is confabulating, most likely to cover for memory deficit.

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? A. No, because the client will not be hospitalized long enough to develop delirium B. No, because the client does not have an underlying disease process C. Yes, because of the head injury and medication D. Yes, because the client is in an unfamiliar environment and overstimulated

C. Yes, because of the head injury and medication

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? A. age of the client B. client preferring to take showers C. client wandering off D. client maintaining stoic affect

C. client wandering off

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 ... A. open juice and insert a straw into the container. B. button a blouse. C. identify a picture of a car. D. find words to describe the client's daughter's appearance.

C. identify a picture of a car.

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: A. preexisting schizophrenia. B. increasing brain damage and poor prognosis. C. tactile hallucinations from delirium. D. a predisposition to such episodes early in the morning.

C. tactile hallucinations from delirium.

The nurse should consider the intervention referred to as "going along with" when managing the care of which client? A. the young adult who is expressing concern about the "police being aliens" B. the adolescent who is hitting and biting because he or she was given time out for disobeying unit rules C. the older widower who is worried about his wife not being able to visit because of the snow D. the middle-aged adult who is convinced that the electrical cords are really snakes

C. the older widower who is worried about his wife not being able to visit because of the snow

When giving tacrine to an elderly client, the nurse must be aware of what information? A. Tacrine works only in clients with late-stage dementia. B. The most common side effects are headache and dizziness, so the client must be monitored for falls. C. The client will experience dry mouth and difficulty urinating. D. Because the liver is most vulnerable to tacrine, liver function tests must be done periodically.

D. Because the liver is most vulnerable to tacrine, liver function tests must be done periodically.

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? A. Tacrine B. Rivastigmine C. Galantamine D. Haloperidol

D. Haloperidol

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? A. Set limits with the client around behavior. B. Apply restraints and place the client in seclusion as necessary. C. Explain to the client the relationship between agitation and injury. D. Monitor amount of environmental stimulation and adjust as needed.

D. 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? A. Atypical antipsychotic B. Cholinesterase inhibitor C. Benzodiazepine D. N-methyl-D-aspartate (NMDA) receptor antagonist

D. 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? A. Electrolyte imbalance B. Medications C. Infection D. Oxidative stress

D. Oxidative stress

A client is in the mild stage of dementia due to Alzheimer's disease. Which intervention would be most appropriate? A. Suggesting new activities for the client and family to do together B. Offering nourishing finger foods to help maintain the client's nutritional status C. Advocating for the client to be transitioned to a care home D. Providing emotional support and gentle reminders

D. Providing emotional support and gentle reminders

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? A. The client may be going through alcohol withdrawal. B. The client is ashamed that the client is unemployed and is trying to cover for it. C. The client may have Alzheimer's disease. D. The client may have Korsakoff's syndrome.

D. The client may have Korsakoff's syndrome.

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? A. The client cannot brush the client's teeth. B. The client identifies the client's fork as a spoon. C. The client has trouble remembering the client's birth date. D. The client removes the client's surgical bandage and begins picking at the sheets.

D. 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? A. The client spends much of the day sleeping in the dayroom and usually denies being hungry B. The client responds to most assessment questions with "I don't know" and appears apathetic C. The client repeatedly asks where the client is and attempts to drink the water in a flower vase D. The client reports seeing "hundreds of bugs" and is not always oriented to time and place

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

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? A. The nurse wants the client to maintain an adequate balance of activity and rest. B. The nurse wants the client to demonstrate good orientation. C. The nurse wants to ensure the client's safety. D. The nurse wants to prevent increasing the client's confusion.

D. The nurse wants to prevent increasing the client's confusion.

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? A. Olfactory B. Auditory C. Gustatory D. Visual

D. Visual