NCLEX Cognitive

The family of a client with increasing dementia asks the nurse how to convince one sibling who refuses to acknowledge their elderly mother's personality change. Which information would the nurse address in teaching the family about personality change in dementia? Select all that apply. 1. Loss of interest in surroundings 2. Lack of consideration for others 3. Difficulty learning new things 4. Disregard for the concept of time 5. Inability to do things in sequence 6. Decreased performance of daily activities

1 and 2. Clients with dementia often manifest a loss of interest in their surroundings, a lack of consideration for others, and a tendency to be self-absorbed as manifestations of a personality change. Having difficulty learning new things and the loss or disregard for the concept of time are cognitive changes that occur in dementia. The inability to do things in an orderly sequence and the decreased performance of daily activities indicate the functional changes seen in clients with dementia.

1. The nurse is asking a client in the psychiatric crisis unit specific questions about recent substance use. Which assessment finding could indicate to the nurse that the client is experiencing mild to moderate delirium? 1. Time and place disorientation 2. Impaired abstract thinking 3. Persistent memory disturbance 4. Changes in personality

1. 1. Clients with delirium experience disorientation to time, then place, and then person. Impaired abstract thinking and noted changes in personality are characteristics of dementia. Persistent memory disturbance is associated with an amnestic disorder.

2. The nurse is explaining the symptoms of dementia to a military family member who has not seen his mother in 15 months. Which characteristics of dementia of the Alzheimer's type would the nurse address in her teaching session? Select all that apply. 1. Experiences an impending sense of doom 2. Forgets that food is cooking on the stove 3. Becomes lost walking on her own street 4. Unable to write and to sign her name 5. Begins to fear using public transportation 6. Unable to understand new information

2. 2, 3, 4, and 6. Common symptoms of dementia of the Alzheimer's type include forgetting things such as cooking food and where specific items were placed, becoming lost in one's own neighborhood, being unable to write or even sign one's name to a document, and being unable to understand new information. A client experiencing an impending sense of doom and fearing public transportation is most likely dealing with a panic attack with agoraphobia.

3. During an interaction with the spouse of a client with Alzheimer's disease, the nurse is asked the following question: "What exactly is Alzheimer's disease?" Which is the correct explanation for the nurse to tell the spouse? 1. " Often, Alzheimer's disease is a combination of several common autoimmune diseases that attack and shrink brain tissue." 2. " It is a brain disease that results from the development of abnormal structures called neurofibrillary tangles found in the person's brain." 3. " The disease is a genetic disease that changes a person's brain tissue, causing it to deteriorate due to an accumulation of excessive fluid." 4. " A biological and psychosocial component of undiagnosed moderate depression is causing a steady decline in daily performance."

3. 2. People with Alzheimer's disease have a disease of the brain where abnormal structures composed of twisted protein fibers (neurofibrillary tangles) are found within the nerve cells. These neurofibrillary tangles attack the inside of the neurons. The possible link of autoimmune diseases to Alzheimer's disease as well as the genetic errors identified on chromosomes 14, 19, and 21 along with biological and neurochemical problems are currently being investigated. Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 13637-13641). Lippincott Williams & Wilkins. Kindle Edition.

The nurse notices that a client with dementia about to eat his dinner picks up his spoon, looks at it, puts it down, and then picks up his fork, looks at it, and puts it back on the table. He sits staring at the utensils and his dinner. How does the nurse interpret this behavior? 1. A risk for altered nutrition 2. A disruption in metabolic functioning 3. A disturbance in executive functioning 4. A potential sensory-motor deficit

3. The client's inability to initiate activities or perform routine tasks are examples of the loss of the ability to think and reason abstractly; hence, a disturbance or interference in the client's executive functioning has occurred. This behavior does not indicate a problem with nutrition or with metabolic or sensory-motor functioning.

The nurse has taught a family about the medication donepezil (Aricept). The nurse determines that teaching was successful when the family makes which statement? 1. " We will need to figure out a schedule to get dad's weekly blood work done." 2. " When dad's Alzheimer's disease worsens, he will need to stop taking this drug." 3. " This drug may slow down dad's pulse, since he has preexisting heart disease." 4. " Aricept acts like a diuretic medication, so dad should take it in the morning."

9. 3. Donepezil has the potential to cause bradycardia in clients with cardiac disease. Weekly blood work is not necessary for clients on donepezil. Donepezil can be used for mild, moderate, or severe Alzheimer's disease. Donepezil does not act like a diuretic; it can cause urinary retention, and the client may have difficulty passing his urine.

4. The home health nurse notices that the elderly, diabetic client she sees every week is starting to demonstrate some difficulty answering questions about her chronic disease strategies and self-management activities. Which action would the nurse take to validate her suspicion of the client having cognitive changes and possibly the beginning stages of dementia? 1. Speak to the doctor about ordering cardiac diagnostic studies. 2. Petition the insurance company for a weekly home health aide. 3. Request that another nurse visit and perform a mental status exam. 4. Arrange to speak to a family caregiver as soon as possible.

4. 4. By speaking to the consistent family caregiver, that person may be able to validate for the nurse the presence of the slow and progressive changes that occur in the early stages of dementia. In the early stages of dementia, the client will have recurrent memory impairment and will attempt to hide these cognitive losses. Communication with the physician would be for the purpose of sharing the nurse's assessment findings, not to request a cardiac workup. The need for a possible home health aide can be addressed when speaking to the caregiver, rather than acting without family consultation. There is no need to request that a different home health nurse perform the mental status assessment. Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 13650-13655). Lippincott Williams & Wilkins. Kindle Edition.

8. Which intervention should help a client diagnosed with Alzheimer's disease perform activities of daily living? 1. Have the client perform all basic care without help. 2. Tell the client morning care must be done by 9 a.m. 3. Give the client a written list of activities he's expected to do. 4. Encourage the client and give ample time to complete basic tasks. Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 13689-13693). Lippincott Williams & Wilkins. Kindle Edition.

4. Clients with Alzheimer's disease respond to the effect of those around them. A gentle, calm approach is comforting and nonthreatening, and a tense, hurried approach may agitate the client. The client has problems performing independently. The inherent expectations of deadlines and activity lists may lead to frustration. Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 13695-13697). Lippincott Williams & Wilkins. Kindle Edition.

5. A nurse is caring for a client with delirium. Which nursing intervention has the highest priority? 1. Providing a safe environment 2. Offering recreational activities 3. Providing a structured environment 4. Instituting measures to promote sleep

5. 1. The nurse's highest priority when caring for a client with delirium is to ensure client safety. Offering recreational activities, providing a structured environment, and promoting sleep are all appropriate interventions after safety measures are in place.