NU273 Chapter 24: Cognitive Disorders
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." "Your report of gradually developing confusion over time was the basis for the diagnosis." "The client's exposure to an infectious agent led us to determine the diagnosis." "Basically, this diagnosis is based on the client's inability to talk normally."
"The client's diagnosis is primarily based on the rapid onset of the change in consciousness." Explanation: The key diagnostic indicator for delirium is impaired consciousness, which is usually sudden in onset. Although infection may be an underlying cause, and other cognitive changes may occur such as problems with memory, orientation, and language, impaired consciousness developing over a short period is key.
The nurse understands that numerous comorbidities can contribute to the development of dementia. Which client may be at risk for dementia? An 87-year-old resident of a long-term care facility who has developed a urinary tract infection (UTI) A 69-year-old client whose lung cancer has metastasized to the bones and liver A 30-year-old client with schizophrenia who has been admitted to the hospital because of psychogenic polydipsia A 49-year-old client whose human immunodeficiency virus (HIV) has progressed to acquired immunodeficiency syndrome (AID
A 49-year-old client whose human immunodeficiency virus (HIV) has progressed to acquired immunodeficiency syndrome (AIDS) Explanation: HIV/AIDS is known to cause dementia. Cancer does not normally result in dementia, and the cognitive changes that may result from a UTI or polydipsia are reversible and thus classified as delirium.
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? Epinephrine Serotonin Norepinephrine Acetylcholine
Acetylcholine Explanation: Acetylcholine is involved in cognitive functioning. Epinephrine, serotonin, and norepinephrine are not as involved in cognitive functioning.
Which would not be considered a primary goal of nursing care for a client with delirium? Achievement of self-esteem needs Meeting physiological and psychological needs Protection from injury Management of confusion
Achievement of self-esteem needs Explanation: Achievement of self-esteem needs would not be a primary goal of nursing care for the client diagnosed with delirium. All other options would be primary goals.
A nurse is assessing a client diagnosed with Alzheimer's disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing for what? Executive functioning Apraxia Agnosia Aphasia
Agnosia Explanation: Agnosia is the failure to recognize or identify objects despite intact sensory function. Aphasia is alterations in language ability. Apraxia is the impaired ability to execute motor activities despite intact motor functioning. Executive functioning is the ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior.
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. Acetylcholine production is decreased. Fragments mix with molecules to make plaques in the brain. Strands of protein are tangled together.
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. Tangles are found in clients with Alzheimer's disease, when proteins intended to provide stability in neurons are tangled together. 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. 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.
An 80-year-old is brought to the clinic by the client's spouse. The client has a history of peripheral vascular disease and type 2 diabetes. The spouse states that the client hasn't seemed to be normal for the preceding few days, noting that the client has been lethargic and mildly confused at times and has been incontinent of urine. The spouse reports that the client's blood glucose levels have been elevated. The nurse considers which as the most likely explanation for the client's change in mental status? Dementia related to advancing age Transient ischemic attacks related to vascular disease and diabetes Delirium related to underlying medical problem Depression related to declining health
Delirium related to underlying medical problem Explanation: Any disturbance in any organ or system that affects the brain can disrupt metabolism and neurotransmission, leading to a decline in cognition and function. Infections, fluid and electrolyte imbalances, and drugs are the most frequent causes of delirium. Older adults are especially susceptible to delirium disorders because the aging neurologic system is particularly vulnerable to insults caused by underlying systemic conditions. Indeed, delirium often predicts or accompanies physical illness in older adults.
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? Tacrine Rivastigmine Haloperidol Galantamine
Haloperidol Explanation: Staff members must seriously consider this option when a client's behavior threatens the safety of self, family, or staff. Haloperidol, a neuroleptic given either orally or by injection, is most commonly used for symptoms of delirium.
Delirium can be differentiated from many other cognitive disorders in which way? It has a rapid onset and is highly treatable if diagnosed quickly. It is characterized by a period of disorganization and confusion. It is much less responsive to pharmacologic treatment than the other disorders. It has as a slow onset, but if caught early it can be treated with medications.
It has a rapid onset and is highly treatable if diagnosed quickly. Explanation: Delirium often is caused by an acute disruption of brain homeostasis. When the cause of that disruption is eliminated or subsides, the cognitive deficits usually resolve within a few days or sometimes weeks. Dementia, in contrast, results from primary brain pathology that usually is irreversible, chronic, progressive, and less amenable to treatment.
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 emotional outbursts. Ensure environmental noise for stimulation. Give acetaminophen if the client appears uncomfortable. Keep a record of bowel movements.
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 client is a 68-year-old who has been showing signs of Alzheimer's disease, including visual hallucinations and disturbed behaviors. When the client was placed on antipsychotic medications, the client suffered significant adverse reactions. This could indicate that the client does not have Alzheimer's disease, but which condition? Pick's disease Creutzfeldt-Jakob disease Huntington's disease Lewy body dementia
Lewy body dementia Explanation: Lewy body disease is sometimes mistaken for Alzheimer's disease because of clinical similarity, but it has earlier and more prominent visual hallucinations, parkinsonian features, and disturbed behaviors. A distinguishing characteristic is significant adverse reactions to antipsychotic drugs.
Which medication is not known to cause delirium? Antidepressants Narcotics Steroids Loop diuretics
Loop diuretics Explanation: Loop diuretics are not known to causes delirium. Steroids, narcotics, and antidepressants may cause delirium.
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. Explain to the client the relationship between agitation and injury. Apply restraints and place the client in seclusion as necessary. Set limits with the client around behavior.
Monitor amount of environmental stimulation and adjust as needed. Explanation: Overstimulation from the environment is a likely trigger for agitation. The nurse must monitor the environment and the client's response to it on an ongoing basis. Seclusion would be unsafe. Teaching and setting limits are unlikely to be effective interventions with a client who has a cognitive disorder due to limitations of cognitive processing and impaired short-term memory.
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? Tremors, unsteady gait, and transient paresthesias Personality change, wandering, and inability to perform purposeful movements Transient blindness, slurred speech, and weakness Uncharacteristic use of illicit substances and alcohol
Personality change, wandering, and inability to perform purposeful movements Explanation: Alzheimer's disease is not typically characterized by delusions, transient paresthesias, blindness, or slurred speech. Instead, general changes in personality, wandering, and the inability to perform purposeful, goal-directed movements are impaired.
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 not be of any use in controlling the client. Physical restraints may cause injury to the client. Physical restraints may increase the client's agitation. Physical restraints may potentially become fatal for the client.
Physical restraints may increase the client's agitation. Explanation: The use of physical restraints are usually a last resort for clients with dementia, as restraint use may increase any fears or thoughts of being threatened. The nurse may need to use physical restraints if the client is pulling at intravenous lines or catheters. Physical restraints do not commonly cause injury to the client or lead to fatality.
An older adult client develops delirium secondary to an infection. Which would be the most likely cause? Cellulitis Appendicitis Low platelet count Pneumonia
Pneumonia Explanation: Delirium in the older adult is associated with medications, infections, fluid and electrolyte imbalance, metabolic disturbances, or hypoxia or ischemia. Infections of the respiratory tract such as pneumonia or urinary tract are among the most common infection-related causes. Appendicitis and cellulitis are not commonly associated with the development of delirium. Although low platelet count would render the older adult vulnerable to bleeding and easy bruising, it does not increase the risk of delirium.
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? Decreasing the frequency of the client's baths from two times to one time per week Providing all of the client's daily medications early on the day of a scheduled bath Reinforcing the facility's zero-tolerance policy for aggressive behavior Reminding the client multiple times that he or she will be soon having a bath
Reminding the client multiple times that he or she will be soon having a bath Explanation: Adequately preparing a client for a task can sometimes prevent episodes of agitation or aggression. Reminding a cognitively impaired client about policies is unlikely to be effective, and decreasing the frequency of baths will not necessarily prevent agitation. It is not normally appropriate to change a client's medication administration schedule in light of activities such as bathing.
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? Irrelevant speech Remote memory loss Impaired consciousness Visual hallucinations
Remote memory loss Explanation: Impaired memory may be present in both delirium and dementia. However, remote memory loss, which can manifest as forgetting the names of adult children, the client's former occupation, or even the client's own name, occurs in the later stages of dementia. Irrelevant speech, visual hallucinations, and impaired consciousness are signs of delirium. In dementia, speech is normal during the initial stages and then progresses to aphasia. Hallucinations may be present in dementia but are typical of delirium. Consciousness is usually not impaired in client with dementia.
Which nursing diagnosis would be the priority for the client experiencing acute delirium? Risk for injury related to confusion and cognitive deficits Risk for self-mutilation related to confusion and cognitive deficits Acute confusion related to delirium of known/unknown etiology Fall precautions related to acute confusion
Risk for injury related to confusion and cognitive deficits Explanation: The plan of care must be deliberately designed to meet the client's unique needs, with safety always being the nurse's highest priority. Risk for injury is a NANDA diagnosis and the etiology of confusion and cognitive deficits are factors that can be modified through nursing care.
Which can be identified as a hallmark symptom of dementia? Clients with these disorders tend to confabulate This class of disorders does not involve memory loss Long-term memory affected most Short-term memory loss
Short-term memory loss Explanation: As a broad diagnosis, dementia includes conditions in which short-term memory loss is a hallmark. The deterioration of memory is so great that it prevents clients from functioning at previous levels of social and occupational performance and seriously deters them from learning new information.
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? Normal, given the client's age Signs of early Alzheimer's disease Signs of delirium Normal for the first postoperative day
Signs of delirium Explanation: Delirium is a syndrome characterized by a rapid onset of cognitive dysfunction and disruption in consciousness. Growing rates of delirium mirror the increasing older adult population and are expected to continue to rise. Delirium is the most common psychiatric syndrome in general hospitals, occurring in up to 50% of elderly inpatients. It is associated with significantly increased morbidity and mortality both during and after hospitalization.
The psychiatric nurse documents that the cognitively impaired client is exhibiting "confabulation" when observed doing what? Telling the staff repeatedly that "my name is George and I'm hungry" Pacing nervously and resisting the staff's request to "get ready for bed" Telling other clients that the client "was a dairy farmer" when the client actually ran a small grocery store Asking where the cats are when told it's "raining cats and dogs"
Telling other clients that the client "was a dairy farmer" when the client actually ran a small grocery store Explanation: Confabulation is the filling in of memory gaps with false but sometimes plausible content to conceal the memory deficit, such as a client telling others that the client "was a dairy farmer" when the client actually ran a small grocery store. Evidence of perseveration is a client telling the staff repeatedly that "my name is George and I'm hungry." Sundown syndrome can be described as a client pacing nervously and resisting the staff's request to "get ready for bed." Concrete thinking is described when the client asks where the cats are when told it's "raining cats and dogs."
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 confused about the client's children and needs refocusing. The client demonstrates aphasia when discussing the client's children. The client is confabulating, most likely to cover for memory deficit. The client is showing signs of agnosia in that the client is unable to name the client's children.
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.
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. The client may be going through alcohol withdrawal. The client is ashamed that the client is unemployed and is trying to cover for it. The client may have Alzheimer's disease.
The client may have Korsakoff's syndrome. Explanation: Korsakoff's syndrome usually is found in the 40- to 70-year-old client with alcoholism and a history of steady and progressive alcohol intake. In time, this person develops a vitamin B1 (thiamin) deficiency that directly interferes with the production of the brain's main nutrient, glucose, resulting in the symptomatology of this syndrome. A client with this disorder has great difficulty with recent memory, specifically the ability to learn new information. Because of the inability to recall recent events, the individual fills in memory gaps with fabricated or imagined data (confabulation).
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 demonstrate increased feelings of self-worth. The client will remain free from injury. The client will identify life areas that require alterations due to illness. The client will demonstrate decreased agitation.
The client will remain free from injury. Explanation: Control of agitation and promotion of self-worth are important outcomes, but safety is a priority concern. A client whose diagnosis necessitates hospitalization may or may not be capable of identifying or making changes in life routines.
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 the client to maintain an adequate balance of activity and rest. The nurse wants to ensure the client's safety. The nurse wants to prevent increasing the client's confusion. The nurse wants the client to demonstrate good orientation.
The nurse wants to prevent increasing the client's confusion. Explanation: The nurse understands that too many visitors or more than one person speaking at once may increase the client's confusion. The nurse should also explain to the visitors that they should speak quietly with the client, one at a time. This may help prevent the client from becoming overstimulated. Talking with many friends at a time doesn't pose a physical danger to the client. While it is ideal for the client to demonstrate proper orientation, it is not the reason the nurse monitors the client's response to visitors. Talking to one person at a time does not help the client maintain an adequate balance of activity and rest.
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 ensure the client establishes a daily routine To ensure the client is involved in therapy To assess for fluctuation in the client's capabilities To assess the prognosis of the client after therapy
To assess for fluctuation in the client's capabilities Explanation: Clients with organic diseases like delirium tend to have fluctuations in their ability to carry out activities of daily living. Thus, the nurse should assess these daily. Although the nurse should encourage the client to make decisions about treatment and assist the client in establishing a daily routine, these actions do not require daily assessment. Assess the prognosis of the client after therapy also is not required daily.
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 ensure the client is involved in therapy To ensure the client establishes a daily routine To assess the prognosis of the client after therapy To assess for fluctuation in the client's capabilities
To assess for fluctuation in the client's capabilities Explanation: Clients with organic diseases like delirium tend to have fluctuations in their ability to carry out activities of daily living. Thus, the nurse should assess these daily. Although the nurse should encourage the client to make decisions about treatment and assist the client in establishing a daily routine, these actions do not require daily assessment. Assess the prognosis of the client after therapy also is not required daily.
To manage voiding issues, such as incontinence, male clients diagnosed with dementia would best be managed by what? Indwelling catheters Use of disposable, adult diapers Intermittent catheterization Condom catheter
Use of disposable, adult diapers Explanation: Urinary incontinence can be managed with the use of disposable, adult-size diapers that must be checked regularly and changed expeditiously when soiled. Indwelling catheters foster the development of urinary tract infections and may compromise the client's dignity and comfort. Use of intermittent catheterization and condom catheters would not be the best options, either.
Which type of hallucination is most commonly seen in clients diagnosed with delirium? Gustatory Autonomic Auditory Visual
Visual Explanation: Visual hallucinations are the most common type seen in clients diagnosed with delirium.
Which type of hallucination most commonly occurs in clients diagnosed with dementia? Auditory Gustatory Olfactory Visual
Visual Explanation: Visual, rather than auditory, hallucinations are the most common in those with dementia. Auditory, gustatory, and olfactory hallucinations are not the most common type seen in people with dementia.
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 the client is in an unfamiliar environment and overstimulated No, because the client does not have an underlying disease process Yes, because of the head injury and medication No, because the client will not be hospitalized long enough to develop delirium
Yes, because of the head injury and medication Explanation: This client is an older adult who has suffered trauma and, given the injuries, is likely receiving medication for pain. Certain clients are at increased risk for delirium, specifically older adults and cognitively impaired older adults recovering from surgery. Older adults are especially susceptible to delirium disorders because the aging neurologic system is particularly vulnerable to insults caused by underlying systemic conditions. Indeed, delirium often predicts or accompanies physical illness in older adults. An underlying disease process is not necessary for this injured older adult to be at risk for delirium, and length of hospitalization is irrelevant. While an unfamiliar environment and overstimulation can exacerbate delirium, these are not risk factors for developing it.
What is the initial intervention the nurse should implement when helping a client diagnosed with dementia deal with paranoid delusions? ask that the client be prescribed medication to help manage the paranoia observe the client in order to identify the triggers for the delusions keep the client occupied when he or she first begins to express the delusion explain to the client that his or her fears are unfounded
observe the client in order to identify the triggers for the delusions Explanation: Clients with dementia may believe that their physical safety is jeopardized; they may feel threatened or suspicious and paranoid. These feelings can lead to agitated or erratic behavior that compromises safety. Avoiding direct confrontation of the client's fears is important. Clients with dementia may struggle with fears and suspicion throughout their illness. Triggers of suspicion include strangers, changes in the daily routine, or impaired memory. The nurse must discover and address these environmental triggers rather than confront the paranoid ideas.
What is the greatest benefit support groups provide to the caregivers of clients diagnosed with dementia? provides time away from the client provides interaction with those with similar concerns provides a social outlet provides resources for needed services
provides interaction with those with similar concerns Explanation: Attending a support group regularly also means that caregivers have time with people who understand the many demands of caring for a family member with dementia. While the other options suggest accurate results, none are the greatest benefit such a support group experience can provide.
Which client behavior should the nurse attempt to change when managing a client's tendency to wander and pace at night? watch television after dinner request a bedtime snack of milk and cookies take a nap mid-afternoon and before dinner insist on having the curtains left open at night
take a nap mid-afternoon and before dinner Explanation: Clients with dementia often experience disturbed sleep-wake cycles; they nap during the day and wander at night. This behavior can contribute to the nighttime activity. The other options are not likely to affect sleep cycles.