Schizophrenia Ch. 22 and 38 prep U
The client was conversing with the nurse when noticeable changes occurred with the client. Which is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia?
Oculogyric crisis
A nurse provides care to a client with schizoaffective disorder during hospitalization for acute psychosis. Nursing interventions to help the client to establish trust with the health care team is best accomplished by what?
Offering reassurance in a soft, nonthreatening voice
Which of the following would the nurse identify as a negative symptom associated with schizophrenia?
Anhedonia
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 Client's ability to perform arithmetic problems to determine cortical function Results of testing the client's ability to remember unrelated words and recent events Assessment of the client's level of consciousness
Answers by the client and family to questions about emotional changes
Delirium can be differentiated from many other cognitive disorders in which way? It is much less responsive to pharmacologic treatment than the other disorders. It has a rapid onset and is highly treatable if diagnosed quickly. It has as a slow onset, but if caught early it can be treated with medications. It is characterized by a period of disorganization and confusion.
It has a rapid onset and is highly treatable if diagnosed quickly.
During a client interview, a client states that "God has sent me a special message. I'm the only one who can carry out his plan." The nurse interprets this statement as suggesting which type of delusion?
Grandiose
A nurse is developing a plan of care for a client diagnosed with delusional disorder. Which of the following would the nurse need to keep in mind?
Clients with delusional disorder typically have problems with medication adherence.
The nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation? Show an instructional video just prior to the activity. Describe the exercise immediately before performing it. Demonstrate the exercises while clients simultaneously perform them. Perform the same routine daily to avoid the need for repeated instruction.
Demonstrate the exercises while clients simultaneously perform them.
The nurse can distinguish delirium from dementia by knowing which of the following? Dementia has an acute onset and can be resolved. Delirium has an acute onset and is progressive in course. Dementia has a gradual onset and is progressive in course. Delirium has a gradual onset and can be resolved.
Dementia has a gradual onset and is progressive in course.
A nurse is providing care to a client with dementia and the client's caregiver. Which areas would the nurse likely identify as a source of frustration that can affect the caregiver? Select all that apply. The client frequently forgets explanations or instructions requiring frequent repetition. The client may seem not to hear or respond to anything the caregiver does. Caregiver may find it difficult to remain positive and supportive due to disease progression. Caregiver experiences difficulty in carving out time for personal needs. The caregiver may get little or no positive response or feedback from the client.
The client frequently forgets explanations or instructions requiring frequent repetition. The client may seem not to hear or respond to anything the caregiver does. Caregiver may find it difficult to remain positive and supportive due to disease progression. Caregiver experiences difficulty in carving out time for personal needs. The caregiver may get little or no positive response or feedback from the client.
When a cognitively impaired client with a history of aggressive outbursts is observed pacing and grimacing while in the dayroom, the nurse initially
Suggests that they go into the client's room. Removing the client from the milieu is the initial intervention that best addresses the safety of all the clients including the agitated client. The other provided options are not necessarily inappropriate, but none represents the best course of action.
To manage voiding issues, such as incontinence, male clients diagnosed with dementia would best be managed by what?
Use of disposable, adult diapers
Which of the following terms is used to describe deterioration in language function? Agnosia Aphasia Executive functioning Apraxia
Aphasia
Which term is used to describe the inability to execute motor functioning, despite intact motor abilities? Executive functioning Agnosia Aphasia Apraxia
Apraxia
When developing the plan of care for a client with schizophrenia who is in the acute phase of illness, the nurse understands that the client is at high risk for what?
Suicide
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 a daily current events quiz, making sure that the client participates. Provide a flexible schedule and change the activities each day. Read to the client for long periods at a time. Use daily newspapers, calendars, and a set routine.
Use daily newspapers, calendars, and a set routine.
A nurse is assessing a client diagnosed with schizophrenia. When documenting the findings, which would the nurse identify as a positive symptom? Select all that apply.
Delusions Hallucinations
Schizoaffective disorder has symptoms typical of both schizophrenia and which type of disorder?
mood disorder
A client had been withdrawn in his room for 3 days, not eating or sleeping, prior to his admission to your inpatient unit. When you interview him, the client demonstrates difficulty answering questions, appears to have no facial expressions, and cannot follow simple instructions. Together, these symptoms are commonly referred to as
negative symptoms
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? No, because the client does not have an underlying disease process Yes, because the client is in an unfamiliar environment and overstimulated No, because the client will not be hospitalized long enough to develop delirium Yes, because of the head injury and medication
Yes, because of the head injury and medication
The client is brought to the clinic with dementia and is unable to recognize ordinary objects, such as a pen or notebook. The family is upset and concerned. The nurse notes that this is a symptom of: agnosia amnesia
agnosia
A week after beginning therapy with thiothixene, the client demonstrates muscle rigidity, a temperature of 103°F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of:
neuroleptic malignant syndrome.
A nurse is caring for a client with delirium who is experiencing illusions. What environmental conditions should the nurse arrange for this client? have the client sit by the nurse's desk while awake in a room with the television on keep the room shadowy with soft lighting around the clock, and keep a radio on continuously provide a well-lit room without glare or shadows and limit noise light the room brightly around the clock and awaken hourly to check mental status
provide a well-lit room without glare or shadows and limit noise
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 resources for needed services provides a social outlet
provides interaction with those with similar concerns
An older adult client with dementia is experiencing sleep problems and becomes restless when he is fatigued. Which of the following would be helpful? Administering a sedative-hypnotic for the long-term Maintaining a highly stimulating environment Ensuring the client has an afternoon nap Having the client rest in a reclining chair during the afternoon
Ensuring the client has an afternoon nap
Which is believed to be a risk factor specific to the development of delirium? Ineffective coping Baseline cognitive impairment Increased severity of physical illness Gradual decline in functioning
Increased severity of physical illness
After assessing a client with schizophrenia, the nurse notes that the client exhibits signs and symptoms related to being unable to experience pleasure. The nurse documents this finding as what?
Anhedonia
A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than:
6 months
Which client is most likely suffering from dementia? A 90-year-old who has experienced progressive mental decline that started with forgetfulness An 80-year-old who has been in excellent health until the client was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff A 22-year-old who was involved in a motorcycle crash without wearing a helmet now unable to remember where the client is A 6-year-old who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that the child's parents have three sets of eyes
A 90-year-old who has experienced progressive mental decline that started with forgetfulness
After teaching a group of nursing students about dementia, 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 Aphasia Apraxia Disturbance of executive function
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? Aphasia Disturbance of executive function Agnosia Apraxia
Agnosia
What is the primary sign of delirium? Impaired socialization Disturbed sleep-wake cycles An altered level of consciousness Inability to fulfill roles
An altered level of consciousness
Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition?
Schizophrenia
A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason?
Alleviate the side effects and help client maintain adherence
Which of the following terms describes an inability to recognize or name objects despite intact sensory abilities?
Agnosia
The nurse preparing an educational program on dementia should include which information?
The onset of symptoms of dementia is gradual
A older adult client develops delirium secondary to an infection. Which would be the most likely cause?
pneumonia
Which nursing diagnosis would be the priority for the client experiencing acute delirium?
Risk for injury related to confusion and cognitive deficits
The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm the client down. The nurse teaches the caregiver to use distraction techniques. Which response would be best to teach as an example of this technique?
"Let's look at what is on television."
The nurse is working with a client with dementia who has hallucinations and delusions. The client tells the nurse that the client cannot take a shower because the client is waiting for the client's spouse to take the client home. Which response by the nurse is best in this situation? "You seem anxious and upset." "Why are you thinking you're going home?" "It would be best if you just took your shower now." "You have plenty of time to shower before it's time to go home."
"You have plenty of time to shower before it's time to go home."
Which is the central focus of persecutory delusions? 1. Injustice that must be remedied by legal action 2. Involving bodily functions or sensations 3. Unfaithfulness 4. A great, unrecognized talent
1. Injustice that must be remedied by legal action
Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait? 1. Pseudoparkinsonism 2. Akathisia 3. Acute dystonia 4. Tardive dyskinesia
1. Pseudoparkinsonism
A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what? 1. Schizophrenia 2. Personality disorder 3. Major depression 4. Substance abuse
1. Schizophrenia
A client is admitted to the psychiatric hospital with a diagnosis of schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. The nurse interprets this as what? 1. Waxy flexibility 2. Hypervigilance 3. Retardation 4. Echopraxia
1. Waxy flexibility
During an admission assessment with a psychiatric-mental health nurse, a client states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. How should the nurse document this symptom? 1. A hallucination 2. A delusion 3. Thought broadcasting 4. Thought insertion 1. A hallucination
1. hallucination
A nurse is working with a client, and family of the client, who has a diagnosis of Alzheimer's disease. The nurse explains to the client and family that the average course of the disease is how many years? 25 20 15 10
10
Which type of delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way? 1. Grandiose type 2. Persecutory type 3. Somatic type 4. Unspecified type
2. Persecutory type
Which of the following clients would have an increased risk for delirium? Elderly woman with abdominal pain 3-year-old child with a temperature of 103.2 °F Middle-aged woman newly diagnosed with multiple sclerosis Young adult male with gastroenteritis and dehydration
3-year-old child with a temperature of 103.2 °F
During a client interview, a client diagnosed with delusional disorder states, "I know my spouse is being unfaithful to me with a colleague from work."The nurse interprets the client's statements as suggesting which type of delusion? 1. Referential 2. Sexual 3. Persucatory/paranoid 4. Grandiose
3. Persucatory/paranoid
A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion? 1. Nihilistic 2. Grandiose 3. Somatic 4. Persecutory
3. Somatic
A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices: 1. An increase in weight of 2 lbs in 1 month. 2. A feeling of dizziness when the client stands up. 3. An increase in thirst. 4. A dramatic change in temperature.
4. A dramatic change in temperature.
A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client? 1. Tardive dyskinesia 2. Parkinsonism 3. Akathisia 4. Neuroleptic malignant syndrome
4. Neuroleptic malignant syndrome
A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder? 1. Prodromal phase 2. Acute illness 3. Stabilization 4. Relapse
4. Relapse
A client is being evaluated for decline in cognitive function. The client's wife asks the nurse to explain the term dementia to her. The nurse bases her response on the knowledge that dementia is which of the following?
A primary brain pathology
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? Serotonin Norepinephrine Epinephrine Acetylcholine
Acetylcholine
The nurse is assessing the adaptive functioning skills of a child diagnosed with intellectual disability. Which of the following would the nurse assess? Select all that apply. Communication skills Spirituality Activities of daily living Safety concerns Academic skills
Activities of daily living Communication skills Academic skills Safety concerns
The nurse is developing interventions to promote socialization in a client with moderate dementia. Which would provide a safe and secure environment for the client? Morning stretch group with music Decorating a bulletin board with the group A card game with other clients An activity with the nurse
An activity with the nurse
A nurse is reviewing a journal article about Huntington's disease and the role of genetics. The nurse demonstrates understanding of the information by identifying which type of genetic transmission as being seen in this condition? X-linked recessive Autosomal recessive X-linked dominant Autosomal dominant
Autosomal dominant
When discussing a client's diagnosis of vascular dementia with the family, the nurse includes which of the following? Select all that apply. The client may develop difficulty verbally communicating needs The client's history of cardiac arrhythmias contributed to the problem Computed tomography scan (CT scan) confirmed the diagnosis They need to be prepared for inappropriate behavior The client may experience very detailed visual hallucinations
Computed tomography scan (CT scan) confirmed the diagnosis The client's history of cardiac arrhythmias contributed to the problem They need to be prepared for inappropriate behavior The client may develop difficulty verbally communicating needs
A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client is restless, approaches the nurse and states, "I'm going to take a walk outside. I'll be back in about 10 minutes." Which is the most appropriate nursing action? Designate a staff member to accompany the client on the walk. Tell the client the walk is not allowed and restrict the client to the unit. Further assess the client's motives for wanting to walk. Give the client permission to go on a walk on the grounds.
Designate a staff member to accompany the client on the walk.
During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium? Unable to identify a water pitcher Disoriented to person Unable to transfer to sitting position Difficulty with verbal expression
Disoriented to person
A nurse is caring for a client receiving an acetylcholinesterase inhibitor (AChEI) for treatment of dementia. What is the primary side effect of AChEIs? Dizziness Muscle cramps Headache Gastrointestinal distress
Gastrointestinal distress
A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, the client's back is arched, and the client's eyes have rolled back in the sockets. The client has recently begun drug therapy with haloperidol. Based on this assessment, which would be the first action of the nurse?
Give a PRN dose of benztropine IM
The adult child of a client with dementia asks the nurse how the adult child should respond when the client repeatedly says the client has had a busy day at work. The client has not worked in over 20 years. Which is the best guidance that the nurse could offer? Give the client 5 to 10 minutes of rest, and the client will have no memory of the incident. Ask the client to explain what the client did at work today that kept the client busy. Reorient the client that the client is at home and did not go to work. Go along with the client's thought of it having been a busy day, but do not refer to the client's work.
Go along with the client's thought of it having been a busy day, but do not refer to the client's work.
The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. The nurse recognizes that this activity is likely to do which of the following? Improve memory retention Decrease environmental misinterpretation Slow the progress of the disease Increase frustration
Increase frustration
After teaching a group of nursing students about drugs used to treat Alzheimer's disease, the instructor determines that additional teaching is needed when the group identifies which as a N-methyl-D-aspartic acid (NMDA) receptor antagonist? Memantine Galantamine Donepezil Rivastigmine
Memantine
A nurse is preparing a presentation for families of clients with Alzheimer disease. When describing the underlying mechanisms associated with this condition, which of the following would the nurse most likely include? Select all that apply. Beta-amyloid destruction Inflammation Enhanced neurotransmission Oxidative stress Neurofibrillary tangles
Neurofibrillary tangles Oxidative stress Inflammation
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? Infection Medications Electrolyte imbalance Oxidative stress
Oxidative stress
A nurse is developing the plan of care for a client with dementia who is demonstrating problems with judgment and decision making. The nurse would identify which area as the priority for this client? Preventing further cognitive decline Maintaining fluid balance Promoting adequate rest Protecting from injury
Protecting from injury
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? Have the client eat in the client's room to avoid distractions while eating. Provide the client with a tray, opening containers for the client. Provide the client with a tray but encourage the client to open the client's own packages. Ask the client what the client would like from the buffet and give the client finger foods.
Provide the client with a tray, opening containers for the client.
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
During morning care, a nursing assistant asks a client with dementia, "How was your night?" The client replies, "It was lovely. My husband and I went out to dinner and to a movie." The nurse, who overhears this conversation, would make which assessment regarding the client? The client is using confabulation. The client is demonstrating a sense of humor. The client is perseverating. The client is delirious.
The client is using confabulation.
The diagnosis of delirium is supported when the nurse notes which in the client? The client responds to most assessment questions with "I don't know" and appears apathetic The client repeatedly asks where the client is and attempts to drink the water in a flower vase The is convinced that the client sees "hundreds" of bugs and is not always oriented to time and place The client spends much of the day sleeping in the dayroom and usually denies being hungry
The is convinced that the client sees "hundreds" of bugs and is not always oriented to time and place
A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, "I feel like all my work doesn't do them any good." Which suggestion would be most appropriate for the supervisor to make initially? Seek counseling if personal feelings get in the way of client care. Try to stay supportive and meet the clients' needs at the current moment. Consider transferring to a different client care specialty area. Cease giving instructions because the clients will not remember them anyway.
Try to stay supportive and meet the clients' needs at the current moment.
A nurse is assessing client with a diagnosis of Huntington's disease (HD) in the later stages. The client has severe cognitive defects. In this case, the nurse will also likely find which classic symptom? ataxia choreiform movements memory loss blindness
choreiform movements
What is the greatest benefit support groups provide to the caregivers of clients diagnosed with dementia? provides interaction with those with similar concerns provides a social outlet provides resources for needed services provides time away from the client
provides interaction with those with similar concerns
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 insist on having the curtains left open at night watch television after dinner request a bedtime snack of milk and cookies
take a nap mid afternoon and before dinner
Which of the following is the most consistent and dramatic cognitive impairment seen in dementia?
Memory
A client diagnosed with schizophrenia has been prescribed Clozapine (Clozaril). Which of the following is a potentially fatal side effect of this medication? Tardive dyskinesia Neuroleptic malignant syndrome Dystonia Agranulocytosis
Agranulocytosis
The nurse should consider the intervention referred to as "going along with" when managing the care of which client? the young adult who is expressing concern about the "police being aliens" the adolescent who is hitting and biting because he or she was given time out for disobeying unit rules the middle-aged adult who is convinced that the electrical cords are really snakes the older widower who is worried about his wife not being able to visit because of the snow
the older widower who is worried about his wife not being able to visit because of the snow
A client is admitted with the diagnosis of possible schizophrenia and to rule out (R/O) organic pathology. Based on this information, what treatment will the nurse expect for this client?
to be scheduled for a computerized tomography (CT) of the brain
A client with schizophrenia is prescribed a second-generation antipsychotic. The client's mother asks, "About how long will it take until we see any changes in his symptoms?" Which response by the nurse would be most appropriate?
"Generally, it takes about 1 to 2 weeks to be effective in changing symptoms."
The adult child of a client with dementia has been the primary caregiver for 5 months. The adult child expresses to the nurse, "At times it is so overwhelming! I feel I do not have a life anymore!" Which is the most helpful response by the nurse? "Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?" "Your parent really appreciates what you do. You are the best one to care for your parent." "Are you saying you don't want to care for your parent anymore?" "I know it is really hard. It takes a lot of work and you are doing such a good job."
"Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?"
Delusional disorders are primarily characterized by which of the following? Select all that apply.
-Paranoia -Jealousy -Distrust
One evening, a client with schizophrenia leaves his room and begins marching in the hall. When approached by the nurse, the client says, "God says I'm supposed to guard the area." Which of the following responses would be best?
"I understand you hear a voice. You and I are the only ones in the hall, and I don't hear a voice." Acknowledging that the client hears a voice validates that the client's experience is real to him, while presenting reality.
Which increases the risk for neuroleptic malignant syndrome (NMS)?
Dehydration
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? "For many older adults, this is considered to be just a normal part of the aging process." "The treatment that the care team will likely provide is simple rest, which will probably bring about a return to normal." "Delirium can be caused by a wide variety of factors but most of the changes in behavior and personality are permanent." "If the underlying cause of delirium is identified and treated, most people return to their previous level of functioning."
"If the underlying cause of delirium is identified and treated, most people return to their previous level of functioning."
A client with schizophrenia is attending a follow-up appointment at the community mental health clinic. The client reports to the nurse, "I stopped taking the antipsychotic medication because I can't get an erection with my girlfriend anymore." Which should the nurse recommend to enhance the client's well-being?
"It is important for you to take an antipsychotic medication. You may need a different type that will be less likely to affect your sexual functioning. I would like to call your physician about this."
The nurse is working with a client who has schizophrenia, disorganized type. It is time for the client to get up and eat breakfast. Which statement by the nurse would be most effective in helping the client prepare for breakfast?
"It's time to put your clothes on now."
The adult child of a client with dementia asks the nurse if the client will ever be able to live independently again. Which would be the most appropriate response by the nurse? "You sound like you aren't ready for the client to be dependent on caregivers." "With early treatment, mild dementia can be reversed. It may be possible." "Symptoms of dementia gradually get worse. Unfortunately, the client will not be independent again." "The client's confusion is a temporary complication of the physical illness and should subside when the illness gets better."
"Symptoms of dementia gradually get worse. Unfortunately, the client will not be independent again."
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."
A college freshman is admitted to the hospital with a diagnosis of schizophrenia. Friends reported that the client had been in the client's room for 2 days in a trance-like state, not eating nor speaking to anyone. Which is the priority for this client?
Assessing fluid intake and output
A nurse is reviewing a journal article about Huntington's disease and the role of genetics. The nurse demonstrates understanding of the information by identifying which type of genetic transmission as being seen in this condition?
Autosomal dominant
Which of the following drug classifications is avoided due to the fact that they may worsen delirium?
Benzodiazepines
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. Fragments mix with molecules to make plaques in the brain. Acetylcholine production is decreased. Strands of protein are tangled together.
Blood flow in the vessels to the brain are blocked.
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?
Delirium related to underlying medical problem
The nurse is questioning the family of a client brought in with cognitive impairment as the nurse assesses and evaluates the client's condition. Which distinguishes delirium from dementia? Dementia has a gradual onset and is progressive in course. Dementia has an acute onset and can be resolved. Delirium has an acute onset and is progressive in course. Delirium has a gradual onset and can be resolved.
Dementia has a gradual onset and is progressive in course.
A client diagnosed with Alzheimer's disease (AD) has decided that he is more comfortable naked than in clothes. This would be documented as which of the following? Hypersexuality Bradykinesia Cognitive reserve Disinhibition
Disinhibition
During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium? Unable to identify a water pitcher Disoriented to person Unable to transfer to sitting position Difficulty with verbal expression
Disoriented to person
The nurse suspects that a client is experiencing a brief psychotic episode based on what? Select all that apply.
Evidence of hallucinations Intense changes in affect Recent life stressor
A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what?
Extrapyramidal side effects
Which type of antipsychotic medication is most likely to produce extrapyramidal effects?
First-generation antipsychotic drugs
A client with Alzheimer's disease is confused and mumbling incoherently and rambling. To help redirect the client's attention, the nurse should encourage the client to ... Put together a 250-piece puzzle Play chess with another client Fold towels Perform an aerobic exercise
Fold towels
When describing the dementia associated with Huntington disease, a nurse understands that the problems involving behavior and attention arise from a disruption in which lobe of the brain? Frontal Temporal Occipital Parietal
Frontal
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
Encephalopathic syndrome has occurred in a few clients when haloperidol is taken with which medication?
Lithium carbonate (Lithium)
Which is the primary treatment for delirium? Maintain intravenous fluid administration Apply physical restraints Identify and treat any causal or contributing medical conditions Provide adequate nutritional food and fluid intake
Identify and treat any causal or contributing medical conditions
A client has been admitted to an inpatient unit for treatment of delirium. Which of the following is the primary treatment for delirium? Provide adequate nutritional food and fluid intake Identify and treat any causal or contributing medical conditions Provide intravenous fluid administration Apply physical restraints
Identify and treat any causal or contributing medical conditions
A client diagnosed with delusional disorder is experiencing persecutory delusions involving the belief that someone is putting poison in his food. When developing the client's plan of care, which nursing diagnosis would be most likely?
Imbalanced Nutrition, Less than Body Requirements
When preparing a class presentation about schizophrenia, what would the nurse most likely include?
Improvement in symptoms can occur as a client with a history of schizophrenia reaches older adulthood.
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
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.
Encephalopathic syndrome has occurred in a few clients when haloperidol is taken with which of the following medications? 1. Ibuprofen (Motrin) 2. Diazepam (Ativan) 3. Lithium carbonate (Lithium) 4. Furosemide (Lasix)
Lithium carbonate (Lithium)
Which is the most effective intervention for clients with delirium? Giving detailed explanations Promoting rest with PRN medications Managing environmental stimuli Providing activities for distraction
Managing environmental stimuli
The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which of the following interventions should the nurse implement first?
Move the client to a quieter area during these times.
The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to the self increase at mealtime and shift change. Which intervention should the nurse implement first? Keep unit activity to a minimum. Move the client to a quieter area during these times. Administer an antianxiety drug such as lorazepam at these times. Explain the unit routine and the reasons for increased activity to the client.
Move the client to a quieter area during these times.
A nurse is reading a journal article about schizophrenia spectrum disorders and theories related to their etiology. Part of the article describes events occurring in utero in which genes involved with cell migration, cell proliferation, axonal outgrowth, and myelination may be affected by neurologic insults such as viral infections. The nurse identifies this as which hypothesis?
Neurodevelopmental
Which should the nurse anticipate when providing therapy and evaluating outcomes for a client with delusional disorder?
Often not met completely
Which type of delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way?
Persecutory type
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
The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment? Plan for the same caregivers to provide care to individuals as much as possible. Assign peer-led exercise activities on a daily basis. Provide a buffet-style menu with many food choices. Open the windows and doors to allow fresh air to circulate through the environment.
Plan for the same caregivers to provide care to individuals as much as possible.
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 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 providing care to a client with dementia to meet the client's nutritional needs. Which approach would be most appropriate for the nurse to implement to assist in meeting adequate dietary intake?
Serve meals in small, bite-size pieces.
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
A client with command auditory hallucinations and a history of aggressive outbursts is observed pacing and grimacing while in the day room. Which should be the nurse's priority?
Support the client in returning to the client's room
A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes during a therapy session that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of what?
Tardive dyskinesia
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
The student nurse correctly recognizes that which finding is best supported by genetic studies in the etiology of schizophrenia?
That schizophrenia is at least partially inherited.
A nurse working in an assisted living facility is holding an inservice for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest? The clients should know when to come to the dining room for meals. The clients may not recognize their family when they come to visit. The clients who are ambulatory can still carry out activities of daily living independently. The clients should be able to ask us for items they need.
The clients may not recognize their family when they come to visit.
Research related to the development of schizophrenia has shown what?
The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors.
A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which best explains the nurse's behavior? The nurse stepped away to verify the safety of other clients. The nurse was frustrated and needed to take a "time-out." The nurse gave the client a chance to calm down before resuming the meal. The nurse was unsure of how to calm the client.
The nurse gave the client a chance to calm down before resuming the meal.
A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do?
Try to change the client's delusional belief
A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, "I feel like all my work doesn't do them any good." Which suggestion would be most appropriate for the supervisor to make initially? Try to stay supportive and meet the clients' needs at the current moment. Consider transferring to a different client care specialty area. Cease giving instructions because the clients will not remember them anyway. Seek counseling if personal feelings get in the way of client care.
Try to stay supportive and meet the clients' needs at the current moment.
Which type of hallucination most commonly occurs in clients diagnosed with dementia? Visual Gustatory Auditory Olfactory
Visual
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 demonstrates aphasia when discussing the client's children. The client is confused about the client's children and needs refocusing. 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.
client is unable to name the client's children. The client is confabulating, most likely to cover for memory deficit.
A caregiver of a client with dementia brings the client to the clinic for an evaluation. During the visit, the caregiver states, "Sometimes, out of the clear blue, he'll come into the kitchen while we're eating breakfast without any clothes on. It's really upsetting to me and the family." The nurse interprets this behavior as: disinhibition. hypersexuality. hypervocalization. catastrophic reaction.
disinhibition
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 schizophrenia is exhibiting hallucinations and delusions. The mental health nurse knows that these symptoms are associated with hyperactivity of which neurotransmitter?
dopamine
nurse is working with a client that has been diagnosed with delusional thoughts. Which is an initial short-term outcome appropriate for this client?
engage in reality oriented conversation
Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication?
hyponatremia
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.