Ch. 13 Neurocognitive Disorders

The spouse of a boxer says, "My partner is having difficulty speaking." On assessment, the nurse also finds that the client has difficulty picking up objects. Which condition does the nurse suspect in the client? 1. Apraxia 2. Aphasia 3. Confabulation 4. Dementia pugilistica

4

Which diagnostic test is performed to evaluate the progression of Alzheimer's disease (AD) in a client? 1. Electroencephalogram (EEG) 2. Magnetic resonance imaging (MRI) 3. Computed tomography (CT) scanning 4. Positron emission tomography (PET) scanning

4

A client with Parkinson disease has involuntary muscle movements and rigidity. What is the pathophysiology associated with these symptoms? 1. Diminished acetylcholine activity 2. Diminished dopamine activity 3. Diminished glutamate activity 4. Diminished norepinephrine activity

2

The client's spouse says, "My partner is depressed in the morning and is fine in the evening." What does the nurse suspect in the client? 1. Delirium 2. Pseudodementia 3. Dementia paralytica 4. NCD

2

A client with neurocognitive disorder (NCD) diagnosed with a disturbed thought process is undergoing psychotherapy. Which outcome does the nurse expect in the client on reassessment? 1. "The client communicates required needs effectively." 2. "The client accomplishes activities of daily living." 3. "The client experiences fewer episodes of confusion." 4. "The client responds to touch and emotional expressions."

3

The nurse is caring for a client who has impaired ability to perform his or her own activities. Which nursing intervention may minimize the client's confusion? 1. Allowing the client to have personal items 2. Displaying clocks and calendars with large numbers 3. Providing consistency in the assignment of daily caregivers 4. Anticipating client's needs that are not verbally communicated

3

Which diagnostic tool is useful for revealing the metabolic activity of the brain? 1. Electroencephalogram (EEG) 2. Magnetic resonance imaging (MRI) 3. Positron emission tomography (PET) scanning 4. Computerized tomography (CT) scanning

3

Which medications are beneficial to a client with neurocognitive disorder (NCD) experiencing apathy? Select all that apply. 1. Quetiapine 2. Trazodone 3. Bupropion 4. Amantadine 5. Methylphenidate

3, 4, 5

A client is admitted into the psychiatric unit with the complaint of pressured and incoherent speech. On further interaction, the nurse finds that the client is suffering from delirium. What is the priority nursing intervention in this situation? 1. Maintain a low level of stimuli. 2. Monitor the behavior of the client. 3. Provide reorientation and assurance to the client. 4. Determine and correct the underlying causes.

4

A client who is in stage 4 of Alzheimer's disease (AD) is undergoing psychotherapy. Which statement of the client's caregiver indicates effective treatment? 1. "The client is less impulsive and emotionally stable." 2. "The client has reduced tremors and stiffness in her hands." 3. "The client has improved cognition and memory." 4. "The client is able to understand and accept problems."

4

After assessing a client's behaviors, the nurse concludes that the client is in stage 4 of Alzheimer's disease (AD). Which behavior of the client supports the nurse's conclusion? 1. The client has difficulty recalling names or words. 2. The client is unable to recognize family members. 3. The client is disoriented to his or her surroundings. 4. The client denies the existence of the problems by covering up memory loss.

4

For a client with Alzheimer's disease, what is the condition called when he or she creates events to fill in memory gaps? 1. Delusion 2. Contusion 3. Hallucination 4. Confabulation

4

Which action does the nurse implement to prevent the risk of accidental trauma while caring for a client with neurocognitive disorder (NCD)? 1. Keeping all lights off at night 2. Positioning the bed as low as possible 3. Using clocks and calendars with large numbers 4. Arranging the client's room away from the nursing station to avoid disturbance

2

After assessing the cognitive capacity of a client with Alzheimer's disease (AD), the nurse concludes that the client is in the fourth stage of the disease. Which finding supports the nurse's conclusion? 1. The client is unable to understand current news events. 2. The client is unable to recall address and phone numbers. 3. The client is unable to recall names of family members. 4. The client is unable to plan or organize office work.

1

An elderly client with neurocognitive disorder (NCD) is experiencing anxiety and has a medical history of confusion and paradoxical excitement. Which could be the reason for the occurrence of these symptoms in the client? 1. Use of barbiturates 2. Use of dopaminergic agents 3. Use of cholinesterase inhibitors 4. Use of longer-acting benzodiazepines

1

The blood pressure of a client with a psychiatric illness is found to be 180/100 mm Hg. The brain scan report reveals the presence of cerebral infarcts. Which complication does the nurse suspect in the client based on these findings? 1. Vascular neurocognitive disorder (NCD) 2. Frontotemporal NCD 3. NCD due to prion disease 4. NCD due to Huntington's disease

1

The nurse asks a client with neurocognitive disorder (NCD) about today's date. Which behavior of the client is the nurse assessing? 1. Orientation 2. Verbal fluency 3. Comprehension 4. Learning ability

1

The nurse is providing soft restraints to a client who is at risk for trauma. Which outcome in the client would evaluate the effectiveness of the nursing intervention? 1. The client will not experience physical injury. 2. The client will anticipate unmet needs. 3. The client will minimize his or her confusion. 4. The client will communicate effectively with the nurse.

1

Which behavioral sign does the nurse find in a client diagnosed with mild neurocognitive disorder (NCD)? 1. Modest cognitive decline in learning and memory 2. Ability to carry out motor activities 3. Disorientation to surroundings 4. Inability to perform everyday activities independently

1

Which medication does the nurse expect the primary health-care provider to prescribe for a client with neurocognitive disorder (NCD) who is agitated and aggressive? 1. Olanzapine 2. Amantadine 3. Alprazolam 4. Mirtazapine

1

While caring for a cognitively impaired client, the nurse provides a cane and instructs the client about its use. Which outcome will the nurse expect from this intervention? 1. The client will not experience physical injury. 2. The client might be able to show wandering behavior. 3. The client will maintain a therapeutic relationship with the nurse. 4. The client might be able to perform the activities of daily living independently.

1

The nurse is caring for a client with disorientation and confusion. Which nursing interventions serve as excellent ways to provide orientation to reality for the client? Select all that apply. 1. Using reminiscence therapy 2. Allowing the client to view old photographs 3. Maintaining consistency of staff and caregivers 4. Allowing the client to have his or her personal items 5. Encouraging family and close friends to be a part of the client's care

1, 2

Which medications are preferred for a client with neurocognitive disorder (NCD) experiencing anxiety? Select all that apply. 1. Oxazepam 2. Lorazepam 3. Diazepam 4. Amobarbital 5. Chlordiazepoxide

1, 2

The nurse is teaching a group of student nurses about the metabolic disorders that precipitate delirium or neurocognitive disorder (NCD) in a client. Which conditions does the nurse include in the teaching plan? Select all that apply. 1. Hypoxia 2. Hypercarbia 3. Hypoglycemia 4. Hypothyroidism 5. Hyperpituitarism

1, 2, 3

Which condition does the nurse suspect in the client with neurocognitive disorder (NCD) who has increased difficulty understanding spoken language? 1. Vascular NCD 2. Frontotemporal NCD 3. NCD due to Parkinson disease 4. NCD due to traumatic brain injury

2

Which is the most significant factor in the etiology of multiple strokes in a client with vascular neurocognitive disorder (NCD)? 1. Pellagra 2. Hypertension 3. Hyperparathyroidism 4. Systemic lupus erythematosus

2

Which psychomotor symptoms are observed in a client who is in the severe cognitive decline stage of Alzheimer's disease (AD)? Select all that apply. 1. Aggression 2. Wandering 3. Frustration 4. Obsessiveness 5. Self-absorption

1, 2, 4

An elderly client with neurocognitive disorder (NCD) is found to be anxious. Which medications help reduce the client's anxiety? Select all that apply. 1. Oxazepam 2. Diazepam 3. Lorazepam 4. Phenobarbital 5. Chlordiazepoxide

1, 3

Which symptoms does the nurse observe in a 34-year-old client diagnosed with neurocognitive disorder (NCD) due to Huntington's disease? Select all that apply. 1. Twitching of limbs 2. Hyperactive behavior 3. Emotional impairment 4. Short-term memory loss 5. Appearance of visual hallucinations

1, 3, 4

Which conditions are known to precipitate delirium in a client? Select all that apply. 1. Febrile illness 2. Hypothyroidism 3. Pernicious anemia 4. Systemic infections 5. Hepatic encephalopathy

1, 4, 5

Which medication is used in the treatment of agitation? 1. Donepezil 2. Risperidone 3. Galantamine 4. Rivastigmine

2

Which medication is useful in treating moderately severe cognitive impairment in a client with a neurocognitive disorder (NCD)? 1. Zaleplon 2. Donepezil 3. Trazodone 4. Physostigmine

2

Which focal neurological signs are commonly observed in a client with vascular neurocognitive disorder (NCD)? Select all that apply. 1. Tremor 2. Amnesia 3. Small-stepped gait 4. Difficulty with speech 5. Weakness of the limbs

3, 4, 5

A client with neurocognitive decline is diagnosed with neuronal degradation caused by overstimulation of the N-methyl-D-aspartate (NMDA) receptors. Which medication does the nurse expect the primary health-care provider to prescribe? 1. Donepezil 2. Memantine 3. Galantamine 4. Rivastigmine

2

The client's medical history indicates that his or her delirium is caused by substance withdrawal. Which class of medications does the primary health-care provider prescribe to the client in this situation? 1. Antipsychotic 2. Antianxiety 3. Antidepressant 4. Cholinesterase inhibitor

2

What is the first-line drug treatment in an elderly client diagnosed with neurocognitive depression? 1. Doxepin 2. Sertraline 3. Imipramine 4. Nortriptyline

2

What is the possible etiology for neurocognitive decline in a client who had a recent fracture of a femur bone? 1. Release of Lewy bodies 2. Interruption of blood flow 3. Diminished dopamine activity 4. Impaired muscle coordination

2

Which instructions does the nurse provide to the wife of a client suffering from severe cognitive decline? Select all that apply. 1. "Don't be surprised if your husband forgets your name." 2. "Your husband may not be able to recognize some family members." 3. "Your husband may be more aggressive during late afternoons and evenings." 4. "It is important to provide institutional care for your husband." 5. "Watch out for infections like pneumonia in your husband caused by decreased immunity."

2, 3, 4, 5

Which exogenous factors are implicated in the development of delirium in a client? Select all that apply. 1. Porphyria 2. Contusions 3. Prolonged labor 4. Prenatal infections 5. Obstetric complications

2, 3, 5

A client with neurocognitive disorder (NCD) is diagnosed with risk for trauma. Which nursing interventions require correction while caring for this client? Select all that apply. 1. Observing the client frequently 2. Avoiding night lights in the client's room 3. Talking to the client about place and time 4. Storing frequently used items out of the client's reach 5. Keeping bedrails down when the client is in the bed

2, 4, 5

A widowed client is diagnosed with neurocognitive disorder (NCD) due to Alzheimer's disease (AD). On interaction, the client says, "It's my birthday today. I am going out with my husband." What is the best response from the nurse in this situation? 1. "Did you take your medicine?" 2. "Don't you remember that your husband died a few months ago?" 3. "Tell me about your husband. What was it like when you were together?" 4. "Today is not your birthday. How do you usually celebrate your birthday?"

3

For which client is it most important to have electronically controlled exit doors in a health-care facility? 1. A client with agitation 2. A client with disorientation 3. A client with wandering behavior 4. A client with delusions and hallucinations

3

Which nursing intervention is effective in an agitated client who is at risk for trauma? 1. Encouraging reminiscence therapy 2. Discussing the positive aspects of life 3. Maintaining a low level of stimuli in the environment 4. Encouraging family members to be a part of the client's care

3

Which stage of Alzheimer's disease (AD) is characterized by sundowning? 1. Very mild change 2. Mild cognitive decline 3. Severe cognitive decline 4. Moderately severe cognitive decline Rationales

3

The nurse is teaching a group of student nurses about various forms of neurocognitive disorders (NCDs). Which disorders does the nurse refer to as being reversible? Select all that apply. 1. NCD due to HIV infection 2. NCD due to Alzheimer's disease (AD) 3. NCD due to folate deficiency 4. NCD due to side effects of medications 5. NCD due to central nervous system infections

3, 4, 5

Which are the causes of secondary neurocognitive disorders (NCDs) in a client? Select all that apply. 1. Concussion 2. Contracture 3. Cerebral trauma 4. Vascular disease 5. Human immunodeficiency virus (HIV) disease

3, 5

The nurse is assessing a client who is diagnosed with Alzheimer's disease (AD) with moderate cognitive decline. Which question does the nurse ask the client to assess the progressive nature of symptoms of the disease to the next stage? 1. "How is your performance at work?" 2. "Do you have difficulty recalling names or words?" 3. "Are you experiencing any short-term memory loss?" 4. "Are you able to perform your daily activities independently?"

4

The nurse is caring for a client with cardiopulmonary disorder who recently had a head injury. On interaction, the nurse finds that the client has a misperception of the environment and likely has delirium. Which medication, along with the head trauma, does the nurse expect to be the cause of this condition in the client? 1. Antibiotic agents 2. Anticoagulant agents 3. Bronchodilator agents 4. Antihypertensive agents

4

The nurse is caring for a client with self-care deficits. Which outcome will demonstrate the effectiveness of the nursing intervention? 1. The client will interpret the environment accurately. 2. The client will be able to make his or her needs known to caregivers. 3. The client will use the measures provided to maintain reality orientation. 4. The client will participate in the activities of daily life with the assistance of caregivers.

4

Which intervention should the nurse implement while caring for a client with neurocognitive disorder (NCD) and diagnosed with wandering behavior? 1. Storing frequently used items out of the client's reach 2. Teaching the client to hold on to a hand-railing 3. Maintaining a low level of stimuli in the environment 4. Keeping the client on a structured schedule of recreational activities

4

Which is the long-term goal for the client with an impaired ability to process verbal communication? 1. To have the client experience fewer episodes of confusion 2. To help the client make his or her needs known to the primary caregiver 3. To help the client understand basic communication 4. To increase the client's ability to express his or her needs so they are easily anticipated and fulfilled by caregivers

4

While caring for a client who is at risk for trauma, the nurse maintains a low level of stimuli in the environment. Which outcome in the client indicates the effectiveness of treatment? 1. The client will maintain reality orientation. 2. The client will accomplish tasks of daily life. 3. The client will interpret the environment correctly. 4. The client will maintain a calm demeanor with minimal agitated behavior.

4