Chapter 24: Neurocognitive Disorders

A client diagnosed with Alzheimer's disease says, "I'm so afraid. Where am I? Where is my family?" How should the nurse respond? a. "You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is 1 hour from now." b. "The name of the hospital is on the sign over the door. Let's go read it again." c. "You know where you are. You were admitted here 2 weeks ago. Don't worry; your family will be back soon." d. "I just told you that you're in the hospital and your family will be here soon."

a. "You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is 1 hour from now." Rationale: Providing the specific information requested comforts and reassures the client, who is lost and confused, and promotes orientation. The nurse should not assume that a client with Alzheimer's disease will remember being admitted to the hospital and should supply specific information about when the family will visit. The nurse should not scold or infantilize the client or assume that the client will remember the name of the hospital after seeing the sign.

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

a. Because the liver is most vulnerable to tacrine, liver function tests must be done periodically. Rationale: The liver rapidly absorbs and metabolizes tacrine; therefore, the liver is most vulnerable to the drug's toxicity.

The spouse caregiver of a client with dementia tells the nurse that the client has been agitated lately. The spouse states, "I don't know how to handle this. The client was always such a gentle person!" Which interventions should the nurse suggest? a. Distract the client with family photos and discuss the events pictured. b. Leave the client in a safe place in the house and go to another area until the client calms down. c. Give the client a sedative when the client begins to get agitated. d. Distract the client by turning on the television or watching a video.

a. Distract the client with family photos and discuss the events pictured. Rationale: At times, there may seem to be no way to resolve the emotional frustration, agitation, or outbursts of the client who is angry with the environment and those in it. The caregiver might find it beneficial to redirect or distract the client. This can be done by asking to see a client's personal items, such as photographs, and then talking about the family members and life events illustrated by the photographs in the book.

A nurse is caring for a client with delirium. The client sees a thermometer on the nurse's table and shouts, "Don't stab me!" and cowers. Which feature of delirium is this client exhibiting? a. Illusion b. Misinterpretation c. Hallucination d. Euphoria

a. Illusion Rationale: Clients with delirium may experience illusions. In this case, the client is having an illusion that the thermometer is a knife. Euphoria refers to an extremely elated mood; however, the client does not appear to be highly elated. Hallucinations are typically things that clients "see" with no stimulus in reality. Misinterpretations are a misunderstanding of an actual event or stimulus. In many cases, the client cannot be convinced that their misinterpretation is incorrect.

Which medication used to treat dementia requires a liver function test every 1 to 2 weeks? a. Tacrine b. Galantamine c. Rivastigmine d. Donepezil

a. Tacrine Rationale: Tacrine requires a liver function tests every 1 to 2 weeks.

A nurse is giving instructions to a client diagnosed with delirium. Why might the nurse repeat the instructions frequently? Select all that apply. a. The client may have impaired recent and immediate memory. b. The client may have impaired attention. c. The client may have poor judgment. d. The client may have abnormal thought processing. e. The client may not understand what the nurse is saying.

a. The client may have impaired recent and immediate memory. b. The client may have impaired attention. Rationale: Clients with dementia may have an inability to sustain attention to conversation or events happening around them. These clients may also have impaired recent and immediate memory. The nurse may have to ask the client questions or give instructions repeatedly to the client in order to make the client understand and respond appropriately. Clients with delirium may have poor judgment, but poor judgment is not related to the inability of the client to respond to instructions.

What is the initial intervention the nurse should implement when helping a client diagnosed with dementia deal with paranoid delusions? a. observe the client in order to identify the triggers for the delusions b. explain to the client that his or her fears are unfounded c. ask that the client be prescribed medication to help manage the paranoia d. keep the client occupied when he or she first begins to express the delusion

a. observe the client in order to identify the triggers for the delusions Rationale: 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 primary sign of delirium? a. Impaired socialization b. An altered level of consciousness c. Disturbed sleep-wake cycles d. Inability to fulfill roles

b. An altered level of consciousness Rationale: The primary sign of delirium is an altered level of consciousness that is seldom stable and usually fluctuates throughout the day. All other options are not the primary sign of delirium.

Which is the primary treatment for delirium? a. Apply physical restraints b. Identify and treat any causal or contributing medical conditions c. Maintain intravenous fluid administration d. Provide adequate nutritional food and fluid intake

b. Identify and treat any causal or contributing medical conditions Rationale: The primary treatment of delirium is to identify and treat any causal or contributing medical conditions.

Which is an infection-related cause of delirium? a. Lithium toxicity b. Pneumonia c. Sleep deprivation d. Renal failure

b. Pneumonia Rationale: Infection-related causes of delirium include pneumonia, sepsis, urinary tract infection, and meningitis. Lithium toxicity is a drug-related cause. Renal failure and sleep deprivation are physiologic causes.

A client with Alzheimer's disease has a nursing diagnosis of risk for injury related to memory loss, wandering, and disorientation. Which nursing intervention should appear in this client's care plan to prevent injury? a. Provide the client with detailed instructions. b. Remove hazards from the environment. c. Use restraints at all times. d. Keep the client sedated whenever possible.

b. Remove hazards from the environment. Rationale: By removing environmental hazards, the nurse can help prevent injury to the client. The nurse should provide single, simple instructions rather than many detailed instructions. The nurse should administer medication as prescribed and as needed—not to keep the client sedated. The nurse should use restraints only when required to prevent self-harm by the client.

Which type of hallucination is most commonly seen in clients diagnosed with delirium? a. Autonomic b. Visual c. Auditory d. Gustatory

b. Visual Rationale: Visual hallucinations are the most common type seen in clients diagnosed with delirium.

What is the greatest benefit support groups provide to the caregivers of clients diagnosed with dementia? a. provides resources for needed services b. provides interaction with those with similar concerns c. provides a social outlet d. provides time away from the client

b. provides interaction with those with similar concerns Rationale: 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.

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

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

The nurse is caring for a client with delirium. Which interventions may help manage this client? Select all that apply. a. Use matter-of-fact approach when assuming tasks the client can no longer perform. b. Encourage the client to follow a regular routine. c. Allow adequate time for the client to comprehend and respond. d. Provide orienting verbal cues when talking with the client. e. Speak in simple sentences.

c. Allow adequate time for the client to comprehend and respond. d. Provide orienting verbal cues when talking with the client. e. Speak in simple sentences. Rationale: To manage the client's confusion, the nurse should use simple sentences and provide verbal cues when talking with the client. The nurse also should allow adequate time for the client to comprehend and respond to any questions. Using a matter-of-fact approach when assuming tasks the client can no longer perform and encouraging the client to follow a regular routine are nursing interventions for dementia.

Which medication is not known to cause delirium? a. Antidepressants b. Steroids c. Loop diuretics d. Narcotics

c. Loop diuretics Rationale: Loop diuretics are not known to causes delirium. Steroids, narcotics, and antidepressants may cause delirium.

Which is the priority intervention for a client diagnosed with delirium? a. Management of confusion b. Proper nutrition c. Maintenance of safety d. Promotion of sleep

c. Maintenance of safety Rationale: Maintenance of safety is the priority intervention for the client diagnosed with delirium. Management of confusion, promotion of sleep, and proper nutrition are important but not the priority.

While reviewing the medical record of a client with moderate dementia of the Alzheimer type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type? a. Cholinesterase inhibitor b. Atypical antipsychotic c. N-methyl-D-aspartate (NMDA) receptor antagonist d. Benzodiazepine

c. N-methyl-D-aspartate (NMDA) receptor antagonist Rationale: Memantine is classified as an NMDA receptor antagonist that has been shown to improve cognition and activities of daily living in clients with moderate to severe symptoms of dementia. Risperidone, olanzapine, and quetiapine are examples of atypical antipsychotics. Galantamine, donepezil, rivastigmine, and tacrine are cholinesterase inhibitors. Clonazepam, alprazolam, and lorazepam are examples of benzodiazepines.

An older client comes to the clinic for a yearly physical exam. During the assessment, the client tells the nurse that the client sometimes has begun feeling anxious about the client's forgetfulness. The nurse notes the client may have mild dementia. Which finding would lead the nurse to conclude this? a. The client reports an inability to perform complex tasks b. The client exhibits confusion c. The client has difficulty finding words d. The client reports having delusions

c. The client has difficulty finding words Rationale: The nurse suspects the client may have mild dementia as the client is reporting difficulty in finding words during conversation, along with anxiety over the client's forgetfulnesss. Confusion and the inability to perform complex tasks are possible indicators of moderate dementia. Delusions are typically experienced by client's suffering from severe dementia.

Which type of hallucination most commonly occurs in clients diagnosed with dementia? a. Olfactory b. Auditory c. Visual d. Gustatory

c. Visual Rationale: 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.

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

c. take a nap mid afternoon and before dinner Rationale: 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.

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

d. Achievement of self-esteem needs Rationale: 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.

Which term is used to describe the inability to execute motor functioning, despite intact motor abilities? a. Agnosia b. Aphasia c. Executive functioning d. Apraxia

d. Apraxia Rationale: Apraxia is the impaired ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function. Agnosia is the inability to recognize the name of objects. Executive functioning is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior.

Which is the hallmark of beginning mild dementia? a. Depression b. Restlessness c. Anxiety d. Forgetfulness

d. Forgetfulness Rationale: The hallmark of the initiation of mild dementia is forgetfulness. Memory impairment is the prominent early sign of dementia.

A client in the client's 50s has contacted the care provider because of concerns for the client's spouse, who has suddenly begun behaving uncharacteristically in recent days. Most recently, the spouse became lost while driving to the spouse's home of 30 years and temporarily forgot the name of the spouse's child. Diagnostic testing has ruled out delirium and the spouse had been previously healthy. What is the most likely cause of the spouse's cognitive changes? a. Dementia with Lewy bodies (DLB) b. Wernicke's encephalopathy c. Dementia of Alzheimer's type (DAT) d. Vascular dementia

d. Vascular dementia Rationale: The onset of vascular dementia is usually earlier than that of DAT and DLB. Onset is generally abrupt, with fluctuating, rapid changes in memory and other cognitive impairment.

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

d. the older widower who is worried about his wife not being able to visit because of the snow Rationale: Going along means providing emotional reassurance to clients without correcting their misperception or delusion. It is important to remember that different interventions are indicated for dealing with psychotic symptoms, depending on the cause. People with dementia cannot regain their cognitive functions, so techniques like redirection or "going along with" the person are indicated. However, when psychotic symptoms are due to a treatable illness, such as schizophrenia, the nurse should not say or do anything to reinforce the notion that the delusions or hallucinations are real in any way. This would only interfere with or impede the client's progress.The child's behavior is not acceptable and limits must be maintained.