Module 23: The Concept of Cognition, 23.A Alzheimer Disease, 23.C Schizophrenia, Schizophrenia - Exemplar 23.C, Schizophrenia/ Alzheimer's Exam 1, 23 A, Alzheimer's for 211 (for test 2), Mental Health practice Questions, 24.2 Pretest Confusion: Delir...

What are some nonpharmacologic therapies used for schizophrenia?

- Family intervention and Psychoeducation - Social skills training - Cognitive remediation - Vocational training - Community service models - Individual, family, and group therapy - Electroconvulsive therapy - Repetitive transcranial magnetic stimulation

Donepezil

- GI effects - Bradycardia, syncope - Avoid use w/ NSAIDs -> give tylenol instead - Avoid w/ antihistamines, TCAs, and conventional antipsychotics, bec they can reduce effectiveness

cognitive support for Alzheimer's

- Memory aids, such as clocks calendars, photographs seasonal decor, familiar objects, reorient when necessary - Keep a consistent routine - Maintain consistent caregivers - Cover or remover mirrors to decrease fear and agitation

physical needs for Alzheimer's

- Monitor neurological status - Assess skin integrity - Monitor VS - Implement measures to promote sleep - Monitor clients level of comfort and watch for nonverbal indications of discomfort - Provide eyeglasses and hearing aids prn - Ensure adequate food and fluid intake

How are the symptoms of Schizophrenia categorized?

- Positive, negative, cognitive types

What are the Phases of Illness?

- Premorbid Phase - Prodromal Phase - Acute Phase - Residual Phase

What are the two critical components of health promotion?

- Recovery - Rehabilitation

memantine

- Slows brain cell death - Approved for moderate to sever alz - Can be giving w cholinesterase inhibitor - Watch for dizziness headache confusion and constipation

What are hallucinations?

- abnormal perceptual experiences that usually occur in the absence of external stimuli

How is schizophrenia classified?

- according to the stage of the illness as well as the types of symptoms that are observed - presenting symptoms may vary from person to person, with periods of exacerbations and remission

What are some known pathologic mechanisms associated with schizophrenia?

- anatomic alterations - neurotransmitter abnormalities - impairments in the immune function

What is the function of Atypical antipsychotics?

- block D2 receptors, block serotonin and alpha-adrenergic receptors

How are Positive symptoms characterized?

- by the psychotic features of the disorder that generally do not occur in healthy people and are outside of the range of normal experiences

What is the Residual Phase?

- can be broken down into the stabilization phase (6-18 months after the resolution of the acute phase) and the maintenance phase. - involves the immediate period of recovery

What are individuals diagnosed with schizophrenia more at risk for?

- cardiovascular disease - diabetes - COPD - many infectious diseases

What alterations cause functional deficits?

- communication - cognition - attention - memory - emotional regulation - initiative - social interactions

What are some types of structural anatomic alterations?

- decreased volumes of gray matter in the prefrontal cortex, temporal lobes, hippocampus, and thalamus - enlarged ventricles and sulci - decreased blood flow to the frontal lobe, thalamus, and temporal lobes

What is the etiology of schizophrenia?

- exact cause not understood

What are delusions?

- false beliefs that are based on faulty perceptions and inferences

What is loose association?

- indication of disordered thinking characterized by the shifting of verbal ideas from one topic to another, with no apparent relation between thoughts, and the person speaking is unaware that the topics are unconnected

What is the acute phase?

- marked by the onset of florid psychotic/positive symptoms

What are the cognitive symptoms of schizophrenia?

- memory deficits - attention deficits - language difficulties - loss of executive function

What are some things you would ask for a patient diagnosed with schizophrenia about possible risk factors for exacerbations or signs of relapse?

- poor adherence to prescribed treatment regimen - possible development of resistance to antipsychotic meds - presence of mild to full-blown symptoms of psychosis - recent life events that may increase the likelihood of relapse

What is the goal of health promotion?

- prevention of relapse

How can you prevent schizophrenia?

- primary prevention includes comprehensive healthcare during pregnancy and childhood - measures to reduce or eliminate adversity and environmental insults (poverty, abuse, trauma, injury, or exposure to environmental toxins) - Secondary prevention focuses on high-risk groups such as those with the family history of schizophrenia or who demonstrate behaviors associated with the progression of psychosis - Tertiary prevention focuses on reducing the impact of the disease in individuals diagnosed with schizophrenia.

What are some things a nurse would monitor for during the evaluation of someone with schizophrenia?

- pt adheres to medication regimen - pt demonstrates utilization of available resources - pt communicates clearly and transitions logically between topics - pt reports and absence of hallucinations and/or delusions - pt able to perform ADLs - pt refrains from use of nicotine, alcohol, and illicit drugs - pt is able to work in a structured setting

What would some outcomes related to achieving life goals be?

- pt will cultivate appropriate occupational skills - pt will find a job and maintain gainful employment - pt will retain responsibly for personal finances - pt will live independently in the community

What would some outcomes related to quality of life be?

- pt will demonstrate appropriate self-care and personal hygiene - pt will obtain adequate sleep - patient will refrain from use of alcohol and/or illicit drugs - pt will demonstrate improved coping skills - pt will make a concerted effort to interact with others and avoid social isolation

What would some outcomes related to symptom reduction be?

- pt will no longer experience hallucinations and delusions - pt will experience a reduction in disordered thoughts - pt will demonstrate appropriate affect - pt will experience fewer negative symptoms of schizophrenia - pt will take all medications as prescribed

How are Negative Symptoms characterized?

- refer to affects and behaviors that are diminished or absent in individuals with schizophrenia - include having flat or blunted affect, thought blocking, alga, anhedonia, avolition

What is echopraxia?

- repeating the movements of others observed

What is Catatonia?

- state of unresponsiveness in an individual who is conscious - it may incorporate features such as mutism, echopraxia, echolalia, waxy flexibility, and automatic obedience

What is the primary goal of pharmacotherapy?

- to decrease the positive symptoms of the disorder to a level that enables the individual to maintain social relationships and complete ADLs with minimal assistance

When can schizophrenia emerge?

- usually early adulthood - can occur in childhood, adolescences, later life

A patient who overdosed on oxycodone is given naloxone. When assessing the patient, the healthcare provider would anticipate which of these clinical manifestations of opioid withdrawal? -Bradycardia and hyporthermia -Irritability and nausea -Hyperthermia and euphoria -Depressed respirations and somnolence

-Irritability and nausea

increased

. Side effects of NMDA inhibitors are less common and usually milder than those associated with donepezil, rivastigmine, and galantamine. They include dizziness, constipation, confusion, headache, fatigue, and ____________ blood pressure.

High potency first generation antipsychotics

1. Thiothixene 2. Trifluoperazine 3. Fluphenazine 4. Haloperidol - high EPS

A nursing instructor is teaching a group of student nurses about the different theories of cognition. Which cognitive development theory proposes that all children progress through the same stages of development? A) Piaget B) Vygotsky C) Information-processing D) Erickson

A

An older client complains of periods of confusion and forgetfulness, but reports clear thought process at most times of the day. What is the an appropriate response of the nurse? A) "Are you having trouble hearing?" B) "You probably have nothing to worry about. It's most likely stress-related." C) "Everybody has a few problems with memory as they get older." D) "You should probably have an MRI of your brain."

A

An older hospitalized client wakes up in the middle of the night very confused. The nurse reorients the client to the surroundings and gets the client to return to sleep. What should the nurse consider as a source for the client's confusion? A) Ambien 10 mg as needed at bedtime for sleep B) The client's age C) The death of the client's husband last month D) History of cardiac disease

A

- Drugs and alcohol - Eyes and ears - Metabolic and endocrine disorders - Emotional disorders - Neurologic disorders - Trauma or tumors - Infection - Arteriovascular disease

A number of other conditions can mimic the symptoms of dementia and AD. A useful mnemonic for remembering to assess for these conditions is DEMENTIA: .............

d ("Research shows that these supplements have no effect on the progression of AD.")

A patient asks the nurse about taking gingko biloba, resveratrol, and omega-3 fatty acids as over-the-counter treatments to slow the progression of AD. How should the nurse respond? a) "These antioxidants have been proven to prevent the progression of AD." b) "Herbal therapies in combination with healing touch help slow the progression of AD." c) "I would take one of each herbal supplement to try and slow the progression of AD." d) "Research shows that these supplements have no effect on the progression of AD."

"Research shows that these supplements have no effect on the progression of AD."

A patient asks the nurse about taking gingko biloba, resveratrol, and omega-3 fatty acids as over-the-counter treatments to slow the progression of AD. How should the nurse respond?

The nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. The most appropriate action by the nurse is to a. secure the patient in bed using a soft chest restraint. b. ask the health care provider to order an antipsychotic drug. c. instruct family members to remain with the patient and prevent injury. d. assign unlicensed assistive personnel (UAP) to stay with the patient and offer reorientation.

ANS: D-assign unlicensed assistive personnel (UAP) to stay with the patient and offer reorientation.

Late Onset Schizophrenia (LOS)

About 20-30% of all patients do not experience symptoms of schizophrenia until after age 40. The incidence of _________________ seems to be greater in women, but other risk factors for the disease are comparable to those associated with an earlier onset.

GI bleed

Acetylcholinesterase inhibitors are associated with ________________. Blood in the stool would require notification to the healthcare provider.

Delirium (Acute confusion)

Acute cognition disorder that affects functional independence; severe onset

Schemes

Adaptive cognitive structures formed in response to environmental stimuli

What are the positive symptoms of schizophrenia?

Additions to normal experiences: - delusions - hallucinations - abnormal movements - formal thought disorder

Psychosis

An abnormal mental state that alters an individuals thoughts, feelings, perceptions, and/or behaviors

Delirium

An acute cognitive disorder that affects functional independence

Dystonia

An acute episode of muscle contractions

Dystonia

An acute episode of muscle contractions (may result from a neurodegenerative disease or a reaction to medication)

a ("What is your name and the month, date, and year?")

A patient is brought to the clinic by family because of increased forgetfulness and concern that the patient may have Alzheimer disease (AD). The nurse notices the patient is dressed in a t-shirt and shorts when it is 25°F (−3.9°C) outside. Which question should the nurse ask the patient first? a) "What is your name and the month, date, and year?" b) "Are you cold with the clothes you are currently wearing?" c) "What made you decide to wear the clothes you have on today?" d) "Do you know why your family brought you here today?"

a ("Try increasing your fluids and changing position slowly.")

A patient presents in the community clinic with complaints about dizziness when standing. During the history and physical exam, the nurse notes that the patient is taking a conventional antipsychotic drug. Which advice should the nurse give the patient? a) "Try increasing your fluids and changing position slowly." b) "Call your healthcare provider in the morning to report these symptoms." c) "Avoid high-fiber or fatty foods." d) "Stop taking the medication immediately and go to the nearest emergency department."

b (Positron emission test PET scan of the brain)

A patient who has had symptoms of hallucinations and delusional thinking is undergoing testing for possible schizophrenia. Which diagnostic testing could indicate possible schizophrenia? a) Computerized tomography (CT) scan of the brain b) Positron emission test (PET) scan of the brain c) Electroencephalogram (EEG) d) Complete metabolic panel

b (Acetylcholinesterase inhibitor)

A patient with a history of Alzheimer disease (AD) is admitted for gastrointestinal bleeding. Which medication in the patient's profile would the nurse expect the healthcare provider to discontinue? a) Antipsychotic b) Acetylcholinesterase inhibitor c) Antidepressant d) N-Methyl-D-aspartate (NMDA) receptor antagonist

A nurse assists a victim of intimate partner abuse to create a plan for escape if it becomes necessary. Which components should the plan include? Select all that apply. a. Keep a cell phone fully charged. b. Hide money with which to buy new clothes. c. Have the phone number for the nearest shelter. d. Take enough toys to amuse the children for 2 days. e. Secure a supply of current medications for self and children. f. Assemble birth certificates, Social Security cards, and licenses. g. Determine a code word to signal children when it is time to leave.

A, C, E, F, G The victim must prepare for a quick exit and so should assemble necessary items. Keeping a cell phone fully charged will help with access to support persons or agencies. Taking a large supply of toys would be cumbersome and might compromise the plan. People are advised to take one favorite small toy or security object for each child, but most shelters have toys to further engage the children. Accumulating enough money to purchase clothing may be difficult.

A patient has been diagnosed as having dementia. Which symptom should the LPN/LVN expect? A. Patient tends to confabulate. B. Patient tends to have flight of ideas. C. Patient's speech tends to be slurred. D. Patient tends to be oriented to time, place, and person.

A. Patient tends to confabulate.

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? b. Present the information again in a calm manner using simple language.

ANS: B Giving information in a calm, simple manner will help the patient grasp the important facts. Introducing extraneous topics as described in the distracters will further scatter the patient's attention.

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety? b. Moderate

ANS: B Moderate anxiety causes the individual to grasp less information and reduces problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem solving. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior.

Which action will help the nurse determine whether a new patient's confusion is caused by dementia or delirium? a. Administer the Mini-Mental Status Exam. b. Use the Confusion Assessment Method tool. c. Determine whether there is a family history of dementia. d. Obtain a list of the medications that the patient usually takes.

ANS: B The Confusion Assessment Method tool has been extensively tested in assessing delirium.

A stockbroker commits suicide after being convicted of insider trading. Which information should a nurse share with the grieving family? A. "Keep in mind that your grieving will only last for 1 year." B. "To deal with your grief, try using coping strategies that have worked for you in the past." C. "You need to write a letter to the brokerage firm to express your anger with them." D. "It would be best if you avoid discussing the suicide."

ANS: B The nurse should discuss coping strategies that have been successful in times of stress in the past, and work to reestablish these within the family.

A non-English-speaking child is hospitalized with encephalitis and is experiencing delirium. Which intervention promotes a therapeutic environment for this child and family? A) Making sure the parents can set up the treatments for their child B) Encouraging the family to remain at the bedside with the client C) Making sure the child comes back for the follow-up appointment D) Providing written instructions before discharge

B

A nurse working in a psychiatric unit is caring for a client with schizophrenia who manifests positive symptoms of the disease. What symptom is the client likely displaying? A) Social withdrawal B) Hallucinations C) Anhedonia D) Concrete thinking

B

A student nurse is learning about the physiology of the nervous system and its relationship to cognition. What structure plays a role in memory formation? A) Neuron B) Hippocampus C) Cerebrum D) Neurotransmitter

B

CONFUSION The client's family says, "We don't understand what is happening to Dad. He becomes very agitated in the evenings, cussing like a sailor." What should the nurse explain is occurring with the client? A) Delirium B) Sundown syndrome C) Anxiety D) Psychosis

B

The client is receiving risperidone (Risperdal) for the treatment of schizophrenia. Which client statement indicates the medication is effective? A) "I promise not to skip breakfast anymore." B) "I am not hearing the voices anymore." C) "I will start going to group therapy." D) "I feel better and I am ready to go home."

B

The family of an older client is informed that the client has delirium. Which statement indicates that the family understands the diagnosis? A) "Dad has always been so independent. He's lived alone for years since my mom died." B) "The changes in his behavior came on so quickly. He was fine when he woke up but didn't know the year or where he was by lunch time." C) "Dad has been becoming increasingly forgetful over the last several months." D) "Maybe it's just caused by aging. This usually happens when people get older."

B

The nurse is assessing an older adult client and observes that the client is having several cognitive problems, including memory and attention deficits and fluctuating levels of orientation. The nurse confirms with the family that the client's symptoms developed over a several-year period. Which health problem is the client most likely experiencing? A) Depression B) Dementia C) Intellectual disability D) Delirium

B

The staff on a care area that has a high percentage of clients with confusion attends an educational program on delirium management. Which staff nurse statement indicates that teaching has been effective? A) "It is important to provide education for family members as needed." B) "Sensory deprivation and overstimulation can worsen the symptoms the client exhibits." C) "Decreasing all stimulation in the client's room is essential." D) "The family should involve the client in all conversations and interactions involving care."

B

A nurse is caring for a client who has been in the PACU for more than 1 hour and is difficult to arouse. The nurse should anticipate which of the following medication prescriptions? A. Pentazocine (Talwin) B. Naloxone (narcan) C. Naltrexone (Trexan) D. Butorphanol (Stadol)

B (Naloxone displaces opiate medications from receptor sites, reversing the respiratory depression, sedation, hypertension, and analgesia opiates cause.)

severe Alzheimer's

Assistance required for ADLs Incontinence Difficulty w/ physical abilities (walking, sitting and eventually swallowing)

What are examples of conditions a pt. may have that would alter cognition in terms of oxygenation?

Asthma, COPD, Acute respiratory distress syndrome

illness, stress

Attention is significantly altered by the experience of _________________ or ______________

60

Average life expectancy for individuals with Down syndrome is about _____ years, although some individuals live 10 or even 20 years longer

) A 70-year-old client comes into the clinic for his pneumonia vaccine. During the client interview, he seems to have mild difficulty with several words and has problems remembering the nurse's name. He is alert and oriented to time, person, and place. His responses seem appropriate. How should the nurse describe this client's cognitive changes? A) Memory impairment that may be related to cerebral ischemia B) Normal signs of aging C) Indicators of depression in the elderly D) Early symptoms of dementia

B

A client is admitted with signs and symptoms of early Alzheimer disease. What would be used to confirm this client's diagnosis? A) Abnormal CT scan findings of neuritic plaques and tangles in the brain B) Client history and physical examination C) Positive blood tests for beta-amyloid and tau proteins D) Blood test for amyloid plaques and neurofibrillary tangles

B

A client with dementia is prescribed donepezil (Aricept). What would be important for the nurse to recall about this medication? A) Donepezil shortens the early stages of Alzheimer disease. B) Donepezil is a cholinesterase inhibitor and has been known to have positive effects when used in the early stage of Alzheimer disease. C) Donepezil is an anticholinergic and has been known to eradicate some of the symptoms associated with Alzheimer disease. D) Donepezil should be taken on an empty stomach.

B

The nurse is observing a student administer a Mini-Mental Status Examination. Which action by the student requires the nurse to intervene? a. Asking the patient to compare two different things. b. Asking the patient to describe a situation that requires good judgment. c. Beginning the assessment by asking about the current date and time. d. Asking the patient questions about simple math problems.

Beginning the assessment by asking about the current date and time.

gray matter

Brain imaging studies of individuals with schizophrenia consistently reveal a pattern of structural abnormalities that include decreased volumes of ______________ in the prefrontal cortex, temporal lobes, hippocampus, and thalamus; enlarged ventricles and sulci; and decreased blood flow to the frontal lobe, thalamus, and temporal lobes

) A client with schizophrenia is exhibiting attention deficit and difficulty remembering recent events. What is an appropriate expected outcome for this client? A) Client will interact well with others before discharge. B) Client will develop occupational skills by discharge. C) Client will exhibit an increased attention span in 1 week. D) Client will deny auditory hallucinations within 7 days.

C

) A nurse is caring for a client with Alzheimer disease (AD) who just recently lost the ability to live independently but can still perform activities of daily living (ADLs). Which stage of the disease is this client in? A) Stage 3 B) Stage 4 C) Stage 5 D) Stage 6

C

A client with Alzheimer disease is scheduled to attend occupational therapy three times a week. What is the purpose of the client attending this type of therapy? A) Improve language deficits B) Improve muscle tone C) Perform activities of daily living D) Improve access to community organizations

C

An older client with no history of cognitive impairment is showing signs of increased confusion. Which health problem should the nurse suspect is causing this client's confusion? A) Cataracts B) Hypertension C) Urinary tract infection D) Lower back strain

C

Which nursing intervention is most appropriate when caring for patients with dementia? A) Avoid direct eye contact. B) Lovingly call the patient "honey" or "sweetie." C) Give simple directions, focusing on one thing at a time. D) Treat the patient according to his or her age-related behavior.

C) Give simple directions, focusing on one thing at a time. Rationale: When dealing with patients with dementia, tasks should be simplified, giving directions using gestures or pictures and focusing on one thing at a time. It is best to treat these patients as adults, with respect and dignity, even when their behavior is childlike. The nurse should use gentle touch and direct eye contact. Calling the patient "honey" or "sweetie" can be condescending and does not demonstrate respect.

A 62-year-old woman is admitted to an assisted-living facility with symptoms of forgetfulness, irritability, difficulty following directions, and neglect of her personal hygiene. These would suggest which stage of AD? A. Late B. Early C. Moderate D. Moderate to severe

C. Moderate

A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to: A. begin after 7 days. B. not occur at all because the time period for their occurrence has passed. C. begin anytime within the next 1 to 2 days. D. begin within 2 to 7 days.

C. begin anytime within the next 1 to 2 days. **Rationale: Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days — even up to 7 days — after the last drink.

) A hospitalized elderly client suddenly does not recognize his daughter and complains that his wife has not visited him, even though she has been dead for 5 years. The client was clear of mind and thought prior to hospitalization. Which nursing diagnosis or diagnoses would be appropriate for this client? Select all that apply. A) Risk for Autonomic Dysreflexia B) Anxiety C) Acute Confusion D) Impaired Memory E) Ineffective Coping

CD

What causes delirium?

Can be caused by infections, metabolic imbalances, trauma, nutritional deficiencies, CNS disease, hypoxia, hypothermia, hyperthermia, circulatory problems, low blood glucose, toxin exposure, sleep deprivation, drugs/alcohol

Pressured/distractible speech

Can be identified when the patient is speaking rapidly and there is an extreme sense of urgency or even frenzy as well as tangentiality. It is nearly impossible to interrupt the person.

Table 23-9, go look?

Cerebral Effects of AD

Alzheimer's disease

Cerebrospinal fluid and blood markers are used to identify biomarkers for

What is the largest, uppermost region of the brain?

Cerebrum

Where in the brain does most cognitive task occur?

Cerebrum

Dyscalculia

Challenges with computation and other mathematical task

Dyslexia

Challenges with spelling, reading, and writing

Dysgraphia

Challenges with spelling, writing, and composition

Dyspraxia

Challenges with tasks that require manual dexterity and coordination

Vygotsky's theory:

Children learn through their culture and through social interactions with other people

What age groups are at the most risk for delirium?

Children; often mistaken as uncooperative Older adults; often mistaken with normal forgetfulness or dementia

The nurse is caring for a group of older adult patients with dementia. Which symptom should the nurse report to the healthcare provider? a. Inability to remember the names of everyday objects. b. Confusion in the evening after dark. c. Choking and coughing after eating a snack. d. Difficulty remembering instructions.

Choking and coughing after eating a snack.

Developmental disability

Chronic condition noticed during early childhood that involves physical and mental impairments

- Reduced concentration and memory lapses noticeable by others - Difficulty learning new information - Problems functioning in work or social settings - Frequently losing or misplacing important objects - Difficulties with planning and organization - Forgetting familiar words or the locations of various objects

Clinical manifestations of stage I include: ......

- Inability to carry out ADLs, such as preparing meals for oneself and choosing appropriate clothing - Loss of ability to live independently - Difficulty recalling one's address or phone number - Disorientation to time and place - Increased tendency to become lost - Changes in ability to control bladder/ bowels

Clinical manifestations of stage II include: ......

- Gradual inability to perform any ADLs, including bathing and toileting - Eventual urinary and fecal incontinence - Inability to identify family and caregivers - Extreme confusion and lack of awareness of one's surroundings

Clinical manifestations of stage III include: ......

second generation antipsychotic medications

Clozapine Olanzapine Risperidone Aripiprazole Lurasidone

Damage or abnormalities in neurotransmitter function can be related to or cause what?

Cognitive disorders

injury

Cognitive disturbances put patients at increased risk of _______________________ so rapid institution of safety measures is critical

donepezil, galantamine

Commonly prescribed acetylcholinesterase inhibitors include _____________ (Aricept), rivastigmine (Exelon), and _____________ (Razadyne).

dual diagnosis

Comorbid substance abuse is found in almost 50% of all individuals with schizophrenia, a condition identified as __________________

Adaptive behaviors involve what 3 categories?

Conceptual skills Social skills Practical skills

Sun-downing

Confusion that intensifies in evening or at bedtime

What are children born with downs syndrome more at risk for?

Congenital heart defects, hearing loss, GI blockages, Celiacs disease, thyroid disease, and skeletal abnormalities, dementia

When administering a mental status examination to a patient, the nurse suspects depression when the patient responds with a. "I don't know." b. "Is that the right answer?" c. "Wait, let me think about that." d. "Who are those people over there?"

Correct Answer: A Rationale: Answers such as "I don't know" are more typical of depression. The response "Who are those people over there?" is more typical of the distraction seen in a patient with delirium. The remaining two answers are more typical of a patient with dementia.

The nurse has identified the nursing diagnosis of disturbed thought processes related to effects of dementia for a patient with late-stage Alzheimer's disease (AD). An appropriate intervention for this problem is to a. maintain a consistent daily routine for the patient's care. b. encourage the patient to discuss events from the past. c. reorient the patient to the date and time every few hours. d. provide the patient with current newspapers and magazines.

Correct Answer: A Rationale: Providing a consistent routine will decrease anxiety and confusion for the patient. In late-stage AD, the patient will not remember events from the past. Reorientation to time and place will not be helpful to the patient with late-stage AD. The patient with late-stage AD will not be able to read.

The nurse has identified the nursing diagnosis of disturbed thought processes related to effects of dementia for a patient with late-stage Alzheimer's disease (AD). An appropriate intervention for this problem is to a. maintain a consistent daily routine for the patient's care. b. encourage the patient to discuss events from the past. c. reorient the patient to the date and time every few hours. d. provide the patient with current newspapers and magazines.

Correct Answer: A Rationale: Providing a consistent routine will decrease anxiety and confusion for the patient. In late-stage AD, the patient will not remember events from the past. Reorientation to time and place will not be helpful to the patient with late-stage AD. The patient with late-stage AD will not be able to read. Cognitive Level: Application Text Reference: p. 1571 Nursing Process: Planning NCLEX: Physiological Integrity

Risperidone (Risperdal) is prescribed for an outpatient with moderate Alzheimer's disease (AD). Which information obtained by the nurse at the next clinic appointment indicates that the medication is effective? a. The patient has less agitation. b. The patient is dressed appropriately. c. The patient is able to swallow a pill. d. The patient's speech is clearer.

Correct Answer: A Rationale: Risperidone is an antipsychotic used to treat the agitation, aggression, and behavioral problems associated with AD. The other improvements might occur with cholinesterase inhibitors. Cognitive Level: Application Text Reference: p. 1568 Nursing Process: Evaluation NCLEX: Physiological Integrity

ALZHEIMER'S DISEASE The spouse of a client with Alzheimer disease does not understand why the client developed the disorder because no one else in the family has the health problem. What would be the nurse's best response to the spouse? A) "Alzheimer disease develops because of smoking and alcohol intake." B) "Someone in your family must not have been correctly diagnosed with the disorder." C) "Alzheimer disease does not have the same course in every individual." D) "There are genetic and environmental factors in the development of Alzheimer disease."

D

The physician has prescribed aripiprazole (Abilify) for the client with schizophrenia. What would be a priority outcome for the client? A) The client will report a decrease in auditory hallucinations. B) The client will report symptoms of restlessness. C) The client will consume adequate fluids and a high-fiber diet. D) The client will be compliant with taking the medication as prescribed.

D

The home care nurse is visiting patients in the community. Which patient is exhibiting an early warning sign of Alzheimer's disease? A) A 65-year-old male does not recognize his family members and close friends. B) A 59-year-old female misplaces her purse and jokes about having memory loss. C) A 79-year-old male is incontinent and not able to perform hygiene independently. D) A 72-year-old female is unable to locate the address where she has lived for 10 years.

D) A 72-year-old female is unable to locate the address where she has lived for 10 years. Rationale: An early warning sign of Alzheimer's disease is disorientation to time and place such as geographic disorientation. Occasionally misplacing items and joking about memory loss are examples of normal forgetfulness. Impaired ability to recognize family and close friends is a clinical manifestation of middle or moderate dementia (or Alzheimer's disease). Incontinence and inability to perform self-care activities are clinical manifestations of severe or late dementia (or Alzheimer's disease).

) A student nurse is reviewing the pathophysiology and etiology of Alzheimer disease (AD). What is true regarding the pathophysiology and etiology of this disease? Select all that apply. A) Damage to the limbic system results in speech decline and slowed movements. B) Familial Alzheimer disease (FAD) is also called delayed-onset Alzheimer disease. C) Sporadic Alzheimer disease usually manifests before age 65. D) Sporadic Alzheimer disease is more common than familial Alzheimer disease. E) In Alzheimer disease, neuronal cells die in a characteristic order.

DE

6

Diagnostic criteria specify that the individual must have experienced significant impairment of functioning for _______ or more months in one or more areas, such as home, work, and self-care. Other mental disorders, such as bipolar disorder, and substance use also must be ruled out for a diagnosis of schizophrenia to be made

Anomia

Difficulty naming people and things

Dysphagia

Difficulty swallowing

Dyscalculia

Difficulty understanding numbers and learning math facts. Poor understanding of math symbols, difficulty with related tasks, such as telling time.

Dyslexia

Difficulty with reading and language-based skills impacting reading fluency, decoding, and comprehension.

What are the negative symptoms of schizophrenia?

Diminished affects and behaviors: - flat or blunted affect - thought blocking - avolition - poverty of speech - social withdrawal

Akinesia

Diminished movement as a result of difficulty initiating movement

Dysgraphia

Disability impacting fine motor skills and the ability to write clearly and legibly. May have difficulty focusing or thinking while performing fine motor tasks.

Learning disabilities

Disorders that impair an individual's ability to receive and process information, causing reduced functioning in verbal, linguistic, reasoning, and academic skills; neurologic conditions in which the brain cannot receive or process information normally.

Illusions

Distorted perceptions of actual sights, sounds, and other stimuli

lobes

Distortions in perceptual processing are often the result of abnormalities in the ________________ responsible for that aspect of sensory processing.

sundowning

Diurnal changes in cognitive function are typical, with patterns of diminished capacity in the evening (also known as ________________

respiratory

Donepezil (Aricept) is an acetylcholinesterase inhibitor used to treat confusion and cognitive decline associated with Alzheimer disease. It should be used cautiously in patients with a _______________ condition, such as COPD.

Nurse watching sleeping senior woman patient in hospital The nurse is caring for a patient recently diagnosed with Alzheimer disease. Which medication does the nurse anticipate will be prescribed for this patient to decrease the rate of cognitive decline? a. Donepezil (Aricept). b. Sertraline (Zoloft). c. Haloperidol (Haldol). d. Buspirone (BuSpar).

Donepezil (Aricept).

The nurse is admitting a patient with suspected chronic obstructive pulmonary disease (COPD) and a known history of Alzheimer disease. Which medication should the nurse question before administering? a. Donepezil (Aricept). b. Sertraline (Zoloft). c. Buspirone (BuSpar). d. Risperidone (Risperdal).

Donepezil (Aricept).

What disorders or diseases are included under Intellectual disabilities?

Down syndrome, Fragile X syndrome, Fetal alcohol syndrome, PKU

The nurse is preparing a program to prevent cognitive disorders in school-aged children. Which program should the nurse consider to be most effective in accomplishing this goal? a. Encouraging kids to wear helmets anytime they ride a bike or scooter or use roller blades. b. Promoting increased hydration in the spring and fall months at school c. Increasing access to screenings for learning disabilities. d. Removing all playground equipment to prevent falls or accidents.

Encouraging kids to wear helmets anytime they ride a bike or scooter or use roller blades.

fragile X syndrome

Epicanthic eye folds, large ears, and a high palate are associated with ______________________.

Adaptive Behavior

Everyday skills, including conceptual skills, social skills, and practical skills

complex phonic tics

Examples of _____________ include echolalia, the meaningless repetition of phrases spoken by another

complex motor tics

Examples of ______________ include pulling at clothing or touching people or objects; echopraxia, imitating the movements of others; copropraxia, performing obscene or forbidden gestures; and carphologia, lint-picking behavior that is often seen in dementia.

Cognitive issues may include: - memory deficits - attention deficits - language difficulties - loss of executive function

Examples of cognitive symptoms of schizophrenia: .............

Diminished affects and behaviors: - flat or blunted affect - thought blocking - avolition - poverty of speech - social withdrawal

Examples of negative symptoms of schizophrenia: .............

Additions to normal experiences: - delusions - hallucinations - abnormal movements - formal thought disorder

Examples of positive symptoms of schizophrenia: .............

Adverse efects of AChE inhibitors?

GI bleeding and bradycardia

Intellectual functioning

General intelligence or mental capacity

The emergency nurse is caring for a patient who is threatening suicide. Which action should be the nurse's priority intervention? a. Implementing suicide prevention precautions. b. Informing the healthcare provider about the patient's suicidality. c. Requesting a consult by the social worker. d. Administering the prescribed medication.

Implementing suicide prevention precautions.

auditory

In individuals with schizophrenia, _____________ hallucinations are generally most prevalent and often have threatening or accusatory content

recovery

In the __________________ phase, the symptoms of the disorder are present but under control. The emphasis for healthcare is on learning strategies to maintain health, such as adhering to treatment, reducing stress, and using effective coping strategies.

declarative, nondeclarative

Long-term memory is further broken down into _________________ and ________________ memories.

Amnesia

Loss of recent or remote memory

Negative symptoms

Loss or absence of a normal function seen in mentally healthy adults, such as the ability to care for one's self; commonly seen in schizophrenia.

Most common test to assess cog status?

MMSE Also for caregivers: two practical tools for assessing caregiver burden include the Zarit Burden Interview (ZBI) and the Caregiver Role Strain Index (CRI).

neurocognitive, neurodevelopmental, and psychotic disorders

MRI's and CT's are used to detect abnormalities that are suggestive of some

benztropine

Management of adverse effects such as anticholinergic symptoms and EPS often includes the use of anticholinergic medications such as __________________ (Cogentin)

viral

Many studies have focused on the impact of external events such as birth complications, in utero ____________ exposure, poor prenatal care, and marijuana use on gene expression in schizophrenia

Mild Alzheimer's

Memory lapses Misplacing items Difficulty concentrating and organizing Short-term memory loss noticeable to close relations

A couple brings in their older parent who has been increasingly forgetful and confused. Which test should the nurse expect the healthcare provider to order? a. Mental status exam. b. Magnetic resonance imaging (MRI). c. Computerized tomography (CT) scan. d. VeriPsych blood test.

Mental status exam.

glutamate

NMDA receptor antagonists are believed to block the effects of ________________, a neurotransmitter that is present with neuronal damage and appears to be involved in cognitive decline.

Age, sex, family Hx, genetic, hypertension, diabetes, obesity, traumatic brain injury, depression, disordered sleep, sedentary lifestyle

Name the risk factors for developing AD

vascular dementia

Neurocognitive or __________________ results from multiple small strokes or infarcts to the brain and is often manifested in a more abrupt change in cognitive function

The nurse is caring for a patient whose dose of a conventional antipsychotic has been increased. The nurse should monitor the patient for which critical condition? a. Anticholinergic reaction. b. Constipation c. Neuroleptic malignant syndrome. d. Tardive dyskinesia.

Neuroleptic malignant syndrome.

What are the diagnostic test for delirium?

Neurological, drug and alcohol screening, laboratory testing of blood and urine, test for presence of infection, screening for depression- no one medication is used

Neurons move between what?

Neurotransmitters

Is dementia a normal part of aging?

No

reality orientation

Nonpharmacologic interventions that have been demonstrated to be effective in treating AD include exercise, ______________ therapy, validation therapy, and reminiscence therapy.

praxis

Normally the ability to plan and coordinate motor functions progresses through the expected stages of development, with adults exercising the ability to control movement in a deliberate, smooth, and coordinated fashion, called __________________

A nurse is providing information about tacrine hydrochloride for the spouse of a client diagnosed with Alzheimer disease​ (AD). Which items will the nurse include in the teaching​ session? Select all that apply.

Notify the healthcare provider if manifestations worsen. The medication must be administered 1 hour before meals. Observe the client for improvement in manifestations. Do not stop the medication without consulting the healthcare provider.

weight loss, word salad

Nurses and others may notice the following in patients with schizophrenia: deteriorating personal appearance and neglect of personal hygiene; ________________; unusual gestures; pacing; or incoherence characterized by making up words or speaking in sentences that make no sense (________________)

- Using "I" language to express positive feelings (e.g., "I am happy when you decide to sit down for dinner with us") - Engaging in active listening (e.g., asking questions and nodding in agreement when another person speaks) - Making positive, specific requests for change that are linked to emotions (e.g., "I would really like it if you could play a game with us tonight") - Expressing negative feelings with "I" rather than "you" language (e.g., saying "I'm worried that you may not be getting enough sleep" instead of "You never get enough sleep at night")

Nurses can teach family members strategies to improve communication. For example, if a family is concerned about a patient's behavior, the nurse can guide them through the use of some of the following techniques: .................

caregiver

Nurses must consider both patient and _________ needs when working with individuals with Alzheimer disease

The nurse is caring for an older adult patient who is suddenly confused and experiencing cognitive changes. Which nursing intervention is the priority? a. Obtaining a full set of vital signs, including oxygen saturation. b. Notifying the healthcare provider and nursing supervisor. c. Obtaining an order for soft restraints and initiate one-to-one monitoring. d. Starting a large-bore intravenous line and administering a bolus of normal saline.

Obtaining a full set of vital signs, including oxygen saturation.

How does Fetal alcohol syndrome (FAS) occur?

Occurs by maternal alcohol intake during pregnancy

How does Fragile X syndrome occur?

Occurs from a single recessive abnormality on the X chromosome; FMR-1 gene

What is sundowning?

Occurs in the late afternoon and at night in older individuals. Characterized by drowsiness, confusion, ataxia, and falling.

Tangentiality

Occurs when a person digresses from the topic at hand and goes off on a tangent, starting an entirely new train of thought.

How does Down syndrome occur?

Occurs when an individual's cells contain a third full or partial copy of the 21st chromosome; Trisomy 21

Circumstantiality

Occurs when the person goes into excessive detail about an event and has difficulty getting to the point of the conversation

concrete

Older children (age 7-11) acquire cognitive operations, or mental activities that are an important part of rational thought. Logical reasoning is possible but limited to ___________________ (observable) problems.

Your patient reports a hallucination where he is aware of strange smells that no one else is aware of; what type of hallucination is this?

Olfactory

pruning

One aspect of normal development is called ______________, a process by which unused connections are remodeled or eliminated in order to strengthen cognitive efficiency.

sporadic

One of the two basic types of Alzheimer disease, it shows no clear pattern of inheritance, although genetic factors may contribute to the disorder. It typically does not develop until after the age of 65. Also called late-onset Alzheimer disease.

time

Orientation to __________ is the ability to correctly identify the time of day, the date, and the season.

Confusion Assessment Method (CAM) assess what?

Overall cognitive impairment, traits associated with reversible confusion - does not measure severity of delirium

Biomarkers for Alz?

PET and analysis of CSF may help find biomarkers (they may be present even before manifestations of the disease)

independence

Parents of adolescents with cognitive disorders may need assistance navigating issues that normally accompany this period of development, including the achievement of increased ________________, hormonal shifts, and sexual development, as well as a greater need for interaction with peers.

confabulation

Patients experiencing memory loss may unconsciously attempt to compensate for memory gaps by filling them in with fabricated events through a process known as ___________________

moderate

Patients typically spend more time in the _______________ stage of Alzheimer disease than in any other stage.

The nurse is discussing intellectual disability with colleagues. Which statement by a colleague indicates understanding of the criterion of intellectual disability? a. Patients who score below 70-75 on an IQ test are considered intellectually disabled. b. Patients with ataxia are intellectually disabled. c. Patients who exhibit echolalia are intellectually disabled. d. Patients with delirium that occurs after the age of 50 are intellectually disabled.

Patients who score below 70-75 on an IQ test are considered intellectually disabled.

70-75

Patients who score below _________ on an IQ test are considered intellectually disabled

mild

Patients with __________ dementia may not present any signs or symptoms notable on appearance. At this stage, family members' reports of noticeable changes in memory or cognitive abilities in certain areas may be the first clue that there is a problem.

concrete thinking

Patients with schizophrenia frequently demonstrate ______________________, focusing on literal aspects of facts and details. They also typically exhibit limited insight due to deficits in theory of mind

Loose associations

Pattern of speech in which a person's ideas slip off track onto another unrelated or obliquely related topic; also known as derailment.

In the Information-processing theory, what is seen as the most important determinant of cognitive ability?

Physical changes associated with brain maturation

hearing

Physical changes associated with fetal alcohol syndrome include small eyes, flattened nasal bridge, and ______________ impairment

What is the best known theory of cognitive development?

Piaget's theory

Which theory in cognitive development is the most important in pediatric nursing?

Piaget's theory

Hippocampus controls:

Plays a role in memory formation

What does an IQ score of 70-75 or below indicate?

Possible limited intellectual functioning

What can Intellectual disabilities result from?

Prenatal errors, external factors during pregnancy, Pre- or postnatal changes in an individual's biological environment

The nurse watches a 3-year-old child in the hospital playroom take a toy out of another child's hands. Based on the child's behavior, the nurse should understand the child is in which of Piaget's Stages of Cognitive Development? a. Preoperational. b. Sensorimotor. c. Concrete operational. d. Formal operational.

Preoperational.

How would Legal Issues relate to cognition?

Preparing an advanced directive or DNR order

safety

Priority interventions address immediate ______________

Dementia

Progressive loss of cognitive function

violence, trauma

Psychosocial factors such as early life adversity (including exposure to chronic and acute stressors such as poverty, ______________, and ______________) have also been implicated in schizophrenia. Biochemical mechanisms involved in the stress response may have an epigenetic influence or exacerbate preexisting neuronal pathology

Toxoplasma gondii

Recent research has implicated _____________________ infection (toxoplasmosis) during pregnancy and early childhood in the development of the disease. It is spread via contact with cat feces, and it is recommended that pregnant women and children do not handle cat litter and that litter boxes be changed daily

Stage 1 Alz?

Reduced concentration and memory lapses, hard to learn new info, issues functioning and planning, losing objects often, forgetting familiar words or locations of various objects

Illogicality

Refers to speech in which there is an absence of reason and rationality

suicide

Regardless of the treatment phase or the presence of additional risk factors, all individuals with schizophrenia should be closely monitored for _______________.

Nursing goals for cognition may include that the client will:

Remain free from injury Orient to time, place, date, person Return to baseline cognitive status Communicate in clear, logical manner Obtain adequate sleep, rest Exhibit reduced anxiety, agitation, restlessness

The nurse is caring for a patient with a cognitive dysfunction. The nurse has concerns that the patient's caregiver and power-of-attorney does not have the patient's best interests at heart. How should the nurse intervene? a. Refusing to honor the caregiver's wishes. b. Informing the police of the suspicions c. Contacting another family member for consent to treat the patient d. Requesting a consult with a social worker.

Requesting a consult with a social worker.

Rigidity

Resistance to movement

Rigidity

Resistance to movement. Cogwheel rigidity refers to ratchet-like resistance when attempting to move the joints.

The nurse is preparing to initiate treatment with an acetylcholinesterase inhibiter, donepezil (Aricept), for a patient with Alzheimer disease. Which condition should the nurse check prior to initiating the treatment? a. Respiratory disease. b. Cardiovascular disease. c. Neuromuscular disease. d. Endocrine disease.

Respiratory disease.

Akathisia

Restlessness

Delusions

Rigid, false beliefs

Nursing diagnosis for cognition may include:

Risk for Injury Disturbed Sleep Pattern Self-Care Deficit Acute Confusion Impaired Memory Impaired Verbal Communication Impaired Social Interaction Risk for Compromised Human Dignity

early, moderate

Rivastigmine and galantamine are approved for ___________ to _______________ stages of AD, while donepezil is approved for all stages.

donepezil

Rivastigmine and galantamine are approved for early to moderate stages of AD, while ______________ is approved for all stages.

supplements

Safety and practical considerations should guide the use of nutritional interventions. The use of __________________ should be discussed with providers so that an individual assessment of the risks versus potential benefits can be made.

What are some risk factors for schizophrenia?

Schizophrenia is a multifactorial disease influenced by a confluence of genetic, epigenetic, environmental, and developmental factors. - Genetic factors - Epigenetic factors - Psychosocial factors - Developmental factors

suicide

Schizophrenia is also associated with a 10- to 25-year reduction in life expectancy as a result of comorbid medical conditions and high rates of ______________

Social skills training

Schizophrenia is characterized by deficits in social cognition that have a profound effect on the individual's ability to accurately read social cues and respond appropriately. __________________ employs a systematic approach to teaching individuals with schizophrenia how to interact with others.

What prevention measures can be done for intellectual disability?

Screen for intellectual disability and related conditions Genetic counseling Early neurological screenings for premature and low-birth-weight infants Monitor for signs of abuse

emotional support

Secondary interventions include teaching patients and families about the illness and prescribed treatments, providing _______________________, and preparing for discharge to settings where they can receive the support necessary to achieve optimal functioning and prevent future hospitalization.

Amyloid Plaques

Seen in Alzheimers, formed when groups of nerve cells degenerate and clump around the amyloid core in the spaces between the neurons and the brain.

facts

Semantic memory consists of a collection of ___________ and verbal information

A client scores 1 on the SAD PERSONS scale. What should the nurse's next step be?

Send the client home with follow-up

What are the four stages of Piaget's theory?

Sensorimotor Preoperational Concrete operational Formal operational

short term

Sensory information that receives attention from an individual passes into _______________ memory.

several seconds

Short-term memory only lasts ________________, but it can be rehearsed or repeated and transferred into long-term memory

Intellectual disabilities

Significant limitations in intellectual functioning and adaptive behavior prior to the age of 18. Previously called mental retardation.

What are the physical traits associated with Fetal alcohol syndrome (FAS)?

Small eyes, abnormal joints and bones, CNS abnormalities, flattened nasal bridge, lack of coordination, small nose

The nurse is caring for a pregnant woman. The patient admits to drinking at least five or six cans of beer each day. The nurse should inform the patient that her child is at risk for which physical characteristic at birth? a. Large ears. b. High palate. c. Small eyes. d. Epicanthic eye folds.

Small eyes.

What are the physical traits associated with Down syndrome?

Small head, flat nose, epicanthic eye folds, decreased muscle tone, hearing impairment, protruding tongue, short neck, congenital cataracts

word salad/neologisms

Speaking in meaningless phrases with words that are seemingly randomly chosen, often made up, and not connected.

Frontal lobe controls:

Speech, learning, and intellect

simple tics

Sudden, brief, meaningless movements involving one muscle group are classified as _______________. Examples include eye blinking and head jerking (motor tics) and throat clearing and humming (phonic tics)

stabilization

The __________________ phase involves the immediate period of recovery, in which symptoms are under control but the individual is struggling to overcome exhaustion and cope with the impact of the illness

Americans with Disabilities

The ____________________ Act of 1990 ensures that individuals with disabilities have equal access to government services, employment, and public accommodations.

Praxis

The ability to plan and coordinate motor functions through stages of development in a deliberate, smooth, and coordinated manner

Social Cognition

The ability to process and apply social information accurately and effectively

Neurons

The basic or specialized cell of the nervous system that carries electrical impulses throughout the body.

schemes

The best-known theory of cognitive development comes from the work of Swiss psychologist Jean Piaget (1896-1980). Piaget claimed that cognitive development is an orderly, sequential process in which children form adaptive cognitive structures—called __________________—in response to environmental stimuli. According to Piaget, as children learn more about the world by physically interacting with it, they actively revise their schemes to better fit with the reality they observe.

- premorbid - prodromal - acute - residual

The classic course of schizophrenia consists of 4 phases: ..........

Cognition

The complex set of mental activities through which individuals acquire, process, store, retrieve, and apply information

Cognition

The complex set of mental activities through which individuals acquire, process, store, retrieve, and apply information.

echolalia

The compulsive parroting of a word or phrase just spoken by another; meaningless repetition of phrases spoken by another

b ("Patients diagnosed with AD younger in life can live up to two decades.")

The family of a 40-year-old patient with a diagnosis of stage 1 Alzheimer disease (AD) asks the nurse how long the disease usually lasts. How should the nurse respond? a) "Your family member may not have many years left because they are in the first stage." b) "Patients diagnosed with AD younger in life can live up to two decades." c) "Patients diagnosed with AD younger in life can live up to two decades." d) "Those with early-onset AD tend to progress through the disease stages faster."

Long-term memory

The final process or destination for information to be stored indefinitely

antipsychotic

The first line of intervention for schizophrenia is pharmacologic treatment with ________________ medications.

Metacognition

The human ability to think about thinking

Metacognition

The human ability to think about thinking.

Avolition

The inability to persist in goal-directed activities

Agnosia

The inability to recognize one or more objects that previously were familiar

agnosia

The inability to recognize one or more objects that previously were familiar.

memory loss

The initial symptoms of AD emerge gradually and may be almost unnoticeable. The first manifestation is usually subtle ____________ that becomes increasingly apparent as time passes. Other early signs include difficulty finding words and performing familiar tasks; impaired judgment and abstract thinking; disorientation to time and place; and frequently misplacing things.

attention, memory

The key components that make up human cognition include perception, _______________, and _________________.

reference

The most common delusions seen in patients with schizophrenia are those of ________________, which incorporate the belief that certain events occur for the benefit of the individual.

Alzheimer disease

The most common kind of dementia; It involves progressive dementia, memory loss, and the inability to care for one's self.

schizophrenia

The most common psychotic disorder, ___________________ is a combination of disordered thinking, perceptual disturbances, behavioral abnormalities, affective disruptions, and impaired social competency.

dopamine, norepinephrine

The neurotransmitters _________________ and __________________ both play a major role in regulating attention.

attention

The neurotransmitters dopamine and norepinephrine both play a major role in regulating ________________.

a (High fever)

The nurse administers a conventional antipsychotic medication to a patient who is experiencing active delusions and hallucinations, and is becoming disruptive. Which manifestation should the nurse report to the healthcare provider immediately? a) High fever b) Constipation c) Dry mouth d) Orthostatic hypotension

c (Guaiac positive stool)

The nurse in a long-term care facility is providing care for a patient who is receiving an acetylcholinesterase inhibitor for Alzheimer disease (AD). Which adverse reaction to the medication should the nurse report to the healthcare provider? a) Tachycardia b) Hypertension c) Guaiac positive stool d) Decreased appetite

C.Guaiac positive stool Acetylcholinesterase inhibitors are associated with gastrointestinal bleeding. Blood in the stool would require notification to the healthcare provider.

The nurse in a long-term care facility is providing care for a patient who is receiving an acetylcholinesterase inhibitor for Alzheimer disease (AD). Which adverse reaction to the medication should the nurse report to the healthcare provider? A.Tachycardia B.Decreased appetite C.Guaiac positive stool D.Hypertension

d (Donepezil)

The nurse is admitting a patient with suspected chronic obstructive pulmonary disease (COPD) and a known history of Alzheimer disease. Which medication should the nurse question before administering? a) Risperidone (Risperdal) b) Buspirone (BuSpar) c) Sertraline (Zoloft) d) Donepezil (Aricept)

A.Donepezil. It should be used cautiously in patients with a respiratory condition, such as COPD

The nurse is admitting a patient with suspected chronic obstructive pulmonary disease (COPD) and a known history of Alzheimer disease. Which medication should the nurse question before administering? A.Donepezil (Aricept) B.Sertraline (Zoloft) C.Buspirone (BuSpar) D.Risperidone (Risperdal)

Donepezil; an acetylcholinesterase inhibitor is used to slow the cognitive decline of Alzheimer disease

The nurse is caring for a patient recently diagnosed with Alzheimer disease. Which medication does the nurse anticipate will be prescribed for this patient to decrease the rate of cognitive decline?

b (Neuroleptic malignant syndrome)

The nurse is caring for a patient whose dose of a conventional antipsychotic has been increased. The nurse should monitor the patient for which critical condition? a) Tardive dyskinesia b) Neuroleptic malignant syndrome c) Anticholinergic reaction d) Constipation

d (Violence, Other-Directed, Risk for)

The nurse is caring for a patient with a new diagnosis of schizophrenia who is not yet stabilized on medication. Which is a priority nursing diagnosis? a) Communication: Verbal, Impaired b) Coping, Ineffective c) Social Isolation d) Violence, Other-Directed, Risk for

a (Small eyes)

The nurse is caring for a pregnant woman. The patient admits to drinking at least five or six cans of beer each day. The nurse should inform the patient that her child is at risk for which physical characteristic at birth? a) Small eyes b) Large ears c) Epicanthic eye folds d) High palate

A. Rapport building

The nurse is interviewing a client who appears highly anxious at the start of an interview. Which approach is most appropriate for beginning the interview with the client? A. Rapport building B. Comfortable C. Directive D. Closed

d (Include family input, if possible.)

The nurse is obtaining a health history for a patient with schizophrenia. The patient repeats "bad blank" over and over in response to all of the questions. Which is an appropriate course of action for the nurse to take, given the patient's impaired communication status? a) Defer the health history interview. b) Only ask the patient "yes" or "no" questions. c) Instruct the patient that this is not an answer. d) Include family input, if possible.

a (Personality changes)

The nurse is preparing a community presentation for people who are caring for older family members. Which symptom should the nurse include as a sign of a potential cognitive disorder? a) Personality changes b) Decreased ability to perform some visual-spatial tasks c) Occasional issues with word retrieval d) Mild memory loss

c (Encouraging kids to wear helmets anytime they ride a bike or scooter or use roller blades)

The nurse is preparing a program to prevent cognitive disorders in school-aged children. Which program should the nurse consider to be most effective in accomplishing this goal? a) Increasing access to screenings for learning disabilities b) Removing all playground equipment to prevent falls or accidents c) Encouraging kids to wear helmets anytime they ride a bike or scooter or use roller blades d) Promoting increased hydration in the spring and fall months at school

b (Intellectual disability)

The nurse is preparing a seminar on developmental disabilities. Which developmental disability should the nurse include as the most prevalent? a) Psychosis b) Intellectual disability c) Dementia d) Learning disability

b (Mini-Mental State Examination MMSE)

The nurse is preparing to assess a patient for cognitive impairments. Which tool should the nurse plan to use? a) Rorschach Inkblot Test b) Mini-Mental State Examination (MMSE) c) Minnesota Multiphasic Personality Inventory (MMPI) d) Wechsler Adult Intelligence Scale (WAIS)

b (Respiratory disease)

The nurse is preparing to initiate treatment with an acetylcholinesterase inhibiter, donepezil (Aricept), for a patient with Alzheimer disease. Which condition should the nurse check prior to initiating the treatment? a) Cardiovascular disease b) Respiratory disease c) Neuromuscular disease d) Endocrine disease

Respiratory disease

The nurse is preparing to initiate treatment with an acetylcholinesterase inhibiter, donepezil (Aricept), for a patient with Alzheimer disease. Which condition should the nurse check prior to initiating the treatment?

A nurse educator is preparing a presentation for a group of students regarding Alzheimer disease​ (AD). Which statement regarding the early pathophysiological changes that occur with this disease process indicates appropriate understanding by the students who attended the​ presentation?

There are deposits of insoluble material in the memory and cognition areas of the brain early in the disease.

familial, sporadic

There are two types of Alzheimer Disease: ____________ and _____________.

supplements

There is NO convincing evidence to date that dietary ______________ such as ginkgo, omega-3, vitamins B and E, ginseng, grape seed extract, or curcumin are beneficial in preventing or mitigating dementia or Alzheimer disease.

progression

There is currently no cure for AD. Two classes of medications are used to slow the _______________ of the disease

Using dietary supplements to tx Alz?

There is no convincing evidence to date that dietary supplements such as ginkgo, omega-3, vitamins B and E, ginseng, grape seed extract, or curcumin are beneficial in preventing or mitigating dementia or Alzheimer disease

differential diagnosis

There is no definitive way to diagnose AD other than performing a brain autopsy. Instead, practitioners rely on __________________, ruling out potential causes of a patient's symptoms until AD remains the most likely explanation

What happens with neurons in Alz?

They die, damaging cerebral functions and causing loss of remote memory etc

auditory hallucinations

Transcranial magnetic stimulation is used to help decrease ____________________.

glucose

Treatment with antipsychotic medications contributes to the overall risk of both cardiovascular disease and diabetes, as common effects include sedation, increased food intake, hyperlipidemia, and alterations in ________________ regulation

Essential tremors

Tremors that are not associated with another condition and may be genetic in origin.

Physiologic tremors

Tremors that occur normally as a result of physiologic exhaustion or emotional stress.

A patient presents in the community clinic with complaints about dizziness when standing. During the history and physical exam, the nurse notes that the patient is taking a conventional antipsychotic drug. Which advice should the nurse give the patient? a. Stop taking the medication immediately and go to the nearest emergency department. b. Avoid high-fiber or fatty foods. c. Try increasing your fluids and changing position slowly. d. Call your healthcare provider in the morning to report these symptoms.

Try increasing your fluids and changing position slowly.

recovery, rehabilitation

Two critical components of health promotion for schizophrenia are an emphasis on ____________ and ______________________

- Akathisia - Akinesia - Bradykinesia - Dystonia - Rigidity

Types of Dyskinesia include: ....

auditory, visual

Types of hallucinations include _________________, in which the individual hears voices or sounds that are not there; _______________, in which the individual sees things that are not there or sees distortions of things that are there; or tactile, in which the individual feels things that are not present.

visual, tactile

Types of hallucinations include auditory, in which the individual hears voices or sounds that are not there; ________________, in which the individual sees things that are not there or sees distortions of things that are there; or ______________, in which the individual feels things that are not present.

chlorpromazine, haloperidol

Typical or conventional antipsychotics consist of phenothiazine type (such as __________________) and nonphenothiazine (________________). This is the "first generation" of drugs introduced to treat schizophrenia.

dry mouth, retention

Unfortunately, there are numerous adverse effects associated with typical antipsychotics that range from uncomfortable to disabling and life threatening. Anticholinergic effects occur, such as _______________, sedation, constipation, postural hypotension, and urinary _______________.

fetal alcohol syndrome

Unlike Down syndrome and fragile X syndrome, ___________________ is a completely preventable condition caused by maternal alcohol intake during pregnancy.

moderate, severe

Unlike acetylcholinesterase inhibitors, NMDA receptor antagonists generally are not prescribed until an individual is in the _______________ to ___________ stages of AD.

Usual ages Alz can manifest?

Usually after age 65, but can be early 30's

schizophrenia

VeriPsych looks for biomarkers of ______

Information-processing theory:

Views the mind as a continuously evolving computational system that takes in information, operates on it and converts it to answers

The nurse is caring for a patient with a new diagnosis of schizophrenia who is not yet stabilized on medication. Which is a priority nursing diagnosis? a. Coping, Ineffective. b. Communication: Verbal, Impaired. c. Violence, Other-Directed, Risk for. d. Social Isolation.

Violence, Other-Directed, Risk for.

What theory in best to use when interacting with clients from different socioeconomic and ethnic backgrounds?

Vygotsky's theory

premorbid

___________ phase: Although 75% of patients with schizophrenia are diagnosed during adolescence or early adulthood, a number of alterations may be evident during childhood and the period immediately preceding the onset of the illness. Manifestations occurring in childhood include a number of nonspecific emotional, cognitive, and motor delays that have been identified in individuals who went on to develop schizophrenia

Alogia

___________ refers to a lack of (sometimes called impoverished) speech.

Tremors

____________ are unintentional rhythmic movements manifested in shaking of the affected part of the body.

Ataxia

____________ is a term used to describe problems with balance and coordination associated with neurologic dysfunction. Lack of muscle coordination.

Anomia

____________ is a type of aphasia where the individual is not able to recall the names of everyday objects and is often related to the progressive degeneration and loss of semantic memory that occurs with dementia.

Aphasia

____________ is the inability to use or understand language.

conceptual

____________ skills: use of language, reading, or telling time

Apraxia

_____________ refers to alterations in speech as a result of impaired motor function. The inability to perform purposeful movements and use objects correctly.

Nihilistic

______________ delusions encompass beliefs that the individual is nonexistent or dead.

Alzheimer disease

______________ is the most common form of dementia, accounting for about 80% of all cases and affecting more than 5 million adults in the United States

Microglia

______________ normally serve as a first line of defense against pathogenic invasion in the central nervous system. They are also involved in other essential brain functions, including the pruning and maintenance of synapses and the consumption of fragments of damaged cells.

social

______________ skills: ability to follow rules and interact appropriately with others

positive

______________ symptoms of psychosis include: hallucinations, delusions, thought disorders, disorganized behavior, and movement disorders

Younger

_______________ age and more recent diagnosis increase the risk of suicide in patients with schizophrenia.

Complex tics

_______________ involve a cluster of movements that appear coordinated and more purposeful and thus may be more difficult to identify.

Psychosis

_______________ is a general term used to describe an abnormal mental state that alters an individual's thought processes and content in a manner that impacts the individual's perception of reality. Indicators of altered thought processes and content are most often observed through the patient's speech and behaviors.

Intelligence

_______________ is a general term used to describe the mental capacity of the individual in relation to learning, reasoning, and problem solving. It is generally measured through the administration of one or more psychometric tests.

Working

_______________ memory is defined as the capacity to manipulate information stored in short-term memory. Examples include following a sequence of directions and performing mental mathematical calculations

prodromal

_______________ phase: a symptomatic period that signals a definite shift from premorbid functioning and continues until psychotic symptoms emerge. Manifestations include sleep disturbance, poor concentration, social withdrawal, perceptual abnormalities, and other attenuated or weakened symptoms of psychosis

Dyskinesia

_______________ represents a general category of difficulty with or distortions of movement. It is may be associated with acquired disorders such as Parkinson disease or as side effect of some medications.

practical

_______________ skills: ability to engage in work and perform activities of daily living [ADLs]

Positive

_______________ symptoms are characterized by the psychotic features of the disorder that generally do not occur in healthy people and are outside of the range of normal experiences. Hallucinations, delusions, abnormal movements, and problems with speech or disordered thinking are all examples

negative

_______________ symptoms of psychosis include: anhedonia, impaired memory, flat affect, avolition, poverty of speech, and poor personal hygiene

Hallucinations

________________ are sensory experiences that do not represent reality, such as hearing, seeing, feeling, or smelling things that are not actually present.

Microglia

________________ are the resident immune cells of the brain.

Avolition

________________ is decreased motivation, or the inability to initiate goal-directed activity, and may be in part related to deficits in executive dysfunction

Indicated

________________ prevention is aimed at individuals who have minimal but detectable manifestations of cognitive disorder. An example would be initiating treatment for an individual who demonstrates prodromal symptoms of schizophrenia or has biomarkers for a dementia

Primary

________________ prevention of schizophrenia includes comprehensive healthcare during pregnancy and childhood, and measures to reduce or eliminate adversity and environmental insults (e.g., poverty, abuse, trauma, injury, or exposure to environmental toxins).

Memory

________________ refers to the process by which individuals retain, store, and retrieve information gained from previous experiences. The ability to remember meaningful information provides the foundation for learning and adaptation from birth to death.

Cognitive

________________ symptoms of schizophrenia include deficits in memory, attention, language, visual-spatial awareness, social and emotional perception, and intellectual and executive function.

Neurons

_________________ are the specialized cells of nervous system that have the capacity to carry messages through electrical and chemical signals.

Dyspraxia

_________________ is a general term used to describe difficulty with the acquisition of motor learning and coordination through the process of growth and development.

Disorientation

_________________ is an element of confusion in which the individual is unable to correctly identify one or more of the following: person, place, time, and situation.

Glutamate

_________________ is required for the degradation of dopamine and several other neurotransmitters that influence prefrontal information processing. These receptors also play an important role in migration of neurons during brain development.

Procedural

_________________ memories are atype of implicit memories that enable individuals to perform learned skills and tasks. Examples include such activities as walking, riding a bike, and driving a car

Semantic

_________________ memory consists of a collection of facts and verbal information

Long term

_________________ memory is used to describe the final sequence or destination of information that can be stored indefinitely.

Sensory

_________________ memory refers to the earliest stage of memory, in which visual input and auditory information are retained for less than a few seconds.

Dystonia

_________________ often results in sudden and severe muscle spasms in the face, neck, and torso that can be frightening for patients and have the potential to lead to airway obstruction if not identified and reversed.

residual

_________________ phase: can be further broken down into the stabilization phase (6-18 months after the resolution of the acute phase) and the maintenance phase. The patient may continue to demonstrate odd patterns of thinking and behavior. The level of dysfunction often increases with each subsequent episode of relapse. Patients often struggle with side effects of their medication and may lack the insight and or motivation required to adhere to treatment.

Secondary

_________________ prevention of schizophrenia focuses on high-risk groups such as individuals who have a family history of the disorder or who demonstrate behaviors associated with progression to psychosis. Interventions include augmenting protective factors for the disease (e.g., teaching social skills or improving family interactions) and treating comorbid psychiatric conditions

Rehabilitation

_________________ refers to a level wellness in which symptoms of the condition are under control to the extent that the affected individual can engage in goal-directed activities (e.g., maintaining a job, carrying out self-care)

Delusions

__________________ are rigid, false beliefs—for example, believing that members of a healthcare team are actually government spies assigned to gather information that will be used to harm the patient or others.

Personality

__________________ changes, such as restlessness or increased temper, can indicate the presence of a cognitive disorder. Mild issues with memory loss, occasional issues with word retrieval, and decreased ability to perform some visual-spatial tasks are normal in the aging process.

Early Onset Schizophrenia

__________________ generally refers to the emergence of symptoms of schizophrenia before 17 to 18 years of age. EOS accounts for approximately 4-5% of all individuals with schizophrenia. Onset prior to puberty is extremely rare, occurring in less than 0.04% of the population

Amnesia

__________________ is a general term that is used to refer to the loss of recent or remote memory.

Dementia

__________________ is a general term used to describe the loss of one or more cortical functions or cognitive attributes as a result of degeneration of the neurologic systems of the brain; The progressive, irreversible loss of cognitive function.

Delirium

__________________ is usually an acute change in mental state that is characterized by confusion; inability to focus, shift, or sustain attention; disorientation; sleep-wake cycle disturbances; disorganized thinking; perceptual abnormalities; mood changes; and both psychomotor retardation and agitation. It typically results from a medical condition, trauma, or chemical/substance exposure or withdrawal and is a common complication observed during stays in acute-care settings.

Nondeclarative

__________________ memories are characterized by information that is outside of our conscious awareness.

acute

__________________ phase: marked by the onset of florid psychotic/positive symptoms. It generally follows the prodromal period but in some instances appears suddenly. This period causes significant distress for the individual and is often the first time that help is sought. If the behavior represents a danger to the individual or others, short-term hospitalization may be required

Tertiary

__________________ prevention focuses on reducing the impact of the disease in individuals diagnosed with schizophrenia.

Universal

__________________ prevention of cognitive disorders targets the general population and includes interventions such as public health campaigns regarding the use of safety devices such as helmets and seatbelts.

Attention

__________________ refers to the brain's ability to remain alert and aware while selectively prioritizing concentration on a stimulus (such as something that is seen or heard) or mental event (thinking and problem solving)

cognitive

__________________ symptoms of schizophrenia include: concrete thinking, impaired memory (problems with words finding and facial recognition), inattention & difficulty filtering out information, and poor planning, organization, & problem-solving skills

Religious

___________________ delusions involve the belief that the individual is a religious figure.

Orientation

___________________ is a component of normal perception that includes four basic elements: person, place, time, and situation.

Tardive dyskinesia (TD)

___________________ is a potentially irreversible condition characterized by unusual facial movements, lip smacking, and wormlike movements of the tongue.

Reality orientation

___________________ is a structured approach to orienting individuals to person, time, place, and situations at regular intervals and as needed through verbal communication and the use of visual cues (pictures, clocks, calendars, orientation boards).

Executive function

___________________ is an umbrella term that is used to describe the mental skills involved in planning and executing complex tasks. Examples include following multistep directions and prioritizing to manage time on a project.

Disorganized thinking

___________________ is generally manifested in disruption of the form and organization of speech and is also referred to as a formal thought disorder (FTD).

Declarative

___________________ memories are those that are explicit and can be consciously accessed; they are distinguished according to semantic and episodic types.

Selective

___________________ prevention targets subgroups of the population whose risk of developing a cognitive disorder is higher than that of the general population based on an analysis of biological, psychologic, or socioeconomic factors. Examples include early intervention programs for children from disadvantaged backgrounds and counseling following exposure to trauma. I

Motor coordination

___________________ refers to the planning, organizing, and execution of complex motor tasks.

Affective

___________________ symptoms such as depression significantly increase the risk of suicide in patients with schizophrenia, especially in combination with other variables such as younger or older age, high IQ, higher levels of premorbid function, proximity to onset, male sex, and recent discharge from the hospital

Persecutory

____________________ delusions involve the belief that others wish to harm the individual.

Catatonia

____________________ is a state of unresponsiveness in an individual who is conscious.

Neurotransmitters

_____________________ are specialized chemicals that carry nerve impulses across the synaptic gaps between neurons.

Grandiose

_____________________ delusions involve beliefs that the individual has special power or significance.

Acetylcholinesterase (AChE) inhibitors

_____________________ have been standard treatment for over a decade. They work by reducing acetylcholine breakdown. Because individuals with Alzheimer disease are gradually losing neurons that communicate by using this substance, the presence of extra acetylcholine increases communication among the remaining neurons. This appears to temporarily stabilize symptoms related to language, memory, and reasoning for an average of 6 to 12 months.

Validation therapy

_____________________ involves searching for emotion or intended meaning in verbal expressions and behaviors. The basic premise is that seemingly purposeless behaviors and incoherent speech have significance to the patient and can be related to current needs. For example, if an individual is wandering and crying out for her mother, instead of reminding the patient that the mother is dead or unavailable, the nurse may say something like "You are looking for Mother. Is there something you need from her?"

Neuroleptic malignant syndrome (NMS)

_____________________ is a potentially fatal condition characterized by severe autonomic instability. Manifestations include high fever, confusion and changes in level of consciousness, muscle rigidity, and hyperthermia.

Adaptive behavior

_____________________ refers to a set of practical skills people need to function in their everyday lives

Reminiscence therapy

_____________________ uses the process of purposely reflecting on past events. The nurse or other healthcare provider may encourage the patient to talk about events that occurred in the past, often by using scrapbooks, photo albums, music, or other items to facilitate the process.

Atypical antipsychotics

______________________ (also called second-generation antipsychotics) are believed to also block D2 receptors, although they have a weaker affinity that may account for the lower profile of certain side effects. Examples include risperidone (Risperdal) and olanzapine (Zyprexa).

Social cognition

______________________ is the ability to process and apply social information accurately and effectively. It depends on the integrated function of the areas responsible for visual motor processing, language, and executive function.

Dopamine serotonin system stabilizers

_______________________ (third-generation antipsychotics) have therapeutic benefits similar to those of atypical antipsychotics and an even lower profile of adverse effects. Aripiprazole (Abilify) was the first drug approved from this class, and a new drug, brexpiprazole (Rexulti), was recently approved.

Confusion

____________________is a general term used to describe increased difficulty in thinking clearly, making judgments, and focusing attention.

Episodic

______________memory is composed of personal experiences.

resting tremors

a coarse, rhythmic tremor often observed in resting arms and hands that is characteristic of Parkinson disease and sometimes seen as a side effect of certain medications

akathisia

a feeling of uncomfortable restlessness

What is akathisia?

a feeling of uncomfortable restlessness that is often not recognized and managed appropriately

Psychosis

a general term used to describe an abnormal mental state that alters a persons perception of reality

What is Prodromal Phase?

a symptomatic period that signals a definite shift from premorbid functioning and continues until psychotic symptoms emerge - manifestations include sleep disturbance, poor concentration, social withdrawal, perceptual abnormalities, and other attenuated or weakened symptoms of psychosis

What manifestations of cognitive impairment are primarily characteristic of delirium (select all that apply)? a. Reduced awareness b. Impaired judgments c. Words difficult to find d. Sleep/wake cycle reversed e. Distorted thinking and perception f. Insidious onset with prolonged duration

a, d, e. Manifestations of delirium include cognitive impairment with reduced awareness, reversed sleep/wake cycle, and distorted thinking and perception. The other options are characteristic of dementia.

extrapyramidal system

acute dystonia parkinsonism akathisia tardive dyskinesia

negative symptoms

affect, alogia, anergia, anhedonia, avolition

clozapine

agranulocytosis

Apraxia

alterations in speech as a result of impaired motor function

automatic obedience

automatic, robotic cooperation with requests

What do NMDA receptor antagonists do?

block the effects of glutamate, a neurotransmitter that is present with neuronal damage and appears to be involved in cognitive decline slows the rate at which new damage occurs, usually at moderate/severe stages of AD, only NMDA is memantine (Namenda) SE: dizziness, constipation, confusion, headache, fatigue, and increased blood pressure

affect

blunted or flat expressions

low potency first generation antipsychotics

chlorpromazine thioridazine - low EPS

Alzheimer's medications

cholinesterase inhibitors: donepezil memantine

Perservation

client avoids answering questions by repeating phrases or behavior, also unconscious

Confabulation

client makes up stories when questioned, can seem like lying but it's actually unconscious

Parietal lobe controls:

conscious awareness of sensory stimuli

Akathisia

continually pacing/agitated

Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries but is experiencing disabling anxiety in the aftermath of the event. What is this type of crisis called? a. crisis resulting from traumatic stress b. maturational or developmental crisis. c. dispositional crisis. d. crisis of anticipated life transitions.

crisis resulting from traumatic stress

After administering naloxone (Narcan), an opioid antagonist, the nurse should monitor the client carefully for which of the following? A Cerebral edema B Kidney failure C Seizure activity D Respiratory depression

d (After administering naloxone, the nurse should monitor the client's respiratory statues carefully because the drug is short acting and respiratory depression may reoccur after its effects wear off. Cerebral edema, kidney failure, and seizure activity are not directly related to opioid overdose or naloxone therapy.)

Which health care worker should be referred for critical incident stress debriefing? a. A nurse who works at an oncology clinic where patients receive chemotherapy b. A case manager whose patients have serious mental illness and are cared for at home c. A health care employee who worked 12 hours at the information desk of a critical care unit d. An emergency medical technician (EMT) who treated victims of a car bombing at a mall

d. An emergency medical technician (EMT) who treated victims of a car bombing at a mall Although each of the individuals mentioned experiencing job-related stress on a daily basis, the person most in need of critical incident stress debriefing is the EMT, who experienced an adventitious crisis event by responding to a bombing and provided care to trauma victims.

Dyspraxia

difficulty with the acquisition of motor learning coordination through the process of growth and development

Nonpharm therapy for Alz?

exercise, reality orientation therapy, validation therapy, and reminiscence therapy

Risk factors for Alz?

fam hx hispanics and AA individuals 3x more common in women most prominent risk factor is age!! After age 65, risk doubles every 5 years Possibly diabetes and mid life obesity Cigarette smoking could lead to cognitive decline and dementia Sedentary lifestyle TBI, depression, dec sleep

persucution

feels singled out for harm by others

A 19-year-old male patient who recently incurred head trauma is exhibiting behavioral changes, including leaving the classroom with no explanation and taking the roommate's cell phone without seeking permission. Based on the patient's behavior, which area of the brain should the nurse anticipate was affected by the head trauma? a. temporal lobe. b. Frontal lobe c. Parietal lobe d. Occipital lobe

frontal lobe.

Stage 3 (Severe) Alz?

gradaul dec in bathing/toileting independently, incontinence, can't identify family members, loss of remote memory and ability to speak, can't perform simple mental calculations, can have personality changes, gradual loss of ability to walk and hold head up, abnormal reflexes, sundowning, agitation, loss of swallowing ability

positive symptoms

hallucinations, delusions, alterations in speech, bizarre behavior

What is the first line of intervention for someone with schizophrenia?

pharmacologic treatment with antipsychotic medications

What is alogia?

poverty of thought and speech

alogia

poverty of thought and speech

substance-induced psychotic disorder

psychosis due to substance intoxication or withdrawl

brief psychotic disorder

psychotic manifestations that last 1 day to 1 month

Schizophrenia

psychotic thinking or behavior lasting longer than 6 months

echopraxia

purposeful imitation of movements made by others

What do Acetylcholinesterase (AChE) inhibitors do?

reducing acetylcholine breakdown, extra acetylcholine increases communication among the remaining neurons, this helps stabilize symptoms related to memory, language etc examples: donepezil (for all stages!) (Aricept), rivastigmine (Exelon), and galantamine (Razadyne)

echopraxia

repeating the movements of others

echolalia

repeating the words of others

echolalia

repeats words spoken to them

Delusions

rigid, false beliefs.

What is validation therapy?

searching for emotion or intended meaning in verbal expressions and behaviors e.g. if an individual is wandering and crying out for her mother, instead of reminding the patient that the mother is dead or unavailable, the nurse may say something like "You are looking for Mother. Is there something you need from her?" The goal is to elicit a response that identifies an unmet need, such as, "Yes, I need her to give me my dinner

second/third generations

sedation hypercholesterolemia anticholinergic diabetes mellitus ortho hypo weight gain mild EPS

Limbic system

set of structures located deep inside the brain, below the cerebrum

What two characteristic abnormalities develop in the brains of those with Alz?

thick protein clots called neurofibrillary tangles, and insoluble deposits known as amyloid plaques

Nurse can anticipate which tests being ordered to help and dx Alz?

thyroid-stimulating hormone (TSH), complete blood count (CBC), serum B12, folate, complete metabolic panel, and testing for sexually transmitted infections

second generation medications

treat both positive and negative symptoms Risperidone, olanzapine, quetiapine, ziprasidone, clozapine

first generation medications

treat only positive symptoms and have more severe EPS symptoms haloperidol, loxapine, chloromazine, fluphenazine

parkinsonism

tremor, muscle rigidity, stooped posture, and a shuffling gait

AIMS scale

used to screen for presence of EPS

The nurse is conducting an admission assessment for a client diagnosed with late stage Alzheimer disease​ (AD). Which statement by the client​'s spouse indicates a need for further teaching regarding the progression of the​ disease?

​"I feel tired all the time. And I often feel guilty and angry. I​ don't understand it. My own health really needs to be secondary. I need to better organize my time so that I can get everything done each​ day."

echopraxia

imitating the movements of others

social

impaired ___________ functioning includes: withdrawal, isolation, difficulty maintaining relationships

What is anhedonia?

inability to experience pleasure

anhedonia

inability to experience pleasure

tardive dyskinesia

involuntary movement of lips

dystonic tremors

involuntary muscle contractions causing twisting repetitive movements and painful or abnormal postures

Carphologia

involuntary, repeated lint picking

anergia

lack of energy

avolition

lack of motivation in activities and hygiene

What is avolition?

lack of motivation or initiative

avolition

lack of motivation or initiative

Ataxia

lack of muscle coordination

anhedonia

lack of pleasure or joy

mutism

lack of speech

alogia

lack of thoughts or speech

diabetes

methylphenidate (Ritalin), can conflict with what medical condition?

command hallucinations

most dangerous; instructs a child to perform an act

How to dx Alz?

no definitive way besides an autopsy, but instead ruling out potential causes of s/s until Alz is all that's left

copropraxia

performing obscene or forbidden gestures

grandeur

believes they are all powerful and important

65

Although AD usually manifests after age ______, some individuals experience symptoms as early as their 30s.

First manifestation of Alz?

subtle memory loss that becomes increasingly apparent as time passes Other early signs include difficulty finding words and performing familiar tasks; impaired judgment and abstract thinking; disorientation to time and place; and frequently misplacing things

mental status

The _________________ exam is a broad screening tool that is used to assess current cognitive functioning of the individual.

maintenance

The __________________ phase corresponds with rehabilitation and a return to goal-directed activities and some level of functional status, such as holding down a job.

Tics

__________ are semi-involuntary movements that are sudden, repetitive, and non-rhythmic. They may involve muscle groups or vocalizations (motor or phonic).

50

Although developing AD is not a normal or expected consequence of aging, the most prominent risk factor for Alzheimer disease is advancing age. After the age of 85, individuals have a _____% chance of developing the disease.

- toxicology screens - drug levels - liver functions - VeriPsych - Cerbrospinal fluid - Genetic testing - Metabolic screening - Diagnostic Imaging - MRIs and CT

Diagnostic Tests for Cognitive Disorders include......

spatial awareness

Frontal lobe and right brain dysfunction impact _________________ to the extent that affected individuals have difficulty gauging physical aspects of social communication, such as how close to stand to someone else.

The nurse is teaching an older adult patient's family about the mental status examination that will be performed. The patient's daughter asks the reason for the exam. Which response by the nurse is accurate? a. It helps the healthcare provider to detect alterations in your mother's perception and thinking. b. It helps to identify alterations that may be contributing to her recent confusion. c. This is just a standard examination when anyone comes in with confusion. d. I'll ask the healthcare provider to come and speak with you about your mother's condition.

"It helps the healthcare provider to detect alterations in your mother's perception and thinking."

What are the two key factors in normal cognition?

*Anatomically and physiologically sound nervous system *Individual must have progressed through one or more stages of cognitive development

hallucinations

Although many people associate the disorder with perceptual alterations such as _______________, the most chronic and disabling aspects of the disease relate to functional deficits caused by alterations in communication, cognition, attention, memory, emotional regulation, initiative, and social interactions.

What are the steps of a cognition assessment?

1. Prepare your client 2. Position and observe client 3. Assess client's language ability 4. Assess client's level or orientation 5. Assess client's memory 6. Asses client's computational ability 7. Asses client's emotions and mood 8. Assess client's perceptions and thinking ability 9. Asses client's decision-making ability

When developing the plan of care for a client with Alzheimer's disease who is experiencing moderate impairment, which of the following types of care should the nurse expect to include? 1. Prompting and guiding activities of daily living. 2. Managing a medication schedule. 3. Constant supervision and total care. 4. Supervision of risky activities such as shaving.

1. Considerable assistance is associated with moderate impairment when the client cannot make decisions but can follow directions. Managing medications is needed even in mild impairment. Constant care is needed in the terminal phase, when the client cannot follow directions. Supervision of shaving is appropriate with mild impairment— that is, when the client still has motor function but lacks judgment about safety issues.

The nurse is attempting to draw blood from a woman with a diagnosis of delirium who was admitted last evening. The client yells out, "Stop; leave me alone. What are you trying to do to me? What's happening to me?" Which response by the nurse is most appropriate? 1. "The tests of your blood will help us figure out what is happening to you." 2. "Please hold still so I don't have to stick you a second time." 3. "After I get your blood, I'll get some medicine to help you calm down." 4. "I'll tell you everything after I get your blood tests to the laboratory."

1. Explaining why blood is being taken responds to the client's concerns or fears about what is happening to her. Threatening more pain or promising to explain later ignores or postpones meeting the client's need for information. The client's statements do not reflect loss of self control requiring medication intervention.

In addition to developing over a period of hours or days, the nurse should assess delirium as distinguishable by which of the following characteristics? 1. Disturbances in cognition and consciousness that fluctuate during the day. 2. The failure to identify objects despite intact sensory functions. 3. Significant impairment in social or occupational functioning over time. 4. Memory impairment to the degree of being called amnesia.

1. Fluctuating symptoms are characteristic of delirium. The failure to identify objects despite intact sensory functions, significant impairment in social or occupational functioning over time, and memory impairment to the degree

Geriatric clients with behavioral changes are often admitted to psychiatric unit for screening and evaluation. As part of the nursing assessment, it is important to observe for signs of dementia. The four "As" of Alzheimer's disease are: 1. Amnesia, apraxia, agnosia, aphasia 2. Avoidance, aloofness, asocial, asexual 3. Autism, loose association, apathy, affect 4. Aggressive, amoral, ambivalent, attractive

1. Amnesia, apraxia, agnosia, aphasia Neurofibrillary tangles in the hippocampus cause recent memory loss (amnesia); temporoparietal deterioration causes cognitive deficiencies in speech (aphasia), purposeful movement (apraxia), and comprehension of visual, auditory, and other sensations (agnosia).

What is sporadic AD?

Alz disease but no clear pattern of inheritance, sometimes called late onset AD, this is more common than early onset!

What disorders or diseases are included under Dementia?

Alzheimer disease, Vascular dementia, Fronotemporal dementia, Dementia with Lowey bodies

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

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

People who complete suicide often have extremely low levels of which neurotransmitter? 1. GABA 2. Serotonin 3. Norepinephrine 4. Acetylcholine

2. Serotonin People who complete suicide often have extremely low levels of the neurotransmitter serotonin. Impairments in the serotonergic system contribute to suicidal behavior. People who make near-lethal suicide attempts have much lower levels of the neurotransmitter dopamine and omega-3. Low levels of the other neurotransmitters have not been implicated in completed suicides

The family of a client, diagnosed with Alzheimer's disease, wants to keep the client at home. They say that they have the most difficulty in managing his wandering. The nurse should instruct the family to do which of the following? (Select all that apply). 1. Ask the physician for a sleeping medication. 2. Install motion and sound detectors. 3. Have a relative sit with the client all night. 4. Have the client wear a Medical Alert bracelet. 5. Install door alarms and high door locks.

2, 4, 5. Motion and sound detectors, a Medical Alert bracelet, and door alarms are all appropriate interventions for wandering. Sleep medications do not prevent wandering before and after the client is asleep and may have negative effects. Having a relative sit with the client is usually an unrealistic burden.

The term motor apraxia relates to a decline in motor patterns essential for complex motor tasks. However, the client with severe dementia may be able to perform which of the following actions? 1. Balance a checkbook accurately. 2. Brush the teeth when handed a toothbrush. 3. Use confabulation when telling a story. 4. Find misplaced car keys.

2. Highly conditioned motor skills, such as brushing the teeth, may be retained by the client who has dementia and motor apraxia. Balancing a checkbook involves calculations, a complex skill that is lost with severe dementia Confabulation is fabrication of details to fill a memory gap. This is more common when the client is aware of a memory problem, not when dementia is severe. Finding keys is a memory factor, not a motor function.

A 69-year-old client is admitted and diagnosed with delirium. Later in the day, he tries to get out of the locked unit. He yells, "Unlock this door. I've got to go see my doctor. I just can't miss my monthly Friday appointment." Which of the following responses by the nurse is most appropriate? 1. "Please come away from the door. I'll show you your room." 2. "It's Tuesday and you are in the hospital. I'm Anne, a nurse." 3. "The door is locked to keep you from getting lost." 4. "I want you to come eat your lunch before you go the doctor."

2. Loss of orientation, especially for time and place, is common in delirium. The nurse should orient the client by telling him the time, date, place, and who the client is with. Taking the client to his room and telling him why the door is locked does not address his disorientation. Telling the client to eat before going to the doctor reinforces his disorientation.

A client is experiencing agnosia as a result of vascular dementia. She is staring at dinner and utensils without trying to eat. Which intervention should the nurse attempt first? 1. Pick up the fork and feed the client slowly. 2. Say, "It's time for you to start eating your dinner." 3. Hand the fork to the client and say, "Use this fork to eat your green beans." 4. Save the client's dinner until her family comes in to feed her.

3. Agnosia is the lack of recognition of objects and their purpose. The nurse should inform the client about the fork and what to do with it. Feeding the client does not address the agnosia or give the client specific directions. It should only be attempted if identifying the fork and explaining what to do with it is ineffective. Waiting for the family to care for the client is not appropriate unless identifying the fork and explaining or feeding the client are not successful.

When caring for the client diagnosed with delirium, which condition is the most important for the nurse to investigate? 1. Cancer of any kind. 2. Impaired hearing. 3. Prescription drug intoxication. 4. Heart failure.

3. Polypharmacy is much more common in the elderly. Drug interactions increase the incidence of intoxication from prescribed medications, especially with combinations of analgesics, digoxin, diuretics, and anticholinergics. With drug intoxication, the onset of the delirium typically is quick. Although cancer, impaired hearing, and heart failure could lead to delirium in the elderly, the onset would be more gradual.

The nurse discusses the possibility of a client's attending day treatment for clients with early Alzheimer's disease. Which of the following is the best rationale for encouraging day treatment? 1. The client would have more structure to his day. 2. Staff are excellent in the treatment they offer clients. 3. The client would benefit from increased social interaction. 4. The family would have more time to engage in their daily activities.

3. The best rationale for day treatment for the client with Alzheimer's disease is the enhancement of social interactions. More daily structure, excellent staff, and allowing caregivers more time for themselves are all positive aspects, but they are less focused on the client's needs.

The client with Alzheimer's disease may have delusions about being harmed by staff and others. When the client expresses fear of being killed by staff, which of the following responses is most appropriate? 1. "What makes you think we want to kill you?" 2. "We like you too much to want to kill you." 3. "You are in the hospital. We are nurses trying to help you." 4. "Oh, don't be so silly. No one wants to kill you here."

3. The nurse needs to present reality without arguing with the delusions. Therefore, stating that the client is in the hospital and the nurses are trying to help is most appropriate. The client doesn't recognize the delusion or why it exists. Telling the client that the staff likes him too much to want to kill him is inappropriate because the client believes the delusions and doesn't know that they are false beliefs. It also restates the word, kill, which may reinforce the client's delusions. Telling the client not to be silly is condescending and disparaging and therefore inappropriate.

A client with dementia who prefers to stay in his room has been brought to the dayroom. After 10 minutes, the client becomes agitated and retreats to his room again. The nurse decides to assess the conditions in the dayroom. Which is the most likely occurrence that is disturbing to this client? 1. There is only one other client in the dayroom; the rest are in a group session in another room. 2. There are three staff members and one physician in the nurse's station working on charting. 3. A relaxation tape is playing in one corner of the room, and a television airing a special on crime is playing in the opposite corner. 4. A housekeeping staff member is washing off the countertops in the kitchen, which is on the far side of the dayroom.

3. The tape and television are competing, even conflicting, stimuli. Crime events portrayed on television could be misperceived as a real threat to the client. A low number of clients and the presence of a few staff members quietly working are less intense stimuli for the client and not likely to be disturbing.

An elderly woman's husband died. When her brother arrives for the funeral, he notices her short-term memory problems and occasional disorientation. A few weeks later, she calls him to say that her husband just died. She says, "I didn't know he was so sick. Why did he die now?" She also complains of not sleeping, urinary frequency and burning, and seeing rats in the kitchen. A home care nurse is sent to evaluate her situation and finds the woman reclusive and passive, but pleasant. The nurse calls the woman's primary care physician to discuss the client's situation and background, and give his assessment and recommendations. The nurse concludes that the woman: 1. Is experiencing the onset of Alzheimer's disease. 2. Is having trouble adjusting to living alone without her husband. 3. Is having delayed grieving related to her Alzheimer's disease. 4. Is experiencing delirium and a urinary tract infection.

4. Delirium is commonly due to a medical condition such as a UTI in the elderly. Delirium often involves memory problems, disorientation, and hallucinations. It develops rather quickly. There is not enough data to suggest Alzheimer's disease especially given the quick onset of symptoms. Delayed grieving and adjusting to being alone are unlikely to cause hallucinations.

A client has sought treatment for a specific phobia: fear of cats. The nurse in the anxiety disorders clinic has established the nursing diagnosis, Anxiety related to exposure to phobic object (cats). A realistic short-term goal for this client would be: within 10 days, client will 1. avoid feared object whenever possible. 2. face feared object unassisted. 3. state that feared object no longer produces feelings of dread associated with anxiety. 4. practice relaxation techniques and report less distress related to thoughts of the feared object.

4. practice relaxation techniques and report less distress related to thoughts of the feared object. Rationale: When the client is able to relax in the presence of thoughts, or the phobic object, the client will begin to experience a sense of control over the phobia

A nurse is caring for a client with Alzheimer disease (AD) who has receptive aphasia. Which area of the brain is likely damaged from AD? A) Temporal lobe B) Limbic system C) Frontal lobe D) Occipital lobe

A

If your parent has eFAD, what are your chances of getting it too?

50/50

A home health nurse visits a client with Stage 2 Alzheimer disease who lives at home with a spouse. What should the nurse suggest to meet the needs of the client's spouse? A) Encouraging the caregiver to take rest periods and avoid fatigue B) Providing the client a list of daily activities to complete C) Making arrangements for the client to visit the local senior citizen center in the afternoon D) Finding placement in a long-term care facility

A

SCHIZOPHRENIA A client with schizophrenia is unable to complete activities of daily living. The client does not respond much to what is happening, and lacks interest in the environment. What does this information indicate to the nurse? A) The client is experiencing negative symptoms. B) The client is experiencing positive symptoms. C) The client is most likely very depressed. D) The client is most likely hearing voices.

A

The nurse identifies the diagnosis of Risk for Injury for a client who is disoriented. Which statement should the nurse identify as an expected outcome for this client's care? A) The client does not sustain injuries during wanderings. B) The client maintains continence on four out of five voidings. C) The client receives culturally appropriate care. D) The client sleeps through the night and stays awake most of the day

A

The nurse is planning care for a client with Stage 1 Alzheimer disease. Which one of the following nursing diagnoses would the nurse base care for this client and family? A) Impaired Memory and Caregiver Role Strain B) Hopelessness and Functional Family Processes C) Knowledge Deficit and Ineffective Coping D) Pseudohostility and Ineffective Coping

A

The nurse is teaching the family of a client who has just been diagnosed with dementia. The family asks what treatments are available that will cure the client. What would be the nurse's best response to the family? A) "There are no treatments that will cure dementia." B) "Treatments to cure dementia include the use of vitamin E." C) "Treatments to cure dementia involve hormone replacement therapy." D) "Treatments to cure dementia include the daily use of ginkgo biloba."

A

While assessing the cognitive status of a 7-year-old child, the nurse notes that the child was unable to perform division problems and unable to name several former presidents of the United States. Prior to determining that this client has cognitive issues, what should the nurse keep in mind? A) The child's developmental level B) The child's home environment C) The child's nutritional status D) The parent's participation in the child's cognitive development

A

Some Biological factors may be associated with the predisposition to suicide. Which of the following biological factors have been implicated? A. genetics and decreased levels of serotonin B. Hereditary and increased levels of norepinephrine C. Temporal lobe atrophy and decreased levels of acetylcholine D. Structural alterations of the brain and increased levels of dopamine.

A Rationale Twin studies have resulted in a possible genetic predisposition. Deficiency of serotonin and changes in the noradrenergic system have been found in suicidal patients and victims.

Which statement made by an emergency department nurse to a graduate nurse communicates accurate knowledge of domestic violence? Select one: a. "Power and control are central to the dynamic of domestic violence." b. "Poor communication and social isolation are central to the dynamic of domestic violence." c. "Erratic relationships and vulnerability are central to the dynamic of domestic violence." d. "Emotional injury and learned helplessness are central to the dynamic of domestic violence."

A The nurse is accurate when stating that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession.

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child may have been physically abused? Select one: a. The child shrinks at the approach of adults. b. The child begs or steals food or money. c. The child is frequently absent from school. d. The child is delayed in physical and emotional development.

A The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns may be a victim of abuse. Maltreatment is considered whether or not the adult intended to harm the child.

The frontal lobe

A 19-year-old male patient who recently incurred head trauma is exhibiting behavioral changes, including leaving the classroom with no explanation and taking the roommate's cell phone without seeking permission. Based on the patient's behavior, which area of the brain should the nurse anticipate was affected by the head trauma?

c

A 25-year-old female patient diagnosed with schizophrenia lives with her parents. The nurse is a part of the patient's treatment team, which includes the healthcare provider, a counselor, and the parents. The patient has been in regular group therapy and is responding well to the medications. Which is the most important life goal identified by the treatment team? a) Making sure the patient follows appropriate self-care measures b) Getting the patient into one-on-one therapy c) Finding the patient a permanent, stable living situation and a job d) Adjusting the patient's medications

c (Paranoia, elaborate delusions, hallucinations)

A 48-year-old female patient is being evaluated for late-onset schizophrenia. Which manifestations should the nurse expect the patient to have? a) Persistent nightmares and increased anxiety b) Disordered speech, motor deficits, and social withdrawal c) Paranoia, elaborate delusions, hallucinations d) Altered thought patterns in which inanimate objects appear to come to life

dehydration

A change in mental status, memory, or attention is often an early sign of ______________ in older adults

The nurse is orienting a novice nurse to the intensive care unit​ (ICU). When assessing​ clients, which items might contribute to the development of​ delirium? Select all that apply.

A client is awakened for frequent assessments and treatment. A client is admitted after a motor vehicle crash with a blood alcohol level of​ 0.25%. A client experiences unrelieved pain.

Extrapyramidal symptoms (EPS)

A cluster of symptoms associated with taking first-generation antipsychotic medications. These include acute dystonia, akathisia, secondary parkinsonism, and TD. The most common being akathisia

trisomy 21

A condition that occurs when an individual born with Down syndrome has an additional full chromosome present.

Fragile X syndrome

A developmental disorder caused by a single recessive gene abnormality on the X chromosome. It is associated most notably with intellectual disability, often accompanied by ADHD and other behavioral problems.

fetal alcohol syndrome (FAS)

A developmental disorder that occurs when a developing fetus is exposed to ethyl alcohol. It is associated with physical, intellectual, behavioral, and/or learning disabilities. Also called fetal alcohol spectrum disorder.

Down syndrome

A developmental disorder that occurs when an individual is born with an extra full or partial chromosome. It is associated with intellectual disability and a wide variety of physical impairments that can range from mild to severe.

Dyskinesia

A general category of difficulty with or distortions of movement.

Frontotemporal dementia (FTD)

A group of disorders caused by progressive cell degeneration in the frontal or temporal lobes

c (The patient is from a different cultural background.)

A non-English-speaking 25-year-old Hispanic patient has begun behaving erratically and anxiously. The patient has become withdrawn and fearful. Which factor may complicate a diagnosis of schizophrenia? a) The patient will not be forthcoming about the symptoms. b) The patient does not speak English. c) The patient is from a different cultural background. d) The patient's family is less likely to be understanding of a psychiatric diagnosis.

A. Acetylcholinesterase inhibitor The acetylcholinesterase inhibitors have a major adverse effect of gastrointestinal bleeding. Therefore, the nurse would expect the healthcare provider to discontinue the medication. The antipsychotic, antidepressant, and the NMDA receptor antagonist do not have this side effect.

A patient with a history of Alzheimer disease (AD) is admitted for gastrointestinal bleeding. Which medication in the patient's profile would the nurse expect the healthcare provider to discontinue? A. Acetylcholinesterase inhibitor B. N-Methyl-D-aspartate (NMDA) receptor antagonist C. Antipsychotic D. Antidepressant

Dementia with Lewy bodies (DLB)

A progressive dementia that resorts from abnormal deposits that accumulate in brain cells

concrete thinking

A type of thinking characterized by a focus on facts and details coupled with an inability to generalize or think abstractly.

ADHD

A variety of signs and symptoms are associated with fragile X syndrome. The most notable is intellectual disability, typically accompanied by behavioral problems such as ____________.

For which patient should the nurse prioritize an assessment for depression? A) A patient in the early stages of Alzheimer's disease B) A patient who is in the final stages of Alzheimer's disease C) A patient experiencing delirium secondary to dehydration D) A patient who has become delirious following an atypical drug response

A) A patient in the early stages of Alzheimer's disease Rationale: Patients in the early stages of Alzheimer's disease are particularly susceptible to depression, since the patient is acutely aware of his or her cognitive changes and the expected disease trajectory. Delirium is typically a shorter-term health problem that does not typically pose a heightened risk of depression.

A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths/min. Which medication would the nurse anticipate administering? A) Naloxone (Narcan) B) Acetylcysteine (Mucomyst) C) Methylprednisolone (Solu-Medrol) D) Protamine sulfate

A) Naloxone (Narcan) Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.

Which of the following interventions are appropriate for a client of suicide precautions? (Select ALL that apply). A. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. B. Accompany the client to off-unit activities C obtain a promise from the client that she will not do anything to harm herself for the next 12 hours. D. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions.

A, B, C Rationale Appropriate interventions include accompany the client, obtain a no harm contract that is short term, and remove any dangerous objects. Removing all of the client's possessions may further increase a client's risk due to feelings of isolation.

A client receiving chlorpromazine (Thorazine) for the treatment of schizophrenia is demonstrating signs of tardive dyskinesia. What would the nurse expect to assess in this client? Select all that apply. A) Wormlike motions of the tongue B) Lip smacking C) Unusual facial movements D) Muscle spasms of the neck E) Shuffling gait

ABC

The nurse is providing discharge instructions to the family of a client with schizophrenia. What should the nurse teach regarding effective communication skills? Select all that apply. A) Talk with family or friends. B) Pick a time and topic to practice. C) Decrease external stimuli. D) Leave the client alone. E) Increase the dose of medication.

ABC

A client has been diagnosed as having Stage 1 Alzheimer disease. What would be the goal for the client and the family at this time? Select all that apply. A) Resolving grief over the diagnosis B) Deciding on the desired treatment and selecting a healthcare proxy; sharing the treatment decision with the healthcare proxy C) Beginning cognitive-enhancing medication, such as Aricept D) Setting up a protective physical environment-such as removing throw rugs

ABCD

An adolescent client is admitted to the hospital for the treatment of schizophrenia. The client's mother is confused and wants to know what she did to cause this to occur. What response(s) should the nurse give to the mother? Select all that apply. A) "Schizophrenia is a biological brain disorder." B) "Research indicates that schizophrenia is a genetic disorder." C) "Research indicates that a very stressful environment causes schizophrenia." D) "Schizophrenia is due to too much dopamine in certain parts of the brain." E) "Schizophrenia is linked to drinking alcohol during pregnancy."

ABD

An adult child who has brought the client in to be evaluated has been told the client has Alzheimer disease. The adult child asks the nurse if all the children of the client are going to get the disease. What should the nurse explain as a risk factor for this disease? Select all that apply. A) Genetic predisposition B) Age C) History of hypertension D) Race E) Environmental exposure

ABE

The nurse is providing family therapy for the family of an adolescent diagnosed with schizophrenia. What is the focus of the nurse's interventions? Select all that apply. A) Establishing boundaries B) Coping mechanisms C) Providing happiness D) Preventing future episodes E) Improving communication

ABE

A nurse is preparing an educational program for clients in a long-term care facility regarding methods for coping with age-associated cognitive changes. Which information should the nurse include? Select all that apply. A) Becoming involved in activities such as reading that keep the mind active B) Playing board games C) Using assistive devices such as a pill box for medications D) Making lists, posting appointments on calendars, and writing notes to self E) Not relying on habits; challenging your mind to remember new things

ACD

GI bleeding, bradycardia.

AChE inhibitors generally produce mild side effects such as decreased appetite, nausea, diarrhea, headaches, and dizziness. Adverse effects include _____________ and _________________

women

AD is almost 3 times more common in ______________ than in men.

A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, "I'm going to use a knotted shower curtain when no one is around." Which information would determine the nurse's plan of care for this client? A. The more specific the plan is, the more likely the client will attempt suicide. B. Clients who talk about suicide never actually commit it. C. Clients who threaten suicide should be observed every 15 minutes. D. After a brief assessment, the nurse should avoid the topic of suicide.

ANS: A Clients who have specific plans are at greater risk for suicide.

A client has a history of daily bourbon drinking for the past 6 months. He is brought to an emergency department by family who report that his last drink was 1 hour ago. It is now 12 midnight. When should a nurse expect this client to exhibit withdrawal symptoms? A. Between 3 a.m. and 11 a.m. B. Shortly after a 24-hour period C. At the beginning of the third day D. Withdrawal is individualized and cannot be predicted.

ANS: A The nurse should expect that this client will begin experiencing withdrawal symptoms from alcohol between 3 a.m. and 11 a.m. Symptoms of alcohol withdrawal usually occur within 4 to 12 hours of cessation or reduction in heavy and prolonged alcohol use.

Which statement should indicate to a nurse that an individual is experiencing a delusion? A. "There's an alien growing in my liver." B. "I see my dead husband everywhere I go." C. "The IRS may audit my taxes." D. "I'm not going to eat my food. It smells like brimstone."

ANS: A The nurse should recognize that a client who claims that an alien is inside his or her body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background.

After a teenager reveals that he is gay, the father responds by beating him. The next morning, the teenager is found hanging in his closet. Which paternal emotions should a nurse anticipate? (Select all that apply.) A. Shock and disbelief B. Guilt and remorse C. Anger and resentment D. Bargaining and depression E. Denial and rationalization

ANS: A, B, C Suicide of a family member can induce a whole gamut of feelings in the survivors. Shock, disbelief, guilt, remorse, anger, and resentment are all feelings that may be experienced by this father.

A patient diagnosed with moderately severe Alzheimer's disease has a self-care deficit of dressing and grooming. Designate appropriate interventions to include in the patient's plan of care. Select all that apply. a. Provide clothing with elastic and hook-and-loop closures. b. Label clothing with the patient's name and name of the item. c. Administer anti-anxiety medication before bathing and dressing. d. Provide necessary items and direct the patient to proceed independently. e. If the patient resists dressing, use distraction and try again after a short interval.

ANS: A, B, E Providing clothing with elastic and hook-and-loop closures facilitates patient independence. Labeling clothing with the patient's name and the name of the item maintains patient identity and dignity (provides information if the patient has agnosia). When a patient resists, it is appropriate to use distraction and try again after a short interval because patient moods are often labile. The patient may be willing to cooperate given a later opportunity. Providing the necessary items for grooming and directing the patient to proceed independently are inappropriate. Be prepared to coach by giving step-by-step directions for each task as it occurs. Administering anxiolytic medication before bathing and dressing is inappropriate. This measure would result in unnecessary overmedication.

A nursing student is developing a study guide related to historical facts about suicide. Which of the following facts should the student include? (Select all that apply.) A. In the Middle Ages, suicide was viewed as a selfish and criminal act. B. During the Roman Empire, suicide was treated by incineration of the body. C. Suicide was an offense in ancient Greece, and a common site burial was denied. D. During the Renaissance, suicide was discussed and viewed more philosophically. E. Old Norse traditionally set a person who committed suicide adrift in the North Sea.

ANS: A, C, D These are true historical facts about suicide and should be included in the student's study guide.

Which nursing action will be most effective in ensuring daily medication compliance for a patient with mild dementia? a. Setting the medications up monthly in a medication box b. Having the patient's family member administer the medication c. Posting reminders to take the medications in the patient's house d. Calling the patient weekly with a reminder to take the medication

ANS: B-Having the patient's family member administer the medication Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the drug.

Which intervention will the nurse include in the plan of care for a patient with moderate dementia who had an appendectomy 2 days ago? a. Provide complete personal hygiene care for the patient. b. Remind the patient frequently about being in the hospital. c. Reposition the patient frequently to avoid skin breakdown. d. Place suction at the bedside to decrease the risk for aspiration.

ANS: B-Remind the patient frequently about being in the hospital. The patient with moderate dementia will have problems with short- and long-term memory and will need reminding about the hospitalization. The other interventions would be used for a patient with severe dementia, who would have difficulty with swallowing, self-care, and immobility.

A 56-year-old patient in the outpatient clinic is diagnosed with mild cognitive impairment (MCI).Which action will the nurse include in the plan of care? a. Suggest a move into an assisted living facility. b. Schedule the patient for more frequent appointments. c. Ask family members to supervise the patient's daily activities. d. Discuss the preventive use of acetylcholinesterase medications.

ANS: B-Schedule the patient for more frequent appointments

What are the physical traits associated with Fragile X syndrome?

Crossed eyes, enlarged testicles, epicanthic eye folds, excessively flexible joints, large ears, scoliosis, long head with protruding jaw

An older adult was stopped by police for driving through a red light. When asked for a driver's license, the adult hands the police officer a pair of sunglasses. What sign of dementia is evident? a. Aphasia b. Apraxia c. Agnosia d. Anhedonia

ANS: C Agnosia refers to the loss of sensory ability to recognize objects. Aphasia refers to the loss of language ability. Apraxia refers to the loss of purposeful movement. Anhedonia refers to a loss of joy in life.

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be: c. "I'm not sure I understand. Give me an example."

ANS: C Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarifying helps the patient identify thoughts and feelings. Asking the patient why he or she feels anxious is non-therapeutic; the patient likely does not have an answer. The patient may be unable to determine what he or she would like the nurse to do in order to help. Telling the patient to get his or her feelings under control is a directive the patient is probably unable to accomplish.

A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurse's priority at this time? A. Give the client off-unit privileges as positive reinforcement. B. Encourage the client to share mood improvement in group. C. Increase frequency of client observation. D. Request that the psychiatrist reevaluate the current medication protocol.

ANS: C The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation should be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act-out self-destructive behaviors prior to the client attaining the full therapeutic effect of the antidepressant medication.

A client diagnosed with paranoid schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? A. Magical thinking; administer an antipsychotic medication B. Persecutory delusions; orient the client to reality C. Command hallucinations; warn the psychiatrist D. Altered thought processes; call an emergency treatment team meeting

ANS: C The nurse should determine that the client is exhibiting command hallucinations. The nurse's legal responsibility is to warn the psychiatrist of the potential for harm. A client who is demonstrating a risk for violence could potentially become physically, emotionally, and/or sexually harmful to others or to self.

A person has minor physical injuries after an auto accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person's level of anxiety? c. Severe

ANS: C The person whose anxiety is severe is unable to solve problems and may have a poor grasp of what is happening in the environment. Somatic symptoms such as those described are usually present. The individual with mild anxiety is only mildly uncomfortable and may even find his or her performance enhanced. The individual with moderate anxiety grasps less information about a situation and has some difficulty with problem solving. The individual in panic will demonstrate markedly disturbed behavior and may lose touch with reality.

A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention, and the rationale for this action? A. Administering lorazepam (Ativan) prn because the client is angry about the discovery of the note B. Establishing room restrictions because the client's threat is an attempt to manipulate the staff C. Placing this client on one-to-one suicide precautions because the more specific the plan, the more likely the client will attempt suicide D. Calling an emergency treatment team meeting because the client's threat must be addressed

ANS: C The priority nursing action should be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide.

A person who has been unable to leave home for more than a week because of severe anxiety says, "I know it does not make sense, but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate? d. Teach the person to use positive self-talk techniques.

ANS: D Positive self-talk, a form of cognitive restructuring, replaces negative thoughts such as "I can't leave my apartment" with positive thoughts such as "I can control my anxiety." This technique helps the patient gain mastery over the symptoms. The other options reinforce the sick role.

After change-of-shift report on the Alzheimer's disease/dementia unit, which patient will the nurse assess first? a. Patient who has not had a bowel movement for 5 days b. Patient who has a stage II pressure ulcer on the coccyx c. Patient who is refusing to take the prescribed medications d. Patient who developed a new cough after eating breakfast

ANS: D A new cough after a meal in a patient with dementia suggests possible aspiration and the patient should be assessed immediately. The other patients also require assessment and intervention, but not as urgently as a patient with possible aspiration or pneumonia.

A patient diagnosed with Alzheimer's disease calls the fire department saying, "My smoke detectors are going off." Firefighters investigate and discover that the patient misinterpreted the telephone ringing. Which problem is this patient experiencing? a. Hyperorality b. Aphasia c. Apraxia d. Agnosia

ANS: D Agnosia is the inability to recognize familiar objects, parts of one's body, or one's own reflection in a mirror. Hyperorality refers to placing objects in the mouth. Aphasia refers to the loss of language ability. Apraxia refers to the loss of purposeful movements, such as being unable to dress.

A student says, "Before taking a test, I feel very alert and a little restless." The nurse can correctly assess the student's experience as: d. mild anxiety.

ANS: D Mild anxiety is rarely obstructive to the task at hand. It may be helpful to the patient because it promotes study and increases awareness of the nuances of questions. The incorrect responses have different symptoms. See relationship to audience response question.

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask? d. "Do you find it difficult to control your worrying?"

ANS: D Patients with generalized anxiety disorder frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event.

treatment failure

Among individuals diagnosed with schizophrenia, an estimated 20 to 40% attempt suicide. Factors associated with this risk include (but are not limited to) greater awareness of the illness, younger age, recent loss, limited support, recent discharge, and _____________________

During a one-to-one session with a client, the client states, "Nothing will ever get better," and "Nobody can help me." Which nursing diagnosis is most appropriate for a nurse to assign to this client at this time? A. Powerlessness R/T altered mood AEB client statements B. Risk for injury R/T altered mood AEB client statements C. Risk for suicide R/T altered mood AEB client statements D. Hopelessness R/T altered mood AEB client statements

ANS: D The client's statements indicate the problem of hopelessness. Prior to assigning either risk for injury or risk for suicide a further evaluation of the client's suicidal ideations and intent would be necessary.

A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? A. To assess for emotional strength B. To assess for Wernicke-Korsakoff syndrome C. To assess for tachycardia D. To assess for fine tremors

ANS: D The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, coarse tremors, and seizure activity.

In planning care for a suicidal client, which correctly written outcome should be a nurse's first priority? A. The client will not physically harm self. B. The client will express hope for the future by day 3. C. The client will establish a trusting relationship with the nurse. D. The client will remain safe during the hospital stay.

ANS: D The nurse's priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse's priority. The "A" answer choice is incorrectly written. Correctly written outcomes must be client focused, measurable, realistic, and contain a time frame. Without a time frame, an outcome cannot be correctly evaluated.

A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply? A. "Why don't you consider doing volunteer work in a homeless shelter." B. "Let's discuss the negative aspects of your life." C. "Things will look better in the morning." D. "It sounds like you are feeling pretty hopeless."

ANS: D This statement verbalizes the client's implied feelings and allows him to validate and explore them.

In Vygotsky's theory, what is seen as the most important determinant of cognitive ability?

Culture and social interaction

A 72-year-old female patient is brought to the clinic by the patient's spouse, who reports that she is unable to solve common problems around the house. To obtain information about the patient's current mental status, which question should the nurse ask the patient? a. "Are you sad?" b. "How is your self-image?" c. "Where were you were born?" d. "What did you eat for breakfast?"

ANS: D-"What did you eat for breakfast?" This question tests the patient's short-term memory, which is decreased in the mild stage of Alzheimer's disease or dementia

abstract

Adolescents' cognitive operations are organized in a way that permits them to think about thinking. Thought is now systematic and ____________.

Preventative strategies?

Adopt a heart-healthy diet such as the Mediterranean diet. Consume alcohol moderately. Stay socially active and connected with others. Engage in activities that exercise cognitive function. Utilize stress management techniques.

What/Who are the risk factors for delirium?

Age: children and older adults Dementia Diabetes Undertreated pain Onset of new illness Exacerbation of chronic illness Emotional disorders

What cognitive limits may a pt. with dementia experience?

Akathisia, Echolalia, Aphasia, Anomia , Dysphagia, Ataxia, and Carphologia

60-80% of dementia cases are ?

Alezheimer's disease

b (There is a greater risk of long-term disability and an increased risk for suicide.)

An adolescent male patient has been diagnosed with early-onset schizophrenia. The nurse is preparing to discuss treatment options and care planning with the family. Which information about the early-onset schizophrenia should the nurse discuss? a) It resolves itself before adulthood and long-term treatment is often not necessary. b) There is a greater risk of long-term disability and an increased risk for suicide. c) It is associated with a continuation of childhood play, and usually resolves itself. d) It is most easily treated and has the lowest severity of all types of schizophrenia.

Confusion

An alteration in cognition that makes it difficult to think clearly, focus attention, or make decisions

loose associations

An indication of disordered thinking characterized by the shifting of verbal ideas from one topic to another, with no apparent relationship between thoughts, and the person speaking being unaware that the topics are unconnected. Commonly seen in schizophrenia.

50

An individual who has a first-degree relative with schizophrenia (such as a parent or sibling) has a risk of schizophrenia of almost ______%

Akathisia

An internal feeling of restlessness that may lead to rocking, pacing, or other constant movement

memantine

Currently, _________________ (Namenda) is the only NMDA receptor antagonist approved by the U.S. Food and Drug Administration (FDA).

physical

As the disease progresses, the continued deterioration in patients' cognition is accompanied by _________________ decline. At some point, affected individuals lose the ability to perform everyday tasks and must rely entirely on their caregivers.

What medications are involved/ given with/for cognitive alterations?

Anti-Alzheimer medications, Anti-psychotics, Atypical Anti-psychotics, Anxiolytics, Selective Serotonin Reuptake Inhibitors (SSRI's) , Cerebral Stimulants

trihexyphenidyl

Antiparkinsonian/antimuscarinic drugs such as _______________ (Artane) may be used to decrease stiffness and rigidity.

maternal stress

Any insults during the period of embryonic development, including exposure to toxic substances, _________________, nutritional deficits, and illness, can have a devastating impact on cognition

- Injury, Risk for - Health Maintenance, Ineffective - Self-care Deficit (specify) - Imbalanced Nutrition: Less Than Body Requirements - Memory: Impaired - Communication: Verbal, Impaired - Fear - Caregiver Role Strain - Swallowing, Impaired - Physical Mobility, Impaired - Wandering - Compromised Human Dignity, Risk for

Appropriate nursing diagnoses for patients with AD vary by stage of the disease and patient and family preferences and needs. Diagnoses should be prioritized to address physiologic and safety needs first. The following list identifies some common nursing diagnoses: ...................

- Suicide, Risk for - Other-Directed Violence, Risk for - Injury, Risk for - Health Maintenance, Ineffective - Self-Care Deficit (Bathing and/or Dressing) - Verbal Communication, Impaired - Social Interaction, Impaired - Coping, Ineffective - Noncompliance.

Appropriate nursing diagnoses for patients with schizophrenia vary depending on symptoms and level of functioning. Examples of these diagnoses include: ............

smoke cigarettes

Approximately 80% of individuals with schizophrenia __________________, possibly because of the short-term relief of symptoms associated with nicotine and its effect on nicotinic receptor

neurofibrillary tangles

As AD progresses and more neurons die, two characteristic abnormalities develop in the brains of affected individuals. The first is thick protein clots called ________________, and the second is insoluble deposits known as amyloid plaques.

amyloid plaques

As AD progresses and more neurons die, two characteristic abnormalities develop in the brains of affected individuals. The first is thick protein clots called neurofibrillary tangles, and the second is insoluble deposits known as ___________________.

caffeine

As mentioned previously, the majority of individuals with schizophrenia smoke cigarettes and are far more likely to consume excess amounts of _______________ (>200 mg/day) than the general public

early adulthood

As previously stated, the majority of individuals with schizophrenia experience an emergence of symptoms in _______________ with a classic course preceded by prodromal symptoms and a lessening of positive symptoms with aging.

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? Select one: a. Discourage the client from discussing the event, as this may lead to further emotional trauma. b. Remain nonjudgmental and actively listen to the client's description of the event. c. Meet the client's self-care needs by assisting with showering and perineal care. d. Provide leads, based on police information, to encourage further description of the event.

B The most appropriate nursing action is to remain nonjudgmental and actively listen to the client's description of the event. It is important to also communicate to the victim that he/she is safe and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis that the client needs to begin healing.

Which of the following individuals is at the highest risk for suicide? A. Nancy, age 22, Asian American, Catholic, middle socioeconomic group, alcoholic B. John, age 72, white, Methodist, low socioeconomic group, diagnosis of metastatic cancer of the pancreas C. Carol, age 15, African American, Baptist, high socioeconomic group, no physical or mental health problems D. Mike, age 55, Jewish, middle socioeconomic group, suffered myocardial infarction a year ago

B Rationale John is an older white male and even though he is involved with a church his low socioeconomic status and diagnosis of a terminal illness increases his risk for suicide.

dementia

The DSM-5 now uses the term mild and major neurocognitive disorders (NCDs) to replace the term _____________

The nurse in the long-term care facility cares for a 70-year-old man with severe (late-stage) dementia who is undernourished and has problems chewing and swallowing. What should the nurse include in the plan of care for this patient? A) Turn on the television to provide a distraction during meals. B) Provide thickened fluids and moist foods in bite-size pieces. C) Limit fluid intake during scheduled meals to prevent aspiration. D) Allow the patient to select favorite foods from the menu choices.

B) Provide thickened fluids and moist foods in bite-size pieces. Rationale: If patients with dementia have problems chewing or swallowing, pureed foods, thickened liquids, and nutritional supplements should be provided. Foods that are easy to swallow are moist and should be in bite-size pieces. Distractions at mealtimes, including the television, should be avoided. Fluids should not be limited but offered frequently; fluids should be thickened. Patients with severe (late-stage) dementia have difficulty understanding words and would not have the cognitive ability to select menu choices.

A patient in the middle stage of Alzheimer's disease (AD) may exhibit which characteristic or behavior? A. Mild depression B. Hallucinations C. Weight loss D. Impaired mobility

B. Hallucinations

A nurse manager is educating a group of staff nurses on recognizing the differences between confusion and delirium. Which statement(s) will the nurse manager include? Select all that apply. A) "Delirium is seen only in older adults." B) "Delirium is a reversible condition while dementia is not." C) "Older adult men are at higher risk for developing delirium." D) "Younger adult females are at higher risk for developing delirium." E) "Adolescents are more prone to developing delirium than young children."

BC

The family of a 10-year-old client is very upset because the child doesn't seem to know the family. The client has been admitted with pneumonia and has a high fever. What should the nurse teach this family to alleviate stress about the child's confusion? Select all that apply. A) Reorient the client to time and place as much as possible. B) Encourage the family remain at the bedside as much as possible. C) Explain that high fevers can cause delirium. D) Reassure that the confusion will not last very long. E) Teach the family how to care for the child upon discharge.

BC

THE CONCEPT OF COGNITION The family of an 82-year-old client is concerned about the changes in the client's behavior. The client used to be a wonderful cook but now cannot even remember how to use a blender. For which causes of impaired cognitive function should the nurse assess the client? Select all that apply. A) Obesity B) Nutritional deficiencies C) Medication reactions D) Stroke E) Snoring

BCD

The nurse plans a class about Alzheimer disease for a caregiver support group. What should the nurse include when teaching this class of caregivers? Select all that apply. A) Glutamatergic inhibitors are the most common class of drugs for treating Alzheimer disease. B) Alzheimer disease accounts for about 70% of all dementias. C) Chronic inflammation of the brain may be a cause of the disease. D) Depression and aggressive behavior are common with the disease. E) Memory difficulties are an early symptom of the disease.

BCDE

A nurse is caring for an older adult who displays symptoms of cognitive decline. What is true regarding the aging process and cognition? Select all that apply. A) Generally, older adults' short-term memory changes significantly. B) Generally, many older adults have increased difficulty finding and rapidly listing words. C) The ability to use and understand word combinations declines steadily with age. D) The ability to acquire practical information declines steadily with age. E) The ability to engage in abstract thought declines slightly.

BE

The nurse is preparing an educational program for the family of a client with dementia who is ready for discharge. On what should the nurse focus to reduce the risk for injury? Select all that apply. A) Have all objects in the room be the same color. B) Check shoes for fit and support. C) Be aware that client in the early stages usually have few problems with unfamiliar places. D) Keep all familiar objects in the home. E) Remove throw rugs and electrical cords.

BE

The nurse is working with a group of parents of children with intellectual disabilities. What should the nurse recommend to support environmental safety for these children? Select all that apply. A) Have parents maintain a regular schedule for activities. B) Teach emotional safety. C) Use medications to decrease agitation. D) Provide aids to assist with orientation. E) Turn the temperature down on the hot water heater.

BE

oxygenation

Because changes in cognitive function are often an early sign of decreased ____________________, perfusion, or an alteration in another biophysical process, begin by obtaining a complete set of vital signs and assessing the patient's level of pain.

diagnostic tests

Because psychosis can result from an underlying medical condition or ingestion of one or more substances, _________________ should be run to rule out any underlying illness or causative substance.

The nurse includes information regarding long-term care placement in the discharge materials for the family of a client newly diagnosed with Alzheimer disease. Why is this information important to provide to the family at this time? A) It often takes 6 to12 months for an individual with Alzheimer disease to establish a successful transfer to a facility, and this will allow adequate time. B) It's better to address the issue of placement now instead of later. C) Early introduction to long-term options will allow the client and family time to make a more informed decision. D) Long-term care placement is inevitable with this diagnosis.

C

The nurse is explaining the difference between delirium and dementia to a family member of a client with confusion. What should the nurse's explanation include? A) The cause of delirium is unknown. B) Dementia develops suddenly. C) Delirium is a common occurrence in hospitalized elderly clients. D) Delirium is often confused with depression in clients over the age of 60.

C

The nurse is helping the family of an adolescent understand why their child has been diagnosed with schizophrenia. What should the nurse explain as a risk for the development of schizophrenia? A) Association with psychotic clients B) Smoking C) Genetic predisposition D) Allergy to shellfish

C

The nurse is planning care for a client who is experiencing Stage 1 Alzheimer disease. What will promote a therapeutic environment for a client with acute confusion? A) Background noise like music will keep this client calm. B) Dim the lights during waking hours. C) Schedule meals at the same time each day. D) Pain medications will enhance the therapeutic environment.

C

The nurse is reviewing content provided to a caregiver of an individual with Alzheimer disease. Which statement indicates that teaching has been effective? A) "There are effective drugs, but they cannot be used over a long period." B) "There aren't any drugs that are effective in treating this disease." C) "The earlier the drugs are started, the greater the effect they will have on the disease." D) "There are drugs that can control symptoms for many years."

C

For an overdose of morphine sulfate, which drug should the nurse have on hand as an antidote? A. phenytoin (Dilantin) B. tramadol (Ultram) C. naloxone (Narcan) D. atropine sulfate (Atropine)

C (Naloxone (Narcan) is an opioid antagonist (blocks receptors. It counteracts the overdose. However, in conditions of extreme pain, Narcan should be given in small increments to avoid a complete loss of pain control. )

The physician ordered I.V. naloxone (Narcan) to reverse the respiratory depression from morphine administration. After administration of the naloxone the nurse should: A) Check Respirations in 5 minutes because naloxone is immediately effective in relieving respiratory depression. B) Check respirations in 30 minutes because the effects of morphine will have worn off by then. C) Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone D) Monitor respirations each time the client receives morphine sulfate 10 mg I.M.

C (Rationale: The nurse should monitor the clients respirations closely for 4 to 6 hours because naloxone has a shorter duration of action than opioids. The client may need repeated doses of naloxone to prevent or treat a recurrence of the respiratory depression. Naloxone is usually effective in a few minutes; however, its effects last only 1 to 2 hours and ongoing monitoring of the clients respiration's is necessary. )

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? A. You are safe here. We will make sure nothing happens to you. B. You're just lucky your roommate came home when she did. C. What exactly do you plan to do? D. I don't understand. You have so much to live for.

C Rationale During the assessment phase it is important to assess how serious the intent was, if the person has a plan, if they do have a plan if they have a means of carrying out said plan, how lethal those means are, and if the individual has attempted suicide before. Theresa already has attempted suicide so it is vital to ask the other questions about her suicidal plan.

When questioned about bruises, a woman states, "It was an accident. My husband just had a bad day at work. He's being so gentle now and even brought me flowers. He's going to get a new job, so it won't happen again." In which phase of the cycle of battering is this client? Select one: a. Phase I: The tension-building phase. b. Phase II: The acute battering incident phase. c. Phase III: The honeymoon phase. d. Phase IV: The resolution and reorganization phase.

C The client is in the honeymoon phase of the cycle of battering. In this phase, the batterer becomes extremely loving, kind, and contrite. Promises are often made that the abuse will not happen again.

A nurse administers naloxone (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? A) Drowsiness B) Tics and tremors C) Increased pain D) Nausea and vomiting

C) Increased pain Naloxone is a medication that reverses the effects of narcotics. Although the patient's respiratory status will improve after the administration of naloxone, pain will be more acute.

When developing a plan of care for a hospitalized patient with moderate dementia, which intervention will the nurse include? a. Reminding the patient frequently about being in the hospital b. Placing suction at the bedside to decrease the risk for aspiration c. Providing complete personal hygiene care for the patient d. Repositioning the patient frequently to avoid skin breakdown

Correct Answer: A Rationale: The patient with moderate dementia will have problems with short- and long-term memory and will need reminding about the hospitalization. The other interventions would be used for a patient with severe dementia, who would have difficulty with swallowing, self-care, and immobility. Cognitive Level: Application Text Reference: p. 1563 Nursing Process: Planning NCLEX: Physiological Integrity

A family member of a patient with possible Alzheimer's disease asks the nurse the purpose of the Mini-Mental State Examination (MMSE). Which response by the nurse is appropriate? a. The MMSE helps in establishing the diagnosis of Alzheimer's disease (AD). b. The MMSE is useful in determining the degree of mental impairment. c. The MMSE determines the choice of the most appropriate treatment. d. The MMSE aids in differentiating acute delirium from chronic dementia.

Correct Answer: B Rationale: The MMSE establishes the degree of mental impairment at the time it is given. It does not establish a diagnosis of AD but when given repeatedly over time may help to determine the progression of AD. The choice of treatment is made on the basis of multiple data, not just the MMSE. The MMSE may be abnormal with either delirium or dementia and is not useful in determining which condition the patient has. Cognitive Level: Application Text Reference: p. 1563 Nursing Process: Implementation NCLEX: Physiological Integrity

When teaching the spouse of a patient who is being evaluated for Alzheimer's disease (AD) about the disorder, the nurse explains that a. the most important risk factor for AD is a family history of the disorder. b. a diagnosis of AD can be made only when other causes of dementia have been ruled out. c. new drugs have been shown to reverse AD dramatically in some patients. d. the presence of brain atrophy detected by MRI confirms the diagnosis of AD in patients with dementia.

Correct Answer: B Rationale: The diagnosis of AD is one of exclusion. Age is the most important risk factor for development of AD. Drugs can slow the deterioration but do not dramatically reverse the effects of AD. Brain atrophy is a common finding in AD, but it can occur in other diseases as well. Cognitive Level: Comprehension Text Reference: p. 1568 Nursing Process: Implementation NCLEX: Physiological Integrity

During the morning change-of-shift report at the long-term care facility, the nurse learns that the patient with dementia has had sundowning. Which nursing action should the nurse take while caring for the patient? a. Move the patient to a quieter room at night. b. Open the blinds in the patient's room and provide frequent activities. c. Have the patient take a brief mid-morning nap. d. Provide hourly orientation to time of day.

Correct Answer: B Rationale: The most likely cause of sundowning is a disruption in circadian rhythms and keeping the patient active and in daylight will help to reestablish a more normal circadian pattern. Moving the patient to a different room might increase confusion. Taking a nap will interfere with nighttime sleep. Hourly orientation will not be helpful in a patient with memory difficulties. Cognitive Level: Application Text Reference: p. 1573 Nursing Process: Implementation NCLEX: Safe and Effective Care Environment

To protect a patient from injury during an episode of delirium, the most appropriate action by the nurse is to a. have a close family member remain with the patient and provide reassurance. b. assign a staff member to stay with the patient and offer frequent reorientation. c. ask the health care provider about ordering an antipsychotic drug. d. secure the patient in bed with a soft chest restraint.

Correct Answer: B Rationale: The priority goal is to protect the patient from harm, and a staff member will be most experienced in providing safe care. Visits by family members are helpful in reorienting the patient, but families should not be responsible for protecting patients from injury. Antipsychotic medications may be ordered, but only if other measures are not effective because these medications have multiple side effects. Restraints are sometimes used but tend to increase agitation and disorientation. Cognitive Level: Application Text Reference: p. 1577 Nursing Process: Implementation NCLEX: Physiological Integrity

3. When administering a mental status examination to a patient with delirium, the nurse should a. give the examination when the patient is well-rested. b. reorient the patient as needed during the examination. c. choose a place without distracting environmental stimuli. d. medicate the patient first to reduce anxiety.

Correct Answer: C Rationale: Because overstimulation by environmental factors can distract the patient from the task of answering the nurse's questions, these stimuli should be avoided. The nurse will not wait to give the examination because action to correct the delirium should occur as soon as possible. Reorienting the patient is not appropriate during the examination. Antianxiety medications may increase the patient's delirium. Cognitive Level: Application Text Reference: pp. 1562, 1576-1577 Nursing Process: Implementation NCLEX: Physiological Integrity

A home-health patient with Alzheimer's disease (AD) and mild dementia has a new prescription for donepezil (Aricept). Which nursing action will be most effective in ensuring compliance with the medication? a. Setting the medications up weekly in a medication box b. Calling the patient daily with a reminder to take the medication c. Having the patient's spouse administer the medication d. Posting reminders to take the medications in the patient's house

Correct Answer: C Rationale: Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the Aricept. The other nursing actions will not be as effective in ensuring that the patient takes the medications. Cognitive Level: Application Text Reference: pp. 1563, 1567 Nursing Process: Implementation NCLEX: Physiological Integrity

A long-term care patient with moderate dementia develops increased restlessness and agitation. The nurse's initial action should be to a. administer the PRN dose of lorazepam (Ativan). b. reorient the patient to time and place. c. assess the patient for anything that might be causing discomfort. d. have a nursing assistant stay with the patient to ensure safety.

Correct Answer: C Rationale: Increased motor activity in a patient with dementia is frequently the patient's only way of responding to factors like pain, so the nurse's initial action should be to assess the patient for any precipitating factors. Administration of sedative drugs may be indicated, but this should not be done until assessment for precipitating factors has been completed and any of these factors have been addressed. Reorientation is unlikely to be helpful for the patient with moderate dementia. Assigning a nursing assistant to stay with the patient may also be necessary, but any physical changes that may be causing the agitation should be addressed first. Cognitive Level: Application Text Reference: p. 1573 Nursing Process: Implementation NCLEX: Physiological Integrity

A client diagnosed with Alzheimer disease has a catastrophic reaction during an activity involving simultaneous music playing and a craft project. The client starts shouting, "No! No! No!" and runs from the room. What should the nurse do? A) Administer a PRN anti-anxiety medication and restrict the client's activity participation. B) Intervene one-on-one with the client until the client is calm, and then redirect the client to another activity such as Bingo. C) Discontinue the activity program because it is upsetting the client. D) Follow the client, reassure the client one-on-one, and then redirect the client to a quiet activity.

D

Coexisting dementia and depression are identified in a patient with Parkinson's disease. The nurse anticipates that the greatest improvement in the patient's condition will occur with administration of a. antipsychotic drugs. b. anticholinergic agents. c. dopaminergic agents and antidepressant drugs. d. selective serotonin reuptake inhibitor (SSRI) agents.

Correct Answer: C Rationale: Parkinson's disease and depression are both potentially reversible conditions, and the patient's symptoms that are caused by these two conditions will improve with appropriate treatment. Anticholinergic agents are likely to worsen the patient's condition because they will block the effect of acetylcholine at the synaptic cleft. There is no indication that the patient needs an antipsychotic agent at this time. A selective serotonin reuptake inhibitor (SSRI) may be effective for the depression, but it does not address the patient's other conditions. Cognitive Level: Application Text Reference: p. 1563 Nursing Process: Planning NCLEX: Physiological Integrity

When assessing a patient with Alzheimer's disease (AD) who is being admitted to a long-term care facility, the nurse learns that the patient has had several episodes of wandering away from home. Which nursing action will the nurse include in the plan of care? a. Ask the patient why the wandering episodes have occurred. b. Reorient the patient to the new living situation several times daily. c. Place the patient in a room close to the nurses' station. d. Have the family bring in familiar items from the patient's home.

Correct Answer: C Rationale: Patients at risk for problems with safety require close supervision. Placing the patient near the nurse's station will allow nursing staff to observe the patient more closely. Use of "why" questions is frustrating for the patient with AD, who are unable to understand clearly or verbalize the reason for wandering behaviors. Because of the patient's short-term memory loss, reorientation will not help to prevent wandering behavior. Because the patient had wandering behavior at home, familiar objects will not prevent wandering. Cognitive Level: Application Text Reference: p. 1573 Nursing Process: Planning NCLEX: Safe and Effective Care Environment

A patient with Alzheimer's disease (AD) is hospitalized with a urinary tract infection. The spouse tells the nurse, "I am just exhausted from the constant care and worry. We don't have any children and we can't afford a nursing home. I don't know what to do." The most appropriate nursing diagnosis for the spouse is a. anxiety related to limited financial resources. b. ineffective health maintenance related to stress. c. caregiver role strain related to limited resources for caregiving. d. social isolation related to unrelieved caregiving responsibilities.

Correct Answer: C Rationale: The spouse's statements are most consistent with caregiver role strain. The other diagnoses each address one aspect of the spouse's problem, but caregiver-role strain related to limited resources for caregiving addresses all the information the nurse has about this situation. Cognitive Level: Application Text Reference: pp. 1574-1575 Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

A nurse is caring for a client who is confused and agitated. The nurse understands that the best method to determine if the client has reversible confusion is to use the Confusion Assessment Method (CAM). What is true regarding this diagnostic tool? A) It consists of five parts and is a lengthy test. B) It measures the severity of the client's delirium. C) It is also effective in screening for depression. D) It is effective in screening for cognitive impairment and reversible confusion.

D

A 62-year-old patient is brought to the clinic by a family member who is concerned about the patient's increasing sleep disturbances and inability to solve common problems. To obtain information about the patient's current mental status, which question should the nurse ask the patient? a. "Where were you were born?" b. "Do have any feelings of sadness?" c. "What day of the week is it today?" d. "How positive is your self-image?"

Correct Answer: C Rationale: This question tests the patient's orientation to time, which is decreased in early Alzheimer's disease (AD) or dementia. Asking the patient about birthplace tests for remote memory, which is intact in the early stages. Questions about the patient's emotions and self-image are helpful in assessing emotional status, but they are not as helpful in assessing mental state.

A 71-year-old patient is diagnosed with moderate dementia as a result of multiple strokes. During assessment of the patient, the nurse would expect to find a. excessive nighttime sleepiness. b. variable ability to perform simple tasks. c. difficulty eating and swallowing. d. loss of recent and long-term memory.

Correct Answer: D Rationale: Loss of both recent and long-term memory is characteristic of moderate dementia. Patients with dementia have frequent nighttime awakening. Dementia is progressive, and the patient's ability to perform tasks would not have periods of improvement. Difficulty eating and swallowing is characteristic of severe dementia. Cognitive Level: Application Text Reference: pp. 1562-1563 Nursing Process: Assessment NCLEX: Physiological Integrity

A 72-year-old patient hospitalized with pneumonia is disoriented and confused 2 days after admission. Which assessment information obtained by the nurse about the patient indicates that the patient is experiencing delirium rather than dementia? a. The patient is disoriented to place and time but oriented to person. b. The patient has a history of increasing confusion over several years. c. The patient's speech is fragmented and incoherent. d. The patient was oriented and alert when admitted.

Correct Answer: D Rationale: The onset of delirium occurs acutely. The degree of disorientation does not differentiate between delirium and dementia. Increasing confusion for several years is consistent with dementia. Fragmented and incoherent speech may occur with either delirium or dementia. Cognitive Level: Application Text Reference: p. 1562 Nursing Process: Assessment NCLEX: Physiological Integrity

Which instruction or question would be appropriate to ask a patient in order to evaluate the patient's computational ability? a. If you won $10,000, how would you spend it? b. Who were the last two presidents of the United States? c. Do you ever see objects or hear voices that other people do not? d. Count by fives from 0 to 100.

Count by fives from 0 to 100.

cognitive

The Mini Mental State Exam is commonly used to screen for ____________ impairment.

semantic, episodic

Declarative memories are those that are explicit and can be consciously accessed; they are distinguished according to _____________ and _______________ types

Relocation syndrome (transfer trauma)

Decline in functioning associated with the stress of moving to another environment.

How does Oxygenation relate to cognition?

Decreases the amount of O2 reaching the brain; can lead to coma or death

Aphasia

Defective or absent language function

thought broadcasting

Delusions may take on bizarre or implausible features such as _____________________ (belief that others can hear thoughts), withdrawal (belief that others can remove thoughts), control (belief that others can control thoughts), and insertion (belief that others can insert thoughts into the person's mind).

risk factor

Depression is considered to be both a symptom of and _____________ for Alzheimer disease with overlapping neurobiological mechanisms responsible for both diseases

Alterations in perfusion can affect the amount of blood that reaches a patient's brain. In the case of inadequate perfusion, not enough blood—and therefore not enough oxygen—is reaching the patient's brain cells. Over time, this shortage of oxygen can result in neuronal death, thus contributing to vascular dementia.

Describe how alterations in perfusion can affect a patient's risk for specific types of dementia.......

The nurse is speaking with a pregnant patient who asks if they can have a glass of wine. Which response by the nurse is correct? a. Drinking alcohol can cause the development of fetal alcohol syndrome. b. There are no known negative health affects associated with drinking during pregnancy. c. Alcohol use can cause fragile X disorder in some male infants. d. You should have no more than one or two alcoholic drinks while pregnant.

Drinking alcohol can cause the development of fetal alcohol syndrome.

Looking for these issues first: DEMENTIA

Drugs and alcohol Eyes and ears Metabolic and endocrine disorders Emotional disorders Neurologic disorders Trauma or tumors Infection Arteriovascular disease

How does Addiction relate to cognition?

Drugs and alcohol interfere with normal neuronal functioning, blood flow, and/or waste removal

A pt. with problems in learning to count, and impaired mental math abilities would have what disorder?

Dyscalculia

A pt. with illegible writing, trouble organizing ideas before and during the composition process would have what disorder?

Dysgraphia

Bradykinesia

Dyskinesia characterized by slow movement

A pt. with a slow reading rate, confusing letters and their sounds ,and problems with combining sounds into words would have what disorder?

Dyslexia

What disorders or diseases are included under Learning disabilities?

Dyslexia, Dyscalculia, Dysgraphia, Dyspraxia

A pt. with problems with object manipulation and physical crafts such as tying shoes, drawing, and using scissors would have what disorder?

Dyspraxia

first generations

EPS symptoms (more) neuroleptic malignant syndrome anticholinergic symptoms sedation sexual dysfunction skin effects seizures

What is eFAD?

Early onset familial Alz, inherited, usually manifests beore age 65

familial, before

Early-onset ________________ Alzheimer Disease (eFAD) is an inherited disease. It is also called early-onset AD because it usually manifests ________________ age 65

A 54-year-old female patient with mild intellectual delay and metastatic cancer tells the nurse, "I don't want to end up in the hospital with all those machines attached." Which nursing action addresses the patient's concern? a. Changing the subject so that the patient will be distracted and not think about their future. b. Asking the supervisor to encourage them to accept aggressive treatment. c. Explaining about advance directives and helping the patient formulate one that specifies their wishes. d. Telling the patient not to worry and that everything will be alright.

Explaining about advance directives and helping the patient formulate one that specifies their wishes.

inputs

External stimuli or ___________ include touch, taste, vision, hearing, and smell

delusions

False ideas or beliefs not based in reality.

What intellectual disability is preventable?

Fetal alcohol syndrome (FAS)

What are the clinical manifestations of delirium?

Fluctuations in symptoms ranging from largely unresponsive to hypervigilant

The nurse is providing care to a client who is diagnosed with delirium. The client​'s family asks what they can expect. Which symptoms of delirium will the nurse include in the response to the​ family? Select all that apply.

Fluctuations in the intensity and level of​ consciousness, from drowsy to near unconsciousness Sudden loss of both​ long-term and​ short-term memory Might look physically​ unwell; acute onset of irrational and repetitive behaviors

How does Fluid and Electrolyte Imbalance relate to cognition?

Fluid and electrolyte imbalance can result in abnormal intracranial pressure, disrupted O2 transport, and/ or poor neuronal function

- Growth deficits -Characteristic facial abnormalities, including a smooth philtrum (ridge between the nose and upper lip), thin vermillion border (line between the lips and surrounding skin), and small palpebral fissures (separations between the upper and lower eyelids) - Central nervous system abnormalities (structural, neurologic, and/or functional)

For a diagnosis of FAS (as opposed to another fetal alcohol spectrum disorder), a child must exhibit all of the following conditions:

- Poor adherence to the prescribed treatment regimen (especially pharmacologic therapy) - Possible development of resistance to antipsychotic medications - Presence of mild to full-blown symptoms of psychosis - Recent life events that may increase the likelihood of relapse

For the patient diagnosed with schizophrenia, ask about possible risk factors for exacerbations or signs of relapse, such as: ................

Moderate Alzheimer's

Forgetting events of one's own history Difficulty performing tasks (paying bills, managing money) Can wander and get lost

Alzheimer disease

Form of dementia that causes problems with memory, thinking, and behavior.

A nurse in a​ long-term care facility is providing care for a client who is receiving memantine for Alzheimer disease​ (AD). Which adverse reaction to the medication would the nurse report to the healthcare​ provider?

Guaiac positive stool

What are children born with Fetal alcohol syndrome (FAS) more at risk for?

Hearing impairment and growth deficits

The nurse administers a conventional antipsychotic medication to a patient who is experiencing active delusions and hallucinations, and is becoming disruptive. Which manifestation should the nurse report to the healthcare provider immediately? a. Constipation. b. Dry mouth. c. High fever. d. Orthostatic hypotension.

High Fever.

What are children born with Fragile X syndrome more at risk for?

High palate, increased likelihood for middle ear infections, seizures

Patients with cognitive disorders are often unable to carry out their typical or previous role within their family. In addition, they may require anywhere from partial to total assistance in performing basic activities of daily living. These changes can take a toll on a patient's family, forcing loved ones to adopt new roles and assume a greater burden in caring for both the patient and the family in general. As a result, all members of the patient's family are more likely to experience communication problems; increased levels of stress, anxiety, and depression; and financial hardship, among other things.

How might a family's normal processes and interactions be affected when one member is diagnosed with a cognitive disorder? ......

Patients who have been diagnosed with AD might find themselves feeling hopeless, questioning whether a higher power exists and, if so, why it would permit them to be affected by this devastating disease. The same emotions may be experienced by their loved ones. As some patients move toward acceptance of their diagnosis, they may feel an increased need to worship, give thanks, forgive others, seek meaning and purpose in their lives, and leave a lasting legacy, among other things. Their loved ones may help them in pursuing these goals and living out their final days with dignity. Some patients and loved ones, however, may continue to feel spiritually distressed throughout the duration of the disease. Similarly, some family members may struggle to come to grips with the meaning of their loved one's suffering even after the person dies.

How might a patient's spirituality be affected by a diagnosis of AD? How might a patient's diagnosis of AD affect her family and loved ones? ....................

The nurse is admitting a patient with suspected dementia to the mental health unit. Which patient statement should cause the nurse to question that the patient is experiencing manifestations of dementia? a. I have to keep running from the spiders—they are going to eat me. b. I am afraid of having someone with me because they will steal all my money. c. I am so confused now, but I was OK until I had surgery. d. I can't seem to find the toilet; I have soiled myself again.

I am so confused now, but I was OK until I had surgery.

antipsychotic

If Neuroleptic malignant syndrome (NMS) is suspected, _________________ agents are immediately discontinued and the patient is admitted to the intensive care unit (ICU) for supportive care.

What are the limitations of Piaget's theory

Ignores the impact of culture and language on learning

Hallucinations

Imagined sensory experiences

visual processing

Impaired ______________ can result in the inability to accurately read and respond to nonverbal cues. Sometimes these individuals are mistakenly believed to be deliberately demonstrating rude or annoying behaviors.

occupational

Impaired ______________ functioning includes: unemployment and difficulty maintaining a job

The nurse is reviewing Piaget's Stages of Cognitive Development with colleagues. Which statement by a nurse demonstrates an understanding of the preoperational stage? a. In the preoperational stage, the patient is able to think in a systematic and abstract way. b. In the preoperational stage, the patient uses motor and sensory capabilities to explore the environment. c. In the preoperational stage, the patient is unable to see things from another's perspective. d. In the preoperational stage, the patient uses logical reasoning that is limited to concrete problems.

In the preoperational stage, the patient is unable to see things from another's perspective.

Aphasia

Inability to express and understand language

Stage 2 (mod) Alz?

Inability to perform ADLs (meals, clothing), can't live independently, can't recall phone number or address, issues communicating clearly, recent and remote memory impaired, disoriented to time and place, can get lost easily, changes in controlling bladder and bowels, changes in sleep patterns, issues interacting socially, flat affect possible

How does Perfusion relate to cognition?

Inadequate perfusion of brain tissue results in low O2 levels

The nurse is teaching a patient about their new antidepressant drug, a selective serotonin reuptake inhibitor, fluoxetine (Prozac). Which instruction should the nurse include in the teaching? a. Increased risk of suicide. b. Closely monitoring blood sugar levels. c. Getting regular exercise. d. Wearing sunscreen when outside.

Increased risk of suicide.

neuronal death

Individuals with AD show a pattern of degenerative changes related to ________________ throughout the brain. The cells die in a characteristic order, beginning with neurons in the limbic system, including the hippocampus. Damage to this region results in emotional problems and loss of recent memory.

long term

Individuals with ____________ memory problems have difficulty recalling events and learning that occurred in the distant past. Examples include forgetting work skills that were learned 10 years ago or the inability to remember important life events, such as a wedding or the death of a loved one.

short term

Individuals with _______________ memory loss may retain the ability to remember events that occurred 15 years ago but have difficulty recalling something that happened several minutes ago

diabetes

Individuals with schizophrenia are at increased risk for cardiovascular disease, ________________, COPD, and many infectious diseases.

glutamate

Individuals with schizophrenia have been shown to have abnormally low levels of ______________ in the CSF.

motor, sensory

Infants use ____________ and _______________ capabilities to explore the physical environment. Learning is largely trial and error.

How does Inflammation relate to cognition?

Inflammation involves changes in the vascular permeability, which may lead to abnormal brain chemistry

Short term memory

Information held in the brain for immediate use; what an individual has in mind at a given moment.

What are examples of non-modifiable factors of intellectual disability?

Inherited gene disorders Prenatal gene abnormalities Phenylketonuria (PKU)

Downs syndrome shows what impairments?

Intellectual and physical

The nurse is preparing a seminar on developmental disabilities. Which developmental disability should the nurse include as the most prevalent? a. Intellectual disability. b. Dementia. c. Psychosis. d. Learning disability.

Intellectual disability.

proprioceptive

Internal stimuli include _________________ sensations that contribute to motor function and spatial awareness.

Temporal lobe controls:

Interprets auditory and olfactory stimuli

Occipital lobe controls:

Interprets visual stimuli

How is the Cerebrum divided?

Into two hemispheres, and four lobes

Echolalia

Involuntary repetition of sounds

Carphologia

Involuntary, repeated lint picking

carphologia

Involuntary, repeated lint picking

Vascular dementia

Involves brain damage from circulatory problems, mainly stroke

A nurse on the​ medical-surgical unit has identified safety as a priority problem for a client who is in the late stages of Alzheimer disease​ (AD). The client is awake at night and tends to wander. Which priority interventions would the nurse use in the care of this​ client? Select all that apply.

Keep the client​'s room free of clutter. Keep a nightlight on in the room. Place nonskid slippers on the client. Take the client to the bathroom every 2 hours.

Ataxia

Lack of muscle coordination

Alogia

Limited or impoverished speech

The nurse is teaching a patient with a new prescription of a CNS stimulant medication, methylphenidate (Ritalin). The patient asks whether the medication will affect their diabetes. Which response by the nurse is accurate? a. Methylphenidate (Ritalin) can make it more difficult to maintain control over your blood sugar if you have diabetes. b. Methylphenidate (Ritalin) will not affect your blood sugar levels. c. You may need to decrease your dose of insulin a little bit if you are diabetic. d. You should not take methylphenidate (Ritalin) if you are a diabetic.

Methylphenidate (Ritalin) can make it more difficult to maintain control over your blood sugar if you have diabetes.

The nurse is preparing to assess a patient for cognitive impairments. Which tool should the nurse plan to use? a. Mini-Mental State Examination (MMSE). b. Rorschach Inkblot Test. c. Wechsler Adult Intelligence Scale (WAIS). d. Minnesota Multiphasic Personality Inventory (MMPI).

Mini-Mental State Examination (MMSE).

genetic

Most developmental and acquired cognitive disorders have a nonmodifiable _______________ component that predisposes individuals to the development of a specific disorder, such as dementia or schizophrenia.

Life expectancy post dx of Alz?

Most individuals with AD survive between 4 and 8 years after diagnosis; those who are diagnosed at younger ages may live up to two decades

seizures

Most individuals with fragile X syndrome are in generally good health and have a normal lifespan. Still, approximately 15% of affected males and 6-8% of females will experience ________________ and require anticonvulsant medications

epigenetic

Most researchers now agree that external modifications to genes (_____________ factors) must occur in order for schizophrenia to manifest.

Your patient reports feeling that bugs are crawling on his skin; what type of hallucination is this?

Tactile

a ("In the preoperational stage, the patient is unable to see things from another's perspective.")

The nurse is reviewing Piaget's Stages of Cognitive Development with colleagues. Which statement by a nurse demonstrates an understanding of the preoperational stage? a) "In the preoperational stage, the patient is unable to see things from another's perspective." b) "In the preoperational stage, the patient uses logical reasoning that is limited to concrete problems." c) "In the preoperational stage, the patient is able to think in a systematic and abstract way." d) "In the preoperational stage, the patient uses motor and sensory capabilities to explore the environment."

d (Monitor blood pressure three times a week)

The nurse is teaching a patient with Alzheimer disease (AD) and their family regarding a new prescription for an N-Methyl-D-aspartate (NMDA) receptor antagonist. Which information should the nurse provide to the patient and family? a) Notify the healthcare provider of blood in the stool. b) Take this medication only on an empty stomach. c) Decrease dietary fiber intake to prevent diarrhea. d) Monitor blood pressure three times a week.

c ("Methylphenidate (Ritalin) can make it more difficult to maintain control over your blood sugar if you have diabetes.")

The nurse is teaching a patient with a new prescription of a CNS stimulant medication, methylphenidate (Ritalin). The patient asks whether the medication will affect their diabetes. Which response by the nurse is accurate? a) "You should not take methylphenidate (Ritalin) if you are a diabetic." b) "You may need to decrease your dose of insulin a little bit if you are diabetic." c) "Methylphenidate (Ritalin) can make it more difficult to maintain control over your blood sugar if you have diabetes." d) "Methylphenidate (Ritalin) will not affect your blood sugar levels."

d (Encouraging active listening)

The nurse is teaching the parents of a 21-year-old patient recently diagnosed with schizophrenia. Which action assists in decreasing the patient's likelihood of relapse? a) Voicing negative feelings using "you" language b) Providing an environment that stimulates the patient c) Setting limits regarding inappropriate behavior only when needed d) Encouraging active listening

Preoperational; Children 2-7

The nurse watches a 3-year-old child in the hospital playroom take a toy out of another child's hands. Based on the child's behavior, the nurse should understand the child is in which of Piaget's Stages of Cognitive Development?

violence

The nurse's first priority of care should be to provide a safe environment for patients with schizophrenia and prevent them from engaging in _______________ toward self or others.

symptoms

The nurse's second priority should be promoting control of the patient's current ______________ and minimizing the likelihood that additional symptoms will arise. Applicable nursing interventions may include orienting the patient to person and place; avoiding overwhelming or overstimulating the patient; remaining calm and consistent when speaking with the patient; and always informing the patient before touching him.

Poverty of speech

The opposite of pressured speech; identified by the absence of spontaneous speech in an ordinary conversation. The person cannot engage in small talk and gives brief or empty responses.

Hallucinations

The perception of seeing, hearing, or feeling something that is not present in reality.

Dementia

The progressive, irreversible loss of cognitive function

caregiver burden

The psychologic, physical, and financial cost of caring for an individual with a chronic physical or mental illness.

arousal, attention

The reticular activating system, thalamus, and frontal cortex are the structures that are primarily involved in ______________ and __________________

60

The risk of schizophrenia increases incrementally with advancing paternal age as a result of cumulative mutations in sperm. Children born to fathers _____ years old and older have an almost twofold risk of developing the disorder

cognitive

The symptoms of schizophrenia are generally divided into positive, negative, and _____________ types

Piaget's theory:

The theory that cognition is an orderly, sequential process

adaptive behavior

The three categories of _____________________ are conceptual skills (use of language, reading, or telling time), social skills (ability to follow rules and interact appropriately with others) and practical skills (ability to engage in work and perform activities of daily living [ADLs]

finite

The total amount of information that can be managed in short-term memory is also _____________. For example, most research has demonstrated that longer strings of information, such as a sequence of numbers exceeding 5 to 9 digits, cannot be retained

injury, death

The use of physical and pharmacologic restraints in individuals with AD and dementia significantly increases the risk of ___________ and ___________ and is never considered therapeutic.

What environment is beneficial for a pt. with delirium?

Therapeutic- Address client by name, wear readable name tag, have a clock or calendar available, speak clearly and calmly, encourage family visits

antipsychotic

Wearing sunscreen is especially important for patients taking an __________________

BMI > 85th percentile

What BMI is an indicator that a child is overweight?

The nurse can support family members of patients with cognitive alterations by teaching them about healthy forms of stress management; referring them to counselors and support groups; connecting them with appropriate government and community resources; educating them about the realities of the patient's condition; and helping arrange for respite care so that the patient's caregivers can take time for themselves and avoid burnout.

What actions can nurses take to support family members of patients with cognitive alterations?..........

To prevent these issues, the nurse should encourage patients to make their wishes known as early as possible following their diagnosis, before they lose the capacity to do so. This includes describing their preferences for general health care, institutional health care/nursing home admission, and end-of-life care. The patient's preferences should be recorded in an advance directive and/or other legal documentation, and the patient should be encouraged to select someone to make medical decisions on his behalf when he is no longer able to do so (e.g., the patient should designate someone as his power of attorney for healthcare).

What actions might nurses recommend to prevent such issues such as issues of informed consent from arising?

Several measures can help limit a patient's risk of dementia by promoting adequate perfusion. For example, the nurse should encourage lifestyle choices that support better cardiovascular function, such as smoking cessation, regular exercise, weight loss, decreased alcohol intake, and a diet that is low in fat and cholesterol. The nurse should also make sure the patient properly takes all medications prescribed to promote better perfusion and/or cardiovascular health. These may include statins, antihypertensives, vasodilators, adrenergic antagonists, calcium-channel blockers, thrombolytics, and various other drugs.

What measures might you implement when caring for a patient with impaired perfusion to limit the risk of dementia? .........

b (A 22-year-old male diagnosed 1 year ago)

Which patient with schizophrenia is at the greatest risk for suicide? a) A 70-year-old male no longer having auditory hallucinations b) A 22-year-old male diagnosed 1 year ago c) A 65-year-old female on a new medication d) A 35-year-old female who was diagnosed 15 years ago

To help limit the risk of HIV exposure, the nurse should take steps to make sure the patient takes all medications exactly as prescribed. Education about HIV transmission is also critical, as is instruction about safer sex practices. If appropriate, the nurse might refer the patient to community resources that supply condoms and other devices that promote safer sex. Referral to drug counseling and recovery groups may also be appropriate for patients who use illicit drugs. In addition, patients with schizophrenia should receive regular HIV screenings.

What measures might you implement when caring for a patient with schizophrenia to limit the risk of HIV exposure?

Appropriate nursing interventions might include referring the patient and family to pastoral care; encouraging them to voice their spiritual concerns with the nurse and with one another; offering to pray with them or read religious writings to them; respecting and/or validating the patient and family's espoused spiritual beliefs; and encouraging the patient to share stories and leave a lasting legacy while she is still able, among other things.

What nursing interventions might be appropriate for patients and families who are experiencing spiritual distress related to the cognitive and physical alterations associated with AD? .............................

Braden scale

What tool is used to assess if a patient is at risk for developing pressure ulcers?

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common signs and symptoms of fragile X syndrome. Thus, patients with fragile X may benefit from any number of therapies used in the treatment of ADHD, including special educational accommodations; behavioral therapy and behavioral management plans; minimization of environmental distractions; and administration of pharmacologic treatments such as methylphenidate (Ritalin), amphetamine sulfate (Adderall), or atomoxetine (Strattera).

What treatment measures used for patients with ADHD might also be useful for patients with fragile X syndrome? Why? ......

Nursing interventions that can help limit the risk of impaired tissue integrity include frequent position adjustments and help ambulating (as appropriate); regular inspection of the patient's skin; assistance with bathing and other skin care tasks; and removal of environmental hazards that increase the risk of burns, falls, and other tissue injuries.

When caring for the patient with AD, what nursing interventions are appropriate when seeking to limit the risk of impaired tissue integrity? ...............

orientation

When individuals are diagnosed with a cognitive disorder, the goal is to provide care that enables them to achieve their fullest potential, maintain their ________________ to their families and communities, and live in environments that promote their inherent worth and self-efficacy.

B12, metabolic panel

When individuals present with signs and symptoms of AD, the nurse can anticipate standard laboratory tests being ordered, including thyroid-stimulating hormone (TSH), complete blood count (CBC), serum _______, folate, complete ________________, and testing for sexually transmitted infections.

What is the Amyloid hypothesis?

When the brain can't properly process amyloid precursor protein, this incorrect processing leads to short, sticky fragments of APP called beta amyloids, which clump together and create insoluble deposits called amyloid plaques These amyloid plaques damage surrounding neurons!

c (Abnormalities in neurotransmitter function)

Which altered physiological process contributes to the manifestations of schizophrenia? a) Excess activity in the prefrontal cortex b) Increased flow of blood to the brain c) Abnormalities in neurotransmitter function d) Decreased activity of neurons

A, C, D, and E.

Which cognitive alterations are expected as a client grows older? A. Decrease in mental flexibility B. Difficulty with receptive language C. A decrease in multitasking abilities D. A decrease in information processing speed E. A decrease in long-term memory processing

limbic system, reticular activating system, and cerebellum

Which systems play a role in arousal, motivation, emotional regulation, and balance?

Care coordination and case management are especially important because patients with schizophrenia face challenges in multiple areas. For example, they often have difficulty adhering to their treatment program, dealing with stress in a healthy way, engaging in basic self-care, finding a safe place to live, avoiding risky behaviors, and finding and holding a job. One of the best ways to make sure all of these challenges are met is to have a single person or group of people arranging and coordinating all facets of the patient's care.

Why are care coordination and case management especially important for patients with schizophrenia?

Issues of informed consent are often problematic because of the progressive cognitive deterioration associated with AD. As the patient's disease advances, he gradually loses the ability to communicate, plan, reason, and make informed decisions for himself. This leaves the patient's loved ones to make healthcare and end-of-life decisions on his behalf, unless the patient has previously made his wishes known to them.

Why are issues of informed consent often problematic for individuals with AD? ......................

Patients with schizophrenia are at an increased risk for substance abuse and addiction because the reward centers in their brain are functioning at below-normal levels. As a result, they may be compelled to consume large amounts of intoxicating substances in order to achieve feelings of pleasure. For example, patients with schizophrenia have fewer nicotinic receptors in their hippocampus, which makes it harder for them to interpret pleasurable stimuli and make new memories. Many patients unknowingly compensate for this deficiency by smoking. Patients with schizophrenia are also likely to have fewer inhibitions and poorer judgment, and to engage in riskier behavior than unaffected individuals—including drug and alcohol use. In addition, they may reside in or have grown up in environments where substance abuse is prevalent and drugs are easy to find.

Why are patients with schizophrenia more likely to abuse nicotine, alcohol, and illicit drugs? Be sure to explore physical, social, and psychologic factors in your response.

Patients with AD might be at heightened risk of impaired tissue integrity because of impaired mobility, deficits in self-care (especially bathing), and increased difficulty communicating with others (which can make it difficult to report skin and tissue problems to caregivers and nursing staff). Expected impairments during the early to moderate stages of AD include burns, cuts, scrapes, and bruises due to unsteadiness and increased risk of injury, as well as rashes and other issues related to poor personal hygiene. As the disease advances, so does a patient's risk of pressure injuries and bedsores.

Why might patients with AD be at a heightened risk for impaired tissue integrity? What types of impairments would you most expect to see, and during which stages of AD would they most likely occur? ..........

Patients with schizophrenia may be at heightened risk of HIV and AIDS because they are more likely to engage in risky behaviors such as unprotected sex and IV drug use.

Why might patients with schizophrenia be at a heightened risk of HIV infection and AIDS?

Where is the Hippocampus located?

Within the Limbic system

intimate relationships

Young adults with cognitive problems, such as intellectual disabilities or schizophrenia, often struggle to achieve the psychosocial tasks associated with this period of time. Nursing care should consider the patient's need to establish ____________________ and pursue vocational goals.

symbols

Young children (2-7 years) use _____________ (images and language) to explore their environment. Thought is egocentric, and children cannot adopt the perspectives of others.

Family members are questioning a nurse about their​ mother's postoperative confusion. They​ ask, "Is our mother developing dementia from the​ anesthesia? She was thinking so clearly before the​ surgery." Which response by the nurse is the most appropriate to the​ family?

Your mother is experiencing postanesthesia​ delirium, which should clear as soon as she is completely recovered from the​ anesthesia."

A patient's relative asks the nurse whether they should be concerned that their 68-year-old mother, who recently retired, is experiencing memory problems because the mother seems unusually restless and loses her temper frequently. Which response by the nurse is appropriate? a. Your mother should be evaluated for possible cognitive changes. b. Don't worry. Memory loss is a normal part of aging. c. If your mother changes her eating patterns, these symptoms will probably end. d. Your mother will probably return to normal once she has had time to adjust to retirement.

Your mother should be evaluated for possible cognitive changes.

Orthostatic hypotension

____ is a side effect of some conventional antipsychotic medications.

What is Dystonia?

________ is a neurologic movement disorder characterized by sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions.

A patient with Alzheimer's disease (AD) dementia has manifestations of depression. The nurse knows that treatment of the patient with antidepressants will most likely do what? a. Improve cognitive function b. Not alter the course of either condition c. Cause interactions with the drugs used to treat the dementia d. Be contraindicated because of the central nervous system (CNS)-depressant effect of antidepressants

a. Depression is often associated with AD, especially early in the disease when the patient has awareness of the diagnosis and the progression of the disease. When dementia and depression occur together, intellectual deterioration may be more extreme. Depression is treatable and use of antidepressants often improves cognitive function.

Naloxone (Narcan) is administered to a client with severe respiratory depression and suspected drug overdose. After 20 minutes, the client remains unresponsive. The most likely explanation for this is: a.) The client did not use an opioid drug. b.) The dose of naloxone was inadequate. c.) The client is resistant to this drug. d.) The drug overdose is irreversible.

a.) The client did not use an opioid drug. If opioid antagonists (Naloxone) fail to reverse symptoms of respiratory depression quickly, the overdose was likely due to a non-opioid substance.

What is the Tau Hypothesis?

abnormal tau proteins that join and twist, forming neurofibrillary tangles ( thick, insoluble clots of protein) instead of the microtubule network necessary for cellular survival

A patient with moderate AD has a nursing diagnosis of impaired memory related to effects of dementia. What is an appropriate nursing intervention for this patient? a. Post clocks and calendars in the patient's environment. b. Establish and consistently follow a daily schedule with the patient. c. Monitor the patient's activities to maintain a safe patient environment. d. Stimulate thought processes by asking the patient questions about recent activities

b. Adhering to a regular, consistent daily schedule helps the patient to avoid confusion and anxiety and is important both during hospitalization and at home. Clocks and calendars may be useful in early AD but they have little meaning to a patient as the disease progresses. Questioning the patient about activities and events they cannot remember is threatening and may cause severe anxiety. Maintaining a safe environment for the patient is important but does not change the disturbed thought processes.

Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries but is experiencing disabling anxiety in the aftermath of the event. The most appropriate crisis intervention with Amanda would be to a. encourage her to recognize how lucky she is to be alive. b. discuss stages of grief and feelings associated with each. c. identify community resources that can help Amanda. d. suggest that she find a place to live that provides a storm shelter.

b. discuss stages of grief and feelings associated with each.

The early stage of AD is characterized by a. no noticeable change in behavior. b. memory problems and mild confusion. c. increased time spent sleeping or in bed. d. incontinence, agitation, and wandering behavior.

b. memory problems and mild confusion. Rationale: An initial sign of AD is a subtle deterioration in memory.

During assessment of a patient with dementia, the nurse determines that the condition is potentially reversible when finding out what about the patient? a. Has long-standing abuse of alcohol b. Has a history of Parkinson's disease c. Recently developed symptoms of hypothyroidism d. Was infected with human immunodeficiency virus (HIV) 10 years ago

c. Hypothyroidism can cause dementia but it is a treatable condition if it has not been long standing. The other conditions are causes of irreversible dementia.

Which of the following is a correct assumption regarding the concept of crisis? a. crises occur only in individuals with psychopathology. b. the stressful event that precipitates crisis is seldom identifiable. c. a crisis situation contains the potential for psychological growth or deterioration. d. crises are chronic situations that recur many times during an individuals's life.

c. a crisis situation contains the potential for psychological growth or deterioration.

A patient has a history of suicidal ideation. The nurse understands that the patient is at highest risk for self-harm at which of the following times? a. Immediately after a family visit b. On the anniversary of significant life events in the patient's life c. During the first few days after admission d. Approximately 2 weeks after starting antidepressant medication

d. Approximately 2 weeks after starting antidepressant medication

A 68-year-old man is admitted to the emergency department with multiple blunt trauma following a one-vehicle car accident. He is restless; disoriented to person, place, and time; and agitated. He resists attempts at examination and calls out the name "Janice." Why should the nurse suspect delirium rather than dementia in this patient? a. The fact that he wouldn't have been allowed to drive if he had dementia b. His hyperactive behavior, which differentiates his condition from the hypoactive behavior of dementia c. The report of emergency personnel that he was noncommunicative when they arrived at the accident scene d. The report of his family that although he has heart disease and is "very hard of hearing," this behavior is unlike him

d. Delirium is an acute problem that usually has a rapid onset in response to a precipitating event, especially when the patient has underlying health problems, such as heart disease and sensory limitations. In the absence of prior cognitive impairment, a sudden onset of confusion, disorientation, and agitation is usually delirium. Delirium may manifest with both hypoactive and hyperactive symptoms.

Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. What is this type of crisis called? a. crisis resulting from traumatic stress b. dispositional crisis. c. psychiatric emergency. d. maturational or developmental crisis.

d. maturational or developmental crisis.

What is the cholinergic Hypothesis?

lowered levels of acetylcholine (a cholinergic neurotransmitter) appeared to produce memory deficits

Medium potency first generation antipsychotics

loxapine perphenazine

neologisms

made up words

waxy flexibility

maintaining a specific position for an extended period of time

waxy flexibility

maintaining whatever position the individual is placed in

What is the Premorbid phase?

manifestations occurring in childhood include a number of nonspecific emotional, cognitive, and motor delays that have been identified in individuals who went on to develop schizophrenia

clang association

meaningless rhyming of words

schizoaffective disorder

meets criteria for both schizophrenia and depressive or bipolar disorder

Bradykinesia

slow movement

Olanzapine

smoking dec the effect

acute dystonia

spasms of tongue, face, neck, and back

Neurotransmitters

specialized chemicals that carry electrical impulses between neurons