Prep U's - Chapter 31 - Mental Health Disorders of Older Adults

The adult child of a client with dementia asks the nurse if the client will ever be able to live independently again. Which is the most appropriate response by the nurse? A. "Symptoms of dementia gradually get worse. The client will not be independent again." B. "You sound like you aren't ready for the client to be dependent on caregivers." C. "With early treatment, mild dementia can be reversed with the administration of medication." D. "The client's confusion is a temporary complication of the physical illness and will subside."

Answer: A Rationale: The prognosis for dementia involves progressive deterioration of physical and mental abilities until death. Typically, in the later stages, clients have minimal cognitive and motor function, are totally dependent on caregivers, and are unaware of their surroundings or people in the environment. Delirium secondary to physical illness will subside with physical recovery. Saying "You sound like you aren't ready for the client to be dependent on caregivers" does not address the family member's specific question. Medication may prolong the early phase of dementia but does not stop the progressive decline.

An older client transferred from a nursing home presents to the emergency department in an agitated state. The nurse is unable to obtain a coherent response to any questions posed. What is the best nursing action? A. Review medication profile record. B. Sedate the client with medication. C. Place the client in restraints to maintain safety. D. Make sure all side rails are up.

Answer: A Rationale: At the present time, additional information is needed to determine whether the older client is experiencing delirium or dementia; therefore, the priority would be to review the medication profile record to see if any prescribed medications are causing delirium. Although the client is agitated, there is insufficient evidence for the use of restraints and using them could cause the confusion to worsen. Making sure that all side rails are up is a form of a restraint. Sedating the client with medication may eventually be needed. but it is not the priority action. The nurse must identify the cause of confusion and agitation prior to using medications.

A family member is the primary caregiver to a client with dementia who states, "This is so overwhelming. I want to do the right thing, but I have no life." Which statement by the nurse would be most appropriate? A. "Spending some time relaxing and doing what you like to do will help you manage the demands of caregiving." B. "Be glad that you still have your family member around and you are able to care of them." C. "Does your family not know what situation you are in? Tell them you need help with caregiving?" D. "Most caregivers seek help when they really need it so this is something to consider."

Answer: A Rationale: Caregivers who are rested, are happy, and have met their own needs are better prepared to manage the rigorous demands of the caregiver role. Most caregivers need to be reminded to take care of themselves; this act is not selfish but really is in the client's best long-term interests. The nurse informing the caregiver that most seek help does not provide them with the needed tools to resolve the issues. Telling the caregiver that they should be grateful will only increase the caregiver's sense of guilt, which is not productive. It is inappropriate for the nurse to blame the individual's family.

The most effective intervention for clients with delirium is which of the following? A. Managing environmental stimuli. B. Giving detailed explanations. C. Providing activities for distraction. D. Promoting rest with PRN medications.

Answer: A Rationale: Clients with delirium become overstimulated easily; their ability to process environmental stimuli is impaired.

When assessing a client with dementia, the nurse notes that the client is having difficulty identifying common items, such as a ball or book. The nurse interprets this finding as what? A. Agnosia B. Aphasia C. Disturbance of executive function D. Apraxia

Answer: A Rationale: The client's difficulty in identifying objects is considered agnosia. With dementia, typical deficits include aphasia (alterations in language ability), apraxia (impaired ability to execute motor activities despite intact motor functioning), agnosia (failure to recognize or identify objects despite intact sensory function), or a disturbance of executive functioning (ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior).

When describing the dementia associated with Huntington disease, a nurse understands that the problems involving behavior and attention arise from a disruption in which lobe of the brain? A. Frontal B. Parietal C. Occipital D. Temporal

Answer: A Rationale: The dementia syndrome of Huntington disease is characterized by insidious changes in behavior and personality. Typically, the dementia is frontal, which means that the person demonstrates prominent behavioral problems and disruption of attention.

The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which of the following interventions should the nurse implement first? A. Move the client to a quieter area during these times. B. Administer an antianxiety drug such as lorazepam (Ativan) at these times. C. Explain the unit routine and the reasons for increased activity to the client. D. Keep unit activity to a minimum.

Answer: A Rationale: The nurse must alter the environment because the client will not learn new coping skills for frustrating or overly stimulating situations. Administering an antianxiety agent or explaining the routine of the unit and reasons for increased activity to the client may be done but would not be the initial intervention. The unit activity does not need to be kept to a minimum.

The nurse is reviewing the medication profile for an older client who is being evaluated for possible dementia. Which medication(s) could impair the client's cognitive status? Select all that apply. A. cimetidine B. theophylline C. warfarin D. digoxin E. acetaminophen

Answer: A, B, C, D Rationale: There are several medications that can have anticholinergic effects that in the presence of dementia can lead to an increased impact on cognitive status. Medications such as warfarin, digoxin, theophylline, and cimetidine should be reviewed both for clinical indication and dosages. Aspirin rather than acetaminophen can be a concern.

A nurse is working with an older client who reports feelings of hopelessness since their spouse passed recently. Which finding(s) would require immediate referral action? Select all that apply. A. Client has recently been diagnosed with end-stage renal disease (ESRD). B. Client has few available support systems. C. Client is receiving meals on wheels on a daily basis. D. Client states nothing is joyful anymore. E. Client keeps mementos of loved one in the bedroom.

Answer: A, B, D Rationale: An older client is at increased risk for suicide due to a multitude of factors. Because this client has experienced a recent loss, been diagnosed with a chronic disease (ESRD), has few support systems, and states that nothing is joyful anymore, the nurse should act and provide immediate referrals to help support the client. Keeping mementos of a loved one and receiving meals on wheels as nutritional support is an appropriate response.

An older client has recently finished treatment for a urinary tract infection (UTI) and has now developed changes in behavior resulting in decreased cognition. Which priority intervention(s) should the nurse perform? Select all that apply. A. Contact the health care provider. B. Obtain a repeat urine culture. C. Obtain an order for sedation. D. Maintain adequate hydration. E. Stop the prescribed antibiotic therapy.

Answer: A, B, D Rationale: Because the older client has finished treatment for the UTI, there is no need for the nurse to stop the prescribed antibiotic therapy. It would be important for the nurse to contact the health care provider and appraise them of the client's present cognitive status. Maintaining adequate hydration is also a priority, as is obtaining a repeat urine culture to make sure that the UTI has resolved and to rule out dehydration. There is no need to sedate the client as they are already experiencing decreased cognition.

The nurse is performing a history and physical assessment for a client in the clinic with moderate dementia. When asking questions, the client gets agitated and asks the nurse why are all of these questions being asked. Which is the best action(s) for the nurse to take to obtain the data needed? Select all that apply. A. Provide simple explanations to the client as often as required. B. If the client does not respond to a question, continue to ask until answered. C. Take frequent breaks during the interview process. D. Ask simple questions instead of compound questions. E. Give the client ample time to answer the questions asked.

Answer: A, C, D, E Rationale: The assessment process may seem confusing and complicated to clients with dementia. They may not know or may forget the purpose of the interview. The nurse provides simple explanations as often as clients need them, such as "I'm asking these questions so the staff can see how your health is." Clients may become confused or tire easily, so frequent breaks in the interview may be needed. It helps to ask simple rather than compound questions and to allow clients ample time to answer. If the client does not respond to a question, ask a different question or take a break and come back to it later.

A nurse is providing education to the care provider of a cognitively impaired client who is prescribed a cholinesterase inhibitor. Which information about medication side effects should the nurse be sure to include? A. Bruising B. Gastrointestinal (GI) symptoms C. Skin rashes D. Syncope

Answer: B Rationale: All four of the commonly prescribed cholinesterase inhibitors have the possibility of producing GI symptoms.

A client diagnosed with Alzheimer's disease has an alteration in language ability. This alteration would be documented as what? A. Akinesia B. Aphasia C. Agnosia D. Apraxia

Answer: B Rationale: Aphasia is an alteration in language ability. Agnosia is the failure to recognize or identify objects despite intact sensory function. Apraxia is impairment in the ability to execute motor activities despite intact motor functioning. Akinesia is impaired muscle movement that may occur in Parkinson's disease.

The adult child of a client with dementia has been the primary caregiver for 5 months. The adult child expresses to the nurse, "At times it is so overwhelming! I feel I do not have a life anymore!" Which is the most therapeutic response by the nurse? A. "I know it is really hard. It takes a lot of work, and you are doing such a good job." B. "Here is the number of a caregivers' support group. Will you talk with others in the same situation?" C. "Are you saying you don't want to care for your parent anymore?" D. "Your parent really appreciates what you do. You are the best one to care for your parent."

Answer: B Rationale: Caregivers need outlets for dealing with their own feelings. Support groups can help them express frustration, sadness, anger, guilt, or ambivalence; all these feelings are common. The nurse should not conclude that the adult child does not want to care for their parent or induce additional guilt. Affirming the adult child can be beneficial, but this does not offer solutions to the their crisis.

The nurse can distinguish delirium from dementia by knowing which of the following? A. Dementia has an acute onset and can be resolved. B. Dementia has a gradual onset and is progressive in course. C. Delirium has a gradual onset and can be resolved. D. Delirium has an acute onset and is progressive in course.

Answer: B Rationale: Delirium has a sudden onset and the underlying cause is treatable; by contrast, dementia has a gradual onset and is progressive rather than treatable.

Delirium can be differentiated from many other cognitive disorders in which way? A. It is much less responsive to pharmacologic treatment than the other disorders. B. It has a rapid onset and is highly treatable if diagnosed quickly. C. It is characterized by a period of disorganization and confusion. D. It has as a slow onset, but if caught early it can be treated with medications.

Answer: B Rationale: Delirium often is caused by an acute disruption of brain homeostasis. When the cause of that disruption is eliminated or subsides, the cognitive deficits usually resolve within a few days or sometimes weeks. Dementia, in contrast, results from primary brain pathology that usually is irreversible, chronic, progressive, and less amenable to treatment.

The nurse provides care to an older adult client who presents with somatic symptoms and a poor appetite. Which mental health disorder does the nurse assess this client for based on the presenting symptoms? A. dysfunctional grief B. depression C. anxiety D. bipolar disorder

Answer: B Rationale: Depression is one of the most common mental disorders of older adults. Because depression can be debilitating and can lead to suicide, recognition and early intervention are the keys to avoiding ongoing depressive episodes. Depressive symptoms among older adults are more likely to include vague somatic concerns, cognitive symptoms, hypersomnia, and appetite changes rather than reports of depressed mood. Without additional data, it is not appropriate for nurse to assess the client for anxiety, bipolar disorder, and dysfunctional grief.

A 35-year-old client is delirious after being lost in the woods for several days and becoming severely dehydrated. At 9 p.m. the client tells the nurse to get the client's clothes because the client has to get home to the client's family. Which response by the nurse is most therapeutic? A. "It's time to sleep now; you can see your family in the morning." B. "You're in the hospital. You did not drink for several days, but you're getting better now." C. "Your family is fine. You need to take care of yourself now." D. "We don't have your clothes; they are at home. You'll be going home when you recover."

Answer: B Rationale: Staff members can try to direct the client's activity and cognitive focus by reorienting the client to the environment with displays of calendars, clocks, and decorations commemorating upcoming holidays. Therapeutic communications concerning the day's activities, repetition of facts concerning why the client is hospitalized, and reassurance that the hallucinations and delusions experienced are part of the transient condition of delirium are helpful.

The nurse understands that clients with neurocognitive disorders often experience visuospatial confusion as their diseases progress. Which measure should be undertaken to maximize clients' safety and independence when navigating an inpatient facility? A. Provide clients with a guided tour of the entire facility during admission. B. Place items for the activity or action in the correct sequence. C. Encourage clients to ask staff members for directions when they are spatially disoriented. D. Ensure there is always a wheelchair available if the client wants to ambulate.

Answer: B Rationale: The client with visuospatial impairments loses the ability to sequence automatic behaviors, such as getting dressed or eating with silverware. For example, clients often put their clothes on backward, inside out, or with undergarments over outer garments. After they are dressed, they become confused as to how they arrived at their current state. If this happens, it may help to place clothes for dressing in a sequence for the client so he or she can move from one article to the next in the correct sequence. This same technique can be used in other situations, such as eating, bathing, and toileting. Visuospatial deficits do not necessarily indicate that the client must mobilize using aids. This is dependent on the individual client's assessed mobility and should not be the standard for all clients with dementia. Due to memory involvement, guided tours and asking for directions may not be helpful.

What is the primary sign of delirium? A. Impaired socialization B. An altered level of consciousness C. Disturbed sleep-wake cycles D. Inability to fulfill roles.

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

A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client is restless, approaches the nurse, and states, "I'm going to take a walk outside. I'll be back in about 10 minutes." Which is the most appropriate nursing action? A. Give the client permission to go on a walk on the grounds. B. Designate a staff member to accompany the client on the walk. C. Further assess the client's motives for wanting to walk. D. Tell the client the walk is not allowed and restrict the client to the unit.

Answer: B Rationale: The principal means of dealing with restless patients is to have an adequate number of staff (or caregivers in the home setting) to provide supervision, as well as electronically controlled exits. The nurse teaches clients to request assistance for activities, such as getting out of bed or going to the bathroom. If clients cannot request assistance, they require close supervision to prevent them from attempting activities they cannot perform safely alone. The nurse responds promptly to calls from clients for assistance and checks clients at frequent intervals. There is no need to suspect a client's motives for wanting to walk. It would be inappropriate and unnecessary to deny the client a walk unless it was the only way to ensure the client's safety.

A client has experienced a gradual flattening of affect, confusion, and withdrawal and has been diagnosed with Alzheimer's disease. Which additional findings would the nurse most likely assess? A. Tremors, unsteady gait, and transient paresthesias. B. Uncharacteristic use of illicit substances and alcohol. C. Personality change, wandering, and inability to perform purposeful movements. D. Transient blindness, slurred speech, and weakness.

Answer: C Rationale: Alzheimer's disease is not typically characterized by delusions, transient paresthesias, blindness, or slurred speech. Instead, general changes in personality, wandering, and the inability to perform purposeful, goal-directed movements are impaired.

A client is in the mild stage of dementia due to Alzheimer's disease. Which intervention would be most appropriate? A. Advocating for the client to be transitioned to a care home. B. Offering nourishing finger foods to help maintain the client's nutritional status. C. Providing emotional support and gentle reminders. D. Suggesting new activities for the client and family to do together.

Answer: C Rationale: Clients in the mild stage of Alzheimer's disease are aware that something is happening to them and may become forgetful, have difficulty finding words, frequently lose objects and begin to experience some anxiety regarding the forgetfulnes. Therefore, nursing care typically focuses on providing emotional support and gentle reminders. The other options are appropriate as the dementia progresses and the client needs continuous monitoring to prevent injuries and when maintaining adequate nutrition may become a challenge. During the later stages, the client will likely need to be moved to a care home to ensure the client is safe and can meet the activities of daily living. At this point, adequate nutrition can only be ensured by having the client monitored throughout the day, providing additional support for the decision to move the client to a care home.

During morning care, unlicensed assistive personnel (UAP) ask a client with dementia, "How was your night?" The client replies, "It was lovely. My spouse and I went out to dinner and to a movie." The nurse, who overhears this conversation, would make which assessment regarding the client? A. The client is perseverating. B. The client is delirious. C. The client is using confabulation. D. The client is demonstrating a sense of humor.

Answer: C Rationale: In mild and moderate dementia, clients may make up answers to fill in memory gaps (confabulation). It is a defensive tactic to protect self-esteem and prevent others from noticing memory loss. The client's response was not given facetiously, so it cannot be assessed as an attempt at humor. Perseveration refers to repeating a word or phrase over and over, and delirium is a less likely cause because the client has a known diagnosis of dementia.

A group of nursing students is reviewing information about delirium and its causes. The students demonstrate a need for additional review when they identify which as a cause of this medical condition? A. Medications B. Electrolyte imbalance C. Oxidative stress D. Infection

Answer: C Rationale: Oxidative stress is associated with dementia. The etiology of delirium is complex and multifaceted. Delirium is associated with medications, infections, fluid and electrolyte imbalance, metabolic disturbances, or hypoxia or ischemia. The probability of the syndrome developing increases if certain predisposing factors, such as advanced age, brain damage, or dementia, are also present. Sensory overload or underload, immobilization, sleep deprivation, and psychosocial stress also contribute to delirium.

The nurse manager in a long-term care facility is managing the environment to give optimal care to clients with dementia. Which will the nurse include when improving the living environment? A. Open the windows and doors to allow fresh air to circulate through the environment. B. Assign peer-led exercise activities on a daily basis. C. Plan for the same staff to provide care to individuals as much as possible. D. Provide a buffet-style menu with many food choices for the clients.

Answer: C Rationale: Providing the same caregiver establishes familiarity and routine and can provide reassurance to clients with dementia. Open doors pose a safety risk of wandering away. Buffet-style meals require the client to make too many choices, thus adding to frustration. Clients are often quite willing to participate in physical activities but cannot initiate, plan, or carry out those activities without assistance.

The client has early Alzheimer's disease. When asked about family history, the client relates that the client has two children who are both grown and who visit the client around the holidays each year. The nurse subsequently discovers that the client has one child who is currently assigned overseas and who has not been home for 2 years. Which would best describe the client's behavior? A. The client is confused about the client's children and needs refocusing. B. The client demonstrates aphasia when discussing the client's children. C. The client is confabulating, most likely to cover for memory deficit. D. The client is showing signs of agnosia in that the client is unable to name the client's children.

Answer: C Rationale: The client may have some difficulty recalling events or knowledge that the client formerly knew to be fact. Because of the inability to recall recent events, the client may be confabulating, or filling in memory gaps with fabricated or imagined data.

The diagnosis of delirium is supported when the nurse notes what about the client? A. The client repeatedly asks where the client is and attempts to drink the water in a flower vase. B. The client spends much of the day sleeping in the dayroom and usually denies being hungry. C. The client reports seeing "hundreds of bugs" and is not always oriented to time and place. D. The client responds to most assessment questions with "I don't know" and appears apathetic.

Answer: C Rationale: The diagnosis of delirium is supported when the nurse documents that the client is convinced that the client sees hundreds of bugs and is not always oriented to time and place. Repeatedly asking about location and attempting to drink the water in a flower vase are more characteristic of dementia than delirium. Spending much of the day sleeping in the dayroom and usually denying being hungry are more representative of depression, as are responding to most assessment questions with "I don't know" and appearing apathetic.

A nurse working with an older client whose family is concerned about the present living arrangements asks the nurse about placement in an assisted living facility (ALF). The older client maintains the ability to perform ADLs in the present residence and wants to stay. What is the best nursing response? A. Tell the family that legal action can be taken to help facilitate the move to an ALF. B. Discuss the benefits versus disadvantages of such a move with the entire family. C. Explore options that may allow the older adult client to remain in the residence. D. Have the family reconsider their decision and talk with other family members.

Answer: C Rationale: The issue of legal issue of competency for an older adult is the threshold for determination of care. At this time, the older adult client is able to perform ADLs in the present residence, which indicates the ability to perform self-care. However, the family is concerned, and the nurse should facilitate a discussion of options that may enable the older adult client to remain in the residence, such as community support/health insurance services. Although a discussion with other family members may be needed, the priority is to look at available options rather than act on a decision that is not supported by the older adult client. Discussion of benefits versus advantages may also be needed, but the priority at this time is to keep the older adult client in the residence so that quality of life can be maintained.

Which is the primary treatment for delirium? A. Maintain intravenous fluid administration. B. Apply physical restraints. C. Identify and treat any causal or contributing medical conditions. D. Provide adequate nutritional food and fluid intake.

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

Which nursing diagnosis would be the priority for the client experiencing acute delirium? A. Risk for self-mutilation related to confusion and cognitive deficits. B. Fall precautions related to acute confusion. C. Acute confusion related to delirium of known/unknown etiology. D. Risk for injury related to confusion and cognitive deficits.

Answer: D Rationale: The plan of care must be deliberately designed to meet the client's unique needs, with safety always being the nurse's highest priority. Risk for injury is a NANDA diagnosis and the etiology of confusion and cognitive deficits are factors that can be modified through nursing care.

A client with dementia gets angry and begins to yell at the nurse during mealtime in the dining area. Which is the best action by the nurse? A. Remove the client from the dining area until they have calmed down. B. Inform the client that they are not to speak to someone in that manner. C. Step away from the client for 5 to 10 minutes and then return. D. Administer antianxiety medication to the client.

Answer: C Rationale: Time-away involves leaving clients for a short period and then returning to them to reengage in interaction. The nurse can leave the client for about 5 or 10 minutes and then return without referring to the previous outburst. The client may have little or no memory of the incident and may be pleased to see the nurse on return. Medication for anxiety is not warranted at this time and may anger the client further at the attempt. The client does not need to be removed from the area since they are not harming anyone and they need the nutrition from their meal. Correcting the client at this point is futile since they will likely have no memory of the behavior to make the change.

Which type of hallucination is most commonly seen in clients diagnosed with delirium? A. Autonomic B. Gustatory C. Visual D. Auditory

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

A nurse's aide has rung the call light for assistance while providing a client's twice-weekly bath because the client became agitated and aggressive while being undressed. Knowing that the client has a diagnosis of Alzheimer's disease and is prone to agitation, which measure may help in preventing this client's agitation? A. Reinforcing the facility's zero-tolerance policy for aggressive behavior. B. Providing all of the client's daily medications early on the day of a scheduled bath. C. Decreasing the frequency of the client's baths from two times to one time per week. D. Reminding the client multiple times that he or she will be soon having a bath.

Answer: D Rationale: Adequately preparing a client for a task can sometimes prevent episodes of agitation or aggression. Reminding a cognitively impaired client about policies is unlikely to be effective, and decreasing the frequency of baths will not necessarily prevent agitation. It is not normally appropriate to change a client's medication administration schedule in light of activities such as bathing.

A client has been diagnosed with dementia and is exhibiting several cognitive disturbances. Which of the following terms is used to describe the inability to execute motor functioning despite intact motor abilities? A. Executive functioning B. Aphasia C. Agnosia D. Apraxia

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

During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium? A. Difficulty with verbal expression. B. Persistent depressed mood. C. Disorientation to person. D. Belief that a water pitcher is another object.

Answer: D Rationale: Clients with delirium have difficulty paying attention and are easily distracted; are often disoriented to place and time, but rarely to person; experience sudden mood swings that may range from fear to euphoria; and may have sensory disturbances such as illusions, misinterpretations, or hallucinations (they may believe a water pitcher is another object). Beyond the hallmark problems with memory, dementia symptoms include aphasia (deterioration of language function); apraxia (impaired ability to execute motor functions despite intact motor abilities); and agnosia (inability to recognize or name objects despite intact sensory abilities). Disorientation to place, time, and person are associated with dementia.

A client is diagnosed with Alzheimer's disease. While assessing the client, the nurse notes that the client has trouble identifying objects such as a key and spoon. The nurse would document this as what? A. Aphasia B. Disturbance of executive function C. Apraxia D. Agnosia

Answer: D Rationale: Deficits typically assessed in clients with Alzheimer's disease include: aphasia (alterations in language ability), apraxia (impaired ability to execute motor activities despite intact motor functioning), agnosia (failure to recognize or identify objects despite intact sensory function), or a disturbance of executive functioning (ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior).

The nurse receives a report that a 75-year-old client is recovering from surgery. During the shift, the nurse notes that the client is forgetful and restless. Several times, the client calls the nurse the name of the client's daughter. The nurse interprets this behavior as what? A. Normal, given the client's age. B. Normal for the first postoperative day. C. Signs of early Alzheimer's disease. D. Signs of delirium.

Answer: D Rationale: Delirium is a syndrome characterized by a rapid onset of cognitive dysfunction and disruption in consciousness. Growing rates of delirium mirror the increasing older adult population and are expected to continue to rise. Delirium is the most common psychiatric syndrome in general hospitals, occurring in up to 50% of elderly inpatients. It is associated with significantly increased morbidity and mortality both during and after hospitalization.

Which of these is a N-methyl-D-aspartic acid (NMDA) receptor antagonist? A. Galantamine B. Donepezil C. Rivastigmine D. Memantine

Answer: D Rationale: Memantine is a NMDA receptor antagonist that has been shown to improve cognition and activities of daily living in clients with moderate to severe symptoms of dementia. Galantamine, donepezil, and rivastigmine are cholinesterase inhibitors.

Which food should the nurse include in the plan of care for an older adult client as part of a healthy lifestyle to prevent illness and promote well-being? A. steak B. hamburger C. potatoes D. apples

Answer: D Rationale: The inclusion of fruits and vegetables in the older adult client's diet is part of a healthy lifestyle to prevent illness and promote well-being; therefore, apples are the food that the nurse includes in this client's plan of care. Although the other foods may be included as part of a healthy diet for the older adult client, these foods do not specifically prevent illness and promote well-being.