Videbeck Chapter 24: Cognitive Disorders

Study Guide CLINICAL EXAMPLE 2. What nursing diagnoses would the nurse identify for this client?

Chronic confusion, impaired socialization, disturbed sleep pattern, self-care deficits, and risk for imbalanced nutrition: less than body requirements

Study Guide CLINICAL EXAMPLE 3. Write an expected outcome and at least two interventions for each nursing diagnosis.

The client will experience as little frustration as possible. Interventions: Point out objects, people, and the time of day to prompt the client and decrease confusion. Do not ask the client to make decisions when she is unable to; offer choices only when she can make them. The client will interact with the nurse. The client will participate in going for a walk with the group. Interventions: Involve the client in solitary activities with the nurse initially. Structure group activities that focus on intact physical abilities rather than those requiring cognition. The client will eat 50% of meals and snacks. Interventions: Provide foods the client likes, and provide those foods in an environment where she will be likely to eat, such as her room or a table alone. The client will sleep 6 hours per night. Interventions: Provide a soothing nighttime routine every night (e.g., offering a beverage, reading aloud, dimming lights). Decrease stimulation after dinner, and discourage daytime naps. The client will participate in hygiene routines with assistance. Interventions: Try to imitate the client's home hygiene routine (bath or shower, morning or evening), and develop a structured routine for hygiene.

Study Guide CLINICAL EXAMPLE Martha Smith, a 79-year-old widow with Alzheimer's disease, was admitted to a nursing home. The disease has progressed during the past 4 years to the point that she can no longer live alone in her own house. Martha has poor judgment and no short-term memory. She had stopped paying bills, preparing meals, and cleaning her home. she had become increasingly suspicious of her visiting nurse and home health aide, finally refusing to allow them in the house. After her arrival at the facility, Martha has been sleeping poorly and frequently wanders from her room in the middle of the night. She seems agitated and afraid in the dining room at mealtimes, is eating very little, and has lost weight. If left alone, Martha would wear the same clothing day and night and would not attend to her personal hygiene. 1. What additional assessments would the nurse want to make to plan care for this client?

What does she like to eat? What were her usual personal hygiene practices? What are her favorite activities? What personal items does she value?

NCLEX-Style Chapter Review Questions 10. Which of the following would not be considered a primary goal of nursing care for a client with delirium? a. Meeting their physiological and psychological needs b. Achievement of self-esteem needs c. Protection from injury d. Management of confusion

b Achievement of self-esteem needs would not be a primary goal of nursing care for the client diagnosed with delirium. All other options would be primary goals.

Study Guide MULTIPLE-CHOICE QUESTIONS 7. Which of the following interventions is most appropriate in helping a client with early-stage dementia complete ADLs? a. Allow enough time for the client to complete ADLs as independently as possible b. Provide the client with a written list of all the steps needed to complete ADLs. c. Plan to provide step-by-step prompting to complete the ADLs. e. Tell the client to finish ADLs before breakfast or the nursing assistant will do them.

a Allow enough time for the client to complete ADLs as independently as possible.

Study Guide MULTIPLE-CHOICE QUESTIONS 8. A client with late moderate-stage dementia has been admitted to a long-term care facility. which of the following nursing interventions will help the client to maintain optimal cognitive function? a. Discuss pictures of children and grandchildren with the client. b. Do word games or crossword puzzles with the client. c. Provide the client with a written list of daily activities. d. Watch and discuss the evening news with the client.

a Discuss pictures of children and grandchildren with the client.

NCLEX-Style Chapter Review Questions 28. The nurse should consider the intervention referred to as "going along with" when managing the care of which client? a. the older widower who is worried about his wife not being able to visit because of the snow b. the adolescent who is hitting and biting because he or she was given time out for disobeying unit rules c. the middle-aged adult who is convinced that the electrical cords are really snakes d. the young adult who is expressing concern about the "police being aliens"

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

NCLEX-Style Chapter Review Questions 11. Which of the following is an infection-related cause of delirium? a. Pneumonia b. Sleep Deprivation c. Lithium toxicity d. Renal failure

a Infection-related causes of delirium include pneumonia, sepsis, UTI, and meningitis. Lithium toxicity is a drug-related cause. Renal failure and sleep deprivation are physiologic causes.

NCLEX-Style Chapter Review Questions 13. Which of the following medications is not known to cause delirium? a. Loop Diuretics b. Nacrotics c. Steroids d. Antidepressants

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

NCLEX-Style Chapter Review Questions 8. Which of the following medications, used to treat dementia, requires a liver function test every 1 to 2 weeks? a. Tacrine (Cognex) b. Donepezil (Aricept) c. Glalantamine (Reminyl) d. Rivastigmine (Exeolon)

a Tacrine (Cognex) requires a liver function tests every 1 to 2 weeks.

NCLEX-Style Chapter Review Questions 17. A woman in her fifties has contacted her care provider because of concerns for her husband, who has suddenly begun behaving uncharacteristically in recent days. Most recently, he became lost while driving to his home of 30 years and temporarily forgot his son's name. Diagnostic testing has ruled out delirium and he had been previously health. What is the most likely cause of the husband's cognitive changes? a. Vascular demential b. Wernicke's encephalopathy c. Dementia of Alzheimer's type (DAT) d. Dementia with Lewy bodies (DLB)

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

NCLEX-Style Chapter Review Questions 27. A client demonstrates an understanding about the risk factors for developing dementia when engaging in which health promotion activities? Select all that apply. a. eating a diet that provides sufficient amounts of B vitamines b. exercise at the gym 3 times a week c. doesn't smoke or drink alcohol d. regularly reads fictional novels for entertainment

a, b, d, e People who regularly participate in brain-stimulating activities such as reading books and newspapers or doing crossword puzzles are less likely to develop Alzheimer's disease than those who do not. Engaging in leisure-time physical activity during midlife and having a large social network are associated with a decreased risk for Alzheimer's disease in later life. In addition, healthy eating habits, physical activity, and minimizing health risks help to decrease or delay cognitive decline. Because folate, vitamin B 12, and betaine are known to reduce plasma homocysteine levels, potential therapeutic strategies using these substances may modify or diminish the risk for dementia. While positive health promotion activities, neither smoking or alcohol consumption has been directly associated with the development of dementia.

NCLEX-Style Chapter Review Questions 22. The nurse is caring for a client with delirium. Which interventions may help manage this client? Select all that apply. a. Speak in simple sentences b Encourage the client to follow regular routine c. Use matter-of-fact approach when assuming tasks the client can no longer perform d. Provide Orienting verbal cues when taking with the client d. Allow adequate time for the client to comprehend and respond

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

NCLEX-Style Chapter Review Questions 25. A nurse is giving instructions to a client diagnosed with delirium. What might the nurse repeat the instructions frequently? Select all that apply. a. The client may have impaired recent and immediate memory. b. The client may not understand what the nurse is saying. c. The client may have abnormal thought processing. d. The client may have poor judgment. e. The client may have impaired attention.

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

Study Guide MULTIPLE-RESPONSE QUESTIONS Select all that apply. 2. Interventions for clients with dementia that follow the psychosocial model of care include a. asking the clients about the place where they were born b. correcting the client's misperceptions or delusion c. finding activities that engage the client's attention d. introducing new topics of discussion at dinner e. processing behavioral problems to improve coping skills f. providing unrelated distractions when the client is agitated

a,c,f asking the clients about the place where they were born, finding activities that engage the client's attention, providing unrelated distractions when the client is agitated

NCLEX-Style Chapter Review Questions 21. A nurse is caring for a client with delirium. The client sees a thermometer on the nurse's table and shouts, "Don't stab me!" and cowers. Which feature of delirium is this client exhibiting? a. Euphoria b. Illusion c. Misinterpretation d. Hallucination

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

NCLEX-Style Chapter Review Questions 29. What is the initial intervention the nurse should implement when helping a client diagnosed with dementia deal with paranoid delusions? a. explain to the client that his or her fears are unfounded b. observe the client in order to identify the triggers for the delusions c. Keep the client occupied when he or she first begins to express the delusion d. ask that the client be prescribed medication to help manage the paranoia

b Clients with dementia may believe that their physical safety is jeopardized; they may feel threatened or suspicious and paranoid. These feelings can lead to agitated or erratic behavior that compromises safety. Avoiding direct confrontation of the client's fears is important. Clients with dementia may struggle with fears and suspicion throughout their illness. Triggers of suspicion include strangers, changes in the daily routine, or impaired memory. The nurse must discover and address these environmental triggers rather than confront the paranoid ideas.

Study Guide MULTIPLE-CHOICE QUESTIONS 5. A client with delirium is attempting to remove the intravenous tubing from his arm, saying to the nurse, "Get off me! Go away!" The client is experiencing which of the following? a. Delusions b. Hallucinations c. Illusions d. Disorientation

b Hallucinations

NCLEX-Style Chapter Review Questions 6. Which of the following is the priority intervention for a client diagnosed with delirium? a. Promotion of sleep b. Maintenance of safety c. Management of confusion d. Proper nutrition

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

NCLEX-Style Chapter Review Questions 20. While reviewing the medical record of a client with moderate dementia of the Alzheimer's type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type? a. Atypical antipsychotic b. NMD receptor antagonist c. Cholinesterase inhibitor d. Benzodiazepine

b Memantine is classified as an NMDA receptor antagonist that has been shown to improve cognition and activities of daily living in clients with moderate to severe symptoms of dementia. Riperidone, olanzapine, and quetiapine are examples of atypical antiphychotics. Galantamine, donepezil, rivastigmine, and tacrine are cholinesterase inhibitors. Clonazepam, alprazolam, and lorazepam are examples of benzodiazepines.

NCLEX-Style Chapter Review Questions 3. A client diagnosed with Alzheimer's disease says, "I'm so afraid. Where am I? Where is my family?" How should the nurse respond? a. "I just told you that you're in the hospital and your family will be here soon." b. "You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is 1 hour from now." c. "The name of the hospital is on the sign over the door. Let's go read it again." d. "You know where you are. You were admitted here 2 weeks ago. Don't worry; your family will be back soon."

b Providing the specific information requested comforts and reassures the client, who is lost and confused, and promotes orientation. The nurse should not assume that a client with Alzheimer's disease will remember being admitted to the hospital and should supply specific information about when the family will visit. The nurse should not scold or infantilize the client or assume that the client will remember the name of the hospital after seeing the sing.

NCLEX-Style Chapter Review Questions 7. Which of the following is the hallmark of beginning mild dementia? a. Restlessness b. Forgetfulness c. Anxiety d. Depression

b The hallmark of the initiation of mild dementia is forgetfulness. Memory impairment is the prominent early sign of dementia.

NCLEX-Style Chapter Review Questions 1. When giving tacrine (Cognex) to an elderly client, the nurse must be aware of what information? a. Tacrine works only in clients with late-stage dementia. b. Because the liver is most vulnerable to tacrine, liver function tests must be done periodically. c. The client will experience dry mouth and difficulty urinating. d. The most common side effects are headache and dizziness, so the client must be monitored for falls.

b The liver rapidly absorbs and metabolizes tacrine; therefore, the liver is most vulnerable to the drug's toxicity.

Study Guide MULTIPLE-CHOICE QUESTIONS 1. The nurse is talking with a woman who is worried that her mother has Alzheimer's disease. The nurse knows that the first sign of dementia is a. disorientation to person, place, or time b. memory loss that is more than ordinary forgetful c. inability to perform self-care tasks without assistance d. variable with different people

b memory loss that is more than ordinary forgetful

Study Guide MULTIPLE-CHOICE QUESTIONS 3. When teaching a client about memantine (Namenda), the nurse will include which of the following? a. Lab tests to monitor the client's liver function are needed. b. Namenda can cause elevated blood pressure. c. Taking Namenda will improve the client's cognitive functioning. d. The most common side effect of Namenda is gastrointestinal bleeding.

b ?

Study Guide MULTIPLE-RESPONSE QUESTIONS Select all that apply. 1. When assessing a client with delirium, the nurse will expect to see a. aphasia b. confusion c. impaired level of consciousness d. long-term memory impariment e. mood fluctuations f. rapid onset of symptoms

b, c, f confusion, impaired level of consciousness, rapid onset of symptoms

Study Guide MULTIPLE-CHOICE QUESTIONS 6. Which of the following statement indicates the caregiver's accurate knowledge about the needs of a parent at the onset of the moderate stage of dementia? a. "I need to give my parent a bath at the same time every day." b. "I need to postpone any vacations for 5 years." c. "I need to spend time with my parent doing things we both enjoy." d. "I need to stay with my parent 24 hours a day for supervision."

c "I need to spend time with my parent doing things we both enjoy."

Study Guide MULTIPLE-CHOICE QUESTIONS 4. Which of the following statements by the caregiver of a client newly diagnosed with dementia requires further intervention by the nurse? a. "I will remind Mother of things she has forgotten." b. "I will keep Mother busy with favorite activities as long as she can participate." c. "I will try to find new and different things to do every day." d. "I will encourage Mother to talk about her firends and family."

c "I will try to find new and different things to do every day."

NCLEX-Style Chapter Review Questions 16. The wife caregiver of a client with dementia tells the nurse that her husband has been agitated lately. She states, "I don't know how to handle this. He was always such a gentle person!" Which of the following interventions should the nurse suggest? a. Distract the client by turning on the television or watching a video b. Leave the client in a safe place in the house and go to another area until he calms down c. Distract the client with family photos and discuss the events pictured d. Give the client a sedative when he begins to get agitated

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

NCLEX-Style Chapter Review Questions 26. What is the greatest benefit support groups provide to the caregivers of clients diagnosed with dementia? a. Provides a social outlet b. Provides time away from the client c. Provides interaction with those with similar concerns d. Provides resources for needed services

c Attending a support group regularly also means that caregivers have time with people who understand the many demands of caring for a family member with dementia. While the other options suggest accurate results, none are the greatest benefit such a support group experience can provide.

NCLEX-Style Chapter Review Questions 30. Which client behavior should the nurse attempt to change when managing a client's tendency to wander and pace at night? a. Insist on having the curtains left open at night b. request a bedtime snack of milk and cookies c. take a nap mid afternoon and before dinner d. watch television after dinner

c Clients with dementia often experience disturbed sleep-wake cycles; they nap during the day and wander at night. This behavior can contribute to the nighttime activity. The other options are not likely to affect sleep cycles.

NCLEX-Style Chapter Review Questions 15. A client with dementia is having difficulty finding the words that he wants to use. When he could not remember the name of his shoes, he referred to them as, "the things you put on your feet." What is the name for this condition? a. Agnosia b. Confabulation c. Aphasia d. Aphraxia

c Frequently, clients with dementia have difficulty finding the words they want to use (aphasia) in conversation. This problem can result in a frustrating process of "charades", relying on others to guess the forgotten word (e.g., referring to Thanksgiving as the time of the turkey or pumpkin).

NCLEX-Style Chapter Review Questions 4. Which of the following is the primary treatment for delirium? a. Apply physical restraints b. Maintain intravenous fluid administration c. Identify and treat any casual or contributing medical conditions d. Provide adequate nutritional food and fluid intake

c The primary treatment of delirium is to identify and treat any casual or contributing medical conditions.

NCLEX-Style Chapter Review Questions 14. Which type of hallucination is most commonly seen in clients diagnosed with delirium? a. Auditory b. Gustatory c. Visual d. Autonomic

c Visual hallucination are the most common type seen in clients diagnosed with delirium.

NCLEX-Style Chapter Review Questions 19. Which type of hallucination most commonly occurs in clients diagnosed with dementia? a. Gustatory b. Olfactory c. Visual d. Auditory

c Visual, rather than auditory, hallucinations are the most common in those with dementia. Auditory, gustatory, and olfactory hallucinations are not the most common type seen in people with dementia.

NCLEX-Style Chapter Review Questions 24. A nurse is providing care to a client with dementia who is hyperactive. A diet high in which of the following would be most appropriate to include in the nutritional plan for this client? Select all that apply. a. Potassium b. Fat c. Carbohydrates d. Fiber e. Protein

c, e Typically, hyperactive clients require frequent feedings of a high-protein, high-carbohydrate diet in the form of finger foods (which they can carry while on the go). The client's fluid and electrolyte levels would determine whether or not the client needs an increase potassium intake. A high fiber diet would be appropriate if the client was experiencing constipation. A high fat diet would be inappropriate.

Study Guide MULTIPLE-CHOICE QUESTIONS 2. The nurse has been teaching a caregiver about donepezil (Aricept). The nurse knows that teaching has been effective by which of the following statements? a. "Let's hope this medication will stop the Alzheimer's disease from progressing any further." b. "It is important to take this medication on an empty stomach." c. "I'll be eager to see if this medication makes any improvement in concentration." d. "This medication will slow the progress of Alzheimer's disease temporarily."

d "This medication will slow the progress of Alzheimer's disease temporarily."

NCLEX-Style Chapter Review Questions 2. Which of the following terms is used to describe the inability to execute motor functioning, despite intact motor abilities? a. Agnosia b. Executive Functiong c. Aphasia d. Apraxia

d Apraxia is the impaired ability to execute motor function 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.

NCLEX-Style Chapter Review Questions 9. A client with Alzheimer's disease has a nursing diagnosis of risk for injury related to memory loss, wandering, and disorientation. Which nursing interventions should appear in this client's care plan to prevent injury? a. Use restraints at all times b. Keep the client sedated whenever possible c. Provide the client with detailed insturctions d. Remove hazards from the environment

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

NCLEX-Style Chapter Review Questions 18. The nurse understands that numerous comorbidities can contribute to the development of dementia. Which of the following clients may be at risk for dementia? a. An 87-year-old resident of a long-term care facility who has developed a urinary tract infection b. A 69-year-old man whose lung cancer has metastasized to his bones and liver c. A 3--year-old client with schizophrenia who has been admitted to the hospital because of pyschogenic polydipsia d. A 49-year-old man whose human immunodeficiency virus (HIV) has progressed to acquired immunodeficiency syndrome (AIDS)

d HIV/AIDS is known to cause dementia. Cancer does not normally result in dementia, and the cognitive changes that may result from a UTI or polydipsia are reversible and thus classified as delirium.

NCLEX-Style Chapter Review Questions 12. Which of the following is a metabolic cause of delirium? a. Dehydration b. Meningitis c. Encephalitis d. Hypoglycemia

d Hypoglycemia Hypoglycemia is a metabolic cause of delirium. Meningitis and encephalitis are infection-related causes. Dehydration is a physiologic cause of delirium.

NCLEX-Style Chapter Review Questions 23. An older client comes to the clinic for a yearly physical exam. During the assessment, the client tells the nurse that he sometimes has begun feeling anxious about his forgetfulness. The nurse notes the client may have mild dementia. Which finding would lead the nurse to conclude this? a. The client reports having delusions b. The client reports an inability to perform complex tasks c. The client exhibits confusion d. The client has difficulty finding words

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

NCLEX-Style Chapter Review Questions 5. What is the primary sign of delirium? a. Disturbed sleep-wake cycles b. Impaired socialization c. Inability to fulfill roles d. An altered level of consciousness

d 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.