ch 24 mental health

Delirium can be differentiated from many other cognitive disorders in which way?

It has a rapid onset and is highly treatable if diagnosed quickly.

The nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate?

"The client's diagnosis is primarily based on the rapid onset of the change in consciousness."

Parkinson's disease is thought to be caused by which neural change?

A loss of neurons at the basal ganglia

After teaching a group of nursing students about dementia, the instructor determines a need for additional teaching when the students identify which as a primary goal of nursing care?

Achievement of self-esteem needs

Which would not be considered a primary goal of nursing care for a client with delirium?

Achievement of self-esteem needs

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?

Agnosia

A nurse is assessing a client diagnosed with Alzheimer's disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing for what?

Agnosia

What is the primary sign of delirium?

An altered level of consciousness

Which term is used to describe the inability to execute motor functioning, despite intact motor abilities?

Apraxia

A client with Alzheimer's disease in the intensive treatment unit repeatedly tries to go into other clients' rooms to nap during the day. The most appropriate nursing intervention for this client is what?

Escorting the client to the client's room for napping

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?

Gastrointestinal (GI) symptoms

The client is an 84-year-old suffering from delirium. The client has been in a nursing home for the past 2 years but recently is becoming combative and has become a threat to staff. Which medication would the client most likely receive for these symptoms?

Haloperidol

Which is a metabolic cause of delirium?

Hypoglycemia

Which is the primary treatment for delirium?

Identify and treat any causal or contributing medical conditions

A client was admitted to an inpatient unit with a diagnosis of dementia. A nursing assessment and interview of the client would include what?

Intellectual ability, health history, and self-care ability

Which of these is a N-methyl-D-aspartic acid (NMDA) receptor antagonist?

Memantine

A client with a medical diagnosis of dementia of Alzheimer's type has been increasingly agitated in recent days. As a result, the nurse has identified the nursing diagnosis of "risk for injury related to agitation and confusion" and an outcome of "the client will remain free from injury." What intervention should the nurse use in order to facilitate this outcome?

Monitor amount of environmental stimulation and adjust as needed.

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?

Oxidative stress

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?

Personality change, wandering, and inability to perform purposeful movements

A client with dementia becomes extremely agitated shortly after being admitted to the psychiatric unit. The nurse is reluctant to use physical restraints to control the client. What is a likely reason the nurse has this reluctance?

Physical restraints may increase the client's agitation.

A older adult client develops delirium secondary to an infection. Which would be the most likely cause?

Pneumonia

Which is an infection-related cause of delirium?

Pneumonia

The client has advanced Alzheimer's disease and becomes confused at mealtimes. The client has agnosia, apraxia, and disturbed executive functioning. Which is the most appropriate nursing intervention?

Provide the client with a tray, opening containers for the client.

A client is brought to the emergency department by a spouse. The spouse states that over the past few hours, the client has become disoriented and confused. "The client didn't know where the client was and didn't seem to recognize me or be able to carry on a coherent conversation." The nurse suspects delirium. When reviewing the client's medication history with the spouse, which medications would alert the nurse to a potential cause? Select all that apply.

Quinidine Propranolol Diphenhydramine

A care 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 dementia of Alzheimer's type and is prone to agitation, which measure may help in preventing this client's agitation?

Reminding the client multiple times that he or she will be soon having a bath

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?

Reminding the client multiple times that he or she will be soon having a bath

which nursing diagnosis would be the priority for the client experiencing acute delirium?

Risk for injury related to confusion and cognitive deficits

Which can be identified as a hallmark symptom of dementia?

Short-term memory loss

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?

Signs of delirium

The client is 42 years old, married, and has two children, ages 16 and 18. The client is also caring for the client's parent, who is in the late stages of Alzheimer's disease. The nurse would want to assess the client for what?

Signs of stress

A client is diagnosed with dementia related to Parkinson's disease. While at a clinic visit, a cholinesterase inhibitor is prescribed for the client. The nurse knows that this type of medication would be prescribed for the client to achieve which goal?

Slow deterioration of memory and function

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?

The client is confabulating, most likely to cover for memory deficit.

The nurse is assessing a client with aphasia and notes the client may be exhibiting echolalia during their conversation. What signs does the nurse observe that leads to this conclusion?

The client may echo whatever is heard.

The nurse asks a client to pretend the client is brushing the client's teeth. The client is unable to perform the action. Upon examination, the nurse finds that the client possesses intact motor abilities. What can this problem be documented as?

The client may have apraxia.

Major goals for the nursing care of clients with dementia should include what?

The client will be safe, be physiologically stable, and have infrequent episodes of agitation.

An 82-year-old client with a diagnosis of vascular dementia has been admitted to the geriatric psychiatry unit of the hospital. In planning the care of this client, which outcome should the nurse prioritize?

The client will remain free from injury.

To manage voiding issues, such as incontinence, male clients diagnosed with dementia would best be managed by what?

Use of disposable, adult diapers

A group of friends have arrived at the hospital to visit a client recently diagnosed with delirium. The nurse tells the friends they can visit with the client one at a time. What is the likely reason for the nurse to give this instruction?

The nurse wants to prevent increasing the client's confusion.

The nurse preparing an educational program on dementia should include which information?

The onset of symptoms of dementia is gradual

A nurse is caring for a client with delirium. The nurse assesses the client's activities of daily living on a daily basis. What is the most likely reason for assessing these so frequently?

To assess for fluctuation in the client's capabilities

A client has contacted the care provider because of concerns for the client's 55-year-old spouse, who suddenly became very forgetful in recent days. Most recently, the spouse became lost while driving to the spouse's home of 30 years and temporarily forgot the client's adult child's name. The client also had a temporary slurring of speech lasting about a minute. Diagnostic testing has ruled out delirium and the spouse had been previously healthy. Which would the nurse most likely suspect?

Vascular neurocognitive disorder

When assessing a client with dementia, a nurse identifies that the client is experiencing hallucinations. Based on the nurse's understanding of this disorder, which type of hallucination would the nurse expect as most common?

Visual

Which type of hallucination most commonly occurs in clients diagnosed with dementia?

Visual

An older adult with no significant medical history is admitted to the hospital through the emergency department after hitting the client's head during a fall and fracturing the humerus. The client does not require surgery and will probably be discharged the following day. Should the nurse be concerned about delirium?

Yes, because of the head injury and medication

The nurse documents that a client diagnosed with dementia of the Alzheimer's type is exhibiting agnosia when the client is observed being unable to ...

identify a picture of a car.

What is the greatest benefit support groups provide to the caregivers of clients diagnosed with dementia?

provides interaction with those with similar concerns

Which client behavior should the nurse attempt to change when managing a client's tendency to wander and pace at night?

take a nap mid afternoon and before dinner

The nurse should consider the intervention referred to as "going along with" when managing the care of which client?

the older widower who is worried about his wife not being able to visit because of the snow