Chapter 23 - Neurocognitive Disorders (Psych) EAQ's

A nurse assists a patient with moderate stage Alzheimer's disease at mealtime. Which statement should the nurse use? 1 "Would you like beans or potatoes?" 2 "Why aren't you eating your dinner, honey?" 3 "Your food is getting cold. Eat your dinner now." 4 "If you don't eat, you could get dehydrated."

1 "Would you like beans or potatoes?" Providing simple choices helps support a patient's sense of control and independence. It is important to keep the message simple as well as to avoid demands and disrespectful forms of address, such as "honey." Text Reference - p. 442, Box 23.3

The nurse caring for a patient with Alzheimer's disease can anticipate that the family will need information about therapy with 1 Benzodiazepines 2 Antihypertensives 3 Immunosuppressants 4 Acetylcholinesterase inhibitors

4 Acetylcholinesterase inhibitors Memory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Acetylcholinesterase inhibitor drugsprevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine. Text Reference - p. 444

When educating the family of an individual who is displaying characteristics of delirium, the nurse stresses that the individual may: 1 Act in an impulsive, inappropriate manner 2 Sleep for long, uninterrupted periods of time 3 Begin to regress both socially and intellectually 4 Have difficultly verbally expressing his or her needs

1 Act in an impulsive, inappropriate manner At times, patients with delirium may exhibit a labile affect and demonstrate a loss of usual social behavior, resulting in impulsive acts such as undressing, playing with food, and grabbing at others. Verbal communication may be confused but not necessarily impaired significantly. Delirium is more likely to result in short periods of disrupted sleep. Regression may be seen but is not considered a classic characteristic of delirium. Text Reference - pp. 432-433

The health care provider mentions to the nurse that a patient who is about to be admitted has "sundowning." The nurse can expect to assess nightly 1 Agitation 2 Lethargy 3 Depression 4 Mania

1 Agitation Sundowning involves increased disorientation and agitation occurring at night. Text Reference - p. 439

A patient's family member brings in a list of medications the patient is taking for Alzheimer disease. The patient has begun experiencing psychotic symptoms as well as dementia. Medication from which class will likely be discontinued? 1 Antipsychotics 2 Anticonvulsants 3 Antidepressants 4 Antianxiety agents

1 Antipsychotics When administered to patients with dementia, antipsychotics can cause psychotic side effects. Antidepressants, antianxiety agents, and anticonvulsants can be used in various combinations without causing psychotic symptoms. Text Reference - p. 445

Which question should be asked when considering the evaluation of outcomes for a patient experiencing cognitive dysfunction? Select all that apply. 1 Are the stated outcomes measureable? 2 Are the patient's cognitive skills deteriorating? 3 Is the patient capable of achieving the outcomes? 4 Are the caregivers capable of creating outcomes? 5 When were the patient's outcomes last evaluated?

1 Are the stated outcomes measureable? 2 Are the patient's cognitive skills deteriorating? 3 Is the patient capable of achieving the outcomes? 5 When were the patient's outcomes last evaluated? The outcome criteria for people with cognitive impairments need to be measurable, within the capabilities of the individual person, and evaluated frequently. As the person's condition continues to deteriorate, outcomes must be altered to reflect the person's diminished functioning. Although working with caregivers is important to the successful achievement of patient outcomes, it is not their responsibility to create the outcomes. Text Reference - p. 447

A family member reports that the patient had been oriented and able to carry on a logical conversation last evening, but this morning is confused and disoriented. The nurse can suspect that the patient is displaying symptoms associated with 1 Delirium 2 Dementia 3 Amnesic disorder 4 Selective inattention

1 Delirium Delirium is characterized by a disturbance of consciousness, a change in cognition (such as impaired attention span), and a fluctuating level of consciousness that develops over a short period of time. Text Reference - pp. 431-432

As part of a clinical study, the nurse has to select elderly hospitalized patients for whom delirium is their most frequent complication. Based on what cardinal features does the nurse select the patients? Select all that apply. 1 Disorganized thinking 2 Disturbed consciousness 3 Irreversible, progressive condition 4 Loss of track of the date or season 5 Acute onset and fluctuating course 6 Reduced ability to direct, focus, and sustain attention

1 Disorganized thinking 2 Disturbed consciousness 5 Acute onset and fluctuating course 6 Reduced ability to direct, focus, and sustain attention Delirium is an acute cognitive disturbance with a sudden onset over hours or days. Delirious patients are unable to direct, focus, and sustain attention. They have impaired memory and judgment. Attention span can fluctuate through the day. Consciousness levels are altered, and they experience sudden changes in reality with a sense that they are dreaming while awake. They have disorganized thinking and are disoriented, first to time, then to place, and lastly to person. Dementia is a progressive deterioration of cognitive functioning and impairment of intellect with no change in consciousness. The dementia patient will have increasing memory loss and will lose track of important dates and seasons. This condition is irreversible. Text Reference - p. 440, Table 23.4

How is delirium different from dementia? Select all that apply. 1 It is typically a reversible condition. 2 If hallucinations are present, they are auditory. 3 It is usually observed in younger patients. 4 It is considered a disorder rather than a syndrome. 5 One fundamental symptom involves focus and attention.

1 It is typically a reversible condition. 5 One fundamental symptom involves focus and attention. Delirium is typically reversible, while dementia is not. One fundamental symptom of delirium includes inability to direct, focus, or sustain attention. Older age is one of the risk factors for delirium. If present, hallucinations are generally visual. As delirium is a collection of symptoms, it is considered a syndrome rather than a disorder. Text Reference - p. 431

What is the usual development of Alzheimer's disease? 1 Progressive deterioration 2 There is no usual progression 3 Recurring remissions and exacerbations 4 A single, short episode followed by years of normal function

1 Progressive deterioration The usual progression of Alzheimer's disease is steadily downward. This is the only accurate description of the developmental path of Alzheimer's disease; a single, short episode followed by years of normal function, recurring remissions and exacerbations, and no usual progression do not apply. Text Reference - p. 437

Which practice demonstrates a proactive approach to minimizing the stress commonly experienced by nursing staff caring for the cognitively impaired patient? Select all that apply. 1 Realistic patient outcomes 2 Mandatory transfers off of units 3 Small nurse-to-patient care ratios 4 Thorough understanding of the disorder 5 Reasonable expectations of patient abilities

1 Realistic patient outcomes 4 Thorough understanding of the disorder 5 Reasonable expectations of patient abilities Because stress is a common occurrence when working with persons with cognitive impairments, nurses need to be proactive in minimizing its effects, which can be facilitated by having an understanding of the disease and realistic expectations. Small nurse-to-patient care ratios and mandatory transfers off of units are not realistic and are unnecessary when staff is informed and well supported in their caregiving. Text Reference - pp. 439-440

A family has asked for assistance from a home health nurse in caring for a patient with Alzheimer disease. What part of the nursing diagnosis will be the top priority? 1 Risk for injury 2 Caregiver strain 3 Anticipatory grieving 4 Level of communication

1 Risk for injury Evaluating the environment for potential injury-causing factors is a priority for all patients with Alzheimer disease to prevent falls. Level and type of communication between the patient and others is a lower priority. Caregiving strain and anticipatory grieving experienced by the family should be included in the care plan, but this is a lower priority than the patient's immediate safety. Text Reference - p. 440

A 75-year-old patient is hospitalized with sudden onset confusion and disorientation. The patient wanders and becomes agitated without any apparent stimulus. What is the highest priority nursing diagnosis? 1 Risk for injury 2 Acute confusion 3 Impaired memory 4 Self-care deficit, bathing, or hygiene

1 Risk for injury Risk for injury; acute confusion; impaired memory; and self-care deficit, bathing, or hygiene are diagnoses likely to apply in this situation; however, safety is the nurse's highest priority. Text Reference - pp. 442, 447-448, Table 23.6

A patient diagnosed with delirium strikes out physically at a staff member. What is the most likely cause of this behavior? 1 State of fear 2 Physical illness 3 An unmet physical need 4 The need for social interaction

1 State of fear Patients with delirium often misinterpret reality, perceiving threat where none actually exists. Delirious patients who are fearful may strike out at others, seemingly without provocation. Physical illness, an unmet physical need, or the need for social interaction generally are not associated with such aggressive behavior. Text Reference - p. 433

Which medication is aimed at preventing the breakdown of acetylcholine? Select all that apply. 1 Tacrine 2 Donepezil 3 Rivastigmine 4 Memantine 5 Galantamine

1 Tacrine 2 Donepezil 3 Rivastigmine 5 Galantamine Because a deficiency of acetylcholine has been linked to Alzheimer's disease, medications aimed at preventing its breakdown (cholinesterase inhibitors) have been developed, including tacrine hydrochloride, donepezil, rivastigmine, and galantamine. Memantine normalizes levels of glutamate, a neurotransmitter that may contribute to neurodegeneration. Text Reference - p. 444

Which behavior is associated with typical age-related cognitive changes? Select all that apply. 1 Taking 30 minutes to find one's misplaced car keys. 2 Having the electricity turned off for lack of payment. 3 Experiencing difficulty recalling a synonym for happy. 4 Forgetting the address of the first apartment you rented. 5 Failing to pay the credit card bill while away on vacation.

1 Taking 30 minutes to find one's misplaced car keys. 3 Experiencing difficulty recalling a synonym for happy. 4 Forgetting the address of the first apartment you rented. 5 Failing to pay the credit card bill while away on vacation. Typical age-related cognitive changes include occasional examples of memory lapse, poor judgment, and omissions. The more serious, atypical changes involve complete, constant, or chronic issues with memory and cognition. Text Reference - p. 437, Table 23.2

A patient is diagnosed with dementia. What nursing care considerations are appropriate for this patient? Select all that apply. 1 The nurse provides finger food to the patient. 2 The nurse uses written signs to direct the patient. 3 The nurse asks the patient the date and time daily. 4 The nurse calls the patient with identification number. 5 The nurse places an identification bracelet on the patient.

1 The nurse provides finger food to the patient. 5 The nurse places an identification bracelet on the patient. Patients with dementia generally do not sit and eat and must be given finger food to maintain nutrition. Patients with dementia may not remember their identity, so identification bracelets must be placed on them. Patients must be directed to the bathroom and other areas with the help of symbols; written signs must not be used. Patients must be called by their names, it helps them to register and recollect their identity. The nurse should avoid asking orientation questions such as the time and day; it can make the patient feel frustrated. Text Reference - p. 442, Box 23.3

A patient with Parkinson's disease reports that bugs are crawling on his bed. The nurse checks the bed and finds peanuts on the bed. What does the nurse conclude from the patient's behavior? 1 The patient has impaired environmental interpretation syndrome. 2 The patient has delusions. 3 The patient has developed an allergy to peanuts. 4 The patient has a skin disorder.

1 The patient has impaired environmental interpretation syndrome. Patients with Parkinson's disease have confusion and dementia, and have impaired environmental interpretation syndrome. It is characterized by hallucinations and illusions. The patients tend to mistake benign objects for objects which are sinister and frightening. The patients may have tactile hallucinations, but not suffer from delusions. An allergy to peanuts or developing a skin disorder are unlikely causes of the patient's complaint, as these disorders are accompanied by other symptoms as well. Text Reference - p. 440

A Chinese-American patient has been diagnosed with dementia. What should the nurse keep in mind when addressing the needs of the family caregivers? Select all that apply. 1 They do not seek help from others. 2 They believe dementia is due to fate. 3 They associate dementia with stigma. 4 They perceive caregiving as burdensome. 5 They feel obligated to sacrifice individual needs. 6 They believe memory loss in early dementia is not a mental disease.

1 They do not seek help from others. 2 They believe dementia is due to fate. 3 They associate dementia with stigma. 5 They feel obligated to sacrifice individual needs. 6 They believe memory loss in early dementia is not a mental disease. Chinese-Americans depict dementia as fate or wrongdoing rather than a disease. They are less likely to seek help from others. Filial piety and family harmony are important, which emphasizes honor and devotion to parents. They feel obligated to sacrifice individual needs and wants. As the disease progresses, dementia is viewed as a mental illness with associated stigma and resulting in feelings of humiliation. Chinese-Americans do not perceive their caregiving role as burdensome. They believe that memory loss in early dementia is a part of the normal aging process. It is not viewed as a mental illness. Text Reference - p. 439

Which statement supports the diagnosis of mild cognitive decline? Select all that apply. 1 "Dad used to be so good at math, but not now." 2 "I can't seem to find the right word when I'm talking." 3 "My children think I'm having problems remembering things." 4 "He got angry when he couldn't remember the rules to the game." 5 "Mother told me she can't remember where she put her wedding ring."

2 "I can't seem to find the right word when I'm talking." 3 "My children think I'm having problems remembering things." 5 "Mother told me she can't remember where she put her wedding ring." Stage 1, mild cognitive decline, presents with cognitive deficiencies that include noticeable problems coming up with the right word or name and losing or misplacing a valuable object. Others begin to notice difficulties in this stage because the individual is losing the ability to cover-up the problems. Previously being good at something or getting angry when forgetting are associated with stage 4 or moderate cognitive decline. Text Reference - p. 437, Table 23.2

A female patient is brought to the hospital by her daughter, who visited the patient this morning and found her to be confused and disoriented. When the patient is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." What would be the best response from the nurse? 1 "That will be fine. I'll have you sign our hospital release form." 2 "I would like to have your mother wear them. It will help her to be less confused." 3 "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." 4 "Because we do not have a copy of durable power of attorney, we cannot release them to you."

2 "I would like to have your mother wear them. It will help her to be less confused." Patients with cognitive disorders usually profit from being able to see and hear clearly. Confusion is reduced through the use of glasses and hearing aids. Text Reference - p. 433

Which assessment question would be asked of either the patient or her family to determine the presence of delirium? Select all that apply. 1 "Do you think you are confused?" 2 "Would you please tell me the names of your grandchildren?" 3 "When did you first notice that your mother seemed confused?" 4 "How would you feel if your mother's confusion becomes a chronic situation?" 5 "What did you mean when you said that your mom has always been a little confused?"

2 "Would you please tell me the names of your grandchildren?" 3 "When did you first notice that your mother seemed confused?" 5 "What did you mean when you said that your mom has always been a little confused?" Delirium assessment would include questions that focus on assessing whether the impairment is acute or chronic in nature, assessing the patient's memory for common facts, and getting clarification regarding statements made about the patient's typical cognitive state. The family's feelings, although important, are not relevant to the assessment. The patient is not the most reliable source in this situation.

A patient diagnosed with Alzheimer's disease picks up his or her glasses from the bedside table but does not recognize what they are or their purpose. The nurse will document this behavior using which term? 1 Apraxia 2 Agnosia 3 Aphasia 4 Agraphia

2 Agnosia Agnosia is the loss of the sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write. Text Reference - pp. 437, 439

The family of a patient diagnosed with Alzheimer's disease mentions to the nurse that seeing the patient's loss of function has been very difficult. A nursing diagnosis that might be considered for such a family would be 1 Ineffective denial 2 Anticipatory grieving 3 Disabled family coping 4 Ineffective family therapeutic regimen management

2 Anticipatory grieving Anticipatory grieving involves working through potential loss. Ineffective denial, disabled family coping, and ineffective family therapeutic regimen management do not adequately address the described family situation. Text Reference - p. 440

Which nursing intervention would be most appropriate for an older individual suspected of being at risk for the development of the unique symptoms of delirium? 1 Assuring that the individual is ambulated sufficiently. 2 Assessing orientation to person, place, and time every two hours. 3 Cutting the individual's food into small pieces to avoid the risk of choking. 4 Assuring that the individual is dressed warmly to avoid the risk of hypothermia.

2 Assessing orientation to person, place, and time every two hours. Delirium reduces awareness of the environment that involves sensory misperceptions and disordered thought (disturbed attention, memory, thinking, and orientation) and also disturbances of psychomotor activity and the sleep-wake cycle. These disturbances develop rapidly (over hours to days). Frequent assessment of an individual at risk for developing delirium for orientation would bemost appropriate. Assuring ambulation, cutting food into small pieces, and assuring warm clothing are appropriate but not needs unique to an individual at risk for developing delirium. Text Reference - p. 435

The family caregivers of an elderly Alzheimer's disease patient are feeling overburdened and overwhelmed by the situation and wish to admit the patient to an assisted care facility. What could be the primary reason? 1 Family discord 2 Caregiver role strain 3 Disruption of social life 4 Distress, guilt, rejection

2 Caregiver role strain Many families take care of the patient with Alzheimer's disease until death. Others, however, find that they can no longer cope with aggressive behavior, incontinence, wandering, unsafe behaviors, or disruptive nocturnal activity. This is known as caregiver role strain. In such cases, the caregivers may admit the patient to an assisted care facility. Disruption of social life, distress, guilt, rejection, and family discord can all be burdens on the family but are not the primary reasons in this case. Text Reference - p. 440

An elderly patient is diagnosed with Alzheimer's disease. What characteristic features may be seen in this patient? Select all that apply. 1 Speaks rapidly, inappropriately, and incoherently 2 Forgets familiar words or the location of everyday objects 3 Becomes moody or withdrawn, especially in challenging situations 4 Shows altered awareness and is unable to focus, or sustain attention 5 Has increasing and frequent trouble controlling bladder and bowels

2 Forgets familiar words or the location of everyday objects 3 Becomes moody or withdrawn, especially in challenging situations 5 Has increasing and frequent trouble controlling bladder and bowels Alzheimer's disease is characterized by progressive deterioration of cognitive functioning, including forgetting familiar words or the location of everyday objects. The patient becomes moody or withdrawn, especially in socially or mentally challenging situations. The patient also has increasing and frequent trouble controlling their bladder and bowels. Delirium is an acute cognitive disturbance where the patient's speech is rapid, inappropriate, incoherent, and rambling. There is an alteration in consciousness levels. This manifests as altered awareness and inability to focus, sustain, and shift attention. Text Reference - p. 438, Table 23.3

The nurse is formulating a safe environment plan for the caregivers of a patient diagnosed with Alzheimer's disease. What does the nurse consider in the plan? Select all that apply. 1 Place extra throw rugs 2 Gradually restrict driving 3 Label all rooms, drawers 4 Increase sensory stimulation 5 Supervise smoking

2 Gradually restrict driving 3 Label all rooms, drawers 5 Supervise smoking Caregivers of an Alzheimer's disease patient must gradually restrict him from driving because judgment becomes impaired and the person can become dangerous to himself and others. All rooms and drawers should be labelled to increase environmental clues to familiar objects. Smoking is supervised to reduce the chance of the patient burning himself or starting a fire. Throw rugs and other objects in the patient's path must be removed to minimize tripping and falling. Sensory stimulation should be minimized. This helps reduce sensory overload, which can increase anxiety and confusion. Text Reference - p. 444, Table 23.9

Which is a drawback of early cholinesterase inhibitors? 1 Constipation 2 Liver toxicity 3 Only useful in mild dementia 4 Increased acetylcholine levels

2 Liver toxicity Earlier forms of cholinesterase inhibitors, such as tacrine, caused liver toxicity, causing them to be withdrawn from the US market in 2012. Increasing availability of acetylcholine is a benefit for patients with dementia. These drugs are not beneficial for people with mild dementia. The side effects include nausea, vomiting, and diarrhea, not constipation. Text Reference - p. 444

What is the best nursing intervention to help orient a patient experiencing confusion associated with a neurocognitive disorder? 1 Remind the patient frequently of upcoming events. 2 Offer a consistent daily routine and easy-to-read clocks. 3 Repeatedly rehearse spheres of orientation with the patient. 4 Provide frequent opportunities for the patient to make choices.

2 Offer a consistent daily routine and easy-to-read clocks. Nursing interventions, such as the provision of clocks, calendars, maps, and other types of orienting information, assist the patient with orientation. A consistent daily routine creates a sense of predictability, which decreases the patient's level of frustration. Repeatedly rehearsing spheres of orientation, decision-making, or discussing future events will produce frustration for the patient. Text Reference - p. 435, Box 23.2

The nurse is caring for an elderly dementia patient being treated with memantine. What does the nurse need to keep in mind when caring for this patient? 1 There is a risk for further memory impairment. 2 Renal impairment reduces the drug clearance. 3 Lower dosages need to be used in elderly patients. 4 Abrupt withdrawal may cause discontinuation syndrome.

2 Renal impairment reduces the drug clearance. Memantine is an N-methyl-d-aspartate (NMDA) antagonist that normalizes the levels of glutamate. The latter is a neurotransmitter that may contribute to neurodegeneration. Clearance is reduced with renal impairment. It must be used cautiously in patients with moderate renal impairment and should not be used in patients with severe renal impairment. Risk of further memory impairment is seen with antianxiety agents such as lorazepam. Antipsychotics such as aripiprazole have increased risk of CVA and death; hence it is given in lower doses to elderly patients. Discontinuation syndrome such as dizziness and insomnia may occur with abrupt withdrawal of antidepressants such as citalopram. Text Reference - pp. 445, 446, Table 23.10

A patient's family tells the nurse that the patient has "middle-stage Alzheimer disease." What symptoms would the nurse expect to observe? Select all that apply. 1 Losing valuable objects 2 Repetitive hand movements 3 Trouble remembering names 4 Difficulty walking and swallowing 5 Lack of bowel or bladder continence

2 Repetitive hand movements 5 Lack of bowel or bladder continence In middle-stage Alzheimer disease, a patient may begin to lose bowel and bladder function and may exhibit compulsive behaviors such as hand-wringing or tissue shredding. Losing objects and failing to remember names are among the early symptoms of the disease. Difficulty walking and swallowing occur in the later stages. Text Reference - p. 438

The nurse gives instructions to family members who provide home care for an 86-year-old patient diagnosed with moderate stage Alzheimer's disease. Which interventions are important and beneficial to teach the family? Select all that apply. 1 Install locks on the sides of exterior doors to the home. 2 Select clothing with easy fasteners to facilitate dressing. 3 Provide the patient with privacy and minimize social activities. 4 Encourage the family to use support resources such as adult day care or respite care. 5 When the patient becomes upset, listen briefly, provide support, and then change the topic.

2 Select clothing with easy fasteners to facilitate dressing. 4 Encourage the family to use support resources such as adult day care or respite care. 5 When the patient becomes upset, listen briefly, provide support, and then change the topic. Clothing with easy fasteners promotes independence of functioning. Family members need access to support services to reduce the risk of caregiver role strain. The patient will benefit from simple social activities. Acknowledging feelings makes the patient feel more understood and less alone; when the patient becomes upset, the family should listen briefly, provide support, and then change the topic. In moderate and late Alzheimer's-type dementia, the ability to look up and reach upward is lost. Locks above the door will help ensure the patient's safety; locks on the side of the door will not achieve the desired outcome. For safety, the patient needs supervision, rather than privacy. Text Reference - pp. 442, 443, 449, Table 23.6, Table 23.7, Table 23.9

A patient on selective serotonin reuptake inhibitors has symptoms of delirium. What interventions are appropriate when caring for the patient? Select all that apply. 1 The nurse interacts with the patient once a day. 2 The nurse performs regular assessment of the patient. 3 The nurse avoids repeating the question to the patient. 4 The nurse places a calendar and watch beside the patient. 5 The nurse notes the sleeping time of the patient.

2 The nurse performs regular assessment of the patient. 4 The nurse places a calendar and watch beside the patient. 5 The nurse notes the sleeping time of the patient. Patients with delirium are often disorientated. The nurse should regularly monitor the patients carefully for complications such as dilated pupils, flushed face, and tachycardia. Patients with delirium have reduced orientation to time and date. Simple objects such as a calendar and clock must be placed near the patient to increase orientation. Taking a note of the patient's sleeping time helps to determine if the sleep and wake cycle is reversed. Interacting frequently with the patient reduces the patient's anxiety and misperception. The patient has reduced concentration levels, so the nurse should repeat questions while communicating. Text Reference - p. 435, Box 23.2

An elderly patient, who had been healthy and living independently, was hospitalized with heart failure. The patient was treated with diuretics and antihypertensive medications. On the third hospital day, the patient became very irritable and said, "Little yellow bugs are crawling across my sheets." What is the best analysis of this scenario? 1 The patient has delusions secondary to depression. 2 The patient is experiencing illusions secondary to delirium. 3 Early dementia emerged because of the stress of the physical illness. 4 Doses of antihypertensive drugs have not managed the patient's blood pressure.

2 The patient is experiencing illusions secondary to delirium. Delirium is the most common complication of hospitalization in the older patients. Illusions (errors in perception of sensory stimuli) indicate this patient is confused. Illusions, irritability, and restlessness are common in delirium. The scenario does not suggest the patient has dementia or depression. This patient is likely experiencing toxicity associated with the multiple medications, which is a common cause of delirium. Text Reference - pp. 431, 433, Box 23.1

An elderly patient is hospitalized with pneumonia and treated with multiple antibiotics. After two days, the patient becomes irritable and restless, and says to the nurse, "My pet parakeet flew across the room." A family member says the patient has been healthy and living independently but does not own a pet. What is the most likely analysis of this scenario? 1 The patient is delusional and likely experiencing depression. 2 The patient is experiencing illusions secondary to delirium. 3 The antibiotic doses have been inadequate to treat the infection. 4 Dementia has emerged as the result of the stress of the physical illness.

2 The patient is experiencing illusions secondary to delirium. The onset of the change in mental status is acute, which is characteristic of delirium. The vision of a bird flying in the room is likely an illusion, another common characteristic of delirium. The patient's condition could be the result of the medical illness, toxicity of the drug regimen, overstimulation from the hospital environment, alcohol withdrawal, or other reasons. Text Reference - pp. 431-433

A patient with cognitive impairment is diagnosed with aphasia. Which symptom is the nurse most likely to find in the patient? 1 The patient wears socks on the hands. 2 The patient talks rapidly and foolishly. 3 The patient doesn't answer the nurse. 4 The patient doesn't identify sounds.

2 The patient talks rapidly and foolishly. Patients with impaired cognition show symptoms like aphasia, apraxia, preservation, and agnosia. The patient with aphasia has reduced language ability, seen as inability to use the correct word and talking rapidly and foolishly. Loss of purposeful movement is called apraxia. The person is unable to put on clothes and may wear socks on hands. The patient with preservation avoids answering the question to maintain self-esteem. Inability to identify sounds, objects, and people is known as agnosia. Text Reference - p. 439

A patient is brought to the emergency room after falling in the street a mile from home. There are no serious injuries. The patient's medical record states the patient has Alzheimer disease, and the patient asks the nurse call his or her spouse, who is long deceased. What should be the focus of care? 1 Family therapy for the patient's family members 2 Health promotion, instructing the patient on ways to be safe 3 Evaluation of the home situation for safety and level of care 4 Biological reasons for the ER visit and possible psychiatric care

3 Evaluation of the home situation for safety and level of care Because patients with Alzheimer disease are at risk for wandering and getting lost, this patient's living situation should be assessed for security; he or she may require full-time care. Because the patient has no serious injuries, biological needs have already been addressed. Telling the patient how to be safe will not be effective due to the nature of the disorder. Family therapy may be helpful, but this is not the priority goal. Text Reference - pp. 440-441

The nurse is assessing a patient suspected of Alzheimer's disease (AD). What action by the patient does the nurse identify as a sign of agnosia? 1 Babbles and speaks incoherently when asked any question 2 Has problem in recalling what was served for breakfast an hour ago 3 Has problem in identifying familiar sounds like the ring of the telephone 4 Talks about how he or she convinced the President to pass a particular law

3 Has problem in identifying familiar sounds like the ring of the telephone When the patient is unable to identify the ring of the telephone, it means there is a loss of sensory ability to recognize familiar sounds. The nurse recognizes it as a feature of auditory agnosia. If the patient babbles and speaks incoherently, it means there is a loss of language ability. The nurse identifies this as a sign of aphasia. In AD, there is a gradual deterioration of recent and remote memory. If the patient is unable to recall what was served for breakfast an hour ago, it indicates impairment of recent memory. Patients with AD often confabulate in an unconscious attempt to maintain self-esteem. When the patient talks about how the President's decision was influenced by the patient, the nurse should recognize it as confabulation Text Reference - pp. 437, 439

Which statement about Alzheimer's disease (AD) is correct? 1 Alzheimer's disease is usually a genetic disorder. 2 Neuronal degeneration in AD usually begins in the cerebellum. 3 Hypertension, diminished activity, and head injury increase the risk of AD. 4 Most people diagnosed with AD have an early onset, usually before age 65 years.

3 Hypertension, diminished activity, and head injury increase the risk of AD. The health of the brain is linked closely to overall heart health. Persons with cardiovascular disease are at greater risk of Alzheimer's disease. Factors associated with cardiovascular disease, such as inactivity, high cholesterol, diabetes, hypertension, and obesity, are risk factors. Brain injury and trauma also are associated with a greater risk. Less than 1% of Alzheimer's disease cases are genetic. In the brains of people with AD, signs of neuronal degeneration begin in the hippocampus, the part of the brain responsible for recent memory, and then spread into the cerebral cortex. Although the disease can occur at a younger age (early onset), most of those with the disease are 65 years of age or older (late onset). Text Reference - p. 436

A nurse administers these medications to various patients diagnosed with Alzheimer's disease. Which medication would be expected to stabilize levels of glutamate rather than inhibiting breakdown of cholinesterase? 1 Donepezil 2 Rivastigmine 3 Memantine 4 Galantamine

3 Memantine Memantine normalizes levels of the neurotransmitter glutamate, which in excessive quantities contributes to neurodegeneration. Donepezil, rivastigmine, and galantamine are medications classified as cholinesterase inhibitors. Text Reference - pp. 445, 446, Table 23.10

An individual diagnosed with dementia has shown symptoms of agnosia. Which nursing documentation confirms the presence of this symptom? 1 Patient unable to correctly state the day and year of birth. 2 Patient requires the assistance of a nursing assistant to dress appropriately. 3 Patient consistently insists that every male he or she has contact with is his or her son. 4 Patient frequently appears unable to find the appropriate words to express him- or herself.

3 Patient consistently insists that every male he or she has contact with is his or her son. Agnosia is demonstrated as difficulty in recognizing well-known objects, including people such as family members. Being unable to state the day and year of birth is an example of amnesia or memory loss. Needing assistance to perform familiar tasks is a condition called apraxia. Aphasia is demonstrated as difficulty finding the right word to express oneself. Text Reference - p. 439

Which risk factor for delirium is a direct result of external factors? 1 Fractures 2 Older age 3 Polypharmacy 4 Multiple comorbidities

3 Polypharmacy Delirium may occur as a result of polypharmacy, which can occur from a lack of continuity of care and communication, external factors. Older age and multiple conditions are internal factors. Fractures may be a result of an external cause but could also be a result of internal osteoporotic changes. Text Reference - p. 431

Every evening, several residents on the Alzheimer disease wing of a long-term care facility become excessively agitated. What is the term for this phenomenon? 1 Apraxia 2 Agraphia 3 Sundowning 4 Confabulation

3 Sundowning Sundowning is the term for the increase in agitation and decrease in mood in the later part of the day or night common among patients with Alzheimer disease. Confabulation describes the creation of vivid stories instead of actual memories. Agraphia refers to diminishment of reading and writing abilities. Apraxia is the loss of purposeful movement. Text Reference - pp. 438-439

An elderly postoperative patient at a well-maintained health care facility is terrified and reports seeing "giant spiders crawling over the bedclothes." Analyze the situation and select the most appropriate statement. 1 The patient actually sees giant spiders. 2 The patient is disoriented and wants to go home. 3 The patient is visually hallucinating due to delirium. 4 The patient misinterprets folds in the bedclothes for spiders.

3 The patient is visually hallucinating due to delirium. Delirious hospitalized patients, especially the elderly, very commonly have visual hallucinations. Such patients may experience false sensory stimuli and see something such as giant spiders crawling over the bedclothes. Insects are highly unlikely to be found in a well-maintained health care facility. Delirious patients can also become disoriented and want to "go home." They may have errors in perception of sensory stimuli and may mistake folds in the bedclothes for spiders. Text Reference - p. 433

A Hispanic family has been taking care of a family member with Alzheimer-related dementia for several years. What additional issue is this family likely to experience? 1 Blanket acceptance of treatment plan due to stigma 2 Belief that dementia is abnormal in all aging patients 3 Increased ability to cope with the strain of caregiving 4 Low levels of culturally and linguistically appropriate materials

4 Low levels of culturally and linguistically appropriate materials There are many additional barriers that may be faced for families of minority cultures. Depending upon geography, there may be no materials readily available to offer assistance and support to non-native English speakers. There is nothing about being from a Hispanic family that makes caregiving less stressful. There is often stigma attached to a mental disorder, and this may result in nonadherence, not blanket acceptance. Alzheimer disease occurs in all strata of society and many groups see the symptoms as normal aging process. Text Reference - p. 439

A nurse administers medications to four patients with Alzheimer's disease. Which medication would be expected to interfere with glutamate rather than cholinesterase? 1 Donepezil 2 Rivastigmine 3 Galantamine 4 Memantine

4 Memantine Memantine blocks the effects of excess glutamate and is used in moderate to late stages of Alzheimer's disease. Donepezil, rivastigmine, and galantamine are all cholinesterase inhibitors. These drugs increase the availability of acetylcholine and are usedmost often to treat mild to moderate Alzheimer's disease. Text Reference - p. 445, Table 23.10

The nurse is assessing a person with dementia. What problem does the nurse document as a problem related to apathy? 1 The patient often wanders out of the house. 2 The patient often loses personal belongings. 3 The patient loses his or her way around the house. 4 The patient engages in very little conversation.

4 The patient engages in very little conversation. If the patient engages in very little conversation, the nurse identifies and documents it as a problem of apathy. When the patient often wanders out of the house, it indicates risks to the patient at home. When the patient often loses things, it indicates memory impairment. If the patient loses his or her way around the house, it is documented as disorientation. Text Reference - p. 441, Table 23.5

The term "perceptual disturbance" refers to difficulty accomplishing what task? 1 Formulating words appropriately. 2 Performing purposeful motor movements. 3 Changing one's way of thinking to accommodate new information. 4 The processing of information about one's internal and external environment.

4 The processing of information about one's internal and external environment. Perceptual disturbance refers to an impaired ability to process intellectual, sensory, and emotional data in a logical, meaningful way. Changing one's way of thinking to accommodate new information, performing purposeful motor movements, and formulating words appropriately fail to adequately describe the term perceptual disturbance. Text Reference - p. 433