EAQ 59 Dementia and Delirium

Which behavioral patterns in an older adult may indicate normal forgetfulness related to aging? Select all that apply. Becomes lost in familiar places Does not remember knowing a person Occasionally forgets to run an errand Forgets an event from the distant past Sometimes misplaces keys, eyeglasses, or other items

Occasionally forgets to run an errand Forgets an event from the distant past Sometimes misplaces keys, eyeglasses, or other items Rationale: The older adult with normal forgetfulness may occasionally forget to run an errand or may forget an event from the distant past. An older adult may also sometimes misplace keys, eyeglasses, or other items. On the other hand, a person with Alzheimer's disease may not remember knowing a person or may get lost in familiar places, owing to profound memory loss.

Which is a key characteristic of delirium? Occurs abruptly Difficulty using words Frequent night awakenings Lasts an average of eight years

Occurs abruptly Rationale: A key distinction of delirium is that it occurs abruptly. The patient with dementia, not delirium, experiences difficulty using words and frequent night awakenings. Alzheimer's disease, not delirium, lasts an average of eight years.

Which statement would the nurse include in a teaching session for an adult patient who is diagnosed with early-onset Alzheimer's disease (AD)? "With proper treatment, your AD will not advance for 10 years." "The type of AD with which you are diagnosed is the most common form of AD." "Your children should consider genetic testing to determine their risk for AD." "Any family member that tests positive for ApoE-4 will develop AD within five years."

"Your children should consider genetic testing to determine their risk for AD."

Which score range on the Mini-Cog test indicates a positive screen for dementia? 0 to 2 3 to 4 5 to 6 Greater than 6

0 to 2 Rationale: The Mini-Cog test is used as a brief assessment tool for cognitive impairment. It can be quickly administered and can guide the need for further evaluation. A score of 0 to 2 is a positive screen for dementia. A score of 3 and above is a negative screen for dementia.

The nurse reviews the medical records of several patients that are seen in the clinic for annual health maintenance visits and identifies that which patient is at the highest risk for Alzheimer's disease (AD)? A 65-year-old Asian American male An 80-year-old African American female An 85-year-oid Hispanic American male A 55-year-old Hispanic American female

An 80-year-old African American female Rationale: AD is not a normal part of aging; however, as with other forms of dementia, age is the most important risk factor for developing AD.

A patient undergoing the Mini-Cog test is being assessed for cognitive impairment. After the clock drawing test, the patient puts the numbers in correct sequence on the clock and recalls two words that the nurse asked the patient to remember. What is the test score for this patient? Record the score using a whole number.

4 Rationale: The clock drawing is a test that can be used as an assessment technique in dementia. The person undergoing testing is asked to draw a clock, put in all of the numbers, and set the hands at 10 past 11. The test is considered normal if 4 all numbers are present in the correct sequence and position and the hands readably display the requested time. In addition, the patient is asked to repeat three previously stated words. Give one point for each recalled word and two for the normal clock drawing test result. Because this patient recalled two words and the clock drawing test was normal, the patient's score is 4.

An older patient who takes haloperidol for delirium is exhibiting extrapyramidal effects. Which action would the nurse take? Hold the next scheduled dose of haloperidol. Instruct the patient on how to control the adverse body movements. Discuss the use of a benzodiazepine with the health care provider. Position the patient in a chair in an area with increased environmental stimuli.

Discuss the use of a benzodiazepine with the health care provider.

The nurse is teaching a group of caregivers about how to help patients with severe agitation in Alzheimer's disease. Which strategies would the nurse include in the plan? Select all that apply. Ignoring Distraction Redirection Restraining Reassurance

Distraction Redirection Reassurance

Which interventions would be delegated to the licensed practical/vocational nurse when caring for a patient with Alzheimer's disease in a long-term care facility? SATA Administer the ordered drug therapy. Provide personal hygiene, skin care, and oral care. Use bed alarms and surveillance to decrease the risk for falls. Teach the patient and caregivers memory-enhancement aids. Administer enteral feedings to patients who are unable to swallow.

Administer the ordered drug therapy. Administer enteral feedings to patients who are unable to swallow. Rationale: that would be delegated to a licensed practical/vocational nurse are administration of the prescribed drug therapy and administration of enteral feedings to patients with swallowing difficulties. Providing personal hygiene, performing skin and oral care, and using bed alarms and surveillance are tasks that would be delegated to the unlicensed assistive personnel. Teaching the patie

After reviewing assessment data, the nurse adds interventions to a patient's plan of care to address the risk for developing delirium. Which findings would cause the nurse to make these additions? Select all that apply. Age 84 Left foot wound Chronic renal failure Macular degeneration Previous hip replacement

Age 84 Left foot wound Chronic renal failure Macular degeneration Rationale: Prevention of delirium involves recognition of high-risk patients. Patient groups at risk include those with advanced age, severe acute illness such as a foot wound, chronic renal disease, and visual impairment such as macular degeneration. Previous surgeries do not contribute to the development of delirium.

A patient diagnosed with moderate to severe Alzheimer's disease (AD) is being discharged home. Which instructions by the nurse are most appropriate to give to the caregiver(s)? Select all that apply. "Be aware that pain may be manifested in changes in behavior." "Be alert to any changes in behavior, fevers, cough, or urinary pain." "If the patient wanders away and cannot be found within an hour, call 911." "Check that the patient swallows the food that is chewed because patients with AD can have difficulty swallowing." "A reduced-calorie diet is preferred because after the primary stage of the disease, AD patients tend to gain too much weight."

"Be aware that pain may be manifested in changes in behavior." "Be alert to any changes in behavior, fevers, cough, or urinary pain." "Check that the patient swallows the food that is chewed because patients with AD can have difficulty swallowing."

The family of a patient with Alzheimer's disease (AD) asks if the diagnosis has been confirmed. How would the nurse respond? "This type of dementia can never be confirmed." "A blood test was taken that confirmed the diagnosis." "Confirmation occurs by examining brain tissue after death." "The response to medications is used to confirm the diagnosis."

"Confirmation occurs by examining brain tissue after death." Rationale: When all other possible conditions that can cause cognitive impairment have been excluded, a clinical diagnosis of AD can be made. A comprehensive evaluation includes a complete health history, physical examination, neurologic and mental status assessments, and laboratory tests. A definitive diagnosis of AD requires an examination of brain tissue at autopsy and findings of neurofibrillary tangles and plaques. It is not confirmed by a blood test or by the patient's response to medications.

A student nurse asks the registered nurse about risk factors for developing Alzheimer's disease (AD). Which response by the nurse is accurate? "Long-term illegal drug abuse always leads to AD." "Low cholesterol levels can make the dementia worse." "Malnutrition can increase a person's chances of getting the disease." "Diabetes greatly increases a person's chances of developing AD."

"Diabetes greatly increases a person's chances of developing AD." Rationale: Diabetes is a dramatic risk factor to people with dementia. Insulin resistance associated with diabetes interferes with how the body breaks down protein amyloid plaques found in the brain tissue of AD patients. Obesity, not malnutrition and high cholesterol, are also risk factors. Long-term drug abuse is not a known risk factor in developing the disease.

The nurse is using the Mini-Cog test to assess a patient for the presence of dementia and possibly Alzheimer's disease (AD). Which statement is appropriate for the nurse to include when administering the test to the patient? "Write the military time for 3:00 p.m. " "Draw the hands of the clock to read 11:10." "I will repeat five words up to three times during this process." "Listen carefully and remember four unrelated words and then repeat the words."

"Draw the hands of the clock to read 11:10."

The nurse is conducting a teaching session on health strategies to decrease the risk for developing Alzheimer's disease (AD). Which statement made by a participant indicates the need for further education? "Staying socially active will contribute to better brain health." "Daily physical activity can decrease my risk of cognitive decline and AD." "Drinking a few glasses of wine each day has been shown to decrease the incidence of AD." "Reading and completing crossword puzzles helps to keep my mind active and challenged."

"Drinking a few glasses of wine each day has been shown to decrease the incidence of AD." Rationale: Drinking wine or beer each day has not been shown to decrease the incidence of AD. It is important to avoid harmful substances because excessive drinking and drug abuse can damage brain cells. This participant requires further education regarding health promotion methods to decrease the risk for developing AD. The other statements indicate appropriate understanding of the health promot

The nurse is assessing an adult patient during a scheduled health maintenance visit. The patient states, "I have become so forgetful. I am worried that I am developing Alzheimer's disease like my parent did." Which assessment question will help to determine whether the patient has memory loss related to Alzheimer's disease (AD)? "Do you sometimes misplace your keys?" "Have you ever forgotten what an item is used for?" "When driving, do you momentarily forget where to turn?" "Do you occasionally have to search for the words that you want to use in a conversation?"

"Have you ever forgotten what an item is used for?" Rationale: One behavior that is associated with memory loss with AD is forgetting what an item is used for. This question will help the nurse determine if the patient has symptoms of AD. Questions about misplaced keys, searching for words, and momentary lapses while driving help to determine normal forgetfulness.

The spouse of a patient, just diagnosed with Alzheimer's disease in the mild stage, asks the nurse how to plan for the future and make treatment decisions. Which response by the nurse is appropriate? "Medicine is researching treatments for Alzheimer's disease actively, and a cure may be near." "Discussing advanced directives may cause the Alzheimer's disease to progress more quickly." "Disease progression is uniform, and decisions about treatment can be made after the patient is comfortable with the diagnosis." "Health care decisions, including advanced directives, should be made while the patient is able to participate in the decision making."

"Health care decisions, including advanced directives, should be made while the patient is able to participate in the decision making."

The nurse provides teaching about prescribed medications to a patient who is diagnosed with Alzheimer's disease (AD). Which statement made by the patient indicates the need for further teaching? "I will take zolpidem to help me sleep." "I will take trazodone if I become agitated." "I am taking donepezil to treat problems with my memory." "I am taking fluoxetine for the depression that I have been experiencing since my diagnosis."

"I will take trazodone if I become agitated." Rationale: Trazodone, an atypical antidepressant, is prescribed for depression associated with the diagnosis of AD, not for agitation. Zolpidem is prescribed for insomnia. Donepezil is prescribed for decreased memory and cognition. Fluoxetine is prescribed for depression. These statements indicate appropriate understanding of the medication teaching.

Which statement by the spouse of a patient with Alzheimer's disease (AD) demonstrates an accurate understanding of the patient's medication regimen? "We're both holding out hope that this medication will cure the disease." "I'm really hoping my spouse's medications will slow down the mental losses." "I know that this won't be a cure, but we learned that it might prevent a bodily decline even if my spouse declines mentally." "I learned that if we are vigilant about the medication schedule, there may be no physical effects of the disease."

"I'm really hoping my spouse's medications will slow down the mental losses." Rationale: There is presently no cure for Alzheimer's disease, and drug therapy aims at improving or controlling decline in cognition. Medications do not directly address the physical manifestations of AD.

Which statement by the nurse is accurate when explaining vascular dementia to a patient's family? "It is caused by low blood pressure." "It is caused by another chronic disease." "It is reversible with medication treatment." "It occurs after a single stroke or multiple strokes."

"It occurs after a single stroke or multiple strokes." Rationale: Vascular conditions are the second most common cause of dementia and may be caused by a single stroke (infarct) or by multiple strokes. High BP is a risk factor for dementia. Vascular dementia is not identified as being caused by another chronic disease. Vascular dementia is not identified as being reversible.

When following the DELIRIUM mnemonic, in which order would the nurse analyze the data?

1. Skin turgor 2. Potassium level 3. Breath sounds 4. Body temperature 5. Medications 6. Ambulatory status 7. Pain level 8. Bowel function Rationale: The DELIRIUM mnemonic identifies causes for the development of delirium. The first letter, D, is dehydration, which can be determined through skin turgor. E represents electrolyte imbalances, which can be determined through potassium level. L is for lung, liver, and other major body organs. Breath sounds are appropriate for this assessment. I represents infection, which can be determined by body temperature. R for "Rx" represents drugs or medications. I represents mobility status or the presence of injury, which can be determined by the patient's ambulatory status. U represents untreated pain, which can be determined by the patient's pain level. M represents metabolic disorders, which can be determined by the patient's bowel function.

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

A patient in the early stages of Alzheimer's disease

Which characteristics are different in familial Alzheimer's disease when compared with those of sporadic disease? Select all that apply. A rapid disease course Presence of amyloid plaques Loss of connections between neurons A clear pattern of inheritance within the family An early onset of the disease (before 60 years of age)

A rapid disease course A clear pattern of inheritance within the family An early onset of the disease (before 60 years of age) Rationale: Familial Alzheimer's disease is characterized by a rapid disease course and a clear pattern of inheritance within the family. The disease onset is also early (before the age of 60 years). The presence of amyloid plaques and loss of connections between neurons are common characteristics in familial as well as sporadic Alzheimer's disease.

Using the confusion-assessment method, which feature includes evidence of a sudden change in the patient's mental status from the patient's baseline? I attention Disorganized thinking Altered level of consciousness Acute onset an fluctuating course

Acute onset an fluctuating course

Which factors would the nurse consider risk factors for developing Alzheimer's disease? Select all that apply. Aging Viral infection Family history Diabetes mellitus Irritable bowel disease

Aging Family History Diabetes mellitus Rationale: Aging is the greatest risk factor for Alzheimer's disease. Diabetes affects the vascular supply of the brain in many ways. Cerebral hypoxia caused by compromised vascular supply may cause neurodegenerative changes in the brain, leading to dementia and Alzheimer's disease. Alzheimer's disease is found to run in families; those with a first-degree relative with dementia are more likely to develop the disease. Those who have more than one first-degree relative with dementia are at even higher risk of developing the disease. Irritable bowel disease and viral infection do not cause degenerative changes in the brain and therefore do not increase the risk of developing dementia.

Which symptoms would a nurse assess in a patient with Alzheimer's disease who is in severe pain but who cannot communicate? Select all that apply. Agitation Wandering Withdrawal Sundowning Increased vocalization

Agitation Withdrawal Increased vocalization

Benzodiazepines are indicated in the treatment of cases of delirium that have which cause? Polypharmacy Cerebral hypoxia Alcohol withdrawal Electrolyte imbalances

Alcohol withdrawal Rationale: Benzodiazepines can be used to treat delirium associated with sedative and alcohol withdrawal. However, these drugs may worsen delirium caused by other factors and must be used cautiously. Polypharmacy, cerebral hypoxia, and electrolyte imbalances are not treated with benzodiazepines.

Which is the most common cause of dementia? The aging process Alzheimer's disease Opioid medications A genetic predisposition

Alzheimer's disease Rationale: Alzheimer's disease (AD) is the most common cause of dementia. Although advanced age is a risk factor for dementia, it is not the most common cause. Opioid medications are often responsible for delirium, not dementia. Although some patients may have a genetic predisposition for dementia, this is not the most common cause.

Which patient may face the greatest risk for developing delirium? A patient with fibromyalgia whose chronic pain has recently worsened A patient with a fracture who has spent the night in the emergency department An older patient whose recent CT shows brain atrophy An older patient who takes multiple medications to treat various health problems

An older patient who takes multiple medications to treat various health problems Rationale: Polypharmacy is implicated in many cases of delirium, and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment, as well as pain, may cause delirium, but this is less of a risk than in an older adult who takes multiple medications.

Which assessment factor is included in a Mini-Cog study? Have patients count back from 100 by sevens. Have patients write the name of the town and state where they grew up. Ask patients to draw and read the hands of a clock and point out a specific time. Ask patients to listen to four unrelated words

Ask patients to draw and read the hands of a clock and point out a specific time. Rationale: The Mini-Cog assessment study is a quick way to guide the need for further studies. One of the three features is to have the patient draw a clock with hands and identify a specific time. Patients are asked to listen to and remember three unrelated words and then restate them at a later time. Asking them to state where they grew up or to count back from 100 by sevens is not part of a cognitive assessment.

Which observation would the nurse identify as a possible beginning sign of delirium in a hospitalized patient? Pain level of 5 Awake at 3:00 a.m. Drop in BP Reports of being hungry

Awake at 3:00 a.m. Rationale: Early manifestations of delirium include insomnia. Being awake at 3:00 a.m. could indicate this early warning sign. Pain, hypotension, and increased hunger are not identified as manifestations of delirium.

Which data in a patient's health history would be associated with an increased risk for developing Alzheimer's disease (AD)? Select all that apply. Body mass index (BMI) of 32.7 A 10-year history of type 2 diabetes mellitus Takes over-the-counter analgesics for arthritic pain Parent death at the age of 85 from cardiomyopathy and renal failure Takes two antihypertensive medications and maintains a BP 150/88 mm Hg

Body mass index (BMI) of 32.7 A 10-year history of type 2 diabetes mellitus Takes two antihypertensive medications and maintains a BP 150/88 mm Hg Rationale: Risk factors for AD include obesity, diabetes mellitus, and hypertension. A BMI of 32.7 indicates obesity. The patient was diagnosed with type 2 diabetes mellitus 10 years ago. The patient's current BP on two antihypertensive medications is 150/88 mm Hg. Arthritis or the use of over-the-counter analgesics are not risk factors for the development of dementia. A familial history of cardiomyopathy and renal failure are not risk factors for the development of AD.

Which diagnostic test would be prescribed to diagnose vascular dementia (VaD)? Lipid panel CT scan of the brain Pituitary hormone levels Partial thromboplastin time

CT scan of the brain Rationale: The diagnosis of dementia related to vascular causes is based on cognitive loss, vascular brain lesions (stroke or infarcts) demonstrated by neuroimaging techniques, and the exclusion of other causes of dementia. A CT scan of the brain will be prescribed to diagnose this type of dementia. A lipid panel, pituitary hormone levels, and partial thromboplastin time will not identify a vascular cause for this type of dementia.

Which methods are used to diagnose the preclinical stage of Alzheimer's disease? SATA Electrocardiogram Thyroid function tests Serum creatinine test Cerebrospinal fluid (CSF) analysis Positron emission tomography (PET) scan

Cerebrospinal fluid (CSF) analysis Positron emission tomography (PET) scan Rationale: At the preclinical stage of the disease, significant clinical symptoms are not yet evident. In some people, amyloid buildup can be detected with positron emission tomography scan and cerebrospinal fluid analysis. An electrocardiogram determines the cardiac activity and may not be an appropriate test for Alzheimer's disease. Thyroid dysfunction does not cause Alzheimer's disease, so thyroid tests are not appropriate. Serum creatinine levels are indicative of renal functioning and are therefore not useful in detecting Alzheimer's disease.

A patient seeks medical attention because of cognitive impairment and is diagnosed with Alzheimer's disease. Which finding forms the basis for the diagnosis? Brain imaging shows atrophy of the brain. Presence of the gene ApoE-4 shows up on genetic testing. CT shows vascular brain lesion. Cognitive impairment with etiologies other than Alzheimer's disease has been ruled out.

Cognitive impairment with etiologies other than Alzheimer's disease has been ruled out. Rationale: The diagnosis of Alzheimer's disease is made after a thorough neurologic examination reveals cognitive impairment. Testing is done to rule out all possible known causes. If no cause is found for the change in mental status, then the diagnosis of Alzheimer's disease is made based on exclusion. Brain atrophy is found with aging and may be present with normal cognitive functioning. The ApoE-4 found upon genetic testing is only a risk factor gene for late onset Alzheimer's disease (after age 60). Vascular brain lesions such as infarcts of the brain occur with vascular dementia.

Which collaborative treatment would be prescribed for an adult patient who is diagnosed with mild cognitive impairment (MCI)? Donepezil Rivastigmine Continued monitoring Placement in assisted living

Continued monitoring Rationale: Currently, the primary treatment of MCI consists of ongoing monitoring. There is little evidence that cholinesterase inhibitors, such as donepezil and rivastigmine, affect progression to dementia or cognitive test scores in people with MCI. MCI is marked by symptoms of memory problems severe enough to be noticed and measured, but not compromising a person's independence; therefore placement in assisted living is not anticipated.

In the mnemonic "DELIRIUM," the M represents which cause of delirium? A. Medication B. Malnutrition C. Memory loss D. Metabolic disorders

D. Metabolic disorders Rationale: The letter "M" represents metabolic disorders in the mnemonic of causes for delirium. The "R" for Rx represents medication. The "D" for dementia and dehydration represents memory loss. Malnutrition is not part of this mnemonic.

A patient with disorganized, distorted thinking and slow or accelerated incoherent speech is demonstrating which cognitive problem? Delirium Dementia Depression Alzheimer's disease

Delirium Rationale: A patient with disorganized, distorted thinking and slow or accelerated incoherent speech is demonstrating delirium. A patient with depression has intact thinking processes but may express apathy and fatigue. Dementia is characterized by difficulty with abstract thinking and judgment. Alzheimer's disease has different stages related to cognitive function.

A nurse is caring for a patient who was alert and showed no signs of cognitive distress then suddenly exhibits severe confusion and emotional distress. Which term describes this temporary state that could indicate a life-threatening syndrome? Delirium Dementia Mixed dementia Alzheimer's disease

Delirium Rationale: Delirium is defined as a state of temporary acute mental confusion that can be a life-threatening syndrome. Mixed dementia is characterized by the hallmark abnormalities of Alzheimer's disease and another type of dementia. Alzheimer's disease is a chronic progressive neurodegenerative disease of the brain. Dementia is a neurocognitive disorder characterized by dysfunction or loss of memory, orientation, attention, language, judgment, and reason.

The adult child of an older patient states, "Since the discharge from the hospital two days ago, my parent won't eat and is confused." Which issue would the nurse suspect is occurring with the patient? Delirium Infection Dementia Psychosis

Delirium Rationale: In most patients, delirium usually develops over a two- to three-day period. Early manifestations of delirium include loss of appetite and confusion. Loss of appetite and confusion are not indications of an infection. Dementia has a slow, insidious onset. The described manifestations are not indicative of psychosis.

Which issue is the leading risk factor for delirium? Age Dementia Sleep deprivation Serious medical illness

Dementia

Which information is correct about the association between Alzheimer's disease (AD), dementia, and diabetes mellitus? Select all that apply. Elevated blood glucose levels contribute to oxidative stress. Insulin resistance may encourage the development of brain plaques. Supplemental insulin alters arterial lining, encouraging atherosclerotic changes. Uncontrolled glucose levels reduce the oxygen-carrying capacity of red blood cells. Elevated glucose and cholesterol levels potentiate the development of atherosclerosis.

Elevated blood glucose levels contribute to oxidative stress. Insulin resistance may encourage the development of brain plaques. Elevated glucose and cholesterol levels potentiate the development of atherosclerosis. Rationale: Diabetes can contribute to AD and dementia in several ways. High blood glucose produces oxygen-containing molecules that can damage cells in a process known as oxidative stress. Insulin resistance, which causes high blood glucose and in some cases leads to type 2 diabetes, may interfere with the body's ability to break down amyloid, a protein that forms brain plaques in AD. High blood glucose along with high cholesterol has a role in atherosclerosis, which contributes to vascular dementia. Supplemental insulin is not identified as encouraging atherosclerotic changes. Uncontrolled glucose levels do not reduce the oxygen-carrying capacity of red blood cells.

Which intervention would the nurse include when planning care for a patient with delirium? Using restraints Eliminating precipitating factors Leaving television on to distract the patient Moving the patient away from the nurse's station to avoid commotion

Eliminating precipitating factors Rationale: Care of the patient with delirium focuses on eliminating the precipitating factors that are causing the delirium. Restraints should be avoided because immobility can worsen delirium. The priority is providing a calm and safe environment. Leaving the television on may add unnecessary noise if the patient is overstimulated. The patient should be placed close to the nurse's station to allow for frequent monitoring.

Which assessment findings support the diagnosis of frontotemporal lobar degeneration (FTLD)? Select all that apply. Erratic behavior Altered memory Sleep disturbances Difficulty with speech Inconsistent motor function

Erratic behavior Altered memory Sleep disturbances Difficulty with speech Rationale: In FTLD, portions of the frontal and temporal lobes atrophy. It is characterized by disturbances in behavior, memory, and sleep, and it may include language impairment. Motor function changes are not identified as a manifestation of FTLD.

When reviewing the chart below, which findings indicate that the patient is suffering from depression? Progresses slowly Lasts for months to years Start abruptly and usually at night Lasts for at least two weeks, but can last several months to years

Lasts for at least two weeks, but can last several months to years

Which risk is the nurse's priority concern for a patient with delirium who becomes severely agitated? Falls Disorientation Thiamine deficiency Hypoactive motor function

Falls Rationale: A patient experiencing severe agitation is at risk for falls, which pose the greatest immediate risk to the patient's well-being. The patient experiencing severe delirium is most likely disoriented, but this is a characteristic, rather than a risk, of delirium. A thiamine deficiency may be related to the cause of the delirium, not an effect of the delirium. A patient with delirium will have hyperactive, not hypoactive, motor function.

Which professionals have a high risk of developing Alzheimer's disease or another type of dementia? Select all that apply. Fishermen Tennis players Football players Baseball players Military members

Football players Military members Rationale: Head trauma is a risk factor for dementia. Football players and military members are at elevated risk of getting injured and eventually developing dementia. Tennis players, baseball players, and fishermen have a low risk of head trauma and therefore are at low risk of developing dementia related to their profession.

Which manifestations would a nurse observe in a patient with mild cognitive impairment (MCI)? Select all that apply. Forgets recent events Frequently misplaces items Does not remember knowing a person Becomes easily lost in familiar places Has increasing difficulty finding desired words

Forgets recent events Frequently misplaces items Has increasing difficulty finding desired words Rationale: A person with MCI may develop memory problems that can be easily noticed and measured. MCI does not affect a person's independence. The nurse should suspect mild cognitive impairment if the patient frequently misplaces items, forgets recent events, and has an increasing difficulty in finding desired words. The symptoms indicate progressive neurodegeneration. Symptoms such as not remembering a known person or becoming easily lost in familiar places indicate profound memory loss related to Alzheimer's disease.

Which actions would the nurse take when assessing a patient with delirium? SATA Greet the patient by name. Assist the patient in applying eyeglasses. Turn on the overhead lights for the patient. Gently touch the patient's arm when talking. Remind that patient that he or she is in the hospital.

Greet the patient by name. Assist the patient in applying eyeglasses. Gently touch the patient's arm when talking. Remind that patient that he or she is in the hospital. Rationale: Overhead lights may be excessive environmental stimuli and should be avoided.

Which medication is appropriate for the nurse to administer when the patient who is diagnosed with Alzheimer's disease (AD) is experiencing agitation and physical aggression? Zolpidem Sertraline Haloperidol Galantamine

Haloperidol Rationale: Haloperidol, an antipsychotic drug, is often prescribed PRN for the agitation and physical aggression that can occur in a patient who is diagnosed with AD. Sertraline, a selective serotonin reuptake inhibitor (SSRI), is prescribed for the depression that can occur with AD. Zolpidem is a medication used to treat sleep disturbances. Galantamine, a cholinesterase inhibitor, is used to treat decrease memory and cognition.

Which nursing interventions would be included in the plan of care for an older adult patient who recently became confused and agitated in the intensive care unit? SATA. Correct any misstatements made by the patient. Have a calm and reassuring approach with the patient. Turn the television on in the room to distract the patient. Reorient the patient and have clock and calendar visible to the patient. Make sure the patient is wearing his or her own eyeglasses and hearing aids.

Have a calm and reassuring approach with the patient. Reorient the patient and have clock and calendar visible to the patient. Make sure the patient is wearing his or her own eyeglasses and hearing aids. Rationale: The patient has developed delirium, which is common among elderly patients in intensive care units. A calm, reassuring approach enhances a feeling of security. Wearing eyeglasses and hearing aids assists the patient in communication. Reorientation verbally with reinforcement visuals such as a clock is helpful. Correcting all misstatements interferes with patient trust. The environment should not be overstimulating, so the television should be off.

A nurse is caring for a patient with Alzheimer's disease in an adult day care facility. Which nursing management goals would help this patient? Select all that apply. Have dignity maintained. Maintain functional ability. Have personal care needs met. Learn to be dependent on the nurse. Get registered in a long-term care facility.

Have dignity maintained. Maintain functional ability. Have personal care needs met.

A patient who has Alzheimer's disease has difficulty with verbal expression. Which advice would the nurse suggest to the patient's spouse to keep the patient safe during the day while the spouse is at work? Consider having the patient move to an assisted living facility. Have the patient attend an adult day care. Complete an advance directive. Monitor for behavioral changes.

Have the patient attend an adult day care. Rationale: To keep this patient safe during the day while the spouse is at work, an adult day care facility would be the best choice. This patient would not need assisted living. Advance directives are important but are not related to safety. Monitoring for behavioral changes will not keep the patient safe during the day.

Which assessment data indicates that a patient has progressed from moderate Alzheimer's disease (AD) to severe AD? Needing assistance with dressing Having difficulty eating and swallowing Having more trouble following directions Lacking judgment and beginning to wander

Having difficulty eating and swallowing Rationale: Difficulty eating and swallowing is a clinical manifestation associated with severe AD and indicates the patient has progressed from moderate to severe AD. Needing assistance with dressing, having trouble following directions, and lacking judgment and wandering are all behaviors associated with moderate AD.

Which nursing interventions would the nurse delegate to unlicensed assistive personnel when taking care of patients with Alzheimer's disease? Select all that apply. Help patients with eating. Monitor the behavioral changes. Assist patients with daily activities. Use bed alarms and surveillance to decrease risk of falls. Teach patient and caregivers memory enhancement aids.

Help patients with eating. Assist patients with daily activities. Use bed alarms and surveillance to decrease risk of falls.

A patient with diabetes mellitus wishes to know why diabetes increases the risk of developing dementia. How would the nurse explain this connection to the patient? High blood glucose eliminates oxidative stress that damages cells. Insulin resistance promotes the body's ability to break down amyloid. High glucose levels reduce cholesterol levels, preventing atherosclerosis. High glucose levels cause microangiopathy, which damages blood vessels of the brain.

High glucose levels cause microangiopathy, which damages blood vessels of the brain. Rationale: Diabetes is one of the major risk factors of dementia. Diabetes mellitus damages the small vessels throughout the body, including those of the brain. A compromised oxygen supply due to these damaged blood vessels may be responsible for progressive cognitive decline in patients with diabetes mellitus. Insulin resistance does not promote the body's ability to break down amyloid; rather, it interferes with it. Amyloid protein is responsible for forming brain plaques in Alzheimer's disease. High blood glucose does not eliminate oxidative stress; it produces oxygen-containing molecules that can damage cells. In addition, high blood glucose, coupled with high cholesterol, accelerates atherosclerosis, which contributes to vascular dementia.

Which disorder can cause dementia and is considered ventricular? Head injury Brain tumor Hydrocephalus Hepatic encephalopathy

Hydrocephalus Rationale: Hydrocephalus is a potentially reversible ventricular disorder that can cause dementia. A traumatic head injury is also a potentially reversible condition that can cause dementia. However, this is not a ventricular disorder. A primary brain tumor can also cause dementia but is not a ventricular dis

Which risk factors found in a patient's health history support the diagnosis of Alzheimer's disease (AD)? Select all that apply. Osteoarthritis Hypertension Anorexia nervosa Diabetes insipidus Hypercholesterolemia

Hypertension Hypercholesterolemia Rationale: Hypertension and hypercholesterolemia are both risk factors for dementia, including AD. Other risk factors include diabetes mellitus and obesity. Osteoarthritis, anorexia nervosa, and diabetes insipidus are not risk factors for AD.

When reviewing the health history of a patient with dementia, which causes of the patient's dementia would the nurse identify as possibly being reversible? SATA Alcoholism Hypothyroidism Parkinson's disease Anticholinergic drug use Hydrocephalus

Hypothyroidism Anticholinergic drug use Hydrocephalus Rationale: Dementia is sometimes caused by conditions that may initially be reversible. Dementia caused by hypothyroidism and hydrocephalus is identified as possibly being reversible. Some medications, including anticholinergics, may cause cognitive impairment that is potentially reversible. Dementia caused by alcoholism and Parkinson's disease are not identified as being reversible.

The nurse is providing discharge teaching to the family of a patient who is diagnosed with Alzheimer's disease (AD). Which interventions would the nurse recommend to enhance the patient's safety within the home environment? Select all that apply. Increasing fluid intake Ensuring a well-lit stairwell Tacking down carpet edges Installing grab rails by the toilet Placing throw rugs on hardwood flooring

Increasing fluid intake Ensuring a well-lit stairwell Tacking down carpet edges Rationale: Interventions that are appropriate to enhance safety for the patient diagnosed with AD in the home environment include having stairwells well lit, tacking down carpet edges, and installing grab rails by the toilet. The use of throw rugs is a safety hazard and is not recommended. Although increasing fluid intake is appropriate for the patient with AD, this is an intervention to decrease the patient's risk for infection, not to promote safety within the home environment.

Which explanation is accurate regarding the rationale for why memantine is prescribed for a patient with dementia? It stops agitation. It slows depression. It blocks the action of glutamate. It inhibits the enzyme cholinesterase.

It blocks the action of glutamate. Rationale: Memantine protects the brain's nerve cells against excess amounts of glutamate, which ultimately leads to cell degeneration. It prevents this by blocking the action of glutamate. It does not have any specific antidepressive components or help with agitation. It also does not have any effect on inhibiting cholinesterase.

Which interventions would help to promote mental health in a group of patients who have a high risk of developing Alzheimer's disease? Select all that apply. Learn new skills. Exercise regularly. Solve crossword puzzles. Consume alcohol in moderation. Avoid crowds and social gatherings.

Learn new skills. Exercise regularly. Solve crossword puzzles.

Which medication would the nurse plan to administer to a patient diagnosed with dementia with Lewy bodies (DLB)? Phenytoin Levodopa Methyldopa Digoxin

Levodopa Rationale: Medications for DLB are determined on an individual basis and may include levodopa/carbidopa and acetylcholinesterase inhibitors. Phenytoin is anticonvulsant and can be a cause of delirium. Methyldopa is a medication used to treat cardiovascular and hypertension disorders. Digoxin is a cardiac medication that can cause delirium.

Which distraction activity would the nurse provide for an adult patient who is diagnosed with mild Alzheimer's disease (AD)? Looking at family photos Looking at dangling ribbons Playing a board game appropriate for a school-age child Participating in an activity appropriate for the preschool-age child

Looking at family photos

Which medication would be prescribed for a patient with delirium related to alcohol withdrawal? Phenytoin Lorazepam Carbamazepine Dexamethasone

Lorazepam Rationale: Lorazepam is a short-acting benzodiazepine used to treat symptoms associated with withdrawal from alcohol and sedatives. Patients are assessed frequently and medicated as symptoms warrant. Phenytoin and carbamazepine are anticonvulsant medications used to treat seizures. Dexamethasone is a corticosteroid medication used frequently for its antiinflammatory effect.

Which symptoms are found in a patient with Alzheimer's disease that indicates memory loss rather than normal forgetfulness? Select all that apply. Loses sense of time Jokes about memory loss Forgets what an item is used for Little awareness of cognitive problems Momentarily forgets acquaintance's name

Loses sense of time Forgets what an item is used for Little awareness of cognitive problems

When providing community health care teaching regarding the early warning signs of Alzheimer's disease, which key signs would the nurse advise family members to report? Select all that apply. Misplacing car keys Losing sense of time Difficulty performing familiar tasks Problems with performing basic calculations Becoming lost in a usually familiar environment

Losing sense of time Difficulty performing familiar tasks Problems with performing basic calculations Becoming lost in a usually familiar environment

Which findings would the nurse identify as supporting a diagnosis of dementia in a patient with behavioral changes? Select all that apply. Loss of memory Early awakening from sleep Hyperactive body movements Difficulty with normal conversation Changes developing over the last few days

Loss of memory Difficulty with normal conversation Rationale: Dementia is often diagnosed when two or more brain functions, such as memory loss or language skills, are significantly impaired. Early awakening from sleep is associated with depression. Hyperactive body movements are associated with either dementia or delirium. Behavioral changes that developed over the last few days are manifestations of delirium.

The nurse who has administered a dose of risperidone to a patient with delirium would assess for which intended effect of the medication? Lying quietly in bed Alleviation of depression Reduction in BP Disappearance of confusion

Lying quietly in bed Rationale: Risperidone is an antipsychotic drug that reduces agitation and produces a restful state in patients with delirium. However, it should be used with caution. Antidepressant medications treat depression, and antihypertensive medications treat hypertension. However, there are no medications that will cause confusion to disappear in a patient with delirium.

Which intervention may be beneficial to a patient in the early stages of Alzheimer's disease (AD)? Admission to an AD unit Respite care once a week Use of antipsychotic drugs Memory aids such as calendars

Memory aids such as calendars Rationale: For patients who are in the early stages of AD, memory aids such as the use of a calendar are often beneficial. Admission to an AD unit and weekly respite care may be appropriate as the disease progresses. Agitation and aggressive behavior do not typically occur in the early stages of AD; therefore the use of antipsychotic drugs is not appropriate. Antidepressants may be needed in the early stages of AD because many patients develop depression in this phase.

Which symptoms would the nurse assess if an older adult is showing signs of dementia? Select all that apply. Seizures Dyspnea Memory loss Cognitive dysfunction Abrupt changes in behavior

Memory loss Cognitive dysfunction Abrupt changes in behavior Rationale: In dementia, there is progressive neurodegeneration, and vascular changes lead to cognitive impairment. The cognitive impairment manifests as abrupt changes in behavior, memory loss, and cognitive dysfunction, which are all symptoms of dementia. Other symptoms include dysfunction or loss of orientation, attention, language, judgment, and reasoning. Presence of seizures indicates other neurolo

Which neurologic disease, if detected early, is treatable by surgery? Parkinsonism Alzheimer's disease Dementia with Lewy bodies Normal pressure hydrocephalus

Normal pressure hydrocephalus Rationale: Normal pressure hydrocephalus is an uncommon disorder characterized by obstruction in the flow of cerebrospinal fluid, causing a buildup of the fluid in the brain. If diagnosed early, it is treatable by surgery in which a shunt is inserted to divert the fluid away from the brain. Alzheimer's disease, Parkinsonism, and dementia with Lewy bodies are progressively neurodegenerative diseases. There is no cure for these diseases, only symptom management.

A patient is admitted to the nursing unit after surgery. During the night, the patient suddenly becomes very agitated. What actions would the nurse take? SATA Administer pain medication as soon as it can be given. Notify the patient's family member of the change in the patient's behavior. Inform the patient about notification of the health care provider and use of restraints. Reassess the patient including vital signs, physical assessment, and laboratory results. Reorient and reassure the patient about being safe and assign a sitter to be with the patient. Notify the health care provider of the patient's behavior and current physical assessment.

Notify the patient's family member of the change in the patient's behavior. Reassess the patient including vital signs, physical assessment, and laboratory results. Reorient and reassure the patient about being safe and assign a sitter to be with the patient. Notify the health care provider of the patient's behavior and current physical assessment.

Which condition is associated with reversible manifestations of dementia? Multiple sclerosis Nutritional deficiency Chronic fatigue syndrome Neurodegenerative disorder

Nutritional deficiency Rationale: A nutritional deficiency of cobalamin can cause reversible dementia, which can be treated with vitamin B 12 supplementation. Dementia caused by multiple sclerosis, chronic fatigue syndrome, and neurodegenerative disorders is generally not reversible.

The nurse would assess a patient with Alzheimer's disease who has increased vocalization and agitation for which issue? Pain Glaucoma Lack of sleep Schizophrenia

Pain Rationale: Patients with Alzheimer's disease have cognitive impairment that may affect their oral and written language. As a result, Alzheimer's disease patients may have difficulty expressing physical complaints, including pain. The nurse should observe for signs of pain, such as increased vocalization, agitation, withdrawal, and changes in function. Pain should be recognized and treated promptly, and the patient's response should be monitored. Lack of sleep, glaucoma, and schizophrenia do not usually present as agitation and increased vocalization.

A patient's spouse asks how one can tell if someone has routine forgetfulness that happens with age or something associated with the beginning of Alzheimer's disease. Select the examples of forgetfulness associated with mild cognitive impairment, which are not "normal" forgetfulness. Select all that apply. Patient frequently becomes lost. Patient worries about memory loss. Patient occasionally misplaces keys or glasses. Patient momentarily forgets an acquaintance's name. Patient frequently forgets a friend's name and is slow to recall.

Patient frequently becomes lost. Patient worries about memory loss. Patient frequently forgets a friend's name and is slow to recall. Rationale: Examples of mild cognitive impairment include forgetting a familiar person's name and having difficulty with recall, becoming lost frequently as a change in behavior, and worrying about the memory loss. Mild cognitive impairment may stabilize or advance to Alzheimer's disease. Momentarily forgetting an acquaintance's name or misplacing keys or glasses are examples of "normal" forgetfulness.

A nurse in a long-term care facility is caring for a patient with Alzheimer's disease. The patient, who is usually cooperative and calm, is agitated and refusing care from the nursing assistant. Which action would the nurse do first? Notify the health care provider and obtain a medication to treat the agitation. Notify the patient's family and ask if someone could come and sit with the patient. Perform a physical assessment, including monitoring vital signs and signs of pain. Ask the nursing assistant to distract the patient with an activity.

Perform a physical assessment, including monitoring vital signs and signs of pain. Rationale: Initially, the nurse should assess the patient's physical status to determine whether the patient is experiencing some physical ailment. Consider that the patient's dementia limits the ability to express needs. Precipitating factors causing the behavior change should be thoroughly investigated before asking a family member to sit with the patient or administering medication to control agitation. Distra

The nurse identifies that a patient with delirium is at risk for injury. Which interventions would be included in the patient's plan of care to address the safety concerns? SATA Place a calendar within view. Obtain a prescription for restraints. Make sure the television is on at all times Keep the overhead lights on during the day. Reorient the patient to person, place, and time as necessary.

Place a calendar within view. Reorient the patient to person, place, and time as necessary. Rationale: The nurse should maintain a calm and safe environment. This includes placing a calendar within the patient's view and orienting the patient to person, place, and time as necessary. Keeping the television on at all times could be excessive environmental stimuli. Overhead lights can also contribute to excessive environmental stimuli. Restraints should be avoided.

Which reported behavior by a patient supports the diagnosis of memory loss associated with Alzheimer's disease (AD)? Placing keys in the freezer Joking about memory loss Misplacing reading glasses frequently Increasing difficulty finding desired words during conversation

Placing keys in the freezer Rationale: Forgetting what an item is used for or placing an item, such as keys, in an inappropriate place is a behavior that supports the diagnosis of memory loss associated with AD. Joking about memory loss is a behavior associated with normal forgetfulness. Frequently misplacing items, such as reading glasses, and having increased difficulty finding desired words during conversation are both beh

When caring for a patient in a long-term care facility who is ambulatory but has moderate Alzheimer's disease, the nurse would assess the patient for which common infections? SATA Pneumonia Skin infection Urinary tract infection Gastrointestinal infection Cerebrospinal fluid infection

Pneumonia Urinary tract infection Rationale: Because of feeding and swallowing problems, the patient is at risk for aspiration pneumonia. Reduced fluid intake, prostate hyperplasia in men, poor hygiene, and urinary devices can predispose patients to bladder infections. The risk for a skin infection is increased in the later stages when the patient becomes confined to bed. Cerebrospinal fluid infection is uncommon. Gastrointestinal infection may happen but is not directly related to Alzheimer's disease.

A patient diagnosed with Alzheimer's disease is prescribed donepezil. Which explanation is accurate regarding the purpose of this medication? Possibly slows the rate of cognitive decline. Dissolves the amyloid plaques in the brain tissue. Treats the associated depression the patient experiences. Reverses the progression of the stages of Alzheimer's disease.

Possibly slows the rate of cognitive decline. Rationale: Donepezil is a cholinesterase inhibitor medication. This medication slows the breakdown of acetylcholine, a neurotransmitter in the brain, and possibly slows the rate of cognitive decline.

Which rationale is accurate for why a patient who is demonstrating signs of delirium is scheduled for a CT scan of the brain? An undiagnosed infection is occurring. Alzheimer's disease is being ruled out. Trauma to the spinal cord has occurred. Potential head injury is causing the symptoms.

Potential head injury is causing the symptoms. Rationale: In delirium, brain imaging studies, such as a CT scan, are used in situations in which head injury is known or suspected. A lumbar puncture would be used to aid in the diagnosis of an infection. There is no definitive diagnostic test for Alzheimer's disease. Spinal cord trauma is not associated with delirium.

The nurse is providing care to an adult patient diagnosed with early-onset Alzheimer's disease (AD). The nurse recommends that the patient's children have genetic testing performed to determine the presence of which genes that are associated with AD? Select all that apply. Presenilin-1 (PSEN1) gene Presenilin-2 (PSEN2) gene Apolipoprotein E-2 (ApoE-2) allele Apolipoprotein E-4 (ApoE-4) allele Amyloid precursor protein (APP) gene

Presenilin-1 (PSEN1) gene Presenilin-2 (PSEN2) gene Amyloid precursor protein (APP) gene Rationale: Early onset AD is associated with various mutations to the PSEN1 gene, the PSEN2 gene, and the APP gene. Late onset AD is associated with the presence of the ApoE-4 allele. The presence of the ApoE-2 allele is associated with a lower risk of AD.

Which symptoms would the nurse include in a teaching plan for a group of caregivers regarding how to detect the early warning signs of Alzheimer's disease? SATA Problems with language Disorientation to time and place Memory loss that affects job skills Patient requiring help with getting dressed Patient requiring assistance while walking

Problems with language Disorientation to time and place Memory loss that affects job skills Rationale: Frequent forgetfulness or unexplainable confusion, problems with language, and disorientation to time and place are all early warning signs of Alzheimer's disease. Most patients have trouble finding the "right" word and may forget simple words or substitute inappropriate words, making speech difficult to understand. Requiring help getting dressed or while walking may be usual in old age, owing to frailty and weakness or the presence of other musculoskeletal problems.

Which instructions would the nurse include when teaching a group of caregivers to manage a patient in a late stage of Alzheimer's disease? Select all that apply. Do not correct misstatements. Get the person to stop driving. Provide a regular schedule for toileting. Continue communication through talking and touching. Register with MedicAlert and Alzheimer's Association Safe Return.

Provide a regular schedule for toileting. Continue communication through talking and touching. Rationale: In the late stage of Alzheimer's disease, the patient has profound loss of memory and cognition and may be confined to bed. The patient requires help in activities of daily living. The patient should be provided with a regular schedule for toileting to reduce incontinence. Communication should be done through talking and touching. Not correcting misstatements and registering with MedicAlert and Alzheimer's Association Safe Return are appropriate interventions when the patient is in earlier stages, but by the late stages, they usually don't apply because the patient's abilities to talk and wander are highly impaired. Getting the patient to stop driving is also an appropriate intervention in earlier stages, but irrelevant in late stages because by this time the patient's impairments have long since precluded driving.

When preparing a plan of care to reduce an elderly patient's risk of developing delirium, which interventions would the nurse include in the plan? SATA Apply a vest restraint to prevent falls. Provide opioid pain medication PRN. Provide for uninterrupted sleep during the night. Assess for pain with every vital signs assessment. Ensure that eyeglasses and hearing aids are within reach.

Provide for uninterrupted sleep during the night. Assess for pain with every vital signs assessment. Ensure that eyeglasses and hearing aids are within reach.

The nurse is providing care to a patient with Alzheimer's disease (AD) who is hospitalized for an appendectomy. Which actions are appropriate when providing care to the patient? Select all that apply. Providing reassurance to the patient Using restraints to prevent wandering Assessing closely for safety concerns Orienting frequently to place and time Alternating staff assigned to the patient

Providing reassurance to the patient Assessing closely for safety concerns Orienting frequently to place and time Rationale: Patients with AD may be hospitalized for other health problems. Appropriate interventions for patients with AD in the acute care setting include observing more closely because of safety concerns, frequently orienting the patient to place and time, and giving reassurance. Anxiety or disruptive behavior may be reduced through the use of consistent nursing staff assignments rather than alternating staff assignments. The use of restraints should only be used when the patient is a threat to self or others. Other interventions should be implemented for wandering prior to the use of restraints.

The nurse determines that a patient with delirium will benefit from pharmacologic intervention. The nurse made this conclusion based on which action performed by the patient? Asked for help with repositioning in the bed Reported pain when performing active range-of-motion (ROM) exercises Pulled out hemodialysis catheters during a dialysis session Started to cry when asked if anyone would be visiting today

Pulled out hemodialysis catheters during a dialysis session

Which medications that help to reduce psychotic behaviors are contraindicated in the older patient population? Select all that apply. Sertraline Donepezil Trazodone Quetiapine Risperidone Aripiprazole

Quetiapine Risperidone Aripiprazole Rationale: Aripiprazole, quetiapine, and risperidone are contraindicated for older adults exhibiting psychotic behaviors due to safety concerns. The use of these drugs in older patients with dementia is associated with an increased risk of death. Trazodone, sertralin

Which interventions would the nurse take for a patient with Alzheimer's disease who is restless and agitated? Select all that apply. Reassure the patient. Change the patient's focus. Call the health care provider. Do not ask the patient challenging "why" questions. Warn the patient to be calm or else restraints will be applied.

Reassure the patient. Change the patient's focus. Rationale: The agitated patient often cannot verbalize distress. In such a case, rephrase the patient's statement to validate its meaning and do not question the patient. For a patient who is agitated and restless, redirecting involves changing the patient's focus to perform other activities. Reassurance involves communicating to the patient that he or she will be protected from danger, harm, or embarrassment. Threatening the patient ("calm down or else") or calling the health care provider is likely to aggravate the behavior.

Which manifestations would the nurse expect a patient to exhibit who is diagnosed with dementia with Lewy bodies (DLB)? Select all that apply. Rigidity Long-term memory loss Bradykinesia Hallucinations Postural instability

Rigidity Bradykinesia Hallucinations Postural instability Rationale: Dementia with Lewy bodies (DLB) is a condition characterized by the presence of Lewy bodies in the brainstem and cortex. Patients typically have symptoms of parkinsonism, hallucinations, short-term memory loss, unpredictable cognitive shifts, and sleep disturbances. A possible diagnosis of DLB is indicated by dementia plus two of the following symptoms: rigidity, bradykinesia, hallucinations, and postural instability.

Which manifestations is the nurse likely to document when performing a physical assessment on a patient with dementia with Lewy bodies? Select all that apply. Rigidity Dementia Physical growth delays Bradykinesia Postural instability Mild to moderate intellectual disability

Rigidity Dementia Bradykinesia Postural instability Rationale: Dementia with Lewy bodies is a condition characterized by the presence of Lewy bodies in the brainstem and cortex. Patients typically have symptoms of dementia and extrapyramidal signs such as bradykinesia, rigidity, and postural instability. Physical growth delays and mild to moderate intellectual disabilities would be seen in Down syndrome.

Which medication helps to improve memory and cognition in patients with Alzheimer's disease? Sertraline Trazodone Haloperidol Rivastigmine

Rivastigmine Rationale: Rivastigmine inhibits cholinesterase, an enzyme responsible for the breakdown of acetylcholine in the synaptic cleft. It is used to treat decreased memory and cognition associated with Alzheimer's disease. Sertraline is a selective serotonin reuptake inhibitor used to treat depression associated with Alzheimer's disease. Haloperidol is an antipsychotic drug used to treat behavioral problems such as agitation and aggression that can be caused by Alzheimer's disease. Trazodone is an atypical antidepressant that may help with sleep problems associated with Alzheimer's disease.

Which area would be a priority of care for a patient who is being admitted to the hospital and is demonstrating signs of delirium? Safety Oxygenation Infection control Pain management

Safety Rationale: Care of a patient experiencing delirium includes protecting the patient from harm. Priority should be given to creating a safe environment for a patient with delirium. Although important, there is no evidence to suggest that the patient is having issues with oxygenation, infection control, or pain management.

A patient who is beginning to demonstrate signs of delirium would have which blood level evaluated as a possible contributing factor? Triglycerides Vitamin D Serum potassium International normalized ratio

Serum potassium Rationale: Care of a patient with delirium focuses on eliminating precipitating factors, such as electrolyte imbalances. Of the choices listed, the one that can contribute to the development of delirium is serum potassium. Triglycerides, vitamin D, and international normalized ratio are not causes of delirium.

Which class of drug is used to treat delirium associated with alcohol withdrawal? Opioids Antipsychotics Short-acting benzodiazepines Long-acting benzodiazepine's

Short-acting benzodiazepines Rationale: Short-acting benzodiazepines are used to treat delirium associated with alcohol withdrawal. Opioids, antipsychotics, and long-acting benzodiazepines are not as useful in treating delirium associated with alcohol withdrawal.

Which instructions would the nurse include when teaching a group of caregivers about the guidelines for caring for a patient with dementia? Select all that apply. Simplify tasks for easy understanding. Treat the patient with respect and dignity. Give directions using gestures or pictures. Remind the patient to hurry to counteract bradykinesia. Mandate participation in all activities or events to counteract social withdrawal.

Simplify tasks for easy understanding. Treat the patient with respect and dignity. Give directions using gestures or pictures. Rationale: For easy understanding, focus on one thing at a time. Simplifying the tasks may also help the patient to understand them and carry out the tasks. Treat the patient with respect and dignity, even when the patient's behavior is childlike. Respect and dignity would encourage the patient to carry out self- care activities. Giving directions using gestures or pictures can facilitate easier understanding. When taking care of a patient with dementia, do not rush or hurry the patient or force the patient to participate in activities and events; such actions can make the patient agitated.

Which treatment would be included in the plan of care for a patient who has normal pressure hydrocephalus? Loop diuretics such as furosemide Fluid restriction and a low-sodium diet Surgical implantation of a vagal nerve stimulator Surgery with insertion of a shunt

Surgery with insertion of a shunt

The nurse is caring for a patient with progressive dementia. Which finding supports frontotemporal lobar degeneration as the cause of the patient's symptoms? Onset of dementia at age 75 Frequent periods of remission Symmetric atrophy of the temporal lobes Improvement with anticholinergic medication

Symmetric atrophy of the temporal lobes Rationale: Frontotemporal lobar degeneration (FTLD) is a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain. The major distinguishing characteristic between this disorder and Alzheimer's disease is marked symmetric lobar atrophy of the temporal and/or frontal lobes. FTLD tends to occur at a younger age than Alzheimer's disease, typically around age 60. The disease progresses relentlessly and does not have periods of remission. There is no specific treatment, so medications will not improve the symptoms.

A patient with delirium who has been treated with haloperidol begins to display involuntary movements of the face, trunk, and arms. Which complication has occurred? Athetosis Severe agitation Tardive dyskinesia Anticholinergic effects

Tardive dyskinesia Rationale: Involuntary movement of the face, trunk, and arms that develops after the use of haloperidol, a neuroleptic drug, is known as tardive dyskinesia, which should be reported immediately to the prescriber. Anticholinergic effects can be a side effect of atypical neuroleptics (antipsychotics) as a result of the neurotransmitter acetylcholine inhibiting parasympathetic nerve impulses. The side effects include a dry mouth, constipation, urinary retention, dilated pupils, and tachycardia. A patient with severe agitation does not present with involuntary movements of the face, trunk, and arms. Athetosis can occur because of the use of neuroleptic drugs and is characterized by involuntary writhing movements of the limbs.

The nurse is caring for a patient with moderate Alzheimer's disease. After assessment, the nurse determines that the patient is in Reisberg stage 6c. Which assessment findings support this determination? The patient requires help dressing. The patient requires help using the toilet. The patient can no longer walk without assistance. The patient's speech is limited to five to six intelligible words per day.

The patient requires help using the toilet. Rationale: A patient who scores a 6c on the Reisberg scale requires help using the toilet. A patient who scores 6a on this scale requires help dressing. A patient who can no longer walk without assistance scores a 7c on the Reisberg scale. A patient whose speech is li

Which patient's dementia is caused by a neurodegenerative disorder? The patient with alcoholism The patient with multiple sclerosis The patient with Alzheimer's disease The patient with uremic encephalopathy

The patient with Alzheimer's disease Rationale: Alzheimer's disease is a major cause of neurodegenerative dementia. About 60% to 80% of patients with dementia are diagnosed with Alzheimer's disease. Dementia associated with alcoholism is caused by toxic, metabolic, or nutritional diseases. Dementia associated with multiple sclerosis is caused by an immunologic disease. Dementia associated with uremic encephalopathy is caused by a systemic disease.

The patient is having some increased memory and language problems. Which diagnostic tests will be done before this patient is diagnosed with Alzheimer's disease? Select all that apply. Urinalysis Liver function tests Neuropsychologic testing MRI of the head Rheumatoid factor and antinuclear antibody (ANA)

Urinalysis Liver function tests Neuropsychologic testing MRI of the head Rationale: there is no definitive diagnostic test for Alzheimer's disease and many conditions can cause manifestations of dementia, testing must be done to eliminate any other causes of cognitive impairment. These include a urinary tract infection, an MRI to eliminate brain tumors, liver function tests to eliminate encephalopathy, and neuropsychologic testing to assess cognitive function. Rheumatoid factor and ANA are used to diagnose inflammatory diseases and are not associated with Alzheimer's disease.

Which nursing intervention would the nurse use with a patient who has been diagnosed with the mild cognitive impairment stage of Alzheimer's disease? Treat disruptive behavior with antipsychotic drugs. Use a calendar and family pictures as memory aids. Use a writing board to communicate with the patient. Use a wander guard mechanism to keep the patient in the area.

Use a calendar and family pictures as memory aids. Rationale: The patient with mild cognitive impairment will have problems with memory, language, or other essential cognitive functions that are severe enough to be noticeable to others but that do not interfere with activities of daily living. A calendar and family pictures for memory aids will help this patient. This patient should not have disruptive behavior yet or get lost easily. Using a writing board will not help this patient with communication.

Which nursing interventions would be included in the plan of care for a patient with Alzheimer's disease who has difficulty eating and swallowing? Select all that apply. Use easy-grip utensils. Provide food in a crowded room. Use pureed foods and thickened liquids. Remind the patient to chew and swallow the food. Encourage the patient to eat while watching television.

Use easy-grip utensils. Use pureed foods and thickened liquids. Remind the patient to chew and swallow the food.

An older adult patient with a history of a cardiovascular disease is undergoing treatment in a long-term care facility. Which disease is the patient most at risk of developing? Delirium Vascular dementia Alzheimer's disease Mild cognitive impairment

Vascular dementia Rationale: Vascular dementia is a loss of cognitive functioning resulting from ischemic or hemorrhagic brain lesions caused by cardiovascular disease. This type of dementia is the result of decreased blood supply from narrowed and blocked arteries that supply oxygen to the brain. Alzheimer's disease is a neurodegenerative disease, and cardiovascular disease is not related to its pathogenesis. Mild cognitive impairment is a nonspecific symptom of various types of dementia, and although it is the second stage of the Alzheimer's spectrum, it is a symptom (not a disease) and is not correlated specifically with cardiovascular disease. Being of advanced age, this patient is at risk of delirium; however, delirium may not be directly caused by cardiovascular disease.

Which drug on the medication administration record would the nurse administer to a patient with Alzheimer's disease who is experiencing sleep disturbances? Fluoxetine Zolpidem Clonazepam Memantine

Zolpidem Rationale: Zolpidem is a hypnotic drug used to treat sleep disturbances that are often associated with Alzheimer's disease. Fluoxetine is a selective serotonin reuptake inhibitor used to treat depression associated with Alzheimer's disease. Clonazepam is a benzodiazepine drug used to treat behavioral problems such as aggression, disinhibition, and agitation that often occur with Alzheimer's disease. Memantine protects the nerve cells against excess amounts of glutamate, which is released in large amounts by damaged cells in patients with Alzheimer's disease.