NCD Mosby Q's

210. When assessing a client with a cognitive disorder, the nurse identifies a behavior related to an alteration in mood when the client: 1. Loses interest in eating 2. Tells sexually explicit jokes 3. Has delusions and hallucinations 4. Reverses day and night activities.

1 Depression, which is common with dementia, can lead to disinterest in food.

211. An 84-year-old widow with dementia, who had been living with her daughter before hospitalization, is being discharged with a referral to the visiting nurse. When the nurse visits, the that she gives her mother sleeping pills to stop her wandering at night. The nurse should: 1. Explore hiring a home health aide to stay with the client at night 2. Discuss the possibility of having the client placed in a nursing home 3. Suggest moving the client among family members on a monthly basis 4. Empathize with the daughter but suggest that wrist restraints would be preferable

1 This action will reduce the need for sleeping pills, which frequently add to the older client's confusion.

228. A 79-year-old widow with dementia living in a nursing home is to join a group in recreational therapy. The nurse identifies that the client has laid out several dresses on her bed but has not changed from her nightgown. What is the nurse's best approach by the nurse? 1. Helping her select appropriate attire and assisting her with dressing 2. Reminding her to dress more quickly to avoid delaying the other clients 3. Allowing her as much time as she needs and explaining that she will be late 4. Telling her which dress to wear while reminding her that she is expected in the activity room soon

1 This approach assists the client with decision making; new situations may be stressful and lead to ambivalence.

220. An older female client who is confused and often does home. The client appears slovenly in attire, often soiling her clothing with feces and urine. How can the nurse best manage this problem? 1. Toilet the client every two hours 2. Place the client in orientation therapy 3. Supervise the client's bathroom activities closely 4. Explain to the client how offensive her behavior is to others

1 This client needs toileting every 2 hours to prevent soiling; physically seating the client on the toilet often prevents accidents and negates the use of disposable pads

221. A 65-year-old retired baker is admitted to the hospital with the diagnosis of dementia. The nurse's question that best tests the client's ability for abstract thinking is: 1. "How are a television and a radio alike?" 2. "Can you give me today's complete date?" 3. "What would you do if you fell and hurt yourself?" 4. "Can you repeat the following numbers: 8, 3, 7, 1, 5?"

1 This forces the client to find a common characteristic of two things, an ability that is the criterion for abstract thinking.

223. An older nursing home resident with the diagnosis of early onset dementia likes to talk about olden days and at times has a tendency to confabulate. The nurse determines that confabulation serves to: 1. Prevent regression 2. Increase self-esteem 3. Attract the attention of others 4. Reminisce about achievements

2 Confabulation is used as a defense mechanism against embarrassment caused by a lapse of memory; the client fills in the blanks in memory by making up details, thus maintaining self-esteem.

212. When the nurse is communicating with a client with substance-induced persisting dementia, the client cannot remember facts and fills in the gaps with imaginary information. The nurse identifies that this is typical of: 1. Concretism 2. Confabulation 3. Flight of ideas 4. Associative looseness

2 Confabulation, or the filling in of memory gaps with imaginary facts, is a defense mechanism used by people experiencing memory deficits.

216. When planning activities for a nursing home resident with a diagnosis of vascular dementia, the nurse should: 1. Plan varied activities that will keep the resident occupied 2. Provide familiar activities that the resident can successfully complete 3. Ensure that the resident actively participates in the unit's daily activities 4. Offer challenging activities to maintain the resident's contact with reality

2 Routines and familiarity with activities or the environment provide for a sense of security.

226. A 54-year-old man has demonstrated increasing forgetfulness, irritability, and antisocial behavior. After being found disoriented and semi-naked walking down a street, the diagnosis of dementia of the Alzheimer's type is made. He expresses fear and anxiety when he is admitted to a long-term care facility. What is the best nursing intervention considering the client's diagnosis? 1. Explore with him the reasons for his concerns 2. Reassure him by the frequent presence of staff members 3. Provide him with a written schedule of planned interactions 4. Explain to him why the admission to the facility is necessary

2 The client needs constant reassurance because forgetfulness blocks previous explanations; frequent presence of staff members to decode a written schedule; the client needs continual reassurance.

208. A client with a history of atrial fibrillation has a brain attack and vascular dementia (multi-infarct dementia) is diagnosed. When comparing assessments of clients with vascular dementia and dementia of the Alzheimer's type, which factor is unique to vascular dementia? 1. Memory impairment 2. Abrupt onset of symptoms 3. Difficulty making decisions 4. Inability to use words to communicate

2 The signs and symptoms associated with vascular dementia have an abrupt onset (days to weeks) because of the is associated with a gradual (years), progressive loss of function.

225. When planning care for a 72-year-old client who has been admitted to the hospital because of bizarre behavior, forgetfulness, and confusion, the nurse should give priority the client 1. Preserving the dignity of the client 2. Promoting a structured environment 3. Determining or ruling out organic etiology 4. Limiting the acceleration of symptomatology

2 This client requires a structured environment, regardless of the cause of the behavior; this helps to provide a safe environment.

222. What should the nurse assess first when evaluating memory impairment in a client with dementia? 1. Disorientation of self 2. Recollection of past events 3. Remembrance of recent events 4. Impaired ability to name objects

3 A common sign of dementia is the loss of memory for recent events.

218. An older client's family tells the nurse that the client has suffered some memory loss in the past few years. They say that the client is sensitive about not being able to remember and tries to cover up this loss to avoid embarrassment. When attempting to increase the client's self-esteem, the nurse should try to avoid discussing events that require memory of the client's: 1. Married life 2. Work years 3. Recent days 4. Young adulthood

3 Clients with dementia have the greatest loss in the area of recent memory.

214. An 84-year-old woman is admitted to the hospital with a diagnosis of dementia of the Alzheimer's type. The nurse determines that this disorder is a: 1. Problem that first emerges in the third decade of life 2. Nonorganic disorder that occurs in the later years of life 3. Cognitive problem that is a slow and relentless deterioration of the mind 4. Disorder that is easily diagnosed through laboratory and psychologic tests

3 Dementia of the Alzheimer's type accounts for 80% of dementias in older adults; it may be due to a neurotransmitter deficiency and it is characterized by a steady decline in intellectual functioning, including memory deficits, disorientation, and decreased cognitive ability.

217. A client with the diagnosis of dementia of the Alzheimer's type, stage 1, is living at home with a grown daughter. To best address the functional and behavioral changes associated with this stage, the nurse should encourage the daughter to: 1. Place the mother in a long-term care facility 2. Provide for the mother's basic physical needs 3. Post a schedule of the mother's daily activities 4. Perform care so that the mother does not need to make decisions

3 In stage 1, clients have a mild cognitive impairment with short-term memory loss; establishing a daily routine, posting it, and adhering to it provides a concrete, structured approach.

229. The nurse is caring for a client with dementia who has an alteration in the expression of emotions. Which behavior is unexpected with this client? 1. Lability 2. Passivity 3. Curiosity 4. Withdrawal

3 Intellectual deterioration associated with dementia decreases interest in the environment.

219. During the first month in a nursing home, a client demonstrates numerous disorganized behaviors related to disorientation and cognitive impairment. The nurse's plan of care should continue to take into consideration the client's: 1. Level of interest in unit activities 2. Orientation to time, place, and person 3. Ability to perform tasks while not becoming frustrated 4. Cognitive impairment, which will increase until adjustment to the home is accomplished

3 When the client is unable to perform a task, frustration occurs and results in more disorganized behavior.

213. When taking a health history from a client who has a moderate level of cognitive impairment due to dementia, the nurse expects the presence of: 1. Hypervigilance 2. Increased inhibition 3. Enhanced intelligence 4. Accentuated premorbid traits

4 A moderate level of cognitive impairment because of dementia is characterized by increasing dependence on environmental and social structure and by increasing psychological rigidity with accentuated previous traits and behaviors.

209. A 70-year-old retired man has difficulty remembering his daily schedule and finding the right words to express himself. He is diagnosed as having dementia of the Alzheimer's type. The nurse expects that symptoms of this disorder: 1. Occur fairly rapidly 2. Have periods of remission 3. Begin after a loss of self-esteem 4. Demonstrate a progression of disintegration

4 Dementias, such as that of the Alzheimer's type, result from pathological changes of CNS cells producing deterioration that is long term and progressive. These changes involve cognitive, functional, and behavioral changes that reflect predictable stages (stage 1, mild; stage 2, moderate; and stage 3, severe). The duration of Alzheimer's disease is 3 to 20 years with an average of 10 years.

227. Nursing management of a forgetful, disoriented client with inappropriate behaviors signifying dementia should be directed toward: 1. Restricting gross motor activity to prevent injury 2. Preventing further deterioration in the client's condition 3. Maintaining scheduled activities through behavior modification 4. Rechanneling the client's energies into more appropriate behaviors

4 Disoriented clients need assistance in how they direct their energy to limit inappropriate behaviors.

224. What should be a priority of nursing care for a client with a dementia resulting from AIDS? 1. Assessing for pain frequently 2. Planning for re-motivational therapy 3. Arranging for long-term custodial care 4. Providing for basic intellectual stimulation

4 This action maintains, for as long as possible, the client's remaining intellectual functions by providing an opportunity to use them.

215. An older client is admitted to the hospital with the diagnosis of dementia of the Alzheimer's type and depression. Which signs of depression does the nurse identify? Select all that apply. 1. _____ Loss of memory 2. _____ Increased appetite 3. _____ Neglect of personal hygiene 4. _____ "I don't know" answers to questions 5. _____ "I can't remember" answers to questions

Answer: 3, 4, 5 1. Depression does not cause memory deficits. 2. A typical symptom of depression is loss of interest in food. 3. This is associated with depression because of low self-esteem. 4. People who are depressed do not have physical or emotional energy; "I don't know" answers require little thought and/or decision making. 5. People who are depressed do not have physical or emotional energy; "I can't remember" answers require little thought and/or decision making.