PrepU Delirium/Dementia Chapter 11 Questions

A patient with Alzheimer's disease is prescribed donepezil (Aricept). When teaching the patient and family about this drug, which of the following would the nurse include?

"The drug helps to control the symptoms of the disease." Explanation: Donepezil is a cholinesterase inhibitor used to control symptoms of Alzheimer's disease. It does not cure or slow progression. Typically cognitive ability improves within 6 to 12 months of therapy, but if stopped, cognitive progression occurs. It is recommended that treatment continue at least through the moderate stage of the illness. However, it usually is not prescribed as life-long therapy.

A client reports to the nurse that her elderly mother has become increasingly angry and responds inappropriately to conversations within the past few months. She notes that her mother does not respond when the mother's back is turned. The best intervention of the nurse is to

Ask if the mother could come in for a hearing evaluation. Explanation: The client's mother may be experiencing a hearing loss, and the mother should be evaluated for the symptoms the client has described. The other options do not facilitate assessment and, thus, treatment.

Which of the following is the leading cause of death in the elderly?

Heart disease Explanation: Heart disease is the leading cause of death in the elderly. Heart failure is the leading cause of hospitalization among Medicare recipients. Cancer, osteoporosis, and pneumonia are not a leading cause of death in the elderly.

An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to

Limit ingestion of caffeinated beverages. Explanation: Symptoms that the client describes may be indicative of benign prostatic hypertrophy. The client should limit caffeinated beverages. He does not want to decrease fluid intake; doing so may increase his susceptibility to urinary tract infections. He needs to void frequently and not wait long periods between voiding. The client also should limit his alcohol intake, preferably decreasing it.

Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to which of the following after a rib fracture?

Pneumonia Explanation: Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to pneumonia after a rib fracture. Confusion, asthma attacks, and bronchospasm are not conditions that occur after a rib fracture.

The most common affect or mood disorder of old age includes

depression. Explanation: Depression is the most common affective or mood disorder of old age. Anxiety disorders, schizophrenia, and phobias are not a common affective or mood disorder of old age.

When performing a respiratory assessment on an older adult patient, what changes associated with aging does the nurse expect to find? (Select all that apply.)

• Reduced vital capacity • Loss of elastic tissue surrounding the alveoli • Increased residual volume Explanation: Age-related changes in the respiratory system include the following: increase in residual lung volume; decrease in muscle strength, endurance, and vital capacity; decreased gas exchange and diffusing capacity; and decreased cough efficiency. The tissue surrounding the alveoli in the lungs becomes less elastic, and pulmonary resistance increases.

A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds:

"What precipitates the outbursts?" Explanation: A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive. The nurse needs to assess the situation and what precipitates the catastrophic reactions to best address how to prevent these events. Other nursing interventions include telling the client's granddaughter to remain calm and to distract the grandmother with quiet music, stroking, or both.

A patient with Alzheimer's disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? You selected:

Distract the patient with a familiar object or music. Explanation: The nurse should try to calm the patient by using distraction with a familiar object or music. Continuing to take the vital signs will cause further agitation and possible harm to the patient or nurse. Placing the patient in a secluded room may increase agitation and should not be used for this situation. The nurse should document the inability to assess vital signs and the reason why this should be done after the patient's basic needs have been met.

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to

Ensure that the mother does not have access to car keys or drive an automobile. Explanation: A person with Alzheimer's disease needs to be provided with a safe environment. Driving is prohibited. Cooking and cleaning may be too much stimulation. Daily activities must be simplified, short, and achievable. Smoking is allowed only with supervision. The person needs adequate lighting, and nightlights are helpful, particularly if the person has increased confusion at night.

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to

Ingest five or six small meals each day. Explanation: A client who experiences orthostatic hypotension should eat five or six small meals to minimize hypotension that can occur after large meals. The client should avoid straining when having a bowel movement. A stool softener would be useful. Hot showers and whirlpools should be avoided.

An elderly client recovering from a hip repair becomes disoriented and tries to get out of bed frequently. The client states, "I forget I am in the hospital." The best nursing intervention is to

Post a sign stating "You are in the hospital" at the client's eye level. Explanation: Client confusion increases the risk of falls. Environmental cues include a sign stating, "You are in the hospital." Measures that are nonrestraining are used first. Raising the lower side rails is considered a restraint. This increases a confused client's risk for falling. Placing a client in a Posey chest restraint is a last resort. Administering an anti-anxiety medication can increase confusion in a client who is already confused.

Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away?

Presbyopia Explanation: Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.

When assessing the older adult, the nurse anticipates an increase in which component of the respiratory status?

Residual lung volume Explanation: With an increase in residual lung volume the patient experiences fatigue and breathlessness with sustained activity. The nurse anticipates decreased vital capacity. The nurse anticipates decreased gas exchange and diffusing capacity resulting in impaired healing of tissues due to decreased oxygenation. The nurse anticipates difficulty coughing up secretions due to decreased cough efficiency.

Which of the following neurotransmitters is implicated in depression?

Serotonin Explanation: Serotonin is implicated in the development of depression. Atropine, acetylcholine, and epinephrine are not implicated in the development of depression.

The reason that federal and state governments carefully regulate the treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement?

Vulnerability of older adult patients Explanation: Because of the vulnerability of older adults, federal and state governments have carefully regulated the treatment given in licensed health care facilities. Cognitive impairment does not automatically constitute incapacity. Older people with fluctuating cognitive status may retain sufficient ability to make some, if not all, their health care decisions. Individuals with different perspectives are required in ethics committees to resolve ethical dilemmas.

Which of the following is an age-related change in the respiratory system?

Decreased gas exchange. Explanation: Age-related changes associated with the respiratory system include decreased gas exchange. Age-related changes associated with the cardiovascular system include increased blood pressure. Changes that occur in the musculoskeletal system include loss of muscle strength and size. Difficulty swallowing occurs as an age-related change associated with the gastrointestinal system.

When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal?

Feeling of fullness Explanation: In an older adult, gastric motility slows modestly, which results in delayed stomach emptying, which in turn leads to early satiety (feeling of fullness). Calcium absorption is also decreased.

Which of the following is a factor that contributes to urinary incontinence in the older female adult?

Relaxed perineal muscle Explanation: Female older adults typically have relaxed perineal muscle. The relaxed muscle can contribute to urinary incontinence, especially when laughing, coughing, and sneezing. Decreased urinary residual would not be a contributing factor. Most older adults have an increase in urinary residual. Most older adults have a decreased bladder capacity; this contributes to an increase in frequency in urination but not incontinence. Detrusor stability is a normal finding and helps prevent incontinence.

The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The patient continuously yells, "It's 1999 and you are going to hurt me." What action should the nurse do first?

Reorient the patient. Explanation: The first action that should be taken by the nurse is to reorient the patient. Hospitalized older adults are at risk for disorientation and confusion. Although the nurse will still need to take the vital signs and assess for infection, reorienting the patient remains the first action. If the patient can be reoriented, then the nurse may be able to complete the other actions without difficulty or potential harm to the patient. The nurse may need to notify the physician if the patient is unable to be oriented or if there are abnormalities with the assessment.

A nurse is caring for an elderly adult client admitted to the hospital from a nursing home because of a change in behavior. The client has a diagnosis of Alzheimer's disease and has started to experience episodes of incontinence. The hospital staff is having difficulty with toileting because the client wanders around the unit all day. To assist with elimination, a nurse should:

incorporate the client's toileting schedule into the pattern of his wandering. Explanation: Incorporating the client's toileting schedule into his wandering assists with elimination and increases the chance of continent episodes. Sedation and restraints will decrease the client's mobility but won't decrease the number of incontinent episodes. Wearing two briefs at a time won't ensure urine absorption and won't address the incontinence issue.

A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate?

"The most common cause of dementia in the elderly is Alzheimer's disease." Explanation: The nurse should inform the family member that Alzheimer's disease is the most common cause of dementia in elderly clients. Dementia is a clinical manifestation, not a disease process. Although drug interactions and overmedication are causes of dementia, these causes aren't as common as Alzheimer's disease. Depression is common in elderly clients, but it doesn't cause dementia.

A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend?

Encouraging clients to avoid cigarette smoking Explanation: Measures to promote healthy skin function in elderly clients include not smoking. Other measures include avoiding exposure to the sun, using emollient skin cream containing petrolatum or mineral oil, and avoiding hot soaks in the bathtub.

An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to

Instruct the family to remove the toddler from the room for the protection of the client. Explanation: Elderly clients, particularly those who may be immunocompromised, need to avoid exposure to those who may have upper respiratory tract infections. The toddler needs to be removed from the client's room, not the whole family. It is appropriate for the family to wash their hands or use the hand sanitizer. However, it does not address the runny nose of the toddler, and it is not the most important action of the nurse.

Students are reviewing information about visual changes and conditions associated with aging. The group demonstrates understanding of the information when they identify which condition as the major cause of vision loss in the elderly?

Macular degeneration Explanation: Age-related macular degeneration is the primary cause of vision loss in the elderly. More than 25% of people older than 75 years have some signs of this disease, and 6% to 8% have advanced disease associated with severe vision loss. Presbyopia refers to the condition in which the lens becomes less flexible and the near point of focus get farther away. It results in the need for reading glasses to magnify objects, but vision is not lost. Cataracts and glaucoma affect older adults, but these conditions are not the major cause of vision loss.