Videbeck: PrepU Chapter 24: Cognitive Disorders

The geriatrician has prescribed an 80-year-old female client donepezil (Aricept) in order to treat her dementia, Alzheimer's type. Which of the following teaching points should the nurse provide to the client's husband about her new medication?

"Aricept won't cure your wife's dementia of Alzheimer's type, but it has the potential to slow down the progression of the disease." Cholinesterase inhibitors such as donepezil (Aricept) cannot cure DAT, but they can slow the progression of the disease and can stabilize symptoms. The drug does not directly affect sleep patterns. (less)

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

"His diagnosis is primarily based on the rapid onset of his change in consciousness." The key diagnostic indicator for delirium is impaired consciousness, which is usually sudden in onset. Although infection may be an underlying cause, and other cognitive changes may occur such as problems with memory, orientation, and language, impaired consciousness developing over a short period is key. (less)

A nurse is working with a client, and family of the client, who has a diagnosis of Alzheimer's disease. The nurse explains to the client and family that the average course of the disease is how many years?

10 Alzheimer's disease is a progressive brain disorder that has a gradual onset but causes an increasing decline in functioning, including loss of speech, loss of motor function, and profound personality and behavioral changes such as paranoia, delusions, hallucinations, inattention to hygiene, and belligerence. It is evidenced by atrophy of cerebral neurons, senile plaque deposits, and enlargement of the third and fourth ventricles of the brain. Risk for Alzheimer's disease increases with age, and average duration from onset of symptoms to death is 8 to 10 years. (less)

What is the primary sign of delirium?

An altered level of consciousness The primary sign of delirium is an altered level of consciousness that is seldom stable and usually fluctuates throughout the day. All other options are not the primary sign of delirium. (less)

A client is diagnosed with Alzheimer's disease. While assessing the client, the nurse notes that the client has trouble identifying objects such as a key and spoon. The nurse would document this as which of the following?

Agnosia Deficits typically assessed in clients with Alzheimer's disease include: aphasia (alterations in language ability), apraxia (impaired ability to execute motor activities despite intact motor functioning), agnosia (failure to recognize or identify objects despite intact sensory function), or a disturbance of executive functioning (ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior). (less)

A client diagnosed with Alzheimer's disease has an alteration in language ability. This alteration would be documented as which of the following?

Aphasia Aphasia is an alteration in language ability. Agnosia is the failure to recognize or identify objects despite intact sensory function. Apraxia is impairment in the ability to execute motor activities despite intact motor functioning. Akinesia is impaired muscle movement that may occur in Parkinson's disease. (less)

A nurse makes a home visit to a family caring for a client with Alzheimer's disease. The client's wife tells the nurse that she hasn't been out of the house for more than 2 weeks because her sister has been unable to help care for the client. Which nursing diagnosis would the nurse identify as the priority?

Caregiver Role Strain related to social isolation Although family coping, activity intolerance, and powerlessness may be issues, the priority nursing diagnosis is Caregiver Role Strain related to social isolation, as evidenced by the wife's statement of not being out of the house for 2 weeks. The nurse should assist the client's wife in obtaining respite care if it is available. (less)

An 80-year-old is brought to the clinic by his wife. He has a history of peripheral vascular disease and Type 2 diabetes. The wife states that he hasn't seemed himself for the preceding few days, noting that he has been lethargic and mildly confused at times and has been incontinent of urine. She reports that his blood glucose levels have been elevated. The nurse considers which of the following as the most likely explanation for the client's change in mental status?

Delirium related to underlying medical problem Any disturbance in any organ or system that affects the brain can disrupt metabolism and neurotransmission, leading to a decline in cognition and function. Infections, fluid and electrolyte imbalances, and drugs are the most frequent causes of delirium. Older adults are especially susceptible to delirium disorders because the aging neurologic system is particularly vulnerable to insults caused by underlying systemic conditions. Indeed, delirium often predicts or accompanies physical illness in older adults. (less)

Which of the following is the hallmark of beginning mild dementia?

Forgetfulness The hallmark of the initiation of mild dementia is forgetfulness. Memory impairment is the prominent early sign of dementia.

A client with amnestic disorder is being evaluated for dementia. Which of the following is a diagnostic characteristic of amnestic disorder?

History and physical examination indicative of memory impairment Diagnostic characteristics of amnestic disorder include memory impairment not solely limited to periods of delirium, history and physical examination indicative of medical condition underlying the memory impairment, demonstration of significant problems with social or occupational functioning, and memory significantly decreased from usual level. (less)

Which of the following is a metabolic cause of delirium?

Hypoglycemia Hypoglycemia is a metabolic cause of delirium. Meningitis and encephalitis are infection-related causes. Alcohol intoxication is a drug related cause of delirium.

Cognitive disorders are characterized by which of the following?

Impaired attention, memory, and abstract thinking Cognitive mental disorders are characterized by a disruption of or deficit in cognitive function, which encompasses orientation, attention, memory, vocabulary, calculation ability, and abstract thinking. (less)

Jean has early Alzheimer's disease. When asked about her family history, she relates that she has two children who are both grown and who visit her around the holidays each year. The nurse subsequently discovers that Jean has one child who is currently assigned overseas and has not been home for 2 years. Which of the following would best describe Jean's behavior?

Jean is confabulating, most likely to cover for her memory deficit. Jean may have some difficulty recalling events or knowledge that she formerly knew to be fact. Because of the inability to recall recent events, she may be confabulating, or filling in memory gaps with fabricated or imagined data. (less)

Which of the following is the most consistent and dramatic cognitive impairment seen in dementia?

Memory The most dramatic and consistent cognitive impairment is memory. The mental status assessment can be difficult for clients with dementia because cognitive disturbance is the clinical hallmark of dementia. Deficits in visuospatial tasks that require sensory and motor coordination develop early, drawing is abnormal, and the ability to write may change. Language is progressively impaired. Judgment, reasoning, and the ability to solve problems or make decisions are also impaired later in the disorder, closer to the time of placement in a nursing home. (less)

While reviewing the medical record of a client with moderate dementia of the Alzheimer type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type?

NMDA receptor antagonist Memantine is classified as an NMDA receptor antagonist that has been shown to improve cognition and activities of daily living in clients with moderate to severe symptoms of dementia. Risperidone, olanzapine, and quetiapine are examples of atypical antipsychotics. Galantamine, donepezil, rivastigmine, and tacrine are cholinesterase inhibitors. Clonazepam, alprazolam, and lorazepam are examples of benzodiazepines. (less)

Which assumption made the principles of cognitive behavioral therapies (CBT) is demonstrated by the quote, "For there is nothing either good or bad but thinking makes it so."

People are disturbed not by an event but by the perception of that event. Thoughts have a powerful effect on emotion and behavior. By changing dysfunctional thinking, a person can alter their emotional reaction to a situation and reinterpret the meaning of an event. By thinking a "thing" is "bad" we make it bad is one of the operations tenets of cognitive behavioral therapy (CBT). (less)

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

Physical restraints may increase the client's agitation. The use of physical restraints are usually a last resort for clients with dementia, as restraint use may increase any fears or thoughts of being threatened. The nurse may need to use physical restraints if the patient is pulling at intravenous lines or catheters. Physical restraints do not commonly cause injury to the client or lead to fatality. (less)

The nurse is assessing a client who is diagnosed with delirium. Which presenting sign in the client indicates to the nurse that the client may may have a diagnosis of dementia?

Remote memory loss Impaired memory may be present in both delirium and dementia. However, remote memory loss and forgetting the names of adult children, their occupations, or even their own names occurs in the later stages of dementia. Irrelevant speech, visual hallucinations, and impaired consciousness are signs of delirium. In dementia, speech is normal at the initial stages and then progresses to aphasia. Hallucinations are less common in dementia. Consciousness is usually not impaired in client with dementia. (less)

Which of the following nursing diagnoses would be the priority for the client experiencing acute delirium?

Risk for Injury related to confusion and cognitive deficits The plan of care must be deliberately designed to meet the client's unique needs, with safety always being the nurse's highest priority. Risk for injury is a NANDA diagnosis and the etiology of confusion and cognitive deficits are factors that can be modified through nursing care. (less)

The nurse receives a report that a 75-year-old client recovering from surgery. During the shift, the nurse notes that the client is forgetful and restless. Several times, the client calls the nurse "Audrey", the name of the client's daughter. The nurse interprets this behavior as which of the following?

Signs of delirium Delirium is a syndrome characterized by a rapid onset of cognitive dysfunction and disruption in consciousness. Growing rates of delirium mirror the increasing older adult population and are expected to continue to rise. Delirium is the most common psychiatric syndrome in general hospitals, occurring in up to 50% of elderly inpatients. It is associated with significantly increased morbidity and mortality both during and after hospitalization. (less)

Keisha is a 42-year-old married woman with two children, ages 16 and 18. She is also caring for her mother, who is in the late stages of Alzheimer's disease. The nurse would want to assess Keisha for which of the following?

Signs of stress Nurses must assess family members, especially caregivers, for signs of stress or burnout. Although this issue might not be pertinent during early stages of dementia, it becomes paramount as clients progressively degenerate and demands for physical care mount. (less)

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

Slow deterioration of memory and function Compelling evidence shows that drugs that inhibit ACh destruction or increase cholinergic activity can slow deterioration of memory and function. Cholinesterase inhibitors increase availability of ACh by interfering with the enzyme that breaks it down. These centrally acting drugs help elevate the level of ACh by decreasing the binding sites of acetylcholinesterase, which lengthens the potential for cholineregic activity. (less)

The psychiatric nurse documents that the cognitively impaired client is exhibiting "confabulation" when observed doing which of the following?

Telling other clients that he "was a dairy farmer" when he actually ran a small grocery store Confabulation is the filling in of memory gaps with false but sometimes plausible content to conceal the memory deficit, such as a client telling others that he "was a dairy farmer" when he actually ran a small grocery store. Evidence of perseveration is a client telling the staff repeatedly that "my name is George and I'm hungry." Sundown syndrome can be described as a client pacing nervously and resisting the staff's request to "get ready for bed." Concrete thinking is described when the client asks where the cats are when told it's "raining cats and dogs." (less)

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

The client may have apraxia. Impaired ability to execute motor functions despite having intact motor abilities is referred to as apraxia. In this case, the client knows how to and has the physical abiltiy to brush his teeth, but is unable to demonstrate the action upon request. Thus the client has apraxia. The inability to recognize or name objects or sounds heard is referred to as agnosia. Aphasia is the deterioration of language function. Disturbed executive function is the inability to carry out complex motor activities. Using a toothbrush is not a complex activity. (less)

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

The client will be safe; be physiologically stable; have infrequent episodes of agitation. Safety is always the nurse's first priority; patients with dementia often cannot meet their basic physical needs; and agitation is a common emotional response to confusion and disorientation. (less)

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

The nurse wants to prevent increasing the client's confusion. The nurse understands that too many visitors or more than one person speaking at once may increase the client's confusion. The nurse should also explain to the visitors, that they should speak quietly with the client, one at a time. This may help prevent the client from becoming overstimulated.Talking with many friends at a time doesn't pose a physical danger to the client. While it is ideal for the client to demonstrate proper orientation, it is not the reason the nurse monitors the client's response to visitors. Talking to one person at a time does not help the client maintain an adequate balance of activity and rest. (less)

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

The onset of symptoms of dementia is gradual Dementia refers to a syndrome of global or diffuse brain dysfunction characterized by a gradual, progressive, chronic deterioration of intellectual function.

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

To assess for fluctuation in the client's capabilities Clients with organic diseases like delirium tend to have fluctuations in their ability to carry out activities of daily living. Thus, the nurse should assess these daily. Although the nurse should encourage the client to make decisions about treatment amd assist the client in establishing a daily routine, these actions do not require daily assessment. Assess the prognosis of the client after therapy also is not required daily. (less)

A nurse is studying the medical chart of a client with delirium. The nurse finds that the client was given haloperidol. What would be the most likely reason for administering this drug to the client?

To decrease agitation Haloperidol is usually given to clients with delirium when they become extremely aggressive. The main purpose of the drug is to reduce agitation, not to sedate the client. Haloperidol does not improve the client's appetite. The nurse should provide adequate nutritious food and fluid intake to improve the health of the client. Benzodiazepines are used instead of haloperidol if delirium is induced by alcohol withdrawal. (less)

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

Visual Visual, rather than auditory, hallucinations are the most common in those with dementia. Auditory, gustatory, and olfactory hallucinations are not the most common type seen in people with dementia. (less)

Delirium can be differentiated from many other cognitive disorders in which of the following ways?

has a rapid onset and is highly treatable if diagnosed quickly. Delirium often is caused by an acute disruption of brain homeostasis. When the cause of that disruption is eliminated or subsides, the cognitive deficits usually resolve within a few days or sometimes weeks. Dementia, in contrast, results from primary brain pathology that usually is irreversible, chronic, progressive, and less amenable to treatment. (less)

What is the initial intervention the nurse should implement when helping a client diagnosed with dementia deal with paranoid delusions?

observe the client in order to identify the triggers for the delusions Clients with dementia may believe that their physical safety is jeopardized; they may feel threatened or suspicious and paranoid. These feelings can lead to agitated or erratic behavior that compromises safety. Avoiding direct confrontation of the client's fears is important. Clients with dementia may struggle with fears and suspicion throughout their illness. Triggers of suspicion include strangers, changes in the daily routine, or impaired memory. The nurse must discover and address these environmental triggers rather than confront the paranoid ideas. (less)

A nurse is caring for a client with delirium who is experiencing illusions. What environmental conditions should the nurse arrange for this client?

provide a well-lit room without glare or shadows and limit noise Clients with delirium have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. A quiet, shadow-free room offers an environment that produces the fewest sensory perceptual distortions for a client with cognitive impairment associated with delirium. The other options have the potential to produce increased perceptual alterations. (less)

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

provides interaction with those with similar concerns Attending a support group regularly also means that caregivers have time with people who understand the many demands of caring for a family member with dementia. While the other options suggest accurate results, none are the greatest benefit such a support group experience can provide. (less)

Which of the following can be identified as a hallmark symptom of dementia?

short-term memory loss. As a broad diagnosis, dementia includes conditions in which short-term memory loss is a hallmark. The deterioration of memory is so great that it prevents clients from functioning at previous levels of social and occupational performance and seriously deters them from learning new information. (less)

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

take a nap mid afternoon and before dinner Clients with dementia often experience disturbed sleep-wake cycles; they nap during the day and wander at night. This behavior can contribute to the nighttime activity. The other options are not likely to affect sleep cycles. (less)

The nurse is assessing the orientation of a client who belongs to the religious group Jehovah's Witnesses. Which question should the nurse ask this client? Select all that apply.

• Where is your residence located? • What is your mother's name? • Where is your workplace located? Explanation: People from different cultural backgrounds may not be familiar with the information requested to assess memory. People belonging to the Jehovah's Witnesses religious group do not celebrate birthdays, thus they may have difficulty stating their date of birth and the nurse may mistake the failure to know such information for impaired orientation. Questions about the location of the client's residence or workplace and about the client's mother's name can be asked this client while assessing for orientation. (less)