Ch. 39: Neurocognitive disorders

A nurse is caring for a client receiving an acetylcholinesterase inhibitor (AChEI) for treatment of dementia. What is the primary side effect of AChEIs?

Gastrointestinal distress

The spouse of a client states to the nurse, "I am worried that my spouse is beginning to have dementia symptoms. How will I be able to tell for sure?" Which is the best response by the nurse?

"Forgetfulness is one of the earliest signs of dementia, but we should rule out other causes."

A family member is the primary caregiver to a client with dementia who states, "This is so overwhelming. I want to do the right thing but I have no life." Which statement by the nurse would be most appropriate?

"Spending some time relaxing and doing what you like to do will help you manage the demands of caregiving."

A client with moderate Alzheimer disease is prescribed memantine and donepezil. Which statement does the nurse include when teaching the client's family member about this medication?

"The efficacy of the medication can decrease over time."

The nurse is preparing to set a client with dementia up for breakfast and gives the client a washcloth to clean their face and hands. The client looks at the washcloth without knowing what to do with it. Which is the best response by the nurse?

"This is a washcloth so you can wash your face and hands."

A group of nursing students is reviewing information about delirium and its causes. The students demonstrate a need for additional review when they identify which as a cause of this medical condition?

Oxidative stress

A 35-year-old client is delirious after being lost in the woods for several days and becoming severely dehydrated. At 9 p.m. the client tells the nurse to get the client's clothes because the client has to get home to the client's family. Which response by the nurse is most therapeutic?

"You're in the hospital. You did not drink for several days, but you're getting better now."

Which type of therapy encompasses thinking about or relating personally significant past experiences?

Reminiscence therapy

In clients with Alzheimer's disease, neurotransmission is reduced, neurons are lost, and the hippocampal neurons degenerate. Which neurotransmitter is most involved in cognitive functioning?

Acetylcholine

When assessing a client with dementia, the nurse notes that the client is having difficulty identifying common items, such as a ball or book. The nurse interprets this finding as what?

Agnosia

Which of the following terms describes an inability to recognize or name objects despite intact sensory abilities?

Agnosia

A client has vascular neurocognitive disorder. When teaching the family about the cause of this disorder, which would the nurse expect to integrate into the explanation?

Blood flow in the vessels to the brain are blocked.

An older client has recently finished treatment for a urinary tract infection (UTI) and has now developed changes in behavior resulting in decreased cognition. Which priority intervention(s) should the nurse perform? Select all that apply.

Contact the health care provider. Maintain adequate hydration. Obtain a repeat urine culture.

The nurse is encouraging a group of clients with dementia to join in the upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation?

Demonstrate the exercises while clients simultaneously perform them.

A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client is restless, approaches the nurse, and states, "I'm going to take a walk outside. I'll be back in about 10 minutes." Which is the most appropriate nursing action?

Designate a staff member to accompany the client on the walk.

A client diagnosed with Alzheimer's disease (AD) has decided that he is more comfortable naked than in clothes. This would be documented as which of the following?

Disinhibition

A nurse is providing education to the care provider of a cognitively impaired client who is prescribed a cholinesterase inhibitor. Which information about medication side effects should the nurse be sure to include?

Gastrointestinal (GI) symptoms

A client has been admitted to an inpatient unit for treatment of delirium. Which of the following is the primary treatment for delirium?

Identify and treat any causal or contributing medical conditions

The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. The nurse recognizes that this activity is likely to do which of the following?

Increase frustration

Delirium can be differentiated from many other cognitive disorders in which way?

It has a rapid onset and is highly treatable if diagnosed quickly.

The most effective intervention for clients with delirium is which of the following?

Managing environmental stimuli

Which of these is a N-methyl-D-aspartic acid (NMDA) receptor antagonist?

Memantine

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

Memory

Which of the following diseases is characterized by tremor, rigidity, bradykinesia, and postural instability?

Parkinson's disease

A client has experienced a gradual flattening of affect, confusion, and withdrawal and has been diagnosed with Alzheimer's disease. Which additional findings would the nurse most likely assess?

Personality change, wandering, and inability to perform purposeful movements

An older adult client develops delirium secondary to an infection. Which would be the most likely cause?

Pneumonia

A nurse is developing the plan of care for a client with dementia who is demonstrating problems with judgment and decision making. The nurse would identify which area as the priority for this client?

Protecting from injury

The client has advanced Alzheimer's disease and becomes confused at mealtimes. The client has agnosia, apraxia, and disturbed executive functioning. Which is the most appropriate nursing intervention?

Provide the client with a tray, opening containers for the client.

A client is in the mild stage of dementia due to Alzheimer's disease. Which intervention would be most appropriate?

Providing emotional support and gentle reminders

A nurse's aide has rung the call light for assistance while providing a client's twice-weekly bath because the client became agitated and aggressive while being undressed. Knowing that the client has a diagnosis of Alzheimer's disease and is prone to agitation, which measure may help in preventing this client's agitation?

Reminding the client multiple times that he or she will be soon having a bath

An older client transferred from a nursing home presents to the emergency department in an agitated state. The nurse is unable to obtain a coherent response to any questions posed. What is the best nursing action?

Review medication profile record.

The nurse is performing a history and physical assessment for a client in the clinic with moderate dementia. When asking questions, the client gets agitated and asks the nurse why are all of these questions being asked. Which is the best action(s) for the nurse to take to obtain the data needed? Select all that apply.

Take frequent breaks during the interview process. Provide simple explanations to the client as often as required. Give the client ample time to answer the questions asked. Ask simple questions instead of compound questions.

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

The client is confabulating, most likely to cover for memory deficit.

During morning care, an unlicensed assistive personnel (UAP) asks a client with dementia, "How was your night?" The client replies, "It was lovely. My spouse and I went out to dinner and to a movie." The nurse, who overhears this conversation, would make which assessment regarding the client?

The client is using confabulation. In mild and moderate dementia, clients may make up answers to fill in memory gaps (confabulation). It is a defensive tactic to protect self-esteem and prevent others from noticing memory loss.

The diagnosis of delirium is supported when the nurse notes what about the client?

The client reports seeing "hundreds of bugs" and is not always oriented to time and place

Family members bring an older client, recently diagnosed with Alzheimer disease, to the clinic stating they need placement in a facility for their loved one. Which finding would support further assistance in care giving for this client?

client wandering off

A nurse has been working with clients with Alzheimer disease for almost 6 months. The nurse expresses frustration to the nurse manager because the same instructions have to be given to clients several times a day. Which suggestion would be most appropriate for the manager to make?

Try to stay supportive and meet the clients' needs at the current moment.

To manage voiding issues, such as incontinence, male clients diagnosed with dementia would best be managed by what?

Use of disposable, adult diapers

The nurse caring for an older adult client with dementia asks the client's children to bring old photo albums when they visit. Which best describes the benefit of viewing photos when caring for the client?

Viewing photos is a form of reminiscence therapy for the client.

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

Visual

An older adult with no significant medical history is admitted to the hospital through the emergency department after hitting the client's head during a fall and fracturing the humerus. The client does not require surgery and will probably be discharged the following day. Should the nurse be concerned about delirium?

Yes, because of the head injury and medication

The nurse documents that a client diagnosed with dementia of the Alzheimer's type is exhibiting agnosia when the client is observed being unable to ...

identify a picture of a car.

An adult child brings their parent, who has Alzheimer disease, to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month. When assessing the client, a nurse would be alert for the possibility of which side effect?

nausea, diarrhea, vomiting

The nurse cares for a client with dementia. Which action determines whether the client has agnosia?

showing the client a pencil and asking the client to name the object

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

The nurse should consider the intervention referred to as "going along with" when managing the care of which client?

the older widower who is worried about his wife not being able to visit because of the snow