Chapter 11- Cognitive Function

15. An older adult expresses frustration about limitations of aging. Which of the following statements by the nurse promotes wellness? A) "Do you have some words of wisdom to share about that valuable experience?" B) "How does living in these conditions compare to your youth?" C) "Have you met any of your neighbors, they seem like nice people?" D) "What you are saying is that you are frustrated with how they are not listening to you?"

Ans: A Instead of asking about current versus historical, the nurse should acknowledge the wisdom of older adults by asking questions such as "Do you have some words of wisdom to share? Asking about neighbors is deflection and not helpful?" Reflection can be appropriate, but at this time positive acknowledgment should be used.

8. A nurse plans activities each month at an assisted living facility. Which of the following activities is most cognitively stimulating? A) Book discussions B) Movie night C) Exercise D) Reminiscence therapy

Ans: A The cognitive reserve model suggests that cognitive abilities can be improved through participation in creative and intellectually stimulating activities. Reminiscence may provide some social interaction and movies serve as a distraction. Exercise does increase the blood flow; however, the brain and neural circuits develop in response to environmental stimuli (neuroplasticity).

11. A nurse in an assisted living facility develops interventions that focus on improving cognitive abilities in the residents. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A) Book club B) Calisthenics C) Christmas caroling D) Letter writing E) Reminiscence therapy F) Shopping trip

Ans: A, D The cognitive reserve model suggests that cognitive abilities can be improved through participation in creative and intellectually stimulating activities, such as art, storytelling, reading, writing, group discussions, and playing musical instruments. Calisthenics, singing traditional tunes, reminiscing, and shopping are not creative and intellectually challenging.

5. Which of the following points should the nurse emphasize when educating older adults about memory and cognition? A) Long-term memory loss is normal. B) Using calendars, notes, and imagery can help enhance memory. C) Drinking caffeinated beverages for mental stimulation is a good idea. D) Having a diminished capacity for learning is an inevitable part of growing older.

Ans: B Metacognition means that an individual understands his or her own cognitive process, and this process will impact performance. Health education provides information about techniques to enhance cognitive abilities. Older adults benefit from internal and external memory-enhancing techniques, such as calendars, imagery, and notes.

4. A nurse assesses a 61-year-old adult who reveals that he can't process as quickly as when younger, and that "all these people talk about multi-tasking, but I can't do that!" Which of the following responses by the nurse is appropriate? A) "Have you had any other symptoms of cognitive impairment?" B)"Slower processing of information is an age-related change, and there are things you can do to help with this." C) "The declines in cognitive skills usually begin around the age or 60." D) "You shouldn't expect to see a decline the cognitive functions that you use all the time."

Ans: B Healthy older adults will not experience any significant cognitive impairment that interferes with daily life, but they will notice minor deficits in some aspects of cognitive function and improvements in other aspects. The earliest cognitive changes are due to decreased perceptual speed. The other distracters do not answer his question. It is important for the nurse to address the client's concerns; in this case, the client is asking if it is expected to already have age-related functional consequences. Age-related declines in some cognitive skills begin around the age of 40, but there are substantial individual variations in these changes. Cognitive functions that depend on experience, accumulated knowledge, and well-practiced tasks (e.g., vocabulary) do not decline in healthy older adults, and may even improve.

13. A nurse determines that a client does not remember current events and has difficulty using technology. The nurse should consider that the client may have difficulty with which of the following? A) Participating in reminiscence group B) Digitally recording blood glucose monitor C) Remembering to weigh daily D) Understanding when to notify health care provider

Ans: B Contextual theories and everyday problem solving emphasize that older adults are able to remember affective and personally relevant information. The client may need to record the blood glucose on paper

10. A nurse interviews a client who is 82 years old and has several chronic conditions, including type 2 diabetes and heart failure. The client expresses feeling of more satisfaction with life now than when younger. Which phenomenon is the client expressing? A) Metamemory B) The paradox of well-being C) Crystallized intelligence D) Neuroplasticity

Ans: B Gerontologists have identified a paradox of well-being among older adults, which describes the phenomenon of older adults suffering significant losses of health, cognition, and social functioning but reporting high levels of well-being and positive emotions. Metamemory, crystallized intelligence, and neuroplasticity are phenomena that are not directly related to subjective well-being and satisfaction

6. An older adult is brought to the community clinic by an adult child with the concern of increasingly frequent lapses in memory. Which assessment question is most likely to identify potential risk factors for impaired cognitive functioning? A) "What did your mother and father die of?" B) "What line of work were you in?" C) "What medications are you currently taking?" D) "Where are you currently living?"

Ans: C Adverse medication effects can have a profound influence on the cognitive functioning of older adults. Genetic, environmental, and occupation factors are potential risk factors, but medications are more commonly implicated

1. A nurse is leading a word-quiz game with a group of nursing home residents because the nurse knows this activity will assist the residents in maintaining: A) Fluid intelligence B) Adaptive thinking C) Crystallized intelligence D) Psychomotor memory

Ans: C Crystallized intelligence refers to vocabulary skills, information, and verbal comprehension. Fluid intelligence involves a person's inherent abilities, such as memory and recognition, and involves adaptive thinking. Memory involves retrieval and storage of information.

9. A nurse providing care in a long-term care setting is aware that the cognitive function of older adults does not necessarily decline on an inevitable trajectory. Which action has the greatest potential to enhance the cognitive function of residents and prevent cognitive declines? A) Encourage older adults to openly express their emotions and opinions. B) Provide residents with four or five low-fat, high-protein meals during the day. C) Encourage older adults to participate in mentally stimulating activities. D) Present older adults with numerous opportunities to make autonomous decisions.

Ans: C Healthy diet, decisional autonomy, and emotional expression are all potentially beneficial, but participation in mentally challenging and stimulating activities has the greatest potential to protect and enhance cognition

2. A 69-year-old has recently been diagnosed with mild cognitive impairment and has asked the nurse to help her remember things better. Which of the following nursing diagnoses is appropriate for this older adult? A) Knowledge deficit B) Altered thought processes C) Health-seeking behaviors D) Altered health maintenance

Ans: C The nursing diagnosis of health-seeking behaviors is defined as "the state in which an individual in stable health actively seeks ways to alter personal health habits and/or the environment in order to move toward a higher level of wellness." The older adult is seeking help from the nurse to remember things better so this is the most appropriate diagnosis

3. A 70-year-old tells a nurse, "I am worried that I'm losing my mind, I have difficulty remembering names as well as I used to, and I missed two health care appointments in the past month because I forgot about them." The nurse initiates a memory training program, although the nurse has been unable to identify any risk factors that might affect the older adult's cognitive abilities. Which of the following questions is the best approach to evaluating the effectiveness of the memory training program? A) "Have you seen an improvement in your memory?" B) "Are you less worried about your memory now?" C) "How have the memory training techniques helped you?" D) "Are you using the memory training techniques now?"

Ans: C The question, "How have the memory training techniques helped you?," allows the older adult to tell the nurse how memory training has helped and is more open-ended than the other options. It also communicates positive expectations. The question helps identify the techniques that are most effective for the individual.

14. A 90-year-old client discusses her life review with a nurse and shares information about how she has raised five children and had "ups and downs" with all of them, but overall feels satisfied with her life. Based on Cohen's empowering model, which of the following statements is the client likely to make? A) "I would sum it up this way." B) "I really would like to see the Grand Canyon." C) "I hope to learn how to Skype with my grandchildren." D) "I know I've done the best that I can do, and I expect I will continue to help my family."

Ans: D Cohen's empowering model related that those at the end of their life are more likely to reaffirm major themes in their life. From the 50s till the 70s, persons reevaluate life and feel a new sense of inner liberation as expressed in the distracters by discussion of goals. After the late 70s, older adults restate and reaffirm their major themes, including the desire to live well to the very end and have a positive impact on others

12. A nurse assesses an 82-year-old client who has a history of coronary artery bypass surgery and heart failure. In the interview, the family expresses concern because the client's "ability to figure out what is going on" has deteriorated. However, the client remains wise and continues to give solid life advice. Which theory explains this phenomenon? A) Crystallized intelligence declines with age. B) Cognitive skills of older adults are better than younger adults under some conditions. C) Mild cognitive impairment begins with cognitive dissidence. D) Cognitive abilities may be impaired by the client's cardiovascular disease

Ans: D Changes in fluid intelligence are more closely associated with pathologic conditions of the circulatory and nervous system than with age-related changes alone. Crystallized intelligence, except for those processes that depend on the speed of response, does not decline with age. Contextual theories do support the idea that memory and other cognitive skills of older adults are better than those of younger adults under some conditions; however, this does not address the variation between fluid and crystallized intelligence.

7. A nurse discusses recent changes with a 74-year-old client. The client is distraught stating, "I forgot an important appointment; and I lost my wallet!" The older adult has always cherished being intelligent, alert, and informed, so even minor lapses in cognition are a source of stress. How should the nurse best interpret these recent deficits in memory? A) The older adult is likely experiencing the early stages of Alzheimer disease. B)The older adult is likely experiencing a temporary state of delirium that will self-resolve. C) The older adult may be experiencing age-related changes in personality. D) The older adult may be experiencing mild cognitive impairment.

Ans: D Healthy older adults will not experience any significant cognitive impairment that interferes with daily life, but they will notice minor deficits in some aspects of cognitive function and improvements in other aspects. Longitudinal studies have identified patterns of cognitive change that are likely to occur even in the absence of any pathologic processes. This does not rule out the possibility of dementia or delirium, but a fundamental change in personality is unlikely.