Chapter 15 Alterations in Cognitive Systems

A nurse is caring for clients with various types of dementia. Which assessment finding is consistent for all clients with dementias?

Progressive deterioration Dementia is a progressive failure of many cerebral functions. Delirium, not dementia, includes an abrupt onset and possible seizures. Receptive (Wernicke) dysphasia is a disruption of verbal comprehension and repetition but not of verbal expression. STUDY TIP: Regular exercise, even if only a 10-minute brisk walk each day, aids in reducing stress. Although you may have been able to enjoy regular sessions at the health club or at an exercise class several times a week, you now may have to cut down on that time without giving up a set schedule for an exercise routine. Using an exercise bicycle that has a book rack on it at home, the YMCA, or a health club can help you accomplish two goals at once. You can exercise while beginning a reading assignment or while studying notes for an exam. Listening to lecture recordings while doing floor exercises is another option. At least a couple of times a week, however, the exercise routine should be done without the mental connection to school; time for the mind to unwind is necessary, too.

A client is in a diving accident that paralyzed all four extremities. Which term will the nurse use to describe this condition to the oncoming shift?

Quadriplegia Quadriplegia refers to paralysis of all four extremities. Hemiplegia means the loss of motor function (paresis or paralysis) of the upper and lower extremities on one side of the body. Diplegia is the paralysis of either upper or lower extremities as a result of cerebral hemisphere injuries. Paraplegia refers to the loss of motor function of the lower extremities.

A client was found at home in the fetal position reporting a severe, sudden onset headache. Assessments in the emergency department reveal confusion, disorientation, and one dilated pupil. While waiting for the primary healthcare provider, respirations have now changed to a cyclic rhythm from increasing depth and rate to periods of apnea. Hiccups have begun. What is the nurse's best response to family concerns?

The nurse needs to notify the primary healthcare provider immediately. Vomiting, yawning, and hiccups are complex reflex-like motor responses that are integrated by neural mechanisms in the lower brain. These responses may be produced by compression or diseases involving tissues of the medulla oblongata. Hiccups and Cheyne-Stokes respirations are significant changes, indicating possible increased intracranial pressure. An emergency situation like the client is experiencing will be performed before scheduled CT scans. Hiccups indicate the client is deteriorating and there should be concern. Test-Taking Tip: The presence of absolute words and phrases can also help you determine the correct answer to a multiple-choice item. If answer choices contain an absolute (e.g., none, never, must, cannot), be very cautious. Remember that there are not many things in the world that are absolute, and in an area as complex as nursing, an absolute may be a reason to eliminate it from consideration as the best choice. This is only a guideline and should not be taken to be true 100% of the time; however, it can help you reduce the number of choices.

A client was found at home in the fetal position reporting a severe, sudden onset headache. Assessments in the emergency department reveal confusion, disorientation, and one dilated pupil. While waiting for the primary healthcare provider, respirations have now changed to a cyclic rhythm from increasing depth and rate to periods of apnea. Hiccups have begun. What is the nurse's best response to family concerns?

These changes are significant. I will have the healthcare provider evaluate these changes immediately. The nurse needs to notify the primary healthcare provider immediately. Vomiting, yawning, and hiccups are complex reflex-like motor responses that are integrated by neural mechanisms in the lower brain. These responses may be produced by compression or diseases involving tissues of the medulla oblongata. Hiccups and Cheyne-Stokes respirations are significant changes, indicating possible increased intracranial pressure. An emergency situation like the client is experiencing will be performed before scheduled CT scans. Hiccups indicate the client is deteriorating and there should be concern. Test-Taking Tip: The presence of absolute words and phrases can also help you determine the correct answer to a multiple-choice item. If answer choices contain an absolute (e.g., none, never, must, cannot), be very cautious. Remember that there are not many things in the world that are absolute, and in an area as complex as nursing, an absolute may be a reason to eliminate it from consideration as the best choice. This is only a guideline and should not be taken to be true 100% of the time; however, it can help you reduce the number of choices.

How will the nurse describe the term "hypotonia"?

"Hypotonia occurs when there is decreased muscle tone." Hypotonia is decreased muscle tone. Hypotonic muscles would not be rigid. Dystonia is a sustained involuntary twisting movement. Hypotonia results in decreased muscle resistance.

Which statement, made by the client recently diagnosed with Huntington disease, will indicate successful teaching about the condition?

"I can expect to have involuntary muscle movements." Involuntary muscle movements are expected with Huntington disease. There is progressive loss of memory (dementia) with this disease. There is no effective treatment to cure this disease. The disease is an autosomal dominant disease (Huntingtin gene), not a disease from a virus.

The nurse receives a report from a licensed practical nurse about care provided to clients on a neurologic unit. It is most important for the nurse to follow up on which statement first?

"The 72-year-old client with Parkinson disease reports dizziness when standing up." The client with Parkinson disease has orthostatic hypotension (dizziness when standing) and is at risk for falls. The clinical manifestations exhibited by the other clients are expected; these clinical manifestations are not priority client safety concerns. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses.

Which response by the nurse best explains agnosia to a nursing assistant personnel (unlicensed personnel)?

"The client would not be able to identify a pencil by touching it." Agnosia, a defect of pattern recognition, may be visual, tactile, or auditory and is a failure to recognize the form and nature of objects. An altered sense of smell would occur with olfactory nerve damage. Amnesia is the loss of memory. Receptive dysphasia is the inability to understand words. Test-Taking Tip: The presence of absolute words and phrases can also help you determine the correct answer to a multiple-choice item. If answer choices contain an absolute (e.g., none, never, must, cannot), be very cautious. Remember that there are not many things in the world that are absolute, and in an area as complex as nursing, an absolute may be a reason to eliminate it from consideration as the best choice. This is only a guideline and should not be taken to be true 100% of the time; however, it can help you reduce the number of choices.

Which information should the nurse include when educating a client about bradykinesia?

"Walking will become slow and will take more time to start." Bradykinesia causes slowness of voluntary movements and includes slow gait, involving a delay in the time it takes to start to perform a movement. Bradykinesia does not result in loss of memory. Voluntary muscle movement is affected, not involuntary movements. Seizures and paralysis are not clinical manifestations of bradykinesia.

Which clinical finding in a client will help a nurse distinguish between pyramidal motor syndromes and extrapyramidal motor syndromes?

A Babinski sign occurs in pyramidal motor syndromes. A Babinski sign is present in pyramidal motor syndromes. Pyramidal motor syndromes will have paralysis. Extrapyramidal motor syndromes will have cogwheel rigidity with hypotonia. Absence of involuntary movement occurs in pyramidal motor syndromes.

Upon assessment of a client, the nurse finds permanent progressive loss of memory, orientation, judgment, and problem-solving ability. The nurse is caring for which client?

A client with dementia Permanent progressive loss of memory, orientation, judgment, and problem-solving ability is a condition called dementia. Delirium is reversible confusion related to multiple factors such as pain, medications, and sleep deprivation. Anterograde amnesia is retention of memories of events in the distant past but inability to form new personal or factual memories, and it may be permanent or temporary. Selective attention deficit refers to the inability to select specific information to be processed from available environmental and internal stimuli.

A nurse is assessing a client with suspected amyotrophic lateral sclerosis (Lou Gehrig disease). Which assessment findings will be consistent with this disease?

A nurse is assessing a client with suspected amyotrophic lateral sclerosis (Lou Gehrig disease). Which assessment findings will be consistent with this disease? Clinical manifestations of amyotrophic lateral sclerosis include progressive muscle weakness and eventual paralysis. Progressive loss of memory, judgment, and self-care ability characterize Alzheimer disease. Writhing movements and progressive dementia characterize Huntington disease. Muscle rigidity, difficulty initiating movement, and drooling characterize Parkinson disease.

An individual having difficulty concentrating is restless, irritable, and tremulous. These changes have developed over 2 to 3 days. Which term will the nurse use to describe this condition?

Acute confusional state The onset of an acute confusional state usually is abrupt. The first clinical manifestations are difficulty in concentration, restlessness, irritability, tremulousness, insomnia, and poor appetite. Coma is a loss of consciousness and unresponsiveness to stimuli. Dementia is a more chronic problem during which progressive failure of many cerebral functions occurs. Hemiparesis is paresis of the upper and lower extremities on one side.

Upon assessment, a client is experiencing difficulty in recognizing a pencil. Based on the nurse's observations, the client is exhibiting which condition?

Agnosia Agnosia is a defect of pattern recognition—a failure to recognize the form and nature of objects, such as being unable to identify a safety pin. Aphasia is a more severe form of dysphasia and an inability to communicate. Dysphasia is impairment of comprehension or production of language, resulting in impaired communication. Dystonia is sustained involuntary twisting movement.

Which term should the nurse use to describe a client that fails to recognize the form and nature of objects?

Agnosia Agnosia is a defect of pattern recognition—a failure to recognize the form and nature of objects. Agnosia can be tactile, visual, or auditory, but generally only one sense is affected. Aphasia is the complete loss of the comprehension or production of language. Diplegia is paralysis of corresponding parts of both sides of the body as a result of cerebral hemisphere injuries.

A client who fell 2 days ago had a head injury. Upon assessment the nurse finds the client restless, irritable, and incoherent. Which condition does the nurse suspect the client is experiencing?

Delirium Delirium initially manifests as difficulty in concentrating, restlessness, irritability, insomnia, tremulousness, and poor appetite. The person appears distressed and often perplexed; conversation is incoherent. A coma is a loss of consciousness, causing no responses to stimuli. Dementia is a more chronic problem in which there is progressive failure of many cerebral functions and confusion may become progressively worse over time. Spinal shock occurs when the spinal cord is severed, resulting in loss of all spinal cord functions below the lesion. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).

A client diagnosed with a cerebellar motor syndrome is likely to demonstrate which clinical finding upon assessment?

Difficulty standing on one foot Cerebellar motor syndromes are associated with ataxia and other symptoms affecting coordinated movement. Impaired respiration may be caused by brainstem injury. Problems with body temperature involve the hypothalamus. Hypermimesis commonly manifests as pathologic laughter or crying. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer.

Which term should the nurse use to describe limp, atrophied muscles that can be moved without resistance?

Flaccidity Flaccidity is associated with limp, atrophied muscles, and the muscles may be moved without resistance. Hypertonia, rigidity, and dystonia describe alterations in muscle tone with increased resistance.

A client is diagnosed with Parkinson disease. Which clinical manifestation will the nurse expect to observe?

Flexed, forward leaning posture Postural abnormalities (flexed, forward leaning), difficulty walking, and weakness develop in Parkinson disease. There is no true paralysis in Parkinson disease. Hydrocephalus and increased intracranial pressure do not occur in Parkinson disease.