Chapter 24

A client with dementia is starting pharmacotherapy to slow the progression of cognitive decline. The client has a history of moderate but steady alcohol use over the past 45 years. Which medication should the nurse question as least suitable for this client?

Tacrine

During morning care, a nursing assistant asks a client with dementia, "How was your night?" The client replies, "It was lovely. My husband 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.

The nurse is performing a health history and assessment of a client exhibiting signs of delirium. The nurse asks the client and family members about possible causes of the delirious state. Which would the nurse likely attribute as underlying causes for the client's delirium? Select all that apply.

Recent alcohol use Dehydration Use of antihistamines Sleep disturbances exposure to pain or gasoline

The client says to the nurse he is having trouble keeping up with things. The nurse is assessing a client with early signs of dementia. What is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning?

Recent memory

The nurse encourages the client with dementia to meet nutritional needs. Which is the best approach to assist in meeting adequate dietary intake?

Serve meals in small, bite-size pieces.

The daughter of a client with dementia has been the primary caregiver for 5 months. The daughter expresses to the nurse, "At times it is so overwhelming! I feel I do not have a life anymore!" Which is the most helpful response by the nurse?

"Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?"

Which statement made by the nurse would be most appropriate to an 89-year-old patient who is confused but has no history of dementia, and is hospitalized for an acute urinary tract infection?

"I know things are upsetting and confusing right now, but your confusion should clear as you get better."

A client with moderate Alzheimer's disease is living with her grown daughter. Which statement by the daughter would indicate the need for intervention by the nurse?

"Mother won't let anyone else do anything for her."

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

A nurse is educating a group of elderly community members about cognitive disorders. Which would the nurse include in her teaching as a measure most likely to prevent Alzheimer's disease and other dementias?

reading

The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. Which response would be best to teach as an example of this technique?

"Let's look at what is on television."

The daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. Which would be the most appropriate response by the nurse?

"Symptoms of dementia gradually get worse. Unfortunately, she will not be independent again."

The nurse is developing interventions to promote socialization in a client with moderate dementia. Which would provide a safe and secure environment for the client?

An activity with the nurse

The nurse is working with a client who has hallucinations and delusions. The client tells the nurse she cannot take a shower because she is waiting for her husband to take her home. Which response by the nurse is best in this situation?

"You have plenty of time to shower before it's time to go home."

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

Which client would have an increased risk for delirium?

A 3-year-old child with a temperature of 103.2°F

Which patient is most likely suffering from dementia?

A 90-year-old male who has experienced progressive mental decline that started with forgetfulness

The client is brought to the clinic with dementia and is unable to recognize ordinary objects, such as a pen or notebook. The family is upset and concerned. Upon assessment of the client, which of the following would this be a symptom of?

Agnosia

The nurse is questioning the family of a client brought in with cognitive impairment as she assesses and evaluates the client's condition. Which distinguishes delirium from dementia?

Dementia has a gradual onset and is progressive in course.

The nurse is encouraging a group of clients with dementia to join in 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 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.

During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium?

Disoriented to person

Which statement by the nurse would be most appropriate to the family member who is the primary caregiver to a client with dementia?

"Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role."

The adult son of a client with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. The mother has not worked in over 20 years. Which is the best guidance that the nurse could offer?

Go along with her thought of it having been a busy day, but do not refer to her work.

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. Which will be accomplished by this intervention?

Increase frustration

Which is believed to be a risk factor specific to the development of delirium?

Increased severity of physical illness

Which is the most effective intervention for clients with delirium?

Managing environmental stimuli

The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which intervention should the nurse implement first?

Move the client to a quieter area during these times.

The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment?

Plan for the same caregivers to provide care to individuals as much as possible.

Which are possible sources of frustrations for nurses caring for persons with dementia? Select all that apply.

The clients do not retain explanations or instructions, so the nurse must repeat the same things continually. The nurse may get little or no positive response or feedback from clients with dementia. It can be difficult to remain positive and supportive to clients and family because the outcome is so bleak. The clients may seem not to hear or respond to anything the nurse does.

A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest?

The clients may not recognize their family when they come to visit.

A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which of the following best explains the nurse's behavior?

The nurse gave the client a chance to calm down before resuming the meal.

A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, "I feel like all my work doesn't do them any good." Which should the nurse's supervisor encourage the nurse to do?

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

The nurse caring for an elderly woman with dementia has asked the woman's children to bring old photo albums when they visit. The nurse observes the actions of the client as she talks about the photos. Which best describes the usefulness of viewing photos when caring for the dementia client?

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

A nurse is talking to a client recently diagnosed with Alzheimer's disease. The nurse explains that which abnormality is found to be associated with Alzheimer's disease of late onset (after 65 years of age)?

a genetic component of chromosome 21, 14, and 19

A nurse is assessing client with a diagnosis of Huntington's disease (HD) in the later stages. The client has severe cognitive defects. In this case, the nurse will also likely find which classic symptom?

choreiform movements