Chapter 72: Caring for Clients with Dementia and Thought Disorders

An older client has developed influenza. Three days into the illness the client became disoriented and confused, and didn't recognize family members. What would the nurse suspect is occurring?

delirium

A client had gradually been losing cognitive function and is understandably fearful. What would the physician likely diagnose?

dementia

Which condition is not a characteristic of schizophrenia?

disturbances in sensory perception

The nurse observes a client with schizophrenia sitting alone, laughing occasionally, and turning his head as if listening to another person. The nurse assesses this behavior to indicate that the client is experiencing auditory hallucinations and says:

"Are you hearing something?"

One evening, a client with schizophrenia leaves his room and begins marching in the hall. When approached by the nurse, the client says, "God says I'm supposed to guard the area." Which of the following responses would be best?

"I understand you hear a voice. You and I are the only ones in the hall, and I don't hear a voice."

The nurse is working with a client with schizophrenia, disorganized type. It is time for the client to get up and eat breakfast. Which of the following statements by the nurse would be most effective in helping the client prepare for breakfast?

"It's time to put your dress on now."

Which term describes an inability to recognize or name objects despite intact sensory abilities?

Agnosia

A 73-year-old man has been brought to the emergency department by his daughter and son-in-law due to abrupt and uncharacteristic changes in behavior, including impairments of memory and judgment. The subsequent history and diagnostic testing have resulted in a diagnosis of delirium. Which of the following teaching points about the client's diagnosis should the nurse provide to his family?

"If the underlying cause of delirium is identified and treated, most people return to their previous level of functioning."

A client with schizophrenia is reluctant to take his prescribed oral medication. The most therapeutic response by the nurse to this refusal is:

"What is it about the medicine that you don't like?"

The nurse enters the room of a client with schizophrenia the day after he has been admitted to an inpatient setting and says, "I would like to spend some time talking with you." The client stares straight ahead and remains silent. The best response by the nurse would be:

"You don't need to talk right now. I'll just sit here for a few minutes."

The nurse is working with a client who has hallucinations and delusions. The client tells the nurse she can't take a shower because she's waiting for her husband to take her home. Which of the following responses by the nurse is best in this situation?

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

The nurse is caring for a client who has been prescribed rivastigmine (Exelon) 2.5 mg twice a day. The medication is available as rivastigmine (Exelon) 2 mg/mL. How much medication will the nurse administer to the client for one dose?

1.3

Where is Alzheimer's disease ranked in the top 20 causes of death in the United States?

6th

The nurse is observing a client who is sitting alone in the day room. The client appears intently focused on the empty chair next to him. Suddenly the client begins laughing hysterically and making frantic hand gestures at the chair. When the nurse approaches the client, he looks over at the chair, whispers something unintelligible, and shakes his head. Based on this observation the nurse would assess the client's behavior as:

A hallucination.

A client with dementia is unable to recognize ordinary objects, such as a pen or notebook. The nurse recognizes this symptom as:

Agnosia

A nurse is caring for a client with delirium. What should the nurse assess for in this client?

Altered level of consciousness

Which term is used to describe deterioration in language function?

Aphasia

A client, age 84 years, is stopped for going through a red light in a small town where he has lived all his life. He tells the officer, "It wasn't there yesterday." He is unable to tell the officer his address and demonstrates labile mood, seeming pleasant one minute and angry the next. The officer knows that the client is a nice old man, and instead of ticketing him, he takes him home to discuss his condition with the family. The client lives with his wife, who is legally blind. She mentions, "John's my eyes, and I'm his mind." She also relates that the client wanders around the neighborhood occasionally, taking tools from people's garages, saying they belong to him. She reluctantly agrees that the client should be admitted to the psychogeriatric inpatient unit for evaluation. His admitting diagnosis is Alzheimer's disease. Which early symptoms of Alzheimer's disease is the client demonstrating?

Aphasia.

A client has been diagnosed with dementia and is exhibiting several cognitive disturbances. Which term is used to describe the inability to execute motor functioning despite intact motor abilities?

Apraxia

A 49-year-old client is admitted to the emergency department frightened and reporting that he's hearing voices telling him to do bad things. Which intervention should be the nurse's priority?

Assess the nature of the commands by asking the client what the voices are saying.

A client is admitted with schizophrenia and episodic delusions. The therapeutic team identifies strategies for working with the client on the unit. What would be a potential barrier for intervention strategies when working with a client in a pronounced delusional state?

Attempting to define reality for the client.

A 70-year-old woman is brought to emergency department. She is confused, incoherent, and agitated after reportedly spray painting metal lawn furniture with metal paint earlier that day. She has no history of illness and is not taking any medication. Which of the following assessments would be appropriate for the nurse to make?

Delirium related to toxin exposure.

A client is admitted after being found on a highway, hitting at cars and yelling at motorists. When approached by the nurse, the client shouts, "You're the one who stole my husband from me." Which condition describes the client's condition?

Delusional experience

The nurse can distinguish delirium from dementia by knowing which of the following?

Dementia has a gradual onset and is progressive in course.

Noncompliance with drug therapy is the leading cause of the return of disease symptoms and the need for short-term hospitalization. What techniques are used to increase medication compliance in the schizophrenic client?

Depot injections, or intramuscular injections of antipsychotic drugs in an oil suspension that are gradually absorbed, are administered every 2 to 4 weeks.

Schizophrenia is theorized to be caused by an excess of which neurotransmitter?

Dopamine

Which of the following life-threatening reactions, related to neuroleptic medication, is exhibited by rigidity, fever, hypertension, and diaphoresis?

Dystonia

A client is repeating every word that the nurse says. This would be correctly documented as which of the following?

Echolalia

A nurse is caring for a client with schizophrenia who is currently experiencing auditory hallucinations. Which of the following nursing actions should be first priority?

Engaging the client in reality-based conversations.

A nurse is caring for a client with dementia. What measure should the nurse employ when communicating with the client?

Give simple, one-step commands

A client with schizophrenia is hearing voices that tell him to kill himself. The nurse understands that this client is experiencing:

Hallucination

Which cluster of symptoms would indicate schizophrenia?

Hallucinations or delusions and decreased ability to function in society

A client with schizophrenia is admitted to the inpatient unit. He does not speak when spoken to but has been observed talking to himself on occasion. At this time, the priority goal for this client is to:

Increase his reality orientation

A nurse is caring for a client with dementia. What measure should the nurse take when assisting the client with nutrition and hydration?

Keep reminding the client to chew and swallow

Which assessment should a nurse initially perform for a client with schizophrenia?

Mini-Mental State Examination

Which of the following life-threatening reactions, related to neuroleptic medication, is exhibited by rigidity, fever, hypertension, and diaphoresis?

Neuroleptic malignant syndrome

Why is important for nurses to assess blood pressure in patients receiving antipsychotic drugs?

Orthostatic hypotension is a common side effect.

A client has experienced a gradual flattening of affect, confusion, and withdrawal and has been diagnosed with Alzheimer's disease. The nurse assesses which of the following additional characteristics of this disorder?

Personality change, wandering, and inability to perform purposeful movements

The nurse understands that clients with cognitive disorders often experience spatial confusion as their diseases progress. Which of the following measures should be undertaken to maximize clients' safety and independence when navigating an inpatient facility?

Post arrows, signs, and paths in the facility and increase lighting.

One of the nursing diagnoses related to schizophrenia is self-care deficit related to lack of motivation, illogical fears, and emotional withdrawal. The expected outcome of interventions is that the client will independently perform ADLs. What interventions would be performed to help meet this outcome? Select all that apply.

Praise any worthy accomplishments. Explain where hygiene is performed and how to obtain soap, shampoo, and toothpaste. Direct the client to care for himself or herself at an appropriate time.

A family transfers their mother to the emergency department because they can no longer care for her at home. The client has been diagnosed with Alzheimer's disease. A member of the family plans to stay with the client during her hospitalization. While in the emergency department a focused plan of care by the nurse would be which of the following?

Provide consistent and familiar care to the client.

Which action by the nurse is an appropriate therapeutic intervention for a client experiencing hallucinations?

Providing a competing stimulus that distracts from the hallucinations

A client is in the first stage of Alzheimer's disease. The nurse should plan to focus this client's care on:

Providing emotional support and individual counseling

A client is admitted with a diagnosis of paranoid schizophrenia. The student nurse asks the charge nurse about the approach to take with the client, who has been exhibiting hostility and isolation. Which approach would be the most appropriate direction from the charge nurse?

Respect the client's need for personal space and avoid physical contact.

A client with Alzheimer's disease has random violent outbursts, wanders, and is incontinent. The client can no longer identify people who were once familiar, and is unable to identify common objects. The nurse should give highest priority to which aspects during care planning?

Risk for injury.

Which of the following is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener?

Word salad

A resident at a long-term care facility is active and independent despite some urinary incontinence. The client is typically alert and oriented but has begun to display confusion and disorientation. What is likely the problem?

UTI

A client with a medical diagnosis of dementia of Alzheimer's type (DAT) has been increasingly agitated in recent days. As a result, the nurse has identified the nursing diagnosis of "risk for injury related to agitation and confusion" and an outcome of "the client will remain free from injury." What intervention should the nurse use in order to facilitate this outcome?

Use the least restrictive devices if necessary.

Which extrapyramidal side effects (EPS) are associated with traditional antipsychotic drugs? Select all that apply.

akinesia akathisia tardive dyskinesia

Symptoms of schizophrenia are classified as positive symptoms and negative symptoms. Which symptom would be classified as a negative symptom?

inability to express emotions

Which drug is not an antipsychotic medication?

memantine

An older adult client who is confused is going to be treated with donepezil (Aricept). This drug is effective in treating clients:

with early-stage Alzheimer's disease.