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Mental Health > NCLEX Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders > Flashcards

NCLEX Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders Flashcards

A patient diagnosed with moderate dementia consistently appears to be distorting the truth resulting in his wife asking, “What should I do when he lies to me about unimportant things?” Upon what rationale should the nurse’s response be based?

a. Changing the topic provides diversion. b. Delusions should be confronted to clarify thinking. c. Ignoring memory deficit avoids catastrophic reactions. d. This isn’t lying but rather a way to fill in the memory gaps.

ANS: D Confabulation is not lying but rather a method for filling in the memory gaps. Ignoring, using confrontation, and changing the topic would not be as useful as gently reorienting.

The nurse is to perform a complete assessment of a patient in her home, using the Mini-Mental State Examination (MMSE) as one component. When the nurse arrives, the patient is seated at the table with her husband, the TV is on, and several grandchildren are visiting. The patient is quiet, but her hands are gripped tightly, and she is staring at the ceiling. The best action for the nurse to take would be which of the following?

a. Ask the husband to make an appointment to bring his wife to the clinic for testing. b. Explain to the husband that accurate data will be sought, and ask him to stay with the grandchildren in another room. c. Do not perform the test during the assessment (because it will not be valid) and rely on observations and reports from the family. d. Explain the importance of the testing process and make an appointment for another day when the environment can be better controlled.

ANS: D Testing the patient in her home under quieter, less distracting circumstances is the best solution. Asking the husband to leave is likely to increase the patient’s anxiety and alter test results. Use of the MMSE is an integral component of the assessment and must not be deleted. Testing in the more familiar, comfortable surroundings of the home will yield more reliable results.

A patient has been admitted with a diagnosis of hypoactive delirium. Which nursing intervention is supported by this diagnosis?

a. Encouraging fluids to minimize constipation b. Frequently assessing both visual and auditory hallucinations c. Scheduling frequent changing of position to prevent skin breakdown d. Dimming the lights to help control eye discomfort resulting from cataracts

ANS: C Because of inactivity, hypoactive delirium patients are more likely to develop further complications, including decubiti that could be minimized by frequent repositioning. The remaining options identify interventions that are not generally a result of this diagnosis

Which of the following should the nurse use as a basis for explaining the etiology of Alzheimer’s disease to the family of a patient with this disease?

a. It is a secondary dementia indicated by loss of recent memory and disorientation to time and place. b. It is a primary dementia that is incurable, irreversible, and fatal. It is caused by the presence of a beta-amyloid protein in the neurons resulting in senile plaques. c. It is a secondary dementia that is treatable with analysis of the diet and removal of toxic substances from the diet and environment. d. It is a primary dementia characterized by stepwise decreases in cognitive abilities. It is irreversible but treatable with antihypertensive medications.

ANS: B This option provides accurate information about Alzheimer’s disease. Alzheimer’s disease is not a secondary dementia nor is it treated with antihypertensive medications.

Which outcome is realistic for a patient with stage 1 Alzheimer’s disease?

a. Caregiver will assume role of decision maker for patient to reduce stress. b. The patient will maintain the highest possible functional level to preserve autonomy. c. Arrangements will be made for appropriate long-term placement to minimize risk of injury. d. The patient will retain full physical functioning through cognitive and occupational therapies.

ANS: B This outcome addresses health maintenance (i.e., maintaining an optimal functional level as determined by present capacity). Although long-term placement may be an option, it is not necessarily appropriate during this stage. Patients in stage 1 are often able to make simple decisions. Continuing to make decisions gives the patient a sense of control. Although a patient in stage 1 does not appear markedly deteriorated, some diminution of function may be present

The home care nurse is visiting a patient who was discharged to home after a procedure at an ambulatory surgical center. The patient lives alone in a senior retirement community. The nurse’s assessment documents mild dysphasia. The patient repeatedly asks, “Why is there a bandage on my arm?” and is not able to state the appropriate day and year. Appropriate planning for the patient should include:

a. Assessing diet and meal preparation, assessing environment for safety problems, referral to a dementia program b. Attending English class to improve speech, transferring finances to a conservator, employing an aide to help with medications c. Arranging Meals on Wheels, attending speech therapy, relocation to a skilled nursing facility if no improvement in 1 month d. Arranging an appointment at a geriatric assessment program, OT referral for swallowing therapy, teaching to manage public transportation

ANS: A Further assessment is appropriate before making changes in the living environment. Enrolling in a dementia program will provide stimulation and help the patient maintain intellectual skills. English classes will not improve speech. The other plans might have relevance, however. The remaining sets of options are either irrelevant or beyond the patient’s abilities.

A patient diagnosed with Alzheimer’s disease has a catastrophic reaction during an activity involving simultaneous playing of music and working on a craft project. The patient starts shouting “no, no, no” and rushes out of the room. The nurse should:

a. Discontinue the activity program since it upsets the patients. b. Follow the patient, reassure her, and redirect her to a quieter activity. c. Isolate the patient until she is calm, and then direct her back to the activity. d. Give the patient prn antianxiety medication and restrict her activity participation.

ANS: B These actions will restore safety and self-esteem. Isolation will decrease self-esteem and may increase confusion. It is only one patient that is distressed, not the entire group. Behavioral interventions should be attempted prior to administering medication.

Which behaviors would indicate that a therapeutic activity program for a patient with Alzheimer’s disease had been successful?

a. Accurate recent memory, positive emotional response, and increased verbal expression b. Increased attention span, verbal expression of remote memory, and positive emotional response c. Positive use of perseveration, reduction in use of habitual skills, and improved abstract reasoning d. Positive emotional response, ability to remember multiple steps, and accurate recent memory

ANS: B These are all observations that would indicate that a therapeutic activity program has kept the patient functioning at the highest level of which he is capable. The behaviors described in the other options are not realistic expectations for this patient.

A patient has been diagnosed with dementia secondary to cerebral disease. The family members note the patient “has not been as sharp as he once was” and that he has developed urinary incontinence and a gait disturbance. Which pathophysiology can cause such symptoms?

a. Normal pressure hydrocephalus b. Vitamin B12 deficiency c. Hepatic disease d. Tuberculosis

ANS: A Normal pressure hydrocephalus is a disorder characterized by dementia, gait disorder, and urinary incontinence. Dilation of ventricles in the absence of increased CSF is a prominent manifestation. Early urinary incontinence is not seen in the disorders listed in the other options

When asked about the prognosis for a patient diagnosed with a dementia secondary to normal pressure hydrocephalus the nurse replies:

a. “Unfortunately the prognosis is for a downhill course ending in death.” b. “There will be good days and bad days for the rest of the patient’s life.” c. “The symptoms generally remit after a shunt is inserted to drain fluid.” d. “We’ll try our very best, but only time will tell how successful we are.”

ANS: C By relieving the cause, the symptoms of secondary dementias are largely reversible. The statements reflected in the other options do not reflect this fact.

Which statement by an adult child concerning the behaviors of their parent supports the diagnosis of Alzheimer’s disease?

a. “Mom forgot to pay her utility bills last month.” b. “Mom isn’t as interested in keeping a neat house as she was.” c. “Mom doesn’t seem interested in going out with friends anymore.” d. “Mom refuses to stop driving even though her reaction time is very slow.”

ANS: A Increased forgetfulness, particularly that involving former routine activities (such as bill paying), is symptomatic of Alzheimer’s disease. The other options do not indicate cognitive deficit.

The daughter of an older patient with dementia tearfully tells the nurse that she doesn’t know what’s wrong with her mother, who has begun accusing the family of holding her prisoner. Which nursing diagnosis would be appropriate for this patient?

a. Powerlessness b. Defensive coping c. Ineffective coping d. Disturbed thought processes

ANS: D Paranoid thinking is common in patients with dementia. Inability to correctly interpret environmental clues and to think logically leads to delusional thinking as the patient tries to make sense of a confusing world. The remaining options are not supported by the data in the scenario.

The daughter of an elderly patient with dementia tearfully tells the nurse that she doesn’t know what’s wrong with her mother, who has begun accusing the family of stealing her money. The nurse assesses the patient’s stage of Alzheimer’s disease as stage:

a. 1 b. 2 c. 3 d. 4

ANS: B In stage 2, memory and cognitive deficits are worsening. The patient is less able to make sense of a confusing world and makes faulty interpretations resulting in paranoid delusional thinking. The patient in stage 1 does not usually have delusions. The patient in stage 3 often is unable to communicate meaningfully. There is no stage 4 of Alzheimer’s disease

An elderly patient was well until 12 hours ago, when she reported to her family that in the middle of the night she awakened to see a man standing at the foot of her bed. There is no evidence that this situation ever happened. This series of events supports which possible diagnosis?

a. Delirium b. Anxiety c. Paranoia d. Dementia

ANS: A Delirium is a disturbance of consciousness and cognition that develops over a short period. It is secondary to a medical condition. The scenario does not fit the disorders mentioned in the remaining options.

A patient diagnosed with delirium has become agitated and fearful. Which nursing intervention should the nurse implement to help prevent a catastrophic response?

a. Interact with the patient on an adult-to-child level. b. Place the patient in a safe, nonstimulating environment. c. Ask the patient to explain what is causing the agitation and fear. d. Be prepared to apply physical restraints to minimize the patient’s risk for injury.

ANS: B The safety of a patient with delirium is of primary importance. Symptoms of delirium fluctuate and may worsen, especially at night. The greater the patient’s confusion and disorientation, the greater the possibility for self-harm. The patient should be treated as an adult; to do otherwise is demeaning. Asking for an explanation is inappropriate, because delirious patients cannot formulate rational answers. Patients are never restrained unless all other less restrictive measures have failed.

A patient has been diagnosed with Alzheimer’s disease, stage 1. The nurse would expect to help the family plan measures to assist the patient with:

a. Perseveration b. Recent memory loss c. Catastrophic reactions d. Progressive gait disturbances

Recent memory loss is the only symptom listed in the options that would be expected in stage 1 Alzheimer’s disease.

An elderly patient with dementia has a nursing diagnosis of self-care deficit: bathing, hygiene. She lives alone and the nursing assessment proves reason to believe she has forgotten how to perform hygiene and bathing activities. Which intervention is most appropriate for this patient?

a. Bathe daily with reminders. b. Bathe twice weekly with assistance. c. Patient will be provided with in-home nursing care. d. Patient will be transferred to an assisted living facility.

ANS: B Bathing twice weekly would be a realistic goal. Assistance should be provided, both to prevent falls and to regulate shower temperature. The elderly are advised not to bathe daily because it is too drying to their skin. The remaining options are not supported by the information given in the scenario.

Which situation would be most likely to serve as a trigger to a catastrophic reaction in a patient with stage 2 Alzheimer’s disease?

a. Participating in singing “Happy Birthday” to another patient at dinner b. Being scolded by an aide for spilling a glass of milk c. Listening to Big Band music from the 1940s d. Eating cupcakes in the activities room

ANS: B Catastrophic reactions are overexaggerated negative emotional responses initiated as a result of a perceived failure at a task or change in the environment. Being scolded by the aide presents a situation that would clearly be frustrating to the patient.

Which theory of etiology of Alzheimer’s disease, suggested by current research, might the nurse use to help a family understand that this disorder is not of psychosocial origin? Alzheimer’s disease is associated with:

a. Abnormal serotonin reuptake b. Prion infection of gray matter c. ß-Amyloid protein deposits in the brain d. Excessive acetylcholine in the frontal cortex

ANS: C The prevailing theories of etiology of Alzheimer’s disease include the following: angiopathy and blood-brain barrier incompetence; neurotransmitter and receptor deficiencies of acetylcholine; abnormal proteins, specifically ß-amyloid and their products; and genetic defects. Neither serotonin nor prions are implicated as problems in Alzheimer’s disease.

The nurse is administering donepezil (Aricept) to a patient with stage 1 Alzheimer’s disease. Based on this drug’s mechanism of action, the nurse will seek evidence of improvement in the patient’s:

a. Social behaviors b. Existing delusions c. Ability to tolerate stress d. Ability to remember recent events

ANS: D Donepezil is a cholinesterase inhibitor that increases the concentration of acetylcholine. Acetylcholine is needed for intact memory and for learning. This medication is not prescribed for the conditions identified in the remaining options.

A patient with dementia is unable to name ordinary objects. Instead, he describes the function of each item (e.g., “the thing you cut meat with”). The nurse assesses this as:

a. Apraxia b. Agnosia c. Aphasia d. Amnesia

ANS: B Agnosia is the failure to identify objects despite intact sensory function. Apraxia is the inability to carry out purposeful, complex movements and use objects properly. Aphasia refers to inability to speak (expressive) or inability to comprehend what is said or written (receptive). Amnesia is inability to remember a significant block of information.

Which intervention has highest priority for a patient with stage 3 Alzheimer’s disease?

a. Cutting the patient’s food into bite size pieces b. Providing fluids to the patient every hour while awake c. Demonstrating to the patient how to put toothpaste on the brush d. Assisting the patient in signing a birthday care for a granddaughter

ANS: B The severe dementia characteristics of stage 3 renders the patient incapable of independently meeting hydration and nutrition needs. These needs are basic to life, so they are of highest priority. The remaining options are not applicable for such an impaired patient.

A patient was admitted to a dementia unit after persistently wandering away from home. Which intervention will best address this patient’s risk for injury?

a. Place the patient in a geriatric chair with a tray across the lap. b. Provide one-to-one supervision when the patient is ambulatory. c. Reinforce verbal explanation to the patient concerning the dangers of wandering. d. Activate alarm system that will alert staff to the patient’s attempt to open the door.

ANS: D Electronic alarms allow patients freedom of movement although still preventing them from wandering off the unit. One-to-one supervision is not necessary in an environment designed as a dementia unit. The geriatric chair would be an unacceptable form of restraint for this patient. The patient would not be capable of processing the verbal explanation.

A patient with moderate dementia does not remember her son’s name. The son repeatedly questions the mother asking, “Do you know my name?” The mother invariably becomes agitated. The nurse can most effectively intervene by explaining to the son:

a. “Your mother is angry with you and is punishing you by ‘forgetting’ who you are. Be patient and she’ll get over it.” b. “Your mother’s dementia is preventing her from retaining information even for short periods of time. She senses your distress and becomes agitated.” c. “You will need to reorient your mother often during your visits with her. With reinforcement, she may be able to begin to recall who you are.” d. “Because you both become so distressed, it might be better if you come to see your mother less frequently and stay for only shorter periods of time.”

ANS: B When a patient with dementia is presented with a demand that exceeds their capacity to function, the demand creates a high level of stress. Showing anxiety and disapproval adds even greater stress. The son should be counseled to make every attempt to demonstrate positive responses to his mother. The other options are not effective interventions.

The wife of a patient with moderate to severe dementia tells the nurse, “I’m exhausted. He wanders at night instead of sleeping, so I get no rest. I’m afraid to leave him during the day, so I have to take him with me wherever I go.” The nurse recognizes the need to provide teaching for this caregiver. An appropriate outcome for this teaching would include:

a. Experiences less stress indicated by improved sleep patterns b. Feels comfortable leaving the patient in the care of others occasionally c. No longer experiences resentment concerning the need to care for the patient d. Feels at peace with the decision to admit the patient to an appropriate care facility

ANS: A Stress reduction allowing for better rest is an appropriate outcome. The other options are not necessarily appropriate nor will they result in improvement for the caregiver.

A teenager is admitted to the ED after being alternately hyperalert and difficult to arouse. The symptoms started within the last few hours, during which time he became disoriented, confused, and delusional. These symptoms support the diagnosis of:

a. Amnesia b. Delirium c. Dementia d. Depression

The symptoms are indicative of delirium. The other options are not supported by the scenario

Which interventions provided by the caregiver will help ensure effective care for the patient diagnosed with dementia? (Select all that apply)

a. Taking the patient’s blood pressure regularly b. Being alert to ways the patient might be hurt c. Keeping the patient on a predictable schedule d. Assuming responsibility for meeting the patient’s needs e. Providing the patient with nonstimulating, private time

ANS: B, C, E These interventions take responsibility for areas in which the patient is incapable of providing self-care and addressing the special needs this patient has. Taking the blood pressure is not necessary unless there is a medical condition that requires doing so. Although the patient’s ability to provide self-care will deteriorate, independence should be encouraged as appropriate.

For which medication will the nurse prepare material for the family of a patient diagnosed with mild to moderate Alzheimer’s disease? (Select all that apply.)

a. Tacrine (Cognex) b. Donepezil (Aricept) c. Haloperidol (Haldol) d. Rivastigmine (Exelon) e. Galantamine (Razadyne)

The only drug that is not generally prescribed for Alzheimer’s disease is Haldol.

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Video Case study Dementia and Delirium

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