Deck 22: Cognitive Responses and Organic Mental Disorders

Question 1

A nurse is caring for a patient who is confused,disoriented,and experiencing visual hallucinations.While preparing to provide personal care,the nurse should:

A) ask the patient, "Do you remember who I am?"
B) speak minimally so as not to disturb the patient.
C) pat the patient on the forearm and say, "Let's get started."
D) explain to the patient what will happen during the care.

Answer 1

explain to the patient what will happen during the care.

Question 2

A person who is the caregiver of a parent with early-to-middle-stage Alzheimer disease is concerned about possible episodes of incontinence.What strategy should the nurse suggest?

A) Limiting the patient's fluid intake to 1000 ml daily
B) Discussing the use of an indwelling catheter with the health care provider
C) Putting plastic coverings on the beds, upholstered chairs, and sofas
D) Taking the patient to the bathroom at least every 2 hours when the patient is awake

Answer 2

Taking the patient to the bathroom at least every 2 hours when the patient is awake

Question 3

The goal for a patient with disturbed thought processes is,"The patient will:

A) be safe from injury."
B) meet basic biological needs."
C) achieve optimum cognitive functioning."
D) maintain positive interpersonal relationships."

Answer 3

achieve optimum cognitive functioning."

Question 4

A 72-year-old female patient has delirium secondary to anticholinergic medication toxicity.The nurse planning discharge care teaches the family to be alert for maladaptive cognitive symptoms because:

A) delirium is a hypersensitivity reaction.
B) the elderly often deny changes in cognition.
C) elderly females are more prone to delirium than elderly males.
D) slower metabolism in the elderly predisposes to medication toxicity.

Question 5

A nurse caring for a patient with Alzheimer disease can anticipate that the family will most likely need information about:

A) antimetabolites.
B) benzodiazepines.
C) immunosuppressants.
D) acetylcholinesterase inhibitors.

Question 6

A patient has sundown syndrome.The nurse can expect that the patient will:

A) exhibit chronic fatigue.
B) evidence extreme lethargy at night.
C) manifest confusion and agitation at night.
D) be more alert between 6 PM and 11 PM.

Question 7

A widowed patient tells a nurse that the door should be left unlocked because her husband will be coming home soon.Which response by the nurse would be most therapeutic?

A) "You've forgotten that your husband's dead, haven't you?"
B) "Just try to sleep. He won't be home for a very long time yet."
C) "You must miss him a lot. It almost seems he's here with you."
D) "Your husband died over 10 years ago. He won't be coming here."

Question 8

An individual is brought to the emergency room after family reports that the patient awoke confused and began "rambling and talking crazy" about 3 hours ago.The patient strikes out at the staff and shouts,"You're not going to kill me!" The most likely analysis of this behavior is:

A) disturbed self-esteem related to catastrophic reaction.
B) disturbed sensory perception related to altered brain function.
C) other-directed violence related to fear associated with hospitalization.
D) impaired environmental interpretational syndrome related to metabolic disturbance.

Question 9

A patient experiencing delirium secondary to drug toxicity is manifesting paranoid thinking and noisy,assaultive behavior and is currently pacing the room.The nurse's initial intervention is to:

A) prepare to apply supervised restraints.
B) request an intravenous sedative.
C) calmly attempt to quiet the patient.
D) attempt to divert the patient's attention.

Question 10

A nurse would attempt to reduce nighttime agitation for a patient with either delirium or dementia by:

A) giving warm milk as a snack at bedtime.
B) keeping a soft light on in the patient's room.
C) placing a large-faced lighted alarm clock opposite the bed.
D) hanging family pictures near enough to the bed to be easily seen.

Question 11

Family members of a delirious elderly patient are very anxious and express their concerns about placing the patient in a nursing home.What information should serve as a basis for the nurse's reply?

A) Delirium is reversible, and the patient will likely recover.
B) The symptoms are related to depression, which can be treated.
C) Delirium usually progresses to dementia, which is usually permanent.
D) Home care should be attempted; a nursing home should be the last resort.

Question 12

A 45-year-old patient shows marked cognitive impairment that has developed progressively over several months.A family member reports the patient's father had early-onset dementia.What research-based information can be given to the family in response to their concerns about the patient developing early-onset dementia?

A) The risk for developing the condition is about 50% only if both parents were affected.
B) The greatest risk exists for relatives of individuals diagnosed with Alzheimer disease before age 55 years.
C) Added risk is present only for people with Down syndrome, so relatives without Down syndrome are essentially safe.
D) Results of the research on genetic predisposition and its effect on the development of early-onset dementia are still unclear.

Question 13

An individual brought to the emergency room fights against the restraints and shouts incoherently.The history reveals that the patient was weak and confused on awakening this morning and soon began "rambling and talking crazy." A nurse notes that the patient's skin is flushed and dry.The priority nursing action is to:

A) assess vital signs.
B) insert an intravenous catheter.
C) request a sedative prescription.
D) perform a mental status examination.

Question 14

A patient diagnosed with dementia associated with excessive alcohol use is shown a pencil,a nickel,and a safety pin and asked to repeat the names of each.Later when asked to identify these three items the patient is unable to do so.The nurse assesses this as:

A) apraxia.
B) agnosia.
C) concreteness.
D) catastrophizing.

Question 15

Which intervention would likely be most useful when attempting to prevent or lessen the symptoms associated with sundown syndrome?

A) Keeping the patient's room quiet and dimly lit at night
B) Interacting frequently with the patient during evening hours
C) Providing the patient with a large protein-based bedtime snack
D) Giving the patient a soft stuffed animal to provide a source of security

Question 16

An adult was brought to the emergency room.The patient's sensorium alternates between clouded and clear,and the patient becomes agitated both physically and verbally when approached.The patient's roommate states,"The patient was fine after getting up this morning but started talking crazy about 3 hours ago." The patient's cognitive impairment is most consistent with:

A) delirium.
B) dementia.
C) sundown syndrome.
D) early-onset Alzheimer disease.

Question 17

A patient diagnosed with dementia associated with excessive alcohol use tells a nurse,"Last week I had to take my baby to the hospital for major surgery.That's why I've been so nervous and needed to come here." The nurse is aware that the patient has never parented any children.The symptom described can be assessed as:

A) akathisia.
B) confabulation.
C) intellectualization.
D) magical thinking.

Question 18

An individual being treated in the emergency room is found to have flushed,dry skin and sensorium that alternates between clouded and clear.A friend reveals the patient has not voided or ingested food or fluid in 18 hours.When the health care provider diagnoses fever of unknown origin,the plan is to make an effort to orally hydrate before attempting to start an IV line.The intervention most likely to be effective will be:

A) placing a pitcher of water at the patient's bedside.
B) placing a "force fluids" sign at the head of the bed.
C) asking the friend to give the patient a drink whenever the patient is alert.
D) staying with the patient to ensure that a glass of liquid is ingested once every hour.

Question 19

Which nursing diagnosis would be appropriate for a patient with Alzheimer disease?

A) Disorientation related to hyperthermia
B) Anxiety (moderate) related to dementia
C) Disturbed sensory perception (visual) related to normal aging
D) Disturbed thought processes related to irreversible brain disorder

Question 20

An individual was brought to the emergency room with impaired cognitive function.The patient's aggressive behavior and attempts to get out of bed present a safety issue.The nurse should first:

A) apply four-point restraints.
B) use a calm tone to orient the patient.
C) assign staff to stay in the room with the patient.
D) call for security guards to assist with controlling the patient.

Question 21

An elderly patient with dementia paces the hallway and often wanders.The nurse documents that the patient is exhibiting which type of behavior characteristic of dementia?

A) Passive behavior
B) Functionally impaired behavior
C) Involuntary psychomotor behavior
D) Nonaggressive psychomotor behavior

Question 22

A nurse is working with a family with an elderly member who is in the prediagnostic phase of Alzheimer disease.The most important nursing intervention at this time would be to provide:

A) family consultation to facilitate communication.
B) information about support groups and counseling.
C) options directed toward the reduction of caregiver stress.
D) education that helps them understand their situation.

Question 23

An adolescent is diagnosed with dementia.The patient's age would cause a nurse to suspect an underlying condition associated with a history of:

A) traumatic brain injury (TBI).
B) neurosyphilis.
C) Pick disease.
D) hypothyroidism.

Question 24

A patient is admitted with a tentative diagnosis of delirium.The patient repeatedly mistakes one of the nursing staff for a family member.The nurse documents that this patient is experiencing a disturbance in which area of functioning?

A) Consciousness
B) Attention
C) Perception
D) Cognition

Question 25

A family has noted these behaviors in their elderly parent: periodic indecisiveness,forgetfulness,mild transient confusion,occasional misperception,distractibility,and occasional unclear thinking.Where on the continuum of cognitive responses would this patient be? Adaptive responses Maladaptive responses
1 2 3

A) At point 1
B) At point 2
C) At point 3