Deck 21: Neurocognitive Disorders

Question 1

The nurse is caring for an older adult patient who presented to the emergency department with delirium. For which conditions will the nurse assess the patient? Select all that apply.

A) Drug abuse
B) Infection
C) Drug toxicity
D) Hypoxemia
E) Fluid volume deficit

Answer 1

Infection
Drug toxicity
Hypoxemia
Fluid volume deficit

Question 2

The nurse is performing a mental status examination when caring for a patient with a neurocognitive disorder (NCD). The patient's spouse asks why a mental status examination is necessary. How will the nurse respond?

A) "The mental status exam is the only way to assess the cognitive decline of a patient with early stage Alzheimer disease."
B) "The mental status exam is used to assess depression in a patient with early stage Alzheimer disease."
C) "The mental status exam will reveal slow and progressive cognitive decline of a patient with early stage Alzheimer disease."
D) "The status exam will reveal rapid and dramatic changes in cognition of a patient with early stage Alzheimer disease."

Answer 2

"The mental status exam will reveal slow and progressive cognitive decline of a patient with early stage Alzheimer disease."

Question 3

The nurse is caring for a patient suspected of having Alzheimer disease. The nurse knows that alterations in which areas can occur with Alzheimer disease? Select all that apply.

A) Memory
B) Executive function
C) Visual acuity
D) Language
E) Behavior and personality

Answer 3

Memory
Executive function
Language
Behavior and personality

Question 4

The nurse is caring for a patient with neurocognitive disease who is suspected of having depression. What is true regarding depression and neurocognitive decline? Select all that apply.

A) Depression may occur as a result of frustration associated with neurocognitive decline.
B) Depression is a universal finding in patients with neurocognitive decline.
C) Depression is easy to diagnose in those with neurocognitive decline.
D) Depression may occur as a result of the pathology of neurocognitive decline.
E) Depression is difficult to diagnose in those with neurocognitive decline.

Question 5

The nurse is caring for a patient with Alzheimer disease who is no longer able to make or plan meals and who is having difficulty managing her personal finances. What stage of Alzheimer disease does the nurse suspect the patient has?

A) Preclinical
B) Mild cognitive impairment
C) Dementia
D) Asymptomatic

Question 6

An 82-year-old man is admitted to a medical-surgical unit for diagnostic confirmation and management of suspected delirium. Which statement by the patient's daughter best supports the diagnosis?

A) "Dad has always been so independent. He's lived alone for years since my mom died."
B) "Dad just hasn't seemed to know what he's been doing lately. He has been very forgetful these last few months."
C) "Maybe it's just caused by aging. This usually happens by age 8
D) "The changes in his behavior came on so quickly. I wasn't sure what was happening."

Question 7

The nurse is caring for a patient with Alzheimer disease. The nurse notes that the health care provider documented that the patient has neurocognitive disorder instead of documenting dementia. Why would the health care provider document in this manner?

A) The word dementia is outdated and no longer used.
B) The word dementia does not describe the patient's condition.
C) The word dementia may increase stigma regarding the patient's condition.
D) The word dementia may be confused with delirium.

Question 8

The nurse is caring for a patient with vascular dementia. Based on the neurobiology of this condition, what is the nurse's primary concern when caring for this patient?

A) Pain
B) Safety
C) Communication
D) Level of consciousness

Question 9

The nurse is caring for a patient with dementia due to Alzheimer disease. What is the nurse's best understanding of the etiology of this disease?

A) A presence of eosinophilic inclusion bodies in the cortex and brain stem results in impaired cognitive function.
B) An infectious form of a normally harmless type of protein, called a prion, interferes with neuronal health, leading to dementia.
C) Multiple vascular lesions occur in the cerebral cortex and subcortical structures, resulting from the decreased blood supply to the brain, lead to a decline in cognitive function.
D) A buildup of beta amyloid plaques and tangled strands of tau protein interferes with neuronal health, communication, and transport functions, leading to dementia.

Question 10

A nurse is caring for a patient who has been diagnosed with dementia due to Parkinson disease. The patient has never heard of Parkinson disease and asks what causes it. What will the nurse explain is the etiology of this disorder?

A) Death of neurons
B) Presence of Lewy bodies
C) Inheritance of a dominant gene
D) Presence of an infectious process

Question 11

A 70-year-old patient presents to the health care provider's office complaining of tremors and memory problems. The patient says "I just can't get around like I used to. It feels like it takes forever to get started." Which disorder will the nurse suspect?

A) Traumatic brain injury
B) Parkinson disease
C) Alzheimer disease
D) Human Immunodeficiency Virus

Question 12

What does the nurse recognize as a risk factor for the development of delirium in older adults?

A) A lack of rigorous exercise that leads to decreased cerebral blood flow
B) Decreased social interaction that leads to profound isolation and psychosis
C) Administration of multiple medications that may cause medication interactions or toxicity
D) Age-related cognitive changes that make older adult patients more susceptible to changes in mental status

Question 13

The patient presents at the health care provider's office at the urging of her spouse. Which statements by the spouse suggest to the nurse that the patient is in stage 2 of Alzheimer disease? Select all that apply.

A) "She sometimes forgets to take her medicine."
B) "All she does is lie in bed and cry."
C) "She's always been good at math, but she has trouble sometimes with things like counting the correct change."
D) "She'll ask me the same question several times in a row."
E) "Yesterday she wandered away from the house and was lost for hours."

Question 14

The nurse is caring for a 75-year-old man with stage 3 Alzheimer disease. The patient's daughter tells the nurse that the family is concerned about his safety because he has fallen three times in the past year. What condition that is associated with Alzheimer disease does the nurse suspect the patient is experiencing?

A) Aphasia
B) Amnesia
C) Apraxia
D) Agnosia

Question 15

A 42-year-old patient presents to the health care provider's office complaining of difficulty "remembering things." The patient's spouse adds that the patient has been making "a lot of funny faces and hasn't been himself lately." The nurse anticipates the need to evaluate the patient for which disorder?

A) Huntington disease
B) Parkinson disease
C) Traumatic brain injury
D) Human Immunodeficiency Virus

Question 16

The novice nurse asks another nurse about differentiating delirium from dementia. The experienced nurse will respond that which change in mental status is consistently seen in patients with delirium and is not seen in patients with dementia?

A) Apraxia
B) Disorientation to self
C) Altered level of consciousness
D) Impaired short-term memory

Question 17

The home health nurse is assigned to a new patient with a major neurocognitive disorder. Which will the nurse include in the initial assessment when visiting the patient at home? Select all that apply.

A) Eating habits
B) Ability to pay bills
C) Ability to shower and shave
D) Internet use
E) Medication adherence

Question 18

The nurse is caring for a patient with Alzheimer disease (AD). A family member of the patient asks the nurse, "Is this disease genetic?" What is the nurse's best response? Select all that apply.

A) "Some forms of AD have a genetic pattern."
B) "Early-onset AD is more likely familial than late-onset AD."
C) "One-third to one-half of all AD may be the genetic form."
D) "One-quarter to one-third of all AD my be the genetic form."
E) "There is not any evidence of a genetic link with AD."

Question 19

The nurse is caring for an older adult patient with a urinary tract infection (UTI). The patient points to the smoke alarm inside the room and asks the nurse, "Would you please turn on the radio?" For which alteration will the nurse assess the patient?

A) Agnosia
B) Delirium
C) Dementia
D) Pseudodementia

Question 20

The nurse is caring for a patient with suspected delirium. In addition to the sudden onset of symptoms, the nurse can expect to find alterations in which functions during the assessment? Select all that apply.

A) Abstract thinking
B) Concrete thinking
C) Memory
D) Concentration
E) Consciousness

Question 21

The student nurse is caring for a patient with Alzheimer disease. The student asks the nurse preceptor, "What types of medications may be used to treat Alzheimer disease?" What is the nurse's best response? Select all that apply.

A) Anticholinesterase agonist
B) Cholinesterase inhibitor
C) Anticholinergic inhibitor
D) NMDA receptor agonist
E) NMDA receptor antagonist

Question 22

The nursing staff working on the dementia unit of a long-term care facility are informed that the entire unit will be redecorated in the next two weeks. Nursing staff tell the nurse manager that this will be a problem for the patients. What particular patient need is addressed by the staff nurse's concern?

A) A stable environment
B) Patient comfort
C) Scheduling of admissions
D) Patient safety

Question 23

Which nursing technique is appropriate for therapeutic interaction with a patient who has been diagnosed with Alzheimer disease?

A) Setting strict time limits and rephrasing misunderstood questions.
B) Encouraging verbal and nonverbal communication while maintaining a calm demeanor.
C) Correcting errors made by the patient and speaking in a loud, clear voice.
D) Using multiple memory cues and giving several directions at once.

Question 24

The nurse is caring for a patient with Alzheimer disease and anticipates an order for which medication that may help delay the rate of cognitive decline?

A) Donepezil (Aricept)
B) Quetiapine (Seroquel)
C) Valproic acid (Depakote)
D) Escitalopram (Lexapro)

Question 25

The nurse is caring for a patient with moderate Alzheimer disease (AD). The health care provider has ordered memantine (Namenda) for the collaborative treatment of the patient's disease. What is the nurse's best understanding of this medication's action?

A) Protects cells against excess glutamate by partially blocking NMDA c-receptors.
B) Slows the degradation of acetylcholine, thereby increasing concentration of the neurotransmitters in the cerebral cortex.
C) Protects cells against excess NMDA by partially blocking glutamate c-receptors.
D) Slows the degradation of dopamine, thereby increasing concentration of the neurotransmitters in the cerebral cortex.

Question 26

The nurse is caring for a patient with severe dementia. What nursing intervention best promotes orientation to time and space?

A) Provide good lighting, especially on stairs.
B) Acknowledge the patient's feelings.
C) Break instructions into short time frames.
D) Cover mirrors to decrease fear.

Question 27

The nurse is caring for a patient with moderate Alzheimer disease. What nursing intervention best promotes communication?

A) Keep a consistent daily routine.
B) Limit the number of food choices.
C) Give the patient step-by-step instructions.
D) Correct the patient when experiencing a hallucination.

Question 28

The nurse is caring for a patient with moderate Alzheimer disease (AD). The health care provider has ordered donepezil (Aricept) for the collaborative treatment of the patient's disease. What medication teaching will the nurse include to both the patient and patient's family?

A) "The medication should be taken twice daily, once in the morning and once at night."
B) "The dose will be started low and will be gradually increased until the medication is no longer helpful."
C) "The medication should be taken three times daily with every meal."
D) "The dose will be started high and will be gradually decreased to make sure that side effects from the medication are tolerable."