Deck 21: Cognitive Impairment

Question 1

Cerebrovascular disease is manifested as either a stroke (ischemic or hemorrhagic) or a transient ischemic attack (TIA). Mr. Dickson, 75 years of age, has been admitted to the hospital with an ischemic stroke. Which of the following would be an expected finding in an older adult with an ischemic stroke?

A) A sudden explosive, unrelenting headache
B) Decreased level of consciousness
C) Sudden weakness or numbness on one side of the body
D) A seizure lasting one to two minutes

Answer 1

Sudden weakness or numbness on one side of the body

Question 2

An older male adult comes to the emergency department after falling at home. He reports that he cannot walk without losing his balance, and his speech is somewhat slurred. Which one of the following steps should the nurse implement for this patient?

A) Arrange to transfer him to radiology immediately.
B) Determine symptom onset or when he fell at home.
C) Organize the tissue plasminogen activator (tPA) infusion.
D) Perform a comprehensive neurological assessment.

Answer 2

Determine symptom onset or when he fell at home.

Question 3

Confirming a diagnosis of Alzheimer's disease in an older adult can be achieved by detecting or utilizing which of the following tests or assessments?

A) Clinical observation of dementia and delirium in the older adult
B) Observing the inability of the older adult to speak with relevance and fluency
C) Neurofibrillary tangles and beta amyloid plaques observed during autopsy
D) Computed axial tomographic scan (CT scan)

Answer 3

Neurofibrillary tangles and beta amyloid plaques observed during autopsy

Question 4

Pharmacological interventions should not replace thoughtful and careful evaluation and management of the underlying causes of delirium. Which medication administered for delirium in a controlled environment can reduce the duration and severity of delirium for high-risk patients?

A) Haloperidol (Haldol)
B) Thioridazine (Mellaril)
C) Fluphenazine (Prolixin)
D) Chlorpromazine (Thorazine)

Question 5

At ten P.M., an older male resident is attempting to climb over the bedrails. Which intervention should the nurse implement first?

A) Gently question the resident about his behaviour.
B) Call the physician and ask for sedation.
C) Apply a vest restraint to the resident.
D) Get a companion to keep the older adult in the bed.

Question 6

An older female adult is recovering in the intensive care unit from a bowel resection, but remains intubated and on a mechanical ventilator. Using the Hospital Elder Life Program (HELP), what should the nurse implement to help prevent delirium in this older adult?

A) Assess cognition with Mini-Mental State Exam.
B) Provide uninterrupted periods of rest and sleep.
C) Maintain adequate sedation and pain management.
D) Cover her eyes with protective ophthalmic ointment.

Question 7

Which of the following is a beneficial approach to hygienic care for an older adult with dementia?

A) Schedule the older adult's full shower at seven A.M. for three mornings every week.
B) Have a team give the older adult a bath together, with each member washing a different body area.
C) Wash the older adult's perineal region first, to remove potentially infectious material.
D) Explain each step as you go, and keep the older adult patient covered as much as possible while bathing.

Question 8

An older female adult has a wound infection five days after having undergone a below-the-knee amputation brought about by diabetes mellitus. What is the nurse's priority intervention to prevent cognitive dysfunction and postoperative complications in this older adult?

A) Remove invasive devices as soon as possible.
B) Minimize administration of opioid analgesics.
C) Allow for self-care and independent activities.
D) Administer short-acting benzodiazepines as needed (PRN).

Question 9

Which assessment parameter should the nurse avoid using to differentiate between delirium and depression in an older adult?

A) Orientation of the older adult
B) Level of consciousness in the older adult
C) Course of behaviour of the older adult over 24 hours
D) Psychomotor activity of the older adult

Question 10

Classic signs of Parkinson's disease (PD) in an older adult include tremors at rest, rigidity (stiff muscles), akinesia (poverty of movement), and postural abnormalities. Which of the following is the most conspicuous sign of PD?

A) T
B) R
C) A
D) P

Question 11

Which type of exercise program is better for improving mood and function in older adults with Alzheimer's disease (AD)?

A) A program that helps to improve balance
B) A program that emphasizes walking
C) A self-paced exercise program
D) A program that emphasizes wandering