Deck 13: Neurocognitive Disorders

Question 1

A client diagnosed recently with AD is prescribed donepezil (Aricept). The client's spouse inquires, "How does this work? Will this cure him?" Which is the appropriate nursing response?

A) "This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease."
B) "This medication encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease."
C) "This medication delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease."
D) "This medication encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease."

Answer 1

"This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease."

Question 2

Major NCD constitutes what was previously described as _______________________ in the DSM-IV-TR.

Answer 2

dementia

Question 3

A client diagnosed with AD has impairments of memory and judgment and is incapable of performing activities of daily living. Which nursing intervention should take priority?

A) Present evidence of objective reality to improve cognition.
B) Design a bulletin board to represent the current season.
C) Label the client's room with name and number.
D) Assist with bathing and toileting.

Answer 3

Assist with bathing and toileting.

Question 4

Which of the following medications that have been known to precipitate delirium?

A) Antineoplastic agents
B) H₂-receptor antagonists
C) Antihypertensives
D) Corticosteroids
E) Lipid-lowering agents

Question 5

Which statement accurately differentiates NCD from pseudodementia (depression)?

A) NCD has a rapid onset, whereas pseudodementia does not.
B) NCD symptoms include disorientation to time and place, and pseudodementia does not.
C) NCD symptoms improve as the day progresses, but symptoms of pseudodementia worsen.
D) NCD causes decreased appetite, whereas pseudodementia does not.

Question 6

A client diagnosed with AD exhibits progressive memory loss, diminished cognitive functioning, and verbal aggression upon experiencing frustration. Which nursing intervention is most appropriate?

A) Organize a group activity to present reality.
B) Minimize environmental lighting.
C) Schedule structured daily routines.
D) Explain the consequences for aggressive behaviors.

Question 7

A geriatric nurse is teaching the client's family about the possible cause of delirium. Which statement by the nurse is most accurate?

A) "Taking multiple medications may lead to adverse interactions or toxicity."
B) "Age-related cognitive changes may lead to alterations in mental status."
C) "Lack of rigorous exercise may lead to decreased cerebral blood flow."
D) "Decreased social interaction may lead to profound isolation and psychosis."

Question 8

An older client has recently moved to a nursing home. The client has trouble concentrating and socially isolates. A physician believes the client would benefit from medication therapy. Which medication should the nurse expect the physician to prescribe?

A) Haloperidol (Haldol)
B) Donepezil (Aricept)
C) Diazepam (Valium)
D) Sertraline (Zoloft)

Question 9

A client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his wife. Which information should cause the nurse to question the client's safety?

A) His wife works from home in telecommunication.
B) The client has worked the nightshift his entire career.
C) His wife has minimal family support.
D) The client smokes one pack of cigarettes per day.

Question 10

A client diagnosed with NCD is disoriented, ataxic and wanders. Which is the priority nursing diagnosis?

A) Disturbed thought processes
B) Self-care deficit
C) Risk for trauma
D) Altered health-care maintenance

Question 11

A client diagnosed with major NCD is exhibiting behavioral problems on a daily basis. At change of shift, the client's behavior escalates from pacing to screaming and flailing. Which action should be a nursing priority?

A) Consult the psychologist regarding behavior-modification techniques.
B) Medicate the client with prn antianxiety medications.
C) Assess environmental triggers and potential unmet needs.
D) Anticipate the behavior and restrain when pacing begins.

Question 12

After one week of continuous mental confusion, an older African American client is admitted with a preliminary diagnosis of AD. What should cause the nurse to question this diagnosis?

A) AD does not typically occur in African American clients.
B) The symptoms presented are more indicative of Parkinsonism.
C) AD does not develop suddenly.
D) There has been no T3- or T4-level evaluation ordered.

Question 13

A client diagnosed with Alzheimer's disease (AD) can no longer ambulate, does not recognize family members, and communicates with agitated behaviors and incoherent verbalizations. The nurse recognizes these symptoms as indicative of which stage of the illness?

A) Stage 4: Mild-to-Moderate Cognitive Decline
B) Stage 5: Moderate Cognitive Decline
C) Stage 6: Moderate-to-Severe Cognitive Decline
D) Stage 7: Severe Cognitive Decline

Question 14

Which is the reason for the proliferation of the diagnosis of NCDs?

A) Increased numbers of neurotransmitters have been implicated in the proliferation of NCD.
B) Similar symptoms of NCD and depression lead to misdiagnoses, increasing numbers of NCD.
C) Societal stress contributes to the increase in this diagnosis.
D) More people now survive into the high-risk period for neurocognitive disorders.

Question 15

A client is diagnosed in stage 7 of AD. To address the client's symptoms, which nursing intervention should take priority?

A) Improve cognitive status by encouraging involvement in social activities.
B) Decrease social isolation by providing group therapies.
C) Promote dignity by providing comfort, safety, and self-care measures.
D) Facilitate communication by providing assistive devices.

Question 16

A client with a history of cerebrovascular accident is brought to an emergency department experiencing memory problems, confusion, and disorientation. Based on this client's assessment data, which diagnosis would the nurse expect the physician to assign?

A) Delirium due to adverse effects of cardiac medications
B) Vascular neurocognitive disorder
C) Altered thought processes
D) Alzheimer's disease

Question 17

Which statement accurately differentiates mild NCD from major NCD?

A) Major NCD involves disorientation that develops suddenly, whereas mild NCD develops more slowly.
B) Major NCD involves impairment of abstract thinking and judgment, whereas mild NCD does not.
C) Major NCD criteria requires substantial cognitive decline from a previous level of performance, and mild NCD requires modest decline.
D) Major NCD criteria requires decline from a previous level of performance in three of the listed domains, and mild NCD requires only one.

Question 18

Which of the following conditions have been known to precipitate delirium in some individuals?

A) Febrile illness
B) Seizures
C) Migraine headaches
D) Herniated brain stem
E) Temporomandibular joint syndrome