Deck 23: Neurocognitive Disorders

Question 1

What is the priority intervention for a patient diagnosed with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations?

A) Distraction using sensory stimulation
B) Careful observation and supervision
C) Avoidance of physical contact
D) Activation of the bed alarm

Answer 1

Careful observation and supervision

Question 2

Consider these phenomena: accumulation of b-amyloid outside the neurons, neurofibrillary tangles, and neuronal degeneration in the hippocampus. Which health problem corresponds to these events?

A) Huntington's disease
B) Alzheimer's disease
C) Parkinson's disease
D) Vascular dementia

Answer 2

Alzheimer's disease

Question 3

An older adult was stopped by police for driving through a red light. When asked for a driver's license, the adult hands the police officer a pair of sunglasses. What sign of dementia is evident?

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

Answer 3

Agnosia

Question 4

A patient diagnosed with delirium is experiencing perceptual alterations. Which environmental adjustment should the nurse make for this patient?

A) Provide a well-lit room without glare or shadows. Limit noise and stimulation.
B) Maintain soft lighting day and night. Keep a radio on low volume continuously.
C) Light the room brightly day and night. Awaken the patient hourly to assess mental status.
D) Keep the patient by the nurse's desk while awake. Provide rest periods in a room with a television on.

Question 5

An older adult patient takes multiple medications daily. Over 2 days, the patient developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of

A) delirium.
B) dementia.
C) amnestic syndrome.
D) Alzheimer's disease.

Question 6

An older adult drove to a nearby store but was unable to remember how to get home or state an address. When police intervened, they found that this adult was wearing a heavy coat and hat, even though it was July. Which stage of Alzheimer's disease is evident?

A) Sundowning
B) Early
C) Middle
D) Late

Question 7

During morning care, a nurse asks a patient diagnosed with dementia, "How was your night?" The patient replies, "It was lovely. I went out to dinner and a movie with my friend." Which term applies to the patient's response?

A) Sundown syndrome
B) Confabulation
C) Perseveration
D) Delirium

Question 8

Two patients in a residential care facility are diagnosed with dementia. One shouts to the other, "Move along, you're blocking the road." The other patient turns, shakes a fist, and shouts, "You're trying to steal my car." What is the nurse's best action?

A) Administer one dose of an antipsychotic medication to both patients.
B) Reinforce reality. Say to the patients, "Walk along in the hall. This is not a traffic intersection."
C) Separate and distract the patients. Take one to the day room and the other to an activities area.
D) Step between the two patients and say, "Please quiet down. We do not allow violence here."

Question 9

A patient with fluctuating levels of awareness, confusion, and disturbed orientation shouts, "Bugs are crawling on my legs. Get them off!" Which problem is the patient experiencing?

A) Aphasia
B) Dystonia
C) Tactile hallucinations
D) Mnemonic disturbance

Question 10

A patient diagnosed with Alzheimer's disease calls the fire department saying, "My smoke detectors are going off." Firefighters investigate and discover that the patient misinterpreted the telephone ringing. Which problem is this patient experiencing?

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

Question 11

A nurse counsels the family of a patient diagnosed with Alzheimer's disease who lives at home and wanders at night. Which action is most important for the nurse to recommend for enhancing safety?

A) Apply a medical alert bracelet to the patient.
B) Place locks at the tops of doors.
C) Discourage daytime napping.
D) Obtain a bed with side rails.

Question 12

A patient with fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, "Someone get these bugs off me." What is the nurse's best response?

A) "No bugs are on your legs. You are having hallucinations."
B) "I will have someone stay here and brush off the bugs for you."
C) "Try to relax. The crawling sensation will go away sooner if you can relax."
D) "I don't see any bugs, but I can tell you are frightened. I will stay with you."

Question 13

Goals of care for an older adult patient diagnosed with delirium caused by fever and dehydration will focus on

A) returning to premorbid levels of function.
B) identifying stressors negatively affecting self.
C) demonstrating motor responses to noxious stimuli.
D) exerting control over responses to perceptual distortions.

Question 14

What is the priority nursing diagnosis for a patient with fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations?

A) Risk for injury related to altered cerebral function, fluctuating levels of consciousness, disturbed orientation, and misperception of the environment
B) Bathing/hygiene self-care deficit related to cerebral dysfunction, as evidenced by confusion and inability to perform personal hygiene tasks
C) Disturbed thought processes related to medication intoxication, as evidenced by confusion, disorientation, and hallucinations
D) Fear related to sensory perceptual alterations as evidenced by visual and tactile hallucinations

Question 15

Which assessment finding would be likely for a patient experiencing a hallucination? The patient

A) looks at shadows on a wall and says, "I see scary faces."
B) states, "I feel bugs crawling on my legs and biting me."
C) reports telepathic messages from the television.
D) speaks in rhymes.

Question 16

Which medication prescribed to patients diagnosed with Alzheimer's disease antagonizes N-methyl-D-aspartate (NMDA) channels rather than cholinesterase?

A) Donepezil
B) Rivastigmine
C) Memantine
D) Galantamine

Question 17

Consider these cerebral pathophysiologies: Lewy body development, frontotemporal degeneration, and accumulation of protein b-amyloid. Which diagnosis applies?

A) Cyclothymia
B) Dementia
C) Delirium
D) Amnesia

Question 18

A patient diagnosed as mild stage Alzheimer's disease tires easily and prefers to stay home rather than attend social activities. The spouse does the grocery shopping because the patient cannot remember what to buy. Which nursing diagnosis applies at this time?

A) Self-care deficit
B) Impaired memory
C) Caregiver role strain
D) Adult failure to thrive

Question 19

A patient has progressive memory deficits associated with dementia. Which nursing intervention would best help the individual function in the environment?

A) Assist the patient to perform simple tasks by giving step-by-step directions.
B) Reduce frustration by performing activities of daily living for the patient.
C) Stimulate intellectual function by discussing new topics with the patient.
D) Read one story from the newspaper to the patient every day.

Question 20

An older adult patient in the intensive care unit is experiencing visual illusions. Which intervention will be most helpful?

A) Use the patient's glasses.
B) Place personally meaningful objects in view.
C) Position large clocks and calendars on the wall.
D) Assure that the room is brightly lit but very quiet at all times.

Question 21

Which assessment findings would the nurse expect in a patient experiencing delirium? (Select all that apply.)

A) Impaired level of consciousness
B) Disorientation to place, time
C) Wandering attention
D) Apathy
E) Agnosia

Question 22

An older adult is prescribed digoxin and hydrochlorothiazide daily as well as lorazepam as needed for anxiety. Over 2 days, the patient developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. What is the most likely reason for the patient's change in mental status?

A) Drug actions and interactions
B) Benzodiazepine withdrawal
C) Hypotensive episodes
D) Renal failure

Question 23

An older adult with moderately severe dementia forgets where the bathroom is and has episodes of incontinence. Which intervention should the nurse suggest to the patient's family?

A) Label the bathroom door.
B) Take the older adult to the bathroom hourly.
C) Place the older adult in disposable adult briefs.
D) Limit the intake of oral fluids to 1000 mL/day.

Question 24

A older patient diagnosed with severe, late-stage dementia no longer recognizes family members. The family asks how long it will be before this patient recognizes them when they visit. What is the nurse's best reply?

A) "Your family member will never again be able to identify you."
B) "I think that is a question the health care provider should answer."
C) "One never knows. Consciousness fluctuates in persons with dementia."
D) "It is disappointing when someone you love no longer recognizes you."

Question 25

A patient with severe dementia no longer recognizes family members and becomes anxious and agitated when they attempt reorientation. Which alternative could the nurse suggest to the family members?

A) Wear large name tags.
B) Focus interaction on familiar topics.
C) Frequently repeat the reorientation strategies.
D) Place large clocks and calendars strategically.

Question 26

An elderly patient is admitted with delirium secondary to a urinary tract infection. The family asks whether the patient will ever recover. Select the nurse's best response.

A) "The health care provider is the best person to answer your question."
B) "The confusion will probably get better as we treat the infection."
C) "Unfortunately, delirium is a progressively disabling disorder."
D) "I will be glad to contact the chaplain to talk with you."

Question 27

Which nursing diagnoses are most applicable for a patient diagnosed with severe late stage Alzheimer's disease? (Select all that apply.)

A) Acute confusion
B) Anticipatory grieving
C) Urinary incontinence
D) Disturbed sleep pattern
E) Risk for caregiver role strain

Question 28

A hospitalized patient diagnosed with delirium misinterprets reality. A patient diagnosed with dementia wanders about the home. Which outcome is the priority in both scenarios? The patients will

A) remain safe in the environment.
B) participate actively in self-care.
C) communicate verbally.
D) acknowledge reality.

Question 29

What is the priority need for a patient diagnosed with severe, late-stage dementia?

A) Promotion of self-care activities
B) Meaningful verbal communication
C) Preventing the patient from wandering
D) Maintenance of nutrition and hydration

Question 30

An elderly person presents with symptoms of delirium. The family reports, "Everything was fine until yesterday." What is the most important assessment information for the nurse to gather?

A) A list of all medications the person currently takes
B) Whether the person has experienced any recent losses
C) Whether the person has ingested aged or fermented foods
D) The person's recent personality characteristics and changes

Question 31

A nurse gives anticipatory guidance to the family of a patient diagnosed with mild early stage Alzheimer's disease. Which problem common to that stage should the nurse address?

A) Violent outbursts
B) Emotional disinhibition
C) Communication deficits
D) Inability to feed or bathe self

Question 32

A patient diagnosed with moderate stage Alzheimer's disease has a self-care deficit of dressing and grooming. Designate appropriate interventions to include in the patient's plan of care. (Select all that apply.)

A) Provide clothing with elastic and hook-and-loop closures.
B) Label clothing with the patient's name and name of the item.
C) Administer antianxiety medication before bathing and dressing.
D) Provide necessary items and direct the patient to proceed independently.
E) If the patient resists dressing, use distraction and try again after a short interval.