Question 1

Which statement accurately differentiates mild NCD from major NCD?

Accepted Answer

Rationale: The progression of the disorder is not a criterion for determining the severity of an NCD.Abstract thinking and judgment can be affected in both mild NCD and major NCD.Major NCD criteria requires substantial cognitive decline,and mild NCD requires modest decline.Both major and mild NCD classifications require decline from a previous level of performance in only one of the listed domains.

Question 2

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

Accepted Answer

Rationale: The most appropriate intervention in the seventh stage of AD is to promote the client's dignity by providing comfort,safety,and self-care measures.Stage is characterized by severe cognitive decline in which the client is unable to recognize family members and is most commonly bedfast and aphasic.

Question 3

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

Accepted Answer

Rationale: The proliferation of NCD has occurred because more people now survive into the high-risk period for neurocognitive disorder,which is middle age and beyond..

Question 4

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?

Accepted Answer

Rationale: The nurse should expect the physician to prescribe sertraline to improve the client's social functioning and concentration levels.Sertraline is an selective serotonin reuptake inhibitor (SSRI)antidepressant.Depression is the most common mental illness in older adults and is often misdiagnosed as a neurocognitive disorder.

Question 5

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?

Accepted Answer

Rationale: The priority nursing action is to first medicate the client to avoid injury to self or others.It is important to assess environmental triggers and potential unmet needs in order to address these problems in the future,but interventions to ensure safety must take priority.Because of the cognitive decline experienced in clients diagnosed with this disorder,communication skills and orientation may limit assessment and teaching interventions.

Question 6

Which of the following conditions have been known to precipitate delirium in some individuals? (Select all that apply.)

Accepted Answer

Rationale: Delirium most commonly occurs in individuals with serious medical,surgical,or neurological conditions.Some examples of conditions that have been known to precipitate delirium in some individuals include the following: systemic infections; febrile illness; metabolic disorders,such as hypoxia,hypercarbia,or hypoglycemia; hepatic encephalopathy; head trauma; seizures; migraine headaches; brain abscess; stroke; postoperative states; and electrolyte imbalance.A herniated brain stem would most likely result in death,not delirium.Temporomandibular joint syndrome is marked by limited movement of the joint during chewing,not delirium.

Question 7

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

Accepted Answer

Rationale: The priority nursing diagnosis for this client is risk for injury.The client who is ataxic suffers from motor coordination deficits and is at an increased risk for falls.Clients that wander are at a higher risk for injury.

Question 8

Which statement accurately differentiates NCD from pseudodementia (depression)?

Accepted Answer

Rationale: NCD has a slow progression of symptoms,whereas pseudodementia has a rapid progression of symptoms.NCD symptoms include disorientation to time and place,and pseudodementia does not.NCD symptoms' severity worsens as the day progresses,whereas in pseudodementia,symptoms improve as the day progresses.In NCD the appetite remains unchanged.whereas in pseudodementia,the appetite diminishes.

Question 9

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?

Accepted Answer

Rationale: The nurse should recognize that AD does not develop suddenly and should question this diagnosis.The onset of AD symptoms is slow and insidious.The disease is generally progressive and deteriorating.

Question 10

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?

Accepted Answer

Rationale: The most appropriate response by the nurse is to explain that donepezil 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 AD.Some side effects include dizziness,headache,gastrointestinal upset,and elevated transaminase.

Question 11

A husband has agreed to admit his spouse,diagnosed with Alzheimer's disease (AD),to a long-term care facility.He is expressing feelings of guilt and symptoms of depression.Which appropriate nursing diagnosis and subsequent intervention would the nurse document?

Accepted Answer

Rationale: The most appropriate nursing diagnosis and intervention for the husband is dysfunctional grieving; AD support group.Clients with AD are often at risk for trauma and have significant self-care deficits that require more care than a spouse may be able to provide.

Question 12

Which of the following medications that have been known to precipitate delirium? (Select all that apply.)

Accepted Answer

Rationale: Medications that have been known to precipitate delirium include anticholinergics,antihypertensives,corticosteroids,anticonvulsants,cardiac glycosides,analgesics,anesthetics,antineoplastic agents,antiparkinson drugs,H₂-receptor antagonists (e.g.,cimetidine),and others.There have been no reports of delirium ascribed to the use of lipid-lowering agents.

Question 13

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?

Accepted Answer

Rationale: The priority nursing intervention for this client is to assist with bathing and toileting.A client who is incapable of performing activities of daily living requires assistance in these areas to ensure health and safety.

Question 14

A client diagnosed with 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?

Accepted Answer

Rationale: The nurse should recognize that a client exhibiting these symptoms is in the severe cognitive decline,seventh stage,of AD.

Question 15

Major NCD constitutes what was previously described as _______________________ in the DSM-5-TR.

Accepted Answer

Rationale: NCD is classified in the DSM-5 as either mild or major,with the distinction primarily being one of severity of symptomatology.Major NCD constitutes what was previously described as dementia in the DSM-5-TR.

Question 16

A client with a history of cerebrovascular accident (CVA)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?

Accepted Answer

Rationale: The nurse should expect that the client will be diagnosed with vascular NCD,which is caused by significant cerebrovascular disease.Vascular NCD often has an abrupt onset.Progression of this disease often occurs in a fluctuating pattern.

Question 17

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

Accepted Answer

Rationale: The most appropriate nursing intervention for this client is to schedule structured daily routines.A structured routine will reduce frustration and thereby reduce verbal aggression.

Question 18

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?

Accepted Answer

Rationale: The nurse should question the client's safety at home if the client smokes cigarettes.Vascular NCD is a clinical syndrome of NCD due to significant cerebrovascular disease.The cause of vascular NCD is related to an interruption of blood flow to the brain.Hypertension is a significant factor in the etiology.

Question 19

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

Accepted Answer

Rationale: The nurse should identify that taking multiple medications that may lead to adverse reactions or toxicity is a risk factor for the development of delirium in older adults.Symptoms of delirium include difficulty sustaining and shifting attention.The client with delirium is disoriented to time and place and may also have impaired memory.

Question 20

Which symptom should a nurse identify that differentiates clients diagnosed with NCDs from clients diagnosed with mood disorders?

Accepted Answer

Rationale: The nurse should identify that impaired memory is a symptom that occurs in NCD and not in mood disorders.Neurocognitive disorder is classified in the DSM-5 as either mild or major,with the distinction primarily being one of severity of symptomatology.

Quiz 13: Neurocognitive Disorders