Question 1

While a 78-year-old client was admitted dehydration and anorexia, the nurse assesses and documents observations that support dementia in this age cohort that includes which of the following? Select all that apply.
A)Forgetting what she ate for lunch today
B)Crying frequently when alone
C)Inability to find her way back to her room from the dayroom
D)Being impatient with the nursing staff for not closing her door
E)Repeatedly asking to call her son

Accepted Answer

Symptoms common to both depression and dementia include irritability, inability to concentrate or feel pleasure, loss of interest in life, and lack of energy and initiative. Individuals with dementia are more likely to show signs of disorientation and loss of short-term memory and are less likely to feel sadness or guilt or to complain about pain, insomnia, and poor appetite.

Question 2

When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to:
A)place printed labels on important items, such as the telephone.
B)place a clock and calendar in the client's immediate environment.
C)use hand gestures instead of verbal communications to demonstrate meaning.
D)show him a picture of a toothbrush when it time for oral hygiene.

Accepted Answer

Reality orientation supports failing memory in early stages of dementia and preserves independent functioning for a longer duration. Although written messages and signs may become meaningless to individuals with advancing dementia, pictures often evoke a response.

Question 3

The son of a 78-year-old suspected of experiencing Alzheimer's disease ( AD ) asks the nurse if there is a diagnostic test that can confirm the diagnosis.The nurse responds that:
A)an electroencephalogram is often very useful in diagnosing AD.
B)a positron emission tomography ( PET ) scan is a cheap but dependable tool.
C)magnetic resonance imaging ( MRI ) is often ordered for that purpose.
D)postmortem autopsy is the only definitive diagnostic tool.

Accepted Answer

Autopsy remains the gold standard for the diagnosis of AD.

Question 4

When assessing an older client displaying symptoms reflective of delirium, the nurse focuses the assessment on:
A)the degree and duration of the symptoms.
B)the amount of self-care deficiency the symptoms cause.
C)identifying processes that commonly result in the symptoms.
D)physiological dysfunction resulting from the symptoms.

Accepted Answer

The treatment of delirium entails the identification and treatment of the underlying cause.

Question 5

An older adult who is experiencing age-related postural hypotension shares with the nurse that he fears "something is really wrong" because he is the only one in his social group experiencing the problems.The nurse responds:
A)"Don't be concerned; just be very careful about your risk for falling."
B)"Your doctor has been very thorough testing you for the common causes of such dizziness so don't worry about it being serious."
C)"It's just a matter of time before they too have to watch not to get up too quickly."
D)"While your dizziness appears to be age-related, the compensating mechanisms of your friends may be the reason they don't have the problem."

Accepted Answer

The age-related symptoms of postural hypotension are dizziness or lightheadedness when changing positions rapidly. However, compensatory processes in the cortex and subcortical areas of the brain help aging individuals maintain relatively normal motor performance.

Question 6

The nurse caring for an older adult client admitted to the hospital documents that the client is at risk for developing delirium when it is determined that he (select all that apply):
A)is receiving medications to manage several chronic illnesses.
B)has a history of urinary tract infections.
C)is in cancer remission.
D)has recently been eating poorly.
E)experienced a mild heart attack 2 years ago.

Accepted Answer

The risk factors for delirium include advanced age, CNS diseases, infection, polypharmacy, hypoalbuminemia, electrolyte imbalances, trauma history, gastrointestinal or genitourinary disorders, cardiopulmonary disorders, and sensory changes. These factors can lead to physiologic imbalances increasing the risk for confusion.

Question 7

The nurse educates the older client on the possible risks for injury related to the common age-related changes to the senses by stressing the importance of:
A)installing auditory smoke alarms.
B)having regular eye checkups.
C)being aware that hearing acuity decreases with age.
D)checking the expiration dates on foods such as dairy.

Accepted Answer

Aging adults are also less likely to detect the bad taste smells. Their reduced ability to smell makes them unable to rapidly detect smoke, gas leaks, or other toxic fumes.

Question 8

An 80-year-old client exhibiting signs of dementia representative of Alzheimer's disease ( AD ).The nurse supports that possibility when determining that the client:
A)experienced a gastric resection several years ago.
B)traveled often to third world countries.
C)was employed as a steelworker for 40 years.
D)has a history of viral encephalitis.

Accepted Answer

Viral illness such as herpes zoster, herpes simplex, or viral encephalitis is believed to be a possible risk factor for AD.

Question 9

A home care nurse is visiting an 88-year-old client who has moderate cognitive impairment resulting from Alzheimer's disease.His partner expresses concern that he is experiencing difficulty getting the client "to eat properly." The nurse suggests which of the following? Select all that apply.
A)Serving meals at the same time each day
B)Offering liquids in place of solid foods when possible
C)Offering a calorie-dense snack at bedtime
D)Cutting food into bite size pieces he can hold in his hand
E)Asking him to identify his favorite foods

Accepted Answer

It is important to support the ongoing nutrition of individuals with dementia because they may experience decreased hunger and ability to taste food. People who demonstrate symptoms of moderate to severe cognitive impairment may benefit from having meals in the same place at the same time each day. Small, frequent, nutritionally dense meals and snacks should be provided. During later stages of dementia, individuals may need to be reminded to open the mouth and chew. Food should be soft and cut in small pieces.

Question 10

The nurse is conducting an admission assessment on a mildly confused older client.The nurse best assures an accurate history by first:
A)scoring the client's cognitive responses using the Dementia Rating Scale (DRS).
B)focusing on the client to respond.
C)directing the questions to both client and family.
D)asking permission to arrange for a Mini-Mental State Examination (MMSE) .

Accepted Answer

An interview with the friend or family member is an appropriate method to first implement when a client is exhibiting confused behavior.

Question 11

A 73-year-old client diagnosed with vascular dementia is admitted for exacerbation of asthma.The nursing history determines that has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior.The nurse's initial responds is to:
A)identify the client as being at high risk for falls.
B)monitor the client for signs of benzodiazepine withdrawal.
C)notify the admitting physician immediately.
D)place the client on strict intake and output.

Accepted Answer

Benzodiazepines should be reserved for acute situations and not used for the long-term management of troubling behaviors.

Question 12

Which of the following statements, when made by family members caring for an older client with dementia, indicates peaceful acceptance of the situation?
A)"I'm so pleased that Mother had a good day today. I'm really very hopeful."
B)"The hospice nurses are so helpful when I needed time for myself."
C)"I promised Mother I would take care of her and I'll never leave her."
D)"It's the least I can do for Mother since she cared for us all these years."

Accepted Answer

Adjusting to the fact that dementia is irreversible and prolonged places families in situations of dealing with grief over a long period. Nurses need to encourage caregivers to take time out from their task and participate in self-care and health promotion activities.

Question 13

A nurse caring for an older client diagnosed with acute depression shows an understanding of the client's risk for developing delirium when:
A)frequently reorienting the client to the day, time and place.
B)physically being present to help the client with eating meals.
C)providing the client with opportunities to discuss the cause of the depression.
D)administering antidepressive medication as prescribed.

Accepted Answer

Depressed older adults may neglect eating or caring for a chronic medical condition, predisposing them to the development of delirium.

Question 14

An 89-year-old diagnosed with dementia was until recently responding well to cognitive cueing techniques.The nurse shows an understanding of dementia when sharing with staff that:
A)"We will implement new interventions that address the disease's progression."
B)"It's important that we frequently re-cue the client to improve his quality of life."
C)"The client's family needs to be made aware of this decline."
D)"This poor response to cueing is likely a result of advanced aging."

Accepted Answer

Positive responses to selected interventions may continue for a time but may decline as the disease progresses, which results in the need to reevaluate strategies.

Quiz 29: Cognitive and Neurologic Function

While a 78-year-old client was admitted dehydration and anorexia, the nurse assesses and documents observations that support dementia in this age cohort that includes which of the following? Select all that apply.

When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to:

The son of a 78-year-old suspected of experiencing Alzheimer's disease ( AD ) asks the nurse if there is a diagnostic test that can confirm the diagnosis.The nurse responds that:

When assessing an older client displaying symptoms reflective of delirium, the nurse focuses the assessment on:

An older adult who is experiencing age-related postural hypotension shares with the nurse that he fears "something is really wrong" because he is the only one in his social group experiencing the problems.The nurse responds:

The nurse caring for an older adult client admitted to the hospital documents that the client is at risk for developing delirium when it is determined that he (select all that apply) :

The nurse educates the older client on the possible risks for injury related to the common age-related changes to the senses by stressing the importance of:

An 80-year-old client exhibiting signs of dementia representative of Alzheimer's disease ( AD ) .The nurse supports that possibility when determining that the client:

A home care nurse is visiting an 88-year-old client who has moderate cognitive impairment resulting from Alzheimer's disease.His partner expresses concern that he is experiencing difficulty getting the client "to eat properly." The nurse suggests which of the following? Select all that apply.

The nurse is conducting an admission assessment on a mildly confused older client.The nurse best assures an accurate history by first:

A 73-year-old client diagnosed with vascular dementia is admitted for exacerbation of asthma.The nursing history determines that has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior.The nurse's initial responds is to:

Which of the following statements, when made by family members caring for an older client with dementia, indicates peaceful acceptance of the situation?

A nurse caring for an older client diagnosed with acute depression shows an understanding of the client's risk for developing delirium when:

An 89-year-old diagnosed with dementia was until recently responding well to cognitive cueing techniques.The nurse shows an understanding of dementia when sharing with staff that: