Deck 18: Neurocognitive Disorders

Question 1

A patient experiencing 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

Answer 1

Tactile hallucinations

Question 2

A patient has progressive memory deficit 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) Promote the use of the patient's sense of humor by telling jokes.

Answer 2

Assist the patient to perform simple tasks by giving step-by-step directions.

Question 3

Consider these problems: apolipoprotein E (apoE) malfunction, neuritic plaques, neurofibrillary tangles, granulovascular degeneration, and brain atrophy. Which condition corresponds to this group?

A) Alzheimer disease
B) Wernicke encephalopathy
C) Central anticholinergic syndrome
D) Acquired immunodeficiency syndrome (AIDS)-related dementia

Answer 3

Alzheimer disease

Question 4

An older adult takes digoxin and hydrochlorothiazide daily, as well as lorazepam (Ativan) as needed for anxiety. Over 2 days, this adult 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 disease.

Question 5

A patient diagnosed with Alzheimer disease wanders at night. Which action should the nurse recommend for a family to use in the home to enhance safety?

A) Place throw rugs on tile or wooden floors.
B) Place locks at the tops of doors.
C) Encourage daytime napping.
D) Obtain a bed with side rails.

Question 6

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

A) "There are no bugs on your legs. Your imagination is playing tricks on you."
B) "Try to relax. The crawling sensation will go away sooner if you can relax."
C) "Don't worry. I will have someone stay here and brush off the bugs for you."
D) "I don't see any bugs, but I know you are frightened so I will stay with you."

Question 7

Goals and desired outcomes for an older adult patient experiencing 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 8

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

A) Avoidance of physical contact
B) High level of sensory stimulation
C) Careful observation and supervision
D) Application of wrist and ankle restraints

Question 9

A patient diagnosed with stage 2 moderate Alzheimer disease calls the police saying, "An intruder is in my home." Police investigate and discover the patient misinterpreted a reflection in the mirror as an intruder. This phenomenon can be assessed as:

A) hyperorality.
B) aphasia.
C) apraxia.
D) agnosia.

Question 10

When used for treatment of patients diagnosed with Alzheimer disease, which medication would be expected to antagonize N-methyl-D-aspartate (NMDA) channels rather than cholinesterase?

A) Donepezil (Aricept)
B) Rivastigmine (Exelon)
C) Memantine (Namenda)
D) Galantamine (Razadyne)

Question 11

During morning care, a nursing assistant 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 12

Consider these health problems: Lewy body disease, Pick disease, and Korsakoff syndrome. Which term unifies these problems?

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

Question 13

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) Memory impairment

Question 14

Which description best applies to a hallucination? A 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) becomes anxious when the nurse leaves his or her bedside.
D) tries to hit the nurse when vital signs are taken.

Question 15

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, "I know what you're up to; 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 16

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

A) Place large clocks and calendars on the wall.
B) Place personally meaningful objects in view.
C) Use the patient's glasses and hearing aids.
D) Keep the room brightly lit at all times.

Question 17

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

A) Bathing/hygiene self-care deficit related to altered cerebral function as evidenced by confusion and inability to perform personal hygiene tasks
B) Risk for injury related to altered cerebral function, misperception of the environment, and unsteady gait
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 hiding from imagined ferocious dogs

Question 18

An older adult drove to a nearby store but was unable to remember how to get home or state an address. When police took the person home, the spouse reported frequent wandering into neighbors' homes. Which stage of Alzheimer disease is evident?

A) 1 (mild)
B) 2 (moderate)
C) 3 (moderate to severe)
D) 4 (late)

Question 19

Which environmental adjustment should the nurse make for a patient experiencing delirium with perceptual alterations?

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

Question 20

A patient diagnosed with stage 1 mild Alzheimer 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) Complicated grieving
B) Impaired memory
C) Self-care deficit
D) Caregiver role strain

Question 21

A patient diagnosed with dementia no longer recognizes family members. The family asks how long it will be before their family member 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 22

Which nursing intervention is appropriate to use for patients diagnosed with either delirium or dementia?

A) Speak in a loud, firm voice.
B) Touch the patient before speaking.
C) Reintroduce the health care worker at each contact.
D) When the patient becomes aggressive, use physical restraint instead of medication.

Question 23

A patient diagnosed 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) Strategically place large clocks and calendars.

Question 24

A hospitalized patient experiencing delirium misinterprets reality and a patient diagnosed with dementia wanders about the home. Which outcome is the priority in both scenarios? Each patient will:

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

Question 25

A nurse should anticipate that which symptoms of Alzheimer's disease will become apparent as the disease progresses from Stage 3, moderate to severe to Stage 4, late stage? (Select all that apply.)

A) Agraphia
B) Hyperorality
C) Fine motor tremors
D) Hypermetamorphosis
E) Improvement of memory

Question 26

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

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

Question 27

An older adult diagnosed with moderate-stage Alzheimer disease 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 diapers.
D) Make sure the older adult does not eat nonfood items.

Question 28

A patient diagnosed with moderate to severe Alzheimer disease has a dressing and grooming self-care deficit. Designate the 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, use distraction and then try again after a short interval.

Question 29

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 and time
C) Wandering attention
D) Apathy
E) Agnosia