Deck 28: Cognitive Disorders

Question 1

A nurse assesses a newly admitted patient with possible delirium. Which aspect of the history contributes to confirmation of the diagnosis?

A) Acute onset of cognitive symptoms
B) Unchanging level of consciousness
C) Loss of ability to think abstractly
D) Paranoid delusions

Answer 1

Acute onset of cognitive symptoms

Question 2

Which assessment finding would be expected in a patient in the early stage of HD?

A) Cogwheel rigidity
B) Irritability
C) Apraxia
D) Aphasia

Answer 2

Irritability

Question 3

A patient diagnosed with delirium stares at the corner of the room, wrings hands, and says, "I'm scared those snakes will bite me." The nurse should document:

A) agnosia.
B) disorientation.
C) confabulation.
D) visual hallucinations.

Answer 3

visual hallucinations.

Question 4

An older adult patient diagnosed with delirium is anxious, agitated, and experiencing visual hallucinations. The nurse entering the room to assess vital signs should:

A) announce his or her name and title, and what is happening.
B) silently take the vital signs to minimize stimulation.
C) ask the patient to identify place, person, and time.
D) turn on all lights in the room.

Question 5

The foundation of the cognitive process is:

A) reasoning and logic.
B) memory and learning.
C) orientation and speech.
D) perception and behavior.

Question 6

An older adult with dementia describes a pencil as "that thing that writes" and a water faucet as "the thing you turn." The nurse documents which problem?

A) Echolalia
B) Apraxia
C) Agnosia
D) Amnesia

Question 7

The focus of nursing care for a patient diagnosed with dementia is:

A) individualizing care.
B) improving cognition.
C) maintaining optimum function.
D) promoting self-confidence and self-esteem.

Question 8

A nurse gives anticipatory guidance to the family of a patient diagnosed with mild AD. Which problem common to that stage should be addressed?

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

Question 9

An older adult patient is admitted with a diagnosis of delirium secondary to a urinary tract infection. The family asks whether or not the patient will recover. Select the nurse's best response.

A) "The healthcare provider is the best person to solve 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 10

An older adult patient developed delirium secondary to diphenhydramine (Benadryl) use. The patient usually took this drug for allergies but recently added a cough syrup that also contained the drug. What information is most important to teach the family?

A) Older adults are more prone to delirium.
B) The patient is now susceptible to progressive cognitive decline.
C) Toxic medication levels often occur because of slower metabolism in older adults.
D) The older adult brain has fewer neurotransmitters than the brain of a younger person.

Question 11

Donepezil ( Aricept ) reduces symptoms for patients diagnosed with mild to moderate Alzheimer's disease ( AD ) by:

A) enhancing acetylcholine ( Ach ) function.
B) inhibiting serotonin reuptake.
C) anti-oxidizing free radicals.
D) reducing GABA action.

Question 12

A patient diagnosed with vascular dementia gets more confused, agitated, and anxious in the evening. This behavior represents:

A) sundowning.
B) moonlighting.
C) differentiating.
D) misinterpreting.

Question 13

An older adult suddenly develops urinary incontinence. A family member says the patient "started walking oddly, like stepping on a sticky floor." Which problem would the nurse suspect?

A) Pick's disease
B) Parkinson's disease
C) HD
D) Normal-pressure hydrocephalus (NPH)

Question 14

The family of a patient diagnosed with AD is concerned about the patient's occasional urinary incontinence. The nurse should give which suggestion?

A) Use adult diapers.
B) Put a sign on the bathroom door.
C) Limit fluid intake to 1,000 ml daily.
D) Take the patient to the bathroom every 2 hours.

Question 15

Last year a patient had a subtotal gastrectomy after being diagnosed with stomach cancer. Now the patient says, "I'd rather take vitamin pills than shots." Which information should the nurse provide to this patient?

A) Most patients have difficulty remembering to take the vitamins. Deficits can precipitate a recurrence of the cancer.
B) Injections are needed, because the loss of stomach tissue reduces absorption of vitamin B₁₂.
C) Injections will eventually be replaced with pills, but it is too soon after the gastrectomy.
D) Injections prevent development of NPH and delirium.

Question 16

The nurse teaches a family who provides in-home care for a patient diagnosed with dementia. Which measure to facilitate environmental safety should the nurse include?

A) Install gates at the tops and bottoms of stairs.
B) Store medications in a clearly visible place.
C) Vary the daily schedule to provide variety and stimulation.
D) Include daily activities that call for use of higher cognitive functions.

Question 17

What is the nursing care priority for a patient diagnosed with Stage 7 Alzheimer's disease?

A) Nutrition and hydration
B) Promoting self-care activities
C) Supporting attempts to communicate
D) Preserving problem-solving abilities

Question 18

An older adult patient has fluctuating levels of awareness, anxiety, and appears to be picking things out of the air. The patient says, "I saw my granddaughter standing at the foot of the bed last night." The nurse should suspect:

A) delirium.
B) dementia.
C) schizophrenia.
D) bipolar disorder.

Question 19

An older adult presents with symptoms of delirium. The family says, "Everything was fine until yesterday." The most important assessment information to gather is:

A) a list of medications the patient currently takes.
B) whether or not the patient has experienced any recent losses.
C) whether or not the patient has ingested aged or fermented foods.
D) the patient's recent personality characteristics and changes.

Question 20

Which assessment finding would be expected in a patient in the later stages of Huntington's disease?

A) Jerking movements
B) Cogwheel rigidity
C) Withdrawal
D) Irritability

Question 21

A patient with vascular dementia does not remember family members' names. The family insistently reorients the patient, and the patient becomes more agitated. What is the most likely reason for the patient's reaction? The patient is:

A) using agitation to distract the family from the cognitive deficits.
B) overstimulated by the reorientation and reacting negatively.
C) reliving family chaos that was previously unresolved.
D) experiencing guilt about the memory deficits.

Question 22

A patient diagnosed with dementia is watching a crime story on television. Suddenly, the patient begins to yell, "Stop! He's got a gun." What is the nurse's best intervention?

A) Administer a PRN dose of an atypical antipsychotic medication.
B) Turn off the television and tell the patient, "You are safe."
C) Reassure the patient that there are no guns nearby.
D) Provide a snack, and put the patient in bed.

Question 23

A patient has coronary artery disease, type 2 diabetes, and hypertension. The patient has risk factors for:

A) vascular dementia.
B) Parkinson's dementia.
C) diffuse Lewy body disease.
D) frontotemporal lobe dementia.

Question 24

Which vector is associated with transmission of variant Creutzfeldt-Jakob disease?

A) Dog ticks
B) Mosquito bites
C) Airborne particles
D) Contaminated meat

Question 25

Which aspects of assessment are most important for a patient with diffuse Lewy body disease who is agitated? Select all that apply.

A) Medications recently administered
B) Objective signs of pain
C) Sleep disturbances
D) Urinary output
E) Heart sounds

Question 26

A newly admitted patient diagnosed with AD has demonstrated apraxia. The nurse should assist the patient with:

A) grooming and hygiene.
B) visual acuity.
C) word finding.
D) orientation.