Deck 17: Cognitive Disorders

Question 1

A patient with stage 1 Alzheimer's disease complains of low energy.She prefers to remain at home rather than attend club meetings and church.Her husband has been doing the grocery shopping because his wife cannot remember what to purchase and is unable to find her way around the store unassisted.Which nursing diagnosis would be most appropriate for this patient?

A) Risk for injury
B) Impaired memory
C) Self-care deficit
D) Caregiver role strain

Answer 1

Impaired memory

Question 2

During morning care,the nursing assistant asks a patient with dementia,"How was your night?" The patient replies,"It was lovely.My husband and I went out to dinner and to a movie." The nurse who overhears this should make the assessment that the patient is:

A) demonstrating a sense of humor.
B) using confabulation.
C) perseverating.
D) delirious.

Answer 2

using confabulation.

Question 3

A patient in a dimly lit room demonstrates fluctuating levels of consciousness,disturbed orientation,and perceptual alterations and begs the nurse to get the bugs off her.Which nursing response would be most therapeutic?

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 away the bugs for you."
D) "I don't see bugs,but I'll stay with you and brighten the lights so we can be sure."

Answer 3

"I don't see bugs,but I'll stay with you and brighten the lights so we can be sure."

Question 4

The outcome that should be established for an elderly patient with delirium caused by fever and dehydration is that the patient will:

A) return to a premorbid level of functioning.
B) demonstrate motor responses to noxious stimuli.
C) identify stressors negatively affecting self.
D) exert control over responses to perceptual distortions.

Question 5

A family states that the father,who has moderate-stage dementia,is incontinent related to forgetting where the bathroom is located.An intervention the nurse should suggest to the family is to:

A) label the bathroom door with a picture of a toilet.
B) have someone take him to the bathroom hourly.
C) place the patient in disposable adult diapers.
D) restrict the patient's fluid intake to reduce voiding.

Question 6

A man,aged 84 years,was stopped for going through a red light in a small town where he has lived all his life.He told the officer,"It wasn't there yesterday." He was unable to tell the officer his address and demonstrated labile mood,seeming pleasant one minute and angry the next.The officer took the man home to discuss his condition with the family and found that he lives with his wife,who is legally blind.She stated,"He's my eyes,and I'm his mind." She also related that her husband wanders around the neighborhood,sometimes taking tools from people's garages,saying they belong to him.She reluctantly agreed that he should go to the emergency department for evaluation.He was diagnosed with Alzheimer's disease.What cardinal sign of Alzheimer's disease does this patient demonstrate?

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

Question 7

What environmental conditions should the nurse arrange for a patient with delirium and altered perceptions of her environment?

A) Provide a quiet,well-lit room without glare or shadows.
B) Have the patient sit by the nurse's desk while awake.
C) Reduce room lighting to minimize overstimulation.
D) Keep a radio on continuously to reduce isolation.

Question 8

B and J both have Alzheimer's disease.B walks up behind J in the hall and shouts,"Move along,you're blocking the road.I'll take a stick to you." J turns around,shakes his fist,and shouts,"I know what you're up to;you're trying to steal my car." The best action for the nurse to take would be to:

A) Reinforce reality by telling B that J can walk in the hall,and telling J that B is not trying to steal his car.
B) Ask the medication nurse to give both patients an as-needed dose of neuroleptic medication.
C) Separate and distract them by directing one to go to the day room and taking the other to the activities area.
D) Step between them,saying "Gentlemen,please quiet down.We do not permit violence here."

Question 9

Which assessment data suggests a person who appears to have dementia instead has depression and pseudodementia?

A) Demonstrates impaired judgment
B) Demonstrates impaired concentration
C) Has a history of significant losses or crises
D) Cognitive changes preceded mood changes

Question 10

Which assessment data suggest a person with confusion has secondary dementia or pseudodementia?

A) Symptoms developed over a 2-week period.
B) Degree of confusion varies from day to day.
C) Has short-term memory loss;long-term memory is intact.
D) Depression is the patient's prevailing mood.

Question 11

An elderly patient in the intensive care unit seems to be becoming agitated.She points to the wall and states,"The people in that picture are moving.That doesn't make sense,I know,but they are.Something is wrong here." Which of the following nursing interventions would be most beneficial for this patient?

A) Place large clocks and calendars on the wall of the patient's room.
B) Have personal belongings brought from home and placed in full view.
C) Remove the picture,and make sure the patient wears her glasses.
D) Keep the window blinds closed to prevent glare and overstimulation.

Question 12

A patient with fluctuating levels of awareness,confusion,and disorientation shouts,"The bugs,they are crawling on my legs! Get them off me!" The nurse's inspections show that no insects or other possible causes of the patient's perceptions are visible.The nurse can best assess this presentation as:

A) perseveration.
B) hypermetamorphosis.
C) tactile hallucinations.
D) tactile illusions.

Question 13

A patient with severe dementia can no longer recognize her only daughter and becomes anxious and agitated when the daughter attempts to reorient her.An alternative the nurse could suggest to the daughter is to:

A) wear a large name tag.
B) visit her mother less often.
C) talk about experiences they've shared.
D) place clocks and calendars strategically.

Question 14

A patient with stage 2 Alzheimer's disease calls the police,saying an intruder is in her home.The police officer who investigates the call determines the patient has seen her own reflection in the mirror and thought an intruder was present.This phenomenon can be assessed as:

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

Question 15

A 70-year-old woman is beginning to notice mild memory impairment.She fears she is developing Alzheimer's disease and asks her granddaughter,a nurse,if this is the case.What factors would the nurse and her grandmother use to distinguish normal age-related memory impairment from a developing dementia?

A) Only dementias interfere with the ability to solve new problems.
B) Difficulty finding words occurs in dementia but not normal aging.
C) Normal changes of aging do not interfere with day-to-day functioning.
D) Dementia progresses much more rapidly than the changes of normal aging.

Question 16

What should the priority nursing diagnosis be for a patient with fluctuating levels of consciousness,disorientation,and visual and tactile hallucinations?

A) Self-care deficit
B) Risk for injury
C) Disturbed thought processes
D) Fear

Question 17

A widow,aged 72 years,lives alone and is visited weekly by her son.She takes digoxin,hydrochlorothiazide,and an antihypertensive drug.She also has a prescription for diazepam (Valium)as needed for moderate to severe anxiety.When the son visited today,he found his mother confused.Her speech was thick and slurred and she had an unsteady gait.She was taken to the emergency department,and hospital admission followed.The nurse assessed the patient as having several cognitive problems,including memory and attention deficits and fluctuating levels of orientation.The nurse confirms that the patient's symptoms developed over a 2-day period.The patient's symptoms are most characteristic of:

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

Question 18

As Alzheimer's disease progresses to the late stage (stage 4),impairment of functioning is pervasive.Which symptom does not usually appear until this final stage of the disorder?

A) Agnosia
B) Social withdrawal
C) Confabulation
D) Hypermetamorphosis

Question 19

An elderly man drove from his home to a nearby convenience store and was unable to remember how to get home.He was unable to tell a police officer his address and demonstrated labile mood.The officer took the man and met the man's wife,who related that her husband often wanders around the neighborhood,sometimes taking tools from people's garages.She reluctantly agreed that he should go to the emergency department for evaluation.He was diagnosed with Alzheimer's disease.On the basis of the patient's history,the nurse can make the assessment that the patient's Alzheimer's disease has progressed to:

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

Question 20

A patient is referred to the visiting nurse agency due to cognitive impairment.Which functional problems is this patient most likely to exhibit?

A) Inability to bathe and dress independently
B) Wandering in and away from his home
C) Lability of moods,from sociable to irritable
D) Becomes frustrated easily

Question 21

An elderly male develops bradycardia and has a pacemaker surgically implanted.Although he was lucid preoperatively and has no history of dementia,at 10:00 PM on the night of his surgery,he becomes disoriented to place and time and insists on going home.When placed in soft restraints,he becomes hostile and is later caught trying to burn his way out of the restraints with a cigarette lighter.Which nursing response is most likely to be therapeutic?

A) Dim the lights in the room so the patient will more likely be able to sleep.
B) Maintain the restraints and have a sitter stay with the patient at night.
C) To monitor his mental status,ask the patient each hour if he knows where he is.
D) Remove the restraints and have a family member stay with him instead.

Question 22

Which intervention would best address the nursing diagnosis of Imbalanced nutrition for elderly patients in stages 2 to 3 of Alzheimer's disease?

A) Monitor the frequency and characteristics of bowel movements.
B) Offer finger foods the patient can take away from the table.
C) Monitor intake and output,and take patient weights each week.
D) Provide protein-dense foods to provide for neurological regrowth.

Question 23

A 72-year-old widow has just returned home after 2 weeks in the hospital after a fall.She lives alone and is visited weekly by her son.She takes digoxin,hydrochlorothiazide,and an antihypertensive drug.She also has a prescription for diazepam (Valium)as needed for moderate to severe anxiety.When the visiting nurse stopped by 2 days after discharge,he found the woman confused and disoriented,with an unsteady gait.The patient asks him who the small people are who have been living in her house.The patient had not evidenced any of these symptoms at the time of discharge.Vital signs were unremarkable except for bradycardia.The nurse correctly deduces that the most likely cause for the changes seen in the patient is:

A) delirium.
B) dementia.
C) amnestic syndrome.
D) drug toxicity.

Question 24

An elderly male develops bradycardia and has a pacemaker surgically implanted.Although he was lucid preoperatively and has no history of dementia,at 10:00 PM on the night of his surgery,he becomes disoriented to place and time and insists on going home.When placed in soft restraints,he becomes hostile and is later caught trying to burn his way out of the restraints with a cigarette lighter.Which of the following charted observations would best indicate that a priority outcome has been achieved?

A) "Patient restraints remain intact this shift."
B) "No further elopement attempts noted."
C) "Pulse consistently 60-64 during night shift."
D) "Patient conversing quietly with sitter."

Question 25

Which symptom would suggest that the patient is experiencing delirium instead of dementia?

A) Altered level of consciousness
B) Disorientation to place and time
C) Wandering of attention
D) Stable autonomic functioning

Question 26

A patient with Alzheimer's disease has been determined to have a dressing/grooming self-care deficit.Which intervention(s)would be appropriate for this nursing diagnosis? Select all that apply.

A) Replace personal clothing with gym clothes that all match each other.
B) Label the patient's clothing with his name and name of the item.
C) Provide clothing with elastic waistbands and hook-and-loop closures.
D) Administer anxiolytic medication before bathing and dressing.
E) If the patient is resistive,use distraction;then try again after a short interval.

Question 27

Which information would be important to incorporate when teaching about medications for dementia in a caregiver's support group? Select all that apply.

A) Antipsychotic medications have been shown to be the most useful category of drugs in reducing behavioral problems in dementias.
B) Most currently available medications slow the progress of the disease in 20% to 50% of patients but usually do not significantly improve functioning.
C) None of the currently available medications for dementias provide a cure,and although some vitamins may be helpful,research so far is inconclusive.
D) Certain antidepressant drugs are sometimes helpful in improving sleep,reducing irritability,and lessening anxiety.
E) Elderly persons require more careful dosing,more monitoring,and are more sensitive to side effects,particularly when taking multiple drugs.

Question 28

An 83-year-old man becomes lost while driving.He pulls into a driveway to turn around and cannot figure out how to put his car in reverse,so he drives into the yard,makes a circle,and drives back out of the driveway.He is stopped by police,who take him to the emergency room.The ER diagnoses the patient with stage 2 (moderate)Alzheimer's disease and refers him to the neurology clinic for follow-up.Given this diagnosis,which behaviors should the clinic nurse anticipate?

A) Does not know today's date
B) Unable to shower without help
C) Denial of mental impairment
D) Inability to recognize family

Question 29

A woman with Alzheimer's disease has significant apraxia and poor hygiene.Which intervention would be most appropriate for ensuring that the patient completes a shower?

A) Remind her of the need for a shower and where the shower is,and repeat this every 30 minutes until the shower is completed.
B) Discuss with her the importance of showers as part of daily self-care,and elicit and resolve any obstacles to the patient's showering.
C) Walk her to the shower,and provide occasional reminders of what she should do next if she seems to be unsure or begins to repeat previous actions.
D) Walk her to the shower,assist her to undress,start the water,supply the soap and washcloth,and instruct her to rub her face with the washcloth.

Question 30

The head nurse on a unit that serves persons with cognitive impairment is concerned about her staff,many of whom seem to be becoming "burned out" by their challenging work.Which response by the head nurse is most likely to minimize staff frustration and burnout on the unit? Select all that apply.

A) Educate staff regarding realistic expectations for this patient population.
B) Arrange for 12-hour shifts so that staff can have more days off per week.
C) Guide staff to use small,realistic goals as their measure of patient progress.
D) Provide for after-work activities such as meeting at taverns for happy hours.
E) Encourage and support staff in taking good care of their own health.

Question 31

An immigrant from Korea who has stage 3 Alzheimer's disease lives with a daughter,an Oregon native,in her hometown.During a patient follow-up visit,the visiting nurse notices that the daughter seems exhausted and has begun to cry.Which nurse response to the daughter would best reflect an understanding of the family's culture?

A) "Being expected to care for one's family can be a significant burden to bear."
B) "You seem very tired.Respite care for a day or two each week might help you."
C) "Caring for a loved one in need can be both a great honor and a great challenge."
D) "There is a very nice nursing home not far from here.Your father might like it there."

Question 32

The patient need that assumes priority when planning care for a patient with late-stage dementia is:

A) meaningful verbal communication.
B) promotion of self-care activities.
C) maintenance of nutrition and hydration.
D) preventing the patient from wandering.

Question 33

You are a nurse meeting for the first time with a stage 3 Alzheimer's patient who is newly referred to your home health agency.Which assessment data about the patient and caregiver(s)would be most important to acquire during your first visit to the family's home?

A) Is the house design such that patient access to exits and stairways can be restricted?
B) Does the family understand that the disease is likely to prove fatal within 3 to 5 years?
C) What resources is the patient's family able to access in their particular community?
D) What activities or memories are most comforting and calming for the patient?

Question 34

An elderly male develops bradycardia and has a pacemaker surgically implanted.Although he was lucid preoperatively and has no history of dementia,at 10:00 PM on the night of his surgery,he becomes disoriented to place and time and insists on going home.When placed in soft restraints,he becomes hostile and is later caught trying to burn his way out of the restraints with a cigarette lighter.Which nursing diagnosis should be the priority diagnosis?

A) Disturbed thought processes
B) Sleep deprivation
C) Risk for injury
D) Ineffective coping