Question 1

A patient has been diagnosed with dementia secondary to cerebral disease.The family members note the patient "has not been as sharp as he once was" and that he has developed urinary incontinence and a gait disturbance.Which pathophysiology can cause such symptoms?

Accepted Answer

Normal pressure hydrocephalus is a disorder characterized by dementia,gait disorder,and urinary incontinence.Dilation of ventricles in the absence of increased CSF is a prominent manifestation.Early urinary incontinence is not seen in the disorders listed in the other options.

Question 2

Which theory of etiology of Alzheimer's disease,suggested by current research,might the nurse use to help a family understand that this disorder is not of psychosocial origin? Alzheimer's disease is associated with:

Accepted Answer

The prevailing theories of etiology of Alzheimer's disease include the following: angiopathy and blood-brain barrier incompetence; neurotransmitter and receptor deficiencies of acetylcholine; abnormal proteins,specifically ß-amyloid and their products; and genetic defects.Neither serotonin nor prions are implicated as problems in Alzheimer's disease.

Question 3

An elderly patient was well until 12 hours ago,when she reported to her family that in the middle of the night she awakened to see a man standing at the foot of her bed.There is no evidence that this situation ever happened.This series of events supports which possible diagnosis?

Accepted Answer

Delirium is a disturbance of consciousness and cognition that develops over a short period.It is secondary to a medical condition.The scenario does not fit the disorders mentioned in the remaining options.

Question 4

The nurse is administering donepezil (Aricept)to a patient with stage 1 Alzheimer's disease.Based on this drug's mechanism of action,the nurse will seek evidence of improvement in the patient's:

Accepted Answer

Donepezil is a cholinesterase inhibitor that increases the concentration of acetylcholine.Acetylcholine is needed for intact memory and for learning.This medication is not prescribed for the conditions identified in the remaining options.

Question 5

An elderly patient with dementia has a nursing diagnosis of self-care deficit: bathing,hygiene.She lives alone and the nursing assessment proves reason to believe she has forgotten how to perform hygiene and bathing activities.Which intervention is most appropriate for this patient?

Accepted Answer

Bathing twice weekly would be a realistic goal.Assistance should be provided,both to prevent falls and to regulate shower temperature.The elderly are advised not to bathe daily because it is too drying to their skin.The remaining options are not supported by the information given in the scenario.

Question 6

Which statement by an adult child concerning the behaviors of their parent supports the diagnosis of Alzheimer's disease?

Accepted Answer

Increased forgetfulness,particularly that involving former routine activities (such as bill paying),is symptomatic of Alzheimer's disease.The other options do not indicate cognitive deficit.

Question 7

Which situation would be most likely to serve as a trigger to a catastrophic reaction in a patient with stage 2 Alzheimer's disease?

Accepted Answer

Catastrophic reactions are overexaggerated negative emotional responses initiated as a result of a perceived failure at a task or change in the environment.Being scolded by the aide presents a situation that would clearly be frustrating to the patient.

Question 8

A patient diagnosed with Alzheimer's disease has a catastrophic reaction during an activity involving simultaneous playing of music and working on a craft project.The patient starts shouting "no,no,no" and rushes out of the room.The nurse should:

Accepted Answer

These actions will restore safety and self-esteem.Isolation will decrease self-esteem and may increase confusion.It is only one patient that is distressed,not the entire group.Behavioral interventions should be attempted prior to administering medication.

Question 9

The home care nurse is visiting a patient who was discharged to home after a procedure at an ambulatory surgical center.The patient lives alone in a senior retirement community.The nurse's assessment documents mild dysphasia.The patient repeatedly asks,"Why is there a bandage on my arm?" and is not able to state the appropriate day and year.Appropriate planning for the patient should include:

Accepted Answer

Further assessment is appropriate before making changes in the living environment.Enrolling in a dementia program will provide stimulation and help the patient maintain intellectual skills.English classes will not improve speech.The other plans might have relevance,however.The remaining sets of options are either irrelevant or beyond the patient's abilities.

Question 10

Which behaviors would indicate that a therapeutic activity program for a patient with Alzheimer's disease had been successful?

Accepted Answer

These are all observations that would indicate that a therapeutic activity program has kept the patient functioning at the highest level of which he is capable.The behaviors described in the other options are not realistic expectations for this patient.

Question 11

Which of the following should the nurse use as a basis for explaining the etiology of Alzheimer's disease to the family of a patient with this disease?

Accepted Answer

This option provides accurate information about Alzheimer's disease.Alzheimer's disease is not a secondary dementia nor is it treated with antihypertensive medications.

Question 12

A patient diagnosed with moderate dementia consistently appears to be distorting the truth resulting in his wife asking,"What should I do when he lies to me about unimportant things?" Upon what rationale should the nurse's response be based?

Accepted Answer

Confabulation is not lying but rather a method for filling in the memory gaps.Ignoring,using confrontation,and changing the topic would not be as useful as gently reorienting.

Question 13

The nurse is to perform a complete assessment of a patient in her home,using the Mini-Mental State Examination (MMSE)as one component.When the nurse arrives,the patient is seated at the table with her husband,the TV is on,and several grandchildren are visiting.The patient is quiet,but her hands are gripped tightly,and she is staring at the ceiling.The best action for the nurse to take would be which of the following?

Accepted Answer

Testing the patient in her home under quieter,less distracting circumstances is the best solution.Asking the husband to leave is likely to increase the patient's anxiety and alter test results.Use of the MMSE is an integral component of the assessment and must not be deleted.Testing in the more familiar,comfortable surroundings of the home will yield more reliable results.

Question 14

The daughter of an older patient with dementia tearfully tells the nurse that she doesn't know what's wrong with her mother,who has begun accusing the family of holding her prisoner.Which nursing diagnosis would be appropriate for this patient?

Accepted Answer

Paranoid thinking is common in patients with dementia.Inability to correctly interpret environmental clues and to think logically leads to delusional thinking as the patient tries to make sense of a confusing world.The remaining options are not supported by the data in the scenario.

Question 15

When asked about the prognosis for a patient diagnosed with a dementia secondary to normal pressure hydrocephalus the nurse replies:

Accepted Answer

By relieving the cause,the symptoms of secondary dementias are largely reversible.The statements reflected in the other options do not reflect this fact.

Question 16

A patient diagnosed with delirium has become agitated and fearful.Which nursing intervention should the nurse implement to help prevent a catastrophic response?

Accepted Answer

The safety of a patient with delirium is of primary importance.Symptoms of delirium fluctuate and may worsen,especially at night.The greater the patient's confusion and disorientation,the greater the possibility for self-harm.The patient should be treated as an adult; to do otherwise is demeaning.Asking for an explanation is inappropriate,because delirious patients cannot formulate rational answers.Patients are never restrained unless all other less restrictive measures have failed.

Question 17

A patient has been admitted with a diagnosis of hypoactive delirium.Which nursing intervention is supported by this diagnosis?

Accepted Answer

Because of inactivity,hypoactive delirium patients are more likely to develop further complications,including decubiti that could be minimized by frequent repositioning.The remaining options identify interventions that are not generally a result of this diagnosis.

Question 18

The daughter of an elderly patient with dementia tearfully tells the nurse that she doesn't know what's wrong with her mother,who has begun accusing the family of stealing her money.The nurse assesses the patient's stage of Alzheimer's disease as stage:

Accepted Answer

In stage 2,memory and cognitive deficits are worsening.The patient is less able to make sense of a confusing world and makes faulty interpretations resulting in paranoid delusional thinking.The patient in stage 1 does not usually have delusions.The patient in stage 3 often is unable to communicate meaningfully.There is no stage 4 of Alzheimer's disease.

Question 19

Which outcome is realistic for a patient with stage 1 Alzheimer's disease?

Accepted Answer

This outcome addresses health maintenance (i.e.,maintaining an optimal functional level as determined by present capacity).Although long-term placement may be an option,it is not necessarily appropriate during this stage.Patients in stage 1 are often able to make simple decisions.Continuing to make decisions gives the patient a sense of control.Although a patient in stage 1 does not appear markedly deteriorated,some diminution of function may be present.

Question 20

A patient has been diagnosed with Alzheimer's disease,stage 1.The nurse would expect to help the family plan measures to assist the patient with:

Accepted Answer

Recent memory loss is the only symptom listed in the options that would be expected in stage 1 Alzheimer's disease.

Quiz 16: Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders