question

A patient who is hospitalized with pneumonia is disoriented and confused 2 days after admission. Which information obtained by the nurse about the patient indicates that the patient is experiencing delirium rather than dementia?

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a. The patient was oriented and alert when admitted.

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When developing a plan of care for a hospitalized patient with moderate dementia, which intervention will the nurse include?

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b. Remind the patient frequently about being in the hospital.

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When administering a mental status examination to a patient with delirium, the nurse should

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d. choose a place without distracting environmental stimuli.

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To protect a patient from injury during an episode of delirium, the most appropriate action by the nurse is to

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d. assign a nursing assistant to stay with the patient and offer frequent reorientation.

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Which action will the nurse in the outpatient clinic include in the plan of care for a patient with mild cognitive impairment (MCI)?

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b. Schedule the patient for more frequent appointments.

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When administering a mental status examination to a patient, the nurse suspects depression when the patient responds with

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a. "I don't know."

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A 72-year-old patient is diagnosed with moderate dementia as a result of multiple strokes. During assessment of the patient, the nurse would expect to find

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d. loss of both recent and long-term memory.

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To determine whether a new patient's confusion is caused by dementia or delirium, which action should the nurse take?

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d. Use the Confusion Assessment Method tool to assess the patient.

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A 62-year-old patient is brought to the clinic by a family member who is concerned about the patient's inability to solve common problems. To obtain information about the patient's current mental status, which question should the nurse ask the patient?

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c. "What did you have for breakfast?"

question

When teaching the children of a patient who is being evaluated for Alzheimer's disease (AD) about the disorder, the nurse explains that

answer

. a diagnosis of AD can be made only when other causes of dementia have been ruled out.

question

A patient with mild dementia has a new prescription for donepezil (Aricept). Which nursing action will be most effective in ensuring compliance with the medication?

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a. Having the patient's spouse administer the medication

question

Which intervention will the nurse include in the plan of care for a patient who has late-stage Alzheimer's disease (AD)?

answer

b. Maintain a consistent daily routine for the patient's care.

question

When assessing a patient with Alzheimer's disease (AD) who is being admitted to a long-term care facility, the nurse learns that the patient has had several episodes of wandering away from home. Which nursing action will the nurse include in the plan of care?

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a. Place the patient in a room close to the nurses' station.

question

During the morning change-of-shift report at the long-term care facility, the nurse learns that the patient with dementia has had sundowning. Which nursing action should the nurse take while caring for the patient?

answer

c. Keep blinds open during the daytime hours.

question

A long-term care patient with moderate dementia develops increased restlessness and agitation. The nurse's initial action should be to

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assess for factors that might be causing discomfort.

question

The spouse of a male patient with early stage Alzheimer's disease (AD) tells the nurse, "I am just exhausted from the constant worry. I don't know what to do." Which action is best for the nurse to take next (select all that apply)?

answer

b. Offer ideas for ways to distract or redirect the patient. d. Educate the spouse about the availability of adult day care as a respite. e. Ask the spouse what she knows and has considered about dementia care options.

question

Dementia is defined as a

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d. syndrome characterized by cognitive dysfunction and loss of memory.

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Vascular dementia is associated with

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c. cognitive changes secondary to cerebral ischemia.

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The clinical diagnosis of dementia is based on

answer

patient history and cognitive assessment.

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Which statement(s) accurately describe(s) mild cognitive impairment (select all that apply)?

answer

b. Caused by variety of factors and may progress to AD

question

The early stage of AD is characterized by

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memory problems and mild confusion.

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A major goal of treatment for the patient with AD is to

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maintain patient safety.

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Creutzfeldt-Jakob disease is characterized by

answer

memory impairment, muscle jerks, and blindness.

question

Which patient is most at risk for developing delirium?

answer

A 78-year-old man admitted to the medical unit with complications related to heart failure

question

Although he has been told that ginkgo biloba will probably have no effect, a 58-year-old man with early stage Alzheimer's disease insists on taking the herb because he believes it will slow the disease progression. Which statement, if made by the patient to the nurse, indicates understanding about the side effects of ginkgo?

answer

"Ginkgo may increase the risk of bruising."

question

The home care nurse is visiting patients in the community. Which patient is exhibiting an early warning sign of Alzheimer's disease?

answer

A 72-year-old female is unable to locate the address where she has lived for 10 years.

question

The nurse in the long-term care facility cares for a 70-year-old man with severe (late-stage) dementia who is undernourished and has problems chewing and swallowing. What should the nurse include in the plan of care for this patient?

answer

Provide thickened fluids and moist foods in bite-size pieces.

question

A 78-year-old woman is in the intensive care unit after emergency abdominal surgery. The nurse notes that the patient is disoriented and confused, has incoherent speech, and is restless and agitated. Which action by the nurse is most appropriate?

answer

Reorient the patient.

question

Unlicensed assistive personnel (UAP) working for a home care agency report a change in the alertness and language of an 82-year-old female patient. The home care nurse plans a visit to evaluate the patient's cognitive function. Which assessment would be most appropriate?

answer

Mini-Mental State Examination (MMSE)

question

The nurse who has administered a dose of risperidone (Risperdal) to a patient with delirium should assess for what intended effect of the medication?

answer

Lying quietly in bed

question

When providing community health care teaching regarding the early warning signs of Alzheimer's disease, which signs should the nurse advise family members to report (select all that apply)?

answer

B) Losing sense of time C) Difficulty performing familiar tasks D) Problems with performing basic calculations E) Becoming lost in a usually familiar environment

question

Which nursing intervention is most appropriate when caring for patients with dementia?

answer

Give simple directions, focusing on one thing at a time.

question

Which statement by the wife of a patient with Alzheimer's disease (AD) demonstrates an accurate understanding of her husband's medication regimen?

answer

"I'm really hoping his medications will slow down his mental losses."

question

Which patient may face the greatest risk of developing delirium?

answer

An older patient who takes multiple medications to treat various health problems

question

For which patient should the nurse prioritize an assessment for depression?

answer

A patient in the early stages of Alzheimer's disease

question

Benzodiazepines are indicated in the treatment of cases of delirium that have which cause?

answer

Alcohol withdrawal

question

The patient has been diagnosed with the mild cognitive impairment stage of Alzheimer's disease. What nursing interventions should the nurse expect to use with this patient?

answer

Use a calendar and family pictures as memory aids.

question

The patient is having some increased memory and language problems. What diagnostic tests will be done before this patient is diagnosed with Alzheimer's disease (select all that apply)?

answer

A) Urinalysis B) MRI of the head C) Liver function tests D) Neuropsychologic testing E) Blood urea nitrogen and serum creatinine

question

A 59-year-old female patient, who has frontotemporal lobar degeneration, has difficulty with verbal expression. One day she walks out of the house and goes to the gas station to get a soda but does not understand that she needs to pay for it. What is the best thing the nurse can suggest to this patient's husband to keep the patient safe during the day while the husband is at work?

answer

Adult day care

question

What manifestations of cognitive impairment are primarily characteristic of delirium (select all that apply)?

answer

a. Reduced awareness d. Sleep/wake cycle reversed e. Distorted thinking and perception

question

Which statement accurately describes dementia?

answer

d. Vascular dementia can be diagnosed by brain lesions identified with neuroimaging.

question

A patient with Alzheimer's disease (AD) dementia has manifestations of depression. The nurse knows that treatment of the patient with antidepressants will most likely do what?

answer

Improve cognitive function

question

For what purpose would the nurse use the Mini-Mental State Examination to evaluate a patient with cognitive impairment?

answer

It can help to document the degree of cognitive impairment in delirium and dementia.

question

During assessment of a patient with dementia, the nurse determines that the condition is potentially reversible when finding out what about the patient?

answer

Recently developed symptoms of hypothyroidism

question

The husband of a patient is complaining that his wife's memory has been decreasing lately. When asked for examples of her memory loss, the husband says that she is forgetting the neighbors' names and forgot their granddaughter's birthday. What kind of loss does the nurse recognize this to be?

answer

d. Memory loss in mild cognitive impairment

question

The newly admitted patient has moderate AD. What does the nurse know this patient will need help with?

answer

c. Dressing

question

What is one focus of collaborative care of patients with AD?

answer

b. Drug therapy for cognitive problems and undesirable behaviors

question

The patient is receiving donepezil (Aricept), lorazepam (Ativan), risperidone (Risperdal), and sertraline (Zoloft) for the management of AD. What benzodiazepine medication is being used to help manage this patient's behavior?

answer

c. Lorazepam (Ativan)

question

The wife of a patient who is manifesting deterioration in memory asks the nurse whether her husband has AD. The nurse explains that a diagnosis of AD is usually made when what happens?

answer

b. All other possible causes of dementia have been eliminated

question

What N-methyl-d-aspartate (NMDA) receptor antagonist is frequently used for a patient with AD who is experiencing decreased memory and cognition?

answer

d. Memantine (Namenda)

question

The son of a patient with early-onset AD asks if he will get AD. What should the nurse tell this man about the genetics of AD?

answer

a. The risk of early-onset AD for the children of parents with it is about 50%.

question

A patient with AD in a long-term care facility is wandering the halls very agitated, asking for her "mommy" and crying. What is the best response by the nurse?

answer

b. Tell the patient, "Let's go get a snack in the kitchen."

question

The sister of a patient with AD asks the nurse whether prevention of the disease is possible. In responding, the nurse explains that there is no known way to prevent AD but there are ways to keep the brain healthy. What is included in the ways to keep the brain healthy (select all that apply)?

answer

a. Avoid trauma to the brain. b. Recognize and treat depression early. f. Exercise regularly to decrease the risk for cognitive decline

question

A patient with moderate AD has a nursing diagnosis of impaired memory related to effects of dementia. What is an appropriate nursing intervention for this patient?

answer

b. Establish and consistently follow a daily schedule with the patient.

question

The family caregiver for a patient with AD expresses an inability to make decisions, concentrate, or sleep. The nurse determines what about the caregiver?

answer

b. The caregiver is manifesting symptoms of caregiver role strain.

question

The wife of a man with moderate AD has a nursing diagnosis of social isolation related to diminishing social relationships and behavioral problems of the patient with AD. What is a nursing intervention that would be appropriate to provide respite care and allow the wife to have satisfactory contact with significant others?

answer

a. Help the wife to arrange for adult day care for the patient.

question

When caring for a patient in the severe stage of AD, what diversion or distraction activities would be appropriate?

answer

d. Mobiles or dangling ribbons

question

The health care provider is trying to differentiate the diagnosis of the patient between dementia and dementia with Lewy bodies (DLB). What observations by the nurse support a diagnosis of DLB (select all that apply)?

answer

b. Fluctuating cognitive ability e. Bradykinesia, rigidity, and postural instability without tremor

question

Delegation Decision: The RN in charge at a long-term care facility could delegate which activities to unlicensed assistive personnel (UAP) (select all that apply)?

answer

a. Assist the patient with eating. b. Provide personal hygiene and skin care. d. Assist the patient to the bathroom at regular intervals.

question

A 68-year-old man is admitted to the emergency department with multiple blunt trauma following a one-vehicle car accident. He is restless; disoriented to person, place, and time; and agitated. He resists attempts at examination and calls out the name "Janice." Why should the nurse suspect delirium rather than dementia in this patient?

answer

d. The report of his family that although he has heart disease and is "very hard of hearing," this behavior is unlike him

question

What should be included in the management of a patient with delirium?

answer

c. Identification and treatment of underlying causes when possible

question

A 72-year-old woman is hospitalized in the intensive care unit (ICU) with pneumonia resulting from chronic obstructive pulmonary disease (COPD). She has a fever, productive cough, and adventitious breath sounds throughout her lungs. In the past 24 hours her fluid intake was 1000 mL and her urine output was 700 mL. She was diagnosed with early-stage AD 6 months ago but has been able to maintain her activities of daily living (ADLs) with supervision. Identify at least six risk factors for the development of delirium in this patient. (Fill in the blanks.) a. b. c. d. e. f.

answer

a. Age b. infection c. hypoxemia (lung disease) d. intensive care unit (ICU) hospitalization (change in environment, sensory overload); e. preexisting dementia f. dehydration

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