Chapter 16: Neurocognitive Disorders: Delirium and Dementia My Nursing Test Banks

Chapter 16: Neurocognitive Disorders: Delirium and Dementia

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Your patient with advanced Alzheimers disease keeps searching the unit for her mother who died many years ago. How should you respond?

A.

Your mother isnt hereshe died long ago.

B.

Lets go to the activity room and see whats going on.

C.

You must be upset that you cant find her.

D.

What makes you keep looking for your mother?

____ 2. Your patient is diagnosed with delirium. He is awake most of the night and becomes increasingly confused. Which is the best initial intervention?

A.

Keep the television on to provide stimulation.

B.

Give him a sleeping pill.

C.

Keep a night light on in the room and turn off the television.

D.

Keep the lights on in the room.

____ 3. Your patient is on donepezil HCL. This tells you your patient has which disorder?

A.

Dementia

B.

Obsessive-compulsive disorder

C.

Major depression

D.

Delirium

____ 4. Team members working with patients who have dementia need to have a common, unified approach because this type of patient requires:

A.

Sameness and consistency in their lives.

B.

Strict rules and regulations.

C.

Behavior modification at all times.

D.

Staff who cannot be manipulated.

____ 5. When preparing a care plan for a patient with a diagnosis of dementia, the nurse will:

A.

Increase mental and physical stimulus to improve mental function.

B.

State five current events from todays newspaper.

C.

Maintain consistent daily routines.

D.

Encourage the patient to discuss memories from his or her childhood.

____ 6. The best way to assist a patient who has mild Alzheimers disease is to:

A.

Ask the physician to keep the patient sedated to avoid acting out behaviors.

B.

Provide strict one-on-one behavior modification techniques to prevent further cognitive deterioration.

C.

Encourage the family to begin preparations to move the person to a skilled nursing facility.

D.

Provide a stable, safe, and consistent environment.

____ 7. Nurses recognize that the main cause for Alzheimers disease is:

A.

Unknown at this time.

B.

Genetic.

C.

Related to use of aluminum cookware.

D.

Long-term alcohol use.

____ 8. A person who is receiving tests to confirm a diagnosis of Alzheimers disease is preparing for a computerized tomography (CT) test. The patient becomes restless and is unable to follow the pre-examination directions given by the personnel. As the nurse who is assisting the patient, your best action at this time is to:

A.

Tell the patient that refusing to cooperate will require having to return another day.

B.

Give the patient the written instructions.

C.

Take the patient to a quiet waiting area until it is time for the CT scan.

D.

Make certain that the patient is tightly strapped to the examination table during the test.

____ 9. Your new patient is admitted to your nursing home with a diagnosis of vascular dementia. You know that this type of dementia differs from Alzheimers dementia is what way?

A.

The progression of symptoms is predictable based on the persons heart disease.

B.

The progression of symptoms is more variable than Alzheimers disease.

C.

Vascular dementia can be treated successfully with surgery compared to Alzheimers disease where there is no surgical treatment.

D.

Vascular dementia is temporary and Alzheimers dementia is permanent.

____ 10. You are working with a patient who has dementia. The patient becomes withdrawn and negative. Your most therapeutic response to this patient is:

A.

Your family will feel very bad if you do not get along here!

B.

Your doctor has ordered you to attend at least two activities each day.

C.

Would you prefer to stay alone in your room?

D.

I need a partner to play cards with.

____ 11. Mavis Brown is a 75-year-old patient in your nursing home. She has Alzheimers disease. Mavis comes to you at the desk one day and is crying. She says, You all hate me. Everyone hates me! Your therapeutic reply is:

A.

Nobody here hates you, Mavis.

B.

Why do you feel hated, Mavis?

C.

You seem upset, Mavis. Lets go for a walk and talk.

D.

Its time for your medication, Mavis.

____ 12. Henry Smith is 88 years old and has been having periods of disorientation and confusion that worsen at night. He has been given a diagnosis of Alzheimers disease. When you pick up Henrys tray after supper, you observe that he has not touched any of the food. As his nurse, you understand that the most likely cause of his not eating is:

A.

He is too depressed to eat.

B.

He sees ants in his food.

C.

He is too forgetful to remember to eat.

D.

He is deliberately obstinate.

____ 13. Henry Smith may be suffering from sundowning. What is the alternate name for this condition?

A.

Nocturnal delirium

B.

Vascular dementia

C.

Pseudodementia

D.

Neurocognitive confusion

____ 14. Which of the following activities would be most appropriate for a patient who is in the moderate stage of Alzheimers disease?

A.

A large jigsaw puzzle

B.

Trivial Pursuit

C.

A scavenger hunt

D.

Playing a game of catch with a soft ball

____ 15. When planning interventions for a patient who has Alzheimers disease, the nurse knows that patients with this disorder:

A.

Should be able to remember teaching that was done yesterday.

B.

Will most likely havememory impairment particularly for recent events.

C.

Will most likely continue to be able to perform activities of daily living like dressing and grooming.

D.

The disease often stabilizes at one level.

____ 16. Aricept is a medication used to treat which condition(s)?

A.

Delirium only

B.

Dementia only

C.

Delirium and dementia

D.

Pseudodementia

____ 17. Pharmacological treatment of delirium is most likely to include which medication?

A.

Antidepressants

B.

Tranquilizers

C.

Antipsychotics

D.

Stimulants

____ 18. Which statement best describes pseudodementia?

A.

Schizophrenia in the elderly.

B.

Depression in the elderly that looks like dementia.

C.

Substance abuse related delirium that looks like dementia.

D.

Autism in children that mimics dementia.

____ 19. Andreas mother has been becoming more and more forgetful. It seems to have gotten worse over the past 15 years. Her most likely diagnosis could be:

A.

Depression.

B.

Alzheimers Disease.

C.

Hyperthyroidism.

D.

Delirium.

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 20. Of the following, which one(s) are part of an effective care plan for someone with advanced dementia? (Select all that apply)

A.

Keep the patient busy with structured activities.

B.

Keep televisions and radios on whenever possible to encourage patient interaction.

C.

Allow more time for performing care.

D.

Emphasize reality orientation.

E.

Encourage independent decision making.

F.

Provide group therapy opportunities to share feelings and problems.

____ 21. Which of the following are characteristics of delirium? (Select all that apply)

A.

Slow onset

B.

Sudden onset

C.

Fluctuating mental status

D.

Treatment is focused on finding the cause

E.

Progressive decline common despite treatment

F.

Can be caused by psychological stress

G.

Treatment the same no matter what the cause

H.

Consistent pattern of decline

True/False

Indicate whether the statement is true or false.

____ 22. All dementias are a form of Alzheimers disease.

Chapter 16: Neurocognitive Disorders: Delirium and Dementia

Answer Section

MULTIPLE CHOICE

1. ANS: B

With advanced Alzheimers disease, reorientation is often ineffective because the patient will not remember. Open-ended questions are also less effective. Response B uses distraction to refocus the patients attention on the here and now.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; General Nursing Interventions; page 254-255

KEY: Integrated Processes: Implementation | Content Area: Mental Health: Cognitive disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

2. ANS: C

Reducing stimulating sounds and providing some light to keep him oriented to his surroundings is the best initial intervention. A sleeping pill can add to confusion.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; General Nursing Interventions; page 254

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Sensory/perceptual alterations

3. ANS: A

This drug is Aricept and is a major treatment for dementia.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Table 16-4 Cholinesterase Inhibitors; page 252

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Geriatrics: Pharmacology | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration

4. ANS: A

Consistency is important when short-term memory is limited. The patient can count on that approach even when he or she cant remember details. Strict rules and behavior modification arent useful when the short-term memory is impaired. These patients are not using manipulation, again, due to poor memory.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With Delirium and Dementia; page 254

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts: Therapeutic environment

5. ANS: C

Consistency is effective for all types of dementias to reduce anxiety and promote participation in the care plan. Stimulating the patient to do mental functions such as reviewing current events, or discussing memories may create more anxiety.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With Delirium and Dementia; page 254

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts: Therapeutic environment

6. ANS: D

A stable, consistent environment will give the patient cues to maintain participation and orientation. Response A is a chemical restraint and is never appropriate. Behavior medication is generally ineffective with cognitive deterioration if the person cannot remember the rewards. Though the family may be thinking about future plans, it is too early for placement.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With Delirium and Dementia; page 254

KEY: Integrated Processes: Nursing Process: Planning | Content Area: Mental Health: Therapeutic Nursing Process | Cognitive Level: Comprehension | Client Need: Safe and Effective Care Environment: Coordinated Care

7. ANS: A

Though extensive research is being conducted in a number of areas, no clear cause has been identified.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Alzheimers disease; page 248

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Comprehension | Client Need: Health Promotion and Maintenance

8. ANS: C

Rather than flood the patient with a lot of information or demands, it is more important to create a calm environment to reduce the patients fear of the unknown.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With Delirium and Dementia; page 254

KEY: Integrated Processes: Nursing Process: Analysis/implementation | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic environment and communication

9. ANS: B

Vascular dementias progression depends on the recurrence of new strokes. It can be stable for long periods if there are no strokes. The progression is not predictable, there is no surgical treatment for this type of dementia, and the damage that is done is permanent.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Other Forms of Dementia; page 252

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Comprehension | Client Need: Health Promotion and Maintenance

10. ANS: D

Distracting the patient to another activity is a positive way to change a behavior rather than promoting guilt.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With Delirium and Dementia; page 254-255

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

11. ANS: C

This response acknowledges her feelings but uses an activity to distract her rather than focus on analyzing the cause, which she does not know.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With Delirium and Dementia; page 254-255

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

12. ANS: C

Memory loss can lead to forgetting to perform daily, routine functions like eating. This is the most likely cause.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Box 16-1, Symptoms of Alzheimers Disease; page 248

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

13. ANS: A

Nocturnal delirium is increased agitation and confusion at dusk.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Delirium; page 245

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

14. ANS: D

The other responses require concentration and memory. Physical activity can improve mood and does not put stress on the patient to concentrate.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With Delirium and Dementia; page 254-255

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication and environment

15. ANS: B

All interventions for Alzheimers patients must incorporate the understanding that memory impairment especially for recent events will impact all aspects of the patients activities. Alzheimers is a progressive deterioration.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Box 16-1, Symptoms of Alzheimers Disease; page 248

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

16. ANS: B

Aricept has been approved for the treatment of Alzheimers type dementia not delirium or pseudodementia.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Pharmacology Corner for Dementia; page 251

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Pharmacology and geriatrics: Pharmacology | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration

17. ANS: C

Using antipsychotic medications to treat delirium has some risk because they can exacerbate symptoms, but the most commonly used are low-dose antipsychotics if the patient is agitated.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Pharmacology Corner for Delirium; page 246

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Pharmacology | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration

18. ANS: B

Depressive symptoms in the elderly such as forgetfulness, withdrawal, and lack of involvement in life can be confused with early dementia.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Dementia; page 247 and Glossary; page 402

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

19. ANS: B

Alzheimers is a slow, progressive form of dementia where deterioration is expected consistently over many years.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with Delirium and Dementia; page 254

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication and environment

MULTIPLE RESPONSE

20. ANS: A, C

B, D, E, and F incorporate added stimulation that can increase the stress level of a patient with impaired memory.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Table 16-5 Characteristics of Delirium and Dementia; page 254

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

21. ANS: B, C, D, F

Delirium is characterized by sudden onset and fluctuating mental status. Treating the cause such as dehydration and electrolyte imbalance often improves symptoms. Psychological stress can contribute to delirium.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Alzheimers disease; page 248

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Cognitive Disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental Health Concepts

TRUE/FALSE

22. ANS: F

Alzheimers disease is a specific type of dementia. There are several other types not considered to be Alzheimers disease.

PTS: 1

REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Dementia; page 247

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

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