Chapter 27: Cognitive and Neurologic Function My Nursing Test Banks

Chapter 27: Cognitive and Neurologic Function

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. An older adult is experiencing age-related postural hypotension and he fears something is really wrong because he is the only one in his social group experiencing the problems. The nurse responds:

a.

Dont be concerned; just be very careful about your risk for falling.

b.

You have had very thorough testing, so dont worry about it being serious.

c.

Its just a matter of time before they too have to watch not to get up too quickly.

d.

You just dont have the compensating mechanisms of your friends.

ANS: D

The age-related symptoms of postural hypotension are dizziness or lightheadedness when changing positions rapidly. However, compensatory processes in the cortex and subcortical areas of the brain help aging individuals maintain relatively normal motor performance.

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TOP: Teaching-Learning MSC: Physiologic Integrity

2. What education by the nurse is most important to address age-related changes to the senses?

a.

Installing auditory smoke alarms

b.

Having regular eye checkups

c.

Being aware that hearing acuity decreases with age

d.

Checking the expiration dates on foods such as dairy

ANS: A

An age-related reduction in the senses makes it less likely that an older person will smell smoke from a fire. Loud fire alarms are important for home safety. The other factors are not as directly related to safety.

DIF: Understanding (Comprehension) REF: Page 566 OBJ: 27-2

TOP: Teaching-Learning MSC: Safe Effective Care Environment

3. The nurse is conducting an admission assessment on a mildly confused older patient. The nurse best assures an accurate history by first:

a.

scoring the clients cognitive responses.

b.

focusing on the client to respond.

c.

directing the questions to both patient and family.

d.

arranging a Mini-Mental State Examination (MMSE).

ANS: C

An interview with the friend or family member is an appropriate method to first implement when a patient is exhibiting confused behavior. The other options will not get accurate information for the assessment.

DIF: Understanding (Comprehension) REF: Page 566 OBJ: 27-2

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. A nurse is caring for an older patient diagnosed with acute depression. What action by the nurse is most important to help prevent delirium in this patient?

a.

Reorienting the patient to the day, time and place frequently

b.

Being physically present to help the patient with eating meals

c.

Providing the patient with opportunities to discuss depression

d.

Administering antidepressive medication as prescribed

ANS: B

Depressed older adults may neglect eating or caring for a chronic medical condition, predisposing them to the development of delirium resulting from hypoalbuminemia and possibly electrolyte imbalances. The other actions will not prevent delirium.

DIF: Applying (Application) REF: N/A OBJ: 27-4

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

5. When assessing an older patient displaying symptoms of delirium, the nurse focuses the assessment on:

a.

the degree and duration of the symptoms.

b.

the amount of self-care deficiency the symptoms cause.

c.

identifying processes that commonly result in the symptoms.

d.

physiologic dysfunction resulting from the symptoms.

ANS: C

The treatment of delirium entails the identification and treatment of the underlying cause. The nurse should assess this factor as the priority. The other assessments are of lesser priority.

DIF: Applying (Application) REF: N/A OBJ: 27-4

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

6. An 80-year-old patient is exhibiting signs of dementia representative of Alzheimer disease (AD). The nurse supports that possibility when determining that the patient:

a.

experienced a gastric resection several years ago.

b.

traveled often to third world countries.

c.

was employed as a steelworker for 40 years.

d.

has a history of viral encephalitis.

ANS: D

Viral illness such as herpes zoster, herpes simplex, or viral encephalitis is believed to be a possible risk factor for AD. However, advancing age is the primary risk factor. The other options are not related.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

7. When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to:

a.

place printed labels on important items, such as the telephone.

b.

place a clock and calendar in the patients immediate environment.

c.

use hand gestures instead of verbal communications to demonstrate meaning.

d.

show the patient a picture of a toothbrush when it is time for oral hygiene.

ANS: D

Reality orientation supports failing memory in early stages of dementia and preserves independent functioning for a longer duration. Although written messages and signs may become meaningless to individuals with advancing dementia, pictures often evoke a response. The other options are not part of this strategy.

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TOP: Nursing Process: Implementation MSC: Physiologic Integrity

8. A 73-year-old patient diagnosed with vascular dementia is admitted for exacerbation of asthma. The patient has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior. The nurses initial response is to:

a.

identify the patient as being at high risk for falls.

b.

monitor the patient for signs of benzodiazepine withdrawal.

c.

notify the admitting physician immediately.

d.

place the patient on strict intake and output.

ANS: C

Benzodiazepines should be reserved for acute situations and not used for the long-term management of troubling behaviors. Long-term use can precipitate withdrawal if use is stopped and can possibly cause seizures. The nurse should notify the physician immediately so that plans for safely discontinuing the drug can be made.

DIF: Applying (Application) REF: N/A OBJ: 27-6

TOP: Communication and Documentation MSC: Physiologic Integrity

9. Which of the following statements, when made by family members caring for an older patient with dementia, indicates peaceful acceptance of the situation?

a.

Im so pleased that Mother had a good day today. Im really very hopeful.

b.

The hospice nurses are so helpful when I need time for myself.

c.

I promised Mother I would take care of her and Ill never leave her.

d.

Its the least I can do for Mother since she cared for us all these years.

ANS: B

Adjusting to the fact that dementia is irreversible and prolonged places families in situations of dealing with grief over a long period. Nurses need to encourage caregivers to take time out from their task and participate in self-care and health promotion activities. The other statements do not show this acceptance as clearly.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 27-6

TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity

10. The son of a patient with possible Alzheimer disease (AD) asks the nurse if there is a diagnostic test that can confirm the diagnosis. The nurse responds that:

a.

an electroencephalogram is often very useful in diagnosing AD.

b.

a positron emission tomography (PET) scan is a cheap but dependable tool.

c.

magnetic resonance imaging (MRI) is often ordered for that purpose.

d.

postmortem autopsy is the only definitive diagnostic tool.

ANS: D

Autopsy remains the gold standard and only definitive method for the diagnosis of AD.

DIF: Understanding (Comprehension) REF: Page 572 OBJ: 27-5

TOP: Teaching-Learning MSC: Physiologic Integrity

11. An 89-year-old diagnosed with dementia was until recently responding well to cognitive cueing techniques. The nurse shows an understanding of dementia when sharing with staff that:

a.

We will implement new interventions that address the diseases progression.

b.

Its important that we frequently recue the patient to improve her quality of life.

c.

The patients family needs to be made aware of this decline.

d.

This poor response to cueing is likely a result of advanced aging.

ANS: A

Positive responses to selected interventions may continue for a time but may decline as the disease progresses, which results in the need to reevaluate strategies. The nursing staff cannot evaluate the patients quality of life; only the patient can, and this patient is not capable. The family should be informed but that is not related to understanding dementia. The change in response is the result of advancing disease, not age.

DIF: Applying (Application) REF: N/A OBJ: 27-6

TOP: Teaching-Learning MSC: Physiologic Integrity

12. An 80-year-old patient who is experiencing symptoms of depression and anxiety is reluctant to comply with the prescribed treatment plan. The nurse initially addresses the issue with the patient by asking:

a.

How do you feel about how others view your mental health problem?

b.

Are you concerned about paying for your psychiatric medications?

c.

Did you know that depression is common among people your age?

d.

Do you have any questions about your the mental health treatment plan?

ANS: A

Older adults are often reluctant to seek care from a mental health professional because they grew up during a period when a strong stigma was attached to mental illness, mental hospitals, and mental treatment. The other questions do not open a discussion.

DIF: Applying (Application) REF: N/A OBJ: 27-8

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

13. An older adult patient being treated for chronic obstructive pulmonary disease (COPD) is exhibiting signs of memory loss and confusion. In planning his care, the nurse should give priority to:

a.

obtaining an order for a pulmonary function test (PFT).

b.

determining the potential of a possible adverse drug reaction.

c.

reorienting the patient to time, place, and person frequently.

d.

assessing for a family history of dementia.

ANS: B

Two of the most common side effects of many medications taken by older adults are mental confusion and disorientation. The initial action should be to determine the possible cause of the symptoms. If a cause can be found, a change might be possible. There is no indication the patient needs a PFT. Reorienting the patient is a good intervention, but it would be better to identify and eliminate the causative factor. Assessing a family history is a potential intervention as well.

DIF: Applying (Application) REF: N/A OBJ: 27-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

14. The nurse caring for an older adult patient recovering from cardiac surgery recognizes that it is most appropriate to assess this patient for mental health problems because:

a.

cardiac surgery often results in anxiety-related issues.

b.

untreated depression can contribute to the patients morbidity risks.

c.

many in this age cohort have undiagnosed depression.

d.

hospitalization is both anxiety and depression inducing.

ANS: B

Depression can and should be treated when it occurs with other illnesses because untreated depression can delay recovery from or worsen the outcome of the other illnesses. Cardiac illness is associated with depression, but not necessarily with anxiety issues. It is true that depression in the older population is underdiagnosed. Hospitalization can lead to depression. But the main reason to assess for depression is because of its effects on other health conditions.

DIF: Applying (Application) REF: N/A OBJ: 27-8

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

15. When planning care for the older adult being treated for depression, the nurse addresses the patients tertiary intervention needs best by:

a.

helping the patient to identify the early symptoms of depression.

b.

helping the patient deal with the physical symptoms of depression.

c.

discussing with the patient how to implement new coping skills.

d.

educating the patient about the importance of being drug compliant.

ANS: C

Tertiary intervention refers to the restorative or rehabilitative functions that the nurse performs to assist patients in the recovery process. An important aspect of tertiary intervention involving patients with depression is teaching new coping skills to lessen the likelihood of recurring depression. Identifying early symptoms is a secondary prevention. Treating the depression will limit the physical symptoms. Education is generally considered primary prevention. However, in this case it is education on part of treatment. This is not the best answer because the nurse is not teaching about the drugs, only about the importance of being compliant.

DIF: Applying (Application) REF: N/A OBJ: 27-8

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

16. To best advocate for an older adult patient being prescribed medication to control newly observed signs of confusion and aggressive behavior, the nurse:

a.

initiates an assessment to determine possible underlying causes of the behavior.

b.

contacts family to inform them of the new medication therapy being planned.

c.

discusses possible nonpharmaceutical treatments with the physician.

d.

documents a detailed description of the behaviors before administering the drugs.

ANS: A

In this population, such symptoms may be mistakenly assumed to be a result of normal aging, so prescription medications may be ordered for anxiety, depression, aggressive and disruptive behavior, or paranoid-type behavior, without assessing the reasons for the behavior. If an underlying cause of the behavior is found, it can be treated, thereby eliminating the problem. The other actions do not demonstrate advocacy.

DIF: Applying (Application) REF: N/A OBJ: 27-9

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

17. An older adult has been recently diagnosed with type 2 diabetes and mild retinal deterioration. To best address the patients potential for developing situation depression, the nurse:

a.

assesses the patients coping skills.

b.

Encourages the patient to participate in a depression support group.

c.

assesses the patients ability to manage the symptoms.

d.

educates the family on early signs of depression.

ANS: A

One of the keys to successful aging is adjusting to or, perhaps more accurately, adapting to, although not necessarily accepting, changes that occur in ones life. The nurse assesses the patients coping skills and methods. The patient does not need a support group before developing depression. Managing symptoms is part of coping. Educating the family is an appropriate intervention but is not the priority.

DIF: Applying (Application) REF: N/A OBJ: 27-8

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

18. An older adult has a medical condition that has required hospitalization at a facility far from home and family. To best minimize the patients risk for depression, the nurse:

a.

keeps the patient informed of the expected discharge date.

b.

offers to help the patient telephone family members each evening.

c.

reassures the patient that early discharge is a nursing goal.

d.

encourages the patient to place family photographs around the room.

ANS: B

The family continues to be the first source of support for older adults. This support is best achieved by regular contact through visiting or telephoning. The other options may be helpful, but they are not the best choice.

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TOP: Caring MSC: Psychosocial Integrity

19. An older patient is anxious about an upcoming diagnostic test and requests something to calm the nerves. To best address the patients need, the nurse prepares to administer a PRN dose of:

a.

clonazepam (Klonopin).

b.

diazepam (Valium).

c.

chlordiazepoxide (Librium).

d.

lorazepam (Ativan).

ANS: D

There are two broad categories of benzodiazepines: short-acting (e.g., alprazolam [Xanax], lorazepam [Ativan], and oxazepam [Serax]) and long-acting (e.g., diazepam [Valium], chlordiazepoxide [Librium], and clonazepam [Klonopin]). The short-acting agents are preferred for older adults because of their lower potential for buildup leading to sedation and depression.

DIF: Applying (Application) REF: N/A OBJ: 27-9

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

20. While collecting a health history for an older adult patient, the nurse learns that the patient had been prescribed Elavil 3 weeks ago and wants to stop taking it because It didnt make me feel any better. In response to this information, the nurse shares with the patient that:

a.

sudden withdrawal is likely to cause a hypertensive crisis.

b.

depression seldom improves without medication.

c.

realistically it will take longer for the patient to feel an improvement.

d.

in time, people adjust to the side effects.

ANS: C

Older patients may need up to 12 weeks of this medication for evaluation of a full response. Psychotropic medications need to be started low and increases should be done slowly. The other options are not correct.

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TOP: Teaching-Learning MSC: Physiologic Integrity

21. The nurse familiar with the old adult population recognizes that the patient who has the greatest potential for successfully committing suicide is the:

a.

63-year-old Asian female.

b.

86-year-old Caucasian male.

c.

76-year-old Hispanic female.

d.

67-year-old African-American male.

ANS: B

The highest rates of suicide are among men over the age of 85.

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TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

22. A 65-year-old adult who recently lost his spouse is admitted to the hospital after a failed suicide attempt. He presents with a sad affect and is reluctant to interact within the milieu. The nursing diagnosis with priority is:

a.

ineffective coping related to recent loss.

b.

hopelessness related to death of spouse.

c.

risk for loneliness related to loss of spouse.

d.

risk for self-directed violence related to depression.

ANS: D

This patient is at risk for another attempt at suicide, so safety is the primary concern.

DIF: Applying (Application) REF: N/A OBJ: 27-8

TOP: Nursing Process: Analysis MSC: Psychosocial Integrity

23. The nurse is caring for a severely depressed older patient. To best effect change in the patients emotional state, the nurses initial goal is to:

a.

plan interventions that will enhance the patients self-esteem.

b.

introduce the patient to new coping skills.

c.

assess the patients potential to self-harm.

d.

develop a therapeutic nurse-patient relationship.

ANS: D

The nurses ability to positively effect change in older adults responses to depression lies in the development of therapeutic relationships. Assessing risk for harm is an important safety issue but does not help the patients emotional state. The other two options come later after the relationship has entered its working phase.

DIF: Applying (Application) REF: N/A OBJ: 27-8

TOP: Caring MSC: Psychosocial Integrity

24. An older adult is hospitalized for treatment of a mental health disorder and is prescribed clomipramine (Anafranil). The nurse documents that the medication is having the desired effect when the patient:

a.

begins sleeping 8 hours per night.

b.

engages in fewer ritualistic behaviors.

c.

reports fewer episodes of nervousness.

d.

exhibits no delusionary thinking.

ANS: B

This medication is a tricyclic antidepressant that is specifically helpful for obsessive-compulsive disorder (OCD). The other assessments are not specific indicators of the effectiveness of this medication.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 27-8

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

25. To help manage the potential side effects of prescribed antipsychotic medications, amantadine (Symmetrel) may be prescribed. Which statement best indicates that the nurse understands the appropriateness of this medication for the older adult patient?

a.

This medication produces few anticholinergic effects.

b.

Symmetrel is an effective dopamine agonist.

c.

Extrapyramidal symptoms are best controlled by Symmetrel.

d.

Older patients seem to have the fewest side effects on this medication.

ANS: A

Amantadine (Symmetrel), a dopamine agonist prescribed to manage EPS, may be used, especially in older patients and in those with cardiovascular dysfunction, because of its reduced anticholinergic effects. The other statements are not accurate.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

MULTIPLE RESPONSE

1. A 72-year-old is prescribed lithium. The nurse educates the patient on the importance of biannual evaluation of which of the following? (Select all that apply.)

a.

Renal function

b.

Serum glucose level

c.

Liver function

d.

Thyroid function

e.

Red blood cell count

ANS: A, C, D

Renal, liver, and thyroid studies should be evaluated every 6 months because of the drugs potential toxicity. Glucose and red blood cell count are not affected.

DIF: Remembering (Knowledge) REF: Page 597 OBJ: 27-8

TOP: Teaching-Learning MSC: Physiologic Integrity

2. A 78-year-old patient was admitted with dehydration. The nurse assesses and documents observations that support a finding of dementia. Which of the following observations are related to dementia? (Select all that apply.)

a.

Forgetting what she ate for lunch today

b.

Crying frequently when alone

c.

Inability to find her way back to her room from the dayroom

d.

Being impatient with the nursing staff for not closing her door

e.

Repeatedly asking to call her son

ANS: A, C, D, E

Common manifestations of dementia include repeated questions and statements, forgetting to pay bills or take medications, increasing problems with orientation, and geographic disorientation. Other symptoms of AD include pervasive forgetfulness and memory loss, language deterioration, impaired ability to mentally manipulate visual information, poor judgment, confusion, restlessness, and mood swings. Personality changes may include apathy or loss of interest in previously enjoyed activities. Crying is not a classic sign of dementia, although depression often accompanies dementia and this could be a sign of depression.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

3. The nurse is caring for an older adult patient admitted to the hospital. What assessment findings place the patient at risk for developing delirium during the hospitalization? (Select all that apply.)

a.

The patent takes medications to manage several chronic illnesses.

b.

The patent has a history of urinary tract infections.

c.

The patent is in cancer remission.

d.

The patent has recently been eating poorly.

e.

The patent experienced a mild heart attack 2 years ago.

ANS: A, B, D

The risk factors for delirium include advanced age, central nervous system diseases, infection, polypharmacy, hypoalbuminemia, electrolyte imbalances, trauma history, gastrointestinal or genitourinary disorders, cardiopulmonary disorders, and sensory changes. These factors can lead to physiologic imbalances increasing the risk for confusion. Cancer remission and a heart attack 2 years prior do not increase the patients risk.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. A home care nurse is visiting a patient with moderate cognitive impairment from Alzheimer disease. The patients partner expresses concern about difficulty getting the patient to eat properly. The nurse suggests which of the following? (Select all that apply.)

a.

Serving meals at the same time each day

b.

Offering liquids in place of solid foods when possible

c.

Offering a calorie-dense snack at bedtime

d.

Cutting food into bite-sized pieces that will fit into the patients hand

e.

Asking the patent to identify favorite foods

ANS: A, C, D

It is important to support the ongoing nutrition of individuals with dementia because they may experience decreased hunger and ability to taste food. People who demonstrate symptoms of moderate to severe cognitive impairment may benefit from having meals in the same place at the same time each day. Small, frequent, nutritionally dense meals and snacks should be provided. During later stages of dementia, individuals may need to be reminded to open the mouth and chew. Food should be soft and cut in small pieces. Liquids do not need to be substituted for solid food. The patient may not be able to identify favorite foods, and asking may cause frustration.

DIF: Applying (Application) REF: N/A OBJ: 27-6

TOP: Teaching-Learning MSC: Physiologic Integrity

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