Chapter 48: Care of Patients with Cognitive Disorders My Nursing Test Banks

Chapter 48: Care of Patients with Cognitive Disorders

MULTIPLE CHOICE

1. The percentage of the population that is 85 years of age and older who have some stage of Alzheimers disease is _____%.

a.

10

b.

20

c.

35

d.

50

ANS: D

Alzheimers disease (AD) is the most common degenerative disease of the brain. Approximately 5.3 million Americans have AD (Alzheimers Association, 2010), and there is no known cause or cure. AD typically affects people over 65 years of age, but can also strike younger people. The 85-year-old-and-over age group is currently the fastest-growing age group in the United States. It is estimated that 50% of this age group have AD.

DIF: Cognitive Level: Knowledge REF: 1087 OBJ: 1 (theory)

TOP: Alzheimers Disease: Incidence KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

2. An 85-year-old man is admitted to the hospital with gastroenteritis and dehydration after a hiking trip to Mexico. He is given a dose of meclizine hydrochloride, an anticholinergic, for vomiting. He begins to hallucinate and talk to his wife, who has been dead for 10 years. The nurse assesses this behavior to be:

a.

dementia related to advanced age.

b.

delirium related to dehydration.

c.

dementia related to early Alzheimers disease (AD).

d.

delirium related to side effect of anticholinergic.

ANS: D

Anticholinergic drugs can cause sudden confusion in the elderly. There is nothing in the history that suggests that the behavior would be related to AD or any other dementia as dementias progress slowly. Dehydration would increase the effect of the anticholinergic.

DIF: Cognitive Level: Analysis REF: 1086 OBJ: 2 (theory)

TOP: Delirium: Etiology KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

3. The nurse is aware the older adult is at risk for drug-induced delirium because of:

a.

slower bowel motility.

b.

reduced fluid intake.

c.

overall reduced metabolism.

d.

sedentary lifestyle.

ANS: C

Slower renal and liver clearance of drugs allows the drugs to accumulate in the system of the older adult.

DIF: Cognitive Level: Comprehension REF: 1086 OBJ: 2 (theory)

TOP: Drug-Induced Delirium: Older Adult

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The nurse is aware that the memory lapses seen in early stages of Alzheimers disease (AD) are related to the pathophysiology of:

a.

frontal lobe atrophy.

b.

overproduction of neurotransmitters.

c.

pituitary disorders.

d.

inadequate clearance of metabolic toxins.

ANS: A

Loss of neurons in the frontal and temporal lobes results in atrophy and the many signs of AD, memory deficits being one of the earliest.

DIF: Cognitive Level: Comprehension REF: 1087 OBJ: 3 (theory)

TOP: Alzheimers Disease: Pathophysiology

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse notes that the newly admitted patient with Alzheimers disease has significant anomia. An appropriate intervention for this problem would be to:

a.

frequently reorient him to his room location.

b.

remind him what a particular item is and what its use is.

c.

help him feed himself.

d.

wait for the patient to find the word he wants.

ANS: D

Anomia is the inability to recall a word. Waiting for the patient to remember the word or be able to substitute another is more supportive than supplying the word for him.

DIF: Cognitive Level: Analysis REF: 1088 OBJ: 3 (theory)

TOP: Anomia: Intervention KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. When assisting the patient with middle-stage Alzheimers disease (AD) to dress, the nurse should:

a.

select clothes and dress him.

b.

lay out clothing and coach patient to dress self.

c.

ask patient what he wants to wear.

d.

open closet and say, Get a shirt.

ANS: B

Coaching to dress self will preserve dignity and function. Asking the patient what he wants to wear and telling him to get a shirt would increase confusion and the patient would be hampered by indecisiveness.

DIF: Cognitive Level: Application REF: 1090-1093 OBJ: 3 (theory)

TOP: Alzheimers Disease: Activities of Daily Living

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

7. The nurse differentiates vascular dementia from Alzheimers dementia in that vascular dementia is related to:

a.

cerebral atrophy.

b.

global reduction of cognition.

c.

hypertension.

d.

emboli in cerebral vessels.

ANS: D

Vascular dementia occurs from brain tissue becoming hypoxic and necrotic in local areas due to small emboli. The deficits may be intellectual or loss of sensory function.

DIF: Cognitive Level: Comprehension REF: 1093 OBJ: 2 (theory)

TOP: Vascular Dementia vs. Alzheimers Dementia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The nurse will record that the patient with Alzheimers disease exhibited agnosia when the patient:

a.

attempted to comb her hair with a spoon.

b.

had difficulty expressing herself verbally.

c.

was unable to understand written language.

d.

could not feed herself, although she had adequate motor function to do so.

ANS: A

Agnosia is the inability to recognize an object and use it as intended. Expressive aphasia is difficulty in expressing oneself. Alexia is the inability to recognize the written language. Apraxia is the inability to do an activity despite having the motor function to accomplish it.

DIF: Cognitive Level: Application REF: 1088 OBJ: 3 (theory)

TOP: Agnosia: Behavior KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. The patient with Alzheimers disease has been on donepezil (Aricept) for several weeks. The nurse suspects an overdose when the patient:

a.

eats hungrily at each meal and looks for snacks between meals.

b.

exhibits a consistent heart rate of 80 beats/min.

c.

has an elevation in blood pressure after each exercise period.

d.

is unable to grasp a glass tightly enough to prevent dropping it.

ANS: D

Inability to grasp the glass indicates muscle weakness, a cardinal indicator of overdose of Aricept. Other overdose signs are hypotension, nausea and vomiting, and bradycardia. Appetite changes are not consistent with the use of this medication.

DIF: Cognitive Level: Analysis REF: 1089 OBJ: 4 (theory)

TOP: Donepezil (Aricept): Overdose KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. When communicating with a patient with moderate Alzheimers dementia, the nurse should speak:

a.

slowly.

b.

clearly.

c.

loudly.

d.

softly.

ANS: B

Clarity is essential when communicating with a patient with Alzheimers dementia. Placing self directly in front of the patient and using pictures or symbols is helpful.

DIF: Cognitive Level: Application REF: 1090-1093 OBJ: 1 (clinical)

TOP: Communication: Technique KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. The nurse takes into consideration that the patient with AIDS dementia complex (ADC) is at risk for injury due to:

a.

manic behavior.

b.

numbness and muscle weakness.

c.

suicidal ideation.

d.

difficulty concentrating.

ANS: B

Peripheral neuropathy results in numbness and muscle weakness that may contribute to falls and thermal skin injuries.

DIF: Cognitive Level: Comprehension REF: 1093 OBJ: 1 (theory)

TOP: ADC: Characteristics KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. The nurse takes into consideration that the patient with moderate Alzheimers disease in a long-term care facility who sundowns would benefit from:

a.

social interaction activities in the morning.

b.

darkened bedroom to encourage sleep.

c.

sedative to enhance initiating sleep.

d.

exercise program after supper.

ANS: A

Sundowning refers to the patient who is completely oriented during the day but becomes disoriented and confused during the evening and night hours. Planning interactive activities when the resident is not confused is beneficial. Exercise programs at night would add to agitation and confusion. Sedatives also frequently cause confusion. Lights should be left on to assist with reorientation should the resident wake up at night.

DIF: Cognitive Level: Application REF: 1087 OBJ: 3 (theory)

TOP: Sundowning: Interventions KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

13. The patient with Alzheimers wakes up at 2:00 AM moaning and frightened and begs that her husbands coffin be removed from her room. The nurse should:

a.

turn light on and say, There is no coffin here, Mrs. Smith. This is the dresser.

b.

leave the light off and shine a flashlight on the dresser and say, See! No coffin!

c.

turn the light on, assist patient to the bathroom, and say, This is your dresser.

d.

leave the light off and say, You are in your room, Mrs. Smith.

ANS: C

Turning the light on helps reorient the patient. Distraction of going to the bathroom and identifying the dresser assist with reorientation after a frightening illusion. The other options would lead to greater confusion.

DIF: Cognitive Level: Analysis REF: 1094 OBJ: 3 (theory)

TOP: Illusions: Interventions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

14. The CNA approaches the older adult in the long-term care facility and says, Oh, look at your pretty dress. It is all icky with food spots! Come with me, sweetie, well put on that special party dress so you will look cute. The CNA is using:

a.

instruction for personal hygiene.

b.

encouragement for self-care.

c.

simplistic elderspeak.

d.

reorientation techniques.

ANS: C

Elderspeak is a way of communicating with the elderly that is infantile, oversimplistic, oversolicitous, and demeaning. It serves no therapeutic purpose.

DIF: Cognitive Level: Application REF: 1090-1093 OBJ: 4 (theory)

TOP: Communication: Elderspeak KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

15. The home health nurse counseling a family who will be caring for a relative with moderate-stage Alzheimers disease will stress the need for:

a.

a consistent routine to provide structured environment.

b.

making each day different to enhance attention span.

c.

using several caregivers to increase social skills.

d.

placing bright scatter rugs, flower arrangements, and wall decorations to stimulate sensory perception.

ANS: A

A consistent routineeating, resting, medication, hygieneare all beneficial to the demented patient. Different caregivers and distracting environmental objects increase confusion.

DIF: Cognitive Level: Application REF: 1098 OBJ: 3 (theory)

TOP: Home Care: Preparations KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

16. The exhausted caregiver to a patient with moderate Alzheimers disease asks what respite care entails. The nurse replies that respite care is:

a.

placing the patient in a long-term care facility for a short period of time for the caregiver to rest.

b.

bringing in home health aides to do housework to lighten duties of the caregiver.

c.

accompanying patient to a long-term care facility and staying there while the facility staff do physical care.

d.

attending a support group to ventilate feelings and communicate with other caregivers.

ANS: A

Respite care is placing the patient temporarily in a long-term care facility (usually for no longer than a month) to give the family respite from the responsibility of 24/7 care.

DIF: Cognitive Level: Comprehension REF: 1098 OBJ: 7 (theory)

TOP: Respite Care: Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

17. Donepezil (Aricept) has been prescribed for a patient with Alzheimers disease. Which statement by the patient and spouse indicates an understanding of the medication?

a.

It is best for me to take the medication at bedtime.

b.

The medication will be most effective if taken on an empty stomach.

c.

Absorption of the medication will be improved if taken with a citrus beverage.

d.

The medication should be taken with meals.

ANS: D

Donepezil (Aricept) is used in the management of Alzheimers disease. It has been shown to elevate acetylcholine levels in the brain and will slow the progression of the condition. The medication should be taken with meals to reduce gastrointestinal distress.

DIF: Cognitive Level: Application REF: 1098 OBJ: 4 (theory)

TOP: Drugs Used to Treat Cognitive Disorders

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. A recently licensed nurse is orienting to the Alzheimers disease care unit. The nurse is caring for a patient who is transitioning from oral rivastigmine (Exelon) to the medication patch. Which action observed by the nurses preceptor indicates an understanding of the medication?

a.

The patient is instructed to put on the patch 12 hours after the last oral medication dosage.

b.

The nurse reports that the patient will need to replace the patch every 36 hours.

c.

The nurse explains to the patient and family that the sites of application will need to be rotated.

d.

The nurse explains to the patient that the patch should not be placed on the trunk region of the body.

ANS: C

Rivastigmine (Exelon) is used to manage Alzheimers disease by elevating acetylcholine. The medication is available orally and transdermally. The patch should be applied 24 hours after the last oral dosage is given. The sites for application of the drug patches should be rotated.

DIF: Cognitive Level: Application REF: 1089 OBJ: 4 (theory)

TOP: Drugs Used to Treat Cognitive Disorders

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The nurse is caring for a patient who has dementia and has been getting up out of bed at night. What action by the nurse will be most therapeutic?

a.

The nurse places all of the side rails in the up position.

b.

The nurse raises the bed to a tall position to reduce the patients ability to get out of bed.

c.

The nurse obtains orders from the physician to apply restraints at night.

d.

The nurse places the mattress on the floor.

ANS: D

The patient who is attempting to get out of bed and is at risk for falls will need provisions made to increase safety. The most appropriate and safest action will be to place the mattress on the floor. The use of side rails can be considered a restraint and it can present an additional safety hazard. Placing the bed in a tall position is a safety hazard and should not be done. Restraints are to be the last option when caring for patients.

DIF: Cognitive Level: Application REF: 1089 OBJ: 1 (theory)

TOP: Alternatives to Restraints KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

MULTIPLE RESPONSE

20. The nurse explains that postmortem brain examinations of people with Alzheimers disease have revealed that there are: (Select all that apply.)

a.

tangled nerve cells.

b.

abnormal buildup of proteins.

c.

hemorrhagic areas.

d.

occluded cerebral vessels.

e.

reduced white matter.

ANS: A, B

Tangled nerve cells and abnormal buildup of protein in the brain have been found on postmortem brain examinations of people who have Alzheimers disease.

DIF: Cognitive Level: Knowledge REF: 1093 OBJ: 3 (theory)

TOP: Alzheimers Disease: Cerebral Changes

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

21. Criteria established for the diagnosis of dementia include: (Select all that apply.)

a.

evidence of cognitive deficits.

b.

evidence of aphasia, apraxia, or agnosia.

c.

impairment in social function.

d.

impairments of occupational function.

e.

neurologic signs and symptoms, such as ataxic gait.

ANS: A, B, C, D, E

Dementia is characterized by several cognitive deficits, memory in particular, and tends to be chronic in nature. It is classified according to etiology (cause or origin of disease). All options are criteria for the diagnosis of dementia.

DIF: Cognitive Level: Comprehension REF: 1087 OBJ: 3 (theory)

TOP: Diagnostic Criteria: Dementia KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

22. The nurse uses the Mini-Mental Status Exam (MMSE) frequently to assess: (Select all that apply.)

a.

orientation.

b.

judgment.

c.

memory.

d.

insight.

e.

ability to follow directions.

ANS: A, C, E

The Mini-Mental Status Exam (MMSE) is a popular shortened version of the mental status examination that was developed by Folstein and colleagues in 1975. It can be used for patients who have cognitive disorders or thought disorders to assess orientation, memory, and ability to follow commands. It consists of 11 easily scored items and should take about 5 to 10 minutes to administer. The MMSE does not measure insight or judgment.

DIF: Cognitive Level: Comprehension REF: 1088 OBJ: 4 (theory)

TOP: MMSE: Purpose KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

23. The nurse is aware the resident with global amnesia in the late stage of Alzheimers disease will benefit from: (Select all that apply.)

a.

reorientation sessions.

b.

music therapy.

c.

reminiscence therapy.

d.

pet therapy.

e.

looking at family scrapbooks.

ANS: B, D

Global amnesia wipes out all memory. Orientation and family pictures will not be helpful. Activities that stimulate the senses, such as music, stroking an animal, or aroma therapy, can be pleasing.

DIF: Cognitive Level: Application REF: 1093 OBJ: 3 (theory)

TOP: Global Amnesia: Interventions KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

24. The home health nurse assesses a family who is caring for a person with a cognitive deficit for responses that indicates exhaustion, which include: (Select all that apply.)

a.

irritability with other family members and the patient.

b.

report of sleep disturbances.

c.

anger at patient and self.

d.

depression.

e.

fatigue.

ANS: A, B, C, D, E

All options are characteristics of exhaustion in caregivers to the cognitively impaired.

DIF: Cognitive Level: Comprehension REF: 1096 OBJ: 7 (theory)

TOP: Caregiver Fatigue: Signs and Symptoms

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

25. A patient who has been experiencing memory deficits questions the nurse about foods that are associated with better memory. What selections are linked to enhanced memory? (Select all that apply.)

a.

Salmon

b.

Red meat

c.

Pork loin

d.

Leafy green vegetables

e.

Fruits

ANS: A, D, E

Studies show that fish and omega-3 polyunsaturated fats, fruits and vegetables, curcumin (curry spice), and the traditional Mediterranean diet may lower the risk for loss of cognitive function and/or Alzheimers disease.

DIF: Cognitive Level: Comprehension REF: 1098 OBJ: 1 (clinical)

TOP: Health Promotion: Diet and Memory

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

MATCHING

The nurse clarifies terminology related to cognitive disorders. Match the options to the expected characteristics. (Options may be used more than once.)

a.

Cognition

b.

Dementia

c.

Delirium

26. An acute alteration in cognition

27. Characterized by slow onset

28. Experiences an illusion

29. Uses confabulation to cover memory gaps

30. Results from cerebrovascular accident

31. Processes of perception, memory, and judgment

26. ANS: C DIF: Cognitive Level: Knowledge REF: 1085

OBJ: 1 (theory) TOP: Terms: Characteristics KEY: Nursing Process Step: NA

MSC: NCLEX: NA

27. ANS: B DIF: Cognitive Level: Knowledge REF: 1086

OBJ: 1 (theory) TOP: Terms: Characteristics KEY: Nursing Process Step: NA

MSC: NCLEX: NA

28. ANS: C DIF: Cognitive Level: Knowledge REF: 1085

OBJ: 1 (theory) TOP: Terms: Characteristics KEY: Nursing Process Step: NA

MSC: NCLEX: NA

29. ANS: B DIF: Cognitive Level: Knowledge REF: 1086

OBJ: 1 (theory) TOP: Terms: Characteristics KEY: Nursing Process Step: NA

MSC: NCLEX: NA

30. ANS: C DIF: Cognitive Level: Knowledge REF: 1085

OBJ: 1 (theory) TOP: Terms: Characteristics KEY: Nursing Process Step: NA

MSC: NCLEX: NA

31. ANS: A DIF: Cognitive Level: Knowledge REF: 1085

OBJ: 1 (theory) TOP: Terms: Characteristics KEY: Nursing Process Step: NA

MSC: NCLEX: NA

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