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d) Escorting the client to the client's room for napping
Pg. 767
Allowing the client to nap in an empty room would disrupt unit activity because of frequent bed changes and does not serve any therapeutic purpose. Explaining to the client why this behavior cannot be tolerated would be ineffective because the client has memory impairment and would not remember not to go into the rooms of others. Escorting the client to the client's room for napping allows the client personal space and reinforces the reality of the personal room. Unless daytime napping interferes with nighttime sleep, there is no reason to eliminate short napping periods.
1. A client with Alzheimer's disease in the intensive treatment unit repeatedly tries to go into other clients' rooms to nap during the day. The most appropriate nursing intervention for this client is what?
a) Allowing the client to nap in an empty room
b) Suggesting that daytime napping be decreased
c) Explaining to the client why this cannot be tolerated
d) Escorting the client to the client's room for napping
c) Reminding the client multiple times that he or she will be soon having a bath
Pg. 776-777
Adequately preparing a client for a task can sometimes prevent episodes of agitation or aggression. Reminding a cognitively impaired client about policies is unlikely to be effective, and decreasing the frequency of baths will not necessarily prevent agitation. It is not normally appropriate to change a client's medication administration schedule in light of activities such as bathing.
2. A nurse's aide has rung the call light for assistance while providing a client's twice-weekly bath because the client became agitated and aggressive while being undressed. Knowing that the client has a diagnosis of Alzheimer's disease and is prone to agitation, which measure may help in preventing this client's agitation?
a) Reinforcing the facility's zero-tolerance policy for aggressive behavior
b) Decreasing the frequency of the client's baths from two times to one time per week
c) Reminding the client multiple times that he or she will be soon having a bath
d) Providing all of the client's daily medications early on the day of a scheduled bath
b) A primary brain pathology
Pg. 783
Dementia results from primary brain pathology that usually is irreversible, chronic, and progressive. The prognosis depends on whether the cause can be identified and the condition reversed.
3. A client is being evaluated for decline in cognitive function. The client's wife asks the nurse to explain the term dementia to her. The nurse bases her response on the knowledge that dementia is which of the following?
a) Does not always affect memory
b) A primary brain pathology
c) Often reversible if diagnosed and treated quickly
d) Secondary to a medical condition
a) Signs of delirium
Pg. 758-759
Delirium is a syndrome characterized by a rapid onset of cognitive dysfunction and disruption in consciousness. Growing rates of delirium mirror the increasing older adult population and are expected to continue to rise. Delirium is the most common psychiatric syndrome in general hospitals, occurring in up to 50% of elderly inpatients. It is associated with significantly increased morbidity and mortality both during and after hospitalization.
4. The nurse receives a report that a 75-year-old client is recovering from surgery. During the shift, the nurse notes that the client is forgetful and restless. Several times, the client calls the nurse the name of the client's daughter. The nurse interprets this behavior as what?
a) Signs of delirium
b) Signs of early Alzheimer's disease
c) Normal for the first postoperative day
d) Normal, given the client's age
c) Agnosia
Pg. 763
Agnosia is the inability to recognize familiar objects. Amnesia is failure to remember past events. Apraxia is impairment in the ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function.
5. The client is brought to the clinic with dementia and is unable to recognize ordinary objects, such as a pen or notebook. The family is upset and concerned. The nurse notes that this is a symptom of which condition?
a) Aphasia
b) Amnesia
c) Agnosia
d) Apraxia
c) Gastrointestinal (GI) symptoms
Pg. 763-766
All four of the commonly prescribed cholinesterase inhibitors have the possibility of producing GI symptoms.
6. A nurse is providing education to the care provider of a cognitively impaired client who is prescribed a cholinesterase inhibitor. Which information about medication side effects should the nurse be sure to include?
a) Syncope
b) Skin rashes
c) Gastrointestinal (GI) symptoms
d) Bruising
c) An 82-year-old client with a temperature of 103.2 degrees F
Pg. 758-759
Risk factors associated with delirium include advanced age, infection, pain, dehydration, and hyperthermia. The client who is 82 years old and has a significantly high fever would be at greatest risk. This client is the oldest and has an additional risk factor of hyperthermia.
7. A nurse is reviewing the medical records of several older adult clients. Which client would the nurse most likely identify as being at greatest risk for developing delirium?
a) A 60-year-old client with abdominal pain
b) A 65-year-old adult client with gastroenteritis
c) An 82-year-old client with a temperature of 103.2 degrees F
d) A 70-year-old client diagnosed with multiple sclerosis
b) Demonstrate the exercises while clients simultaneously perform them
Pg. 767
The nurse demonstrates physical activity because they may not initiate such activities independently; many clients tend to become sedentary as cognitive abilities diminish. Clients often are quite willing to participate in physical activities but cannot initiate, plan, or carry out those activities without assistance. Clients are likely to be unable to adequately follow verbal or video instructions. Excessive variation in routines should be avoided, but there is no need to repeat the same routine every day.
8. The nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation?
a) Perform the same routine daily to avoid the need for repeated instruction
b) Demonstrate the exercises while clients simultaneously perform them
c) Describe the exercise immediately before performing it
d) Show an instructional video just prior to the activity
d) Managing environmental stimuli
Pg. 758
Adequate lighting, easy-to-read calendars and clocks, a reasonable noise level, and frequent verbal orientation may reduce the frightening experiences associated with delirium. Clients with delirium become overstimulated easily; their ability to process environmental stimuli is impaired and overstimulation must be avoided. Detailed explanations will be difficult for the client to follow. Rest is important, but nonpharmacologic methods are preferred. Distraction is likely to lead to overstimulation.
9. Which is the most effective intervention for clients with delirium?
a) Promoting rest with PRN medications
b) Providing activities for distraction
c) Giving detailed explanations
d) Managing environmental stimuli
c) Memory
Pg. 763-766
The most dramatic and consistent cognitive impairment is memory. The mental status assessment can be difficult for clients with dementia because cognitive disturbance is the clinical hallmark of dementia. Deficits in visuospatial tasks that require sensory and motor coordination develop early, drawing is abnormal, and the ability to write may change. Language is progressively impaired. Judgment, reasoning, and the ability to solve problems or make decisions are also impaired later in the disorder, closer to the time of placement in a nursing home.
10. Which of the following is the most consistent and dramatic cognitive impairment seen in dementia?
a) Language
b) Visuospatial
c) Memory
d) Executive functioning
b) Fold towels
Pg. 779
Folding towels and pillowcases is a simple activity that redirects the client's attention. Also, because this activity is familiar, the client is likely to perform it successfully. Playing chess, putting together a large puzzle, and aerobic exercise are too complicated for a confused client.
11. A client with Alzheimer's disease is confused and mumbling incoherently and rambling. To help redirect the client's attention, the nurse should encourage the client to...
a) Perform an aerobic exercise
b) Fold towels
c) Put together a 250-piece puzzle
d) Play chess with another client
c) An altered level of consciousness
Pg. 758-759
The primary sign of delirium is an altered level of consciousness that is seldom stable and usually fluctuates throughout the day. All other options are not the primary sign of delirium.
12. A client has been newly diagnosed with delirium. The nurse knows that the primary sign of delirium includes which of the following?
a) Impaired socialization
b) Disturbed sleep-wake cycles
c) An altered level of consciousness
d) Inability to fulfill role
d) Client wandering off
Pg. 763
Alzheimer disease (AD) is a progressive neurological, neuropsychiatric disorder that results in cognitive, functional, physical, and behavioral decline and ultimately death. Typically, AD presents late onset in age, but it can also occur early onset in age. There are three stages of progression: mild, moderate, and severe. Wandering is associated with the moderate stage. Wandering off and incontinence are the main factors leading to placement of individuals in care facilities. Maintaining a stoic affect is seen in the mild stage. Preference of taking showers is not considered a reason for placement.
13. Family members bring an older client, recently diagnosed with Alzheimer disease, to the clinic stating they need placement in a facility for their loved one. Which finding would support further assistance in care giving for this client?
a) Client maintaining stoic affect
b) Client preferring to take showers
c) Age of the client
d) Client wandering off
b) Protecting from injury
Pg. 766-767
The priority of care changes throughout the course of AD. Initially, the priority is delaying cognitive decline and supporting family members. Later, the priority is protecting the client from injury because of lack of judgment. Near the end, the physical needs of the client are the focus of care.
14. A nurse is developing the plan of care for a client with dementia who is demonstrating problems with judgment and decision making. The nurse would identify which area as the priority for this client?
a) Preventing further cognitive decline
b) Protecting from injury
c) Maintaining fluid balance
d) Promoting adequate rest
c) Aphasia
Pg. 763
Aphasia is an alteration in language ability. Agnosia is the failure to recognize or identify objects despite intact sensory function. Apraxia is impairment in the ability to execute motor activities despite intact motor functioning. Akinesia is impaired muscle movement that may occur in Parkinson's disease.
15. A client diagnosed with Alzheimer's disease has an alteration in language ability. This alteration would be documented as what?
a) Agnosia
b) Akinesia
c) Aphasia
d) Apraxia
c) Move the client to a quieter area during these times
Pg. 774
The nurse must alter the environment because the client will not learn new coping skills for frustrating or overly stimulating situations. Administering an antianxiety agent or explaining the routine of the unit and reasons for increased activity to the client may be done but would not be the initial intervention. The unit activity does not need to be kept to a minimum.
16. The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which of the following interventions should the nurse implement first?
a) Explain the unit routine and the reasons for increased activity to the client
b) Administer an antianxiety drug such as lorazepam (Ativan) at these times
c) Move the client to a quieter area during these times
d) Keep unit activity to a minimum
d) Apraxia
Pg. 763
Apraxia is the impaired ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function. Agnosia is the inability to recognize the name of objects. Executive functioning is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior.
17. A client has been diagnosed with dementia and is exhibiting several cognitive disturbances. Which of the following terms is used to describe the inability to execute motor functioning despite intact motor abilities?
a) Executive functioning
b) Agnosia
c) Aphasia
d) Apraxia
c) Obtain a repeat urine culture
d) Contact the health care provider
e) Maintain adequate hydration
Pg. 758-759
Because the older client has finished treatment for the UTI, there is no need for the nurse to stop the prescribed antibiotic therapy. It would be important for the nurse to contact the health care provider and appraise them of the client's present cognitive status. Maintaining adequate hydration is also a priority, as is obtaining a repeat urine culture to make sure that the UTI has resolved and to rule out dehydration. There is no need to sedate the client as they are already experiencing decreased cognition.
18. An older client has recently finished treatment for a urinary tract infection (UTI) and has now developed changes in behavior resulting in decreased cognition. Which priority intervention(s) should the nurse perform? Select all that apply.
a) Obtain an order for sedation
b) Stop the prescribed antibiotic therapy
c) Obtain a repeat urine culture
d) Contact the health care provider
e) Maintain adequate hydration
c) Providing emotional support and gentle reminders
Pg. 776-777
Clients in the mild stage of Alzheimer's disease are aware that something is happening to them and may become forgetful, have difficulty finding words, frequently lose objects and begin to experience some anxiety regarding the forgetfulnes. Therefore, nursing care typically focuses on providing emotional support and gentle reminders. The other options are appropriate as the dementia progresses and the client needs continuous monitoring to prevent injuries and when maintaining adequate nutrition may become a challenge. During the later stages, the client will likely need to be moved to a care home to ensure the client is safe and can meet the activities of daily living. At this point, adequate nutrition can only be ensured by having the client monitored throughout the day, providing additional support for the decision to move the client to a care home.
19. A client is in the mild stage of dementia due to Alzheimer's disease. Which intervention would be most appropriate?
a) Advocating for the client to be transitioned to a care home
b) Suggesting new activities for the client and family to do together
c) Providing emotional support and gentle reminders
d) Offering nourishing finger foods to help maintain the client's nutritional status
d) The nurse gave the client a chance to calm down before resuming the meal
Pg. 773-774
Time away involves leaving clients for a short period and then returning to them to reengage in interaction. The nurse can leave the client for about 5 or 10 minutes and then return without referring to the previous outburst. The client may have little or no memory of the incident and may be pleased to see the nurse on his or her return. The safety of other clients is important but is not threatened by a client's outburst to a nurse.
20. A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which best explains the nurse's behavior?
a) The nurse stepped away to verify the safety of other clients
b) The nurse was frustrated and needed to take a "time-out"
c) The nurse was unsure of how to calm the client
d) The nurse gave the client a chance to calm down before resuming the meal
b) Visual
Pg. 758-759
Visual, rather than auditory, hallucinations are the most common in those with dementia. Auditory, gustatory, and olfactory hallucinations are not the most common type seen in people with dementia.
21. Which type of hallucination most commonly occurs in clients diagnosed with dementia?
a) Auditory
b) Visual
c) Gustatory
d) Olfactory
a) Visual
Pg. 758-759
Visual hallucinations are the most common type seen in clients diagnosed with delirium.
22. Which type of hallucination is most commonly seen in clients diagnosed with delirium?
a) Visual
b) Autonomic
c) Auditory
d) Gustatory
d) The client reports seeing "hundreds of bugs" and is not always oriented to time and place
Pg. 758-759
The diagnosis of delirium is supported when the nurse documents that the client is convinced that the client sees hundreds of bugs and is not always oriented to time and place. Repeatedly asking about location and attempting to drink the water in a flower vase are more characteristic of dementia than delirium. Spending much of the day sleeping in the dayroom and usually denying being hungry are more representative of depression, as are responding to most assessment questions with "I don't know" and appearing apathetic.
23. The diagnosis of delirium is supported when the nurse notes what about the client?
a) The client repeatedly asks where the client is and attempts to drink the water in a flower vase
b) The client spends much of the day sleeping in the dayroom and usually denies being hungry
c) The client responds to most assessment questions with "I don't know" and appears apathetic
d) The client reports seeing "hundreds of bugs" and is not always oriented to time and place
c) Take a nap mid-afternoon and before dinner
Pg. 779
Clients with dementia often experience disturbed sleep-wake cycles; they nap during the day and wander at night. This behavior can contribute to the nighttime activity. The other options are not likely to affect sleep cycles.
24. Which client behavior should the nurse attempt to change when managing a client's tendency to wander and pace at night?
a) Watch television after dinner
b) Insist on having the curtains left open at night
c) Take a nap mid-afternoon and before dinner
d) Request a bedtime snack of milk and cookies
c) Acetylcholine
Pg. 763-764
Acetylcholine is involved in cognitive functioning. Epinephrine, serotonin, and norepinephrine are not as involved in cognitive functioning.
25. In clients with Alzheimer's disease, neurotransmission is reduced, neurons are lost, and the hippocampal neurons degenerate. Which neurotransmitter is most involved in cognitive functioning?
a) Serotonin
b) Epinephrine
c) Acetylcholine
d) Norepinephrine
b) Agnosia
Pg. 763
Agnosia is the inability to recognize the name of objects. Apraxia is the impaired ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function. Executive functioning is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior.
26. Which of the following terms describes an inability to recognize or name objects despite intact sensory abilities?
a) Aphasia
b) Agnosia
c) Apraxia
d) Executive functioning disturbance
a) Pneumonia
Pg. 760
Delirium in the older adult is associated with medications, infections, fluid and electrolyte imbalance, metabolic disturbances, or hypoxia or ischemia. Infections of the respiratory tract such as pneumonia or urinary tract are among the most common infection-related causes. Appendicitis and cellulitis are not commonly associated with the development of delirium. Although low platelet count would render the older adult vulnerable to bleeding and easy bruising, it does not increase the risk of delirium.
27. An older adult client develops delirium secondary to an infection. Which would be the most likely cause?
a) Pneumonia
b) Cellulitis
c) Appendicitis
d) Low platelet count
d) The client is using confabulation
Pg. 769
In mild and moderate dementia, clients may make up answers to fill in memory gaps (confabulation). It is a defensive tactic to protect self-esteem and prevent others from noticing memory loss. The client's response was not given facetiously, so it cannot be assessed as an attempt at humor. Perseveration refers to repeating a word or phrase over and over, and delirium is a less likely cause because the client has a known diagnosis of dementia.
28. During morning care, a nursing assistant asks a client with dementia, "How was your night?" The client replies, "It was lovely. My husband and I went out to dinner and to a movie." The nurse, who overhears this conversation, would make which assessment regarding the client?
a) The client is perseverating
b) The client is demonstrating a sense of humor
c) The client is delirious
d) The client is using confabulation
c) Identify a picture of a car
Pg. 763
Agnosia is the failure to recognize or identify objects despite intact sensory function, so the nurse documents that a client diagnosed with dementia of the Alzheimer's type is exhibiting it when the client is observed being unable to identify a picture of a car. Apraxia is the impaired ability to carry out motor activities despite motor function; aphasia is the presence of language disturbance; and disturbances in executive functioning manifest in things like the inability to open a juice container.
29. The nurse documents that a client diagnosed with dementia of the Alzheimer's type is exhibiting agnosia when the client is observed being unable to...
a) Open juice and insert a straw into the container
b) Button a blouse
c) Identify a picture of a car
d) Find words to describe the client's daughter's appearance
a) Reminding the client multiple times that he or she will be soon having a bath
Pg. 776-777
Adequately preparing a client for a task can sometimes prevent episodes of agitation or aggression. Reminding a cognitively impaired client about policies is unlikely to be effective, and decreasing the frequency of baths will not necessarily prevent agitation. It is not normally appropriate to change a client's medication administration schedule in light of activities such as bathing.
30. A nurse's aide has rung the call light for assistance while providing a client's twice-weekly bath because the client became agitated and aggressive while being undressed. Knowing that the client has a diagnosis of Alzheimer's disease and is prone to agitation, which measure may help in preventing this client's agitation?
a) Reminding the client multiple times that he or she will be soon having a bath
b) Providing all of the client's daily medications early on the day of a scheduled bath
c) Reinforcing the facility's zero-tolerance policy for aggressive behavior
d) Decreasing the frequency of the client's baths from two times to one time per week
d) Serve meals in small, bite-size pieces
Pg. 774
Clients with dementia should eat well-balanced meals appropriate to their activity level and eating abilities, with special attention given to electrolyte balance and fluid intake. Clients who have difficulty manipulating utensils may be unable to cut meat or other foods into bite-sized pieces. Food that can be eaten without utensils, or finger foods such as sandwiches and fresh fruits, may be best. Distractions should be avoided so the client can focus on eating. If the client is taking a long time to eat, it may be beneficial to do another activity and then return to eating later.
31. The nurse is providing care to a client with dementia to meet the client's nutritional needs. Which approach would be most appropriate for the nurse to implement to assist in meeting adequate dietary intake?
a) Sit with the client as long as necessary to complete the meal
b) Provide entertainment during meals such as television or music
c) Avoid between-meal snacks to encourage appetite
d) Serve meals in small, bite-size pieces
c) Use of disposable, adult diapers
Pg. 766-767
Urinary incontinence can be managed with the use of disposable, adult-size diapers that must be checked regularly and changed expeditiously when soiled. Indwelling catheters foster the development of urinary tract infections and may compromise the client's dignity and comfort. Use of intermittent catheterization and condom catheters would not be the best options, either.
32. To manage voiding issues, such as incontinence, male clients diagnosed with dementia would best be managed by what?
a) Condom catheter
b) Indwelling catheters
c) Use of disposable, adult diapers
d) Intermittent catheterization
d) Signs of stress
Pg. 763-764
Nurses must assess family members, especially caregivers, for signs of stress or burnout. Although this issue might not be pertinent during early stages of dementia, it becomes paramount as clients progressively degenerate and demands for physical care mount.
33. The client is 42 years old, married, and has two children, ages 16 and 18. The client is also caring for the client's parent, who is in the late stages of Alzheimer's disease. The nurse would want to assess the client for what?
a) Signs of dominance
b) Likelihood to engage in elder abuse
c) Early signs of Alzheimer's disease
d) Signs of stress
a) Benzodiazepines
Pg. 760-761
Sedatives and benzodiazepines are avoided because they may worsen delirium.
34. Which of the following drug classifications is avoided due to the fact that they may worsen delirium?
a) Benzodiazepines
b) Antipsychotics
c) Vitamins
d) Nonbenzodiazepines
b) Frontal
Pg. 783
The dementia syndrome of Huntington disease is characterized by insidious changes in behavior and personality. Typically, the dementia is frontal, which means that the person demonstrates prominent behavioral problems and disruption of attention.
35. When describing the dementia associated with Huntington disease, a nurse understands that the problems involving behavior and attention arise from a disruption in which lobe of the brain?
a) Parietal
b) Frontal
c) Temporal
d) Occipital
a) Designate a staff member to accompany the client on the walk
Pg. 779
The principal means of dealing with restless patientsis to have an adequate number of staff (or caregivers in the home setting) to provide supervision, as well as electronically controlled exits. The nurse teaches clients to request assistance for activities such as getting out of bed or going to the bathroom. If clients cannot request assistance, they require close supervision to prevent them from attempting activities they cannot perform safely alone. The nurse responds promptly to calls from clients for assistance and checks clients at frequent intervals. There is no need to suspect a client's motives for wanting to walk. It would be inappropriate and unnecessary to deny the client a walk unless it was the only way to ensure the client's safety.
36. A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client is restless, approaches the nurse and states, "I'm going to take a walk outside. I'll be back in about 10 minutes." Which is the most appropriate nursing action?
a) Designate a staff member to accompany the client on the walk
b) Give the client permission to go on a walk on the grounds
c) Tell the client the walk is not allowed and restrict the client to the unit
d) Further assess the client's motives for wanting to walk
b) Achievement of self-esteem needs
Pg. 760
The primary goal of treatment of individuals with delirium is prevention or resolution of the acute confusional episode with return to previous cognitive status and interventions focusing on (1) elimination or correction of the underlying cause and (2) symptomatic and safety and supportive measures. Self-esteem is not an issue with delirium.
37. After teaching a group of nursing students about delirium, the instructor determines a need for additional teaching when the students identify which as a primary goal of nursing care?
a) Protection from injury
b) Achievement of self-esteem needs
c) Management of confusion
d) Meeting physiological and psychological needs
b) Increase frustration
Pg. 776-777
Alzheimer's disease is progressive; clients do not learn new information, and they become frustrated when asked to perform tasks they are not capable of doing.
38. The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. The nurse recognizes that this activity is likely to do which of the following?
a) Slow the progress of the disease
b) Increase frustration
c) Improve memory retention
d) Decrease environmental misinterpretation
a) Memantine
Pg. 774-776
Memantine is a NMDA receptor antagonist that has been shown to improve cognition and activities of daily living in clients with moderate to severe symptoms of dementia. Galantamine, donepezil, and rivastigmine are cholinesterase inhibitors.
39. Which of these is a N-methyl-D-aspartic acid (NMDA) receptor antagonist?
a) Memantine
b) Donepezil
c) Rivastigmine
d) Galantamine
d) Increased severity of physical illness
Pg. 758-759
Risk factors for delirium include increased severity of physical illness, older age, and baseline cognitive impairment such as that seen in dementia. Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of a day. Prevalence of dementia also rises with age, and progression is gradual. Obesity does not necessarily predispose a client to delirium. An individual's coping skills do not predispose him or her to delirium.
40. Which is believed to be a risk factor specific to the development of delirium?
a) Ineffective coping
b) Gradual decline in functioning
c) Obesity
d) Increased severity of physical illness
d) The capsule can be opened and contents sprinkled over food
Pg. 774-775
Memantine and donepezil is a combination drug used to treat dementia. The effects of the drug decrease in efficacy over time. The medication should be given in the evening, not the morning. The contents of the capsule can be opened and sprinkled over food for easier medication administration and to minimize nausea and vomiting, side effects of the medications.
41. A client diagnosed with dementia has been prescribed memantine and donepezil by the health care provider. Which information does the nurse include when providing education to the family?
a) Each medication can be given separately
b) The effects of the drug become stronger over time
c) The medication should be given in the morning
d) The capsule can be opened and contents sprinkled over food
c) The client is confabulating, most likely to cover for memory deficit
Pg. 769
The client may have some difficulty recalling events or knowledge that the client formerly knew to be fact. Because of the inability to recall recent events, the client may be confabulating, or filling in memory gaps with fabricated or imagined data.
42. The client has early Alzheimer's disease. When asked about family history, the client relates that the client has two children who are both grown and who visit the client around the holidays each year. The nurse subsequently discovers that the client has one child who is currently assigned overseas and who has not been home for 2 years. Which would best describe the client's behavior?
a) The client is confused about the client's children and needs refocusing
b) The client demonstrates aphasia when discussing the client's children
c) The client is confabulating, most likely to cover for memory deficit
d) The client is showing signs of agnosia in that the client is unable to name the client's children
a) It has a rapid onset and is highly treatable if diagnosed quickly
Pg. 760
Delirium often is caused by an acute disruption of brain homeostasis. When the cause of that disruption is eliminated or subsides, the cognitive deficits usually resolve within a few days or sometimes weeks. Dementia, in contrast, results from primary brain pathology that usually is irreversible, chronic, progressive, and less amenable to treatment.
43. Delirium can be differentiated from many other cognitive disorders in which way?
a) It has a rapid onset and is highly treatable if diagnosed quickly
b) It is much less responsive to pharmacologic treatment than the other disorders
c) It has as a slow onset, but if caught early it can be treated with medications
d) It is characterized by a period of disorganization and confusion
b) Provide the client with a tray, opening containers for the client
Pg. 767
The ability of clients to care for themselves decreases as the severity of the cognitive order increases. Caregivers can help by enhancing the client's environment to facilitate his or her limited ability to perform activities of daily living and instrumental activities of daily living and by fulfilling unmet client needs.
44. The client has advanced Alzheimer's disease and becomes confused at mealtimes. The client has agnosia, apraxia, and disturbed executive functioning. Which is the most appropriate nursing intervention?
a) Ask the client what the client would like from the buffet and give the client finger foods
b) Provide the client with a tray, opening containers for the client
c) Have the client eat in the client's room to avoid distractions while eating
d) Provide the client with a tray but encourage the client to open the client's own packages
a) 10
Pg. 758-759
Risk for Alzheimer's disease increases with age, and average duration from onset of symptoms to death is 8 to 10 years.
45. A nurse is working with a client, and family of the client, who has a diagnosis of Alzheimer's disease. The nurse explains to the client and family that the average course of the disease is how many years?
a) 10
b) 15
c) 20
d) 25
a) Slow deterioration of memory and function
Pg. 783
Compelling evidence shows that drugs that inhibit acetylcholine (ACh) destruction or increase cholinergic activity can slow deterioration of memory and function. Cholinesterase inhibitors increase availability of ACh by interfering with the enzyme that breaks it down. These centrally acting drugs help elevate the level of ACh by decreasing the binding sites of acetylcholinesterase, which lengthens the potential for cholineregic activity.
46. A client is diagnosed with dementia related to Parkinson's disease. While at a clinic visit, a cholinesterase inhibitor is prescribed for the client. The nurse knows that this type of medication would be prescribed for the client to achieve which goal?
a) Slow deterioration of memory and function
b) Decrease tremors associated with Parkinson's disease
c) Increase the number of neurons in the brain
d) Decrease combative behaviors and hallucinations
a) Distract the client with family photos and discuss the events pictured
Pg. 773
At times, there may seem to be no way to resolve the emotional frustration, agitation, or outbursts of the client who is angry with the environment and those in it. The caregiver might find it beneficial to redirect or distract the client. This can be done by asking to see a client's personal items, such as photographs, and then talking about the family members and life events illustrated by the photographs in the book.
47. The spouse caregiver of a client with dementia tells the nurse that the client has been agitated lately. The spouse states, "I don't know how to handle this. The client was always such a gentle person!" Which interventions should the nurse suggest?
a) Distract the client with family photos and discuss the events pictured
b) Distract the client by turning on the television or watching a video
c) Leave the client in a safe place in the house and go to another area until the client calms down
d) Give the client a sedative when the client begins to get agitated
c) Disinhibition
Pg. 773
The client is exhibiting disinhibition, which involves acting on thoughts and feelings without exercising appropriate social judgment. In AD, the client may decide that he or she is more comfortable naked than with clothes. Or the client may not be able to find his or her clothes and may walk into a room of people without any clothes on. Hypersexuality is inappropriate and socially unacceptable sexual behavior. Hypervocalization involves the screams, curses, moans, groans, and verbal repetitiveness that are common in the later stages of AD in cognitively impaired older adults. Catastrophic reactions are overreactions or extreme anxiety reactions to everyday situations. Catastrophic responses occur when environmental stressors are allowed to continue or increase beyond the patient's threshold of stress tolerance. Behaviors indicative of catastrophic reactions typically include verbal or physical aggression, violence, agitated or anxious behavior, emotional outbursts, noisy behavior, compulsive or repetitive behavior, agitated night awakening, and other behaviors in which the patient is cognitively or socially inaccessible.
48. A caregiver of a client with dementia brings the client to the clinic for an evaluation. During the visit, the caregiver states, "Sometimes, out of the clear blue, he'll come into the kitchen while we're eating breakfast without any clothes on. It's really upsetting to me and the family." The nurse interprets this behavior as:
a) Hypersexuality
b) Catastrophic reaction
c) Disinhibition
d) Hypervocalization
