Lewis 12th edition Chapter 64: Dementia and Delirium

A patient hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information would indicate that the patient is experiencing delirium rather than

dementia?

a. The patient was oriented and alert when admitted.

b. The patient's speech is fragmented and incoherent.

c. The patient is oriented to person but disoriented to place and time.

d. The patient has a history of increasing confusion over several years.

a. The patient was oriented and alert when admitted.

Which intervention will the nurse include in the plan of care for a patient with mild dementia who is admitted for other health problems?

a. Provide complete personal hygiene care for the patient.

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

c. Reposition the patient frequently to avoid skin breakdown.

d. Place suction at the bedside to decrease the risk for aspiration.

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

Which action would the nurse incorporate during a mental status examination of a patient with

delirium?

a. Wait until the patient is well-rested.

b. Administer an anxiolytic medication.

c. Choose a place without distracting stimuli.

d. Reorient the patient during the examination.

c. Choose a place without distracting stimuli.

The nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. Which intervention would the nurse Implement initially?

a. Secure the patient in bed using a soft chest restraint.

b. Ask the health care provider to prescribe an antipsychotic drug.

c. Assign assistive personnel (AP) to stay with and reorient the patient.

d. Instruct family members to remain with the patient and prevent injury.

c. Assign assistive personnel (AP) to stay with and reorient the patient.

A patient seen in the outpatient clinic is newly diagnosed with mild cognitive impairment (MCI). Which action will the nurse include in the plan of care?

a. Suggest a move into an assisted living facility.

b. Schedule the patient for more frequent appointments.

c. Ask family members to supervise the patient's daily activities.

d. Discuss the preventive use of acetylcholinesterase medications.

b. Schedule the patient for more frequent appointments.

The nurse is administering a mental status examination to a patient with hypertension. The nurse suspects depression when the patient responds to each of the nurse's questions with

which response?

a. "Is that right?"

b. "I don't know."

c. "Wait, let me think about that."

d. "Who are those people over there?"

b. "I don't know."

A patient is diagnosed with moderate dementia after having multiple strokes. Which assessment finding would the nurse expect?

a. Excessive nighttime sleepiness.

b. Difficulty eating and swallowing.

c. Loss of recent and long-term memory.

d. Fluctuating ability to perform simple tasks.

c. Loss of recent and long-term memory.

Which action will help the nurse determine whether a new patient's confusion is caused by dementia or delirium?

a. Ask about a family history of dementia.

b. Administer the Mini-Mental Status Exam.

c. Use the Confusion Assessment Method tool.

d. Obtain a list of the patient's usual medications.

c. Use the Confusion Assessment Method tool.

A 72-yr-old patient is brought to the clinic by the patient's spouse, who reports that the patient is unable to solve common problems around the house. To obtain information about the

patient's current mental status, which question would the nurse ask the patient?

a. "Are you sad right now?"

b. "How is your self-image?"

c. "What did you eat for lunch?"

d. "Where were you were born?"

c. "What did you eat for lunch?"

A patient is being evaluated for Alzheimer's disease (AD). Which information would the nurse explain to the patient's adult children?

a. Brain atrophy detected by an MRI would confirm the diagnosis of AD.

b. New drugs can reverse AD deterioration dramatically in some patients.

c. The most important risk factor for AD is a family history of the disorder.

d. A diagnosis of AD is made only after other causes of dementia are ruled out.

d. A diagnosis of AD is made only after other causes of dementia are ruled out.

Which nursing action will be most effective in ensuring daily medication compliance for a patient with mild dementia?

a. Setting the medications up monthly in a medication box

b. Having the patient's family member administer the medication

c. Posting reminders to take the medications in the patient's house

d. Calling the patient weekly with a reminder to take the medication

b. Having the patient's family member administer the medication

A patient who has severe Alzheimer's disease (AD) is being admitted to the hospital for surgery. Which intervention will the nurse include in the plan of care?

a. Encourage the patient to discuss events from the past.

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

c. Reorient the patient to the date and time every 2 to 3 hours.

d. Provide the patient with current newspapers and magazines.

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

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

a. Reorient the patient several times daily.

b. Have the family bring in familiar items.

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

d. Remind the patient not to wander from the nursing unit.

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

The day shift nurse at the long-term care facility learns that a patient with dementia experienced sundowning late in the afternoon on the previous two days. Which action would the nurse take?

a. Keep window blinds open during the day.

b. Have the patient take a mid-morning nap.

c. Provide hourly orientation to time and place.

d. Move the patient to a quiet room in the afternoon.

a. Keep window blinds open during the day.

Which initial action would the nurse take for a patient with moderate dementia who develops increased restlessness and agitation?

a. Reorient the patient to time, place, and person.

b. Administer a PRN dose of lorazepam (Ativan).

c. Assess for factors that might be causing discomfort.

d. Assign assistive personnel (AP) to stay in the patient's room.

c. Assess for factors that might be causing discomfort.

When administering the Mini-Cog exam to a patient with possible Alzheimer's disease, which action will the nurse take?

a. Check the patient's orientation to time and date.

b. Obtain a list of the patient's prescribed medications.

c. Ask the patient to indicate a specific time on a clock drawing.

d. Determine the patient's ability to recognize a common object.

c. Ask the patient to indicate a specific time on a clock drawing.

Which hospitalized patient will the nurse assign to the room closest to the nurses' station?

a. Patient with Alzheimer's disease who has long-term memory deficit

b. Patient with vascular dementia who takes medications for depression

c. Patient with new-onset confusion, restlessness, and irritability after surgery

d. Patient with dementia who has an abnormal Mini-Mental State Examination

c. Patient with new-onset confusion, restlessness, and irritability after surgery

After change-of-shift report on the memory care unit, which patient with dementia will the nurse assess first?

a. Patient who has not had a bowel movement for 5 days

b. Patient who has a stage II pressure ulcer on the coccyx

c. Patient who is refusing to take the prescribed medications

d. Patient who developed a new cough after eating breakfast

d. Patient who developed a new cough after eating breakfast

After reviewing the health record shown in the accompanying figure for a patient who has multiple risk factors for Alzheimer's disease (AD), which topic will be most important for the

nurse to discuss with the patient?

a. Tobacco use

b. Family history

c. Cholesterol level

d. Head injury history

a. Tobacco use

The spouse of a 67-yr-old male patient with early stage Alzheimer's disease (AD) tells the nurse, "I am exhausted from worrying all the time. I don't know what to do." Which initial actions would the nurse take? (Select all that apply.)

a. Suggest that a long-term care facility be considered.

b. Offer ideas for ways to distract or redirect the patient.

c. Teach the spouse about adult day care as a possible respite.

d. Ask what the spouse knows and thinks about dementia care options.

e. Suggest that the spouse consult with the physician for antianxiety drugs.

b. Offer ideas for ways to distract or redirect the patient.

c. Teach the spouse about adult day care as a possible respite.

d. Ask what the spouse knows and thinks about dementia care options.

Which actions could the nurse delegate to a licensed practical/vocational nurse (LPN/VN)

who is part of the team caring for a patient with Alzheimer's disease? (Select all that apply.)

a. Develop a plan to minimize difficult behavior.

b. Administer the prescribed memantine (Namenda).

c. Remove potential safety hazards from the patient's environment.

d. Refer the patient and caregivers to appropriate community resources.

e. Help the patient and caregivers choose memory enhancement methods.

f. Evaluate the effectiveness of enteral nutrition on the patient's nutrition status.

b. Administer the prescribed memantine (Namenda).

c. Remove potential safety hazards from the patient's environment.

Which actions would the nurse incorporate when communicating with a patient who has moderate Alzheimer's disease? (Select all that apply.)

a. Use kind endearments such as "honey" or "sweetie."

b. Give verbal directions supported by using gestures or pictures.

c. Correct the patient when the patient makes errors in naming items.

d. Give detailed explanations before beginning a procedure or therapy.

e. Redirect the patient to another activity when the patient is frustrated.

b. Give verbal directions supported by using gestures or pictures.

e. Redirect the patient to another activity when the patient is frustrated.