Gero Chapter 28 - Delirium and Dementia

A nurse is assessing several older adult clients. The nurse determines which client is experiencing a health problem characterized as delirium rather than dementia?

A. An older adult client experiencing forgetfulness and confusion over the last 48 hours.

B. An older adult client whose personality has changed markedly and has difficulty

finding words lately.

C. An older adult client who has developed an unsteady and awkward gait coupled

with uncoordinated motor skills in recent months.

D. An older adult client who was diagnosed with a brain tumor and who has

experienced changes in behavior and cognition.

A. An older adult client experiencing forgetfulness and confusion over the last 48 hours.

An older adult is admitted to the hospital for surgery. A day later, the client seems confused and disoriented, imagining a trapdoor in the ceiling above the bed. The client's wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that he has always seemed "sharp as a tack." Which action would be the priority?

A. Controlling the environmental temperatures and noises.

B. Checking the client's chart for medications that can cause delirium.

C. Having the client evaluated for Alzheimer's disease.

D. Telling the wife there is nothing to worry about.

B. Checking the client's chart for medications that can cause delirium.

As per routine, the adult child of an 82-year-old client, recovering from a prostate resection, comes to the hospital in the morning to be at the bedside. The child has approached the parent's nurse and stated that the parent is uncharacteristically difficult to rouse this morning, with the only verbal response being occasional nonsensical muttering. Which intervention would be appropriate?

A. Diagnostic imaging to determine the location of any organic brain changes.

B. Assessment of the client's mood and current stressors.

C. Assessment to determine the cause of the client's delirium.

D. Screening for risk factors that would suggest Alzheimer disease.

C. Assessment to determine the cause of the client's delirium.

A 79-year-old client, admitted for hip replacement surgery, reports insomnia the night before. The client received a dose of a prescribed benzodiazepine. Shortly thereafter, the client began displaying signs of delirium that persisted until the morning. Which instruction would the night nurse give to the nurse coming on shift?

A. "Make sure you get a prescription for a sedative this morning."

B. "Try to keep the client's level of stimulation as low as you can."

C. "Let the family know that there are effective drug treatments that will resolve the delirium."

D. "Work with the discharge-planning nurse to help the family reassess living arrangements after discharge."

B. "Try to keep the client's level of stimulation as low as you can."

A nurse is providing care to an older adult client with dementia. When reviewing the client's history, which condition would the nurse suspect as the likely cause?

A. Genetic predisposition

B. Hyperlipidemia

C. Hypokalemia

D. Hypertension

A. Genetic predisposition

A 78-year-old client has been diagnosed as being in the stage 3 of Alzheimer's disease. Which findings would support this assessment?

A. The client displays an uncharacteristically flat affect and denies any cognitive deficits.

B. The client's spouse has recently noticed a change in memory and judgment with the client getting easily flustered in public.

C. The client is commonly oriented to person but becomes easily disoriented to time and place.

D. The client no longer remembers the spouse's name and requires assistance with

most activities of daily living.

B. The client's spouse has recently noticed a change in memory and judgment with the client getting easily flustered in public.

An autopsy is performed to determine the cause of death in an older adult who may have been poisoned. Brain tissue shows neuritic plaques and neurofibrillary tangles in the cortex, but no other abnormalities. What would the future have held for him if he had lived?

A. Vascular dementia

B. Alzheimer's disease

C. Frontotemporal dementia

D. Lewy body dementia

B. Alzheimer's disease

The spouse of an older adult client notices that the client is posting reminder notes throughout the house and making many lists. The spouse thinks these behaviors might be early signs of Alzheimer's disease. What should he do?

A. Be alert for signs of depression.

B. Do not mention the behavior to the client.

C. Provide his wife with zinc and antioxidant supplements.

D. Ask his wife's health care provider to order blood work.

A. Be alert for signs of depression.

A nurse is making a home visit to an older adult client diagnosed with Alzheimer's disease. During the visit, the client's spouse asks, "What would be most helpful in slowing the symptoms?" Which response by the nurse would be appropriate?

A. "There are medications that can slow down the progression by affecting an enzyme that breaks down acetylcholine."

B. "There has been some improvement in the condition when the person avoids exposure to aluminum."

C. "You might want to ask the health care provider to prescribe antibiotics prophylactically to keep things under control."

D. "It has been shown that being exposed to zinc is a cause, so to keep things from

getting worse, avoid further exposure to zinc."

A. "There are medications that can slow down the progression by affecting an enzyme that breaks down acetylcholine."

A nurse is facilitating a group consisting of family members of older adults recently diagnosed with Alzheimer's disease. One of the family members asks the nurse, "What causes this disease?" Which information would the nurse include?

A. "Modifying causative factors can cause a significant improvement in your loved one's condition."

B. "Unfortunately, we still do not really know anything about what exactly causes Alzheimer's disease."

C. "Science has recently discovered the direct link between diet and the development of Alzheimer's disease."

D. "Alzheimer's disease appears to result from a combination of genetic and environmental factors."

D. "Alzheimer's disease appears to result from a combination of genetic and environmental factors."

A nurse is providing care to several adults in the medical unit. When reviewing the medical records of each of the clients, the nurse notes potential risk factors for developing Alzheimer's disease. Which factor would the nurse identify?

A. Family history of Down syndrome

B. A diagnosis of autism

C. Polypharmacy

D. Poorly controlled type 1 diabetes`

A. Family history of Down syndrome

A 71-year-old client, who is obese and has poorly controlled hypertension, is brought to the clinic by the spouse. The client states that while being a smoker since adolescence, many peers have done likewise and still enjoy good health. Over the last 2 to 3 days, the client's spouse has noted that the client has become uncharacteristically forgetful and suspicious. The client was found wandering outside the house last night. The nurse interprets these findings as indicative of which condition?

A. Creutzfeldt-Jakob disease

B. Alzheimer's disease

C. Wernicke encephalopathy

D. Vascular dementia

D. Vascular dementia

The family of a client with Alzheimer's disease wants to know more about the implications of the disease for the entire family. Which response by the nurse would be appropriate for the client's childless 35-year-old daughter?

A. "You should have a brain scan and other testing for Alzheimer's disease."

B. "If you become pregnant, be sure to undergo fetal testing for Down syndrome."

C. "It's probably best if you avoid getting pregnant and having children."

D. "Alzheimer's disease is not hereditary, so you really don't need to worry."

B. "If you become pregnant, be sure to undergo fetal testing for Down syndrome."

A 70-year-old client of a long-term care facility is in the advanced stages of Alzheimer's disease. Consequently, the client frequently wanders throughout and outside the facility. Due to cognitive deficits, the client is not responsive to teaching and redirection. Which action by the staff would be the most appropriate response to the client's behavior?

A. Provide a controlled and safe place within which the client can wander freely around.

B. Work with the client's family to establish a supervision schedule.

C. Administer the minimum effective dose of a sedative when the client is most restless.

D. Begin placing the client in a wheelchair with a tray when he shows signs of restlessness.

A. Provide a controlled and safe place within which the client can wander freely around.

The nursing staff on a subacute medical unit have noted that an 80-year-old client, with a diagnosis of Alzheimer's disease, tends to become agitated in the evening and early in the night. Which intervention would be appropriate to implement to address the client's behavior?

A. Ensure the client's room is kept as dark as possible during the times in question.

B. Limit the client's fluid intake after 1700 to prevent nocturia.

C. Minimize the amount of touch used in nursing care to avoid stimulating the client.

D. Schedule physical therapy in the afternoon hours to help the client expend energy.

D. Schedule physical therapy in the afternoon hours to help the client expend energy.

The nurse is making a home visit to a 77-year-old client diagnosed with Alzheimer's disease 3 months ago. The spouse is the sole care provider, a responsibility that has become increasingly more difficult. When working with the spouse, which action would be most appropriate for the home care nurse to implement?

A. Encouraging the spouse to independently develop techniques for basic care that the spouse feels work best.

B. Emphasizing to the spouse the importance of remaining optimistic and enthusiastic when interacting with the client.

C. Encouraging the spouse to avoid feeling guilty for times when the spouse needs respite.

D. Organizing outside help to eliminate the amount of direct care that the spouse provides.

C. Encouraging the spouse to avoid feeling guilty for times when the spouse needs respite.

The prognosis for an older adult woman in the final stages of Alzheimer's disease is about a year or less. The client has developed breast cancer and the surgeon wants to operate. The client cannot grasp the situation, however, is becoming agitated about it. The client's children think surgery would be painful and not worth the potential benefit. Which suggestion would be most appropriate for the nurse to make?

A. The client should make the decision.

B. The need for surgery is of secondary importance.

C. Surgery is definitely indicated.

D. The insurer should be involved in the decision.

B. The need for surgery is of secondary importance.

The environment of a client with dementia includes photographs of the client's family, soft music, and low lighting. The client wears personal items received as gifts. Unused electrical outlets are covered. Once a day, the client exercises with a group. What additional item should the nurse recommend be used?

A. Nutritional supplements

B. A walker

C. An ID bracelet

D. A commode chair

C. An ID bracelet

A daughter reports that her mother, who has Alzheimer's disease, thinks and acts so slowly that everything must be done for her. Which suggestion would be most appropriate for the nurse to provide initially to the daughter that might be helpful for both the client and herself?

A. "Encourage your mother's self-care, but do it under supervision."

B. "It is important to continue doing tasks for your mother so she does not get

frustrated."

C. "It might be helpful to investigate respite care for yourself."

D. "Allow your mother to do her own care, and let her do it independently."

A. "Encourage your mother's self-care, but do it under supervision."

The spouse of a 74-year-old client is distraught at the client's recent diagnosis of Alzheimer disease. To identify a cure, the spouse is conducting extensive online research as well as speaking with each member of the care team about possible treatments. When talking with the spouse, which response would be appropriate?

A. "There is presently no cure for Alzheimer disease, but highly promising treatments are expected."

B. "Eliminating any exposure to aluminum or mercury has been shown to have a positive impact on people in the early stages of Alzheimer disease."

C. "There is not currently a cure available for Alzheimer disease, but some drugs have been shown to slow the progression of the disease."

D. "There is no treatments for Alzheimer disease. You must move forward and learn to deal with the resulting dementia."

C. "There is not currently a cure available for Alzheimer disease, but some drugs have been shown to slow the progression of the disease."

A nurse is providing care for a client who is in the late stages of vascular dementia. The nurse is in the habit of reorienting the client to person, place, and time. Which statement best explains the nurse's action?

A. Reality orientation can prevent a client from lapsing into a constant state of

dementia.

B. Reality orientation is useful when a client is in the later stages of dementia.

C. Reality orientation can be a useful, beneficial intervention when it is used appropriately.

D. Reality orientation is used to slow the progression of cognitive losses.

C. Reality orientation can be a useful, beneficial intervention when it is used appropriately.

A client diagnosed with Alzheimer disease is agitated and keeps trying to leave the unit. Which action will the nurse take?

A. Apply a seatbelt to the client to prevent rising.

B. Allow the client to wander freely.

C. Engage the client to follow you throughout the unit.

D. Ensure the client's basic needs are met.

D. Ensure the client's basic needs are met.

The unlicensed assistive personnel (UAP) at a long-term care facility reports to the nurse that an older adult client has been found night-wandering several times over the past week. Which intervention(s) will the nurse include in the client's plan of care? Select all that apply.

A. Ensure that the client is engaged in daytime activities, particularly late day exercise.

B. Keep the client's overhead light on all night.

C. Lock the door so that the client cannot leave the room.

D. Assist the client to the bathroom before bedtime.

E. Encourage the client to sleep in the daytime.

A. Ensure that the client is engaged in daytime activities, particularly late day exercise.

D. Assist the client to the bathroom before bedtime.

A gerontological nurse is conducting a program for a group of older adults at a senior center about dementia. One of the group members asks, "I know about Alzheimer's disease, but are there other common causes of dementia in older adults?" Which information would the nurse most likely include as a common cause?

Select all that apply.

A. Normal age-related change

B. Traumatic injury

C. Creutzfeldt-Jakob disease

D. Parkinson's disease

E. Small infarcts of the brain blood vessels

B. Traumatic injury

E. Small infarcts of the brain blood vessels

The nursing staff at a long-term care facility are providing care for a client who requires total assistance secondary to severe Alzheimer's disease. Which intervention(s) will the nursing staff implement to foster the client's dignity, personal worth, and individuality? Select all that apply.

A. Ensuring that any nursing interventions for the client are performed in privacy as much as possible.

B. Using the client's name during interactions despite the fact the client is disoriented to person.

C. Giving the client choices and options even though the client has difficulty making decisions.

D. Attempting to engage the client in conversation despite evidence of cognitive losses.

E. Minimizing stressors by performing as many of the client's activities of daily living (ADLs) as possible.

A. Ensuring that any nursing interventions for the client are performed in privacy as much as possible.

B. Using the client's name during interactions despite the fact the client is disoriented to person.

C. Giving the client choices and options even though the client has difficulty making decisions.

D. Attempting to engage the client in conversation despite evidence of cognitive losses.

A nurse is reviewing the medical records of several older adult clients. Each of the clients experienced delirium. Which factor(s) will the nurse identify as precipitating the clients' delirium? Select all that apply.

A. Urinary tract infection

B. Dehydration from gastroenteritis

C. Low zinc levels

D. A new medication

E. Neurofibrillary tangles

A. Urinary tract infection

B. Dehydration from gastroenteritis

D. A new medication

A gerontological nurse is conducting a program for a group of senior adults and their families about dementia. One of the family members asks, "One time my dad had delirium. What is different if my dad gets diagnosed with dementia?" Which statement(s) would be appropriate? Select all that apply.

A. Dementia will eventually lead to a need for 24-hour care.

B. Dementia and delirium are the same condition.

C. Dementia will present progressively and be an irreversible decline in cognition.

D. Dementia occurs in all older persons at some point in life.

E. Dementia will present quickly and will be a reversible condition.

A. Dementia will eventually lead to a need for 24-hour care.

C. Dementia will present progressively and be an irreversible decline in cognition.