CH 12 psych exam 2

The geriatric nurse is teaching the client’s family about the possible cause of

delirium. Which information should the nurse include in the teaching session?

1. “Taking multiple medications may lead to adverse interactions or toxicity.”

2. “Age-related cognitive changes may lead to alterations in mental status.”

3. “Lack of rigorous exercise may lead to decreased cerebral blood flow.”

4. “Decreased social interaction may lead to profound isolation and psychosis.”

1. taking multiple meds…

A nurse is teaching a community health class about current etiological theories related to Alzheimer’s disease (AD). Which statement by a participant indicates a correct understanding of the information?

1. “A single genetic mutation is responsible for nearly all cases of Alzheimer’s

disease.”

2. “Head injuries can increase the risk of Alzheimer’s disease due to the inflammation they cause.”

3. “Plaques and tangles in the brain are unique to Alzheimer’s disease and not seen in normal aging.”

4. “Ketone bodies contribute to the development of Alzheimer’s disease by

damaging neurons.

2. head injuries can increase the risk…

A client diagnosed with Alzheimer’s disease (AD) can no longer ambulate, does not

recognize family members, and communicates with agitated behaviors and incoherent

moaning. The nurse recognizes these symptoms as indicative of which stage of the

illness?

1. Stage 2

2. Stage 3

3. Stage 4

4. Stage 5

4. stage 5

A client is diagnosed in stage 5 of Alzheimer’s disease (AD). To address the client’s

symptoms, which nursing intervention should take priority?

1. Improve cognitive status by encouraging involvement in social activities.

2. Decrease social isolation by providing group therapies.

3. Promote dignity by providing comfort, safety, and self-care measures.

4. Facilitate communication by providing assistive devices

3. promote dignity….

The nurse is asked why there seems to be more people diagnosed with neurocognitive

disorders (NCDs). Which rationale would the nurse offer?

1. Increased numbers of neurotransmitters have been implicated in the proliferation of NCDs.

2. Similar symptoms of NCD and depression lead to misdiagnoses, increasing numbers of NCDs.

3. Societal stress contributes to the increase in this diagnosis.

4. More people now survive into the high-risk period for NCDs.

4. more people now survive into the high-risk period for NCDs

A client diagnosed recently with Alzheimer’s disease (AD) is prescribed donepezil

(Aricept). The client’s spouse inquires, “How does this work? Will this cure him?”

Which response by the nurse is appropriate?

1. “This medication delays the destruction of acetylcholine, a chemical in the brain

necessary for memory processes. Although most effective in the early stages, it

serves to delay, but not stop, the progression of the disease.”

2. “This medication encourages production of acetylcholine, a chemical in the brain

necessary for memory processes. It delays the progression of the disease.”

3. “This medication delays the destruction of dopamine, a chemical in the brain

necessary for memory processes. Although most effective in the early stages, it

serves to delay, but not stop, the progression of the disease.”

4. “This medication encourages production of dopamine, a chemical in the brain

necessary for memory processes. It delays the progression of the disease.”

1. this medication delays the destruction of acetylcholine….

A client diagnosed with Alzheimer’s disease (AD) exhibits diminished cognitive

functioning, has verbal aggression upon experiencing frustration, and has a nursing

diagnosis of inability to provide self-care. Which nursing intervention is most

appropriate?

1. Organize a group activity to present reality.

2. Minimize environmental lighting.

3. Schedule structured daily routines.

4. Explain the consequences for aggressive behaviors.

3. schedule structured daily routines

After 1 week of continuous mental confusion, an older black client is admitted with a

preliminary diagnosis of Alzheimer’s disease (AD). What would cause the nurse to

question this diagnosis?

1. AD does not typically occur in black clients.

2. The symptoms presented are more indicative of parkinsonism.

3. AD does not develop suddenly.

4. There have been no liver function studies ordered.

3. AD does not develop suddenly

A client diagnosed with Alzheimer’s disease (AD) has impairments of memory and

judgment and is incapable of performing activities of daily living. Which nursing

intervention should take priority?

1. Present evidence of objective reality to improve cognition.

2. Design a bulletin board to represent the current season.

3. Label the client’s room with name and number.

4. Assist with bathing and toileting.

4. assist with bathing and toileting

A nurse is assisting with the diagnostic evaluation of an older adult experiencing

symptoms of dementia. Which of the following diagnostic tests is most commonly

used to identify brain atrophy, which is seen in conditions such as Alzheimer’s

disease?

1. Rapid plasma reagin (RPR)

2. CT scan

3. Vitamin B12 level

4. Blood glucose test

2. CT scan

A client with a history of cerebrovascular accident is brought to an emergency

department experiencing memory problems, confusion, and disorientation. Based on

this client’s assessment data, on which medical diagnosis would the nurse focus the

plan of care?

1. Delirium due to adverse effects of cardiac medications

2. Vascular neurocognitive disorder

3. Neurocognitive disorder due to Huntington’s disease

4. Alzheimer’s disease

2. vascular neurocognitive

An older client has recently moved to a nursing home. The client has a sad affect, has trouble concentrating, and socially isolates. A physician believes the client would benefit from medication therapy. Which medication would the nurse most likely administer to the client?

1. Haloperidol (Haldol)

2. Donepezil (Aricept)

3. Diazepam (Valium)

4. Sertraline (Zoloft)

4. sertaline (zoloft)

The client diagnosed with neurocognitive disorder (NCD) is disoriented and ataxic and wanders. Which is the priority nursing diagnosis?

1. Disturbed thought processes

2. Self-care deficit

3. Risk for injury

4. Altered health-care maintenance

3. risk for injury

A nurse is providing care for a client diagnosed with moderate Alzheimer’s disease (AD) and is discussing treatment options with the health-care team. Which of the following medications is most commonly used to treat cognitive impairment in clients with moderate AD?

1. Memantine (Namenda)

2. Donepezil (Aricept)

3. Ramelteon (Rozerem)

4. Brexpiprazole (Rexulti)

1. memantine (namenda)

The nurse attended a seminar about neurocognitive disorders (NCDs). Which information from the nurse indicates a correct understanding of the differences between NCD and pseudodementia (depression)?

1. NCD has a rapid onset, whereas pseudodementia does not.

2. NCD symptoms include disorientation to time and place, but pseudodementia symptoms do not.

3. NCD symptoms improve as the day progresses, but symptoms of pseudodementia worsen.

4. NCD causes decreased appetite, whereas pseudodementia does not.

2. NCD symptoms include disorientation to time and place, but pseudodementia symptoms do not

Which diagnostic tool is useful for revealing the metabolic activity of the brain?

1. Electroencephalogram (EEG)

2. Magnetic resonance imaging (MRI)

3. Positron emission tomography (PET) scanning

4. Computerized tomography (CT) scanning

3. PET scanning

Which stage of Alzheimer’s disease (AD) is characterized by sundowning?

1. Very mild change

2. Mild cognitive decline

3. Severe cognitive decline

4. Moderately severe cognitive decline

3. severe cognitive decline

Which medication is useful in treating moderately severe cognitive impairment in a

client with a neurocognitive disorder (NCD)?

1. Zaleplon

2. Donepezil

3. Trazodone

4. Physostigmine

2. donepezil

The nurse is caring for a client with self-care deficits. Which outcome will

demonstrate the effectiveness of the nursing intervention?

1. The client will interpret the environment accurately.

2. The client will be able to make their needs known to caregivers.

3. The client will use the measures provided to maintain reality orientation.

4. The client will participate in the activities of daily life with the assistance of

caregivers.

4. The client will participate in the activities of daily life with the assistance of

caregivers.

Which nursing intervention is effective in an agitated client who is at risk for trauma?

1. Encouraging reminiscence therapy

2. Discussing the positive aspects of life

3. Maintaining a low level of stimuli in the environment

4. Encouraging family members to be part of the client’s care

3. maintaining a low level of stimuli in the environment

The nurse is providing soft restraints to a client who is at risk for trauma. Which outcome in the client would demonstrate the effectiveness of the nursing intervention?

1. The client will not experience physical injury.

2. The client will anticipate unmet needs.

3. The client will minimize their confusion.

4. The client will communicate effectively with the nurse.

1. the client will not experience physical injury

Which action does the nurse implement to prevent the risk of accidental trauma while caring for a client with neurocognitive disorder (NCD)?

1. Keeping all lights off at night

2. Positioning the bed as low as possible

3. Using clocks and calendars with large numbers

4. Arranging the client’s room away from the nursing station to avoid disturbance

2. positioning the bed as low as possible

For which client is it most important to have electronically controlled exit doors in a health-care facility?

1. A client with agitation

2. A client with disorientation

3. A client with wandering behavior

4. A client with delusions and hallucinations

3. a client with wandering behavior

An older adult client with neurocognitive disorder (NCD) is experiencing anxiety and has a medical history of confusion and paradoxical excitement. Which could be the reason for the occurrence of these symptoms in the client?

1. Use of barbiturates

2. Use of dopaminergic agents

3. Use of cholinesterase inhibitors

4. Use of longer-acting benzodiazepines

1. use of barbituates

After assessing the cognitive capacity of a client with Alzheimer’s disease (AD), the nurse concludes that the client is in the fourth stage of the disease. Which finding supports the nurse’s conclusion?

1. The client is unable to understand current news events.

2. The client is unable to recall address and phone numbers.

3. The client is unable to recall names of family members.

4. The client is unable to plan or organize office work.

1. the client is unable to understand current news events

A client with neurocognitive disorder (NCD) diagnosed with a disturbed thought

process is undergoing psychotherapy. Which outcome does the nurse expect in the

client on reassessment?

1. The client communicates required needs effectively.

2. The client accomplishes activities of daily living.

3. The client experiences fewer episodes of confusion.

4. The client responds to touch and emotional expressions.

3. the client experiences fewer episodes of confusion

A client who is in stage 4 of Alzheimer’s disease (AD) is undergoing psychotherapy. Which statement of the client’s caregiver indicates effective treatment?

1. “The client is less impulsive and emotionally stable.”

2. “The client has reduced tremors and stiffness in her hands.”

3. “The client has improved cognition and memory.”

4. “The client is able to understand and accept problems.”

4. the client is able to understand and accept problems

Which conditions have been known to precipitate delirium in some individuals?

Select all that apply.

1. Febrile illness

2. Seizures

3. Migraine headaches

4. Gallstones

5. Temporomandibular joint syndrome

1 febrile illness

2 seizures

3 migraine headaches

Which medications have been known to precipitate delirium in clients? Select all that

apply.

1. Antineoplastic agents

2. H2-receptor antagonists

3. Antihypertensives

4. Corticosteroids

5. Lipid-lowering agents

1 antineoplastic agents

2 H2 receptor antagonist

3 antihypertensives

4 corticosteroids

Which focal neurological signs are commonly observed in a client with vascular

neurocognitive disorder (NCD)? Select all that apply.

1. Tremor

2. Posttraumatic amnesia

3. Small-stepped gait

4. Difficulty with speech

5. Weakness of the limbs

3 small stepped gait

4 difficulty with speech

5 weakness of the limbs

Which are the causes of secondary neurocognitive disorders (NCDs) in a client?

Select all that apply.

1. Concussion

2. Contracture

3. Cerebral trauma

4. Vascular disease

5. HIV disease

3 cerebral trauma

5 HIV disease

An older adult client with neurocognitive disorder (NCD) is found to be anxious.

Which medications help reduce the client’s anxiety? Select all that apply.

1. Oxazepam

2. Diazepam

3. Lorazepam

4. Phenobarbital

5. Chlordiazepoxide

1 oxazepam

3 lorazepam

The nurse is teaching a group of student nurses about the metabolic disorders that

precipitate delirium or neurocognitive disorder (NCD) in a client. Which conditions

does the nurse include in the teaching plan? Select all that apply.

1. Hypoxia

2. Hypercarbia

3. Hypoglycemia

4. Hypothyroidism

5. Hyperpituitarism

1 hypoxia

2 hypercarbia

3 hypoglycemia

Major neurocognitive disorder (NCD) constitutes what was previously described as _____ in the DSM-IV-TR.

dementia

Highlight in the case study the most significant abnormal laboratory result that could

be the cause of the client’s current signs/symptoms.

A 70-year-old client has been admitted to your unit for confusion. According to the family, the confusion started 24 hours ago. The client has just been transferred from the emergency room department, and you have finished your report. The client is a resident in a local long-term care facility and has a history of Alzheimer’s dementia, hypertension, coronary artery disease, and diabetes mellitus type 2.

0700 Appears drowsy and is only oriented to person. BP 120/70, P 90, RR 20, oral temp. 98.4°F. Client is lying in bed and is restless and distracted. Speech is rambling and incoherent.

Gave prescribed acetaminophen 325 mg

0900 Urinalysis with 2+ ketones, 1 = protein, positive nitrites, and large leukocytes. WBC is 15,000, Hgb 10.8 g/dL.

Notified health-care provider of the laboratory findings. Received order to start ceftriaxone (Rocephin) 1 g every 24 hours and a urine culture and sensitivity.

1000 Pt. continues to become more agitated. Family member now in room and reports that pt. was oriented ×3 at their last visit 3 days ago. BP 110/55, P 120, RR 24, oxygen saturation 94% on room air. Serum lab results: K 4.9 mEq/L, creatinine 1.3 mg/dL; Na 138 mEq/L.

Initiated oxygen at 2 L/NC per emergency protocol. Notified HCP and received order for FBS stat. Asked LPN to retake client temperature.

1020 Pt. less agitated, oriented X1. Oral temp. 99.6°F; oxygen saturation at 98%. Lab result: serum glucose 180 mg/dL.

Administered 4 units of insulin lispro (Humalog) per sliding scale. Will recheck FBS per sliding scale protocol.

positive nitrites, and large leukocytes. WBC is 15,000