ch 33 Flashcards
A nurse working in a pediatric clinic recognizes that which child is most at risk for cognitive impairment? a. An infant who is being fed reconstituted powdered formula
b. A toddler living in an older home that is being remodeled
c. A preschooler who attends a play group 3 days a week
d. A school-age child who rides a school bus 5 days a week
ANS: B
Older homes frequently have lead-based paint; paint chips generated by remodeling put toddlers, who often put foreign objects in their mouths, at risk for exposure to lead which is a known toxic substance that can affect cognitive function. Powdered formulas, attendance at play groups, or riding on a school bus are not known to impair cognitive development.
The nurse is reviewing new medication orders for several patients in a long-term care facility. Which patient does the nurse recognize as being at the highest risk for having cognitive impairment related to prescribed medications?
a. The patient prescribed an antibiotic for a urinary tract infection
b. The patient prescribed a cholinesterase inhibitor for early Alzheimer disease
c. The patient prescribed a β-blocker for hypertension
d. The patient prescribed a bisphosphonate for osteoporosis
ANS: C
Anti-hypertensives such as the β-blockers can cause adverse changes in cognition. While an infection can affect cognition, antibiotics do not generally cause cognitive changes. The cholinesterase inhibitors are prescribed to slow the progression in cognitive decline for patients diagnosed with Alzheimer disease. Bisphosphonates are used for osteoporosis and are not generally a risk for altered cognition.
The nurse is developing a care plan for a patient newly admitted to a unit that cares for patients with cognitive impairment. What is an important component of care for the patients on this unit?
a. Allow food selections from a menu with several choices.
b. Schedule frequent field trips off the unit for cognitive stimulation.
c. Plan for attendance at activities with several other patients on the unit.
d. Plan for a structured daily routine of events and caregivers.
ANS: D
Patients with a cognitive impairment benefit from a predictable routine and consistent caregivers. Trips off of the unit may confuse the patient and disrupt their normal routine. Offering too many selections causes confusion and can lead to agitation. Being in large groups for activities can overstimulate the patient and lead to agitation and fear.
A patient who is dehydrated has been experiencing confusion. The daughter is concerned about taking the patient home in a confused state. What statement by the nurse is correct?
a. “Don’t worry; the patient should be fine once they are in a familiar environment.”
b. “I can make a referral for a home health aide to assist with the patient.”
c. “Once the dehydration is corrected, the patient’s confusion should improve.”
d. “I can show you how to care for the patient once you return home.”
ANS: C
The confusion caused by an underlying medical condition is a temporary condition that can be corrected once the underlying condition is treated, in this case once the patient is rehydrated. It is not necessary to teach home care or make a referral to home health because it is not expected that the patient will be confused at discharge. Telling the daughter that there is nothing to worry about diminishes her concern and may decrease her trust in the nurse.
An older adult who is cognitively impaired is admitted to the hospital with pneumonia. Which sign or symptom would the nurse expect to be exhibited by the patient?
a. Severe headache
b. Flank pain
c. Increased confusion
d. Decreased blood glucose
ANS: C
Increased confusion is a symptom that occurs in cognitively impaired patients who experience an infection. Severe headache occurs with migraines, meningitis, and other conditions. Flank pain occurs with pyelonephritis. Blood glucose typically increases with an infection.
The nurse is sitting with the family of a patient who has just received the diagnosis of dementia. The family asks for information on what treatment will be needed to cure the condition. What is the nurse’s best response?
a. “Hormone therapy will reverse the condition.”
b. “Vitamin C and zinc will reverse the condition.”
c. “There is no treatment that reverses dementia.”
d. “Dementia can be reversed with diet, exercise, and medications.”
ANS: C
Currently there is no proven treatment that has been shown to reverse dementia, although some treatments can slow the progression of the illness. Hormone therapy, vitamin therapy, diet, and exercise are all important for overall health but do not reverse the progression of dementia.
A cognitively impaired patient newly admitted to the hospital is experiencing signs of sundown syndrome. Which intervention is best for the nurse to implement?
a. Leave a night light on in the room at all times.
b. Leave the television on at night with the volume up.
c. Restrain the patient to maintain safety during the confusion.
d. Administer a sleeping medication to help the patient sleep.
ANS: A
Having a night light on for the patient can help orient them to their surroundings. Having the flickering light and sound from a television will not help a confused patient remain calm or oriented. Restraining a patient will increase their agitation and actually increase their risk of injury if they try to get out of bed. Sleeping medications often increase confusion in cognitively impaired patients.
An 82-year-old patient who is in the hospital awakens from sleep and is disoriented to where she is at the present time. The nurse reorients the patient to her surroundings and helps the patient return to sleep. What data does the nurse consider as a probable cause of the patient’s confusion?
a. Pain medication received earlier in the night
b. The death of the patient’s spouse 2 years ago
c. The patient’s history of diabetes
d. The age of the patient
ANS: A
Medications such as narcotics, hypertensives, sleeping meds, and others can cause disorientation and symptoms of delirium. The death of a spouse is more likely to cause depression than disorientation. A history of diabetes alone does not cause disorientation. Normal aging alone does not cause disorientation, although it is a risk factor.
The nurse is teaching primary prevention of cognitive impairment at a community health fair. Which topics would be included in the presentation? (Select all that apply.)
a. Do not use substances such as cannabis and alcohol.
b. Wear helmets when riding bicycles and motorcycles.
c. Complete a Mini Mental Status Exam (MMSE) yearly.
d. Correct acid-base imbalances related to underlying disease processes.
e. Wear a seat belt whenever riding in a motorized vehicle.
f. Complete a Confusion Assessment Method (CAM) scale yearly.
ANS: A, B, E
Primary prevention attempts to prevent injury. Not using chemical substances, wearing a helmet, and wearing a seat belt are all measures to prevent injury to the brain, which protects cognitive function. An MMSE and CAM are secondary prevention, or screening tools performed once symptoms are present. Correcting acid-base imbalances from underlying disease processes is a tertiary prevention level, aimed at minimizing complications for disease already present.
