Chapter 17 Flashcards
A 75-year-old male client is brought to the clinic by his son. The son states, “Ever since Mom died, Dad hasn’t been the same. At first he just seemed sad, but now he seems to get mixed up about everything.” The nurse is aware that based on the client’s history, the source of confusion is most likely:
a. Dementia
b. Depression from the loss of his wife
c. Hypoxia of the brain
d. Delirium from medications
ANS: B
Depression in the elderly population is often a cause of confusion. The son’s description of the behaviors of his father since his wife’s death indicate that he became depressed, which has been followed by confusion. Dementia is a gradual onset of confusion, hypoxia is the result of brain injury, and delirium is sudden. Even though it appears that the confusion is caused by the depression, a thorough examination is warranted to confirm the cause.
Vascular dementia is more common in individuals living in:
a. The United States
b. Japan
c. France
d. Australia
ANS: B
The incidence of vascular dementia is more common in Japan for unknown reasons. Japanese citizens who move to the United States have been found to have a decreased rate of vascular dementia.
A newly admitted elderly client seems to become confused and agitated every evening after dinner. This client most likely is suffering from:
a. Alzheimer’s disease
b. Acute dementia
c. Sundown syndrome
d. Delirium
ANS: C
Sundown syndrome typically occurs during the late afternoon, evening, or night when an elderly person is in unfamiliar surroundings. The other three options occur at any time of day, evening, or night. The symptoms often disappear when the client is back in familiar surroundings.
The elderly spouse of a 74-year-old male client states that she has noticed that her husband “doesn’t remember as well as he used to.” She explains that he has been putting on his coat before his shirt, and that he can never get their checkbook to balance as it did in the past. The client is exhibiting signs and symptoms typical of:
a. Vascular dementia
b. Alzheimer’s disease
c. Acute delirium
d. Aging
ANS: B
The person with Alzheimer’s disease commonly shows deficits in familiar tasks. Vascular dementia and acute delirium relate more to confused states, and dementia symptoms should not be assumed to be part of normal aging.
The affective losses of Alzheimer’s N U R S I disease N G T B.C refer O to M losses noticed in the individual’s:
a. Personality
b. Thought processes
c. Ability to make and carry out plans
d. Self-care
ANS: A
Affective losses result in personality changes in the individual with Alzheimer’s disease. Thought processes and self-care do not relate to the individual’s personality, and the ability to make and carry out plans is referred to as conative loss.
The average time that a person with Alzheimer’s disease lives after diagnosis is:
a. 2 years
b. 8 years
c. 10 years
d. 20 years
ANS: B
Eight years is the average, with the life span ranging from 2 to 20 years after diagnosis of the disease.
For those family members who desire to care at home for loved ones who have been given a diagnosis of Alzheimer’s disease, it is important for the nurse to ensure that the family is aware of which caregiver skills and responsibilities will be necessary. What is one of the responsibilities of the caregiver during the middle stage of the disease?
a. Helping the loved one with memory and communication problems
b. Providing a stable, routine environment
c. Providing complete assistance with physical care
d. Adapting to the changing personality and behavior of the loved one
ANS: D
The middle stage is when personality changes begin to occur. It is difficult for the family to see the loss of their loved one’s personality. Helping with memory and communication problems and providing a stable, routine environment occur in the early stage, and complete assistance with physical care is typically a responsibility of the caregiver during the severe stage.
The nurse is answering questions from a client and his family regarding a recent diagnosis of Alzheimer’s disease. The client asks how effective medication is in treating the disease. What is the nurse’s best response?
a. “There is no cure or treatment for Alzheimer’s disease.”
b. “Medications have shown little improvement in symptoms.”
c. “Medications for the disease have been found to improve thinking abilities,
behavior, and daily functioning in some clients.”
d. “Alternative therapies, such as co-enzyme Q-10 and Ginkgo biloba, are more
effective than any of the prescription medications used to treat the symptoms.”
ANS: C
The most accurate statement is to say that medications have been found to improve thinking abilities, behavior, and daily functioning in some clients. Although no cure for the disease is known, it is inaccurate to say that there is no treatment. To say that medications have produced little improvement in symptoms is misleading because it sounds as though medications are not effective. Stating that alternative therapies are more effective is inaccurate because these therapies are still under investigation for determination of their effectiveness in treating symptoms of the disease.
Which of the following is an effective communication technique that should be included in the teaching plan for the family members of a woman in whom Alzheimer’s disease has been diagnosed recently?
a. Use simple, familiar words, along with short and simple sentences.
b. If the client tends to pace a lot, be sure to encourage her to sit during interactions.
c. If she doesn’t understand the communication, change key words.
d. Use hand gestures when speaking to try to explain what is being said.
ANS: A
Alzheimer’s affects cognitive ability, so it is best to use words and phrases that do not require a great deal of thought to be understood. Having the client sit when she likes to pace may increase her anxiety and block communication. Repeat key words to assist in understanding; changing the key words may further confuse the client. Hand gestures may further confuse the troubled thought processes.
The elderly spouse of a female Alzheimer’s client states that his wife seems to wander aimlessly from room to room looking for things in incorrect places, such as kitchen utensils in the bedroom and laundry detergent in the kitchen. He asks the nurse for suggestions of what he can do to help her. What is the nurse’s best response?
a. “Keep rooms well lit.”
b. “Keep the home environment simple and user-friendly for her.”
c. “Have clocks and calendars with large letters in several rooms of the house.”
d. “Place large signs on doors or entryways that identify the room.”
ANS: D
All of these options will assist her in keeping her orientation to the environment, but because she is wandering to the wrong rooms to look for items, signs on the doors and entryways would be most helpful to her N as U she R S finds I N G the appropriate room.
The nurse performs a functional assessment of a client upon admission to a home health service. The purpose of this assessment is to determine the client’s:
a. Level of consciousness
b. Ability to perform activities of daily living
c. Degree of reasoning, judgment, and thought processes
d. Level of functioning memory
ANS: B
This is an important point of assessment if the nurse is trying to determine the level of care necessary for this client. The other options also may be assessed at some point in the admission, but they do not make up the functional assessment.
A 72-year-old client with dementia, who resides in a long-term care facility, frequently goes to her room and cries because she misses her children. This client could benefit most from which intervention?
a. Life review
b. Doll therapy
c. Comfort touch
d. Audio presence therapy
ANS: D
Because missing her children brings sadness to this client, she may benefit from hearing their voices on tape and recalling pleasant family memories. The other interventions are effective therapies for clients with dementia, but they do not address this client’s immediate need.
The medication donepezil (Aricept) frequently is used to treat the early-stage symptoms of Alzheimer’s disease. When administering this particular medication, the nurse should be especially alert to assess the client for:
a. Weight changes
b. Tremors
c. Increased sweating
d. Alterations in blood pressure
ANS: D
This medication may cause high or low blood pressure. The other options typically are not seen with donepezil (Aricept) but sometimes are seen with other Alzheimer’s medications.
Which symptom of Alzheimer’s disease is associated with disorientation to time and place?
a. Forgetting in what order to put clothes on
b. Forgetting simple words
c. Forgetting where one lives
d. Becoming suspicious of others
ANS: C
Additional examples of disorientation to time and place include a person’s getting lost on the street where he or she lives and forgetting how he or she got to places. Forgetting in what order to put on clothing relates to difficulty with performing familiar tasks; forgetting simple words relates to problems with language; and becoming suspicious of others relates to changes in personality.
An elderly woman is brought to the clinic by her daughter. The client states that she has had a cold for several days. Her daughter states that her mother has been confused about when her routine medications are to be taken and that her mother has never experienced confusion about her medications before. Based on this information, it is important that the nurse ask the client whether:
a. There is a history of mental illness in the family.
b. She has been given a diagnosis of a mental health disorder in the past.
c. She can recall her last visit to a physician.
d. She has taken any over-the-counter medications for her cold.
ANS: D
Over-the-counter cold medications can cause confusion in the elderly population. Because this client has had a cold recently, it would be important to determine whether she has been taking any of these types of medications. There is no indication that the other options have any significance in relation to the acute confusion.
