Dementia

Question 1

Dementia
a) onset
b) duration
c) s/s when occur?

Answer 1

a) gradually worsen over time
b) years
c) better and worse times of day

Question 2

Delirium
a) onset
b) duration
c) s/s when occur?

Answer 2

a) Rapid
b) hours, weeks,months
c) significantly and frequently throughout the day

Question 3

Delirium
Risk factor

Answer 3

-sever or chronic illenss
-older males
-drugs
-environment
-infection
-surgery(is this normal nehavior?)

Question 4

The Confusion Assessment Method (CAM)
Feature 1
a) obtained from?
b) what questions?

Answer 4

a) family member or nurse
b) Is there evidence of an acute change in mental status from the patient’s baseline?

Question 5

The Confusion Assessment Method (CAM)
Feature 2
a) what questions?

Answer 5

Did the patient have difficulty focusing attention, for example, being easily distractible, or having difficulty keeping track of what was being said?

Question 6

a) Feature 3?
b) Feature 4?

Answer 6

a) Disorganized thinking
b) Altered LOC(alraet=normal)
The diagnosis of delirium by CAM requires the presence of features 1 and 2 and either 3 or 4.

Question 7

Delilium
Nursing care

Answer 7

-Touch and verbal communication
-nurse can chart in the patient’s rooms
-sit with pt
-reoriented frequently
-close to the nurses’ station
-if pt is overstimulated, private room, dim the lights, reduce the noise.

Question 8

Question 9

Mild stage

Answer 9

-forgetness beyond normal
-short term memory loss
-unable to slove simple math

-stop driving

Question 10

Moderate

Answer 10

-obvious confusion/memory loss
-require ADL help
-incontinence
-family recognize problem
-behavior problem

lock doors
wear briefs
well lit home
label drawers

Question 11

Severe

Answer 11

-unable to perform seld-care
-aphasia
-dysphagia
-eating disorder
-immobile

Question 12

a) DO
b) DO NOT

Answer 12

a)
-Use gentle touch and direct eye contact.
-Give directions using gestures or pictures.
-Simplify tasks. Focus on one thing at a time.
b)
-do everything for them
-Correct them
-Rush or hurry the patient.
-Force participation in activities or events.
-Try to explain “why” or rationalize.

Question 13

Dementia is defined as a
a) syndrome that results only in memory loss
b) disease associated with abrupt changes in behavior
c) disease that is always due to reduced blood frow to the brain
d) syndrome characterized by cognitive dysfunction and loos of memory

Answer 13

d

Question 13

Which statements accurately describe mild cognitive impairment? SATA
a) Cannot be detected by screening tests
b) The person may appear normal to the casual observer
c) Family members may see changes in the pt’s abilities
d) Problems that the person is experiencing interfere with daily activities
e) The person is usually aware that there is a problem with his pr her memory

Answer 13

b,c,e

Question 14

The clinical diagnosis of dementia is based in
a) CT or MRS
b) brain biopsy
c) electroencephalogram
d) pt history and cognitive assesment

Answer 14

d

Question 15

Which statement by the wife of a patient with Alzheimer’s disease demonstrates an accurate understanding of her husband’s medication regimen?
a) “I’m really hoping his medications will slow down his mental losses.”
b) “We’re both holding out hope that this medication will cure his disease.”
c) “The medications might prevent a bodily decline while he declines mentally.”
d) “If we follow his medication schedule, he may not have any physical effects of his disease.”

Answer 15

a
There is presently no cure for AD, and drug therapy aims at improving or controlling decline in cognition. Medications do not directly address the physical manifestations of AD.

Question 16

The patient is having some increased memory and language problems. What diagnostic tests will be done before this patient is diagnosed with Alzheimer’s disease? (Select all that apply.)
a) Urinalysis
b) Chest x-ray
c) MRI of the head
d) Liver function tests
e) Neuropsychologic testing
f) Blood urea nitrogen and serum creatinine

Answer 16

a,c,d,e,f
Because there is no definitive diagnostic test for Alzheimer’s disease, and many conditions can cause manifestations of dementia, testing must be done to eliminate any other causes of cognitive impairment. These include urinalysis to eliminate a urinary tract infection, an MRI to eliminate brain tumors, liver function tests to eliminate encephalopathy, BUN and serum creatinine to rule out renal dysfunction, and neuropsychologic testing to assess cognitive function. A chest x-ray examination is not used to investigate an alternate cause of memory or language problems.

Question 17

Which nursing intervention is most appropriate when caring for patients with dementia?
a) Avoid direct eye contact.
b) Lovingly call the patient “honey” or “sweetie.”
c) Give simple directions, focusing on one thing at a time.
d) Treat the patient according to their age-related behavior.

Answer 17

C
When dealing with patients with dementia, tasks should be simplified, giving directions using gestures or pictures and focusing on one thing at a time. It is best to treat these patients as adults, with respect and dignity, even when their behavior is childlike. The nurse should use gentle touch and direct eye contact. Calling the patient “honey” or “sweetie” can be condescending and does not show respect.

Question 18

A 78-yr-old woman was transferred to the intensive care unit after emergency abdominal surgery. The nurse notes the patient is disoriented and confused, has incoherent speech, is restless, and agitated. Which action by the nurse is most appropriate?
a) Reorient the patient.
b) Document the findings.
c) Notify the health care provider.
d) Administer lorazepam (Ativan).

Answer 18

a
The patient has manifestations of delirium. Care of the patient with delirium is focused on eliminating precipitating factors and protecting the patient from harm. Give priority to creating a calm and safe environment. The nurse should stay at the bedside and provide reassurance and reorienting information as to place, time, and procedures. The nurse should reduce environmental stimuli, including noise and light levels. Avoid the use of chemical and physical restraints if possible.

Question 19

A patient is diagnosed with the mild cognitive impairment stage of Alzheimer’s disease. What nursing intervention is most appropriate for the nurse use with the patient?
a) Communicate using a letter or picture board.
b) Treat disruptive behavior with antipsychotic drugs.
c) Use a calendar and family pictures as memory aids.
d) Apply a wander guard mechanism to keep the patient in the area.

Answer 19

c
The patient with mild cognitive impairment will have problems with memory, language, or another essential cognitive function that is severe enough to be noticeable to others but does not interfere with activities of daily living. A calendar and family pictures for memory aids will help this patient. This patient should not yet have disruptive behavior or get lost easily. Using a writing board will not help this patient with communication.

Question 20

Which patient should receive a depression assessment first?
a) A patient in the early stages of Alzheimer’s disease
b) A patient who is in the final stage of Alzheimer’s disease
c) A patient experiencing delirium secondary to dehydration
d) A patient who has become delirious following an atypical drug response

Answer 20

a
Patients in the early stages of Alzheimer’s disease are particularly susceptible to depression because they are acutely aware of their cognitive changes and the expected disease trajectory. Delirium is typically a short-term health problem that does not typically pose a heightened risk of depression.

Question 21

Which patient has the greatest risk of developing delirium?
a) An older patient whose recent CT scan shows brain atrophy.
b) A patient with fibromyalgia whose chronic pain has worsened.
c) A patient with a fracture who spent the night in the emergency department.
d) An older patient who takes multiple medications to treat various health problems.

Answer 21

d
Polypharmacy is implicated in many cases of delirium, and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment, as well as pain, may cause delirium, but this is less of a risk than in an older adult who takes multiple medications.

Question 22

When providing community health care teaching about the early warning signs of Alzheimer’s disease (AD), which signs should the nurse ask family members to report? (Select all that apply.)
a) Misplacing car keys
b) Losing sense of time
c) Difficulty performing familiar tasks
d) Problems with performing basic calculations
e) Momentarily forgets an acquaintance’s name
f) Becoming lost in a usually familiar environment

Answer 22

b,c,d,f
Difficulty performing familiar tasks, problems with performing basic calculations, losing sense of time, and becoming lost in a usually familiar environment are all part of the early warning signs of AD. Misplacing car keys and momentarily forgetting a name is a normal frustrating event for many people

Question 23

The home care nurse is visiting patients in the community. Which patient is exhibiting an early warning sign of Alzheimer’s disease (AD)?
a) A 65-yr-old male patient does not recognize his family members and close friends
b) A 59-yr-old female patient misplaces her purse and jokes about having memory loss
c) A 79-yr-old male patient is incontinent and not able to perform hygiene independently.
d) A 72-yr-old female patient is unable to locate the address where she has lived for 10 years.

Answer 23

d

Question 24

Unlicensed assistive personnel (UAP) working for a home care agency report a change in the alertness and language of an 82-yr-old female patient. The home care nurse plans a visit to evaluate the patient’s cognitive function. Which assessment would be most appropriate?
a) Glasgow Coma Scale (GCS)
b) Confusion Assessment Method (CAM)
c) Mini-Mental State Examination (MMSE)
d) National Institutes of Health Stroke Scale (NIHSS)

Answer 24

c
The MMSE is often used to assess cognitive function. Cognitive testing is focused on evaluating memory, ability to calculate, language, visual-spatial skills, and degree of alertness. The CAM is used to assess for delirium. The GCS is used to assess the degree of impaired consciousness. The NIHSS is a neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.

Question 25

A 59-yr-old female patient with a frontotemporal lobar dementia has difficulty with verbal expression. While her husband was at work, she walked to the gas station for a soda but did not understand the request for payment. What can the nurse suggest to keep the patient safe?
a) Adult day care
b) Assisted living
c) Advance directives
d)Monitor for behavioral changes

Answer 25

a
To keep the patient safe during the day while the husband is at work, an adult day care facility would be the best choice. This patient would not need assisted living. Advance directives are important but are not related to her safety. Monitoring for behavioral changes will not keep her safe during the day.