Med Surg - Exam 3 - Ch 60 (AD, Dementia, Delirium)

Question 1

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 flow to the brain.
d. syndrome characterized by cognitive dysfunction and loss of memory.

Answer 1

d. syndrome characterized by cognitive dysfunction and loss of memory.

Dementia is a syndrome characterized by dysfunction in or loss of memory, orientation, attention, language, judgment, and reasoning. Personality changes and behavioral problems such as agitation, delusions, and hallucinations may result.

Question 2

Vascular dementia is associated with

a. transient ischemic attacks.
b. bacterial or viral infection of neuronal tissue.
c. cognitive changes secondary to cerebral ischemia.
d. abrupt changes in cognitive function that are irreversible.

Answer 2

c. cognitive changes secondary to cerebral ischemia.

Vascular dementia is the loss of cognitive function that results from ischemic, ischemic-hypoxic, or hemorrhagic brain lesions caused by cardiovascular disease. In this type of dementia, narrowing and blocking of arteries that supply the brain causes a decrease in blood supply.

Question 3

The clinical diagnosis of dementia is based on

a. CT or MRS.
b. brain biopsy.
c. electroencephalogram.
d. patient history and cognitive assessment.

Answer 3

d. patient history and cognitive assessment.

The diagnosis of dementia depends on determining the cause. A thorough physical examination is performed to rule out other potential medical conditions. Cognitive testing (e.g., Mini-Mental State Examination) is focused on evaluating memory, ability to calculate, language, visual-spatial skills, and degree of alertness. Diagnosis of dementia related to vascular causes is based on the presence of cognitive loss, the presence of vascular brain lesions demonstrated by neuroimaging techniques, and the exclusion of other causes of dementia. Structural neuroimaging with computed tomography (CT) or magnetic resonance imaging (MRI) is used in the evaluation of patients with dementia. A psychologic evaluation is also indicated to determine the presence of depression.

Question 4

Which statement(s) accurately describe(s) mild cognitive impairment (select all that apply)?

a. Always progresses to AD
b. Caused by a variety of factors and may progress to AD
c. Should be aggressively treated with acetylcholinesterase drugs
d. Caused by vascular infarcts that, if treated, will delay progression to AD
e. Patient is usually not aware that there is a problem with his or her memory

Answer 4

b. Caused by a variety of factors and may progress to AD

Although some individuals with mild cognitive impairment (MCI) revert to normal cognitive function or do not go on to develop Alzheimer’s disease (AD), those with MCI are at high risk for AD. No drugs have been approved for the treatment of MCI. A person with MCI is often aware of a significant change in memory.

Question 5

The early stage of AD is characterized by

a. no noticeable change in behavior.
b. memory problems and mild confusion.
c. increased time spent sleeping or in bed.
d. incontinence, agitation, and wandering behavior.

Answer 5

b. memory problems and mild confusion.

An initial sign of AD is a subtle deterioration in memory.

Question 6

A major goal of treatment for the patient with AD is to

a. maintain patient safety.
b. maintain or increase body weight.
c. return to a higher level of self-care.
d. enhance functional ability over time.

Answer 6

a. maintain patient safety.

The overall management goals are that the patient with AD will (1) maintain functional ability for as long as possible, (2) be maintained in a safe environment with a minimum of injuries, (3) have personal care needs met, and (4) have dignity maintained. The nurse should place emphasis on patient safety while planning and providing nursing care.

Question 7

Creutzfeldt-Jakob disease is characterized by

a. remissions and exacerbations over many years.
b. memory impairment, muscle jerks, and blindness.
c. parkinsonian symptomsin, including muscle rigidity and tremors at rest.
d. increased intracranial pressure secondary to decreased CSF drainage.

Answer 7

b. memory impairment, muscle jerks, and blindness.

Creutzfeldt-Jakob disease (CJD) is a fatal brain disorder caused by a prion protein. The earliest symptom of the disease may be memory impairment and behavioral changes. The disease progresses rapidly, with mental deterioration, involuntary movements (i.e., muscle jerks), weakness in the limbs, blindness, and eventually coma.

Question 8

Which patient is most at risk for developing delirium?

a. A 50-year-old woman with cholecystitis
b. A 19-year-old man with a fractured femur
c. A 42-year-old woman having an elective hysterectomy
d. A 78-year-old man admitted to the medical unit with complications related to heart failure

Answer 8

d. A 78-year-old man admitted to the medical unit with complications related to heart failure

Risk factors that can precipitate delirium include age of 65 years or older, male gender, and severe acute illness (e.g., heart failure). The 78-year-old man has the most risk factors for delirium (see Table 60-14).

Question 9

What manifestations of cognitive impairment are primarily characteristic of delirium (select all that apply)?

a. Reduced awareness
b. Impaired judgments
c. Words difficult to find
d. Sleep/wake cycle reversed
e. Distorted thinking and perception
f. Insidious onset with prolonged duration

Answer 9

a. Reduced awareness
d. Sleep/wake cycle reversed
e. Distorted thinking and perception

Manifestations of delirium include cognitive impairment with reduced awareness, reversed sleep/wake cycle, and distorted thinking and perception. The other options are characteristic of dementia.

Question 10

Which statement accurately describes dementia?

a. Overproduction of B-amyloid protein causes all dementias.
b. Demential resulting from neurodegenerative causes can be prevented.
c. Dementia caused by hepatic or renal encephalopathy cannot be reversed.
d. Vascular dementia can be diagnosed by brain lesions identified with neuroimaging.

Answer 10

d. Vascular dementia can be diagnosed by brain lesions identified with neuroimaging.

The diagnosis of vascular dementia can be aided by neuroimaging studies showing vascular brain lesions along with exclusion of other causes of dementia. Overproduction of B-amyloid protein contributes to Alzheimer’s disease (AD). Vascular dementia can be prevented or slowed by treating underlying diseases (e.g., diabetes mellitus, cardiovascular disease). Dementia caused by hepatic or renal encephalopathy potentially can be reversed.

Question 11

A patient with Alzheimer’s disease (AD) dementia has manifestations of depression. The nurse knows that treatment of the patient with antidepressants will most likely do what?

a. Improve cognitive function
b. Not alter the course of either condition
c. Cause interactions with the drugs used to treat the dementia
d. Be contraindicated because of the central nervous system (CNS)-depressant effect of antidepressants

Answer 11

a. Improve cognitive function

Depression is often associated with AD, especially early in the disease when the patient has awareness of the diagnosis and the progression of the disease. When dementia and depression occur together, intellectual deterioration may be more extreme. Depression is treatable and use of antidepressants often improves cognitive function.

Question 12

For what purpose would the nurse use the Mini-Mental State Examination to evaluate a patient with cognitive impairment?

a. It is a good tool to determine the etiology of dementia.
b. It is a good tool to evaluate mood and thought processes.
c. It can help to document the degree of cognitive impairment in delirium and dementia.
d. It is useful for initial evaluation of mental status but additional tools are needed to evaluate changes in cognition over time.

Answer 12

c. It can help to document the degree of cognitive impairment in delirium and dementia.

The Mini-Mental State Examination is a tool to document the decree of cognitive impairment and it can be used to determine a baseline from which changes over time can be evaluated. It does not evaluate mood or thought processes but can detect dementia and delirium and differentiate these from psychiatric mental illness. It cannot help to determine etiology.

Question 13

During assessment of a patient with dementia, the nurse determines that the condition is potentially reversible when finding out what about the patient?

a. Has long-standing abuse of alcohol
b. Has a history of Parkinson’s disease
c. Recently developed symptoms of hypothyroidism
d. Was infected with human immunodeficiency virus (HIV) 10 years ago

Answer 13

c. Recently developed symptoms of hypothyroidism

Hypothyroidism can cause dementia but it is a treatable condition if it has not been long standing. The other conditions are causes of irreversible dementia.

Question 14

The husband of a patient is complaining that his wife’s memory has been decreasing lately. When asked for examples of her memory loss, the husband says that she is forgetting the neighbors’ names and forgot their granddaughter’s birthday. What kind of loss does the nurse recognize this to be?

a. Delirium
b. Memory loss in AD
c. Normal forgetfulness
d. Memory loss in mild cognitive impairment

Answer 14

d. Memory loss in mild cognitive impairment

In mild cognitive impairment people frequently forget people’s names and begin to forget important events. Delirium changes usually occur abruptly. In Alzheimer’s disease the patient may not remember knowing a person and loses the sense of time and which day it is. Normal forgetfulness includes momentarily forgetting names and occasionally forgetting to run an errand.

Question 15

The wife of a patient who is manifesting deterioration in memory asks the nurse whether her husband has AD. The nurse explains that a diagnosis of AD is usually made when what happens?

a. A urine test indicates elevated levels of isoprostanes
b. All other possible causes of dementia have been eliminated
c. Blood analysis reveals increased amounts of B-amyloid protein
d. A computed tomography (CT) scan of the brain indicates brain atrophy

Answer 15

b. All other possible causes of dementia have been eliminated

The only definitive diagnosis of AD can be made on examination of brain tissue during an autopsy but a clinical diagnosis is made when all other possible causes of dementia have been eliminated. Patients with AD may be B-amyloid proteins in the blood, brain atrophy, or isoprostanes in the urine but these findings are not exclusive to those with AD.

Question 16

The newly admitted patient has moderate AD. What does the nurse know this patient will need help with?

a. Eating
b. Walking
c. Dressing
d. Self-care activities

Answer 16

c. Dressing

In the moderate stage of AD, the patient may need help with getting dressed. In the severe stage, patients will be unable to dress or feed themselves and are usually incontinent.

Question 17

What is one focus of collaborative care of patients with AD?

a. Replacement of deficient acetylcholine in the brain
b. Drug therapy for cognitive problems and undesirable behaviors
c. The use of memory-enhancing techniques to delay disease progression
d. Prevention of other chronic diseases that hasten the progression of AD

Answer 17

b. Drug therapy for cognitive problems and undesirable behaviors

Because there is no cure for AD, collaborative management is aimed at controlling the decline in cognition, controlling the undesirable manifestations that the patient may exhibit, and providing support for the family caregiver. Anticholinesterase agents help to increase acetylcholine (ACh) in the brain but a variety of other drugs are also used to control behavior. Memory-enhancing techniques have little or no effect in patients with AD, especially as the disease progresses. Patients with AD have limited ability to communicate health symptoms and problems, leading to a lack of professional attention for acute and other chronic illnesses.

Question 18

The patient is receiving donepezil (Aricept), lorazepam (Ativan), risperidone (Risperdal) and sertraline (Zoloft) for the management of AD. Which benzodiazepine medication is being used to help manage this patient’s behavior?

a. Sertraline (Zoloft)
b. Donepezil (Aricept)
c. Lorazepam (Ativan)
d. Risperidone (Risperdal)

Answer 18

c. Lorazepam (Ativan)

Lorazepam (Ativan) is a benzodiazepine used to manage behavior with AD. Sertraline (Zoloft) is a selective serotonin reuptake inhibitor used to treat depression. Donepezil (Aricept) is a cholinesterase inhibitor used for decreased memory and cognition. Risperidone (Risperdal) is an antipsychotic used for behavior management.

Question 19

Which N-methyl-D-aspartate (NMDA) receptor antagonist is frequently used for a patient with AD who is experiencing decreased memory and cognition?

a. Trazodone (Desyrel)
b. Olanzapine (Zyprexa)
c. Rivastigmine (Exelon)
d. Memantine (Namenda)

Answer 19

d. Memantine (Namenda)

Memantine (Namenda) is the N-methyl-D-aspartate (NMDA) receptor antagonist frequently used for AD patients with decreased memory and cognition. Trazodone (Desyrel) is an atypical antidepressant that may help with sleep problems. Olanzapine (Zyprexa) is an antipsychotic medication used for behavior management. Rivastigmine (Exelon) is a cholinesterase inhibitor used for decreased memory and cognition.

Question 20

A patient with AD in a long-term care facility is wandering the halls very agitated, asking for her “mommy” and crying. What is the best response by the nurse?

a. Ask the patient, “Why are you behaving this way?”
b. Tell the patient, “Let’s go get a snack in the kitchen.”
c. Ask the patient, “Wouldn’t you like to lie down now?”
d. Tell the patient, “Just take some deep breaths and calm down.”

Answer 20

b. Tell the patient, “Let’s go get a snack in the kitchen.”

Patients with moderate to severe AD frequently become agitated but because their short-term memory loss is so pronounced, distraction is a very good way to calm them. “Why” questions are upsetting to them because they don’t know the answer and they cannot respond to normal relaxation techniques.

Question 21

The sister of a patient with AD asks the nurse whether prevention of the disease is possible. In responding, the nurse explains that there is no known way to prevent AD but there are ways to keep the brain healthy. What is included in the ways to keep the brain healthy (select all that apply)?

a. Avoid trauma to the brain.
b. Recognize and treat depression early.
c. Avoid social gatherings to avoid infections.
d. Do not overtax the brain by trying to learn new skills.
e. Daily wine intake will increase circulation to the brain.
f. Exercise regularly to decrease the risk for cognitive decline.

Answer 21

a. Avoid trauma to the brain.
b. Recognize and treat depression early.
f. Exercise regularly to decrease the risk for cognitive decline.

Avoiding trauma to the brain, treating depression early, and exercising regularly can maintain cognitive function. Staying socially active, avoiding intake of harmful substances, and challenging the brain to keep its connections active and create new ones also help to keep the brain healthy.

Question 22

The son of a patient with early-onset AD asks if he will get AD. What should the nurse tell this man about the genetics of AD?

a. The risk of early-onset AD for the children of parents with it is about 50%.
b. Women get AD more often than men do, so his chances of getting AD are slim.
c. The blood test for the ApoE gene to identify this type of AD can predict who will develop it.
d. This type of AD is not as complex as regular AD, so he does not need to worry about getting AD.

Answer 22

a. The risk of early-onset AD for the children of parents with it is about 50%.

The risk of early-onset AD for the children of parents with it is 50%. Women do get AD more often than men but that is more likely related to women living longer than men than to the type of AD. ApoE gene testing is used for research with late-onset AD but does not predict who will develop the disease. Late-onset AD is more genetically complex than early-onset AD and is more common in those over age 60 but because his parent has early-onset AD he is at a 50% risk of getting it.

Question 23

A patient with moderate AD has a nursing diagnosis of impaired memory related to effects of dementia. What is an appropriate nursing intervention for this patient?

a. Post clocks and calendars in the patient’s environment.
b. Establish and consistently follow a daily schedule with the patient.
c. Monitor the patient’s activities to maintain a safe patient environment.
d. Stimulate thought processes by asking the patient questions about recent activities.

Answer 23

b. Establish and consistently follow a daily schedule with the patient.

Adhering to a regular, consistent daily schedule helps the patient to avoid confusion and anxiety and is important both during hospitalization and at home. Clocks and calendars may be useful in early AD but they have little meaning to a patient as the disease progresses. Questioning the patient about activities and events they cannot remember is threatening and may because severe anxiety. Maintaining a safe environment for the patient is important but does not change the disturbed thought processes.

Question 24

The family caregiver for a patient with AD expresses an inability to make decisions, concentrate, or sleep. The nurse determines what about the caregiver?

a. The caregiver is also developing signs of AD.
b. The caregiver is manifesting symptoms of caregiver role strain.
c. The caregiver needs a period of respite from care of the patient.
d. The caregiver should ask other family members to participate in the patient’s care.

Answer 24

b. The caregiver is manifesting symptoms of caregiver role strain.

Family caregiver role strain is characterized by such symptoms of stress as the inability to sleep, make decisions, or concentrate. It is frequently seen in family members who are responsible for the care of the patient with AD. Assessment of the caregiver may reveal a need for assistance to increase coping skills, effectively use community resources, or maintain social relationships. Eventually the demands on a caregiver exceed the resources and the person with AD may be placed in an institutional setting.

Question 25

The wife of a man with moderate AD has a nursing diagnosis of social isolation related to diminishing social relationships and behavioral problems of the patient with AD. What is a nursing intervention that should be appropriate to provide respite care and allow the wife to have satisfactory contact with significant others?

a. Help the wife to arrange adult day care for the patient.
b. Encourage permanent placement of the patient in the Alzheimer’s unit of a long-term care facility.
c. Refer the wife to a home health agency to arrange for daily home nursing visits to assist with the patient’s care.
d. Arrange for the hospitalization of the patient for 3 to 4 days so that the wife can visit out-of-town friends and relatives.

Answer 25

a. Help the wife to arrange adult day care for the patient.

Adult dare care is an option to provide respite for caregivers and a protective environment for the patient during the early and middle stages of AD. There are also in-home respite care providers. The respite from the demands of care allows the caregiver to maintain social contacts, perform normal tasks of living, and be more responsive to the patient’s needs. Visits by home health nurses involve the caregiver and cannot provide adequate respite. Institutional placement is not always an acceptable option at earlier stages of AD, nor is hospitalization available for respite care.

Question 26

A 72-year-old woman is hospitalized in the intensive care unit (ICU) with pneumonia resulting from chronic obstructive pulmonary disease (COPD). She has a fever, productive cough, and adventitious breath sounds throughout her lungs. In the past 24 hours her fluid intake was 1000 mL and her urine output was 700 mL. She was diagnosed with early-stage AD 6 months ago but has been able to maintain her activities of daily living (ADLs) with supervision. Identify at least six risk factors for the development of delirium in this patient.

Answer 26

a. age
b. infection
c. hypoxemia (lung disease)
d. intensive care unit (ICU) hospitalization (change in environment, sensory overload)
e. preexisting dementia
f. dehydration
g. hyperthermia
h. potentially medications to treat COPD
i. pneumonia

Question 27

A 68-year-old man is admitted to the emergency department with multiple blunt trauma following a one-vehicle car accident. He is restless; disoriented to person, place, and time; and agitated. He resists attempts at examination and calls out the name “Janice.” Why should the nurse suspect delirium rather than dementia in this patient?

a. The fact that he wouldn’t have been allowed to drive if he had dementia
b. His hyperactive behavior, which differentiates his condition from the hypoactive behavior of dementia
c. The report of emergency personnel that he was noncommunicative when they arrived at the accident scene
d. The report of his family that although he has heart disease and is “very hard of hearing,” this behavior is unlike him

Answer 27

d. The report of his family that although he has heart disease and is “very hard of hearing,” this behavior is unlike him

Delirium is an acute problem that usually has a rapid onset in response to a precipitating event, especially when the patient has underlying health problems, such as heart disease and sensory limitations. In the absence of prior cognitive impairment, a sudden onset of confusion, disorientation, and agitation is usually delirium. Delirium may manifest with both hypoactive and hyperactive symptoms.

Question 28

What should be included in the management of a patient with delirium?

a. The use of restraints to protect the patient from injury
b. The use of short-acting benzodiazepines to sedate the patient
c. Identification and treatment of underlying causes when possible
d. Administration of high doses of an antipsychotic drug such as haloperidol (Haldol)

Answer 28

c. Identification and treatment of underlying causes when possible

Care of the patient with delirium is focused on identifying and eliminating precipitating factors if possible. Treatment of underlying medical conditions, changing environmental conditions, and discontinuing medications that induce delirium are important. Drug therapy is reserved for those patients with severe agitation because the drugs themselves may worsen delirium.

Question 29

When caring for a patient in the severe stage of AD, what diversion or distraction activities would be appropriate?

a. Watching TV
b. Playing games
c. Books to read
d. Mobiles or dangling ribbons

Answer 29

d. Mobiles or dangling ribbons

In the severe stage of AD, the patient is at a developmental level of 15 months or less; therefore appropriate distractions would be infant toys. Watching TV and playing games are more appropriate in the mild stage. Books to read would need to be at developmentally appropriate levels to be used as a diversion.

Question 30

The nurse who has administered a dose of risperidone (Risperdal) to a patient with delirium should assess for what intended effect of the medication?

a. Lying quietly in bed
b. Alleviation of depression
c. Reduction in blood pressure
d. Disappearance of confusion

Answer 30

a. Lying quietly in bed

Risperidone is an antipsychotic drug that reduces agitation and produces a restful state in patients with delirium. However, it should be used with caution. Antidepressant medications treat depression, and antihypertensive medications treat hypertension. However, there are no medications that will cause confusion to disappear in a patient with delirium.

Question 31

When providing community health care teaching regarding the early warning signs of Alzheimer’s disease, which signs should the nurse advise 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. Becoming lost in a usually familiar environment

Answer 31

b. Losing sense of time
c. Difficulty performing familiar tasks
d. Problems with performing basic calculations
e. Becoming lost in a usually familiar environment

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 Alzheimer’s disease. Misplacing car keys is a normal frustrating event for many people.

Question 32

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 his or her age-related behavior.

Answer 32

c. Give simple directions, focusing on one thing at a time.

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 demonstrate respect.

Question 33

Which statement by the wife of a patient with Alzheimer’s disease (AD) 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. “I know that this won’t cure him, but we learned that it might prevent a bodily decline while he declines mentally.”
d. “I learned that if we are vigilant about his medication schedule, he may not experience the physical effects of his disease.”

Answer 33

a. “I’m really hoping his medications will slow down his mental losses.”

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

Question 34

Which patient may face the greatest risk of developing delirium?

a. A patient with fibromyalgia whose chronic pain has recently worsened
b. A patient with a fracture who has spent the night in the emergency department
c. An older patient whose recent computed tomography (CT) shows brain atrophy
d. An older patient who takes multiple medications to treat various health problems

Answer 34

d. An older patient who takes multiple medications to treat various health problems

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 35

For which patient should the nurse prioritize an assessment for depression?

a. A patient in the early stages of Alzheimer’s disease
b. A patient who is in the final stages 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 35

a. A patient in the early stages of Alzheimer’s disease

Patients in the early stages of Alzheimer’s disease are particularly susceptible to depression, since the patient is acutely aware of his or her cognitive changes and the expected disease trajectory. Delirium is typically a shorter-term health problem that does not typically pose a heightened risk of depression.

Question 36

Benzodiazepines are indicated in the treatment of cases of delirium that have which cause?

a. Polypharmacy
b. Cerebral hypoxia
c. Alcohol withdrawal
d. Electrolyte imbalances

Answer 36

c. Alcohol withdrawal

Benzodiazepines can be used to treat delirium associated with sedative and alcohol withdrawal. However, these drugs may worsen delirium caused by other factors and must be used cautiously. Polypharmacy, cerebral hypoxia, and electrolyte imbalances are not treated with benzodiazepines.

Question 37

The patient has been diagnosed with the mild cognitive impairment stage of Alzheimer’s disease. What nursing interventions should the nurse expect to use with this patient?

a. Treat disruptive behavior with antipsychotic drugs.
b. Use a calendar and family pictures as memory aids.
c. Use a writing board to communicate with the patient.
d. Use a wander guard mechanism to keep the patient in the area.

Answer 37

b. Use a calendar and family pictures as memory aids.

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 38

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. MRI of the head
c. Liver function tests
d. Neuropsychologic testing
e. Blood urea nitrogen and serum creatinine

Answer 38

All of the above.

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.

Question 39

A 59-year-old female patient, who has frontotemporal lobar degeneration, has difficulty with verbal expression. One day she walks out of the house and goes to the gas station to get a soda but does not understand that she needs to pay for it. What is the best thing the nurse can suggest to this patient’s husband to keep the patient safe during the day while the husband is at work?

a. Assisted living
b. Adult day care
c. Advance directives
d. Monitor for behavioral changes

Answer 39

b. Adult day care

To keep this 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.

Question 40

Which finding is considered to be one of the warning signs of developing Alzheimer’s disease?

a. Difficulty performing familiar tasks.
b. Problems with orientation to date, time, and place.
c. Having problems focusing on a task.
d. Atherosclerotic changes in the vessels.

Answer 40

b. Problems with orientation to date, time, and place.
Disorientation to time and place is a warning sign.

a - The client may experience minor difficulty in work or social activities but has not adequate cognitive ability to hide the loss and continue to function independently.
c - Not being able to focus on a task is more likely a sign of attention-deficit hyperactivity disorder.
d - Atherosclerotic changes are not warning signs of Alzheimer’s disease. Amyloid protein plaques do have something to do with the disease, but they are not found until autopsy.

Question 41

Which information should be shared with the client diagnosed with Stage I Alzheimer’s disease who is prescribed donepezil (Aricept), a cholinesterase inhibitor?

a. The client must continue taking this medication forever to maintain function.
b. The drug may delay the progression of the disease, but it does not cure it.
c. A serum drug level must be obtained monthly to evaluate for toxicity.
d. If the client develops any muscle aches, the HCP should be notified.

Answer 41

b. The drug may delay the progression of the disease, but it does not cure it.
This medication does not cure Alzheimer’s disease, and at some point it will become ineffective as the disease progresses.

a- This is not a true statement. The client will no longer be prescribed this medication as the disease progresses and it becomes ineffective.
c- There is no monthly drug level to be monitored. Toxicity includes jaundice and GI distress.
d - Muscle aches are an adverse effect of the lipid-lowering medications, not of Aricept.

Question 42

A family member brings the client to the emergency department reporting that the 78-year-old father has suddenly become very confused and thinks he is living in 1942, that he has to go to war, and that someone is trying to poison him. Which question should the nurse ask the family member?

a. “Has your father been diagnosed with dementia?”
b. “What medication has your father taken today?”
c. “What have you given him that makes him think it’s poison?”
d. “Does your father like to watch old movies on television?”

Answer 42

b. “What medication has your father taken today?”
Drug toxicity and interactions are common causes of delirium in the elderly.

a- Dementia involves behavior changes that are irreversible and occur over time. Delirium, however, occurs suddenly (as in this man’s symptom onset), is caused by an acute event, and is reversible.
c - This is blaming the family member for the client’s paranoid ideation.
d - Watching old movies on television will not cause delirium.

Question 43

A 62-year-old client is brought to the clinic by a family member who is concerned about the client’s inability to solve common problems. To identify whether the client’s current mental status indicates an early stage in dementia, which question should the nurse ask the client?

a. “Where were you were born?”
b. “How positive is your self-image?”
c. “What did you have for breakfast?”
d. “Do you have any feelings of sadness?”

Answer 43

c. “What did you have for breakfast?”

Question 44

Which intervention will the nurse include in the plan of care for a client who has late stage Alzheimer’s disease?

a. Encourage the client to discuss events from the past
b. Maintain a consistent daily routine for the client’s care
c. Reorient the client to the date and time every 2 to 3 hours
d. Provide the client with current newspapers and magazines

Answer 44

b. Maintain a consistent daily routine for the client’s care