TV questions

Question 1

Which of the following has an insidious onset of symptoms?

a. ) Dementia
b. ) Delirium
c. ) Depression
d. ) Delirium and depression

Answer 1

a.) Dementia

has an insidious onset of symptoms

Question 2

A patient living independently is being treated for depression and complains that she forgot two of her appointments this week. She is likely to have a concurrent:

a. ) none of the below
b. ) stroke
c. ) delirium
d. ) dementia

Answer 2

a.) none of the below

Question 3

What is the incidence of older adults admitted to an acute care unit with delirium?

a. ) 8%
b. ) 30%
c. ) 40%
d. ) 50%

Answer 3

b.) 30%

Question 4

What is the most important assessment in understanding cognition?

a. ) Baseline level of functioning
b. ) Vital signs
c. ) Brain imaging
d. ) Family history of dementia

Answer 4

a.) Baseline level of functioning

most important assessment in understanding cognition

Question 5

Name 3 common causes for delirium in older adults.

Answer 5

• Urinary tract infection (UTI)
• Dehydration
• Medication
• Electrolyte imbalances
• Pneumonia
• Alcohol withdrawal

Question 6

Which of the following is the priority in caring for an older adult with delirium?

a. ) Keeping the patient sedated
b. ) Treating the underlying cause
c. ) Keeping the patient stimulated
d. ) Medicating for pain

Answer 6

b.) Treating the underlying cause

the priority in caring for an older adult with delirium

The change in behavioral symptoms will often prompt a treatment of those symptoms by sedating or “calming” the patient. However best practices are to treat the underlying cause and subsequently symptoms will improve. Adding medication to the picture often clouds the issue and worsens behavioral symptoms. If medications are used, they should not sedate the patient and they should only be used for a short term and as the delirium clears. Overstimulation will add to confusion and behavioral disturbances in the delirious patient. Though pain should not be ignored and could worsen behavioral symptoms, treating the underlying cause of the delirium is the priority. It is also important to note that even when the underlying cause is treated, it could take weeks and even months for the delirium to resolve. Do not expect the delirium to clear as soon as a course of antibiotics is completed in treating the underlying infection.

Question 7

Which group of medications is more likely to contribute to a change in mental status with older adults?

a. ) Sedative hypnotics
b. ) Antipsychotic medications
c. ) Opioids
d. ) All of the above

Answer 7

d.) All of the above

Question 8

When caring for the client diagnosed with delirium, which condition is the most important for the nurse to assess first?

a. ) Concurrent diagnosis of cancer
b. ) Prescription drug intoxication
c. ) impaired hearing
d. ) Heart failure

Answer 8

b.) Prescription drug intoxication

When caring for the client diagnosed with delirium, prescription drug intoxication is the most important for the nurse to assess first

Question 9

I’m 92 years old and I am stuck in this place. They are keeping me captive. They call it a hospital. Look at the children hiding under the bed, call the police! You are the nurse right? How are you going to help me?

Answer 9

• CAM
• Talk with family about her baseline level of functioning
• Evaluate he rlevel of fearfulness regarding the visual hallucinations
• Safe and reassuring environment
• Better understand the etiology of likely delirium

Question 10

Can a patient have dementia, delirium, and depression concurrently? If so, how would they present?

Answer 10

• increase in confusion from baseline
• Change in sensorium or level of consciousness usually deliniates delirium
• Changes in sleep, appetite, energy, and behavior may have been seen prior to emerging delirium
• Baseline cognitive deficits caused by dementia may worsen with concurrent delirium and depression

Question 11

Depression in older adults often presents in an atypical manner when compared to younger adults. What is an example of this presentation?

a. ) Behavioral issues
b. ) Congitive slowing
c. ) Somatic complaints
d. ) All of the above

Answer 11

d.) All of the above

Older adults frequently have an atypical presentation of depression (as well as delirium). Oftentimes older adults think of depression as a weakness and can become defensive when asked if they feel depressed. Asking questions like “how are your spirits?” or “do you feel blue?” can be less intimidating. They often present with symptoms such as irritability, difficulty processing information, somatic complaints, behavioral changes. It is important to stress that especially in terms of somatic complaints (which frequently come in the form of pains, gastrointestinal discomfort, constipation), older adults genuinely feel these symptoms; they are not making them up. It is also important that all physical complaints get assessed and addressed before assuming they are psychological in nature.

Also of note is that someone with cognitive slowing looks different than the person with dementia. For example, the person with dementia will attempt to answer the questions in a cognitive exam but will get them wrong. The person with cognitive slowing will say “I don’t know” as they often don’t have the energy to even try and answer the question. In terms of assessment asking a question such as “do you find things are getting on your nerves more,” can get to the irritability and behavioral change symptoms. It is sometimes also good to ask the client’s permission to talk with family members or friends about behavior or irritability as they may not have the awareness they are presenting in such a way.

Question 12

Which of the following evaluation tools assesses for depression?

a. ) GDS
b. ) MINI-COG
c. ) CAM
d. ) MoCA

Answer 12

GDS

assesses for depression

Question 13

Which of the following evaluation tools differentiates dementia from delirium?

a. ) GDS
b. ) MINI-COG
c. ) CAM
d. ) MoCA

Answer 13

CAM

Evaluation tool that differentiates dementia from delirium

GDS →​ depression

Question 14

Which of the following evaluation tools evalutes cognition?

a. ) GDS
b. ) MINI-COG
c. ) CAM
d. ) MoCA

Answer 14

MINI-COG

MoCA

evaluate cognition

Question 15

Symptoms of delirium include which of the following?

a. ) Change in mental status
b. ) irreversible symptoms
c. ) Distractability
d. ) Both A & C

Answer 15

d.) Both A & C

• Delirium onset is acute and the symptoms are reversible however an underlying cognitive deficit or delayed recognition of the delirium can compromise full return to baseline
• The marked change in mental status is a hallmark symptom of delirium
• Fluctuation or waxing and waning of symptoms
• Inattention, distractibility, disorientation, perceptual changes, disturbed sleep-wake cycle are additional symptoms

Question 16

An 87 year old woman is seen in the emergency department with the following labs:

BUN: 20 mg/dL

Creatinine: 1.4 mg/dL

Serum potassium: 4.3 mEq/L

Serum sodium: 129 mEq/L

She has a diagnosis of Alzheimer’s dementia, but her daughter said she is more agitated and paranoid about eating over the past week. She is likely to have:

a. ) renal failure
b. ) advancing dementia
c. ) depression
d. ) delirium

Answer 16

d.) delirium

This patient is hyponatremic and is demonstrating an acute change in mental status consistent with delirium.

Bun, Creatinine, and potassium levels are unremarkable. She has an underlying Alzheimer’s dementia which puts her at higher risk of developing a delirium.

Dementia does not advance that quickly, and while agitation (behavioral changes) and appetite changes can occur as an atypical presentation of depression, the sodium level in the context of the behavioral changes is most likely to indicate a delirium.

Question 17

Sundowning and wandering are associated with dementia