Cognitive Disorder Quiz

cognitive disorder practice questions
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1. A 72-year-old patient hospitalized with Correct Answer: D

pneumonia is disoriented and con- Rationale: The onset of delirium
fused 2 days after admission. Which occurs acutely. The degree of dis-
assessment information obtained by orientation does not differentiate
the nurse about the patient indicates between delirium and dementia.
that the patient is experiencing deliri- Increasing confusion for several
um rather than dementia? years is consistent with demen-
a. tia. Fragmented and incoherent
The patient is disoriented to place and speech may occur with either delir-
time but oriented to person. ium or dementia.
b.
The patient has a history of increasing Cognitive Level: Application Text
confusion over several years. Reference: p. 1562
c. Nursing Process: Assessment
The patient's speech is fragmented NCLEX: Physiological Integrity
and incoherent.
d.
The patient was oriented and alert
when admitted.
2. When developing a plan of care for Correct Answer: A

a hospitalized patient with moderate Rationale: The patient with mod-
dementia, which intervention will the erate dementia will have problems
nurse include? with short- and long-term memo-
a. ry and will need reminding about
Reminding the patient frequently the hospitalization. The other in-
about being in the hospital terventions would be used for a
b. patient with severe dementia, who
Placing suction at the bedside to de- would have difficulty with swallow-
crease the risk for aspiration ing, self-care, and immobility.
c.
Providing complete personal hygiene Cognitive Level: Application Text
care for the patient Reference: p. 1563
d. Nursing Process: Planning
Repositioning the patient frequently NCLEX: Physiological Integrity
to avoid skin breakdown
3. 3. When administering a mental status Correct Answer: C

examination to a patient with delirium, Rationale: Because overstimula-
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the nurse should tion by environmental factors can
a. distract the patient from the task of
give the examination when the patient answering the nurse's questions,
is well-rested. these stimuli should be avoided.
b. The nurse will not wait to give the
reorient the patient as needed during examination because action to cor-
the examination. rect the delirium should occur as
c. soon as possible. Reorienting the
choose a place without distracting en- patient is not appropriate during
vironmental stimuli. the examination. Antianxiety med-
d. ications may increase the patient's
medicate the patient first to reduce delirium.
anxiety.
Cognitive Level: Application Text
Reference: pp. 1562, 1576-1577
Nursing Process: Implementation
NCLEX: Physiological Integrity
4. To protect a patient from injury during Correct Answer: B

an episode of delirium, the most ap- Rationale: The priority goal is to
propriate action by the nurse is to protect the patient from harm, and
a. a staff member will be most ex-
have a close family member remain perienced in providing safe care.
with the patient and provide reassur- Visits by family members are help-
ance. ful in reorienting the patient, but
b. families should not be responsible
assign a staff member to stay with the for protecting patients from injury.
patient and offer frequent reorienta- Antipsychotic medications may be
tion. ordered, but only if other mea-
c. sures are not effective because
ask the health care provider about or- these medications have multiple
dering an antipsychotic drug. side effects. Restraints are some-
d. times used but tend to increase ag-
secure the patient in bed with a soft itation and disorientation.
chest restraint.
Reference: p. 1577
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5. A family member of a patient with Correct Answer: B
possible Alzheimer's disease asks the Rationale: The MMSE establishes
nurse the purpose of the Mini-Mental the degree of mental impairment
State Examination (MMSE). Which re- at the time it is given. It does not
sponse by the nurse is appropriate? establish a diagnosis of AD but
a. when given repeatedly over time
The MMSE helps in establishing may help to determine the progres-
the diagnosis of Alzheimer's disease sion of AD. The choice of treat-
(AD). ment is made on the basis of mul-
b. tiple data, not just the MMSE. The
The MMSE is useful in determining the MMSE may be abnormal with ei-
degree of mental impairment. ther delirium or dementia and is not
c. useful in determining which condi-
The MMSE determines the choice of tion the patient has.
the most appropriate treatment.
d. Cognitive Level: Application Text
The MMSE aids in differentiating acute Reference: p. 1563
delirium from chronic dementia. Nursing Process: Implementation
6. When administering a mental status Correct Answer: A

examination to a patient, the nurse Rationale: Answers such as "I don't
suspects depression when the patient know" are more typical of depres-
responds with sion. The response "Who are those
a. people over there?" is more typical
"I don't know." of the distraction seen in a patient
b. with delirium. The remaining two
"Is that the right answer?" answers are more typical of a pa-
c. tient with dementia.
"Wait, let me think about that."
d.
"Who are those people over there?"
7. A 71-year-old patient is diagnosed Correct Answer: D

with moderate dementia as a result of Rationale: Loss of both recent and
multiple strokes. During assessment long-term memory is characteris-
of the patient, the nurse would expect tic of moderate dementia. Patients
to find with dementia have frequent night-
a. time awakening. Dementia is pro-
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excessive nighttime sleepiness. gressive, and the patient's ability
b. to perform tasks would not have
variable ability to perform simple periods of improvement. Difficulty
tasks. eating and swallowing is character-
c. istic of severe dementia.
difficulty eating and swallowing.
loss of recent and long-term memory. Reference: pp. 1562-1563
Nursing Process: Assessment
8. Coexisting dementia and depression Correct Answer: C

are identified in a patient with Parkin- Rationale: Parkinson's disease
son's disease. The nurse anticipates and depression are both potential-
that the greatest improvement in the ly reversible conditions, and the pa-
patient's condition will occur with ad- tient's symptoms that are caused
ministration of by these two conditions will im-
a. prove with appropriate treatment.
antipsychotic drugs. Anticholinergic agents are likely to
b. worsen the patient's condition be-
anticholinergic agents. cause they will block the effect of
c. acetylcholine at the synaptic cleft.
dopaminergic agents and antidepres- There is no indication that the pa-
sant drugs. tient needs an antipsychotic agent
d. at this time. A selective serotonin
selective serotonin reuptake inhibitor reuptake inhibitor (SSRI) may be
(SSRI) agents. effective for the depression, but it
does not address the patient's oth-
er conditions.

Reference: p. 1563
Nursing Process: Planning
9. A 62-year-old patient is brought to the Correct Answer: C

clinic by a family member who is con- Rationale: This question tests the
cerned about the patient's increas- patient's orientation to time, which
ing sleep disturbances and inability to is decreased in early Alzheimer's
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solve common problems. To obtain in- disease (AD) or dementia. Asking
formation about the patient's current the patient about birthplace tests
mental status, which question should for remote memory, which is in-
the nurse ask the patient? tact in the early stages. Questions
a. about the patient's emotions and
"Where were you were born?" self-image are helpful in assess-
b. ing emotional status, but they are
"Do have any feelings of sadness?" not as helpful in assessing mental
c. state.
"What day of the week is it today?"
"How positive is your self-image?" Reference: pp. 1564, 1567
Nursing Process: Assessment
10. When teaching the spouse of a pa- Correct Answer: B

tient who is being evaluated for Rationale: The diagnosis of AD is
Alzheimer's disease (AD) about the one of exclusion. Age is the most
disorder, the nurse explains that important risk factor for develop-
a. ment of AD. Drugs can slow the
the most important risk factor for AD deterioration but do not dramatical-
is a family history of the disorder. ly reverse the effects of AD. Brain
b. atrophy is a common finding in AD,
a diagnosis of AD can be made only but it can occur in other diseases
when other causes of dementia have as well.
been ruled out.
c. Cognitive Level: Comprehension
new drugs have been shown to re- Text Reference: p. 1568
verse AD dramatically in some pa- Nursing Process: Implementation
tients. NCLEX: Physiological Integrity
d.
the presence of brain atrophy detect-
ed by MRI confirms the diagnosis of
AD in patients with dementia.
11. A home-health patient with Correct Answer: C

Alzheimer's disease (AD) and mild Rationale: Because the patient
dementia has a new prescription for with mild dementia will have diffi-
donepezil (Aricept). Which nursing ac- culty with learning new skills and
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tion will be most effective in ensuring forgetfulness, the most appropriate
compliance with the medication? nursing action is to have someone
a. else administer the Aricept. The
Setting the medications up weekly in other nursing actions will not be as
a medication box effective in ensuring that the pa-
b. tient takes the medications.
Calling the patient daily with a re-
minder to take the medication Cognitive Level: Application Text
c. Reference: pp. 1563, 1567
Having the patient's spouse adminis- Nursing Process: Implementation
ter the medication NCLEX: Physiological Integrity
d.
Posting reminders to take the medica-
tions in the patient's house
12. Risperidone (Risperdal) is prescribed Correct Answer: A

for an outpatient with moderate Rationale: Risperidone is an an-
Alzheimer's disease (AD). Which infor- tipsychotic used to treat the agi-
mation obtained by the nurse at the tation, aggression, and behavioral
next clinic appointment indicates that problems associated with AD. The
the medication is effective? other improvements might occur
a. with cholinesterase inhibitors.
The patient has less agitation.
b. Cognitive Level: Application Text
The patient is dressed appropriately. Reference: p. 1568
c. Nursing Process: Evaluation
The patient is able to swallow a pill. NCLEX: Physiological Integrity
d.
The patient's speech is clearer.
13. The nurse has identified the nurs- Correct Answer: A

ing diagnosis of disturbed thought Rationale: Providing a consis-
processes related to effects of de- tent routine will decrease anxiety
mentia for a patient with late-stage and confusion for the patient. In
Alzheimer's disease (AD). An appro- late-stage AD, the patient will not
priate intervention for this problem is remember events from the past.
to Reorientation to time and place
a. will not be helpful to the patient
maintain a consistent daily routine for with late-stage AD. The patient with
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the patient's care. late-stage AD will not be able to
b. read.
encourage the patient to discuss
events from the past. Cognitive Level: Application Text
c. Reference: p. 1571
reorient the patient to the date and Nursing Process: Planning
time every few hours. NCLEX: Physiological Integrity
d.
provide the patient with current news-
papers and magazines.
14. A patient with Alzheimer's disease Correct Answer: C

(AD) is hospitalized with a urinary Rationale: The spouse's state-
tract infection. The spouse tells the ments are most consistent with
nurse, "I am just exhausted from the caregiver role strain. The other di-
constant care and worry. We don't agnoses each address one aspect
have any children and we can't afford of the spouse's problem, but care-
a nursing home. I don't know what to giver-role strain related to limited
do." The most appropriate nursing di- resources for caregiving address-
agnosis for the spouse is es all the information the nurse has
a. about this situation.
anxiety related to limited financial re-
sources. Cognitive Level: Application Text
b. Reference: pp. 1574-1575
ineffective health maintenance related Nursing Process: Diagnosis
to stress. NCLEX: Psychosocial Integrity
c.
caregiver role strain related to limited
resources for caregiving.
d.
social isolation related to unrelieved
caregiving responsibilities.
15. A long-term care patient with moder- Correct Answer: C

ate dementia develops increased rest- Rationale: Increased motor activity
lessness and agitation. The nurse's in a patient with dementia is fre-
initial action should be to quently the patient's only way of
a. responding to factors like pain, so
administer the PRN dose of lorazepam the nurse's initial action should be
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(Ativan). to assess the patient for any pre-
b. cipitating factors. Administration of
reorient the patient to time and place. sedative drugs may be indicated,
c. but this should not be done un-
assess the patient for anything that til assessment for precipitating fac-
might be causing discomfort. tors has been completed and any
d. of these factors have been ad-
have a nursing assistant stay with the dressed. Reorientation is unlikely
patient to ensure safety. to be helpful for the patient with
moderate dementia. Assigning a
nursing assistant to stay with the
patient may also be necessary, but
any physical changes that may be
causing the agitation should be ad-
dressed first.

Reference: p. 1573
16. When assessing a patient with Correct Answer: C

Alzheimer's disease (AD) who is be- Rationale: Patients at risk for prob-
ing admitted to a long-term care facil- lems with safety require close su-
ity, the nurse learns that the patient pervision. Placing the patient near
has had several episodes of wander- the nurse's station will allow nurs-
ing away from home. Which nursing ing staff to observe the patient
action will the nurse include in the more closely. Use of "why" ques-
plan of care? tions is frustrating for the patient
a. with AD, who are unable to under-
Ask the patient why the wandering stand clearly or verbalize the rea-
episodes have occurred. son for wandering behaviors. Be-
b. cause of the patient's short-term
Reorient the patient to the new living memory loss, reorientation will not
situation several times daily. help to prevent wandering behav-
c. ior. Because the patient had wan-
Place the patient in a room close to the dering behavior at home, familiar
nurses' station. objects will not prevent wandering.
d.
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Have the family bring in familiar items Cognitive Level: Application Text
from the patient's home. Reference: p. 1573
Nursing Process: Planning
NCLEX: Safe and Effective Care
Environment
17. During the morning change-of-shift Correct Answer: B

report at the long-term care facility, Rationale: The most likely cause of
the nurse learns that the patient with sundowning is a disruption in circa-
dementia has had sundowning. Which dian rhythms and keeping the pa-
nursing action should the nurse take tient active and in daylight will help
while caring for the patient? to reestablish a more normal cir-
a. cadian pattern. Moving the patient
Move the patient to a quieter room at to a different room might increase
night. confusion. Taking a nap will inter-
b. fere with nighttime sleep. Hourly
Open the blinds in the patient's room orientation will not be helpful in a
and provide frequent activities. patient with memory difficulties.
c.
Have the patient take a brief Cognitive Level: Application Text
mid-morning nap. Reference: p. 1573
d. Nursing Process: Implementation
Provide hourly orientation to time of NCLEX: Safe and Effective Care
day. Environment
18. 1. A geriatric nurse is teaching the ANS: 1

client's family about the possible Rationale: The nurse should identi-
cause of delirium. Which statement by fy that taking multiple medications
the nurse is most accurate? that may lead to adverse reactions
1. "Taking multiple medications may or toxicity is a risk factor for the
lead to adverse interactions or toxic- development of delirium in older
ity." adults. Symptoms of delirium in-
2. "Age-related cognitive changes clude difficulty sustaining and shift-
may lead to alterations in mental sta- ing attention. The client with deliri-
tus." um is disoriented to time and place
3. "Lack of rigorous exercise may lead and may also have impaired mem-
to decreased cerebral blood flow." ory.
4. "Decreased social interaction may
9 / 35
lead to profound isolation and psy-
chosis."
19. 2. A husband has agreed to admit his ANS: 1

spouse, diagnosed with Alzheimer's Rationale: The most appropriate
disease (AD), to a long-term care fa- nursing diagnosis and intervention
cility. He is expressing feelings of for the husband is dysfunctional
guilt and symptoms of depression. grieving; AD support group. Clients
Which appropriate nursing diagnosis with AD are often at risk for trau-
and subsequent intervention would ma and have significant self-care
the nurse document? deficits that require more care than
1. Dysfunctional grieving; AD support a spouse may be able to provide.
group
2. Altered thought process; AD sup-
port group
3. Major depressive episode; psychi-
atric referral
4. Caregiver role strain; psychiatric re-
ferral
20. 3. A client diagnosed with vascular ANS: 4

neurocognitive disorder (NCD) is dis- Rationale: The nurse should ques-
charged to home under the care of his tion the client's safety at home if
wife. Which information should cause the client smokes cigarettes. Vas-
the nurse to question the client's safe- cular NCD is a clinical syndrome of
ty? NCD due to significant cerebrovas-
1. His wife works from home in cular disease. The cause of vascu-
telecommunication. lar NCD is related to an interruption
2. The client has worked the nightshift of blood flow to the brain. Hyper-
his entire career. tension is a significant factor in the
3. His wife has minimal family support. etiology.
4. The client smokes one pack of ciga-
rettes per day.
21. 4. A client diagnosed with AD can no ANS: 4

longer ambulate, does not recognize Rationale: The nurse should recog-
family members, and communicates nize that a client exhibiting these
with agitated behaviors and incoher- symptoms is in the severe cogni-
ent verbalizations. The nurse recog- tive decline, seventh stage, of AD.
10 / 35
nizes these symptoms as indicative of
which stage of the illness?
1. Stage 4: Mild-to-Moderate Cognitive
Decline
2. Stage 5. Moderate Cognitive Decline
3. Stage 6. Moderate-to-Severe Cogni-
tive Decline
4. Stage 7. Severe Cognitive Decline
22. 5. A client is diagnosed in stage ANS: 3

seven of AD. To address the client's Rationale: The most appropriate
symptoms, which nursing interven- intervention in the seventh stage of
tion should take priority? AD is to promote the client's dig-
1. Improve cognitive status by encour- nity by providing comfort, safety,
aging involvement in social activities. and self-care measures. Stage is
2. Decrease social isolation by provid- characterized by severe cognitive
ing group therapies. decline in which the client is un-
3. Promote dignity by providing com- able to recognize family members
fort, safety, and self-care measures. and is most commonly bedfast and
4. Facilitate communication by provid- aphasic.
ing assistive devices.
23. 6. Which is the reason for the prolifer- ANS: 4

ation of the diagnosis of NCDs? Rationale: The proliferation of NCD
1. Increased numbers of neurotrans- has occurred because more peo-
mitters has been implicated in the pro- ple now survive into the high-risk
liferation of NCD. period for neurocognitive disorder,
2. Similar symptoms of NCD and de- which is middle age and beyond..
pression lead to misdiagnoses, in-
creasing numbers of NCD.
3. Societal stress contributes to the
increase in this diagnosis.
4. More people now survive into the
high-risk period for neurocognitive
disorders.
24. 7. A client diagnosed recently with AD ANS: 1

is prescribed donepezil (Aricept). The Rationale: The most appropriate
client's spouse inquires, "How does response by the nurse is to explain
11 / 35
this work? Will this cure him?" Which that donepezil delays the destruc-
is the appropriate nursing response? tion of acetylcholine, a chemical
1. "This medication delays the de- in the brain necessary for memory
struction of acetylcholine, a chemical processes. Although most effective
in the brain necessary for memory in the early stages, it serves to de-
processes. Although most effective in lay, but not stop, the progression of
the early stages, it serves to delay, but the AD. Some side effects include
not stop, the progression of the dis- dizziness, headache, gastrointesti-
ease." nal upset, and elevated transami-
2. "This medication encourages pro- nase.
duction of acetylcholine, a chemical
in the brain necessary for memory
processes. It delays the progression
of the disease."
3. "This medication delays the de-
struction of dopamine, a chemical
in the brain necessary for memory
processes. Although most effective in
the early stages, it serves to delay, but
not stop, the progression of the dis-
ease."
4. "This medication encourages pro-
duction of dopamine, a chemical in the
brain necessary for memory process-
es. It delays the progression of the
disease."
25. 8. Which symptom should a nurse ANS: 3

identify that differentiates clients di- Rationale: The nurse should identi-
agnosed with NCDs from clients diag- fy that impaired memory is a symp-
nosed with mood disorders? tom that occurs in NCD and not
1. Altered sleep in mood disorders. Neurocognitive
2. Altered concentration disorder is classified in the DSM-5
3. Impaired memory as either mild or major, with the
4. Impaired psychomotor activity distinction primarily being one of
severity of symptomatology.
26. 9. A client diagnosed with AD exhibits ANS: 3

progressive memory loss, diminished Rationale: The most appropriate
12 / 35
cognitive functioning, and verbal ag- nursing intervention for this client
gression upon experiencing frustra- is to schedule structured daily rou-
tion. Which nursing intervention is tines. A structured routine will re-
most appropriate? duce frustration and thereby re-
1. Organize a group activity to present duce verbal aggression.
reality.
2. Minimize environmental lighting.
3. Schedule structured daily routines.
4. Explain the consequences for ag-
gressive behaviors.
27. 10. After one week of continuous men- ANS: 3

tal confusion, an older African Amer- Rationale: The nurse should rec-
ican client is admitted with a prelim- ognize that AD does not develop
inary diagnosis of AD. What should suddenly and should question this
cause the nurse to question this diag- diagnosis. The onset of AD symp-
nosis? toms is slow and insidious. The dis-
1. AD does not typically occur in ease is generally progressive and
African American clients. deteriorating.
2. The symptoms presented are more
indicative of Parkinsonism.
3. AD does not develop suddenly.
4. There has been no T3- or T4-level
evaluation ordered.
28. 11. A client diagnosed with AD has ANS: 4

impairments of memory and judgment Rationale: The priority nursing in-
and is incapable of performing activi- tervention for this client is to assist
ties of daily living. Which nursing in- with bathing and toileting. A client
tervention should take priority? who is incapable of performing ac-
1. Present evidence of objective reali- tivities of daily living requires as-
ty to improve cognition. sistance in these areas to ensure
2. Design a bulletin board to represent health and safety.
the current season.
3. Label the client's room with name
and number.
4. Assist with bathing and toileting.
29.
13 / 35
12. A client diagnosed with major NCD ANS: 2
is exhibiting behavioral problems on Rationale: The priority nursing ac-
a daily basis. At change of shift, the tion is to first medicate the client to
client's behavior escalates from pac- avoid injury to self or others. It is
ing to screaming and flailing. Which important to assess environmental
action should be a nursing priority? triggers and potential unmet needs
1. Consult the psychologist regarding in order to address these problems
behavior-modification techniques. in the future, but interventions to
2. Medicate the client with prn antianx- ensure safety must take priority.
iety medications. Because of the cognitive decline
3. Assess environmental triggers and experienced in clients diagnosed
potential unmet needs. with this disorder, communication
4. Anticipate the behavior and restrain skills and orientation may limit as-
when pacing begins. sessment and teaching interven-
tions.
30. 13. A client with a history of cere- ANS: 2

brovascular accident (CVA) is brought Rationale: The nurse should ex-
to an emergency department expe- pect that the client will be diag-
riencing memory problems, confu- nosed with vascular NCD, which is
sion, and disorientation. Based on this caused by significant cerebrovas-
client's assessment data, which di- cular disease. Vascular NCD often
agnosis would the nurse expect the has an abrupt onset. Progression
physician to assign? of this disease often occurs in a
1. Delirium due to adverse effects of fluctuating pattern.
cardiac medications
2. Vascular neurocognitive disorder
3. Altered thought processes
4. Alzheimer's disease
31. 14. An older client has recently moved ANS: 4

to a nursing home. The client has trou- Rationale: The nurse should ex-
ble concentrating and socially iso- pect the physician to prescribe ser-
lates. A physician believes the client traline to improve the client's so-
would benefit from medication ther- cial functioning and concentration
apy. Which medication should the levels. Sertraline is an selective
nurse expect the physician to pre- serotonin reuptake inhibitor (SSRI)
scribe? antidepressant. Depression is the
1. Haloperidol (Haldol) most common mental illness in
14 / 35
2. Donepezil (Aricept) older adults and is often misdiag-
3. Diazepam (Valium) nosed as a neurocognitive disor-
4. Sertraline (Zoloft) der.
32. 15. A client diagnosed with NCD is ANS: 3

disoriented and ataxic and wanders. Rationale: The priority nursing di-
Which is the priority nursing diagno- agnosis for this client is risk for in-
sis? jury. The client who is ataxic suffers
1. Disturbed thought processes from motor coordination deficits
2. Self-care deficit and is at an increased risk for falls.
3. Risk for injury Clients that wander are at a higher
4. Altered health-care maintenance risk for injury.
33. 16. Which statement accurately differ- ANS: 3

entiates mild NCD from major NCD? Rationale: The progression of the
1. Major NCD involves disorientation disorder is not a criterion for deter-
that develops suddenly, whereas mild mining the severity of an NCD. Ab-
NCD develops more slowly. stract thinking and judgment can
2. Major NCD involves impairment be affected in both mild NCD and
of abstract thinking and judgment, major NCD. Major NCD criteria
whereas mild NCD does not. requires substantial cognitive de-
3. Major NCD criteria requires sub- cline, and mild NCD requires mod-
stantial cognitive decline from a pre- est decline. Both major and mild
vious level of performance, and mild NCD classifications require decline
NCD requires modest decline. from a previous level of perfor-
4. Major NCD criteria requires decline mance in only one of the listed do-
from a previous level of performance mains.
in three of the listed domains, and
mild NCD requires only one.
34. 17. Which statement accurately differ- ANS: 2

entiates NCD from pseudodementia Rationale: NCD has a slow pro-
(depression)? gression of symptoms, whereas
1. NCD has a rapid onset, whereas pseudodementia has a rapid pro-
pseudodementia does not. gression of symptoms. NCD symp-
2. NCD symptoms include disorienta- toms include disorientation to time
tion to time and place, and pseudode- and place, and pseudodementia
mentia does not. does not. NCD symptoms' sever-
3. NCD symptoms improve as the day ity worsens as the day progress-
15 / 35
progresses, but symptoms of pseudo- es, whereas in pseudodementia,
dementia worsen. symptoms improve as the day
4. NCD causes decreased appetite, progresses. In NCD the appetite
whereas pseudodementia does not. remains unchanged. whereas in
pseudodementia, the appetite di-
minishes.
Multiple Response
35. 18. Which of the following conditions ANS: 1, 2, 3

have been known to precipitate delir- Rationale: Delirium most common-
ium in some individuals? (Select all ly occurs in individuals with se-
that apply.) rious medical, surgical, or neu-
1. Febrile illness rological conditions. Some exam-
2. Seizures ples of conditions that have been
3. Migraine headaches known to precipitate delirium in
4. Herniated brain stem some individuals include the fol-
5. Temporomandibular joint syndrome lowing: systemic infections; febrile
illness; metabolic disorders, such
as hypoxia, hypercarbia, or hy-
poglycemia; hepatic encephalopa-
thy; head trauma; seizures; mi-
graine headaches; brain abscess;
stroke; postoperative states; and
electrolyte imbalance. A herniated
brain stem would most likely re-
sult in death, not delirium. Tem-
poromandibular joint syndrome is
marked by limited movement of the
joint during chewing, not delirium.
36. 19. Which of the following medica- ANS: 1, 2, 3, 4

tions that have been known to precip- Rationale: Medications that have
itate delirium? (Select all that apply.) been known to precipitate delirium
1. Antineoplastic agents include anticholinergics, antihyper-
2. H2-receptor antagonists tensives, corticosteroids, anticon-
16 / 35
3. Antihypertensives vulsants, cardiac glycosides, anal-
4. Corticosteroids gesics, anesthetics, antineoplas-
5. Lipid-lowering agents tic agents, antiparkinson drugs,
H2-receptor antagonists (e.g.,
cimetidine), and others. There
have been no reports of delirium
ascribed to the use of lipid-lower-
ing agents.
37. An older adult patient takes multiple Delerium

medications daily. Over 2 days, the
patient developed confusion, slurred
speech, an unsteady gait, and fluctu-
ating levels of orientation. These find-
ings are most characteristic of
38. A patient with fluctuating levels of Tactile Hallucinations

awareness, confusion, and disturbed
orientation shouts, "Bugs are crawl-
ing on my legs. Get them off!" Which
problem is the patient experiencing?
39. A patient with fluctuating levels "I don't see any bugs, but I can tell
of consciousness, disturbed orienta- you are frightened. I will stay with
tion, and perceptual alteration begs, you."
"Someone get these bugs off me."
What is the nurse's best response?
40. What is the priority nursing diagnosis Risk for injury related to altered
for a patient with fluctuating levels of cerebral function, fluctuating levels
consciousness, disturbed orientation, of consciousness, disturbed orien-
and visual and tactile hallucinations? tation, and misperception of the en-
vironment
41. What is the priority intervention for a Careful observation and supervi-
patient diagnosed with delirium who sion
has fluctuating levels of conscious-
ness, disturbed orientation, and per-
ceptual alterations?
17 / 35
42. A patient diagnosed with deliri- Provide a well-lit room without
um is experiencing perceptual alter- glare or shadows. Limit noise and
ations. Which environmental adjust- stimulation.
ment should the nurse make for this
patient?
43. Which assessment finding would be States, "I feel bugs crawling on my
likely for a patient experiencing a hal- legs and biting me."
lucination? The patient:
44. Consider these health problems: Dementia

Lewy body disease, frontal-temporal
lobar degeneration, and Huntington's
disease. Which term unifies these
problems?
45. Which medication prescribed to pa- Memantine

tients diagnosed with Alzheimer's dis-
ease antagonizes N-Methyl-D-Aspar-
tate (NMDA) channels rather than
cholinesterase?
46. An older adult was stopped by police Agnosia

for driving through a red light. When
asked for a driver's license, the adult
hands the police officer a pair of sun-
glasses. What sign of dementia is evi-
dent?
47. An older adult drove to a nearby store Moderately severe cognitive de-
but was unable to remember how to cline
get home or state an address. When
police intervened, they found that this
adult was wearing a heavy coat and
hat, even though it was July. Which
stage of Alzheimer's disease is evi-
dent?
48. Consider these diagnostic findings: Alzheimer's disease

apolipoprotein E (apoE) malfunction,
18 / 35
neurofibrillary tangles, neuronal de-
generation in the hippocampus, and
brain atrophy. Which health problem
corresponds to these diagnostic find-
ings?
49. A patient with stage 3 Alzheimer's dis- Impaired memory

ease tires easily and prefers to stay
home rather than attend social ac-
tivities. The spouse does the grocery
shopping because the patient cannot
remember what to buy. Which nursing
diagnosis applies at this time?
50. A patient has progressive memo- Assist the patient to perform simple
ry deficits associated with demen- tasks by giving step-by-step direc-
tia. Which nursing intervention would tions.
best help the individual function in the
environment?
51. Two patients in a residential care fa- Separate and distract the patients.
cility have dementia. One shouts to Take one to the day room and the
the other, "Move along, you're block- other to an activities area
ing the road." The other patient turns,
shakes a fist, and shouts, "You're
trying to steal my car." What is the
nurse's best action?
52. An older adult patient in the intensive Using the patient's glasses and
care unit has visual and auditory illu- hearing aids
sions. Which intervention will be most
helpful?
53. A patient diagnosed with Alzheimer's Agnosia

disease calls the fire department say-
ing, "My smoke detectors are going
off." Firefighters investigate and dis-
cover that the patient misinterpreted
the telephone ringing. Which problem
is this patient experiencing?
19 / 35
54. During morning care, a nurse asks Confabulation

a patient diagnosed with dementia,
"How was your night?" The patient
replies, "It was lovely. I went out to
dinner and a movie with my friend."
Which term applies to the patient's re-
sponse?
55. A nurse counsels the family of a pa- Place locks at the tops of doors.
tient diagnosed with Alzheimer's dis-
ease who lives at home and wanders
at night. Which action is most impor-
tant for the nurse to recommend to
enhance safety?
56. Goals of care for an older adult pa- returning to premorbid levels of
tient diagnosed with delirium caused function.
by fever and dehydration will focus on
57. An older adult with moderately severe Label the bathroom door
dementia forgets where the bathroom
is and has episodes of incontinence.
Which intervention should the nurse
suggest to the patient's family?
58. A older patient diagnosed with severe, "It is disappointing when some-
late-stage dementia no longer recog- one you love no longer recognizes
nizes family members. The family asks you."
how long it will be before this patient
recognizes them when they visit. What
is the nurse's best reply?
59. A patient with severe dementia no Focus interaction on familiar top-

longer recognizes family members ics.
and becomes anxious and agitat-
ed when they attempt reorientation.
Which alternative could the nurse sug-
gest to the family members?
20 / 35
60. What is the priority need for a patient Maintenance of nutrition and hy-
with late-stage dementia? dration
61. An older adult is prescribed digox- Drug actions and interactions

in (Lanoxin) and hydrochlorothiazide
daily as well as lorazepam (Ativan) as
needed for anxiety. Over 2 days, the
patient developed confusion, slurred
speech, an unsteady gait, and fluc-
tuating levels of orientation. What is
the most likely reason for the patient's
change in mental status?
62. A hospitalized patient diagnosed with Remain safe in the environment.

delirium misinterprets reality, while a
patient diagnosed with dementia wan-
ders about the home. Which outcome
is the priority in both scenarios? The
patients will:
63. An elderly patient is admitted with "The confusion will probably get
delirium secondary to a urinary tract better as we treat the infection."
infection. The family asks whether the
patient will ever recover. Select the
nurse's best response.
64. An elderly person presents with A list of all medications the person
symptoms of delirium. The family re- currently takes
ports, "Everything was fine until yes-
terday." What is the most important
assessment information for the nurse
to gather?
65. A nurse gives anticipatory guidance Communication defecits

to the family of a patient diagnosed
with stage 3, mild cognitive decline
Alzheimer's disease. Which problem
common to that stage should the
nurse address?
21 / 35
66. A patient diagnosed with moderate- Provide clothing with elastic and
ly severe Alzheimer's disease has hook-and-loop closures
a self-care deficit of dressing and Label clothing with the patient's
grooming. Designate appropriate in- name and name of the item
terventions to include in the patient's
plan of care. Select all that apply
67. Which assessment findings would the Impaired level of consciousness

nurse expect in a patient experiencing Disorientation to place and time
delirium? Select all that apply Wandering attention
68. Which nursing diagnoses are most ap- Urinary incontinence

plicable for a patient diagnosed with Distrurbed sleep pattern
severe Alzheimer's disease? Select all Risk for caregiver role strain
that apply.
69. The nurse notes signs if uncreased An early sign is a change in the
ICP in a kid who has undergone inser- level of consciousness, HA, N&V,
tion of a shunt to tx. hydrocephalus. diplopia or visual disturbances and
What should the nurse do? seizures.
*normally the DR. orders the kid to
be kept flat to avoid rapid reduction
of intracranial fluid. If increased
ICP occurs the HOB should be ele-
vated 15-30 degrees and enhance
flow, surgeon notified STAT
70. What is the earliest indication of an The child's level of consciousness

improvement or deterioration of the
neurological condition?
71. A high shrill cry in an infant can be a Increased ICP

sign of what?
72. The parents of a kid recently dx. with 4

CP asks the nurse about the disorder. Cerebral palsy is a chronic disabili-
The nurse bases the response on the ty characterized by impaired move-
understanding that CP is what type of ment and posture resulting from an
condition? abnormality in the extrapyramidal
1. An infectious disease of the CNS or pyramidal motor system
22 / 35
2. An inflammation of the brain as a
result of a viral illness *meningitis is an infection process
3. A congenital condition that results of the CNS
in moderate to severe retardation *encephalitis is an inflammation d/t
4. A chronic disability characterized virus
by impaired muscle movement and *DS is a congenital condition
posture
73. The nurse notes a kid has a positive 4

Kernig's sign. Which observation is
characteristic of this sign?
1. The kid c/o muscle and joint pain
2. petechial and purpuric rashes are
noted on the child's trunk
3. neck flexion causes adduction and
flexion movements of the lower ex-
tremities
4. The child in not able to extend the
leg when the thigh is flexed anteriorly
at the hip
74. A 5 year old arrives at ER and mom 4

states he fell off bunk bed. What is a Late signs are
late sign of increased ICP? *significant level of consciousness
1. Nausea *bradycardia
2. irritability *decreases motor and sensory re-
3. HA sponses
4. bradycardia *alterations in pupil sizes and reac-
tivity
*posturing
*Cheyne- stokes respirations and
coma
75. 8 yr old with basilar skull fx.; Which 1

order should the nurse question and This is contraindicated in this pt,
call the HCP the catheter could enter the brain
1. Suction as needed through the fx; increasing the risk
2. daily wt. of secondary infection
23 / 35
3. clean liquids
4. maintain patent IV line
76. The nurse is reviewing notes on kid 3

with increased ICP, What are charac- Extension posturing is character-
teristics of decerebrate posturing? ized by the rigid extension and
1. flaccid paralysis pronation of the arms and legs
2. adduction of the arms at the shoul-
ders
3. rigid extension and pronation of the
arms and legs
4. abnormal flexion of the upper ex-
tremities and extension of the lower
ones
77. A kids is Dx. with Reye's syndrome. 4. Reye's is an acute encephalopa-

Which intervention should be added thy that follows a viral illness and
to the plan? is characterized by cerebral edema
1. assess hearing loss and fatty changes in the liver
2. monitor urine output * care is directed towards man-
3. change position q 2 hr aging cerebral edema; decreas-
4. provide quiet room with dim lighting ing stimuli and dimming lights de-
creases the stress on the cerebral
tissue and neuron responses
*position with HOB elevated to de-
crease the progression of edema
and promote drainage
78. What should be bedside in a patient 4

with tonic clonic seizures? Suctioning and O2
1. emergency cart
2. trach set * a trach set is not done at bedside,
3. padded tongue blade and an emergency cart would not
4. suctioning and O2 be left in a room
79. A LP is done on a kid who is suspect- 3

ed of having bacterial meningitis and meningitis = elevated pressure,
CSF is obtained. Which result would cloudy CNS, elevated leukocyte
be positive for meningitis? and protein and decreased glu-
1. Clear CNS, decreased pressure, & cose
24 / 35
elevated protein level
2. Clear CNS, ^protein, decreased glu-
cose level
3. Cloudy CNS, ^protein, decreased
glucose
4. Cloudy CNS, decreased protein and
glucose
80. What precautionary intervention 4

should be in place for a pt. with bac- A major priority with meningitis is
terial meningitis? to have ATB started stat, the kid
1. maintain enteric precautions is also placed in resp. isolation for
2. maintain neutropenic precautions at least 24 hrs while cultures are
3. no precautions are required as long collected and the ABT is having an
as an ATB has been started effect
4. maintain resp. isolation precautions
for at least 24 hrs after the initiation of
ATB
81. The nurse is caring for a pt with 2

hydrocephalus that is scheduled for the head should be reposition so
surgery. What is the priority interven- they do not get ulcers and sores on
tion in the preop period? their head
1. test urine for protein
2. reposition the infant frequently
3. provide a stimulating environment
4. Bp q 15 minutes
82. What interventions should be done if 1,4,5

a kid has a seizure?
SELECT ALL
1. time it
2. restrain the kid
3. place in prone position
4. move furniture away from kid
5. stay with the kid
6. insert tongue blade
83. What manifestations of cognitive im- a, d, e. Manifestations of deliri-

pairment are primarily characteristic um include cognitive impairment
25 / 35
of delirium (select all that apply)? with reduced awareness, reversed
sleep/wake cycle, and distorted
a. Reduced awareness thinking and perception. The oth-
b. Impaired judgments er options are characteristic of de-
c. Words difficult to find mentia.
d. Sleep/wake cycle reversed
e. Distorted thinking and perception
f. Insidious onset with prolonged du-
ration
84. 2. Which statement accurately de- 2. d. The diagnosis of vascular

scribes dementia? dementia can be aided by neu-
roimaging studies showing vascu-
a. Overproduction of ²-amyloid protein lar brain lesions along with exclu-
causes all dementias. sion of other causes of dementia.
b. Dementia resulting from neurode- Overproduction of ²-amyloid protein
generative causes can be prevented. contributes to Alzheimer's disease
c. Dementia caused by hepatic or (AD). Vascular dementia can be
renal encephalopathy cannot be re- prevented or slowed by treating un-
versed. derlying diseases (e.g., diabetes
d. Vascular dementia can be diag- mellitus, cardiovascular disease).
nosed by brain lesions identified with Dementia caused by hepatic or re-
neuroimaging. nal encephalopathy potentially can
be reversed.
85. 3. A patient with Alzheimer's dis- 3. a. Depression is often associ-

ease (AD) dementia has manifesta- ated with AD, especially early in
tions of depression. The nurse knows the disease when the patient has
that treatment of the patient with anti- awareness of the diagnosis and
depressants will most likely do what? the progression of the disease.
When dementia and depression
a. Improve cognitive function occur together, intellectual deterio-
b. Not alter the course of either condi- ration may be more extreme. De-
tion pression is treatable and use of an-
c. Cause interactions with the drugs tidepressants often improves cog-
used to treat the dementia nitive function.
d. Be contraindicated because of the
central nervous system (CNS)-depres-
sant effect of antidepressants
26 / 35
86. 4. For what purpose would the nurse 4. c. The Mini-Mental State Exami-
use the Mini-Mental State Examination nation is a tool to document the de-
to evaluate a patient with cognitive gree of cognitive impairment and it
impairment? can be used to determine a base-
line from which changes over time
a. It is a good tool to determine the can be evaluated. It does not eval-
etiology of dementia. uate mood or thought processes
b. It is a good tool to evaluate mood but can detect dementia and delir-
and thought processes. ium and differentiate these from
c. It can help to document the degree psychiatric mental illness. It cannot
of cognitive impairment in delirium help to determine
and dementia. etiology.
d. It is useful for initial evaluation of
mental status but additional tools are
needed to evaluate changes in cogni-
tion over time.
87. 5. During assessment of a patient with 5. c. Hypothyroidism can cause de-

dementia, the nurse determines that mentia but it is a treatable condition
the condition is potentially reversible if it has not been long standing.
when finding out what about the pa- The other conditions are causes of
tient? irreversible dementia.
a. Has long-standing abuse of alcohol

b. Has a history of Parkinson's dis-
ease
c. Recently developed symptoms of
hypothyroidism
d. Was infected with human immunod-
eficiency virus (HIV) 10 years ago
88. 6. The husband of a patient is com- 6. d. In mild cognitive impairment

plaining that his wife's memory has people frequently forget people's
been decreasing lately. When asked names and begin to forget impor-
for tant events. Delirium changes usu-
examples of her memory loss, the ally occur abruptly. In Alzheimer's
husband says that she is forgetting disease the patient may not re-
the neighbors' names and forgot their member knowing a person and los-
granddaughter's birthday. What kind es the sense of time and which day
27 / 35
of loss does the nurse recognize this it is. Normal
to be? forgetfulness includes momentari-
ly forgetting names and occasion-
a. Delirium ally forgetting to run an errand.
b. Memory loss in AD
c. Normal forgetfulness
d. Memory loss in mild cognitive im-
pairment
89. The newly admitted patient has mod- c. In the moderate stage of AD, the
erate AD. What does the nurse know patient may need help with getting
this patient will need help with? dressed. In the severe stage, pa-
tients will be unable to dress or
a. Eating feed themselves and are usually
b. Walking incontinent.
c. Dressing
d. Self-care activities
90. 9. What is one focus of collaborative 9. b. Because there is no cure for

care of patients with AD? AD, collaborative management is
aimed at controlling the decline in
a. Replacement of deficient acetyl- cognition, controlling the undesir-
choline in the brain able manifestations that the patient
b. Drug therapy for cognitive prob- may exhibit, and providing sup-
lems and undesirable behaviors port for the family caregiver. Anti-
c. The use of memory-enhancing tech- cholinesterase agents help to in-
niques to delay disease progression crease acetylcholine (ACh) in the
d. Prevention of other chronic dis- brain but a variety of other drugs
eases that hasten the progression of are also used to control behav-
AD ior. Memoryenhancing techniques
have little or no effect in patients
with AD, especially as the dis-
ease progresses. Patients with AD
have limited ability to communicate
health symptoms and problems,
leading to a lack of professional at-
tention for acute and other chronic
illnesses.
28 / 35
91. 10. The patient is receiving donepezil 10. c. Lorazepam (Ativan) is a ben-
(Aricept), lorazepam (Ativan), risperi- zodiazepine used to manage be-
done (Risperdal), and sertraline havior with AD. Sertraline (Zoloft)
(Zoloft) for the management of AD. is a selective serotonin reup-
What benzodiazepine medication is take inhibitor used to treat de-
being used to help manage this pa- pression. Donepzil (Aricept) is a
tient's behavior? cholinesterase inhibitor used for
decreased memory and cognition.
a. Sertraline (Zoloft) Risperidone (Risperdal) is an an-
b. Donepezil (Aricept) tipsychotic used for behavior man-
c. Lorazepam (Ativan) agement.
d. Risperidone (Risperdal)
92. 7. The wife of a patient who is mani- 7. b. The only definitive diagnosis of
festing deterioration in memory asks AD can be made on examination of
the nurse whether her husband has brain tissue during an autopsy but
AD. The nurse explains that a diagno- a clinical diagnosis is made when
sis of AD is usually made when what all other possible causes of de-
happens? mentia have been eliminated. Pa-
tients with AD may have ²-amyloid
a. A urine test indicates elevated lev- proteins in the blood, brain atro-
els of isoprostanes phy, or isoprostanes in the urine
b. All other possible causes of demen- but these findings are not exclusive
tia have been eliminated to those with AD.
c. Blood analysis reveals increased
amounts of ²-amyloid protein
d. A computed tomography (CT) scan
of the brain indicates brain atrophy
93. 11. What N-methyl-d-aspartate 11. d. Memantine (Namenda) is the

(NMDA) receptor antagonist is fre- N-methyl-d-aspartate (NMDA) re-
quently used for a patient with AD ceptor antagonist frequently used
who is experiencing decreased mem- for AD patients with decreased
ory and cognition? memory and cognition. Trazodone
(Desyrel) is an atypical antidepres-
a. Trazodone (Desyrel) sant that may help with sleep prob-
b. Olanzapine (Zyprexa) lems. Olanzapine (Zyprexa) is an
c. Rivastigmine (Exelon) antipsychotic medication used for
d. Memantine (Namenda) behavior management. Rivastig-
29 / 35
mine (Exelon) is a cholinesterase
inhibitor used for decreased
memory and cognition.
94. 14. The son of a patient with early-on- 14. a. The risk of early-onset AD
set AD asks if he will get AD. What for the children of parents with it is
should the nurse tell this man about 50%. Women do get AD more often
the genetics of AD? than men but that is more likely
related to women living longer than
a. The risk of early-onset AD for the men than to the type of AD. ApoE
children of parents with it is about gene testing is used for research
50%. with late-onset AD but does not
b. Women get AD more often than men predict who will develop the dis-
do, so his chances of getting AD are ease. Late-onset AD is more ge-
slim. netically complex than early-onset
c. The blood test for the ApoE gene AD and is more common in those
to identify this type of AD can predict over age 60 but because his parent
who will develop it. has early-onset AD he is at a 50%
d. This type of AD is not as complex risk of getting it.
as regular AD, so he does not need to
worry about getting AD.
95. 12. A patient with AD in a long-term 12. b. Patients with moderate to

care facility is wandering the halls severe AD frequently become ag-
very agitated, asking for her "mommy" itated but because their short-term
and memory loss is so pronounced,
crying. What is the best response by distraction is a very good way to
the nurse? calm them. "Why" questions are
upsetting to them because they
a. Ask the patient, "Why are you be- don't know the answer and they
having this way?" cannot respond to normal relax-
b. Tell the patient, "Let's go get a snack ation techniques.
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."
96.
30 / 35
13. The sister of a patient with AD asks 13. a, b, f. Avoiding trauma to
the nurse whether prevention of the the brain, treating depression ear-
disease is possible. In responding, the ly, and exercising regularly can
nurse explains that there is no known maintain cognitive function. Stay-
way to prevent AD but there are ways ing socially active, avoiding intake
to keep the brain healthy. What is in- of harmful substances, and chal-
cluded in the ways to keep the brain lenging the brain to keep its con-
healthy (select all that apply)? nections active and create new
ones also help to keep the brain
a. Avoid trauma to the brain. healthy.
b. Recognize and treat depression
early.
c. Avoid social gatherings to avoid in-
fections.
d. Do not overtax the brain by trying to
learn new skills.
e. Daily wine intake will increase circu-
lation to the brain.
f. Exercise regularly to decrease the
risk for cognitive decline
97. 15. A patient with moderate AD has a 15. b. Adhering to a regular, con-
nursing diagnosis of impaired memo- sistent daily schedule helps the pa-
ry related to effects of dementia. Whattient to avoid confusion and anxiety
is an appropriate nursing intervention and is important both during hospi-
for this patient? talization and at home. Clocks and
calendars may be useful in early
a. Post clocks and calendars in the AD but they have little meaning to
patient's environment. a patient as the disease progress-
b. Establish and consistently follow a es. Questioning the patient about
daily schedule with the patient. activities and events they cannot
c. Monitor the patient's activities to remember is threatening and may
maintain a safe patient environment. cause severe anxiety. Maintaining
d. Stimulate thought processes by a safe environment for the patient
asking the patient questions about re- is important but does not change
cent activities the disturbed thought processes.
98. The family caregiver for a patient with b. Family caregiver role strain is
AD expresses an inability to make characterized by such symptoms
31 / 35
decisions, concentrate, or sleep. The of stress as the inability to sleep,
nurse determines what about the care- make decisions, or concentrate. It
giver? is frequently seen in family mem-
bers who are responsible for the
a. The caregiver is also developing care of the patient with AD. As-
signs of AD. sessment of the caregiver may re-
b. The caregiver is manifesting symp- veal a need for assistance to in-
toms of caregiver role strain. crease coping skills, effectively use
c. The caregiver needs a period of community resources, or maintain
respite from care of the patient. social relationships. Eventually the
d. The caregiver should ask other fam- demands on a caregiver exceed
ily members to participate in the pa- the resources and the person with
tient's care. AD may be placed in an institution-
al setting.
99. 17. The wife of a man with moder- 17. a. Adult day care is an op-
ate AD has a nursing diagnosis of tion to provide respite for care-
social isolation related to diminishing givers and a protective environ-
social relationships and behavioral ment for the patient during the
problems of the patient with AD. What early and middle stages of AD.
is a nursing intervention that would There are also in-home respite
be appropriate to provide respite care care providers. The respite from
and allow the wife to have satisfactory the demands of care allows the
contact with significant others? caregiver to maintain social con-
tacts, perform normal tasks of liv-
a. Help the wife to arrange for adult ing, and be more responsive to
day care for the patient. the patient's needs. Visits by home
b. Encourage permanent placement of health nurses involve the caregiv-
the patient in the Alzheimer's unit of a er and cannot provide adequate
long-term care facility. respite. Institutional placement is
c. Refer the wife to a home health not always an acceptable option at
agency to arrange daily home nursing earlier stages of AD, nor is hospi-
visits to assist with the patient's care. talization available for respite care.
d. Arrange for hospitalization of the
patient for 3 or 4 days so that the wife
can visit out-of-town friends and
relatives.
100.
32 / 35
23. When caring for a patient in the 23. d. In the severe stage of AD, the
severe stage of AD, what diversion or patient is at a developmental level
distraction activities would be appro- of 15 months or less; therefore ap-
priate? propriate distractions would be in-
fant toys. Watching TV and playing
a. Watching TV games are more appropriate in the
b. Playing games mild stage. Books to read would
c. Books to read need to be at developmentally ap-
d. Mobiles or dangling ribbons propriate levels to be used as a
diversion.
101. 18. The health care provider is trying 18. b, e. Dementia with Lewy bod-
to differentiate the diagnosis of the pa-
ies (DLB) is diagnosed with de-
tient between dementia and dementia mentia plus two of the follow-
with Lewy bodies (DLB). What obser- ing symptoms: (1) extrapyramidal
vations by the nurse support a diag- signs such as bradykinesia, rigidi-
nosis of DLB (select all that apply)? ty, and
postural instability but not always
a. Tremors a tremor, (2) fluctuating cognitive
b. Fluctuating cognitive ability ability, and (3) hallucinations. The
c. Disturbed behavior, sleep, and per- extrapyramidal
sonality signs plus tremors would more
d. Symptoms of pneumonia, including likely indicate Parkinson's disease.
congested lung sounds Disturbed behavior, sleep, person-
e. Bradykinesia, rigidity, and postural ality, and
instability without tremor eventually memory are character-
istics of frontotemporal lobe de-
generation (FTLD).
102. 19. Delegation Decision: The RN in 19. a, b, d. All caregivers are re-
charge at a long-term care facility sponsible for the patient's safety.
could delegate which activities to un-
Basic care activities, such as those
licensed associated with personal
assistive personnel (UAP) (select all
hygiene and activities of daily living
that apply)? (ADLs) can be delegated to unli-
censed assistive personnel (UAP).
a. Assist the patient with eating. The RN will perform ongoing as-
b. Provide personal hygiene and skin sessments and develop and revise
care. the plan of care as needed. The
33 / 35
c. Check the environment for safety RN will assess the patient's safety
hazards. risk factors, provide education, and
d. Assist the patient to the bathroom make referrals.
at regular intervals. The licensed practical nurse (LPN)
e. Monitor for skin breakdown and could check the patient's environ-
swallowing difficulties. ment for potential safety hazards.
103. 21. A 68-year-old man is admitted to 21. d. Delirium is an acute problem

the emergency department with mul- that usually has a rapid onset in
tiple blunt trauma following a one-ve- response to a precipitating event,
hicle car accident. He is restless; dis-
especially when the patient has un-
oriented to person, place, and time; derlying health problems, such as
and agitated. He resists attempts at heart disease and sensory limita-
examination and calls out the name tions. In the absence of prior cogni-
"Janice." Why should the nurse sus- tive impairment, a sudden onset of
pect delirium rather than dementia in confusion, disorientation, and agi-
this patient? tation is usually delirium. Delirium
may manifest with both hypoactive
a. The fact that he wouldn't have been and hyperactive symptoms.
allowed to drive if he had dementia
b. His hyperactive behavior, which dif-
ferentiates his condition from the hy-
poactive 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 al-
though he has heart disease and is
"very hard of hearing," this behavior
is
unlike him
104. What should be included in the man- 22. c. Care of the patient with delir-
agement of a patient with delirium? ium is focused on identifying and
eliminating precipitating factors if
a. The use of restraints to protect the possible.
patient from injury Treatment of underlying medical
b. The use of short-acting benzodi- conditions, changing environmen-
azepines to sedate the patient tal conditions, and discontinuing
34 / 35
c. Identification and treatment of un- medications
derlying causes when possible that induce delirium are important.
d. Administration of high doses of an Drug therapy is reserved for those
antipsychotic drug such as haloperi- patients with severe agitation be-
dol (Haldol) cause the drugs
themselves may worsen delirium.
105. 20. A 72-year-old woman is hospi- 20. a. Age; b. infection; c. hy-

talized in the intensive care unit poxemia (lung disease); d. inten-
(ICU) with pneumonia resulting from sive care unit (ICU) hospitalization
chronic obstructive pulmonary dis- (change in environment, sensory
ease (COPD). She has a fever, produc- overload); e. preexisting dementia;
tive cough, and adventitious breath f. dehydration. Also: hyperthermia
sounds throughout her lungs. In the and potentially medications to treat
past 24 hours her fluid intake was chronic obstructive pulmonary dis-
1000 mL and her urine output was ease (COPD) and pneumonia.
700 mL. She was diagnosed with ear-
ly-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 pa-
tient. (Fill in the blanks.)
a.
b.
c.
d.
e.
f.
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Cognitive Disorder Quiz

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cognitive disorder practice questions

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1. A 72-year-old patient hospitalized with Correct Answer: D

2. When developing a plan of care for Correct Answer: A

3. 3. When administering a mental status Correct Answer: C

4. To protect a patient from injury during Correct Answer: B

6. When administering a mental status Correct Answer: A

7. A 71-year-old patient is diagnosed Correct Answer: D

8. Coexisting dementia and depression Correct Answer: C

Cognitive Level: Application Text

9. A 62-year-old patient is brought to the Correct Answer: C

10. When teaching the spouse of a pa- Correct Answer: B

11. A home-health patient with Correct Answer: C

12. Risperidone (Risperdal) is prescribed Correct Answer: A

13. The nurse has identified the nurs- Correct Answer: A

14. A patient with Alzheimer's disease Correct Answer: C

15. A long-term care patient with moder- Correct Answer: C

Cognitive Level: Application Text

16. When assessing a patient with Correct Answer: C

17. During the morning change-of-shift Correct Answer: B

18. 1. A geriatric nurse is teaching the ANS: 1

19. 2. A husband has agreed to admit his ANS: 1

20. 3. A client diagnosed with vascular ANS: 4

21. 4. A client diagnosed with AD can no ANS: 4

22. 5. A client is diagnosed in stage ANS: 3

23. 6. Which is the reason for the prolifer- ANS: 4

24. 7. A client diagnosed recently with AD ANS: 1

25. 8. Which symptom should a nurse ANS: 3

26. 9. A client diagnosed with AD exhibits ANS: 3

27. 10. After one week of continuous men- ANS: 3

28. 11. A client diagnosed with AD has ANS: 4

30. 13. A client with a history of cere- ANS: 2

31. 14. An older client has recently moved ANS: 4

32. 15. A client diagnosed with NCD is ANS: 3

33. 16. Which statement accurately differ- ANS: 3

34. 17. Which statement accurately differ- ANS: 2

35. 18. Which of the following conditions ANS: 1, 2, 3

36. 19. Which of the following medica- ANS: 1, 2, 3, 4

37. An older adult patient takes multiple Delerium

38. A patient with fluctuating levels of Tactile Hallucinations

44. Consider these health problems: Dementia

45. Which medication prescribed to pa- Memantine

46. An older adult was stopped by police Agnosia

48. Consider these diagnostic findings: Alzheimer's disease

49. A patient with stage 3 Alzheimer's dis- Impaired memory

53. A patient diagnosed with Alzheimer's Agnosia

54. During morning care, a nurse asks Confabulation

59. A patient with severe dementia no Focus interaction on familiar top-

61. An older adult is prescribed digox- Drug actions and interactions

62. A hospitalized patient diagnosed with Remain safe in the environment.

65. A nurse gives anticipatory guidance Communication defecits

67. Which assessment findings would the Impaired level of consciousness

68. Which nursing diagnoses are most ap- Urinary incontinence

70. What is the earliest indication of an The child's level of consciousness

71. A high shrill cry in an infant can be a Increased ICP

72. The parents of a kid recently dx. with 4

73. The nurse notes a kid has a positive 4

74. A 5 year old arrives at ER and mom 4

75. 8 yr old with basilar skull fx.; Which 1

76. The nurse is reviewing notes on kid 3

77. A kids is Dx. with Reye's syndrome. 4. Reye's is an acute encephalopa-

78. What should be bedside in a patient 4