Chapter 39: Neurocognitive Disorders

Format: Multiple Choice

Client Needs: Psychosocial Integrity

Cognitive Level: Apply

Integrated Process: Teaching/Learning

Objective: 1

Page and Header: 758, Delirium/Diagnostic Criteria; 759, Table 39.1

1. The nurse assesses a client who has received a tentative diagnosis of delirium and explains to the family about the major cause of the client’s condition. Which statement by the nurse would be most appropriate?

A) “Basically, this diagnosis is based on the client’s inability to talk normally.”

B) “Your report of gradually developing confusion over time was the basis for the diagnosis.”

C) “The client’s diagnosis is primarily based on the rapid onset of the change in consciousness.”

D) “The client’s exposure to an infectious agent led us to determine the diagnosis.”

Page and Header: 758, Delirium/Diagnostic Criteria; 759, Table 39.1

2. A nurse is caring for a client diagnosed with delirium who has been brought for treatment by the client’s adult child. While taking the client’s history, which question would be most appropriate for the nurse to ask the client’s adult child?

A) “Has your parent taken any medications recently?”

B) “Are you aware of your parent falling or injuring the head in any way?”

C) “Has your parent had a recent stroke?”

D) “Has your parent experienced any major losses recently?”

Page and Header: 781, Psychoeducation for Families/Boxes 39.7 and 39.8

3. A nurse makes a home visit to a family caring for a client with Alzheimer’s disease. The client’s spouse tells the nurse, “I haven’t been out of the house for more than 2 weeks because my sister has been unable to help with care.” Which nursing diagnosis would the nurse identify as the priority?

A) Ineffective Family Coping related to care of a client with Alzheimer’s disease

B) Risk for Activity Intolerance related to Alzheimer’s disease

C) Caregiver Role Strain related to social isolation

D) Powerlessness related to seclusion and long-term care of client

Page and Header: 775, Cholinesterase Inhibitors

4. A daughter brings her parent, who has Alzheimer’s disease, to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month. When assessing the client, the nurse would be alert for the possibility of which side effect?

A) Gastrointestinal distress

B) Mild headache

C) Muscle tics

D) Blurred vision

Page and Header: 772, Catastrophic Reactions

5. A son brings his parent to the clinic for an evaluation. The client is diagnosed with moderate Alzheimer’s disease without delirium. The nurse assesses the client for which of the following as the priority?

A) Hearing deficits

B) Mania

C) Strange verbalizations

D) Catastrophic reactions

Page and Header: 783, Dementia Caused by Parkinson Disease

6. A client is admitted to the hospital with dementia related to Parkinson’s disease. The client is being treated for a fractured tibia from a recent fall. The nurse should assess the client’s history for use of which type of medication as a possible contributor to an increase in the client’s cognitive impairment?

A) Anticholinergics

B) Dopamine agonists

C) Anxiolytics

D) Benzodiazepines

Page and Header: 772, Catastrophic Reactions

7. While the nurse is caring for a hospitalized client in the advanced stages of Alzheimer’s disease, the client begins to have a catastrophic reaction to feeding. Which action should the nurse take first?

A) Remain calm and reassuring

B) Restrain the client temporarily

C) Draw the curtains to darken the room

D) Offer to feed the client

Page and Header: 776, Memantine and Donepezil Combination/Box 39.4

8. While reviewing the medical record of a client diagnosed with moderate dementia of the Alzheimer type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type?

A) Atypical antipsychotic

B) Cholinesterase inhibitor

C) N-methyl-d-aspartate (NMDA) receptor antagonist

D) Benzodiazepine

Page and Header: 758, Diagnostic Criteria; 759, Table 39.1

9. A group of nurses is reviewing information about delirium and dementia. The nurses demonstrate a need for additional review when they identify which sign as characteristic of dementia?

A) Fluctuating changes within a 24-hour period

B) Possible hallucinations

C) Normal psychomotor activity

D) Globally impaired cognition

Page and Header: 763, Alzheimer Disease/Diagnostic Criteria

10. A nurse is assessing a client diagnosed with Alzheimer’s disease. As part of the assessment, the nurse asks the client to identify common objects. Which finding is the nurse is assessing?

A) Aphasia

B) Apraxia

C) Agnosia

D) Executive functioning

Page and Header: 763, Alzheimer Disease;764, Synaptic Micron RNA and Neurotransmission

11. A nursing instructor is preparing a presentation on the etiology of Alzheimer’s disease (AD). When discussing the role of neurotransmitters in the course of the disease, which neurotransmitter would the instructor most likely emphasize?

A) Serotonin

B) Acetylcholine

C) Dopamine

D) Norepinephrine

Page and Header: 772, Hallucinations

12. When assessing a client with dementia, a nurse identifies that the client is experiencing hallucinations. Based on the nurse’s understanding of this disorder, which type of hallucination would the nurse expect as most common?

A) Auditory

B) Visual

C) Gustatory

D) Olfactory

Page and Header: 773, Aberrant Motor Behavior

13. A nurse is talking with the partner of a client diagnosed with Alzheimer’s disease. During the conversation, the partner tells the nurse that the client “often begins to scream and curse for no apparent reason.” Which behavior does the nurse interprets this as?

A) Hypersexuality

B) Disinhibition

C) Hypervocalization

D) Apathy

Page and Header: 776, Psychosocial Interventions

14. After educating a group of nurses on Alzheimer’s disease and appropriate nursing care, the group leader determines that the education was successful when the nurses identify which as the foundation for providing care to the client and family?

A) Therapeutic relationship

B) Medication therapy

C) Injury prevention

D) Functional independence

Page and Header: 773, Stress and Coping Skills

15. A nurse is providing care to a client diagnosed with Alzheimer’s disease who is exhibiting suspiciousness and delusional thinking. Which action would be most important for the nurse to take with this client?

A) Tell the client that he or she is experiencing delusions.

B) Confront the client about distorted thinking.

C) Correct the client’s interpretation of the situation.

D) Determine the trigger for the distorted thinking.

Page and Header: 779, Coping with Stress and Anxiety

16. A client diagnosed with Alzheimer’s disease is admitted to an acute care facility for treatment of an infection. Assessment reveals that the client is anxious. When developing the client’s plan of care, which intervention will be least appropriate for a nurse to include?

A) Frequently provide reality orientation

B) Simplify the client’s routines

C) Limit the number of choices to be made

D) Establish predictable routines

Page and Header: 763, Alzheimer Disease/Diagnostic Criteria

17. A client diagnosed with dementia is having difficulty finding the words that the client wants to use. When asked, the client could not identify the shoes as “shoes.” The nurse interprets this as which condition?

A) Agnosia

B) Aphasia

C) Apraxia

D) Confabulation

Page and Header: 758, Delirium/Diagnostic Criteria; 759, Table 39.1

18. As part of a follow-up home visit to an 80-year-old client who has had surgery, a nurse discusses the client’s risk for delirium with family members. Which of the following would the nurse include as placing the client at increased risk? Select all that apply.

A) Urinary tract infection

B) Hypertension

C) Acute stress

D) Bone fractures

E) Dehydration

F) Electrolyte balance

Page and Header: 760, Evidence-Based Nursing Care for Persons with Delirium/Medication Assessment; 761, Table 39.2

19. A client is brought to the emergency department by a spouse. The spouse states that over the past few hours, the client has become disoriented and confused and is not able to have a coherent conversation. The nurse suspects delirium. When reviewing the client’s medication history with the spouse, which medications would alert the nurse to a potential cause? Select all that apply.

A) Propranolol

B) Acetaminophen

C) Diphenhydramine

D) Verapamil

E) Quinidine