Dementia Prac Ques
Dementia Prac Ques
Dementia Prac Ques
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c. variable ability to perform simple tasks. to perform tasks would not have periods of improvement. Difficulty
d. loss of both recent and long-term memory. eating and swallowing is characteristic of severe dementia.
8. To determine whether a new patient's confusion is caused by d. Use the Confusion Assessment Method tool to assess the
dementia or delirium, which action should the nurse take? patient.
a. Assess the patient using the Mini-Mental Status Exam. The Confusion Assessment Method tool has been extensively
b. Obtain a list of the medications that the patient usually takes. tested in assessing delirium. The other actions will be helpful
c. Determine whether there is positive family history of dementia. in determining cognitive function or risk factors for dementia or
d. Use the Confusion Assessment Method tool to assess the delirium, but they will not be useful in differentiating between
patient. dementia and delirium.
9. A 62-year-old patient is brought to the clinic by a family member
c. "What did you have for breakfast?"
who is concerned about the patient's inability to solve common
problems. To obtain information about the patient's current mental
This question tests the patient's recent memory, which is de-
status, which question should the nurse ask the patient?
creased early in Alzheimer's disease (AD) or dementia. Asking the
patient about birthplace tests for remote memory, which is intact
a. "Where were you were born?"
in the early stages. Questions about the patient's emotions and
b. "Do you have any feelings of sadness?"
self-image are helpful in assessing emotional status, but they are
c. "What did you have for breakfast?"
not as helpful in assessing mental state.
d. "How positive is your self-image?"
10. When teaching the children of a patient who is being evalu-
ated for Alzheimer's disease (AD) about the disorder, the nurse
explains that c. a diagnosis of AD can be made only when other causes of
dementia have been ruled out.
a. the most important risk factor for AD is a family history of the
disorder. The diagnosis of AD is one of exclusion. Age is the most important
b. new drugs have been shown to reverse AD dramatically in some risk factor for development of AD. Drugs can slow the deterioration
patients. but do not dramatically reverse the effects of AD. Brain atrophy is
c. a diagnosis of AD can be made only when other causes of a common finding in AD, but it can occur in other diseases as well
dementia have been ruled out. and does not confirm an AD diagnosis.
d. the presence of brain atrophy detected by MRI confirms the
diagnosis of AD in patients with dementia.
11. A patient with mild dementia has a new prescription for
a. Having the patient's spouse administer the medication
donepezil (Aricept). Which nursing action will be most effective in
ensuring compliance with the medication?
Because the patient with mild dementia will have difficulty with
learning new skills and forgetfulness, the most appropriate nurs-
a. Having the patient's spouse administer the medication
ing action is to have someone else administer the drug. The other
b. Setting the medications up weekly in a medication box
nursing actions will not be as effective in ensuring that the patient
c. Calling the patient daily with a reminder to take the medication
takes the medications.
d. Posting reminders to take the medications in the patient's house
12. Which intervention will the nurse include in the plan of care for b. Maintain a consistent daily routine for the patient's care.
a patient who has late-stage Alzheimer's disease (AD)?
Providing a consistent routine will decrease anxiety and confusion
a. Encourage the patient to discuss events from the past. for the patient. In late-stage AD, the patient will not remember
b. Maintain a consistent daily routine for the patient's care. events from the past. Reorientation to time and place will not be
c. Reorient the patient to the date and time every 2 to 3 hours. helpful to the patient with late-stage AD, and the patient will not
d. Provide the patient with current newspapers and magazines. be able to read.
13. When assessing a patient with Alzheimer's disease (AD) who a. Place the patient in a room close to the nurses' station.
is being admitted to a long-term care facility, the nurse learns
that the patient has had several episodes of wandering away from Patients at risk for problems with safety require close supervision.
home. Which nursing action will the nurse include in the plan of Placing the patient near the nurse's station will allow nursing staff
care? to observe the patient more closely. The use of "why" questions
is frustrating for patients with AD because they are unable to un-
a. Place the patient in a room close to the nurses' station. derstand clearly or verbalize the reason for wandering behaviors.
b. Ask the patient why the wandering episodes have occurred. Because of the patient's short-term memory loss, reorientation
c. Have the family bring in familiar items from the patient's home. will not help prevent wandering behavior. Because the patient
d. Reorient the patient to the new living situation several times had wandering behavior at home, familiar objects will not prevent
daily. wandering.
14. During the morning change-of-shift report at the long-term
c. Keep blinds open during the daytime hours.
care facility, the nurse learns that the patient with dementia has
had sundowning. Which nursing action should the nurse take
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while caring for the patient? The most likely cause of sundowning is a disruption in circadian
rhythms and keeping the patient active and in daylight will help to
a. Provide hourly orientation to time of day. reestablish a more normal circadian pattern. Moving the patient
b. Move the patient to a quieter room at night. to a different room might increase confusion. Taking a nap will
c. Keep blinds open during the daytime hours. interfere with nighttime sleep. Hourly orientation will not be helpful
d. Have the patient take a brief mid-morning nap. in a patient with memory difficulties.
c. assess for factors that might be causing discomfort.
15. A long-term care patient with moderate dementia develops Increased motor activity in a patient with dementia is frequently
increased restlessness and agitation. The nurse's initial action the patient's only way of responding to factors like pain, so the
should be to nurse's initial action should be to assess the patient for any precip-
itating factors. Administration of sedative drugs may be indicated,
a. reorient the patient to time, place, and person. but this should not be done until assessment for precipitating
b. administer the PRN dose of lorazepam (Ativan). factors has been completed and any of these factors have been
c. assess for factors that might be causing discomfort. addressed. Reorientation is unlikely to be helpful for the patient
d. have a nursing assistant stay with the patient to ensure safety. with moderate dementia. Assigning a nursing assistant to stay with
the patient also may be necessary, but any physical changes that
may be causing the agitation should be addressed first.
b. Offer ideas for ways to distract or redirect the patient.
1. The spouse of a male patient with early stage Alzheimer's dis-
d. Educate the spouse about the availability of adult day care as
ease (AD) tells the nurse, "I am just exhausted from the constant
a respite.
worry. I don't know what to do." Which action is best for the nurse
e. Ask the spouse what she knows and has considered about
to take next (select all that apply)?
dementia care options.
a. Suggest that a long-term care facility be considered.
b. Offer ideas for ways to distract or redirect the patient.
The stress of being a caregiver can be managed with a multi-
c. Suggest that the spouse consult with the physician for antianx-
component approach. This includes respite care, learning ways to
iety drugs.
manage challenging behaviors, and further assessment of what
d. Educate the spouse about the availability of adult day care as
the spouse may already have considered. The patient is in the
a respite.
early stages and does not need long-term placement. Antianxiety
e. Ask the spouse what she knows and has considered about
medications may be appropriate but other measures should be
dementia care options.
tried first.
Bridge to NCLEX questions:
d. syndrome characterized by cognitive dysfunction and loss of
Dementia is defined as a memory.
a. syndrome that results only in memory loss. Rationale: Dementia is a syndrome characterized by dysfunction
b. disease associated with abrupt changes in behavior. in or loss of memory, orientation, attention, language, judgment,
c. disease that is always due to reduced blood flow to the brain. and reasoning. Personality changes and behavioral problems
d. syndrome characterized by cognitive dysfunction and loss of such as agitation, delusions, and hallucinations may result.
memory.
Bridge to NCLEX questions:
c. cognitive changes secondary to cerebral ischemia.
Vascular dementia is associated with
Rationale: Vascular dementia is the loss of cognitive function that
results from ischemic, ischemic-hypoxic, or hemorrhagic brain le-
a. transient ischemic attacks.
sions caused by cardiovascular disease. In this type of dementia,
b. bacterial or viral infection of neuronal tissue.
narrowing and blocking of arteries that supply the brain causes a
c. cognitive changes secondary to cerebral ischemia.
decrease in blood supply.
d. abrupt changes in cognitive function that are irreversible.
d. patient history and cognitive assessment.
A major goal of treatment for the patient with AD is to Rationale: The overall management goals are that the patient with
AD will (1) maintain functional ability for as long as possible, (2) be
a. maintain patient safety. maintained in a safe environment with a minimum of injuries, (3)
b. maintain or increase body weight. have personal care needs met, and (4) have dignity maintained.
c. return to a higher level of self-care. The nurse should place emphasis on patient safety while planning
d. enhance functional ability over time. and providing nursing care.
Bridge to NCLEX questions:
b. memory impairment, muscle jerks, and blindness.
Creutzfeldt-Jakob disease is characterized by
Rationale: Creutzfeldt-Jakob disease (CJD) is a fatal brain dis-
a. remissions and exacerbations over many years. order caused by a prion protein. The earliest symptom of the
b. memory impairment, muscle jerks, and blindness. disease may be memory impairment and behavioral changes. The
c. parkinsonian symptoms, including muscle rigidity and tremors disease progresses rapidly, with mental deterioration, involuntary
at rest. movements (i.e., muscle jerks), weakness in the limbs, blindness,
d. increased intracranial pressure secondary to decreased CSF and eventually coma
drainage.
Bridge to NCLEX questions:
d. A 78-year-old man admitted to the medical unit with complica-
Which patient is most at risk for developing delirium? tions related to heart failure
a. A 50-year-old woman with cholecystitis Rationale: Risk factors that can precipitate delirium include age
b. A 19-year-old man with a fractured femur of 65 years or older, male gender, and severe acute illness (e.g.,
c. A 42-year-old woman having an elective hysterectomy heart failure). The 78-year-old man has the most risk factors for
d. A 78-year-old man admitted to the medical unit with complica- delirium
tions related to heart failure
Pre-test practice questions:
A) "Ginkgo may increase the risk of bruising."
Although he has been told that ginkgo biloba will probably have
no effect, a 58-year-old man with early stage Alzheimer's disease
Rationale:
insists on taking the herb because he believes it will slow the
Ginkgo biloba may increase the risk for bruising and bleeding.
disease progression. Which statement, if made by the patient
There are no indications that sudden withdrawal of ginkgo biloba is
to the nurse, indicates understanding about the side effects of
unsafe. Ginkgo biloba is possibly effective for treating intermittent
ginkgo?
claudication (leg pain while walking). There is insufficient evidence
A) "Ginkgo may increase the risk of bruising."
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B) "Ginkgo may cause leg pain while walking."
to indicate that ginkgo biloba is effective in treatment of tinnitus
C) "It is not safe to suddenly stop taking ginkgo."
(ringing in the ears).
D) "Ringing in the ears is a side effect of ginkgo."
Pre-test practice questions:
D) A 72-year-old female is unable to locate the address where she
has lived for 10 years.
The home care nurse is visiting patients in the community. Which
patient is exhibiting an early warning sign of Alzheimer's disease?
Rationale:
An early warning sign of Alzheimer's disease is disorientation to
A) A 65-year-old male does not recognize his family members and
time and place such as geographic disorientation. Occasionally
close friends.
misplacing items and joking about memory loss are examples
B) A 59-year-old female misplaces her purse and jokes about
of normal forgetfulness. Impaired ability to recognize family and
having memory loss.
close friends is a clinical manifestation of middle or moderate
C) A 79-year-old male is incontinent and not able to perform
dementia (or Alzheimer's disease). Incontinence and inability to
hygiene independently.
perform self-care activities are clinical manifestations of severe or
D) A 72-year-old female is unable to locate the address where she
late dementia (or Alzheimer's disease).
has lived for 10 years.
Pre-test practice questions:
B) Provide thickened fluids and moist foods in bite-size pieces.
The nurse in the long-term care facility cares for a 70-year-old
Rationale: If patients with dementia have problems chewing or
man with severe (late-stage) dementia who is undernourished
swallowing, pureed foods, thickened liquids, and nutritional sup-
and has problems chewing and swallowing. What should the
plements should be provided. Foods that are easy to swallow are
nurse include in the plan of care for this patient?
moist and should be in bite-size pieces. Distractions at mealtimes,
including the television, should be avoided. Fluids should not be
A) Turn on the television to provide a distraction during meals.
limited but offered frequently; fluids should be thickened. Patients
B) Provide thickened fluids and moist foods in bite-size pieces.
with severe (late-stage) dementia have difficulty understanding
C) Limit fluid intake during scheduled meals to prevent aspiration.
words and would not have the cognitive ability to select menu
D) Allow the patient to select favorite foods from the menu choic-
choices.
es.
Pre-test practice questions: A) Reorient the patient.
The patient has been diagnosed with the mild cognitive impair- Rationale:
ment stage of Alzheimer's disease. What nursing interventions The patient with mild cognitive impairment will have problems with
should the nurse expect to use with this patient? memory, language, or another essential cognitive function that is
severe enough to be noticeable to others but does not interfere
A) Treat disruptive behavior with antipsychotic drugs. with activities of daily living. A calendar and family pictures for
B) Use a calendar and family pictures as memory aids. memory aids will help this patient. This patient should not yet have
C) Use a writing board to communicate with the patient. disruptive behavior or get lost easily. Using a writing board will not
D) Use a wander guard mechanism to keep the patient in the area. help this patient with communication.
A) Urinalysis
B) MRI of the head
NCLEX review questions: C) Liver function tests
D) Neuropsychologic testing
The patient is having some increased memory and language E) Blood urea nitrogen and serum creatinine
problems. What diagnostic tests will be done before this patient
is diagnosed with Alzheimer's disease (select all that apply)? Rationale:
Because there is no definitive diagnostic test for Alzheimer's dis-
A) Urinalysis ease, and many conditions can cause manifestations of dementia,
B) MRI of the head testing must be done to eliminate any other causes of cognitive
C) Liver function tests impairment. These include urinalysis to eliminate a urinary tract
D) Neuropsychologic testing infection, an MRI to eliminate brain tumors, liver function tests
E) Blood urea nitrogen and serum creatinine to eliminate encephalopathy, BUN and serum creatinine to rule
out renal dysfunction, and neuropsychologic testing to assess
cognitive function.
NCLEX review questions:
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a. Sertraline (Zoloft) cholinesterase inhibitor used for decreased memory and cogni-
b. Donepezil (Aricept) tion. Risperidone (Risperdal) is an antipsychotic used for behavior
c. Lorazepam (Ativan) management.
d. Risperidone (Risperdal)
7. The wife of a patient who is manifesting deterioration in memory
asks the nurse whether her husband has AD. The nurse explains
7. b. The only definitive diagnosis of AD can be made on exam-
that a diagnosis of AD is usually made when what happens?
ination of brain tissue during an autopsy but a clinical diagnosis
is made when all other possible causes of dementia have been
a. A urine test indicates elevated levels of isoprostanes
eliminated. Patients with AD may have ²-amyloid proteins in the
b. All other possible causes of dementia have been eliminated
blood, brain atrophy, or isoprostanes in the urine but these findings
c. Blood analysis reveals increased amounts of ²-amyloid protein
are not exclusive to those with AD.
d. A computed tomography (CT) scan of the brain indicates brain
atrophy
11. What N-methyl-d-aspartate (NMDA) receptor antagonist is 11. d. Memantine (Namenda) is the N-methyl-d-aspartate (NMDA)
frequently used for a patient with AD who is experiencing de- receptor antagonist frequently used for AD patients with de-
creased memory and cognition? creased memory and cognition. Trazodone (Desyrel) is an atypical
antidepressant that may help with sleep problems. Olanzapine
a. Trazodone (Desyrel) (Zyprexa) is an antipsychotic medication used for behavior man-
b. Olanzapine (Zyprexa) agement. Rivastigmine (Exelon) is a cholinesterase inhibitor used
c. Rivastigmine (Exelon) for decreased
d. Memantine (Namenda) memory and cognition.
14. 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?
14. a. 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
a. The risk of early-onset AD for the children of parents with it is
likely related to women living longer than men than to the type of
about 50%.
AD. ApoE gene testing is used for research with late-onset AD but
b. Women get AD more often than men do, so his chances of
does not predict who will develop the disease. Late-onset AD is
getting AD are slim.
more genetically complex than early-onset AD and is more com-
c. The blood test for the ApoE gene to identify this type of AD can
mon in those over age 60 but because his parent has early-onset
predict who will develop it.
AD he is at a 50% risk of getting it.
d. This type of AD is not as complex as regular AD, so he does
not need to worry about getting AD.
12. A patient with AD in a long-term care facility is wandering the
halls very agitated, asking for her "mommy" and
12. b. Patients with moderate to severe AD frequently become agi-
crying. What is the best response by the nurse?
tated but because their short-term memory loss is so pronounced,
distraction is a very good way to calm them. "Why" questions are
a. Ask the patient, "Why are you behaving this way?"
upsetting to them because they don't know the answer and they
b. Tell the patient, "Let's go get a snack in the kitchen."
cannot respond to normal relaxation techniques.
c. Ask the patient, "Wouldn't you like to lie down now?"
d. Tell the patient, "Just take some deep breaths and calm down."
13. The sister of a patient with AD asks the nurse whether preven-
tion 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
13. a, b, f. Avoiding trauma to the brain, treating depression early,
brain healthy (select all that apply)?
and exercising regularly can maintain cognitive function. Staying
socially active, avoiding intake of harmful substances, and chal-
a. Avoid trauma to the brain.
lenging the brain to keep its connections active and create new
b. Recognize and treat depression early.
ones also help to keep the brain healthy.
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
15. A patient with moderate AD has a nursing diagnosis of im-
15. b. Adhering to a regular, consistent daily schedule helps the
paired memory related to effects of dementia. What is an appro-
patient to avoid confusion and anxiety and is important both
priate nursing intervention for this patient?
during hospitalization and at home. Clocks and calendars may
be useful in early AD but they have little meaning to a patient as
a. Post clocks and calendars in the patient's environment.
the disease progresses. Questioning the patient about activities
b. Establish and consistently follow a daily schedule with the
and events they cannot remember is threatening and may cause
patient.
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c. Monitor the patient's activities to maintain a safe patient envi-
ronment. severe anxiety. Maintaining a safe environment for the patient is
d. Stimulate thought processes by asking the patient questions important but does not change the disturbed thought processes.
about recent activities
The family caregiver for a patient with AD expresses an inability
b. Family caregiver role strain is characterized by such symptoms
to make decisions, concentrate, or sleep. The nurse determines
of stress as the inability to sleep, make decisions, or concentrate.
what about the caregiver?
It is frequently seen in family members who are responsible for
the care of the patient with AD. Assessment of the caregiver may
a. The caregiver is also developing signs of AD.
reveal a need for assistance to increase coping skills, effectively
b. The caregiver is manifesting symptoms of caregiver role strain.
use community resources, or maintain social relationships. Even-
c. The caregiver needs a period of respite from care of the patient.
tually the demands on a caregiver exceed the resources and the
d. The caregiver should ask other family members to participate
person with AD may be placed in an institutional setting.
in the patient's care.
17. 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 17. a. Adult day care is an option to provide respite for caregivers
intervention that would be appropriate to provide respite care and and a protective environment for the patient during the early
allow the wife to have satisfactory contact with significant others? and middle stages of AD. There are also in-home respite care
providers. The respite from the demands of care allows the care-
a. Help the wife to arrange for adult day care for the patient. giver to maintain social contacts, perform normal tasks of living,
b. Encourage permanent placement of the patient in the and be more responsive to the patient's needs. Visits by home
Alzheimer's unit of a long-term care facility. health nurses involve the caregiver and cannot provide adequate
c. Refer the wife to a home health agency to arrange daily home respite. Institutional placement is not always an acceptable option
nursing visits to assist with the patient's care. at earlier stages of AD, nor is hospitalization available for respite
d. Arrange for hospitalization of the patient for 3 or 4 days so that care.
the wife can visit out-of-town friends and
relatives.
23. When caring for a patient in the severe stage of AD, what
diversion or distraction activities would be appropriate? 23. d. In the severe stage of AD, the patient is at a developmen-
tal level of 15 months or less; therefore appropriate distractions
a. Watching TV would be infant toys. Watching TV and playing games are more
b. Playing games appropriate in the mild stage. Books to read would need to be at
c. Books to read developmentally appropriate levels to be used as a diversion.
d. Mobiles or dangling ribbons
18. The health care provider is trying to differentiate the diagnosis
18. b, e. Dementia with Lewy bodies (DLB) is diagnosed with
of the patient between dementia and dementia with Lewy bodies
dementia plus two of the following symptoms: (1) extrapyramidal
(DLB). What observations by the nurse support a diagnosis of
signs such as bradykinesia, rigidity, and
DLB (select all that apply)?
postural instability but not always a tremor, (2) fluctuating cognitive
ability, and (3) hallucinations. The extrapyramidal
a. Tremors
signs plus tremors would more likely indicate Parkinson's disease.
b. Fluctuating cognitive ability
Disturbed behavior, sleep, personality, and
c. Disturbed behavior, sleep, and personality
eventually memory are characteristics of frontotemporal lobe de-
d. Symptoms of pneumonia, including congested lung sounds
generation (FTLD).
e. Bradykinesia, rigidity, and postural instability without tremor
19. Delegation Decision: The RN in charge at a long-term care 19. a, b, d. All caregivers are responsible for the patient's safety.
facility could delegate which activities to unlicensed Basic care activities, such as those associated with personal
assistive personnel (UAP) (select all that apply)? hygiene and activities of daily living (ADLs) can be delegated
to unlicensed assistive personnel (UAP). The RN will perform
a. Assist the patient with eating. ongoing assessments and develop and revise the plan of care
b. Provide personal hygiene and skin care. as needed. The RN will assess the patient's safety risk factors,
c. Check the environment for safety hazards. provide education, and make referrals.
d. Assist the patient to the bathroom at regular intervals. The licensed practical nurse (LPN) could check the patient's en-
e. Monitor for skin breakdown and swallowing difficulties. vironment for potential safety hazards.
21. 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. 21. d. Delirium is an acute problem that usually has a rapid onset in
He resists attempts at examination and calls out the name "Jan- response to a precipitating event, especially when the patient has
ice." Why should the nurse suspect delirium rather than dementia underlying health problems, such as heart disease and sensory
in this patient?
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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
limitations. In the absence of prior cognitive impairment, a sudden
the hypoactive behavior of dementia
onset of confusion, disorientation, and agitation is usually deliri-
c. The report of emergency personnel that he was noncommu-
um. Delirium may manifest with both hypoactive and hyperactive
nicative when they arrived at the accident scene
symptoms.
d. The report of his family that although he has heart disease and
is "very hard of hearing," this behavior is
unlike him
What should be included in the management of a patient with
22. c. Care of the patient with delirium is focused on identifying
delirium?
and eliminating precipitating factors if possible.
Treatment of underlying medical conditions, changing environ-
a. The use of restraints to protect the patient from injury
mental conditions, and discontinuing medications
b. The use of short-acting benzodiazepines to sedate the patient
that induce delirium are important. Drug therapy is reserved for
c. Identification and treatment of underlying causes when possible
those patients with severe agitation because the drugs
d. Administration of high doses of an antipsychotic drug such as
themselves may worsen delirium.
haloperidol (Haldol)
20. A 72-year-old woman is hospitalized in the intensive care
unit (ICU) with pneumonia resulting from chronic obstructive pul-
monary 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
20. a. Age; b. infection; c. hypoxemia (lung disease); d. intensive
has been able to maintain her activities of daily living (ADLs) with
care unit (ICU) hospitalization (change in environment, sensory
supervision. Identify at least six risk factors for the development
overload); e. preexisting dementia; f. dehydration. Also: hyper-
of delirium in this patient. (Fill in the blanks.)
thermia and potentially medications to treat chronic obstructive
pulmonary disease (COPD) and pneumonia.
a.
b.
c.
d.
e.
f.
A 68-year-old patient who is hospitalized with pneumonia is dis-
oriented and confused 3 days after admission. Which information
indicates that the patient is experiencing delirium rather than ANS: A
dementia? The onset of delirium occurs acutely. The degree of disorientation
a. The patient was oriented and alert when admitted. does not differentiate between delirium and dementia. Increasing
b. The patient's speech is fragmented and incoherent. confusion for several years is consistent with dementia. Frag-
c. The patient is oriented to person but disoriented to place and mented and incoherent speech may occur with either delirium or
time. dementia.
d. The patient has a history of increasing confusion over several
years.
Which intervention will the nurse include in the plan of care for
ANS: B
a patient with moderate dementia who had an appendectomy 2
The patient with moderate dementia will have problems with short-
days ago?
and long-term memory and will need reminding about the hos-
a. Provide complete personal hygiene care for the patient.
pitalization. The other interventions would be used for a patient
b. Remind the patient frequently about being in the hospital.
with severe dementia, who would have difficulty with swallowing,
c. Reposition the patient frequently to avoid skin breakdown.
self-care, and immobility.
d. Place suction at the bedside to decrease the risk for aspiration.
ANS: C
When administering a mental status examination to a patient with Because overstimulation by environmental factors can distract the
delirium, the nurse should patient from the task of answering the nurse's questions, these
a. wait until the patient is well-rested. stimuli should be avoided. The nurse will not wait to give the
b. administer an anxiolytic medication. examination because action to correct the delirium should occur
c. choose a place without distracting stimuli. as soon as possible. Reorienting the patient is not appropriate
d. reorient the patient during the examination. during the examination. Antianxiety medications may increase the
patient's delirium.
The nurse is concerned about a postoperative patient's risk for ANS: D
injury during an episode of delirium. The most appropriate action The priority goal is to protect the patient from harm. Having a UAP
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by the nurse is to stay with the patient will ensure the patient's safety. Visits by family
a. secure the patient in bed using a soft chest restraint. members are helpful in reorienting the patient, but families should
b. ask the health care provider to order an antipsychotic drug. not be responsible for protecting patients from injury. Antipsychotic
c. instruct family members to remain with the patient and prevent medications may be ordered, but only if other measures are
injury. not effective because these medications have many side effects.
d. assign unlicensed assistive personnel (UAP) to stay with the Restraints are not recommended because they can increase the
patient and offer reorientation. patient's agitation and disorientation.
A 56-year-old patient in the outpatient clinic is diagnosed with mild
cognitive impairment (MCI).Which action will the nurse include in
ANS: B
the plan of care?
Ongoing monitoring is recommended for patients with MCI.
a. Suggest a move into an assisted living facility.
MCI does not interfere with activities of daily living, acetyl-
b. Schedule the patient for more frequent appointments.
cholinesterase drugs are not used for MCI, and an assisted living
c. Ask family members to supervise the patient's daily activities.
facility is not indicated for MCI.
d. Discuss the preventive use of acetylcholinesterase medica-
tions.
The nurse is administering a mental status examination to a
48-year-old patient who has hypertension. The nurse suspects ANS: B
depression when the patient responds to the nurse's questions Answers such as "I don't know" are more typical of depression
with than dementia. The response "Who are those people over there?"
a. "Is that right?" is more typical of the distraction seen in a patient with delirium.
b. "I don't know." The remaining two answers are more typical of a patient with mild
c. "Wait, let me think about that." to moderate dementia.
d. "Who are those people over there?"
A 68-year-old patient is diagnosed with moderate dementia after
ANS: C
multiple strokes. During assessment of the patient, the nurse
Loss of both recent and long-term memory is characteristic of
would expect to find
moderate dementia. Patients with dementia have frequent night-
a. excessive nighttime sleepiness.
time awakening. Dementia is progressive, and the patient's ability
b. difficulty eating and swallowing.
to perform tasks would not have periods of improvement. Difficulty
c. loss of recent and long-term memory.
eating and swallowing is characteristic of severe dementia.
d. fluctuating ability to perform simple tasks.
Which action will help the nurse determine whether a new pa- ANS: B
tient's confusion is caused by dementia or delirium? The Confusion Assessment Method tool has been extensively
a. Administer the Mini-Mental Status Exam. tested in assessing delirium. The other actions will be helpful
b. Use the Confusion Assessment Method tool. in determining cognitive function or risk factors for dementia or
c. Determine whether there is a family history of dementia. delirium, but they will not be useful in differentiating between
d. Obtain a list of the medications that the patient usually takes. dementia and delirium.
A 72-year-old female patient is brought to the clinic by the patient's
spouse, who reports that she is unable to solve common prob- ANS: D
lems around the house. To obtain information about the patient's This question tests the patient's short-term memory, which is
current mental status, which question should the nurse ask the decreased in the mild stage of Alzheimer's disease or dementia.
patient? Asking the patient about her birthplace tests for remote memory,
a. "Are you sad?" which is intact in the early stages. Questions about the patient's
b. "How is your self-image?" emotions and self-image are helpful in assessing emotional sta-
c. "Where were you were born?" tus, but they are not as helpful in assessing mental state
d. "What did you eat for breakfast?"
A patient is being evaluated for Alzheimer's disease (AD). The
nurse explains to the patient's adult children that
a. the most important risk factor for AD is a family history of the ANS: C
disorder. The diagnosis of AD is usually one of exclusion. Age is the most
b. new drugs have been shown to reverse AD dramatically in some important risk factor for development of AD. Drugs may slow the
patients. deterioration but do not reverse the effects of AD. Brain atrophy is
c. a diagnosis of AD is made only after other causes of dementia a common finding in AD, but it can occur in other diseases as well
are ruled out. and does not confirm a diagnosis of AD.
d. the presence of brain atrophy detected by magnetic resonance
imaging (MRI) will confirm the diagnosis of AD.
Which nursing action will be most effective in ensuring daily
ANS: B
medication compliance for a patient with mild dementia?
Because the patient with mild dementia will have difficulty with
a. Setting the medications up monthly in a medication box
learning new skills and forgetfulness, the most appropriate nurs-
b. Having the patient's family member administer the medication
ing action is to have someone else administer the drug. The other
c. Posting reminders to take the medications in the patient's house
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d. Calling the patient weekly with a reminder to take the medica- nursing actions will not be as effective in ensuring that the patient
tion takes the medications.
A patient who has severe Alzheimer's disease (AD) is being
ANS: B
admitted to the hospital for surgery. Which intervention will the
Providing a consistent routine will decrease anxiety and confusion
nurse include in the plan of care?
for the patient. Reorientation to time and place will not be helpful to
a. Encourage the patient to discuss events from the past.
the patient with severe AD, and the patient will not be able to read.
b. Maintain a consistent daily routine for the patient's care.
The patient with severe AD will probably not be able to remember
c. Reorient the patient to the date and time every 2 to 3 hours.
events from the past.
d. Provide the patient with current newspapers and magazines.
ANS: C
A 71-year-old patient with Alzheimer's disease (AD) who is being Patients at risk for problems with safety require close supervision.
admitted to a long-term care facility has had several episodes of Placing the patient near the nurse's station will allow nursing staff
wandering away from home. Which action will the nurse include to observe the patient more closely. The use of "why" questions
in the plan of care? can be frustrating for patients with AD because they are unable to
a. Reorient the patient several times daily. understand clearly or verbalize the reason for wandering behav-
b. Have the family bring in familiar items. iors. Because of the patient's short-term memory loss, reorienta-
c. Place the patient in a room close to the nurses' station. tion will not help prevent wandering behavior. Because the patient
d. Ask the patient why the wandering episodes have occurred. had wandering behavior at home, familiar objects will not prevent
wandering.
The day shift nurse at the long-term care facility learns that a pa- ANS: A
tient with dementia experienced sundowning late in the afternoon A likely cause of sundowning is a disruption in circadian rhythms
on the previous two days. Which action should the nurse take? and keeping the patient active and in daylight will help reestablish
a. Keep blinds open during the daytime hours. a more normal circadian pattern. Moving the patient to a different
b. Provide hourly orientation to time and place. room might increase confusion. Taking a nap will interfere with
c. Have the patient take a brief mid-morning nap. nighttime sleep. Hourly orientation will not be helpful in a patient
d. Move the patient to a quieter room late in the afternoon. with dementia
ANS: C
Increased motor activity in a patient with dementia is frequently
The nurse's initial action for a patient with moderate dementia who the patient's only way of responding to factors like pain, so the
develops increased restlessness and agitation should be to nurse's initial action should be to assess the patient for any precip-
a. reorient the patient to time, place, and person. itating factors. Administration of sedative drugs may be indicated,
b. administer a PRN dose of lorazepam (Ativan). but this should not be done until assessment for precipitating
c. assess for factors that might be causing discomfort. factors has been completed and any of these factors have been
d. assign unlicensed assistive personnel (UAP) to stay in the addressed. Reorientation is unlikely to be helpful for the patient
patient's room. with moderate dementia. Assigning UAP to stay with the patient
may also be necessary, but any physical changes that may be
causing the agitation should be addressed first.
When administering the Mini-Cog exam to a patient with possible
Alzheimer's disease, which action will the nurse take? ANS: C
a. Check the patient's orientation to time and date. In the Mini-Cog, patients illustrate a specific time stated by the
b. Obtain a list of the patient's prescribed medications. examiner by drawing the time on a clock face. The other actions
c. Ask the person to use a clock drawing to indicate a specific time. may be included in assessment for Alzheimer's disease, but are
d. Determine the patient's ability to recognize a common object not part of the Mini-Cog exam.
such as a pen.
Which hospitalized patient will the nurse assign to the room
closest to the nurses' station?
a. Patient with Alzheimer's disease who has long-term memory ANS: C
deficit This patient's history and clinical manifestations are consistent
b. Patient with vascular dementia who takes medications for de- with delirium. The patient is at risk for safety problems and should
pression be placed near the nurses' station for ongoing observation. The
c. Patient with new-onset confusion, restlessness, and irritability other patients have chronic symptoms that are consistent with
after surgery their diagnoses but are not at immediate risk for safety issues.
d. Patient with dementia who has an abnormal Mini-Mental State
Examination
After change-of-shift report on the Alzheimer's disease/dementia
ANS: D
unit, which patient will the nurse assess first?
A new cough after a meal in a patient with dementia suggests pos-
a. Patient who has not had a bowel movement for 5 days
sible aspiration and the patient should be assessed immediately.
b. Patient who has a stage II pressure ulcer on the coccyx
The other patients also require assessment and intervention, but
c. Patient who is refusing to take the prescribed medications
not as urgently as a patient with possible aspiration or pneumonia.
d. Patient who developed a new cough after eating breakfast
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The spouse of a 67-year-old male patient with early stage
Alzheimer's disease (AD) tells the nurse, "I am exhausted from
ANS: B, C, E
worrying all the time. I don't know what to do." Which actions are
The stress of being a caregiver can be managed with a multi-
best for the nurse to take next (select all that apply)?
component approach. This includes respite care, learning ways
a. Suggest that a long-term care facility be considered.
to manage challenging behaviors, and further assessment of
b. Offer ideas for ways to distract or redirect the patient.
what the spouse may already have considered for care options.
c. Teach the spouse about adult day care as a possible respite.
The patient is in the early stages and does not need long-term
d. Suggest that the spouse consult with the physician for antianx-
placement. Antianxiety medications may be appropriate, but other
iety drugs.
measures should be tried first.
e. Ask the spouse what she knows and has considered about
dementia care options.
Which nursing actions could the nurse delegate to a licensed
practical/vocational nurse (LPN/LVN) who is part of the team car-
ing for a patient with Alzheimer's disease (select all that apply)?
a. Develop a plan to minimize difficult behavior. ANS: B, C
b. Administer the prescribed memantine (Namenda). LPN/LVN education and scope of practice includes medication
c. Remove potential safety hazards from the patient's environ- administration and monitoring for environmental safety in stable
ment. patients. Planning of interventions such as ways to manage be-
d. Refer the patient and caregivers to appropriate community havior or improve memory, referrals, and evaluation of the ef-
resources. fectiveness of interventions require registered nurse (RN)-level
e. Help the patient and caregivers choose memory enhancement education and scope of practice.
methods.
f. Evaluate the effectiveness of the prescribed enteral feedings on
patient nutrition.
A 68-year-old patient who is hospitalized with pneumonia is dis-
oriented and confused 3 days after admission. Which information
ANS: A-The patient was oriented and alert when admitted
indicates that the patient is experiencing delirium rather than
dementia?
The onset of delirium occurs acutely. The degree of disorientation
a. The patient was oriented and alert when admitted.
does not differentiate between delirium and dementia. Increasing
b. The patient's speech is fragmented and incoherent.
confusion for several years is consistent with dementia. Frag-
c. The patient is oriented to person but disoriented to place and
mented and incoherent speech may occur with either delirium or
time.
dementia.
d. The patient has a history of increasing confusion over several
years.
Which intervention will the nurse include in the plan of care for ANS: B-Remind the patient frequently about being in the hospital.
a patient with moderate dementia who had an appendectomy 2
days ago? The patient with moderate dementia will have problems with short-
a. Provide complete personal hygiene care for the patient. and long-term memory and will need reminding about the hos-
b. Remind the patient frequently about being in the hospital. pitalization. The other interventions would be used for a patient
c. Reposition the patient frequently to avoid skin breakdown. with severe dementia, who would have difficulty with swallowing,
d. Place suction at the bedside to decrease the risk for aspiration. self-care, and immobility.
ANS: C-choose a place without distracting stimuli.
When administering a mental status examination to a patient with
Because overstimulation by environmental factors can distract the
delirium, the nurse should
patient from the task of answering the nurse's questions, these
a. wait until the patient is well-rested.
stimuli should be avoided. The nurse will not wait to give the
b. administer an anxiolytic medication.
examination because action to correct the delirium should occur
c. choose a place without distracting stimuli.
as soon as possible. Reorienting the patient is not appropriate
d. reorient the patient during the examination.
during the examination. Antianxiety medications may increase the
patient's delirium.
The nurse is concerned about a postoperative patient's risk for
injury during an episode of delirium. The most appropriate action
by the nurse is to
a. secure the patient in bed using a soft chest restraint.
ANS: D-assign unlicensed assistive personnel (UAP) to stay with
b. ask the health care provider to order an antipsychotic drug.
the patient and offer reorientation.
c. instruct family members to remain with the patient and prevent
injury.
d. assign unlicensed assistive personnel (UAP) to stay with the
patient and offer reorientation.
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A 56-year-old patient in the outpatient clinic is diagnosed with mild
cognitive impairment (MCI).Which action will the nurse include in
the plan of care?
a. Suggest a move into an assisted living facility.
ANS: B-Schedule the patient for more frequent appointments
b. Schedule the patient for more frequent appointments.
c. Ask family members to supervise the patient's daily activities.
d. Discuss the preventive use of acetylcholinesterase medica-
tions.
The nurse is administering a mental status examination to a
ANS: B-"I don't know."
48-year-old patient who has hypertension. The nurse suspects
depression when the patient responds to the nurse's questions
Answers such as "I don't know" are more typical of depression
with
than dementia. The response "Who are those people over there?"
a. "Is that right?"
is more typical of the distraction seen in a patient with delirium.
b. "I don't know."
The remaining two answers are more typical of a patient with mild
c. "Wait, let me think about that."
to moderate dementia.
d. "Who are those people over there?"
A 68-year-old patient is diagnosed with moderate dementia after
multiple strokes. During assessment of the patient, the nurse
would expect to find ANS: C
a. excessive nighttime sleepiness. Loss of both recent and long-term memory is characteristic of
b. difficulty eating and swallowing. moderate dementia
c. loss of recent and long-term memory.
d. fluctuating ability to perform simple tasks.
Which action will help the nurse determine whether a new pa-
tient's confusion is caused by dementia or delirium?
ANS: B
a. Administer the Mini-Mental Status Exam.
The Confusion Assessment Method tool has been extensively
b. Use the Confusion Assessment Method tool.
tested in assessing delirium.
c. Determine whether there is a family history of dementia.
d. Obtain a list of the medications that the patient usually takes.
A 72-year-old female patient is brought to the clinic by the patient's
spouse, who reports that she is unable to solve common prob-
lems around the house. To obtain information about the patient's
ANS: D-"What did you eat for breakfast?"
current mental status, which question should the nurse ask the
patient?
This question tests the patient's short-term memory, which is
a. "Are you sad?"
decreased in the mild stage of Alzheimer's disease or dementia
b. "How is your self-image?"
c. "Where were you were born?"
d. "What did you eat for breakfast?"
A patient is being evaluated for Alzheimer's disease (AD). The
nurse explains to the patient's adult children that
a. the most important risk factor for AD is a family history of the
disorder.
ANS: C
b. new drugs have been shown to reverse AD dramatically in some
The diagnosis of AD is usually one of exclusion. Age is the most
patients.
important risk factor for development of AD
c. a diagnosis of AD is made only after other causes of dementia
are ruled out.
d. the presence of brain atrophy detected by magnetic resonance
imaging (MRI) will confirm the diagnosis of AD.
Which nursing action will be most effective in ensuring daily
ANS: B-Having the patient's family member administer the med-
medication compliance for a patient with mild dementia?
ication
a. Setting the medications up monthly in a medication box
b. Having the patient's family member administer the medication
Because the patient with mild dementia will have difficulty with
c. Posting reminders to take the medications in the patient's house
learning new skills and forgetfulness, the most appropriate nurs-
d. Calling the patient weekly with a reminder to take the medica-
ing action is to have someone else administer the drug.
tion
A patient who has severe Alzheimer's disease (AD) is being
admitted to the hospital for surgery. Which intervention will the ANS: B
nurse include in the plan of care? Providing a consistent routine will decrease anxiety and confusion
a. Encourage the patient to discuss events from the past. for the patient.
b. Maintain a consistent daily routine for the patient's care.
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c. Reorient the patient to the date and time every 2 to 3 hours.
d. Provide the patient with current newspapers and magazines.
A 71-year-old patient with Alzheimer's disease (AD) who is being
admitted to a long-term care facility has had several episodes of
ANS: C-Place the patient in a room close to the nurses' station.
wandering away from home. Which action will the nurse include
in the plan of care?
Patients at risk for problems with safety require close supervision.
a. Reorient the patient several times daily.
Placing the patient near the nurse's station will allow nursing staff
b. Have the family bring in familiar items.
to observe the patient more closely
c. Place the patient in a room close to the nurses' station.
d. Ask the patient why the wandering episodes have occurred.
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