Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
GC (cognitive)
EXAM 3
| Question | Answer |
|---|---|
| A 73-year-old woman with pneumonia becomes agitated after being admitted to the intensive care unit through the emergency department. She is placed in soft restraints when she continues to try to leave her bed despite being too weak to walk. Her vital sig | The patient is experiencing delirium secondary to the pneumonia. |
| Intervention(s) appropriate for a hospitalized patient experiencing delirium include which of the following? Select all that apply. | Assuring that a clock and a sign indicating the day and date is displayed where the patient can see it easily . Being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care Speaking with the patient frequ |
| Which statement about dementia is accurate? | Hypertension, diminished activity levels, and head injury increase the risk of dementia. |
| Mrs. Smith dies at the age of 82. In the 2 months following her death, her husband, aged 84 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping | Arrange for an appointment with a therapist for evaluation and treatment of suspected depression. |
| Which of the following intervention(s) would be beneficial for those caring for a loved one with Alzheimer's disease? Select all that apply. | Discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them. For situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the |
| Which problem is not considered a causative agent in delirium? | Antibiotic therapy |
| The term "perceptual disturbance" refers to difficulty | processing information about one's internal and external environment. |
| Which event would a client with early (stage 1) Alzheimer's disease have greatest difficulty remembering? | What was eaten for breakfast |
| A client has been diagnosed with delirium caused by a metabolic disorder. He begs the nurse to get someone to take away the huge snake in the hallway before it comes into his room. The nurse looks to where he is pointing and sees the hose of the vacuum cl | an illusion |
| A client with delirium strikes out at staff. The nurse can most correctly hypothesize that this behavior is related to | fear |
| Which cause of dementia has a clear genetic link? | Alzheimer's disease |
| What is the usual course of Alzheimer's disease? | Progressive deterioration |
| A client with Alzheimer's disease looks confused when the phone rings and seems not to recognize what the stimulus is. He also cannot recall many common household objects by name, such as a pencil or glass. The nurse can document this as | agnosia |
| The family of a client with Alzheimer's disease mentions to the nurse that seeing his loss of function when he was once such a competent individual has been very difficult. A nursing diagnosis that might be considered for such a family would be | anticipatory grieving |
| A nursing diagnosis appropriate for a client with Alzheimer's disease, regardless of the stage, would be | risk for injury |
| The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess nightly | agitation. |
| The nurse caring for a client with Alzheimer's disease can anticipate that the family will need information about therapy with | acetylcholinesterase inhibitors. |
| A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. The client has difficulty answering the questions asked by the nurse. The daughter reports that her mother had been oriented | delirium |
| A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. The daughter remembered to bring her mother's medication to the hospital. They include digoxin, an antihypertensive, a tricy | suggesting the social worker talk to the family about institutionalization. |
| A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states "I'll take her glasses and hearing aid home so they don't get lost." The be | "I would like to have your mother wear them. It will help her to be less confused." |
| The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character if the client truly has stage 1 Alzheimer's disease? | Willingness to respond directly to questions posed by nurse |
| A client with Alzheimer's disease can no longer perform hygiene and grooming. She often objects to being led to the shower and does not participate in washing herself. She puts her arms into the legs of her slacks, and so forth. She tests doors and walks | stage 3, moderate-severe |
| An initial intervention the nurse might suggest to the family members of a client with Alzheimer's disease who has begun to be incontinent for urine is to: | label the bathroom door with a picture |
| Dementia in an older adult is often a misdiagnosis for | depression |
| The family members of a client with stage 1 Alzheimer's disease have jobs and cannot provide adequate supervision for the client. A reasonable alternative for the nurse to explore with them would be | day care |
| The nurse assessing a patient with suspected delirium should expect to find that the symptoms developed: | over a period of hours to days |
| A reasonable outcome that would be appropriate for a patient with cognitive impairment related to delirium would be that the patient will: | return to the premorbid level of functioning |
| The nursing diagnosis of highest priority for patients with late Alzheimer's disease is: | risk for injury |
| Strategies to help staff caring for cognitively impaired patients avoid developing burnout include: | setting realistic patient goals |
| Medications approved for the treatment of cognitive impairment in patients with Alzheimer's disease include: | cholinesterase inhibitors |
| Which intervention should the nurse incorporate into the care plan for a patient with dementia in order to support short-term memory? | Daily activity schedule |
| If a patient is hospitalized with delirium of unknown etiology, which assessment finding should the nurse expect? | Fluctuating levels of consciousness |
| A patient with dementia is unable to name a knife but describes the function as "the thing you cut meat with." Which term should the nurse use to document this finding? | Agnosia |
| The nurse should recognize the patient is experiencing an illusion when the patient: | misinterprets shadows on a wall as frightening faces |
| Which is the best example of a cognitive impairment? | Inability to name a familiar object |
| Which action should a nurse recommend for a family that has a member with moderate Alzheimer's disease? | Apply an identification bracelet to the person |
| When formulating long-term goals for a patient with Alzheimer's disease, the nurse should be aware of the need to: | modify expectations as the patient's abilities deteriorate |
| What is the appropriate nursing intervention for a patient with dementia who develops a catastrophic reaction? | Eliminate or reduce environmental stimulation. |
| The husband of a patient with moderately advanced Alzheimer's disease tells the nurse, "My wife becomes very distressed several times a week. She sees strangers walking around in the house and thinks they are taking her things." How should the nurse respo | Suggest he try to divert her attention through alternate activities Recognize how challenging and frustrating these experiences can be |
| An objective sign that frequently accompanies symptoms of delirium is: | disturbed sleep/wake cycle |
| Which nursing technique is appropriate for successful interaction with a patient diagnosed with Alzheimer's disease? | Encourage communication and maintain a calm demeanor |
| A nurse notes that an older adult patient has fluctuating levels of awareness and seems anxious. The patient says, "I saw my granddaughter standing at the foot of the bed during the night." Later, the nurse sees the patient's hands waving and picking thin | Delirium |
| When a nurse gives anticipatory guidance to the family of a patient with early Alzheimer's disease, which behavioral problem common to that stage of the disease should be mentioned? | Inability to carry on an in-depth conversation |
| The nurse is caring for an older adult patient. Which symptom should the nurse recognize as a normal part of aging? | Situational grieving |
| The nurse is caring for a patient experiencing delirium. Which nursing response is appropriate when the patient's daughter asks, "Will he ever stop acting like this?" | "Once we know the cause of the delirium, we can begin treatment to attempt to reverse the process." |
| A patient with dementia exhibits difficulty feeding himself despite the fact that there is nothing wrong with his motor functions. Which term should the nurse use to document this finding? | Apraxia |
| An older adult patient experiencing pain states that she is going to use kava kava, which she has heard provides pain relief. Which nursing response is appropriate? | "Are you using any other treatments for pain relief?" |
| The nurse is caring for a patient who is a "DNR-CCO." Which nursing action would be appropriate if the patient were to go into cardiac arrest? | Administer morphine for pain control |
| A nurse planning continuing education programs for nursing staff at a multipurpose senior center will plan programs based on the knowledge that one of the most common mental health problems among the elderly is | suicidal ideation |
| Which of the following statements should be disregarded by a nurse planning care for elderly individuals? | Most adults past the age of 75 years have some form of cognitive disorder |
| Ageism is best explained as | discrimination against the elderly on the basis of age |
| A nurse doing a survey about adequacy of pain management in the elderly will be most likely to find that the elderly | receive less analgesia than younger adults, resulting in inadequate pain relief. |
| The intervention strategy least useful when addressing suicidal ideation in an elderly client is | psychoanalytic psychotherapy |
| A usually quiet resident in a long-term care facility has become confused and has shouted out a number of times during the night. The other residents in nearby rooms are upset by the noise and the interruptions to their sleep. The nurse in charge should | investigate the reason for the client's behavioral change |
| Under what conditions can the nurse seek an order to restrain an elderly resident of a health care facility? | To ensure the physical safety of the resident or other residents |
| A client has osteoarthritis and describes the inability to sleep because of aching in her hips and shoulders. An appropriate intervention the nurse could anticipate is administering a bedtime dose of | acetaminophen |
| What is the nurse's responsibility under the Patient Self-Determination Act of 1990 when a client is admitted to a long-term care facility? | Give written materials concerning client rights to make decisions about medical care and formulate advance directives, and ask if the client has an advance directive |
| A terminally ill elderly client wishes to guarantee that his wishes about end-of-life care will be followed. The approach that will most closely guarantee this is for the client to | execute a durable power of attorney for health care |
| A client tells the nurse that he prefers not to attend senior citizens meetings held in his apartment building because the members are "old fuddy duddies" who talk subjects to death but never take action. He states "They dodder around and never accomplish | exhibiting ageism |
| In performing quality assurance surveys of health education received by elderly clients, the nurse is most likely to find that the elderly | receive considerably less information on available resources |
| Which client would be most suitable for inclusion in a maintenance day care program? | a pt who is regressed and apathetic and sits staring out the window most of the day |
| An elderly client is moderately cognitively impaired and terminally ill with breast cancer. When asked if she is in pain, she usually denies it. She tells staff "My back aches a bit." The nurses note she lies rigidly in bed and grimaces when she turns fro | the Pain Assessment in Advanced Dementia (PAINAD) scale |
| A client has been a resident of the long-term care center for 6 weeks. She has been able to bathe with minimal assistance, feed herself, and ambulate short distances. Today, she tells the nurse "you bathe me." When the nurse inquires as to why the residen | learned helplessness |
| A client is a widower who lives with his employed daughter and her busy family. He is quite self-sufficient but tells the community health nurse that he gets lonely being by himself so much of the time with only the television set for company. A suggestio | attend a social day care three times a week |
| A client wanders about the long-term care unit. She is unsteady and often falls, sustaining bruises and scrapes. The family is concerned about her falls and the potential for serious injury. They suggest that she be restrained. The best response for the n | "Using restraints puts the client at higher risk for serious injury, even death." |
| Dr. White writes the following order for restraint for a confused elderly resident who walks up to other residents and slaps them: "3/11/01 Restrain in chair or bed prn. William A. White, MD." The nurse transcribing the order should | point out that the order is premature |
| Blood transfusions are no longer the main cause for the spread of AIDS. Research shows that the risk for HIV-AIDS among elders is | caused by failure to practice safer sex |
| A client recently lost his wife for whom he had cared for several years. The community health nurse visits his apartment in the senior living complex and finds the house has not been cleaned and the client is wearing dirty clothing and appears disheveled | accompany the client to a meeting for residents with drinking problems held at the community center |
| Knowledge of which topic is essential for high-quality nursing assessment of older adults? | Normal aging |
| Mrs. McCreanor is an 82-year-old physically healthy widow who lives with her daughter and son-in-law, both of whom work during the day. Mrs. McCreanor states that she is lonely at home, since all her friends are older and unable to visit her. Mrs. McCrean | Social day care center |
| What does the nurse need to know when caring for an older adult patient in restraints? | The nurse is responsible for patient safety during the time the patient is restrained |
| Which nursing viewpoint may prevent adequate intervention for an older adult experiencing pain? | Pain perception decreases with aging |
| Which action is ethically unsuitable for a nurse? | Ignoring a "Do not resuscitate" order for an older adult patient in the intensive care unit |
| An employer provides educational sessions for individuals planning to retire. The nurse leading the sessions is aware that these individuals are at risk to experience: | loss of identity and purpose. |
| Mrs. Kendel is an 82-year-old woman who has Alzheimer’s disease. She lives with her husband, who has been trying to care for her in their home. Mrs. Kendel is having trouble dressing. She has put her blouse on backwards and sometimes puts her bra on over | Assist Mr. Kendel by writing out a list of suggestions that he can try at home that might help facilitate (a) communication, (b) activities of daily living, and (c) maintenance of a safe home environment. Communication: Always identify yourself, and cal |
| Identify at least three interventions that are appropriate to this situation for each of the areas cited above. | In terms of having difficulty dressing, some of the suggestions listed in question A would be appropriate. Allow Mrs. Kendel to do as much for herself as possible, and assist her as needed. In addition, she should pick out her own clothing as much as poss |
| Identify resources available for maintaining Mrs. Kendel in her home for as long as possible. Provide the name of a self-help group that you would urge Mr. Kendel to join. There are a host of services available for Mrs. Kendel that would enable her to re | Meals on Wheels Home health aide services Homemaker services Hospice services Occupational therapy Paid companion or sitter services Physical therapy Skilled nursing Personal care services: assistance in basic self-care activities Social work ser |
| A 73-year-old woman with pneumonia becomes agitated after being admitted to the intensive care unit through the emergency department. She is placed in soft restraints when she continues to try to leave her bed despite being too weak to walk. Her vital | The patient is experiencing delirium secondary to the pneumonia |
| onset is sudden, over hours and days | delirium |
| life long history ,losses, lonliness, crises, declining, health ,medical condition | depression |
| onset slowly, over months | dementia |
| emotional state-flat;delusions | dementia |
| speech and language rapid,, inappropriate ,incoherent ,rambling | delirium |
| psychiatric disorders that are manifested in deficits in memory, perceptions ,and problem solving | cognitive disorders |
| sundowning | s/s and problem behaviors become more pronounced in evening ,may occur in both delirium and dementia |
| illusions | error in perception of sensory stimulation--ex-person mistake folds in clothes as white rats or cord of window blind as a snake |
| hallucinations | false sensory stimuli-visual, tactile, auditory |
| the emotional response is____ans ____ percetual distruance is present | fear,anxiety |
| ______,______,______,and _______are the four cardinal features when delirum is present | acute onset, inattention, disorganized thinking, and disturbance of consciousness |
| what is the most common nursing dx for illusions, delusions,or hallucinations | fear |
| what are some infections that cause deliruium | systemic- pneumonia, typhoid fever, malaria, urinary tract infections, and septicemia |
| dementia is defined as the ________ _______ of ________functioning and global impairment fo the intellect with no change of consciousness | progressive deterioration, cognitive |
| what are the classifications of dementia? | primary and secondary |
| primary dementias | alzheimers, picks disease,lewy body disease, and vasucular dementias are irreversible, and progressive |
| karsakoff;s syndrome and Aids dementia complex | secondary dementia- occurs as a result of other pathological process |
| apraxia | loss of purposeful movement in absence of motor or sensory impairment |
| mimics dementia | pseudodementia |
| confabulation | un unconscious attempt to maintain self-esteem-creation of stories or answers in place of actual memories |
| Alzheimer disease defense mechanisms | denial, confabulation, perseveration ,and avoidance of questions |
| What are the 4 stages of Alzheimer's disease | stage1-mild(forgetfulness), stage 2-moderate( confusion, stage 3 -moderate to severe (ambulatory dementia), Stage 4-late (end stage) |
| What drugs are used for delirium | digitalis, steroids, lithium, levodopa, anticholinergics, benzodiazepines, cns depressants, tricyclic antidepressants |
| the behavioral manifestations of AD include: | confabulation, perseveration, aphasia, apraxia, agnosia, and hyperorality |
| accounts for 20% of dementias | vascular dementia |
| slows the progress of AD down-it is a nerve communication chemical | acetycholine |
| loss of language ability, which progresses with the disease,initially the person has difficulty finding the correct word, then is reduced to a few words,and finally is reduced to babbling or mutism | aphasia |
| memory impairment/ amnesia | initially the person has difficulty remembering RECENT events.gradually, deterioration progresses to include both recent and remote memory |
| apraxia | loss of purposeful movement in the absence of motor or sensory impairment.the person is unable to perform familiar and purposeful task |
| disturbance is executive functioning | planning, organizing,abstract thinking.the degeneration of neurons in brain results in the wasting away of the brain working components.cells contain memory ,receive sights,and sounds ,cause hormones to secrete,produce emotions,command muscles into motion |
| basic medical workup for dementia | chest and skull radiographic studies, elecroencephalography, electrocadiography, ua,tft,folate level, vdrl, serum creatine assay,electrolyte ,vit b 12 level, lft, vision and hearing test,neruoimaging,serum profile 12-test |
| loc | is not altered with dementia |
| emotional state -delirium | rapid sings, can be fearful, anxious,suspicious,aggressive,have hallucinations and or delusions |
Created by:
soangwil