Misc
A nurse is caring for a patient who has been diagnosed with dementia due to Parkinson disease. The patient has never heard of Parkinson disease and asks what causes it. What will the nurse explain is the etiology of this disorder?
1. Death of neurons
2. Presence of Lewy bodies
3. Inheritance of a dominant gene
4. Presence of an infectious process
Answer: 1
Explanation: 1. The etiology of dementia related to Parkinson disease is due to death of neurons, including those that produce dopamine, the chemical responsible for movement and coordination. The presence of Lewy bodies is the etiology for Lewy body dementia. The inheritance of a dominant gene is the etiology for dementia related to Huntington disease. The presence of an infectious process is the etiology for dementia due to prion disease.
The nurse is caring for an older adult patient with a urinary tract infection (UTI). The patient points to the smoke alarm inside the room and asks the nurse, "Would you please turn on the radio?" For which alteration will the nurse assess the patient?
1. Agnosia
2. Delirium
3. Dementia
4. Pseudodementia
Answer: 2
Explanation: 2. Delirium typically is an abrupt, short-term change in mental state marked by confused thinking, disorientation, perceptual disturbances, agitation, and mood swings. Delirium results from an underlying medical condition, substance intoxication or withdrawal, exposure to a toxin, or other etiology. In this case, the patient is suffering from a UTI, which may be causing delirium. Dementia is a progressive disorder characterized by gradual loss of cognitive functioning. Pseudodementia is characterized by cognitive changes that arise secondary to depression. Agnosia, is the loss of sensory ability to recognize objects, and is a manifestation of Alzheimer disease.
The nurse is caring for a patient with suspected delirium. In addition to the sudden onset of symptoms, the nurse can expect to find alterations in which functions during the assessment? Select all that apply.
1. Abstract thinking
2. Concrete thinking
3. Memory
4. Concentration
5. Consciousness
Answer: 3, 5
Explanation: 3. Delirium results in alterations in memory and consciousness. An alteration in abstract thinking occurs with dementia, not delirium. An alteration in concrete thinking does not occur with delirium.
5. Delirium results in alterations in memory and consciousness. An alteration in abstract thinking occurs with dementia, not delirium. An alteration in concrete thinking does not occur with delirium.
The nurse is caring for a 75-year-old man with stage 3 Alzheimer disease. The patient's daughter tells the nurse that the family is concerned about his safety because he has fallen three times in the past year. What condition that is associated with Alzheimer disease does the nurse suspect the patient is experiencing?
1. Aphasia
2. Amnesia
3. Apraxia
4. Agnosia
Answer: 3
Explanation: 3. The patient's daughter is describing the presence of apraxia, which is the loss of purposeful movement in the absence of motor/sensory impairment. This condition leads to the patient falling more frequently. While aphasia, amnesia, and agnosia are symptoms Alzheimer disease, they represent alterations in cognitive or sensory, not motor, functioning.
The nurse is caring for a patient with moderate Alzheimer disease (AD). The health care provider has ordered donepezil (Aricept) for the collaborative treatment of the patient's disease. What medication teaching will the nurse include to both the patient and patient's family?
1. "The medication should be taken twice daily, once in the morning and once at night."
2. "The dose will be started low and will be gradually increased until the medication is no longer helpful."
3. "The medication should be taken three times daily with every meal."
4. "The dose will be started high and will be gradually decreased to make sure that side effects from the medication are tolerable."
Answer: 2
Explanation: 2. Donepezil (Aricept) is a cholinesterase inhibitor (ChEI), used in the treatment of moderate-to-severe AD. Dosage of this medication should start low and gradually be increased until side effects are no longer tolerable or the medication is no longer beneficial. Donepezil should be taken once daily in the evening.
What does the nurse recognize as a risk factor for the development of delirium in older adults?
1. A lack of rigorous exercise that leads to decreased cerebral blood flow
2. Decreased social interaction that leads to profound isolation and psychosis
3. Administration of multiple medications that may cause medication interactions or toxicity
4. Age-related cognitive changes that make older adult patients more susceptible to changes in mental status
Answer: 3
Explanation: 3. Multiple medications may cause medication interactions or toxicity that may result in delirium. While the older adult patient is at higher risk for delirium, delirium is not caused by age-related cognitive changes. A lack of rigorous exercise will not promote delirium. Decreased social interaction can exacerbate delirium, but does not cause the condition.
The home health nurse is assigned to a new patient with a major neurocognitive disorder. Which will the nurse include in the initial assessment when visiting the patient at home? Select all that apply.
1. Eating habits
2. Ability to pay bills
3. Ability to shower and shave
4. Internet use
5. Medication adherence
Answer: 2
Explanation: 2. Patients with neurocognitive disorders experience decline in functioning across the wellness domains, including their ability to manage finances, recognize safety risks, and care for themselves independently. The nurse will assess patients in these areas and provide referrals and plan interventions as appropriate to ensure patients are able to maintain good nutrition and hygiene, take their medications safely, and have the financial resources that they need. Use of the internet is not a priority for assessment.
A 42-year-old patient presents to the health care provider's office complaining of difficulty "remembering things." The patient's spouse adds that the patient has been making "a lot of funny faces and hasn't been himself lately." The nurse anticipates the need to evaluate the patient for which disorder?
1. Huntington disease
2. Parkinson disease
3. Traumatic brain injury
4. Human Immunodeficiency Virus
Answer: 1
Explanation: 1. Huntington disease, Parkinson disease, traumatic brain injury, and HIV can all result in memory loss and dementia. However, symptoms of Huntington disease include choreic movements including facial contortions, earlier onset, and changes in personality.
The nurse is caring for a patient with Alzheimer disease who is no longer able to make or plan meals and who is having difficulty managing her personal finances. What stage of Alzheimer disease does the nurse suspect the patient has?
1. Preclinical
2. Mild cognitive impairment
3. Dementia
4. Asymptomatic
Answer: 3
Explanation: 3. The patient presents with dementia, which is the third stage Alzheimer disease At this stage, patients are unable to make or plan meals or the take care of the needed finances at home. Asymptomatic, or preclinical, refers to stage 1 of Alzheimer disease when symptoms are either absent or are so subtle that they go undetected. Mild cognitive impairment describes the severity of stage 2 Alzheimer disease.
The nurse is caring for a patient with moderate Alzheimer disease (AD). The health care provider has ordered memantine (Namenda) for the collaborative treatment of the patient's disease. What is the nurse's best understanding of this medication's action?
1. Protects cells against excess glutamate by partially blocking NMDA c-receptors.
2. Slows the degradation of acetylcholine, thereby increasing concentration of the neurotransmitters in the cerebral cortex.
3. Protects cells against excess NMDA by partially blocking glutamate c-receptors.
4. Slows the degradation of dopamine, thereby increasing concentration of the neurotransmitters in the cerebral cortex.
Answer: 1
Explanation: 1. Memantine (Namenda) is a NMDA receptor antagonist. This medication may protect cells against excess glutamate by partially blocking NMDA c-receptors. Cholinesterase inhibitors (ChEIs) are also used in the treatment of AD. These medications slow the degradation of acetylcholine, thereby increasing concentration of the neurotransmitters in the cerebral cortex.
The nurse is caring for a patient with Alzheimer disease. The nurse notes that the health care provider documented that the patient has neurocognitive disorder instead of documenting dementia. Why would the health care provider document in this manner?
1. The word dementia is outdated and no longer used.
2. The word dementia does not describe the patient's condition.
3. The word dementia may increase stigma regarding the patient's condition.
4. The word dementia may be confused with delirium.
Answer: 3
Explanation: 3. Some clinicians consider the term dementia as stigmatizing and favor the term neurocognitive disorder. The term dementia is not outdated. The health care provider would not avoid using the word dementia in documentation out of concern other clinicians might confuse the term with delirium. The term dementia is appropriate for use when describing Alzheimer disease.
The nurse is caring for a patient with neurocognitive disease who is suspected of having depression. What is true regarding depression and neurocognitive decline? Select all that apply.
1. Depression may occur as a result of frustration associated with neurocognitive decline.
2. Depression is a universal finding in patients with neurocognitive decline.
3. Depression is easy to diagnose in those with neurocognitive decline.
4. Depression may occur as a result of the pathology of neurocognitive decline.
5. Depression is difficult to diagnose in those with neurocognitive decline.
Answer: 1, 4, 5
Explanation: 1. Individuals with an NCD may experience depression related to frustration with changes in functioning or to the pathology of the disorder. Depression in individuals with neurocognitive disease is often difficult to diagnose due to the similarity of symptoms between neurocognitive decline and depression. Not all patients with NCDs will develop depression.
4. Individuals with an NCD may experience depression related to frustration with changes in functioning or to the pathology of the disorder. Depression in individuals with neurocognitive disease is often difficult to diagnose due to the similarity of symptoms between neurocognitive decline and depression. Not all patients with NCDs will develop depression.
5. Individuals with an NCD may experience depression related to frustration with changes in functioning or to the pathology of the disorder. Depression in individuals with neurocognitive disease is often difficult to diagnose due to the similarity of symptoms between neurocognitive decline and depression. Not all patients with NCDs will develop depression.
The nurse is caring for a patient with vascular dementia. Based on the neurobiology of this condition, what is the nurse's primary concern when caring for this patient?
1. Pain
2. Safety
3. Communication
4. Level of consciousness
Answer: 2
Explanation: 2. Safety is the primary concern for nurses at all times. However, this is especially true for the client with vascular dementia. In vascular dementia, patients suffer the equivalent of small strokes that destroy many areas of the brain. Onset is abrupt, resulting in rapid changes to functioning. The patient may have an altered gait and weakness of the limbs, increasing the risk for falls. Pain is not a common feature of vascular dementia. While the nurse will assess communication and level of consciousness, these are not the primary concerns when caring for a patient with vascular dementia.
The nurse is caring for a patient suspected of having Alzheimer disease. The nurse knows that alterations in which areas can occur with Alzheimer disease? Select all that apply.
1. Memory
2. Executive function
3. Visual acuity
4. Language
5. Behavior and personality
Answer: 1, 2, 4, 5
Explanation: 1. Alterations in memory, executive function, language, and behavior/personality may all occur in individuals with Alzheimer disease. Visuospatial ability, not visual acuity, may be impaired with Alzheimer disease.
2. Alterations in memory, executive function, language, and behavior/personality may all occur in individuals with Alzheimer disease. Visuospatial ability, not visual acuity, may be impaired with Alzheimer disease.
4. Alterations in memory, executive function, language, and behavior/personality may all occur in individuals with Alzheimer disease. Visuospatial ability, not visual acuity, may be impaired with Alzheimer disease.
5. Alterations in memory, executive function, language, and behavior/personality may all occur in individuals with Alzheimer disease. Visuospatial ability, not visual acuity, may be impaired with Alzheimer disease.
Which nursing technique is appropriate for therapeutic interaction with a patient who has been diagnosed with Alzheimer disease?
1. Setting strict time limits and rephrasing misunderstood questions.
2. Encouraging verbal and nonverbal communication while maintaining a calm demeanor.
3. Correcting errors made by the patient and speaking in a loud, clear voice.
4. Using multiple memory cues and giving several directions at once.
Answer: 2
Explanation: 2. Nonverbal communication will become more prominent as verbal communication skills decline. A calm demeanor will reassure the patient and allow for a response without sensory overload. Correcting errors by the patient, speaking in a loud voice, using multiple memory cues, setting time limits, and rephrasing questions may overstimulate and increase the patient's frustration and anxiety.
The nurse is caring for a patient with dementia due to Alzheimer disease. What is the nurse's best understanding of the etiology of this disease?
1. A presence of eosinophilic inclusion bodies in the cortex and brain stem results in impaired cognitive function.
2. An infectious form of a normally harmless type of protein, called a prion, interferes with neuronal health, leading to dementia.
3. Multiple vascular lesions occur in the cerebral cortex and subcortical structures, resulting from the decreased blood supply to the brain, lead to a decline in cognitive function.
4. A buildup of beta amyloid plaques and tangled strands of tau protein interferes with neuronal health, communication, and transport functions, leading to dementia.
Answer: 4
Explanation: 4. Alzheimer disease occurs when a buildup of beta amyloid plaques and tangled strands of tau protein interferes with neuronal health, communication, and transport functions, leading to dementia. Eosinophilic inclusion bodies, also known as Lewy bodies, are seen in Lewy body dementia. Vascular dementia occurs when multiple vascular lesions are present in the cerebral cortex and subcortical structures, resulting from the decreased blood supply to the brain.
An 82-year-old man is admitted to a medical-surgical unit for diagnostic confirmation and management of suspected delirium. Which statement by the patient's daughter best supports the diagnosis?
1. "Dad has always been so independent. He's lived alone for years since my mom died."
2. "Dad just hasn't seemed to know what he's been doing lately. He has been very forgetful these last few months."
3. "Maybe it's just caused by aging. This usually happens by age 82."
4. "The changes in his behavior came on so quickly. I wasn't sure what was happening."
Answer: 4
Explanation: 4. Delirium is characterized by a rapid and abrupt onset of symptoms. While delirium is more common in older individuals, aging is not a cause of delirium. The fact that the patient has been independent has no bearing on his current symptoms.
The nurse is caring for a patient with Alzheimer disease (AD). A family member of the patient asks the nurse, "Is this disease genetic?" What is the nurse's best response? Select all that apply.
1. "Some forms of AD have a genetic pattern."
2. "Early-onset AD is more likely familial than late-onset AD."
3. "One-third to one-half of all AD may be the genetic form."
4. "One-quarter to one-third of all AD my be the genetic form."
5. "There is not any evidence of a genetic link with AD."
Answer: 1, 2, 3
Explanation: 1. A combination of genetics and biology is thought to play a role in the development of AD: There is clearly a familial pattern with some forms of the disease. Some studies indicate that early-onset cases are more likely to be familial than late-onset cases, and that from one-third to one-half of all cases may be of the genetic form.
2. A combination of genetics and biology is thought to play a role in the development of AD: There is clearly a familial pattern with some forms of the disease. Some studies indicate that early-onset cases are more likely to be familial than late-onset cases, and that from one-third to one-half of all cases may be of the genetic form.
3. A combination of genetics and biology is thought to play a role in the development of AD: There is clearly a familial pattern with some forms of the disease. Some studies indicate that early-onset cases are more likely to be familial than late-onset cases, and that from one-third to one-half of all cases may be of the genetic form.
The nurse is caring for a patient with Alzheimer disease and anticipates an order for which medication that may help delay the rate of cognitive decline?
1. Donepezil (Aricept)
2. Quetiapine (Seroquel)
3. Valproic acid (Depakote)
4. Escitalopram (Lexapro)
Answer: 1
Explanation: 1. Donepezil (Aricept) is used to slow the rate of cognitive decline in patients with Alzheimer disease. Quetiapine (Seroquel) is used to reduce or eliminate delusions and hallucinations in patients diagnosed with vascular dementia with psychosis. Escitalopram (Lexapro) is used to treat depressive symptoms in patients with Lewy body dementia. Valproic acid (Depakote) is used to reduce mood swings seen in Pick disease and other mood disorders.
A nurse is describing the multifactorial perspective of mental health and illness to the parents of a child recently diagnosed with autism spectrum disorder. Which statement would the nurse utilize when describing this approach?
1. Exposure to drugs and alcohol has been associated with psychiatric disorders.
2. Early psychological trauma may create deficits or abnormalities in brain structure.
3. The child's genetically determined attributes and life experiences interact to influence mental health outcomes.
4. The feedback mechanism appears dysfunctional, creating neurotoxic effects on brain development and function.
Answer: 3
Explanation: 3. The best explanation of the multifactorial nature of psychiatric disorders is that genetically determined attributes and life experiences interact to influence mental health outcomes. Discussing the association of exposure to drugs and alcohol to psychiatric disorders partially explains complications occurring during the perinatal period as a cause of some mental illnesses. Discussing the effects of early psychological trauma on brain structure partially explains nervous system responsiveness. Discussing feedback mechanism dysfunction would provide a partial explanation of neuroendocrine reactivity.
The nurse is performing a mental status examination when caring for a patient with a neurocognitive disorder (NCD). The patient's spouse asks why a mental status examination is necessary. How will the nurse respond?
1. "The mental status exam is the only way to assess the cognitive decline of a patient with early stage Alzheimer disease."
2. "The mental status exam is used to assess depression in a patient with early stage Alzheimer disease."
3. "The mental status exam will reveal slow and progressive cognitive decline of a patient with early stage Alzheimer disease."
4. "The status exam will reveal rapid and dramatic changes in cognition of a patient with early stage Alzheimer disease."
Answer: 3
Explanation: 3. Psychological assessment of the individual with NCDs focuses on cognitive changes revealed through the mental status examination, as well as the resulting behavioral manifestations. In the patient with dementia, a mental status examination may not initially reveal a cognitive deficit, but will show a slow but progressive change if administered at given intervals over time. The mental status examination is not the only way to assess the cognitive decline of a patient with early stage Alzheimer disease; rather, the patient's family is often who notices the cognitive decline first. The nurse will often use the family member's assessment of the patient's cognition, and use this information to further assess the patient's mental state. Rapid and dramatic changes to a mental status exam, often indicates delirium, not dementia. Mental status examinations are not used to assess for depression.
The novice nurse asks another nurse about differentiating delirium from dementia. The experienced nurse will respond that which change in mental status is consistently seen in patients with delirium and is not seen in patients with dementia?
1. Apraxia
2. Disorientation to self
3. Altered level of consciousness
4. Impaired short-term memory
Answer: 3
Explanation: 3. Individuals with delirium have fluctuating consciousness, but individuals with dementia are as attentive as they can be and do not experience altered consciousness until terminal stages. Impaired short-term memory is consistently seen in dementia. Apraxia is the loss of purposeful movement without loss of muscle power or coordination and is not seen in delirium. Disorientation to self is seen in amnesiac disorders, not delirium.
The patient presents at the health care provider's office at the urging of her spouse. Which statements by the spouse suggest to the nurse that the patient is in stage 2 of Alzheimer disease? Select all that apply.
1. "She sometimes forgets to take her medicine."
2. "All she does is lie in bed and cry."
3. "She's always been good at math, but she has trouble sometimes with things like counting the correct change."
4. "She'll ask me the same question several times in a row."
5. "Yesterday she wandered away from the house and was lost for hours."
Answer: 1, 3
Explanation: 1. Symptoms of stage 2, mild cognitive impairment, include deterioration of or impairment in one or more abilities including executive functioning (as evidenced by difficulty counting change), memory, and attention. Repeating the same question several times and wandering are indicative of stage 3, dementia. Lying in bed and crying for significant periods suggests depression, not mild cognitive impairment.
3. Symptoms of stage 2, mild cognitive impairment, include deterioration of or impairment in one or more abilities including executive functioning (as evidenced by difficulty counting change), memory, and attention. Repeating the same question several times and wandering are indicative of stage 3, dementia. Lying in bed and crying for significant periods suggests depression, not mild cognitive impairment.
The student nurse is caring for a patient with Alzheimer disease. The student asks the nurse preceptor, "What types of medications may be used to treat Alzheimer disease?" What is the nurse's best response? Select all that apply.
1. Anticholinesterase agonist
2. Cholinesterase inhibitor
3. Anticholinergic inhibitor
4. NMDA receptor agonist
5. NMDA receptor antagonist
Answer: 2, 5
Explanation: 2. Two types of medications have been approved to treat Alzheimer disease: cholinesterase inhibitors (ChEIs) and NMDA receptor antagonists. The other answer choices are incorrect.
5. Two types of medications have been approved to treat Alzheimer disease: cholinesterase inhibitors (ChEIs) and NMDA receptor antagonists. The other answer choices are incorrect.
A parent tells the nurse that her brother has Tourette syndrome and she is concerned that her five-year-old son may be at risk for the same disorder. Which is the most appropriate reply?
1. There is no known genetic association in Tourette syndrome.
2. There may be a genetic predisposition for developing Tourette syndrome.
3. A person whose uncle has Tourette syndrome will definitely develop the condition.
4. We do not have any information on the hereditary factors associated with Tourette syndrome.
Answer: 2
Explanation: 2. Genetic associations have been found in Tourette syndrome. The impact of environmental effects, heterogeneity, and other factors complicate what this means for diagnosis and treatment of children with this disorder, and no definite cause-effect relationship has been determined. Advances in genetic technology have implicated genetic associations in Tourette syndrome.