Delirium & Dementia
Rapid onset confusion with fluctuating attention and disorganized thinking best describes what syndrome?
What is Delirium?
Which neurotransmitter is most associated with SSRIs like sertraline? One common SSRI side effect?
Serotonin. Side effects: GI upset, insomnia/somnolence, sexual dysfunction; monitor for serotonin syndrome.
Provide a therapeutic response to a patient saying, “I’m scared about my diagnosis.”
Use empathy and reflection: “It sounds like you’re feeling really scared. Tell me more about what’s worrying you.”
Define autonomy and give one nursing example.
Respecting a competent patient’s right to make decisions; e.g., honoring informed refusal after teaching risks/benefits.
List two high-risk indicators for suicide.
Prior attempt, specific plan with means, hopelessness, recent major loss, substance misuse.
Positive vs. negative symptoms in schizophrenia—give one of each.
Positive: hallucinations or delusions. Negative: flat affect, avolition, anhedonia, alogia.
In Alzheimer’s disease, list one early symptom and one late symptom.
What is Early: Short term memory loss, word finding difficulty, apathy.
Late: incontinence, inability to perform ADLs, agnosia/apraxia
State the typical therapeutic serum range for lithium and two key patient teaching points.
Approx. 0.6–1.2 mEq/L (maintenance). Teach: maintain consistent fluids/salt; monitor renal/thyroid; watch toxicity (coarse tremor, GI upset, confusion).
Name two non-therapeutic techniques to avoid and why.
Giving advice, asking “why” questions, and false reassurance—these can shut down exploration and reduce trust.
What is the “duty to warn/protect”?
Obligation to take reasonable steps (e.g., notify identifiable potential victim/authorities) when a credible threat is disclosed.
First nursing priority for a client expressing active suicidal intent with a plan.
Ensure immediate safety: 1:1 observation, remove lethal means, notify team, implement safety protocols.
One nursing priority when a patient reports command hallucinations.
Assess content/intent, ensure safety, offer reality testing and distraction, notify team.
What environmental and personal items can reduce agitation in delirium?
what are Clocks/calendars, adequate lighting, glasses/hearing aids, and familiar objects/photos to aid orientation.
Valproic acid—what labs to monitor and two frequent adverse effects?
Monitor LFTs and platelets. Adverse effects: GI upset, weight gain, tremor; risk hepatotoxicity, thrombocytopenia, pancreatitis.
Name two key nursing roles in milieu management.
Maintain safety/structure, orient new patients, model boundaries, facilitate groups, and provide health teaching/counseling.
Mandatory reporting applies to suspected abuse of which groups?
Typically children, elders, and vulnerable/dependent adults per state law—report suspicion, not proof.
ame the three phases of the cycle of violence in IPV.
Tension building → acute battering → honeymoon/reconciliation.
Bipolar mania—two hallmark symptoms and one safety concern
Elevated/irritable mood, decreased need for sleep, pressured speech; concern: risky behavior, poor nutrition, exhaustion.
Alcohol withdrawal delirium typically appears within what timeframe and with which hallmark signs?
What is :Usually 48–72 hours after last drink; severe autonomic hyperactivity (HTN, tachycardia, fever), confusion, agitation, halluci nations, possible seizures.
In older adults, why are psychotropic doses typically lower?
Altered pharmacokinetics/dynamics: reduced renal/hepatic clearance and increased sensitivity → start low, go slow; consult drug references.
List two patient rights within a therapeutic milieu.
Right to least restrictive care, dignity/privacy, informed consent, and to refuse medications (unless emergency/court-ordered).
State criteria for mechanical restraint use.
Imminent danger to self/others, least-restrictive measures failed, time-limited order, and ongoing assessment/documentation.
Name two key elements of a safety plan.
Emergency contacts, safe exit strategies, code words, copies of important documents, shelter/hotline info.
Borderline personality disorder—hallmark and nursing approach.
Splitting/instability and self-harm risk; use clear boundaries, consistent team approach, and DBT skills coaching.
Differentiate delirium from dementia by onset, attention, and course.
Delirium: acute onset, impaired attention, fluctuating course. Dementia: insidious onset, relatively preserved attention early, progressive decline.
Disulfiram teaching—purpose and three alcohol-avoidance instructions.
Aversion therapy causing acetaldehyde reaction with alcohol. Avoid all alcohol sources (OTC elixirs, mouthwash, sauces); wear medical ID; reaction risk can persist up to ~14 days after last dose.
Boundary crossing vs. boundary violation—define briefly.
Crossing: brief departure from usual limits with therapeutic intent. Violation: harmful/exploitative breach undermining professionalism.
Give one cultural consideration to improve communication and trust.
Give one cultural consideration to improve communication and trust.
List core steps in crisis intervention.
Establish rapport, assess risk/needs, ensure safety, problem-solve immediate stressors, mobilize supports, plan follow-up.
Dissociative disorders—feature and common association.
Disruption in identity/memory (e.g., depersonalization, amnesia, DID), often associated with significant trauma.