Assessments
Why establishing a client’s cognitive baseline is important
It allows the nurse to identify acute changes from the client’s usual level of cognition.
Rationale:
Cognitive baseline helps distinguish chronic conditions, such as dementia, from new or acute changes that may indicate delirium or another urgent problem.
What is the most common type of dementia?
Alzheimer’s disease?
Alzheimer’s accounts for 60–80% of dementia cases, making it the most prevalent form.
Describe the typical onset of delirium.
Sudden or acute, developing over hours to days.
Rationale:
Delirium develops rapidly and represents an acute change from baseline, unlike dementia, which progresses gradually.
Parkinson’s disease primarily affects which area of the brain?
The basal ganglia, specifically the substantia nigra, where dopamine-producing neurons degenerate.
What is one benefit of maintaining consistent caregivers for a client with dementia?
It promotes trust, reduces confusion, and supports communication through familiarity.
Consistency is key for clients with memory impairment.
A hospitalized client is acutely restless, sleeping poorly, and requires frequent reorientation throughout the day.
Is this more consistent with delirium or dementia?
Answer
Delirium.
Rationale
Delirium is characterized by acute onset, fluctuating cognition, and changes in attention and sleep–wake cycle, whereas dementia develops gradually over time.
A client with moderate-stage dementia begins wandering at night in a long-term care facility. Which nursing action best promotes safety while preserving independence?
Provide a safe, well-lit walking path and increased supervision rather than restricting movement.
Rationale:
Wandering is a common behavior in dementia. Supporting mobility in a safe environment reduces fall risk while respecting the client’s autonomy and dignity.
Which of the following clients is at highest risk for developing delirium?
A. 72-year-old with mild hearing loss and stable CHF
B. 68-year-old admitted for elective knee surgery
C. 75-year-old with a UTI and multiple recent medication changes
D. 80-year-old who lives alone and has a history of controlled hypertension
C. 75-year-old with a UTI and multiple recent medication changes
Infection and polypharmacy are well-known delirium triggers in older adults. (Slide 49)
Why do clients with Parkinson’s disease often experience difficulty with movement initiation?
Loss of dopamine impairs the brain’s ability to initiate and regulate voluntary movement.
Rationale:
Degeneration of dopamine-producing neurons disrupts motor signaling, leading to bradykinesia and difficulty starting movements.
What is a common emotional experience of family caregivers of clients with dementia, often resulting from prolonged caregiving demands?
Caregiver role strain.
This may include stress, fatigue, guilt, or feeling overwhelmed, and is a key nursing concern.
Why chronic conditions that affect blood flow contribute to long-term cognitive changes
Because sustained reductions in cerebral perfusion can impair cognitive processing over time.
Rationale:
The brain depends on continuous oxygen and nutrient delivery; long-term perfusion changes can affect cognition even without acute injury.
Which of the following best describes communication strategies for a client with late-stage dementia?
A. Use open-ended questions
B. Speak quickly to keep attention
C. Offer visual cues and short phrases
D. Avoid touch to prevent overstimulation
Offer visual cues and short phrases
Clear, simple communication supports comprehension; visual cues are especially helpful.
What screening tool is commonly used by nurses to identify delirium in hospitalized clients?
The Confusion Assessment Method (CAM) or CAM-ICU
CAM and CAM-ICU are validated tools used to screen for delirium, especially in acute care and ICU settings.
Which of the following nursing interventions best promotes safe feeding in a client with Parkinson’s disease?
A. Encourage the client to eat quickly before fatigue sets in
B. Offer large meals with high protein for nutritional support
C. Position the client upright and allow ample time to chew and swallow
D. Limit fluid intake during meals to prevent aspiration
C. Position the client upright and allow ample time to chew and swallow.
Clients with PD are at risk for dysphagia. Upright positioning and pacing reduce aspiration risk.
Which of the following medication categories (with examples) should be used with caution in older adults due to increased fall risk and cognitive side effects?
A. Non-opioid Pain relievers – Acetaminophen
B. Anticholinergics – Diphenhydramine
C. Lipid-lowering agents – Simvastatin
D. Antihypertensives – Lisinopril
B. Anticholinergics – Diphenhydramine
Anticholinergics can impair cognition, cause sedation, urinary retention, and increase fall risk in older adults.
List the four hallmark motor symptoms of Parkinson’s Disease.
Bradykinesia
Resting tremor
Rigidity
Postural instability
These are the core motor manifestations used to support diagnosis.
A nurse administers donepezil to a client with dementia. What assessment finding should prompt immediate follow-up?
Bradycardia
Donepezil, a cholinesterase inhibitor, may cause bradycardia—monitoring HR is essential.
Which class of medications is sometimes used to manage severe agitation in clients with delirium when non-drug strategies are ineffective?
Atypical antipsychotics
Although not first-line, atypical antipsychotics like quetiapine and risperidone may be used for short-term management of agitation in delirium when safety is a concern.
A client with Parkinson’s disease reports dizziness when standing. This symptom is most likely related to which complication?
Orthostatic hypotension.
Rationale: Orthostatic hypotension is common in Parkinson’s disease due to autonomic nervous system dysfunction, which impairs blood pressure regulation when changing positions. In addition, medications used to treat Parkinson’s disease, such as dopaminergic agents, can further contribute to drops in blood pressure. Both the disease process and its treatment increase the risk for dizziness, falls, and injury when standing.
Which of the following statements best demonstrates the use of validation therapy?
A. “You’re not going to work today—you’ve been retired for years.”
B. “It’s okay. Tell me about what you used to do at work.”
C. “Let’s focus on the here and now.”
D. “Remember, your family said you shouldn’t go outside alone.”
B. “It’s okay. Tell me about what you used to do at work.”
Validation therapy supports the client’s emotional reality, rather than correcting them.
A nurse is assessing cognition in an older adult. Which question best evaluates the client’s judgment?
A. “What is today’s date?”
B. “Can you tell me where you are right now?”
C. “If you smelled smoke in your home, what would you do?”
D. “Can you repeat these three words back to me?”
C “If you smelled smoke in your home, what would you do?”
Rationale:
Judgment is assessed by asking how a client would respond to a potentially unsafe situation, rather than by testing orientation or memory.
A client with moderate dementia is admitted to a hospital unit. Identify 4 strategies the nurse can use to structure the environment to promote orientation and reduce anxiety.
Place a photo of the client on their door
Keep personal items (e.g. glasses, hairbrush) in consistent locations
Use a calendar and large-face clock
Provide a communication board or handheld device for routine and orientation info
Place familiar photos or objects from home at the bedside
Cover or remove mirrors if distressing
Reduce environmental noise and visual distractions
Ensure non-glare, adequate lighting without harsh shadows
Follow a consistent daily routine
Explain changes in routine in advance and just before they occur
Promote undisturbed nighttime sleep
Avoid wall art or decorations that could be misinterpreted as people or animals
Identify 3 strategies the nurse can use to help prevent delirium in a hospitalized older adult.
Promote early mobility and ambulation
Maintain a sleep-wake cycle with quiet nights
Monitor and manage pain
Ensure use of sensory aids (glasses, hearing aids)
Provide hydration and nutrition
Use non-drug alternatives for sleep and agitation
Remove or camouflage tubes when possible
Provide cognitive stimulation and personalized activities
Encourage family presence
Use motion sensor alarms and frequent rounding
Keep the environment calm and appropriate for sensory needs
A client with Parkinson’s disease reports increased stiffness and slowed movement before their next scheduled dose of medication. How should the nurse interpret this finding?
The client may be experiencing a “wearing-off” effect.
Rationale:
As Parkinson’s medications wear off between doses, motor symptoms such as stiffness, slowed movement, or tremor may temporarily worsen. This “wearing-off” effect reflects medication timing rather than disease progression. The nurse should assess the timing of symptoms in relation to medication administration, encourage the client or caregiver to track symptom patterns, and communicate findings to the healthcare provider so adjustments to dosing schedule or therapy can be considered.
Identify 4 considerations for communicating with clients experiencing late-stage dementia.
Approach slowly from the front and maintain eye level
Use touch gently and respectfully
Speak in a calm, reassuring tone
Use visual cues and gestures
Pause after speaking to allow processing time
Focus on emotional validation rather than facts
Respect nonverbal communication (facial expressions, body tension)