Neurocognitive Disorders (NCDs)
A nurse is providing education to a group of older adults about neurocognitive disorders (NCDs). Which statement by a participant indicates an understanding of the most common type of neurocognitive disorder?
A. "Alzheimer's disease is the most common type of neurocognitive disorder."
B. "Parkinson's disease is the most common cause of neurocognitive decline."
C. "Vascular neurocognitive disorder occurs more frequently than Alzheimer's disease."
D. "Frontotemporal neurocognitive disorder is the most common neurocognitive disorder in older adults."
A. "Alzheimer's disease is the most common type of neurocognitive disorder."
Alzheimer's disease is the most common cause of major neurocognitive disorder, accounting for the majority of dementia cases in older adults. Vascular neurocognitive disorder is the second most common cause. Parkinson's disease and frontotemporal neurocognitive disorder can lead to cognitive impairment but are less common causes of neurocognitive disorders than Alzheimer's disease.
A nurse is caring for an older adult client who was admitted to the hospital with pneumonia. During the evening shift, the client becomes confused, attempts to get out of bed, and states, "I need to get to work right now." The client's family reports that the client was alert and oriented earlier in the day. Which finding is most consistent with delirium?
A. Gradual decline in memory over several years
B. Sudden onset of confusion with fluctuating levels of consciousness
C. Persistent cognitive impairment that remains stable throughout the day
D. Progressive loss of language and executive functioning
B. Sudden onset of confusion with fluctuating levels of consciousness
Delirium is an acute, short-term, and reversible state that comes on quickly. The onset of dementia is slow.
A nurse is caring for a client diagnosed with a mild neurocognitive disorder. The client reports, “I’ve started making lists so I don’t forget appointments and errands.” In which stage of neurocognitive disorder is this client most likely functioning?
A. Severe stage (5), requiring total assistance with all activities of daily living
B. Moderate stage (4), with significant impairment in communication and recognition of family
C. Mild cognitive impairment (2), where the client may misplace items or forget minor things
D. Mild stage (3), in which the client compensates for worsening memory loss by making up stories
C. Mild cognitive impairment (2), where the client may misplace items or forget minor things
When caring for clients with NCDs or delirium, which nursing task should be prioritized?
A. Ensure belongings are within reach
B. Initiate suicide precautions
C. Teach relaxation techniques
D. Administer lorazepam TID
A. Ensure belongings are within reach
Safety is always the priority nursing problem, but specific safety precautions differ depending on the diagnosis and client. The priority nursing problem when caring for a client with delirium or an NCD is risk for (accidental) injury (as opposed to suicide, homicide, medication toxicity, etc. that may be common with other diagnoses). Teaching relaxation techniques would not be very effective with these clients. Lorazepam is a benzodiazepine, it should only be used PRN and should be avoided if possible in the elderly.
A nurse is assessing several older adult clients during a community health screening. Which finding is most suggestive of a neurocognitive disorder rather than normal age-related cognitive changes?
A. Requiring a demonstration to learn how to use his new hearing aids instead of reading the instructions
B. Occasionally forgetting a person's name but remembering it later
C. Repeatedly asking the same question despite receiving the answer several times within a short period
D. Misplacing reading glasses and finding them after retracing recent activities
C. Repeatedly asking the same question despite receiving the answer several times within a short period
Neurocognitive disorders are characterized by a decline in cognitive functioning that exceeds expected age-related changes and interferes with daily life. Repeatedly asking the same question within a short period suggests impaired short-term memory and difficulty retaining new information, a common symptom of neurocognitive disorders.
A nurse is caring for a client recently diagnosed with a neurocognitive disorder (NCD). Which statement best describes a neurocognitive disorder?
A. A disorder characterized by disturbances in mood that interfere with daily functioning.
B. A syndrome involving chronic cognitive decline that represents a change from a previous level of functioning.
C. A condition in which a client experiences excessive anxiety and recurrent panic attacks.
D. A disorder characterized by the presence of delusions and hallucinations.
B. A syndrome involving chronic cognitive decline that represents a change from a previous level of functioning.
Primary NCDs (Alzheimer's, Lewy Body Disease, Vascular Dementia, etc.) are chronic, progressive processes that get worse over time.
Secondary NCDs are caused by chronic medical conditions (e.g., AIDS, Parkinson's Disease, etc.) so they are also non-curable.
A client was recently admitted to the hospital with a diagnosis of delirium. After implementing interventions to ensure the client's immediate safety, which assessment should the nurse perform next?
A. Administer a cognitive screening test to establish a baseline for dementia.
B. Determine the client's long-term memory deficits by interviewing family members.
C. Assess for potential underlying causes, such as infection, medication effects, or metabolic disturbances.
D. Evaluate the client's ability to perform activities of daily living independently.
C. Assess for potential underlying causes, such as infection, medication effects, or metabolic disturbances.
Delirium is often caused by an underlying physiological condition, such as infection, electrolyte imbalance, hypoxia, medication effects, or substance withdrawal. Once safety is addressed, the nurse's priority is to identify and treat the underlying cause because delirium is often reversible when the precipitating factor is corrected.
The nurse is caring for a client who cannot recall what he did for his birthday yesterday, so he reports that he went to Disneyland with his grandkids. What stage is this behavior seen in?
A. Stage 4 (Moderate dementia)
B. Stage 2 (mild cognitive impairment)
C. Stage 1 (Preclinical)
D. Stage 3 (mild dementia)
D. Stage 3 (mild dementia)
You hear your client with Lewy Body Dementia yelling from down the hall. Upon entering his room, he states that there are birds in his room that will not leave. Which response is most appropriate?
A. "That's not possible. Are you sure?"
B. "You must be hallucinating, there are no birds in here"
C. "Don't worry, the birds cannot hurt you"
D. "That sounds very frightening, but I don't see any birds in here"
D. "That sounds very frightening, but I don't see any birds in here"
A nurse is providing discharge teaching to the family of a client diagnosed with a major neurocognitive disorder. Which intervention is most important to include to promote home safety?
A. Encourage the client to stay alone during the day to maintain independence
B. Install locks on exterior doors that are placed out of the client’s direct line of sight
C. Keep all household medications easily accessible for the client to maintain autonomy
D. Use throw rugs throughout the home to help the client identify walking paths
B. Install locks on exterior doors that are placed out of the client’s direct line of sight
Clients with neurocognitive disorders are at high risk for wandering and getting lost. Safety interventions include securing exits and using locks placed out of sight to reduce elopement risk while maintaining a safe environment.
A nurse is providing education to the family of a client newly diagnosed with Alzheimer's Disease. Which medication prescribed for the client should the nurse identify as a medication commonly used to manage the cognitive symptoms of Alzheimer's disease in the early to moderate stages of the disease?
A. Memantine
B. Lorazepam
C. Haloperidol
D. Donepezil
Early: Donepezil, Rivastigmine, etc. (acetylcholinesterase inhibitors)
Later: Memantine (NMDA receptor antagonist)
Lorazepam is a benzodiazepine (anxiolytic). Haloperidol is a first-generation antipsychotic.
A client who has a history of heavy alcohol use is admitted to the hospital. The nurse suspects alcohol withdrawal delirium. Which symptom would the nurse expect to assess?
A. Gradual memory loss over several years
B. Slow decline in judgment and problem-solving skills
C. Stable confusion that improves throughout the day
D. Sudden confusion with hallucinations and agitation
D. Sudden confusion with hallucinations and agitation
Alcohol withdrawal is a common cause of delirium, especially in younger people. Delirium occurs rapidly and is reversible. We treat acute alcohol withdrawal with benzodiazepines (e.g., lorazepam, diazepam, chlordiazepoxide, etc.) to prevent delirium tremens (DTs)
A client is able to dress herself if her daughter lays her clothes out for her, but she is unable to go grocery shopping, cook her meals, and cleanup afterward. Which stage is she likely in?
A. Stage 2 (mild cognitive impairment)
B. Stage 3 (mild dementia)
C. Stage 4 (moderate dementia)
D. Stage 5 (severe dementia)
C. Stage 4 (moderate dementia)
Which of the following medications has a black box warning specific to elderly clients?
A. Bupropion
B. Olanzapine
C. Duloxetine
D. Lamotrigine
B. Olanzapine
Olanzapine is a 2nd gen/atypical antipsychotic. All antipsychotics have a black box warning for increased risk of death when given to elderly clients with dementia-related psychosis.
Your 68-year-old client developed confusion, disorientation, and sleep disturbances after beginning a new medication. The nurse recognizes that which of the following is true about these symptoms?
A. This is likely a neurocognitive disorder that cannot be reversed
B. These are symptoms of acute dystonia and the client needs to seek emergency care
C. The client should be educated that these are expected side effects of the medication
D. This is likely delirium, which can be reversed
D. This is likely delirium, which can be reversed
The client’s acute onset of confusion, disorientation, and sleep disturbances following initiation of a new medication is most consistent with delirium, which is a sudden change in cognition and attention often triggered by medications, infections, metabolic imbalances, or other physiological stressors. Delirium is typically reversible once the underlying cause is identified and treated, such as discontinuing or adjusting the offending medication.
A nurse is assessing a client for possible neurocognitive disorder (NCD). Which findings are commonly associated with neurocognitive disorders? Select all that apply.
A. Difficulty recalling recently learned information
B. Impaired judgment when making decisions
C. Taking longer to learn how to use a new smartphone
D. Problems finding the correct words during conversation
E. Difficulty managing medications and finances
A, B, D, E
Common symptoms: impaired impulse control, impaired judgment, concrete thinking, neglected hygiene/appearance, behavioral disinhibition, social misconduct, speech/language abnormalities, personality changes, paranoia, mood swings, apathy, apraxia, incontinence, agitation, sundowning, etc.
A nurse is caring for an older adult client who suddenly becomes confused and disoriented. The provider suspects delirium. Which of the following are common causes of delirium? (Select all that apply.)
A. Urinary tract infection
B. Electrolyte imbalance
C. Hypoxia
D. Alzheimer's disease
E. Medication side effects
A, B, C, E
Common causes include: infection, substance intoxication/withdrawal, medications, liver failure, kidney failure, COPD exacerbation/hypercarbia, stroke, seizures, head trauma, etc.
Getting lost driving may occur in stage _______ , while sundowning occurs in stage _________.
A. Stage 3 (mild dementia); stage 4 (moderate dementia)
B. Stage 2 (mild cognitive impairment); stage 4 (moderate dementia)
C. Stage 3 (mild dementia); stage 5 (severe dementia)
D. Stage 2 (mild cognitive impairment); stage 5 (severe dementia)
B. Stage 2 (mild cognitive impairment); stage 4 (moderate dementia)
Which nursing interventions are appropriate for a client with a neurocognitive disorder (NCD)?
A. Turn on a cartoon when the client is anxious
B. Offer the client as many choices as possible
C. Speak slowly and allow more time for tasks
D. Change up their activities to prevent boredom
C. Speak slowly and allow more time for tasks
A nurse is caring for a client diagnosed with a neurocognitive disorder. During the assessment, the client is unable to correctly use a toothbrush when asked, despite having the physical ability to hold it. The client also fails to recognize a familiar object, such as a watch, when it is placed in front of them. How should the nurse interpret these findings?
A. Apraxia and agnosia
B. Aphasia and apraxia
C. Agitation and apraxia
D. Apathy and agnosia
A. Apraxia and agnosia
A nurse is reviewing the medical records of four clients diagnosed with major neurocognitive disorder (NCD). Which client is most likely experiencing a secondary neurocognitive disorder rather than a primary neurocognitive disorder?
A. A client with progressive memory loss and brain changes consistent with Alzheimer's Disease
B. A client with hallucinations and agitation that developed after a diagnosis of Lewy Body Disease
C. A client with behavioral disinhibition and mood swings associated with Frontotemporal Dementia
D. A client with cognitive decline following a diagnosis of acquired immunodeficiency syndrome
D. A client with cognitive decline following a diagnosis of acquired immunodeficiency syndrome
Common causes/types of NCDs
Alzheimer's Disease/Dementia
Lewy Body Disease/Dementia
Vascular Dementia
Frontotemporal Dementia
Parkinson's Disease
Wernicke-Korsakoff syndrome (secondary NCD)
HIV/AIDS (secondary NCD)
Huntington's Disease (secondary NCD)
Traumatic brain injury (secondary NCD)
A nurse is assessing a client who is suspected of having delirium. Which of the following findings are consistent with delirium? (Select all that apply.)
A. Acute onset of confusion over hours to days
B. Fluctuating levels of consciousness throughout the day
C. Gradual memory loss over several years
D. Difficulty maintaining attention and easily distractible behavior
E. Hallucinations or misinterpretations of the environment
A, B, D, E
Symptoms include: confusion, disorientation, distractibility, waxing and waning mental status, sleep disruptions, illusions, hallucinations, memory impairment, speech difficulties, behavioral changes (mood swings, misconduct, agitation, etc.)
A nurse is caring for a client diagnosed with dementia. Which of the following findings are associated with stage 5 of Alzheimer's Disease?
Select all that apply.
A. Requires assistance with all activities of daily living
B. Occasional forgetfulness but able to live independently
C. Inability to recognize family members
D. Loss of bowel and bladder control
E. Difficulty finding words but maintains social skills
F. Difficulty swallowing
A. Requires assistance with all activities of daily living
C. Inability to recognize family members
D. Loss of bowel and bladder control
F. Difficulty swallowing
Rationale:
A. Requires assistance with all activities of daily living – Correct. In severe dementia, the client is completely dependent on others for care.
B. Occasional forgetfulness but able to live independently – Incorrect. This is consistent with early-stage (mild) dementia.
C. Inability to recognize family members – Correct. Profound memory loss occurs in late stages.
D. Loss of bowel and bladder control – Correct. Incontinence is common in severe dementia.
E. Difficulty finding words but maintains social skills – Incorrect. This is more typical of moderate dementia.
F. Difficulty swallowing – Correct. Dysphagia occurs in late stages and increases aspiration risk.
Your client with Alzheimer's Disease became restless upon awakening from a nap and is now demanding to see his wife who passed away 6 years ago. Which intervention(s) is/are appropriate at this time? Select all that apply.
A. Try to reorient the client to time and place
B. Escort the client to group therapy
C. Show the client photos of his children and ask him to tell you about them
D. Administer haloperidol
E. Take the client for a short walk
F. Turn all of the lights off and help him back to bed
A. Try to reorient the client to time and place
C. Show the client photos of his children and ask him to tell you about them
E. Take the client for a short walk
Your client has been taking risperidone for agitation for about three years. Which behavior should the nurse monitor for?
A. The client taking a higher dose than prescribed
B. Muscle rigidity of the jaw and neck
C. Involuntary movements
D. Extremely high blood pressure
C. Involuntary movements
Tardive dyskinesia is an adverse effect of antipsychotics that develops slowly. Muscle rigidity of the jaw/neck (acute dystonia) develops rapidly. Misuse of antipsychotics is uncommon, it's more important to monitor for misuse of benzodiazepines/sedative hypnotics. Extremely high blood pressure (hypertensive crisis) is common with use of MAOIs