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Exam 17: Cognitive Disorders

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Question 1

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An elderly male develops bradycardia and has a pacemaker surgically implanted.Although he was lucid preoperatively and has no history of dementia,at 10:00 PM on the night of his surgery,he becomes disoriented to place and time and insists on going home.When placed in soft restraints,he becomes hostile and is later caught trying to burn his way out of the restraints with a cigarette lighter.Which nursing response is most likely to be therapeutic?

A) Dim the lights in the room so the patient will more likely be able to sleep.
B) Maintain the restraints and have a sitter stay with the patient at night.
C) To monitor his mental status,ask the patient each hour if he knows where he is.
D) Remove the restraints and have a family member stay with him instead.

E) None of the above
F) All of the above

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Question 2

Multiple Choice

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Which symptom would suggest that the patient is experiencing delirium instead of dementia?

A) Altered level of consciousness
B) Disorientation to place and time
C) Wandering of attention
D) Stable autonomic functioning

E) B) and D)
F) All of the above

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Question 3

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A man,aged 84 years,was stopped for going through a red light in a small town where he has lived all his life.He told the officer,"It wasn't there yesterday." He was unable to tell the officer his address and demonstrated labile mood,seeming pleasant one minute and angry the next.The officer took the man home to discuss his condition with the family and found that he lives with his wife,who is legally blind.She stated,"He's my eyes,and I'm his mind." She also related that her husband wanders around the neighborhood,sometimes taking tools from people's garages,saying they belong to him.She reluctantly agreed that he should go to the emergency department for evaluation.He was diagnosed with Alzheimer's disease.What cardinal sign of Alzheimer's disease does this patient demonstrate?

A family states that the father,who has moderate-stage dementia,is incontinent related to forgetting where the bathroom is located.An intervention the nurse should suggest to the family is to:

A woman with Alzheimer's disease has significant apraxia and poor hygiene.Which intervention would be most appropriate for ensuring that the patient completes a shower?

A patient with severe dementia can no longer recognize her only daughter and becomes anxious and agitated when the daughter attempts to reorient her.An alternative the nurse could suggest to the daughter is to:

You are a nurse meeting for the first time with a stage 3 Alzheimer's patient who is newly referred to your home health agency.Which assessment data about the patient and caregiver(s) would be most important to acquire during your first visit to the family's home?

The head nurse on a unit that serves persons with cognitive impairment is concerned about her staff,many of whom seem to be becoming "burned out" by their challenging work.Which response by the head nurse is most likely to minimize staff frustration and burnout on the unit? Select all that apply.

During morning care,the nursing assistant asks a patient with dementia,"How was your night?" The patient replies,"It was lovely.My husband and I went out to dinner and to a movie." The nurse who overhears this should make the assessment that the patient is:

As Alzheimer's disease progresses to the late stage (stage 4) ,impairment of functioning is pervasive.Which symptom does not usually appear until this final stage of the disorder?

An elderly man drove from his home to a nearby convenience store and was unable to remember how to get home.He was unable to tell a police officer his address and demonstrated labile mood.The officer took the man and met the man's wife,who related that her husband often wanders around the neighborhood,sometimes taking tools from people's garages.She reluctantly agreed that he should go to the emergency department for evaluation.He was diagnosed with Alzheimer's disease.On the basis of the patient's history,the nurse can make the assessment that the patient's Alzheimer's disease has progressed to:

Which assessment data suggests a person who appears to have dementia instead has depression and pseudodementia?

An elderly male develops bradycardia and has a pacemaker surgically implanted.Although he was lucid preoperatively and has no history of dementia,at 10:00 PM on the night of his surgery,he becomes disoriented to place and time and insists on going home.When placed in soft restraints,he becomes hostile and is later caught trying to burn his way out of the restraints with a cigarette lighter.Which nursing diagnosis should be the priority diagnosis?

A 72-year-old widow has just returned home after 2 weeks in the hospital after a fall.She lives alone and is visited weekly by her son.She takes digoxin,hydrochlorothiazide,and an antihypertensive drug.She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety.When the visiting nurse stopped by 2 days after discharge,he found the woman confused and disoriented,with an unsteady gait.The patient asks him who the small people are who have been living in her house.The patient had not evidenced any of these symptoms at the time of discharge.Vital signs were unremarkable except for bradycardia.The nurse correctly deduces that the most likely cause for the changes seen in the patient is:

The patient need that assumes priority when planning care for a patient with late-stage dementia is:

An 83-year-old man becomes lost while driving.He pulls into a driveway to turn around and cannot figure out how to put his car in reverse,so he drives into the yard,makes a circle,and drives back out of the driveway.He is stopped by police,who take him to the emergency room.The ER diagnoses the patient with stage 2 (moderate) Alzheimer's disease and refers him to the neurology clinic for follow-up.Given this diagnosis,which behaviors should the clinic nurse anticipate?

A patient with stage 1 Alzheimer's disease complains of low energy.She prefers to remain at home rather than attend club meetings and church.Her husband has been doing the grocery shopping because his wife cannot remember what to purchase and is unable to find her way around the store unassisted.Which nursing diagnosis would be most appropriate for this patient?

Which assessment data suggest a person with confusion has secondary dementia or pseudodementia?

A widow,aged 72 years,lives alone and is visited weekly by her son.She takes digoxin,hydrochlorothiazide,and an antihypertensive drug.She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety.When the son visited today,he found his mother confused.Her speech was thick and slurred and she had an unsteady gait.She was taken to the emergency department,and hospital admission followed.The nurse assessed the patient as having several cognitive problems,including memory and attention deficits and fluctuating levels of orientation.The nurse confirms that the patient's symptoms developed over a 2-day period.The patient's symptoms are most characteristic of:

A patient is referred to the visiting nurse agency due to cognitive impairment.Which functional problems is this patient most likely to exhibit?