Chapter 18: Neurocognitive Disorders

Chapter 18: Neurocognitive Disorders

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. An older adult patient takes digoxin and hydrochlorothiazide daily, as well as lorazepam (Ativan) as needed for anxiety. Over 2 days, the patient developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of:

a.	delirium
b.	dementia
c.	amnestic syndrome
d.	Alzheimer’s disease

 

 

ANS:  A

Delirium is characterized by an abrupt onset of fluctuating levels of awareness, clouded consciousness, perceptual disturbances, and disturbed memory and orientation. The onset of dementia or Alzheimer’s disease, a type of dementia, is more insidious. Amnestic syndrome involves memory impairment without other cognitive problems.

 

DIF:    Cognitive Level: Application           REF:   Pages: 332-334

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

2. A patient with fluctuating levels of awareness, confusion, and disturbed orientation shouts, “Bugs are crawling on my legs! Get them off!” Which problem is the patient experiencing?

a.	Aphasia
b.	Dystonia
c.	Tactile hallucinations
d.	Mnemonic disturbance

 

 

ANS:  C

The patient feels bugs crawling on both legs, although no sensory stimulus is actually present. This description coincides with the definition of a hallucination, a false sensory perception. Tactile hallucinations may be part of the symptom constellation of delirium. Aphasia refers to a speech disorder. Dystonia refers to excessive muscle tonus. Mnemonic disturbance is associated with dementia rather than delirium.

 

DIF:    Cognitive Level: Comprehension     REF:   Pages: 334-335

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

3. A patient with fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, “Someone get the bugs off me.” What is the nurse’s best response?

a.	“There are no bugs on your legs. Your imagination is playing tricks on you.”
b.	“Try to relax. The crawling sensation will go away sooner if you can relax.”
c.	“Don’t worry, I will have someone stay here and brush off the bugs for you.”
d.	“I don’t see any bugs, but I know you are frightened so I will stay with you.”

 

 

ANS:  D

When hallucinations are present, the nurse should acknowledge the patient’s feelings and state the nurse’s perception of reality, but not argue. Staying with the patient increases feelings of security, reduces anxiety, offers the opportunity for reinforcing reality, and provides a measure of physical safety. Denying the patient’s perception without offering help does not emotionally support the patient. Telling the patient to relax makes the patient responsible for self-soothing. Telling the patient that someone will brush the bugs away supports the perceptual distortions.

 

DIF:    Cognitive Level: Application           REF:   Page: 339|Pages: 345-348

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

4. What is the priority nursing diagnosis for a patient with fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations?

a.	Bathing/hygiene self-care deficit, related to altered cerebral function, as evidenced by confusion and inability to perform personal hygiene tasks
b.	Risk for injury, related to altered cerebral function, misperception of the environment, and unsteady gait
c.	Disturbed thought processes, related to medication intoxication, as evidenced by confusion, disorientation, and hallucinations
d.	Fear, related to sensory perceptual alterations, as evidenced by hiding from imagined ferocious dogs

 

 

ANS:  B

The physical safety of the patient is the highest priority among the diagnoses given. Many opportunities for injury exist when a patient misperceives the environment as distorted, threatening, or harmful; when the patient exercises poor judgment; and when the patient’s sensorium is clouded. The other diagnoses may be concerns but are lower priorities.

 

DIF:    Cognitive Level: Application           REF:   Pages: 336-337

TOP:   Nursing Process: Diagnosis| Nursing Process: Analysis

MSC:  NCLEX: Safe, Effective Care Environment