Chapter 60: Nursing Management: Alzheimer's Disease, Dementia, and Delirium

Chapter 60: Nursing Management: Alzheimer’s Disease, Dementia, and Delirium

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE
1. A patient who is hospitalized with pneumonia is disoriented and confused 2 days after
admission. Which information obtained by the nurse about the patient indicates that the
patient is experiencing delirium rather than dementia?
a. The patient was oriented and alert when admitted.
b. The patient’s speech is fragmented and incoherent.
c. The patient is disoriented to place and time but oriented to person.
d. The patient has a history of increasing confusion over several years.
ANS: A
The onset of delirium occurs acutely. The degree of disorientation does not differentiate
between delirium and dementia. Increasing confusion for several years is consistent with
dementia. Fragmented and incoherent speech may occur with either delirium or dementia.
DIF: Cognitive Level: Comprehension REF: 1521
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. When developing a plan of care for a hospitalized patient with moderate dementia, which
intervention will the nurse include?
a. Provide complete personal hygiene care for the patient.
b. Remind the patient frequently about being in the hospital.
c. Reposition the patient frequently to avoid skin breakdown.
d. Place suction at the bedside to decrease the risk for aspiration.
ANS: B
The patient with moderate dementia will have problems with short- and long-term
memory and will need reminding about the hospitalization. The other interventions would
be used for a patient with severe dementia, who would have difficulty with swallowing,
self-care, and immobility.
DIF: Cognitive Level: Application REF: 1522 TOP: Nursing Process:
Planning
MSC: NCLEX: Physiological Integrity
3. When administering a mental status examination to a patient with delirium, the nurse
should
a. medicate the patient first to reduce any anxiety.
b. give the examination when the patient is well-rested.
c. reorient the patient as needed during the examination.
d. choose a place without distracting environmental stimuli.
ANS: D
Test Bank 60-2
Because overstimulation by environmental factors can distract the patient from the task of
answering the nurse’s questions, these stimuli should be avoided. The nurse will not wait
to give the examination because action to correct the delirium should occur as soon as
possible. Reorienting the patient is not appropriate during the examination. Antianxiety
medications may increase the patient’s delirium.
DIF: Cognitive Level: Application REF: 1535-1537
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
4. To protect a patient from injury during an episode of delirium, the most appropriate
action by the nurse is to
a. secure the patient in bed using a soft chest restraint.
b. ask the health care provider about ordering an antipsychotic drug.
c. instruct family members to remain with the patient and prevent injury.
d. assign a nursing assistant to stay with the patient and offer frequent reorientation.
ANS: D
The priority goal is to protect the patient from harm, and a staff member will be most
experienced in providing safe care. Visits by family members are helpful in reorienting
the patient, but families should not be responsible for protecting patients from injury.
Antipsychotic medications may be ordered, but only if other measures are not effective
because these medications have multiple side effects. Restraints are sometimes used but
tend to increase agitation and disorientation.
DIF: Cognitive Level: Application REF: 1535 | 1537
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care
Environment
5. Which action will the nurse in the outpatient clinic include in the plan of care for a
patient with mild cognitive impairment (MCI)?
a. Suggest a move into an assisted living facility.
b. Schedule the patient for more frequent appointments.
c. Ask family members to supervise the patient’s daily activities.
d. Discuss the preventive use of acetylcholinesterase medications.
ANS: B
Ongoing monitoring is recommended for patients with MCI. MCI does not interfere with
activities of daily living, acetylcholinesterase drugs are not used for MCI, and an assisted
living facility is not indicated for MCI.
DIF: Cognitive Level: Application REF: 1522-1523 TOP: Nursing Process:
Planning
MSC: NCLEX: Psychosocial Integrity