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An older adult was stopped by police for driving through a red light. When asked for a driver's license, the adult hands the police officer a pair of sunglasses. What sign of dementia is evident?
- A. Aphasia
- B. Apraxia
- C. Agnosia
- D. Memory impairment
Correct Answer: C
Rationale: Agnosia refers to the loss of sensory ability to recognize objects. Aphasia refers to the loss of language ability. Apraxia refers to the loss of purposeful movement. No evidence of memory loss is revealed in this scenario.
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A patient experiencing fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, 'Someone get these 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.'
Correct Answer: D
Rationale: 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.
Which environmental adjustment should the nurse make for a patient experiencing delirium with perceptual alterations?
- A. Keep the patient by the nurse's desk while the patient is awake. Provide rest periods in a room with a television on.
- B. Light the room brightly, day and night. Awaken the patient hourly to assess mental status.
- C. Maintain soft lighting day and night. Keep a radio on low volume continuously.
- D. Provide a well-lit room without glare or shadows. Limit noise and stimulation.
Correct Answer: D
Rationale: A quiet, shadow-free room offers an environment that produces the fewest sensory perceptual distortions for a patient experiencing cognitive impairment associated with delirium. The other options have the potential to produce increased perceptual alterations.
Which condition is characterized with apolipoprotein E (apoE) malfunction, neuritic plaques, neurofibrillary tangles, granulovascular degeneration, and brain atrophy?
- A. Alzheimer's disease
- B. Wernicke encephalopathy
- C. Central anticholinergic syndrome
- D. Acquired immunodeficiency syndrome (AIDS)-related dementia
Correct Answer: A
Rationale: The problems are all aspects of the pathophysiological characteristics of Alzheimer's disease. These characteristics are not noted in any of the other options.
During morning care, an assistive personnel asks a patient diagnosed with dementia, 'How was your night?' The patient replies, 'It was lovely. I went out to dinner and a movie with my friend.' Which term applies to the patient's response?
- A. Sundown syndrome
- B. Confabulation
- C. Perseveration
- D. Delirium
Correct Answer: B
Rationale: Confabulation is the making up of stories or answers to questions by a person who does not remember. It is a defensive tactic to protect self-esteem and prevent others from noticing memory loss. The patient's response was not sundown syndrome. Perseveration refers to repeating a word or phrase over and over. Delirium is not present in this scenario.
A patient diagnosed with moderate to severe Alzheimer's disease has a dressing and grooming self-care deficit. The nurse notes that the patient is wearing mismatched clothing and has poor personal hygiene. Which interventions should be included in the patient's plan of care?
- A. Provide clothing with elastic and hook-and-loop closures.
- B. Label clothing with the patient's name and name of the item.
- C. Administer antianxiety medication before bathing and dressing.
- D. Provide necessary items and direct the patient to proceed independently.
- E. If the patient resists, use distraction and then try again after a short interval.
Correct Answer: A,B,E
Rationale: Providing clothing with elastic and hook-and-loop closures facilitates patient independence. Labeling clothing with the patient's name and the name of the item maintains patient identity and dignity (and provides information if the patient has agnosia). When a patient resists, using distraction and trying again after a short interval are appropriate because patient moods are often labile; the patient may be willing to cooperate during a later opportunity. Providing the necessary items for grooming and directing the patient to proceed independently are inappropriate. Staff members are prepared to coach by giving step-by-step directions for each task as it occurs. Administering anxiolytic medication before bathing and dressing is inappropriate. This measure would result in unnecessary overmedication.