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The daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. Which would be the most appropriate response?
- A. You sound like you aren't ready for her to be dependent on caregivers.
- B. Her confusion is a temporary complication of her physical illness and should subside when the illness gets better.
- C. Symptoms of dementia gradually get worse. Unfortunately she will not be independent again.
- D. With early treatment, mild dementia can be reversed. It may be possible.
Correct Answer: C
Rationale: Dementia is progressive, leading to increasing dependence, unlike delirium, which may be reversible.
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A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which of the following best explains the nurse's behavior?
- A. The nurse was unsure of how to calm the client.
- B. The nurse was frustrated and needed to take a time-out.
- C. The nurse gave the client a chance to calm down before resuming the meal.
- D. The nurse stepped away to verify the safety of other clients.
Correct Answer: C
Rationale: Leaving briefly allows the client to calm down, leveraging their short memory to resume interaction calmly.
The nurse is performing a health history with a client exhibiting signs of delirium. The nurse asks the client and family members about possible causes of the delirious state. Which would the nurse likely attribute as underlying causes for the client's delirium? Select all that apply.
- A. Recent alcohol use
- B. Dehydration
- C. Use of antihistamines
- D. Sleep disturbances
- E. Use of megadoses of vitamins
- F. Exposure to paint or gasoline
Correct Answer: A,B,C,D,F
Rationale: Delirium can be triggered by alcohol, dehydration, antihistamines, sleep disturbances, and exposure to toxins like paint or gasoline, but not typically by megadoses of vitamins.
The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment?
- A. Plan for the same caregivers to provide care to individuals as much as possible.
- B. Open the windows and doors to allow fresh air to circulate through the environment.
- C. Provide a buffet-style menu with many food choices.
- D. Assign peer-led exercise activities on a daily basis.
Correct Answer: A
Rationale: Consistent caregivers provide familiarity and reduce confusion in clients with dementia.
The nurse is assessing a client with early signs of dementia. What is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning?
- A. Orientation
- B. Food preferences
- C. Recent memory
- D. Remote memory
Correct Answer: C
Rationale: Asking about breakfast assesses recent memory, which is typically impaired early in dementia.
The nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation?
- A. Show an instructional video just prior to the activity.
- B. Describe the exercise immediately before performing it.
- C. Demonstrate the exercises while clients simultaneously perform them.
- D. Perform the same routine daily to avoid the need for repeated instruction.
Correct Answer: C
Rationale: Demonstrating exercises simultaneously encourages participation by providing clear, immediate guidance.