Alzheimer’s, Delirium, and Dementia NCLEX Practice Quiz: 65 Questions
1. 1. Question
Nurse Isabelle enters the room of a client with a cognitive
... [Show More] impairment disorder and asks what day of the week it is; what the date, month, and year are; and where the client is. The nurse is attempting to assess:
o A. Confabulation.
o B. Delirium.
o C. Orientation.
o D. Perseveration.
Incorrect
Correct Answer: C. Orientation.
The initial, most basic assessment of a client with cognitive impairment involves determining his level of orientation (awareness of time, place, and person). The tools for reality orientation aim to reinforce the naming of objects and people as well as a timeline of events, past or present. Multiple studies have demonstrated that the use of reality orientation has improved cognitive functioning for people living with dementia when compared to control groups who did not receive it. As a rule, reality orientation must be mixed with compassion and used appropriately to benefit someone living with the confusion of dementia. Applying it without evaluating if it might cause emotional distress to the individual since there are some times when it would not be appropriate.
• Option A: Confabulation is a type of memory error in which gaps in a person’s memory are unconsciously filled with fabricated, misinterpreted, or distorted information. When someone confabulates, they are confusing things they have imagined with real memories. A person who is confabulating is not lying. They are not making a conscious or intentional attempt to deceive. Rather, they are confident in the truth of their memories even when confronted with contradictory evidence.
• Option B: Delirium is a type of cognitive impairment; however, other symptoms are necessary to establish this diagnosis. Delirium, also known as the acute confusional state, is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of consciousness and cognition with reduced ability to focus, sustain, or shift attention. It develops over a short period and fluctuates during the day. The clinical presentation can vary, but usually, it flourishes with psychomotor behavioral disturbances such as hyperactivity or hypoactivity with increased sympathetic activity and impairment in sleep duration and architecture.
• Option D: The nurse may also assess for perseveration in a client with cognitive impairment but the questions in this situation would not elicit the symptom response. Perseveration according to psychology, psychiatry, and speech-language pathology, is the repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus. It is usually caused by a brain injury or other organic disorder.
2. 2. Question
A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition?
• A. Memory loss occurring as part of the natural consequence of aging.
• B. Difficulty coping with physical and psychological change.
• C. Severe cognitive impairment that occurs rapidly.
• D. Loss of cognitive abilities, impairing ability to perform activities of daily living.
Incorrect
Correct Answer: D. Loss of cognitive abilities, impairing ability to perform activities of daily living.
The impaired ability to perform self-care is an important measure of a client’s dementia progression and loss of cognitive abilities. Difficulty or impaired ability to perform normal activities of daily living, such as maintaining hygiene and grooming, toileting, making meals, and maintaining a household, are significant indications of dementia. Slowing of processes necessary for information retrieval is a normal consequence of aging. However, the global statement that memory loss occurs as part of natural aging is not true.
• Option A: Dementia is not normal; it is a disease. Dementia is a disorder that is characterized by cognitive decline involving memory and at least 1 of the other domains, including personality, praxis, abstract thinking, language, executive functioning, complex attention, social and visuospatial skills.
• Option B: Difficulty coping with changes can be experienced by any client, not just one with dementia. In addition to the noted decline, the severity must be significant enough to interfere with daily functionality. It is often a progressive disorder, and individuals often do not have insight into their deficits. Currently, no cure exists for any of the causes of dementia.
• Option C: The rapid occurrence of cognitive impairment refers to delirium. History must be obtained from the patient and their family members. Patients may present with symptoms of change in behavior, getting lost in familiar neighborhoods, memory loss, mood changes, aggression, social withdrawal, self-neglect, cognitive difficulty, personality changes, difficulty performing tasks, forgetfulness, difficulty in communication, vulnerability to infections, loss of independence, etc., A detailed history should include past medical, family, drug, and alcohol history
3. 3. Question
Which of the following will Nurse Dory use when communicating with a client who has cognitive impairment?
• A. Complete explanations with multiple details.
• B. Pictures or gestures instead of words.
• C. Stimulating words and phrases to capture the client's attention.
• D. Short words and simple sentences.
Incorrect
Correct Answer: D. Short words and simple sentences.
Short words and simple sentences minimize client confusion and enhance communication. Assess the patient’s ability to speak, language deficit, cognitive or sensory impairment, presence of aphasia, dysarthria, aphonia, dyslalia, or apraxia. Presence of psychosis, and/or other neurologic disorders affecting speech. This identifies problem areas and speech patterns to help establish a plan of care.
• Option A: Use simple, direct questions requiring one-word answers. Repeat and reword questions if misunderstanding occurs. This promotes self-confidence of the patient who is able to achieve some degree of speech or communication. Encourage the patient to breathe prior to speaking, pause between words, and use the tongue, lips, and jaw to speak. Encourage the patient to control the length and rate of phrases, over articulate words, and separate syllables, emphasizing consonants.
• Option B: Although pictures and gestures may be helpful, they would not substitute for verbal communication. When communicating with the patient, face the patient and maintain eye contact, speaking slowly and enunciating clearly in a moderate or low-pitched tone. Clarity, brevity, and time provided for responses promote the opportunity for successful speech by allowing patient time to receive and process the information.
• Option C: Complete explanations with multiple details and stimulating words and phrases would increase confusion in a client with short attention span and difficulty with comprehension. Remove competing stimuli, and provide a calm, unhurried atmosphere for communication. This reduces unnecessary noise and distraction and allows patient time to decrease frustration.
4. 4. Question
Mrs. Mendoza is a 75-year-old client who has dementia of the Alzheimer’s type and confabulates. The nurse understands that this client:
• A. Denies confusion by being jovial. [Show Less]