Chapter 17: Cognitive Impairment, Alzheimers Disease, and Dementia Nursing School Test Banks

Chapter 17: Cognitive Impairment, Alzheimers Disease, and Dementia
Test Bank

MULTIPLE CHOICE

1. A 75-year-old male client is brought to the clinic by his son. The son states, Ever since Mom died, Dad hasnt been the same. At first he just seemed sad, but now he seems to get mixed up about everything. The nurse is aware that based on the clients history, the source of confusion is most likely:
a. Dementia
b. Depression from the loss of his wife
c. Hypoxia of the brain
d. Delirium from medications
ANS: B
Depression in the elderly population is often a cause of confusion. The sons description of the behaviors of his father since his wifes death indicate that he became depressed, which has been followed by confusion. Dementia is a gradual onset of confusion, hypoxia is the result of brain injury, and delirium is sudden. Even though it appears that the confusion is caused by the depression, a thorough examination is warranted to confirm the cause.

DIF: Cognitive Level: Application REF: p. 190 OBJ: 2
TOP: The Five Ds of Confusion KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

2. Vascular dementia is more common in individuals living in:
a. The United States
b. Japan
c. France
d. Australia
ANS: B
The incidence of vascular dementia is more common in Japan for unknown reasons. Japanese citizens who move to the United States have been found to have a decreased rate of vascular dementia.

DIF: Cognitive Level: Knowledge REF: p. 193 OBJ: 5
TOP: Causes of Dementia KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

3. A newly admitted elderly client seems to become confused and agitated every evening after dinner. This client most likely is suffering from:
a. Alzheimers disease
b. Acute dementia
c. Sundown syndrome
d. Delirium
ANS: C
Sundown syndrome typically occurs during the late afternoon, evening, or night when an elderly person is in unfamiliar surroundings. The other three options occur at any time of day, evening, or night. The symptoms often disappear when the client is back in familiar surroundings.

DIF: Cognitive Level: Comprehension REF: p. 193 OBJ: 5
TOP: Symptoms of Dementia KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

4. The elderly spouse of a 74-year-old male client states that she has noticed that her husband doesnt remember as well as he used to. She explains that he has been putting on his coat before his shirt, and that he can never get their checkbook to balance as it did in the past. The client is exhibiting signs and symptoms typical of:
a. Vascular dementia
b. Alzheimers disease
c. Acute delirium
d. Aging
ANS: B
The person with Alzheimers disease commonly shows deficits in familiar tasks. Vascular dementia and acute delirium relate more to confused states, and dementia symptoms should not be assumed to be part of normal aging.

DIF: Cognitive Level: Comprehension REF: p. 195 OBJ: 6
TOP: Alzheimers Disease KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

5. The affective losses of Alzheimers disease refer to losses noticed in the individuals:
a. Personality
b. Thought processes
c. Ability to make and carry out plans
d. Self-care
ANS: A
Affective losses result in personality changes in the individual with Alzheimers disease. Thought processes and self-care do not relate to the individuals personality, and the ability to make and carry out plans is referred to as cognitive loss.

DIF: Cognitive Level: Comprehension REF: p. 194 OBJ: 6
TOP: Symptoms and Course of Alzheimers Disease
KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity

6. The average time that a person with Alzheimers disease lives after diagnosis is _____ years.
a. 2
b. 8
c. 10
d. 20
ANS: B
Eight years is the average, with the life span ranging from 2 to 20 years after diagnosis of the disease.

DIF: Cognitive Level: Knowledge REF: p. 195 OBJ: 6
TOP: After the Diagnosis KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

7. For those family members who desire to care at home for loved ones who have been given a diagnosis of Alzheimers disease, it is important for the nurse to ensure that the family is aware of which caregiver skills and responsibilities will be necessary. What is one of the responsibilities of the caregiver during the middle stage of the disease?
a. Helping the loved one with memory and communication problems
b. Providing a stable, routine environment
c. Providing complete assistance with physical care
d. Adapting to the changing personality and behavior of the loved one
ANS: D
The middle stage is when personality changes begin to occur. It is difficult for the family to see the loss of their loved ones personality. Helping with memory and communication problems and providing a stable, routine environment occur in the early stage, and complete assistance with physical care is typically a responsibility of the caregiver during the severe stage.

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 6
TOP: Stages of Alzheimers Disease KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

8. The nurse is answering questions from a client and his family regarding a recent diagnosis of Alzheimers disease. The client asks how effective medication is in treating the disease. What is the nurses best response?
a. There is no cure or treatment for Alzheimers disease.
b. Medications have shown little improvement in symptoms.
c. Medications for the disease have been found to improve thinking abilities, behavior, and daily functioning in some clients.
d. Alternative therapies, such as co-enzyme Q-10 and ginkgo biloba, are more effective than any of the prescription medications used to treat the symptoms.
ANS: C
The most accurate statement is to say that medications have been found to improve thinking abilities, behavior, and daily functioning in some clients. Although no cure for the disease is known, it is inaccurate to say that there is no treatment. To say that medications have produced little improvement in symptoms is misleading because it sounds as though medications are not effective. Stating that alternative therapies are more effective is inaccurate because these therapies are still under investigation for determination of their effectiveness in treating symptoms of the disease

DIF: Cognitive Level: Comprehension REF: p. 196 OBJ: 6
TOP: Interventions with Alzheimers Disease
KEY: Nursing Process Step: Planning MSC: Client Needs: Physiological Integrity

9. Which of the following is an effective communication technique that should be included in the teaching plan for the family members of a woman in whom Alzheimers disease has been diagnosed recently?
a. Use simple, familiar words, along with short and simple sentences.
b. If the client tends to pace a lot, be sure to encourage her to sit during interactions.
c. If she doesnt understand the communication, change key words.
d. Use hand gestures when speaking to try to explain what is being said.
ANS: A
Alzheimers disease affects cognitive ability, so it is best to use words and phrases that do not require a great deal of thought to be understood. Having the client sit when she likes to pace may increase her anxiety and block communication. Repeat key words to assist in understanding; changing the key words may further confuse the client. Hand gestures may further confuse the troubled thought processes.

DIF: Cognitive Level: Application REF: p. 198 OBJ: 7
TOP: Interventions with Alzheimers Disease
KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity

10. The elderly spouse of a female Alzheimers client states that his wife seems to wander aimlessly from room to room looking for things in incorrect places, such as kitchen utensils in the bedroom and laundry detergent in the kitchen. He asks the nurse for suggestions of what he can do to help her. What is the nurses best response?
a. Keep rooms well lit.
b. Keep the home environment simple and user-friendly for her.
c. Have clocks and calendars with large letters in several rooms of the house.
d. Place large signs on doors or entryways that identify the room.
ANS: D
All of these options will assist her in keeping her orientation to the environment, but because she is wandering to the wrong rooms to look for items, signs on the doors and entryways would be most helpful to her as she finds the appropriate room.

DIF: Cognitive Level: Application REF: p. 198 OBJ: 7
TOP: Interventions with Alzheimers Disease
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

11. The nurse performs a functional assessment of a client upon admission to a home health service. The purpose of this assessment is to determine the clients:
a. Level of consciousness
b. Ability to perform activities of daily living
c. Degree of reasoning, judgment, and thought processes
d. Level of functioning memory
ANS: B
This is an important point of assessment if the nurse is trying to determine the level of care necessary for this client. The other options also may be assessed at some point in the admission, but they do not make up the functional assessment.

DIF: Cognitive Level: Comprehension REF: p. 197 OBJ: N/A
TOP: Assessment KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

12. A 72-year-old client with dementia, who resides in a long-term care facility, frequently goes to her room and cries because she misses her children. This client could benefit most from which intervention?
a. Life review
b. Doll therapy
c. Comfort touch
d. Audio presence therapy
ANS: D
Because missing her children brings sadness to this client, she may benefit from hearing their voices on tape and recalling pleasant family memories. The other interventions are effective therapies for clients with dementia, but they do not address this clients immediate need.

DIF: Cognitive Level: Application REF: p. 200 OBJ: 7
TOP: Interventions with Alzheimers Disease
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

13. The medication donepezil (Aricept) frequently is used to treat the early-stage symptoms of Alzheimers disease. When administering this particular medication, the nurse should be especially alert to assess the client for:
a. Weight changes
b. Tremors
c. Increased sweating
d. Alterations in blood pressure
ANS: D
This medication may cause high or low blood pressure. The other options typically are not seen with donepezil (Aricept) but sometimes are seen with other Alzheimers medications.

DIF: Cognitive Level: Application REF: p. 197 OBJ: 7
TOP: Interventions with Alzheimers Disease
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

14. Which symptom of Alzheimers disease is associated with disorientation to time and place?
a. Forgetting in what order to put clothes on
b. Forgetting simple words
c. Forgetting where he or she lives
d. Becoming suspicious of others
ANS: C
Additional examples of disorientation to time and place include getting lost on the street that one lives on and forgetting how he or she got to places. Forgetting in what order to put on clothing relates to difficulty with performing familiar tasks; forgetting simple words relates to problems with language; becoming suspicious of others relates to changes in personality

DIF: Cognitive Level: Comprehension REF: p. 195 OBJ: 6
TOP: Stages of Alzheimers Disease KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. An elderly woman is brought to the clinic by her daughter. The client states that she has had a cold for several days. Her daughter states that her mother has been confused about when her routine medications are to be taken and that her mother has never experienced confusion about her medications before. Based on this information, it is important that the nurse ask the client whether:
a. There is a history of mental illness in the family
b. She has been given a diagnosis of a mental health disorder in the past
c. She can recall her last visit to a physician
d. She has taken any over-the-counter medications for her cold
ANS: D
Over-the-counter cold medications can cause confusion in the elderly population. Because this client has had a cold recently, it would be important to determine whether she has been taking any of these types of medications. There is no indication that the other options have any significance in relation to the acute confusion.

DIF: Cognitive Level: Application REF: p. 191 OBJ: 3
TOP: Medications and the Elderly Population
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

16. The daughter of an elderly nursing home resident is crying outside her fathers room. When the nurse comforts her, she states, It is so hard to come here to visit when my mother doesnt even know who I am. The nurse knows the client is in which stage of Alzheimers disease?
a. Early stage
b. Intermediate stage
c. Severe stage
d. End stage
ANS: B
Visual agnosia, the loss of recognition of previously known or familiar people, is a manifestation of the intermediate stage of Alzheimers disease.

DIF: Cognitive Level: Application REF: p. 195 OBJ: 6
TOP: Stages of Alzheimers Disease KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

17. A 75-year-old man finds that he continually misplaces items he uses every day. In addition, his wife becomes annoyed when he asks the same question several times because he does not remember the answer. What advice is the most appropriate for his health care provider to give him?
a. These symptoms are a normal part of aging and he should accept it.
b. He has Alzheimers disease, and nothing can be done to help him.
c. Further assessment is needed to determine the cause of these symptoms.
d. Admission to a nursing home for more intensive care is needed.
ANS: C
Multiple factors influence how one ages mentally. Culture, education, general health, genetics, and living conditions all have an influence on ones cognitive (intellectual) abilities. We all age individually, but one thing is certain: confusion is not normal. Although it most often occurs in older adults, individuals of any age can become confused. No matter what the age, confusion demands investigation.

DIF: Cognitive Level: Application REF: p. 190 OBJ: 1
TOP: Normal Changes in Cognition KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

18. The most common severe cognitive impairment in the United States is Alzheimers dementia. What percentage of the population over the age of 85 are at risk for getting the disease?
a. 30%
b. 50%
c. 70%
d. 90%
ANS: B
The incidence of dementia increases with age. Alzheimers dementia is the most common severe cognitive impairment in the United States. For people age 85 years or older, the risk of getting the disease (AD) approaches 50% (Small, 2010).

DIF: Cognitive Level: Application REF: p. 194 OBJ: 4
TOP: Symptoms of Dementia KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

19. Which client exhibits signs and symptoms of delirium and not dementia or depression?
a. The onset is sudden and acute.
b. The cognitive changes are hidden by client.
c. The client demonstrates apathetic demeanor or flat affect.
d. The clients ability to perform ADLs is intact.
ANS: A
Cognitive changes which that occur with delirium are sudden in nature. A client with dementia may attempt to hide cognitive changes in the early stages, and they are able to perform ADLs in the early stage as well. Clients suffering from depression often display apathy or a flat affect.

DIF: Cognitive Level: Application REF: p. 191 OBJ: 4
TOP: Clients with Delirium KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

MULTIPLE RESPONSE

20. The nurse anticipates that the normal aging process of losing neurons and shrinkage of brain size will result in which assessment findings in older adults? (Select all that apply.)
a. Confusion
b. Slower response times
c. Depression
d. Deficiencies in short-term memory
ANS: B, D
These are normal occurrences in aging. Confusion and depression are not considered normal responses to aging and should be investigated further.

DIF: Cognitive Level: Knowledge REF: p. 190 OBJ: 1
TOP: Normal Changes in Cognition KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

21. Which characteristics are commonly seen in clients with dementia? (Select all that apply.)
a. Gradual onset
b. Poor short-term memory
c. Problems with judgment
d. Fast onset
e. Poor remote memory
f. Difficulty with abstract thinking
g. Personality changes
ANS: A, B, C, E, F, G
These are all signs and symptoms of dementia, regardless of whether it is classified as Alzheimers or nonAlzheimer-type dementia.

DIF: Cognitive Level: Knowledge REF: p. 193 OBJ: 5
TOP: Symptoms of Dementia KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

22. Which interventions will help to lessen the effects of sundown syndrome? (Select all that apply.)
a. Provide activity that stimulates the clients interest.
b. Assist in toileting to prevent incontinence.
c. Turn on lights before the room gets dark.
d. Provide companionship.
e. Prepare client for sleep by turning off lights.
f. Reduce environmental stimulation at dinner.
g. Maintain clients familiar routine.
ANS: B, C, D, F, G
Sundown syndrome is associated with physical and social stressors including the decrease of visual and social cues. Interventions include meeting the clients basic needs and maintaining a consistent routine without abrupt changes such as decreasing lighting, withdrawing companionship, and changing or increasing stimulation.

DIF: Cognitive Level: Knowledge REF: p. 194 OBJ: 2
TOP: Symptoms of Dementia KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

COMPLETION

23. __________ refers to thinking and thought processes.

ANS:
Cognition
Cognition relates to intelligence, judgment, reasoning, knowledge, understanding, and memory.

DIF: Cognitive Level: Knowledge REF: p. 190 OBJ: 1
TOP: Confusion Has Many Faces KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

24. __________ is a progressive, degenerative disease that affects the brain and causes impaired memory, cognition, and behavior

ANS:
Alzheimers disease
The disease was discovered in 1907. Pathological findings include abnormal tangles of nerve fibers in the brain, degenerated nerve endings, and shrunken brain tissue.

DIF: Cognitive Level: Knowledge REF: p. 194 OBJ: 6
TOP: Alzheimers Disease KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

25. The causes of confusion are grouped into five categories known as the five Ds. These categories consist of damage, delirium, dementia, depression, and __________.

ANS:
deprivation
Deprivation refers to sensory deprivation related to poor vision or hearing.

DIF: Cognitive Level: Knowledge REF: p. 190 OBJ: 2
TOP: The Five Ds of Confusion KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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