Chapter 21 Cognitive Disorders

Chapter 21  Cognitive Disorders

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1) A widow, aged 72 years, lives alone and is visited weekly by her son. She takes digoxin, hydrochlorothiazide, and an antihypertensive drug. She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety. When the son visited today he found his mother confused. Her speech was thick and slurred and she had an unsteady gait. She was taken to the emergency department, and hospital admission followed. The nurse assessed the client as having several cognitive problems, including memory and attention deficits and fluctuating levels of orientation. The nurse confirms that the client’s symptoms developed over a 2-day period. The client’s symptoms are most characteristic of
A.
delirium.
B.
dementia.
C.
amnestic syndrome.
D.
Alzheimer’s disease.

ANS: A
Delirium is characterized by an abrupt onset of fluctuating levels of awareness, clouded consciousness, perceptual disturbances, and disturbed memory and orientation. Options B and D: The onset of dementia or Alzheimer’s disease, a type of dementia, is more insidious. Option C: Amnestic syndrome involves memory impairment without other cognitive problems.

DIF: Cognitive Level: Analysis REF: Text Page: 423, Text Page: 424
TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

2) A client with fluctuating levels of awareness, confusion, and disturbed orientation shouts “The bugs, they are crawling on my legs! Get them off me!” The nurse can assess this behavior as indicating that the client is experiencing
A.
aphasia.
B.
dystonia.
C.
tactile hallucinations.
D.
mnemonic disturbance.

ANS: C
The client feels bugs crawling on her legs, even though no sensory stimulus is actually present. This description coincides with the definition of a hallucination, a false sensory perception. Tactile hallucinations may be part of the symptom constellation of delirium. Option A: Aphasia refers to a speech disorder. Option B: Dystonia refers to excessive muscle tonus. Option D: Mnemonic disturbance is associated with dementia rather than delirium.

DIF: Cognitive Level: Application REF: Text Page: 426
TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

3) The most appropriate response for the nurse to make when a client with fluctuating levels of consciousness, disturbed orientation, and perceptual alterations begs to have someone get the bugs off her would be
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 away the bugs for you.”
D.
“I don’t see any bugs, but I know you are frightened so I will stay with you.”

ANS: D
When hallucinations are present, the nurse should acknowledge the client’s feelings and state the nurse’s perception of reality, but not argue. Staying with the client increases feelings of security, reduces anxiety, offers the opportunity for reinforcing reality, and provides a measure of physical safety. Option A does not support the client emotionally. Option B makes the client responsible for self-soothing. Option C supports the perceptual distortions.

DIF: Cognitive Level: Application REF: Text Page: 426, Text Page: 427
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment;

4) The nursing diagnosis established for a client with fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations that should be given priority is
A.
bathing/hygiene self-care deficit related to altered cerebral function, as evidenced by confusion and inability to perform personal hygiene tasks.
B.
risk for injury related to altered cerebral function, as evidenced by sensory perceptual alterations and unstable gait.
C.
disturbed thought processes related to altered cerebral function resulting from medication intoxication, as evidenced by confusion, disorientation, and hallucinations.
D.
fear related to sensory perceptual alterations, as evidenced by hiding from hallucinated dog and wanting nurse to remove hallucinated bugs from her legs.

ANS: B
The physical safety of the client is of highest priority among the diagnoses given. Many opportunities for injury exist when a client misperceives the environment as distorted, threatening, or harmful; when the client exercises poor judgment; and when the client’s sensorium is clouded. The other diagnoses, although valid, are of lower priority.

DIF: Cognitive Level: Analysis REF: Text Page: 428
TOP: Nursing Process: Nursing Diagnosis
MSC: NCLEX: Safe, Effective Care Environment;

5) An important facet of nursing care for a client with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations is
A.
avoidance of physical contact.
B.
application of wrist and ankle restraints.
C.
careful observation and supervision.
D.
a high level of sensory stimulation.

ANS: C
Careful observation and supervision are of ultimate importance because an appropriate outcome would be that the client will remain safe and free from injury while hospitalized. Option A: Physical contact during caregiving cannot be avoided. Option B: Restraint is a last resort. Option D: Sensory stimulation should be reduced.

DIF: Cognitive Level: Application REF: Text Page: 430
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment;