Chapter 21 Cognitive Impairment

Chapter 21  Cognitive Impairment

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. Which of the following statements is true about cognitive impairments in older adults?
a.
Loss or interruption of sleep can lead to delirium.
b.
Confusion is a normal and unavoidable consequence of aging.
c.
Older patients who are agitated often have a lower cognitive status than those who are quietly sitting.
d.
The Mini-Mental State Examination–2nd edition (MMSE-2) should be administered on admission to detect delirium.

ANS: D
The MMSE-2 or a similar instrument should be administered to a patient at admission to ascertain the patient’s baseline cognitive status. The loss or interruption of sleep, in of itself, does not often lead to delirium. It can potentiate delirium in the presence of other factors. Confusion or delirium is not a normal consequence of aging but an indicator of a potentially underlying problem. The hypoactive subtype of delirium can be associated with a worse prognosis than with the hyperactive subtype; it is easily overlooked.

PTS: 1 DIF: Understand REF: 7| 48
TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

2. At 10 PM, an older male resident attempts to climb over the bedrails. Which intervention should the nurse implement first?
a.
Talk to the resident about his behavior.
b.
Call the physician, and ask for a sedative.
c.
Apply a vest restraint on the resident.
d.
Get a companion to keep him in the bed.

ANS: A
The resident is expressing a need that the nurse can potentially determine with gentle questioning. Pharmacological intervention can be necessary but should not replace careful evaluation and management of the underlying cause. Simply restraining the patient will not address the underlying problem, and the imposition of restraints can trigger delirium. Applying a restraint is the last resort, and the nurse must consider the problems that accompany the application of restraints before doing so. Placing a companion in the room can be an effective method of keeping the resident safe if the companion can determine and meet the resident’s needs.

PTS: 1 DIF: Analyze REF: 55-57
TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

3. A definitive diagnosis of Alzheimer disease (AD) can be made by detecting or using which one of the following methods?
a.
Clinical observation of dementia
b.
Inability to speak with relevance
c.
Development of neurofibrillary tangles
d.
Computed axial tomographic (CAT) scan

ANS: C
Confirming the development of neurofibrillary tangles is the only accurate method for diagnosing AD. Patients with AD can be observed for dementia and delirium, but these indicators are nonspecific for the disease. The inability to speak with relevance is a feature of dementia; if other causes of dementia are ruled out, then it may be dementia of the Alzheimer type. A CAT scan is the most useful means for diagnosing a stroke.

PTS: 1 DIF: Remember REF: 11
TOP: Nursing Process: Assessment MSC: Physiological Integrity

4. Which assessment parameter should the nurse use to differentiate between delirium and depression in an older adult?
a.
Orientation
c.
Course over the morning hours
b.
Activity
d.
Psychomotor activity

ANS: A
Qualities about the patient’s orientation are a good method for the nurse to use for distinguishing between delirium and depression; in delirium, orientation is usually impaired, and in depression, orientation is normal. Activity can vary throughout the day and is not a good indicator. Delirium tends to be worse at night, and depression tends to be worse in the morning. The nurse avoids using qualities about the patient’s psychomotor activities to distinguish between delirium and depression in an older adult; psychomotor activities in both disorders are highly variable and make distinctions difficult.

PTS: 1 DIF: Understand REF: 38
TOP: Nursing Process: Assessment MSC: Psychosocial Integrity