NCLEX Alzheimer’s, Delirium, and Dementia Practice Quiz 65 Q&A 2024 update, Exams of Nursing

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NCLEX Alzheimer’s, Delirium, and Dementia Practice Quiz: 65 Questions NCLEX

NCLEX Alzheimer’s, Delirium, and

Dementia Practice Quiz: 65 Questions

1. 1. Question

Nurse Isabelle enters the room of a client with a cognitive 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

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.  B. Pretends to be someone else.  C. Rationalizes various behaviors.

 A. Remembering the daily schedule.  B. Recalling past events.  C. Coping the anxiety.  D. Solving problems of daily living. Incorrect Correct Answer: B. Recalling past events Recent memory loss is the characteristic sign of cognitive difficulty in early Alzheimer’s disease. The ability to recall past events is usually retained until the later stages of this disorder. Symptoms of Alzheimer’s disease depend on the stage of the disease. Alzheimer’s disease is classified into preclinical or presymptomatic, mild, and dementia-stage depending on the degree of cognitive impairment. These stages are different from the DSM-5 classification of Alzheimer’s disease. The initial and most common presenting symptom is episodic short-term memory loss with relative sparing of long-term memory and can be elicited in most patients even when not the presenting symptom.  Option A: Dementia is a general term that refers to a decline in cognitive ability severe enough to interfere with activities of daily living. Alzheimer’s disease (AD) is the most common type of dementia, accounting for at least two-thirds of cases of dementia in people aged 65 and older. Alzheimer’s disease is a neurodegenerative disease with insidious onset and progressive impairment of behavioral and cognitive functions including memory, comprehension, language, attention, reasoning, and judgment.  Option C: Neuropsychiatric symptoms like apathy, social withdrawal, disinhibition, agitation, psychosis, and wandering are also common in the mid to late stages. Difficulty performing learned motor tasks (dyspraxia), olfactory dysfunction, sleep disturbances, extrapyramidal motor signs like dystonia, akathisia, and parkinsonian symptoms occur late in the disease. This is followed by primitive reflexes, incontinence, and total dependence on caregivers.  Option D: Short-term memory impairment is followed by impairment in problem-solving, judgment, executive functioning, lack of motivation, and disorganization, leading to problems with multitasking and abstract thinking. In the early stages,

impairment in executive functioning ranges from subtle to significant. This is followed by language disorder and impairment of visuospatial skills.

6. 6. Question

82-year-old Mr. Robeson together with his daughter arrived at the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client’s daughter best supports the diagnosis?  A. "Maybe it's just caused by aging. This usually happens by age 82."  B. "The changes in his behavior came on so quickly! I wasn't sure what was happening."  C. "Dad just didn't seem to know what he was doing. He would forget what he had for breakfast."  D. "Dad has always been so independent. He's lived alone for years since mom died." Incorrect Correct Answer: B. “The changes in his behavior came on so quickly! I wasn’t sure what was happening.” Delirium is an acute process characterized by abrupt, spontaneous cognitive dysfunction. 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.  Option A: Cognitive impairment disorders (dementia or delirium) are not normal consequences of aging. There are two groups of risk factors related to delirium: predisposing and precipitant factors. The most common predisposing factors are older age (older than 70 years), dementia (often not recognized clinically), functional disabilities, male gender, poor vision and hearing, and mild cognitive impairment. Alcohol use disorder and laboratory abnormalities have been associated with an increased risk.  Option C: Option C would be characteristic of someone with dementia. The clinical presentation of delirium can vary, but usually, it flourishes with psychomotor behavioral disturbances

conversations. Avoid anger and expectation of the patient to remember or follow instructions. Do not expect more than the patient is capable of doing. Catastrophic emotional responses are prompted by task failure when the patient feels expected to perform beyond ability and becomes frustrated and angry. Responding calmly to the patient validates feelings and causes less stress.  Option B: Restraints are a last resort to ensure client safety and are inappropriate in this situation. Assess the patient for reversible or irreversible dementia, causes, ability to interpret environment, intellectual thought processes, memory loss, disturbances with orientation, behavior, and socialization. Determines type and extent of dementia to establish a plan of care to enhance cognition and emotional functioning at optimal levels.  Option D: Sedation should be avoided, if possible, because it will interfere with CNS functioning and may contribute to the client’s confusion. Maintain consistent scheduling with allowances for patient’s specific needs, and avoid frustrating situations and overstimulation. Prevents patient agitation, erratic behaviors, and combative reactions. Scheduling may need revision to show respect for the patient’s sense of worth and to facilitate completion of tasks.

8. 8. Question

Which goal is a priority for a client with a DSM-IV-TR diagnosis of delirium and the nursing diagnosis acute confusion related to recent surgery secondary to traumatic hip fracture?  A. The client will complete activities of daily living.  B. The client will maintain safety.  C. The client will remain oriented.  D. The client will understand communication. Incorrect Correct Answer: B. The client will maintain safety. Maintaining safety is the priority goal for an acutely confused client who recently had surgery. All measures to promote physiologic safety and psychosocial wellbeing would be implemented. Remove all

potentially dangerous objects from the client’s environment; in a disoriented, confused state, clients may use objects to harm self or others. Have sufficient staff available to execute a physical confrontation, if necessary; assistance may be required from others to provide for the physical safety of the client or primary nurse, or both.  Option A: This client would not be able to complete activities of daily living, and safety is a priority over these tasks. Assess the client’s level of anxiety and behaviors that indicate the anxiety is increasing; recognizing these behaviors, the nurse may be able to intervene before violence occurs. Maintain a low level of stimuli in the client’s environment (low lighting, few people, simple decor, low noise level) because anxiety increases in a highly stimulating environment.  Option C: Interrupt periods of unreality and reorient; client safety is jeopardized during periods of disorientation; correcting misinterpretations of reality enhances client’s feelings of self- worth and personal dignity. Orient the patient to surroundings, staff, necessary activities as needed. Present reality concisely and briefly. Avoid challenging illogical thinking—defensive reactions may result. Increased orientation ensures greater degree of safety for the patient.  Option D: The goals of remaining oriented and understanding communication would be appropriate only after the client’s acute confusion has resolved. Give simple directions. Allow sufficient time for the patient to respond, communicate, to make decisions. This communication method can reduce anxiety experienced in a strange environment. Avoid challenging illogical thinking. Challenges to the patient’s thinking can be perceived as threatening and result in a defensive reaction.

9. 9. Question

Which of the following is not included in the care plan of a client with a moderate cognitive impairment involving dementia of the Alzheimer’s type?  A. Daily structured schedule.  B. Positive reinforcement for performing activities of daily living.  C. Stimulating environment.

 A. Aphasia.  B. Agnosia.  C. Sundowning.  D. Confabulation. Incorrect Correct Answer: C. Sundowning. Sundowning is a common phenomenon that occurs after daylight hours in a client with a cognitive impairment disorder. The term “sundowning” refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression, or ignoring directions. Sundowning can also lead to pacing or wandering. Sundowning isn’t a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer’s disease. The exact cause of this behavior is unknown.  Option A: Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is always due to injury to the brain-most commonly from a stroke, particularly in older individuals. Aphasia can be so severe as to make communication with the patient almost impossible, or it can be very mild. It may affect mainly a single aspect of language use, such as the ability to retrieve the names of objects, or the ability to put words together into sentences, or the ability to read. More commonly, however, multiple aspects of communication are impaired, while some channels remain accessible for a limited exchange of information.  Option B: Agnosia is a rare disorder whereby a patient is unable to recognize and identify objects, persons, or sounds using one or more of their senses despite otherwise normally functioning senses. The deficit cannot be explained by memory, attention, language problems, or unfamiliarity to the stimuli. Usually, one of the sensory modalities is affected.  Option D: 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.

11. 11. Question

80-year-old Mr. Stevens is accompanied to the clinic by his son, who tells the nurse that the client’s constant confusion, incontinence, and tendency to wander are intolerable. The client was diagnosed with chronic cognitive impairment disorder. Which nursing diagnosis is most appropriate for the client’s son?  A. Risk for other-directed violence.  B. Disturbed sleep pattern.  C. Caregiver role strain.  D. Social isolation. Incorrect Correct Answer: C. Caregiver role strain The son’s description exemplifies some of the problems commonly encountered by a primary caregiver who is caring for someone with a cognitive impairment disorder. Assess family’s knowledge of patient’s disease and erratic behaviors and possible violent reactions. Knowledge will enhance the family’s understanding of dementia associated with the disease and development of coping skills and strategies.  Option A: Assess for level of family’s fatigue, reduced social exposure of family, feelings about role reversal in caring for the patient, and increasing demands of the patient. Long-term needs of the patient may affect the physical and psychosocial health of the caregiver, their economic status, and prevent the family from achieving their own goals in life. Provide an opportunity for the family to express concerns and lack of control of the situation to promote venting of feelings and reduce anxiety.  Option B: Assist in defining problems and use of techniques to cope and solve problems. Provides support for problem solving and management of family’s fatigue and chronic stress. Assist the family to identify patient’s reactions and behaviors and reasons for them. This may indicate onset of agitation and allow for interventions to prevent or reduce frustration.

 Option C: Instruct family members in the disease process, what can be expected, and assist with providing a list of community resources for support. Once diagnosis of AD is made, the family should be prepared to make long-term plans in order to discuss problems before they arise. Choices for resuscitation, legal competency, and guardianship including financial responsibility needed to be addressed. The care of a person with AD is expensive and time-consuming, as well as energy-draining and emotionally devastating for the family. Community resources can help delay the need for placement in a long-term care facility and may help defray some costs.

13. 13. Question

A family member expresses concern to a nurse about behavioral changes in an elderly aunt. Which would cause the nurse to suspect a cognitive impairment disorder?  A. Decreased interest in activities that she once enjoyed.  B. Fearfulness of being alone at night.  C. Increased complaints of physical ailments.  D. Problems with preparing a meal or balancing her checkbook. Incorrect Correct Answer: D. Problems with preparing a meal or balancing her checkbook. Making a meal and balancing a checkbook are higher-level cognitive functions that, when unable to be performed, may signal onset of a cognitive disorder. 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. 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.  Option A: Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease the ability to function at work and at home. Depression affects an estimated

one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can occur at any time, but on average, first appears during the late teens to mid-20s.  Option B: Autophobia is considered a situational phobia. This means that the situation of being alone or loneliness causes extreme distress. To be diagnosed with autophobia, the fear of being alone causes you so much anxiety that it interferes with daily routine.  Option C: Somatic symptom disorder is characterized by an extreme focus on physical symptoms — such as pain or fatigue — that cause major emotional distress and problems functioning. The client may or may not have another diagnosed medical condition associated with these symptoms, but the reaction to the symptoms is not normal.

14. 14. Question

During the home visit of a client with dementia, the nurse notes that an adult daughter persistently corrects her father’s misperceptions of reality, even when the father becomes upset and anxious. Which intervention should the nurse teach the caregiver?  A. Anxiety-reducing measures  B. Positive reinforcement  C. Reality orientation techniques  D. Validation techniques Incorrect Correct Answer: D. Validation techniques Validation techniques are useful measures for making emotional connections with a client who can no longer maintain reality orientation. These measures are also helpful in decreasing anxiety. The basic idea behind validation therapy is that people who are in the late stages of life may have unresolved issues that drive their behaviors and emotions. The way caregivers or family members respond to these behaviors and emotions can either make them worse or help resolve them.  Option A: Anxiety-reducing measures and positive reinforcements will also be appropriate, but validation techniques

 F. Use a calm, supportive, quiet manner when assisting the client. Incorrect Answer: A, C, and F Maintaining a consistent routine with the same staff members will help decrease the client’s anxiety that occurs whenever changes are made. A calm, quiet manner will be reassuring to the client, also helping to minimize anxiety. Maintain a regular daily schedule routine to prevent problems that may result from thirst, hunger, lack of sleep, or inadequate exercise. Limit decisions that the patient makes. Be supportive and convey warmth and concern when communicating with the patient. The patient may be unable to make even the simplest choice decisions and this will result in frustration and distraction. By avoiding this, the patient has an increased feeling of security. Patients frequently have feelings of loneliness, isolation and depression, and they respond positively to a smile, friendly voice, and gentle touch.  Option B: Moving quickly with several staff members will increase the client’s anxiety and may precipitate a catastrophic reaction. Assess a patient’s ability to cope with events, interests in surroundings and activity, motivation, and changes in memory pattern. The elderly may have a decrease in memory for more recent events and more active memory for past events and more active memory for past events and reminisce about the pleasant ones. The patient may exhibit assertiveness or aggressiveness to compensate for feelings of insecurity, or develop more narrowed interests and have difficulty accepting changes in lifestyle.  Option D: The use of sedation is not indicated and may increase the risk of client injury from the side effect of drowsiness. Assess and identify a patient’s previous history of grooming and bathing, and attempt to maintain similar care. Promotes familiarity with routine bathing time and type of bath or shower, and lessens further confusion and agitation. Ensure all needed items are present in the bathroom prior to the patient’s arrival. Ensure that water temperature in the tube is appropriate. Prevents the need to leave the patient unattended, which may result in injury. Elderly are easily child and have fragile skin that is susceptible to scalding.  Option E: Telling the client to remain calm is inappropriate because a client with dementia cannot respond to such a direction. Divert attention to a client when agitated or dangerous behaviors like getting out of bed by climbing the fence bed to

promote safety and prevent risk for injury. Eliminate or minimize sources of hazards in the environment. Maintain security by avoiding a confrontation that could improve the behavior or increase the risk for injury.

16. 16. Question

Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe:  A. Hyperactivity  B. Depression  C. Suspicion  D. Delirium Incorrect Correct Answer: B. Depression There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug. When cocaine use is stopped or when a binge ends, a crash follows almost right away. The cocaine user has a strong craving for more cocaine during a crash. Other symptoms include fatigue, lack of pleasure, anxiety, irritability, sleepiness, and sometimes agitation or extreme suspicion or paranoia. Cocaine withdrawal often has no visible physical symptoms, such as the vomiting and shaking that accompany withdrawal from heroin or alcohol.  Option A: The craving and depression can last for months after stopping long-term heavy use. Withdrawal symptoms may also be associated with suicidal thoughts in some people. During withdrawal, there can be powerful, intense cravings for cocaine. The “high” associated with ongoing use may become less and less pleasant. It can produce fear and extreme suspicion rather than euphoria. Even so, the cravings may remain powerful.  Option C: Feeling depressed, anxious, or irritable is a normal part of cocaine withdrawal. Although these feelings are often intense during cocaine withdrawal, they tend to pass once the withdrawal stage is over. Feeling very tired is a normal part of cocaine withdrawal. In addition to the exhaustion that you naturally feel after the stimulating effects of cocaine, you may