NURS 211 - NCLEX Style Questions (Cognition)
Exam With Complete Solutions
A patient diagnosed with moderate dementia consistently appears to be
distorting the truth resulting in his wife asking, "What should I do when he lies to
me about unimportant things?" Upon what rationale should the nurse's response
be based?
a. Changing the topic provides diversion.
b. Delusions should be confronted to clarify thinking.
c. Ignoring memory deficit avoids catastrophic reactions.
d. This isn't lying but rather a way to fill in the memory gaps. - ANSWER ANS: D
Confabulation is not lying but rather a method for filling in the memory gaps.
Ignoring, using confrontation, and changing the topic would not be as useful as
gently reorienting.
The nurse is to perform a complete assessment of a patient in her home, using
the Mini-Mental State Examination (MMSE) as one component. When the nurse
arrives, the patient is seated at the table with her husband, the TV is on, and
several grandchildren are visiting. The patient is quiet, but her hands are
gripped tightly, and she is staring at the ceiling. The best action for the nurse to
take would be which of the following?
a. Ask the husband to make an appointment to bring his wife to the clinic for
testing.
b. Explain to the husband that accurate data will be sought, and ask him to stay
with the grandchildren in another room.
c. Do not perform the test during the assessment (because it will not be valid)
and rely on observations and reports from the family.
d. Explain the importance of the testing process and make an appointment for
another day when the environment can be better controlled. - ANSWER ANS: D
Testing the patient in her home under quieter, less distracting circumstances is
the best solution. Asking the husband to leave is likely to increase the patient's
anxiety and alter test results. Use of the MMSE is an integral component of the
assessment and must not be deleted. Testing in the more familiar, comfortable
surroundings of the home will yield more reliable results.
A patient has been admitted with a diagnosis of hypoactive delirium. Which
nursing intervention is supported by this diagnosis?
a. Encouraging fluids to minimize constipation
,b. Frequently assessing both visual and auditory hallucinations
c. Scheduling frequent changing of position to prevent skin breakdown
d. Dimming the lights to help control eye discomfort resulting from cataracts -
ANSWER ANS: C
Because of inactivity, hypoactive delirium patients are more likely to develop
further complications, including decubiti that could be minimized by frequent
repositioning. The remaining options identify interventions that are not generally
a result of this diagnosis
Which of the following should the nurse use as a basis for explaining the etiology
of Alzheimer's disease to the family of a patient with this disease?
a. It is a secondary dementia indicated by loss of recent memory and
disorientation to time and place.
b. It is a primary dementia that is incurable, irreversible, and fatal. It is caused
by the presence of a beta-amyloid protein in the neurons resulting in senile
plaques.
c. It is a secondary dementia that is treatable with analysis of the diet and
removal of toxic substances from the diet and environment.
d. It is a primary dementia characterized by stepwise decreases in cognitive
abilities. It is irreversible but treatable with antihypertensive medications. -
ANSWER ANS: B
This option provides accurate information about Alzheimer's disease.
Alzheimer's disease is not a secondary dementia nor is it treated with
antihypertensive medications.
Which outcome is realistic for a patient with stage 1 Alzheimer's disease?
a. Caregiver will assume role of decision maker for patient to reduce stress.
b. The patient will maintain the highest possible functional level to preserve
autonomy.
c. Arrangements will be made for appropriate long-term placement to minimize
risk of injury.
d. The patient will retain full physical functioning through cognitive and
occupational therapies. - ANSWER ANS: B
This outcome addresses health maintenance (i.e., maintaining an optimal
functional level as determined by present capacity). Although long-term
placement may be an option, it is not necessarily appropriate during this stage.
Patients in stage 1 are often able to make simple decisions. Continuing to make
decisions gives the patient a sense of control. Although a patient in stage 1 does
not appear markedly deteriorated, some diminution of function may be present
The home care nurse is visiting a patient who was discharged to home after a
procedure at an ambulatory surgical center. The patient lives alone in a senior
retirement community. The nurse's assessment documents mild dysphasia. The
patient repeatedly asks, "Why is there a bandage on my arm?" and is not able to
, state the appropriate day and year. Appropriate planning for the patient should
include:
a. Assessing diet and meal preparation, assessing environment for safety
problems, referral to a dementia program
b. Attending English class to improve speech, transferring finances to a
conservator, employing an aide to help with medications
c. Arranging Meals on Wheels, attending speech therapy, relocation to a skilled
nursing facility if no improvement in 1 month
d. Arranging an appointment at a geriatric assessment program, OT referral for
swallowing therapy, teaching to manage public transportation - ANSWER ANS:
A
Further assessment is appropriate before making changes in the living
environment. Enrolling in a dementia program will provide stimulation and help
the patient maintain intellectual skills. English classes will not improve speech.
The other plans might have relevance, however. The remaining sets of options
are either irrelevant or beyond the patient's abilities.
A patient diagnosed with Alzheimer's disease has a catastrophic reaction during
an activity involving simultaneous playing of music and working on a craft
project. The patient starts shouting "no, no, no" and rushes out of the room. The
nurse should:
a. Discontinue the activity program since it upsets the patients.
b. Follow the patient, reassure her, and redirect her to a quieter activity.
c. Isolate the patient until she is calm, and then direct her back to the activity.
d. Give the patient prn antianxiety medication and restrict her activity
participation. - ANSWER ANS: B
These actions will restore safety and self-esteem. Isolation will decrease self-
esteem and may increase confusion. It is only one patient that is distressed, not
the entire group. Behavioral interventions should be attempted prior to
administering medication.
Which behaviors would indicate that a therapeutic activity program for a patient
with Alzheimer's disease had been successful?
a. Accurate recent memory, positive emotional response, and increased verbal
expression
b. Increased attention span, verbal expression of remote memory, and positive
emotional response
c. Positive use of perseveration, reduction in use of habitual skills, and improved
abstract reasoning
d. Positive emotional response, ability to remember multiple steps, and accurate
recent memory - ANSWER ANS: B
These are all observations that would indicate that a therapeutic activity
program has kept the patient functioning at the highest level of which he is
Exam With Complete Solutions
A patient diagnosed with moderate dementia consistently appears to be
distorting the truth resulting in his wife asking, "What should I do when he lies to
me about unimportant things?" Upon what rationale should the nurse's response
be based?
a. Changing the topic provides diversion.
b. Delusions should be confronted to clarify thinking.
c. Ignoring memory deficit avoids catastrophic reactions.
d. This isn't lying but rather a way to fill in the memory gaps. - ANSWER ANS: D
Confabulation is not lying but rather a method for filling in the memory gaps.
Ignoring, using confrontation, and changing the topic would not be as useful as
gently reorienting.
The nurse is to perform a complete assessment of a patient in her home, using
the Mini-Mental State Examination (MMSE) as one component. When the nurse
arrives, the patient is seated at the table with her husband, the TV is on, and
several grandchildren are visiting. The patient is quiet, but her hands are
gripped tightly, and she is staring at the ceiling. The best action for the nurse to
take would be which of the following?
a. Ask the husband to make an appointment to bring his wife to the clinic for
testing.
b. Explain to the husband that accurate data will be sought, and ask him to stay
with the grandchildren in another room.
c. Do not perform the test during the assessment (because it will not be valid)
and rely on observations and reports from the family.
d. Explain the importance of the testing process and make an appointment for
another day when the environment can be better controlled. - ANSWER ANS: D
Testing the patient in her home under quieter, less distracting circumstances is
the best solution. Asking the husband to leave is likely to increase the patient's
anxiety and alter test results. Use of the MMSE is an integral component of the
assessment and must not be deleted. Testing in the more familiar, comfortable
surroundings of the home will yield more reliable results.
A patient has been admitted with a diagnosis of hypoactive delirium. Which
nursing intervention is supported by this diagnosis?
a. Encouraging fluids to minimize constipation
,b. Frequently assessing both visual and auditory hallucinations
c. Scheduling frequent changing of position to prevent skin breakdown
d. Dimming the lights to help control eye discomfort resulting from cataracts -
ANSWER ANS: C
Because of inactivity, hypoactive delirium patients are more likely to develop
further complications, including decubiti that could be minimized by frequent
repositioning. The remaining options identify interventions that are not generally
a result of this diagnosis
Which of the following should the nurse use as a basis for explaining the etiology
of Alzheimer's disease to the family of a patient with this disease?
a. It is a secondary dementia indicated by loss of recent memory and
disorientation to time and place.
b. It is a primary dementia that is incurable, irreversible, and fatal. It is caused
by the presence of a beta-amyloid protein in the neurons resulting in senile
plaques.
c. It is a secondary dementia that is treatable with analysis of the diet and
removal of toxic substances from the diet and environment.
d. It is a primary dementia characterized by stepwise decreases in cognitive
abilities. It is irreversible but treatable with antihypertensive medications. -
ANSWER ANS: B
This option provides accurate information about Alzheimer's disease.
Alzheimer's disease is not a secondary dementia nor is it treated with
antihypertensive medications.
Which outcome is realistic for a patient with stage 1 Alzheimer's disease?
a. Caregiver will assume role of decision maker for patient to reduce stress.
b. The patient will maintain the highest possible functional level to preserve
autonomy.
c. Arrangements will be made for appropriate long-term placement to minimize
risk of injury.
d. The patient will retain full physical functioning through cognitive and
occupational therapies. - ANSWER ANS: B
This outcome addresses health maintenance (i.e., maintaining an optimal
functional level as determined by present capacity). Although long-term
placement may be an option, it is not necessarily appropriate during this stage.
Patients in stage 1 are often able to make simple decisions. Continuing to make
decisions gives the patient a sense of control. Although a patient in stage 1 does
not appear markedly deteriorated, some diminution of function may be present
The home care nurse is visiting a patient who was discharged to home after a
procedure at an ambulatory surgical center. The patient lives alone in a senior
retirement community. The nurse's assessment documents mild dysphasia. The
patient repeatedly asks, "Why is there a bandage on my arm?" and is not able to
, state the appropriate day and year. Appropriate planning for the patient should
include:
a. Assessing diet and meal preparation, assessing environment for safety
problems, referral to a dementia program
b. Attending English class to improve speech, transferring finances to a
conservator, employing an aide to help with medications
c. Arranging Meals on Wheels, attending speech therapy, relocation to a skilled
nursing facility if no improvement in 1 month
d. Arranging an appointment at a geriatric assessment program, OT referral for
swallowing therapy, teaching to manage public transportation - ANSWER ANS:
A
Further assessment is appropriate before making changes in the living
environment. Enrolling in a dementia program will provide stimulation and help
the patient maintain intellectual skills. English classes will not improve speech.
The other plans might have relevance, however. The remaining sets of options
are either irrelevant or beyond the patient's abilities.
A patient diagnosed with Alzheimer's disease has a catastrophic reaction during
an activity involving simultaneous playing of music and working on a craft
project. The patient starts shouting "no, no, no" and rushes out of the room. The
nurse should:
a. Discontinue the activity program since it upsets the patients.
b. Follow the patient, reassure her, and redirect her to a quieter activity.
c. Isolate the patient until she is calm, and then direct her back to the activity.
d. Give the patient prn antianxiety medication and restrict her activity
participation. - ANSWER ANS: B
These actions will restore safety and self-esteem. Isolation will decrease self-
esteem and may increase confusion. It is only one patient that is distressed, not
the entire group. Behavioral interventions should be attempted prior to
administering medication.
Which behaviors would indicate that a therapeutic activity program for a patient
with Alzheimer's disease had been successful?
a. Accurate recent memory, positive emotional response, and increased verbal
expression
b. Increased attention span, verbal expression of remote memory, and positive
emotional response
c. Positive use of perseveration, reduction in use of habitual skills, and improved
abstract reasoning
d. Positive emotional response, ability to remember multiple steps, and accurate
recent memory - ANSWER ANS: B
These are all observations that would indicate that a therapeutic activity
program has kept the patient functioning at the highest level of which he is
