Primary Care A Collaborative Practice 5th Edition Buttaro Test Bank.

Primary Care A Collaborative Practice 5th Edition Buttaro Test Bank. Chapter 192: DeliriumTest Bank Multiple Choice 1. What are initial approaches when managing delirium in a hospitalized patient who is agitated and confused? Select all that apply. a. Administer medications for sleep b. Apply physical restraints c. Attend to hydration and toileting needs d. Decrease stimulation e. Discontinue any non-essential medications ANS: C, D, E Patients with delirium should be assisted with hydration and toileting needs. Stimulation should be decreased. Any non-essential medications should be discontinued. Giving medications for sleep may exacerbate the delirium. Physical restraints should be avoided unless necessary for safety.REF: Management 2. A previously lucid patient with early-stage Alzheimer’s disease is hospitalized after a surgical procedure and exhibits distractibility and perceptual disturbances that occur only in the late afternoon. The patient has difficulty sleeping at night and instead sleeps much of the morning. What is the likely cause of these symptoms? a. Hyperactive delirium b. Hypoactive delirium c. Sundowner syndrome Test Bank 2 d. Worsening dementia ANS: C Patients with dementia are at increased risk of sundowner syndrome, characterized by the symptoms above and which typically appear in late afternoon and early evening. Hyperactive delirium is manifested by agitation and restlessness. Hypoactive delirium includes patients with decreased alertness, lethargy, and slowed speech. Delirium and worsening of dementia would cause symptoms around the clock, not just in the late afternoon or evening.REF: Clinical Presentation Buttaro: Primary Care, A Collaborative Practice, 5 th Ed. 3. An 80-year-old patient becomes apathetic, with decreased alertness and a slowing of speech several days after hip replacement surgery alternating with long periods of lucidity. What is the most likely cause of these symptoms? a. Anesthesia effects b. Delirium c. Pain medications d. Stroke ANS: B An acute presentation of these symptoms is most likely delirium since they alternate with lucid periods. The other causes may contribute to delirium by intensifying it.REF: Clinical Presentation Test Bank 2 Chapter 193: DementiaTest Bank Multiple Choice 1. A patient with dementia experiences agitation and visual hallucinations and is given haloperidol with a subsequent worsening of symptoms. Based on this response, what is the likely cause of this patient’s symptoms? a. Alzheimer’s disease b. Lewy body dementia c. Pseudodementia d. Vascular neurocognitive disorder ANS: B Patients with Lewy body dementia may present with these symptoms and will have an increased sensitivity to neuroleptics; when given haloperidol for agitation, will actually get worse. The other causes do not have these characteristic symptoms and are not sensitive to neuroleptics in this manner.REF: Clinical Presentation 2. A patient with Alzheimer’s disease (AD) is taking donepezil to treat cognitive symptoms. The patient’s son reports noting increased social withdrawal and sleep impairment. What is the initial step to manage these symptoms? a. Encourage activity and exercise b. Prescribe a selective serotonin reuptake inhibitor c. Recommend risperidone d. Referral to a neurologist for evaluation Buttaro: Primary Care, A Collaborative Practice, 5 th Ed. ANS: A Patients with AD may have improvement in depression with nonpharmacologic management, including exercise and increased activity. If this is not effective, an SSRI may be prescribed. Risperidone, and other antipsychotics should not be prescribed.REF: Management 3. An elderly patient has symptoms of depression and the patient’s daughter asks about possible Alzheimer’s disease since there is a family history of this disease. A screening evaluation shows no memory loss. What is the initial step in managing this patient? a. Order brain imaging studies such as CT or MRI b. Perform genetic testing to identify true risk Test Bank 2 c. Prescribe a trial of an antidepressant medication d. Recommend a trial of a cholinesterase inhibitor drug ANS: C Elderly patients with depression who do not have other signs of AD may be given a trial of antidepressant medications initially in order to evaluate these symptoms. Brain imaging studies are not indicated initially. Genetic testing is not indicated. Once the degree of depression is determined and if other symptoms appear, an anticholinesterase inhibitor may be ordered.REF: Clinical Presentation/Diagnostics