Chapter 59: Dementia and Delirium Harding: Lewis's Medical-Surgical Nursing, 11th Edition Exam Questions and Answers

Chapter 59: Dementia and Delirium Harding: Lewis's Medical-Surgical Nursing, 11th Edition Exam Questions and Answers A patient hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the patient is experiencing delirium rather than dementia? - Ans:-The patient was oriented and alert when admitted. Rational: The onset of delirium is acute. The degree of disorientation does not differentiate between delirium and dementia. Increasing confusion for several years is consistent with dementia. Fragmented and incoherent speech may occur with either delirium or dementia. Which intervention will the nurse include in the plan of care for a patient with moderate dementia who is admitted for other health problems? - Ans:-Remind the patient frequently about being in the hospital. Rational: ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/10 The patient with moderate dementia will have problems with short- and long-term memory and will need reminding about the hospitalization. The other interventions would be used for a patient with severe dementia, who would have difficulty with swallowing, self-care, and immobility. What action should the nurse incorporate when administering a mental status examination to a patient with delirium? - Ans:-Choose a place without distracting stimuli. Rational: Because overstimulation by environmental factors can distract the patient from the task of answering the nurse's questions, these stimuli should be avoided. The nurse will not wait to give the examination because action to correct the delirium should occur as soon as possible. Reorienting the patient is not appropriate during the examination. Antianxiety medications may increase the patient's delirium. The nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. What is the nurse's most appropriate action? - Ans:-Assign unlicensed assistive personnel (UAP) to stay with and reorient the patient. Rational: The priority goal is to protect the patient from harm. Having a UAP stay with the patient will ensure the patient's safety. Visits by family members are helpful in reorienting the patient, but families should not be responsible for protecting patients from injury. Antipsychotic medications may be ordered, but only if other measures are not effective because these medications have many side effects. Restraints should be avoided, when possible, because they can increase the patient's agitation and disorientation. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/10 A patient seen in the outpatient clinic is newly diagnosed with mild cognitive impairment (MCI). Which action will the nurse include in the plan of care? - Ans:-Schedule the patient for more frequent appointments. Rational: Ongoing monitoring is recommended for patients with MCI. MCI does not usually interfere with activities of daily living, acetylcholinesterase drugs are not used for MCI, and an assisted living facility is not indicated for a patient with MCI. The nurse is administering a mental status examination to a patient who has hypertension. The nurse suspects depression when the patient responds to the nurse's questions with - Ans:-"I don't know." Rational: Answers such as "I don't know" are more typical of depression than dementia. The response "Who are those people over there?" is more typical of the distraction seen in a patient with delirium. The remaining two answers are more typical of a patient with mild to moderate dementia. A patient is diagnosed with moderate dementia after multiple strokes. What would the nurse expect to find during assessment of the patient? - Ans:-Loss of recent and long-term memory. Rational: Loss of both recent and long-term memory is characteristic of moderate dementia. Patients ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/10 with dementia have frequent nighttime awakening. Dementia is progressive, and the patient's ability to perform tasks would not have periods of improvement. Difficulty eating and swallowing is characteristic of severe dementia. Which action will help the nurse determine whether a new patient's confusion is caused by dementia or delirium? - Ans:-Use the Confusion Assessment Method tool. Rational: The Confusion Assessment Method tool has been extensively tested in assessing delirium. The other actions will be helpful in determining cognitive function or risk factors for dementia or delirium, but they will not be useful in differentiating between dementia and delirium. A 72-yr-old patient is brought to the clinic by the patient's spouse, who reports