NCLEX test question: Alzheimer's Disease, Dementia, and Delirium Questions and Answers
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Course
NCLEX
Institution
NCLEX
A 68-year-old patient who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the patient is experiencing delirium rather than dementia?
a. The patient was oriented and alert when admitted.
b. The patient's speech is fragmented and i...
a 68 year old patient who is hospitalized with pneumonia is disoriented and confused 3 days after admission w
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NCLEX test question: Alzheimer's
Disease, Dementia, and Delirium
A 68-year-old patient who is hospitalized with pneumonia is disoriented and confused 3
days after admission. Which information indicates that the patient is experiencing
delirium rather than dementia?
a. The patient was oriented and alert when admitted.
b. The patient's speech is fragmented and incoherent.
c. The patient is oriented to person but disoriented to place and time.
d. The patient has a history of increasing confusion over several years. Correct ANS: A-
The patient was oriented and alert when admitted
The onset of delirium occurs acutely. 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 had an appendectomy 2 days ago?
a. Provide complete personal hygiene care for the patient.
b. Remind the patient frequently about being in the hospital.
c. Reposition the patient frequently to avoid skin breakdown.
d. Place suction at the bedside to decrease the risk for aspiration. Correct ANS: B-
Remind the patient frequently about being in the hospital.
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.
When administering a mental status examination to a patient with delirium, the nurse
should
a. wait until the patient is well-rested.
b. administer an anxiolytic medication.
c. choose a place without distracting stimuli.
d. reorient the patient during the examination. Correct ANS: C-choose a place without
distracting stimuli.
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. The most appropriate action by the nurse is to
a. secure the patient in bed using a soft chest restraint.
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