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
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.
Option B: Delirium is a type of cognitive impairment; however,
other symptoms are necessary to establish this diagnosis.
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. The clinical presentation
can vary, but usually, it flourishes with psychomotor behavioral
disturbances such as hyperactivity or hypoactivity with increased
sympathetic activity and impairment in sleep duration and
architecture.
Option D: The nurse may also assess for perseveration in a
client with cognitive impairment but the questions in this
situation would not elicit the symptom response. Perseveration
according to psychology, psychiatry, and speech-language
pathology, is the repetition of a particular response (such as a
word, phrase, or gesture) regardless of the absence or cessation
of a stimulus. It is usually caused by a brain injury or other
organic disorder.
2. 2. Question
A student nurse was asked which of the following best describes
dementia. Which of the following best describes the condition?
A. Memory loss occurring as part of the natural consequence of
aging.
B. Difficulty coping with physical and psychological change.
C. Severe cognitive impairment that occurs rapidly.
D. Loss of cognitive abilities, impairing ability to perform
activities of daily living.
Incorrect
Correct Answer: D. Loss of cognitive abilities, impairing ability
to perform activities of daily living.
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.
D. Fills in memory gaps with fantasy.
Incorrect
Correct Answer: D. Fills in memory gaps with fantasy.
