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1. During the change of shift report in the intensive care unit, the nurse learns that a client has
developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes
would be consistent with delirium?
A) Unable to identify a water pitcher
B) Unable to transfer to sitting position
C) Difficultywithverbal expression D) Disoriented to person Ans: D Feedback:
Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes,
throughout the course of the day. Clients with delirium have difficulty paying attention, are easily
distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or
hallucinations. Dementia symptoms include aphasia(deterioration of language function), apraxia
(impaired ability to execute motor functions despite intact motor abilities), and agnosia (inability to
recognize or name objects despite intact sensory abilities).
2. A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The
nurse reviews common behaviorsassociated with cognitive deterioration associated with dementia.
Which would cause the nurse to know that the assistants correctly understood if it were expressed
during a posttest?
A) The clients should be able to ask us for items they need.
B) The clients may not recognize their family when they come to visit. C) The clients who are
ambulatory can still carry out activities of daily living independently.
D) The clientsshouldknow when to come to the dining room for meals. Ans: B Feedback:
Dementia is a mental disorder that involves multiple cognitive deficits, primarily memory impairment,
and at least one of the following cognitive disturbances: (1) aphasia, which is deterioration of language
function; (2) apraxia, which is impaired ability to execute motorfunctions despite intact motor abilities;
(3) agnosia, which is inability to recognize or name objects despite intact sensory abilities; and (4)
disturbance in executive functioning, which is the ability to think abstractly and to plan, initiate,
sequence, monitor, and stop complex behavior.
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3. Whichis believed to be a risk factor specific to the development of delirium?
A) Increased severity of physical illness
B) Older age
C) Baselinecognitive impairment D) Gradual decline in functioning Ans: A Feedback:
An estimated 10% to 15% of people in the hospital for general medical conditions are delirious at any
given time. Onset is sudden. Delirium is common in older, acutely ill clients. Risk factors for delirium
include increased severity of physical illness, older age, and baseline cognitive impairment suchas that
seen in dementia. Children may be more susceptible to delirium, especially that related to a febrile
illness or certain medications such as anticholinergics. Delirium usually develops over a short period,
sometimes a matter of hours,and fluctuates, or changes, throughoutthe courseof a day. Prevalence of
dementia also rises with age, and progression is gradual.
4. Whichpatient is most likely suffering from dementia?
A) A 90-year-old male who has experienced progressive mental decline that started with
forgetfulness
B) An80-year-old femalewho has been in excellent health until she was admitted throughthe
emergency department witha severe urinary tract infection and is now very anxious and is threatening
staff
C) A 6-year-old child who has just been administered conscious sedation for a closed reduction of a
fracturedwrist and says that her parents have three sets of eyes
D) A 22-year-old male whowas involved in a motorcycle crashwithout wearinga helmet now unable
to remember where he is Ans: A Feedback:
Memory impairment is the prominent earlysignof dementia. The courseof dementia is usually
progressive. A 90-year-old gentleman who has experienced progressive mental decline that started with
forgetfulness is most likely suffering from dementia. An 80year-old lady who has been in excellent
health until she was admitted through the emergency department with a severe urinary tract infection
is likely experiencing delirium.Deliriumalmost always results froman identifiable physiologic, metabolic,
or cerebral disturbance or from drug intoxication or withdrawal. The 6-year-old who has just been
administered conscious sedation is likely delirious. A 22-year-old male who was involved in a motorcycle
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crash without wearing a helmet and now cannot remember where he is likely experiencing an amnestic
disorder.
5. A client with dementia is unable to recognize ordinary objects, such as a penor notebook. Which
would this be a symptom of?
A) Agnosia
B) Amnesia
C) Apraxia D) Aphasia Ans: A
Feedback:
Agnosia is the inability to recognizefamiliar objects. Amnesia is failure to remember past events. Apraxia
is impairment in the ability to execute motor functions despite intact motor abilities.Aphasia is a
deterioration of language function.
6. Whichclient would have an increased riskfor delirium?
A) An elderly womanwith abdominal pain
B) A3-year-old child with a temperature of 103.2∞F
C) Amiddle-aged woman newly diagnosed with multiple sclerosis
D) A young adult male with gastroenteritis and dehydration
Ans: B
Feedback:
Young children with high fever are at risk for delirium. The other choices would not beIt he most likely
candidates for increased risk for delirium.
7. The nurse is caring for a client with cognitive impairment. To determine whether the client is
suffering from delirium or dementia, the nurse reviews the symptoms and course of each disorder. Place
the letter ìAî beside terms describing delirium and the letter ìBî beside terms describing dementia.
Rapid onset
Progressive decline
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Long-term memory impairment
Slurred speech
Hallucinations
Ans: A, B, B,A, A Feedback:
Onsetof delirium is rapid, but of dementia is gradual. Duration of delirium is brief, butof dementia is
progressing. Delirium affects only short-term memory. Dementia begins with short-term memory loss
and progresses to long-term memoryloss. Slurred speech is characteristic of delirium. Speechwith
dementia is unchanged until the client begins to develop aphasia. Visual and tactile hallucinations are
common with delirium, but rarely experienced with dementia.
8. The daughter of a woman with dementia asks the nurse if her mother will ever be ableto live
independently again. Which would be the most appropriate response by the nurse?
A) ìYousound like you aren't ready for her to be dependent on caregivers.î
B) ìHer confusion is a temporary complication of her physical illness and should subside when the
illness gets better.î
C) ìSymptoms of dementiagraduallygetworse. Unfortunately she will not be independent again.î
D) ìWithearly treatment, mild dementia can be reversed. It may be possible.î
Ans: C
Feedback:
The prognosis for dementiainvolves progressive deterioration of physical andmental abilities until death.
Typically, in the later stages, clients have minimal cognitive and motor function, are totally dependent
on caregivers, and are unaware of their surroundings or people in the environment. They may be totally
uncommunicative or make unintelligible sounds or attempts to verbalize. Delirium secondary to physical
illness will subside with physical recovery.
9. Which statement made by the nurse would be most appropriate to an 89-year-old patient who
is confused buthas no history of dementiaand is hospitalized for an acute urinary tract infection?
A) ìYouare likely to become progressively more confused now.î
B) ìThis should be just a temporary situation.î
