Basic Concepts of Psychiatric-Mental Health Nursing 8th Edition Shives Test Bank

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Basic Concepts of Psychiatric-Mental Health Nursing 8th Edition Shives Test Bank

ISBN-13: 978-1605478876

ISBN-10: 1605478873




Basic Concepts of Psychiatric-Mental Health Nursing 8th Edition Shives Test Bank

ISBN-13: 978-1605478876

ISBN-10: 1605478873





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Chapter 27- Cognitive Disorders

1. A client with Alzheimer’s disease in the intensive treatment unit repeatedly tries to go into other patients’ rooms to nap during the day. The most appropriate nursing intervention for this patient is what?
  A) Allowing her to nap in an empty room
  B) Explaining to her why this cannot be tolerated
  C) Escorting the patient to her room for napping
  D) Suggesting that daytime napping be decreased
  Ans: C
  Allowing the client to nap in an empty room would disrupt unit activity because of frequent bed changes and does not serve any therapeutic purpose. Explaining to the client why this behavior cannot be tolerated would be ineffective, because the client has memory impairment and would not remember not to go into the rooms of others. Escorting the client to her room for napping allows the client her own space and reinforces the reality of her personal room. Unless daytime napping interferes with nighttime sleep, there is no reason to eliminate short napping periods.



2. A client has experienced a gradual flattening of affect, confusion, and withdrawal and has been diagnosed with Alzheimer’s disease. The nurse assesses which of the following additional characteristics of this disorder?
  A) Personality change, wandering, and inability to perform purposeful movements
  B) Delusions, hallucinations, and confusion about date and time
  C) Tremors, unsteady gait, and transient paresthesias
  D) Transient blindness, slurred speech, and weakness
  Ans: A
  Alzheimer’s disease is not typically characterized by delusions, transient paresthesias, blindness, or slurred speech. Instead, general changes in personality, wandering, and the inability to perform purposeful, goal-directed movements are impaired.



3. Heindel and Salloway (1999) identified four distinct, yet mutually interacting, memory systems as being affected in dementia. Which of the following is not one of them?
  A) Working memory
  B) Episodic memory
  C) Semantic memory
  D) Short-term memory
  Ans: D
  Heindel and Salloway (1999) have found that memory is not a single homogenous entity. Rather, it is composed of four distinct, yet mutually interacting, memory systems: working memory, episodic memory, semantic memory, and procedural memory. Short-term memory refers to the length of time during which material is remembered, not to a distinct type of memory system.



4. A client was admitted to the ICU after a motor vehicle accident. She sustained a right parietal injury, resulting in an acute confusional state or delirium. She complains that there are “bugs crawling around” on her arms. The nurse understands what?
  A) Such hallucinations suggest preexisting schizophrenia.
  B) Transient tactile hallucinations are sometimes seen in delirium.
  C) Such symptoms indicate increasing brain damage and poor prognosis.
  D) The client is more prone to such episodes early in the morning.
  Ans: B
  With delirium, as is the case with the client, transient tactile hallucinations are seen in many cases. This type of tactile hallucination would not indicate schizophrenia or brain damage, nor would the client be any more prone to them at any time of the day.



5. The nurse is working with the family of a client who is newly diagnosed with Alzheimer’s type dementia. Which of the following suggestions would be effective for assisting the family in daily orienting of their family member when the client returns home?
  A) Provide a flexible schedule and change the activities each day.
  B) Use daily newspapers, calendars, and a set routine.
  C) Read to the client for long periods at a time.
  D) Use a daily current events quiz, making sure that the client participates.
  Ans: B
  Using daily newspapers, calendars, and a set, unchanging routine would be a more effective way to provide daily orientation for the family member. Changing daily activities would make it more difficult to maintain orientation. Reading to the client for long periods of time would not maintain client involvement and appropriate stimulation. Using daily quizzes would place stressful demands on the client and not provide functionally appropriate tasks.



6. A client was admitted with multi-infarct dementia. Nursing assessment and interview of the client would include what?
  A) Electroencephalogram, X-rays, blood chemistries, and skull series
  B) Intellectual ability, health history, and self-care ability
  C) Early parent–child conflict and relational patterns
  D) Assessment of deep tendon reflexes and muscle strength
  Ans: B
  A comprehensive nursing assessment should include obtaining the premorbid intellectual ability, health history, and self-care abilities of the client. The medical assessments, which are important, are not as critical to nursing assessment as the actions in the correct answer. Exploring early parent–child conflict and relational patterns would not be helpful with dementive process.



7. Which of the following neuroimaging diagnostic evaluations is highly predictive of dementia of Alzheimer’s type?
  A) Neurohistologic lesion in basal ganglia
  B) Small infarctions in the white matter of brain
  C) Bilateral temporal and parietal perfusion defects
  D) Infarction of small- and medium-sized cerebral vessels
  Ans: C
  The predominate finding of bilateral posterior temporal and parietal perfusion defects is thought to be highly predictive of DAT. Parkinson’s disease is due to the presence of neurohistologic lesions in the basal ganglia. Binswanger’s disease is a type of vascular dementia that is characterized by the presence of many small infarctions affecting the white matter of the brain. Vascular dementia is thought to result from infraction of small- and medium-sized vessels causing parenchymal lesions to occur over wide areas of the brain.



8. A client with dementia is sleeping throughout the day at the nursing home. The client is most likely exhibiting which of the following?
  A) Agnosia
  B) Sundown syndrome
  C) Confabulation
  D) Preservation
  Ans: B
  Sundown syndrome may be caused by a misinterpretation of the environment, lower tolerance for stress at the end of the day, or overstimulation due to increased environmental activity later in the day. Clients may exhibit altered sleep patterns, such as sleeping throughout the day. Agnosia is the failure to recognize or identify objects despite intact sensory function. Confabulation is the filling in of memory gaps with false but sometimes plausible content to conceal the memory deficit. Preservation is the inappropriate continuation or repetition of a behavior.



9. A client who has had a right-sided stroke is being very aggressive toward the caregiver. The nurse would suspect CNS pathology in which of the following lobes of the brain?
  A) Parietal
  B) Frontal
  C) Temporal
  D) Occipital
  Ans: B
  Pathology in the frontal lobe causes lack of attention, loss of emotional control, rage, or violent behavior. Damage to the parietal lobe causes neglect or inattention to left half of space. Temporal lobe pathology causes inability to store or retrieve information. Occipital lobe damage causes visual disturbances such as agnosia.



10. A client with amnestic disorder is being evaluated for dementia. Which of the following is a diagnostic characteristic of amnestic disorder?
  A) History and physical examination indicative of memory impairment
  B) Memory minimally decreased from usual
  C) Memory impairment limited to periods of delirium
  D) No significant problems with occupational or social functioning
  Ans: A
  Diagnostic characteristics of amnestic disorder include memory impairment not solely limited to periods of delirium, history and physical examination indicative of medical condition underlying the memory impairment, demonstration of significant problems with social or occupational functioning, and memory significantly decreased from usual level.



11. A 73-year-old man has been brought to the emergency department by his daughter and son-in-law due to abrupt and uncharacteristic changes in behavior, including impairments of memory and judgment. The subsequent history and diagnostic testing have resulted in a diagnosis of delirium. Which of the following teaching points about the client’s diagnosis should the nurse provide to his family?
  A) “Delirium can be caused by a wide variety of factors but most of the changes in behavior and personality are permanent.”
  B) “If the underlying cause of delirium is identified and treated, most people return to their previous level of functioning.”
  C) “The treatment that the care team will likely provide is simple rest, which will probably bring about a return to normal.”
  D) “For many older adults, this is considered to be just a normal part of the aging process.”
  Ans: B
  Delirium is characterized by reversibility, but this does not mean that treatment is not required or that spontaneous resolution occurs. Delirium is never considered a normal, age-related change.



12. A nurse is providing care for a client whose recent cognitive and behavioral changes have been attributed to dementia with Lewy bodies (DLB). The nurse understands that the organic brain changes accompanying this disease result in alterations in the normal action of which neurotransmitters?
  A) Acetylcholine and dopamine
  B) Serotonin and GABA
  C) Histamine and norepinephrine
  D) Glutamate and cholecystokinin
  Ans: A
  DLB is caused by neurohistologic changes in the cerebral cortex and other areas of the brain. Their presence in the brain disrupts the brain’s normal functioning, interrupting the action of important chemical messengers, including acetylcholine and dopamine.



13. A woman in her fifties has contacted her care provider because of concerns for her husband, who has suddenly begun behaving uncharacteristically in recent days. Most recently, he became lost while driving to his home of 30 years and temporarily forgot his son’s name. Diagnostic testing has ruled out delirium and he had been previously healthy. What is the most likely cause of the husband’s cognitive changes?
  A) Dementia of Alzheimer’s type (DAT)
  B) Dementia with Lewy bodies (DLB)
  C) Vascular dementia
  D) Wernicke’s encephalopathy
  Ans: C
  The onset of vascular dementia is usually earlier than that of DAT and DLB. Onset is generally abrupt, with fluctuating, rapid changes in memory and other cognitive impairment.



14. Mr. Parkinson, aged 79, has moderately severe dementia of Alzheimer’s type (DAT), a diagnosis that necessitated his move to a long-term care facility several months ago. Today, the nurse has entered Mr. Parkinson’s room to find him lying in bed and grimacing, moaning, and rubbing his left flank. Which of the following tools may assist the nurse in assessing Mr. Parkinson?
  A) The Agitated Behavior in Dementia Scale
  B) The Wong-Baker Faces Rating Scale
  C) The NEECHAM Confusion Scale
  D) The CAGE questionnaire
  Ans: B
  The client’s behavior is suggestive of pain, and the Wong-Baker Faces Rating Scale may be used to determine the presence or absence of pain in clients who are not able to communicate their needs. The other assessment scales do not measure pain.



15. The geriatrician has begun an 80-year-old female client on donepezil (Aricept) in order to treat her dementia of Alzheimer’s type (DAT). Which of the following teaching points should the nurse provide to the client’s husband about her new medication?
  A) “Aricept won’t cure your wife’s dementia of Alzheimer’s type, but it has the potential to slow down the progression of the disease.”
  B) “It’s important to closely follow the administration schedule for this drug if it is to make your wife recover.”
  C) “This won’t result in any improvements to her symptoms of dementia of Alzheimer’s type, but it will make her much more compliant and easier to manage.”
  D) “Aricept will help your wife sleep much better at night and stay awake during the day.”
  Ans: A
  Cholinesterase inhibitors such as donepezil (Aricept) cannot cure DAT, but they can slow the progression of the disease and can stabilize symptoms. The drug does not directly affect sleep patterns.



16. A client with a medical diagnosis of dementia of Alzheimer’s type (DAT) has been increasingly agitated in recent days. As a result, the nurse has identified the nursing diagnosis of “risk for injury related to agitation and confusion” and an outcome of “the client will remain free from injury.” What intervention should the nurse use in order to facilitate this outcome?
  A) Apply restraints and place the client in seclusion as necessary.
  B) Use the least restrictive devices if necessary.
  C) Explain to the client the relationship between agitation and injury.
  D) Set limits with the client around behavior.
  Ans: B
  If restrictive devices are necessary, they should be used as a measure of last resort using the least restrictive device possible. Seclusion would be unsafe, and teaching and setting limits are unlikely to be effective interventions with a client who has a cognitive disorder.



17. The nurse understands that clients with cognitive disorders often experience spatial confusion as their diseases progress. Which of the following measures should be undertaken to maximize clients’ safety and independence when navigating an inpatient facility?
  A) Post large, simple maps on the walls of the facility in high-visibility locations.
  B) Provide clients with a guided tour of the entire facility during admission.
  C) Encourage clients to ask staff members for directions when they are spatially disoriented.
  D) Post arrows, signs, and paths in the facility and increase lighting.
  Ans: D
  Obvious and visible aides such as bright arrows, signs, and paths are more likely to be of use to clients than maps, which require abstract reasoning. Bright lighting is important, and clients with cognitive disorders may not necessarily benefit from tours or reminders to ask for help.



18. An 82-year-old woman with a diagnosis of vascular dementia has been admitted to the geriatric psychiatry unit of the hospital. In planning the care of this client, which of the following outcomes should the nurse prioritize?
  A) The client will demonstrate increased feelings of self-worth.
  B) The client will identify life areas that require alterations due to illness.
  C) The client will demonstrate decreased agitation.
  D) The client will be free of injury.
  Ans: D
  Control of agitation and promotion of self-worth are important outcomes, but safety is a priority concern. A client whose diagnosis necessitates hospitalization may or may not be capable of identifying or making changes in life routines.



19. A care aide has rung the call light for assistance while providing a client’s twice-weekly bath because the client became agitated and aggressive while being undressed. Knowing that the client has a diagnosis of dementia of Alzheimer’s type (DAT) and is prone to agitation, which of the following measures may help in preventing this client’s agitation?
  A) Decreasing the frequency of the client’s baths from two times to one time per week
  B) Reminding the client multiple times that he or she will be soon having a bath
  C) Reinforcing the facility’s zero-tolerance policy for aggressive behavior
  D) Providing all of the client’s daily medications early on the day of a scheduled bath
  Ans: B
  Adequately preparing a client for a task can sometimes prevent episodes of agitation or aggression. Reminding a cognitively impaired client about policies is unlikely to be effective, and decreasing the frequency of baths will not necessarily prevent agitation. It is not normally appropriate to change a client’s medication administration schedule in light of activities such as bathing.



20. The nurse understands that numerous comorbidities can contribute to the development of dementia. Which of the following clients may be at risk for dementia?
  A) An 87-year-old resident of a long-term care facility who has developed a urinary tract infection
  B) A 69-year-old man whose lung cancer has metastasized to his bones and liver
  C) A 30-year-old client with schizophrenia who has been admitted to the hospital because of psychogenic polydipsia
  D) A 49-year-old man whose human immunodeficiency virus (HIV) has progressed to acquired immunodeficiency syndrome (AIDS)
  Ans: D
  HIV/AIDS is known to cause dementia. Cancer does not normally result in dementia, and the cognitive changes that may result from a UTI or polydipsia are reversible and thus classified as delirium.





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