NCLEX-Style Questions - Delirium & Dementia (Chapter 9)

NCLEX-Style Questions - Delirium & Dementia (Chapter 9) 1. A nurse is caring for a client who has Alzheimer's disease. Which of the following interventions should the nurse include to promote a safe environment? (Select all that apply) a. Remove scatter rugs b. Lock up cleaning supplies c. Keep a nightlight on in the room d. Keep doorways unlocked e. Move client near the nursing station 2. A nurse is providing teaching to the family of a client newly diagnosed with Alzheimer's disease. Which of the following risk factors should the nurse include in the teaching? (Select all that apply) a. Advanced age b. Female gender c. Prior head trauma d. High vitamin D intake e. Genetic predisposition 3. A nurse is caring for a client who has moderate Alzheimer’s disease. Which of the following findings should the nurse expect? a. Memory lapses and forgetting names b. Inability to recall address or phone number c. No memory problems d. Ability to perform complex math problems 4. A nurse is caring for a client with Alzheimer’s disease who is experiencing wandering behavior. Which of the following interventions should the nurse include in the plan of care? a. Use reality orientation b. Apply physical restraints c. Provide frequent walks d. Lock all doors 5. Which of the following tests are used to assess cognitive function in clients with suspected dementia or delirium? (Select all that apply) a. Mini-Mental State Examination (MMSE) b. Glucose tolerance test c. Clock Drawing Test d. FACT test e. Electrocardiogram (ECG) 6. A nurse is assessing a client who has delirium. Which of the following findings should the nurse expect? (Select all that apply) a. Restlessness b. Rapid onset c. Chronic progressive decline d. Fluctuating levels of consciousness e. Clear speech patterns 7. Which of the following medications is approved to slow the progression of Alzheimer's disease? a. Donepezil b. Acetaminophen c. Fluoxetine d. Lorazepam 8. Which of the following statements by a caregiver indicates a need for further teaching about Alzheimer's care? a. "I will remove scatter rugs at home." b. "I’ll keep cleaning products locked away." c. "I’ll ask the client to perform complex math to improve memory." d. "I will keep photos of family around to help with orientation." 9. A nurse is providing teaching to the family of a client taking donepezil. Which of the following is an expected therapeutic outcome? a. Improved appetite b. Enhanced daily functioning c. Increased sedation d. Weight gain 10. Which of the following is a potential adverse effect of cholinesterase inhibitors? a. Hypertension b. Constipation c. Dizziness d. Weight gain 11. A nurse is discussing home safety with the family of a client with Alzheimer’s disease. Which of the following should the nurse include? (Select all that apply) a. Secure electrical cords b. Keep bed elevated c. Remove clutter d. Install locks on water heater e. Use throw rugs for comfort 12. Which of the following interventions is most appropriate for a client with late-stage Alzheimer’s disease? a. Reality orientation b. Validation therapy c. Challenging memory tasks d. Daily medication reminders 13. A nurse is assessing a client with Alzheimer’s disease. Which of the following findings require immediate intervention? a. Memory loss b. Wandering c. Difficulty swallowing d. Repetitive speech 14. Which of the following risk factors for Alzheimer’s disease are modifiable? a. Age b. Gender c. Hypertension d. Genetic predisposition 15. A nurse is caring for a client with Alzheimer’s disease. Which of the following are effective communication strategies? (Select all that apply) a. Speak in short, clear sentences b. Use therapeutic touch c. Allow time for responses d. Speak loudly and quickly e. Offer multiple choices at once 16. A nurse is developing a plan of care for a client with moderate Alzheimer’s disease. Which of the following interventions should be included? a. Encourage participation in complex games b. Schedule rest periods during the day c. Teach new tasks daily d. Isolate the client to prevent stimulation 17. Which of the following are signs of hypoactive delirium? (Select all that apply) a. Lethargy b. Agitation c. Withdrawal d. Restlessness e. Subdued behavior 18. A nurse is caring for a client with delirium related to an infection. Which of the following is the priority action? a. Administer sedatives b. Reduce environmental stimuli c. Treat the underlying infection d. Restrain the client to prevent injury 19. Which of the following is a manifestation of moderate Alzheimer’s disease? a. No memory problems b. Wandering behavior c. Complete dependency for care d. Loss of awareness of surroundings 20. Which diagnostic test is most definitive in confirming Alzheimer’s disease? a. MRI scan b. PET scan c. Brain tissue examination after death d. Lumbar puncture