Neurocognitive Disorders DocTrey Part II

A client diagnosed with NCD has progressive memory loss, diminished cognitive

functioning, verbal aggression, and is experiencing frustration. Which nursing

intervention is most appropriate?

• Schedule structured daily routines.

• Minimize environmental lighting.

• Organize a group activity to present reality.

• Explain the consequences for aggressive behaviors.

Answer explanation

1. This is correct. The most appropriate nursing intervention for this client is to

schedule structured daily routines. A structured routine will reduce frustration and

verbal aggression.

2. This is incorrect. Minimizing lighting will help the client relax but will not reduce

frustration or aggression.

3. This is incorrect. Organizing a group activity may not be appropriate for the client

who is frustrated and exhibiting verbal aggression.

4. This is incorrect. Explaining the consequences will not have an impact if the client

has memory loss and is frustrated.

A client diagnosed with an NCD due to late-stage Alzheimer’s disease is incapable

of performing ADLs. Which intervention is the nurse’s priority?

• Present evidence of objective reality to improve cognition.

• Design a bulletin board to represent the current season.

• Label the client’s room with name and number.

• Assist the client with bathing and toileting.

Answer explanation

1. This is incorrect. If the client is in the stage where they are unable to perform ADLs,

the client is past the stage where cognition will improve.

2. This is incorrect. If the client is in the stage where they are unable to perform ADLs,

then the client is past the stage where cognition will improve, so designing a bulletin

board with the current season will not be beneficial for them.

3. This is incorrect. If the client is in the stage where they are unable to perform ADLs,

then the client is past the stage where cognition will improve, so labeling the client’s

room with their name and number will not be beneficial for them.

4. This is correct. The nurse’s priority is to assist with bathing and toileting. A client

who is incapable of performing ADLs requires assistance in these areas to ensure

health and safety.

A client diagnosed with an NCD is exhibiting behavioral problems every day. At

change of shift, the client’s behavior escalates from pacing to screaming and flailing.

Which action would the nurse implement first?

• Consult the psychologist regarding behavior-modification techniques.

• Medicate the client with prn antianxiety medications.

• Assess environmental triggers and potential unmet needs.

• Anticipate the behavior, and restrain when pacing begins.

Answer explanation

This is incorrect. Although the nurse will consult with the psychologist, first the

nurse will assess the client to determine triggers and unmet needs.

2. This is incorrect. The nurse will first assess the client prior to medicating them with

antianxiety medication.

3. This is correct. Assessment is the first step of the nursing process. Due to the

cognitive decline experienced by a client diagnosed with an NCD, the nurse should

first assess environmental triggers and potential unmet needs. The client’s

communication skills may be limited, and the client may become disoriented and

frustrated.

4. This is incorrect. The nurse would not restrain the client without attempting other

interventions first. Restraints are a last resort.

A client diagnosed with an NCD due to Alzheimer’s disease is disoriented, ataxic,

and wanders. Which nursing diagnosis is the priority?

• Disturbed thought processes

• Self-care deficit

• Risk for injury

• Altered health-care maintenance

Answer explanation

1.This is incorrect. Disturbed thought process is not a priority for client care.

2. This is incorrect. Although self-care is important, it is not as important as safety.

3. This is correct. The priority nursing diagnosis is “risk for injury” related to the

client’s ataxia (muscular incoordination) and purposeless wandering. Safety is

always a priority.

4. This is incorrect. Health-care maintenance is not as high of a priority as client safety.

Which nursing intervention would take priority for a client in the late stage of

Alzheimer’s disease?

• Improve cognitive status by encouraging involvement in social activities.

• Decrease social isolation by providing group therapies.

• Promote dignity by providing comfort, safety, and self-care measures.

• Facilitate communication by providing assistive devices

Answer explanation

1. This is incorrect. Encouraging social activities is appropriate during the early stage.

The nursing priority is to promote dignity.

2. This is incorrect. Decreasing isolation is appropriate during the early stage.

3. This is correct. The nursing priority is to promote dignity. During the late stage, the

person becomes bedbound and may have very active hands and repetitive

movements, grunting, or other vocalizations. Speech and language are severely

impaired, and the person may no longer recognize any family members. Caregivers

need to complete most ADLs.

4. This is incorrect. Using assistive communication devices is appropriate during the

middle stage, when communication becomes more difficult due to increasing loss of

language skills.