Delirium and Dementia

The symptoms most characteristic of delirium are:

• Acute onset of confusion, fluctuating consciousness, and disorganized thinking

• Gradual memory loss and steady cognitive decline

• Persistent low mood and loss of interest

• Hallucinations without changes in consciousness

Answer explanation

The correct choice describes the hallmark features of delirium: an acute onset of confusion, fluctuating levels of consciousness, and disorganized thinking, distinguishing it from other cognitive disorders.

A priority nursing intervention for a patient with acute delirium is:

• Maintain a safe environment to prevent injury.

• Encourage independent decision-making.

• Limit fluid intake to prevent overload.

• Increase sensory stimulation in the room.

Answer explanation

Maintaining a safe environment is crucial for patients with acute delirium, as they are at high risk for injury due to confusion and altered mental status. This intervention prioritizes their safety above all.

A distinguishing feature of Alzheimer's disease compared to other types of dementia is:

• Progressive memory loss

• Sudden onset of symptoms

• Primarily affects motor skills first

• Caused by vitamin deficiency

Answer explanation

A distinguishing feature of Alzheimer's disease is progressive memory loss, which occurs gradually over time, unlike other types of dementia that may present with sudden symptoms or affect motor skills first.

The assessment finding that most supports a diagnosis of dementia is:

• Progressive memory loss and confusion

• Sudden onset of paralysis

• Intermittent chest pain

• Acute shortness of breath

Answer explanation

The correct choice, progressive memory loss and confusion, is a hallmark of dementia, indicating cognitive decline. In contrast, sudden paralysis, chest pain, and shortness of breath are not typical signs of dementia.

The nurse notes sudden confusion in an older adult. What should be assessed first?

• Oxygen saturation

• Blood pressure

• Temperature

• Blood glucose level

Answer explanation

Sudden confusion in older adults can indicate hypoglycemia. Assessing blood glucose level first helps identify if low sugar is the cause, allowing for prompt treatment. Other assessments can follow based on findings.

Nursing interventions to support orientation in a patient with moderate Alzheimer’s include:

• Providing clocks and calendars in the room

• Encouraging complete independence in all activities

• Frequently changing the patient’s environment

• Limiting social interactions to reduce confusion

Answer explanation

Providing clocks and calendars helps orient patients with moderate Alzheimer’s by giving them visual cues about time and date, which can reduce confusion and enhance their sense of stability.

The medication used to slow cognitive decline in early Alzheimer’s disease is:

• Donepezil

• Ibuprofen

• Metformin

• Atorvastatin

Answer explanation

Donepezil is a cholinesterase inhibitor that helps improve cognitive function in patients with early Alzheimer's disease, making it the correct choice. The other options do not have this effect.

Factors that increase the risk for delirium include:

• Advanced age, infection, polypharmacy, and sensory impairment

• Regular exercise and healthy diet

• Low stress levels and good sleep hygiene

• Young age and absence of chronic illness

Answer explanation

The correct choice lists factors that are known to increase the risk of delirium, including advanced age, infection, polypharmacy, and sensory impairment, all of which can contribute to cognitive disturbances.

Place these interventions in order to manage sundowning in Alzheimer's disease:

• Maintain routine, Limit naps, Reduce evening stimulation, Ensure lighting

• Limit naps, Reduce evening stimulation, Ensure lighting, Maintain routine

• Reduce evening stimulation, Ensure lighting, Maintain routine, Limit naps

• Ensure lighting, Maintain routine, Limit naps, Reduce evening stimulation

Answer explanation

The correct order to manage sundowning in Alzheimer's is to maintain a routine, limit naps to ensure better nighttime sleep, reduce evening stimulation to create a calm environment, and ensure proper lighting to prevent confusion.

What is the best response to a patient with Alzheimer’s who is experiencing a false belief?

• Respond calmly and redirect the conversation; do not argue.

• Firmly correct the patient and insist on the truth.

• Ignore the patient until they stop talking about the belief.

• Encourage the patient to explain their belief in detail.

Answer explanation

Responding calmly and redirecting the conversation is essential when dealing with a patient with Alzheimer’s. Arguing can increase confusion and distress, while a calm approach helps maintain a supportive environment.