Physiology of cognition largely depends on...

Which of the following are components of cognition

Brains interpretation of stimuli or inputs

-depends on sensory reception of internal and external data

*includes orientation

Which type of stimuli includes the five senses?

Which type of stimuli includes proprioceptive sensations?

How do we assess orientation?

Your patient knows their name and where they are at, but they cannot tell you why they're at the hospital and keep saying it is 1995. Your patient is...

Brains ability to remain alert and aware

-selectively prioritizing concentration

*variations in this span are normal

Process by which individuals retain, store and retrieve information

-foundation for learning and adaption

Interpretation of social cues, verbal and nonverbal communication

Planning, organizing and execution of complex motor tasks

Ability to control movement in a deliberate, smooth, and coordination fashion

Mental skills involved in planning and executing complex tasks

-coordination of the attributes of normal cognition

-problem solving, organizing speech and motor activity, control of emotions

Mental capacity in relation to learning, reasoning, and problem solving

Set of practical skills people need to function in everyday lives

-conceptual skills, social skills, practical skills

Difficulty thinking clearly, making judgments, or focusing attention
• Disorientation

altered perception of reality

Rigid, false beliefs

-persecution, reference, or grandeur

Sensory experiences that do not represent reality

-auditory, visual, or tactile

All of the following describe what?

-deficits in ability to focus, shift or sustain attention

-may occur as a distinct disorder (ADD or ADHD) or secondary to other cognitive disorders

-short term attention difficulties may be caused by stress, anxiety or illness

-may cause inappropriate/unsafe responses or actions

All of the following describe what?

-initial sign of cognitive disorder

-may relate to underlying disease or trauma

-amnesia, confabulation, agnosia

All of the following describe what?

-aphasia, anomia, alogia

-frontal lobe or right brain dysfunction affect physical communication

-impaired visual processing can disrupt ability to read or respond to nonverbal cues

Loss of recent memory or remote memory

Unconscious attempts to compensate for memory gaps by filling them with fabricated events

Inability to recognize objects through use of one or more senses

Inability to use or understand language

Person cannot recall names of everyday objects

Lack of speech/impoverished speech

The following describe alterations in what?

-Dyspraxia, apraxia, ataxia, tics, tremors

Alterations in speech from impaired motor function.

-ex. your patient who just recently had a stroke is struggling with this

Unintentional rhythmic shaking

Which of the following terms refers to slow movement

The following describes what type of alterations?

-emotional dysregulation, avolition, poor judgement/decision making, reduced insight, forgetfulness, difficulty planning/organizing

Your patient is experiencing decreased motivation or inability to initiate goal-directed activity. What term would be used to describe your pt?

The following describes alterations in what?

-developmental/acquired due to environmental factors

-learning disabilities: affect ability to process information

-intellectual disabilities: significant limitations in intellectual functioning and adaptive behavior beginning before age 18

All of the following are examples of what?

-down syndrome, fragile X syndrome, fetal alcohol syndrome

You are educating a client on ways to prevent cognitive disorders. Which of the following do you recommend?

Which term describes unused connections that are remodeled or eliminated while a child develops?

Brains are not fully mature until mid-late twenties.

The nurse is aware that the population that is most at risk for confusion and
hallucinations related to dehydration, fever, infections, or anesthesia is which group?
A. Young children
B. Teenagers
C. Pregnant women
D. Young adults

The nurse is caring for a client who believes the television is listening to her conversations and she needs aluminum foil to put around her head so her thoughts cannot be stolen from her. What would the nurse chart about this client?
A. Client is exhibiting signs of psychosis.
B. Client is exhibiting signs of delusions.
C. Client is exhibiting signs of hallucinations.
D. Client is exhibiting signs of confusion

Being the caregiver of someone with dementia has higher level of stress and burden than most other chronic illnesses.

Alzheimer disease is the least common type of dementia.

What age does Alzheimer disease develop?

The following pathophysiology describes what?

Progressive degenerative changes related to neuronal death
• Begins in limbic system/hippocampus
• Memory loss (recent)
• Fluctuating emotions
• Depression
• Difficulty learning new information
• Spreads up and out to cerebral surface

Which of the following are risk factors for Alzheimer's disease?

Which stage of Alzheimer's disease is described below?

Symptoms emerge gradually, but go beyond changes associated with normal aging

-subtle memory loss that becomes more apparent over time

-decreased initiative, signs of depression

-difficulty finding words, performing familiar tasks, finding objects

-disorientation to time or place

Which stage of Alzheimer's is described?

Inability to carry out ADLs
• Loss of ability to live independently
• Difficulty recalling own address or phone number
• Increased problems finding words and communicating clearly
• Inability to recall information from recent memory
• Increasing difficulty remembering details from remote memory

Inability to perform any ADLs
• Urinary and fecal incontinence
• Inability to identify family members and caregivers
• Extreme confusion
• Lack of awareness of surroundings
• Loss of remote memory and ability to speak
• Inability to perform simple mental calculations

Which of the following are conditions that mimic the symptoms of dementia and AD using the acronym DEMENTIA?

What are some questions we might include in the assessment of a caregiver in AD?

You can definitely diagnose Alzheimer's without a brain autopsy.

Clinicians use differential diagnosis to diagnose Alzheimer's.

Which of the following are interventions for AD?

Care in the final stage of AD focuses on...

Which of the following are medications used to slow AD progression?

Which of the following medications are used to treat AD-associated symptoms?

Which pharm treatment used to slow AD progression is described below?

MOA: reduce acetylcholine breakdown

Temporary stabilization of symptoms related to language, memory, reasoning
Adverse effects: GI bleed, bradycardia

*Do not stop abruptly!

Which pharm treatment used to slow AD progression is described below?

Blocks effects of glutamate, slows rate at which new damage occurs, does not reverse damage

-for moderate-severe stages of AD

The nurse is working with families of clients with Alzheimer disease. One of the members says, “I feel so sad because my loved one is lost.” What response by the nurse can best facilitate group discussion on this issue?

A. “Grieving for a lost relationship is a normal behavior.”

B. “Are you experiencing anger about this?”

C. “How have others in the group dealt with these feelings?”

D. “You will not feel sad as soon as you can accept your loved one’s illness.”

The nurse discusses the disease process of Alzheimer disease with the client and caregiver. What does the nurse explain is the cause of Alzheimer disease?
A. The cause is unknown. Amyloid plaques and neurofibrillary tangles have been found in the brain at autopsy.
B. The cause is unknown. Chronic small intracranial bleeds have been found on CT scans.
C. Loss of circulation to the brain has been found on CT scans.
D. Loss of dopamine receptors is thought to occur as a part of the aging process

Which manifestation is usually the first indication of the onset of Alzheimer disease?
A. Inability to perform activities of daily living (ADLs)
B. Sundowning at night
C. Subtle memory deficits
D. Inability to communicate

All of the following symptoms describe...

Acute loss of most or all cognitive function
• Disorganized thinking
• Disorientation
• Perceptual disturbances

Restlessness
• Agitation
• Lability
• Reduced awareness

Fluctuating symptoms are not typical in delirium.

Delirium is usually a sign of a reversible life-threatening condition.

Which of the following puts your pt at biggest risk for delirium?

Which of the following could potentially cause delirium in your pt?

Older adults have a 6x higher rate of developing delirium.

Your patient is delirious. What are the treatment options for your pt?

An 83-year-old client is in the emergency department and is acting in a bizarre manner. The client is being treated for otitis media. Which sign will the nurse recognize as indicating that the client is delirious?
A. Sundowning symptoms
B. Gradual onset of symptoms
C. Impaired thinking skills
D. Specific attention to detail

The nurse is caring for a 10-year-old child who has meningitis and is delirious. Which is a priority nursing diagnosis for this client?
A. Anxiety
B. Risk for Injury
C. Ineffective Airway Clearance
D. Activity Intolerance

The spouse of a client who is experiencing delirium from dehydration is
concerned about taking the client home in a confused state. The nurse would
respond with which correct statement?
A. “I’ll teach you how to make your home safe.”
B. “Once the dehydration is corrected, your spouse will no longer be delirious.”
C. “We’ll be ordering a home health aide to help you.”
D. “Oh, it won’t be so bad; the client is harmless."

A client is admitted to the nursing unit with fever and dehydration, which have
caused the client to experience delirium. The nurse expects which treatment tobe ordered for this client?
A. Acetaminophen and IV fluids
B. Provide a stimulating environment
C. Psychotropic medications
D. Drugs to assist the memory

The nurse is promoting a therapeutic environment for a client with delirium and congestive heart failure. Which intervention will the nurse initiate for this client?
A. Keep the drapes over the windows closed at all times.
B. Avoid medicating client with any type of pain medication.
C. Maintain appropriate levels of noise in the room to avoid overstimulation.
D. Discourage family and loved ones visiting the client.

The nurse is caring for the older adult client and is aware that many conditions can cause signs and symptoms of delirium. Which factor in the older adult client is least likely to cause delirium?
A. Urinary tract infection
B. Dehydration
C. Gout
D. Urinary retention