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Chapter 16: Neurocognitive Disorders: Delirium and Dementia
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____
1. Your patient with advanced Alzheimer’s disease keeps searching the unit for her mother who died
many years ago. How should you respond?
A. “Your mother isn’t here—she died long ago.”
B. “Let’s go to the activity room and see what’s going on.”
C. “You must be upset that you can’t find her.”
D. “What makes you keep looking for your mother?”
____
2. Your patient is diagnosed with delirium. He is awake most of the night and becomes increasingly
confused. Which is the best initial intervention?
A. Keep the television on to provide stimulation.
B. Give him a sleeping pill.
C. Keep a night light on in the room and turn off the television.
D. Keep the lights on in the room.
____
3. Your patient is on donepezil HCL. This tells you your patient has which disorder?
A. Dementia
B. Obsessive-compulsive disorder
C. Major depression
D. Delirium
____
4. Team members working with patients who have dementia need to have a common, unified approach
because this type of patient requires:
A. Sameness and consistency in their lives.
B. Strict rules and regulations.
C. Behavior modification at all times.
D. Staff who cannot be manipulated.
____
5. When preparing a care plan for a patient with a diagnosis of dementia, the nurse will:
A. Increase mental and physical stimulus to improve mental function.
B. State five current events from today’s newspaper.
C. Maintain consistent daily routines.
D. Encourage the patient to discuss memories from his or her childhood.
____
6. The best way to assist a patient who has mild Alzheimer’s disease is to:
A. Ask the physician to keep the patient sedated to avoid “acting out” behaviors.
B. Provide strict one-on-one behavior modification techniques to prevent further
cognitive deterioration.
C. Encourage the family to begin preparations to move the person to a skilled nursing
facility.
D. Provide a stable, safe, and consistent environment.
____
7. Nurses recognize that the main cause for Alzheimer’s disease is:
A. Unknown at this time.
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B. Genetic.
C. Related to use of aluminum cookware.
D. Long-term alcohol use.
____
8. A person who is receiving tests to confirm a diagnosis of Alzheimer’s disease is preparing for a
computerized tomography (CT) test. The patient becomes restless and is unable to follow the
pre-examination directions given by the personnel. As the nurse who is assisting the patient, your
best action at this time is to:
A. Tell the patient that refusing to cooperate will require having to return another day.
B. Give the patient the written instructions.
C. Take the patient to a quiet waiting area until it is time for the CT scan.
D. Make certain that the patient is tightly strapped to the examination table during the
test.
____
9. Your new patient is admitted to your nursing home with a diagnosis of vascular dementia. You know
that this type of dementia differs from Alzheimer’s dementia is what way?
A. The progression of symptoms is predictable based on the person’s heart disease.
B. The progression of symptoms is more variable than Alzheimer’s disease.
C. Vascular dementia can be treated successfully with surgery compared to
Alzheimer’s disease where there is no surgical treatment.
D. Vascular dementia is temporary and Alzheimer’s dementia is permanent.
____ 10. You are working with a patient who has dementia. The patient becomes withdrawn and negative.
Your most therapeutic response to this patient is:
A. “Your family will feel very bad if you do not get along here!”
B. “Your doctor has ordered you to attend at least two activities each day.”
C. “Would you prefer to stay alone in your room?”
D. “I need a partner to play cards with.”
____ 11. Mavis Brown is a 75-year-old patient in your nursing home. She has Alzheimer’s disease. Mavis
comes to you at the desk one day and is crying. She says, “You all hate me. Everyone hates me!”
Your therapeutic reply is:
A. “Nobody here hates you, Mavis.”
B. “Why do you feel hated, Mavis?”
C. “You seem upset, Mavis. Let’s go for a walk and talk.”
D. “It’s time for your medication, Mavis.”
____ 12. Henry Smith is 88 years old and has been having periods of disorientation and confusion that worsen
at night. He has been given a diagnosis of Alzheimer’s disease. When you pick up Henry’s tray after
supper, you observe that he has not touched any of the food. As his nurse, you understand that the
most likely cause of his not eating is:
A. He is too depressed to eat.
B. He sees ants in his food.
C. He is too forgetful to remember to eat.
D. He is deliberately obstinate.
____ 13. Henry Smith may be suffering from sundowning. What is the alternate name for this condition?
A. Nocturnal delirium
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B. Vascular dementia
C. Pseudodementia
D. Neurocognitive confusion
____ 14. Which of the following activities would be most appropriate for a patient who is in the moderate
stage of Alzheimer’s disease?
A. A large jigsaw puzzle
B. Trivial Pursuit
C. A scavenger hunt
D. Playing a game of catch with a soft ball
____ 15. When planning interventions for a patient who has Alzheimer’s disease, the nurse knows that
patients with this disorder:
A. Should be able to remember teaching that was done yesterday.
B. Will most likely havememory impairment particularly for recent events.
C. Will most likely continue to be able to perform activities of daily living like
dressing and grooming.
D. The disease often stabilizes at one level.
____ 16. Aricept is a medication used to treat which condition(s)?
A. Delirium only
B. Dementia only
C. Delirium and dementia
D. Pseudodementia
____ 17. Pharmacological treatment of delirium is most likely to include which medication?
A. Antidepressants
B. Tranquilizers
C. Antipsychotics
D. Stimulants
____ 18. Which statement best describes pseudodementia?
A. Schizophrenia in the elderly.
B. Depression in the elderly that looks like dementia.
C. Substance abuse related delirium that looks like dementia.
D. Autism in children that mimics dementia.
____ 19. Andrea’s mother has been becoming more and more forgetful. It seems to have gotten worse over
the past 15 years. Her most likely diagnosis could be:
A. Depression.
B. Alzheimer’s Disease.
C. Hyperthyroidism.
D. Delirium.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
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____ 20. Of the following, which one(s) are part of an effective care plan for someone with advanced
dementia? (Select all that apply)
A. Keep the patient busy with structured activities.
B. Keep televisions and radios on whenever possible to encourage patient interaction.
C. Allow more time for performing care.
D. Emphasize “reality orientation.”
E. Encourage independent decision making.
F. Provide group therapy opportunities to share feelings and problems.
____ 21. Which of the following are characteristics of delirium? (Select all that apply)
A. Slow onset
B. Sudden onset
C. Fluctuating mental status
D. Treatment is focused on finding the cause
E. Progressive decline common despite treatment
F. Can be caused by psychological stress
G. Treatment the same no matter what the cause
H. Consistent pattern of decline
True/False
Indicate whether the statement is true or false.
____ 22. All dementias are a form of Alzheimer’s disease.
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Chapter 16: Neurocognitive Disorders: Delirium and Dementia
Answer Section
MULTIPLE CHOICE
1. ANS: B
With advanced Alzheimer’s disease, reorientation is often ineffective because the patient will not
remember. Open-ended questions are also less effective. Response B uses distraction to refocus the
patient’s attention on the here and now.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; General Nursing Interventions; page
254-255
KEY: Integrated Processes: Implementation | Content Area: Mental Health: Cognitive disorder | Cognitive
Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication
2. ANS: C
Reducing stimulating sounds and providing some light to keep him oriented to his surroundings is
the best initial intervention. A sleeping pill can add to confusion.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; General Nursing Interventions; page
254
KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive
disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Sensory/perceptual alterations
3. ANS: A
This drug is Aricept and is a major treatment for dementia.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Table 16-4 Cholinesterase Inhibitors;
page 252
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Geriatrics: Pharmacology | Cognitive
Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies:
Medication administration
4. ANS: A
Consistency is important when short-term memory is limited. The patient can count on that approach
even when he or she can’t remember details. Strict rules and behavior modification aren’t useful
when the short-term memory is impaired. These patients are not using manipulation, again, due to
poor memory.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With
Delirium and Dementia; page 254
KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive
disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts:
Therapeutic environment
5. ANS: C
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Consistency is effective for all types of dementias to reduce anxiety and promote participation in the
care plan. Stimulating the patient to do mental functions such as reviewing current events, or
discussing memories may create more anxiety.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With
Delirium and Dementia; page 254
KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive
disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts:
Therapeutic environment
6. ANS: D
A stable, consistent environment will give the patient cues to maintain participation and orientation.
Response A is a chemical restraint and is never appropriate. Behavior medication is generally
ineffective with cognitive deterioration if the person cannot remember the rewards. Though the
family may be thinking about future plans, it is too early for placement.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With
Delirium and Dementia; page 254
KEY: Integrated Processes: Nursing Process: Planning | Content Area: Mental Health: Therapeutic Nursing
Process | Cognitive Level: Comprehension | Client Need: Safe and Effective Care Environment: Coordinated
Care
7. ANS: A
Though extensive research is being conducted in a number of areas, no clear cause has been
identified.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Alzheimer’s disease; page 248
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders |
Cognitive Level: Comprehension | Client Need: Health Promotion and Maintenance
8. ANS: C
Rather than flood the patient with a lot of information or demands, it is more important to create a
calm environment to reduce the patient’s fear of the unknown.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With
Delirium and Dementia; page 254
KEY: Integrated Processes: Nursing Process: Analysis/implementation | Content Area: Mental Health:
Cognitive disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic
environment and communication
9. ANS: B
Vascular dementia’s progression depends on the recurrence of new strokes. It can be stable for long
periods if there are no strokes. The progression is not predictable, there is no surgical treatment for
this type of dementia, and the damage that is done is permanent.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Other Forms of Dementia; page 252
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders |
Cognitive Level: Comprehension | Client Need: Health Promotion and Maintenance
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10. ANS: D
Distracting the patient to another activity is a positive way to change a behavior rather than
promoting guilt.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With
Delirium and Dementia; page 254-255
KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive
disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication
11. ANS: C
This response acknowledges her feelings but uses an activity to distract her rather than focus on
analyzing the cause, which she does not know.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With
Delirium and Dementia; page 254-255
KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive
disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication
12. ANS: C
Memory loss can lead to forgetting to perform daily, routine functions like eating. This is the most
likely cause.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Box 16-1, Symptoms of Alzheimer’s
Disease; page 248
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders |
Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts
13. ANS: A
Nocturnal delirium is increased agitation and confusion at dusk.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Delirium; page 245
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders |
Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts
14. ANS: D
The other responses require concentration and memory. Physical activity can improve mood and
does not put stress on the patient to concentrate.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients With
Delirium and Dementia; page 254-255
KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive
disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication
and environment
15. ANS: B
All interventions for Alzheimer’s patients must incorporate the understanding that memory
impairment especially for recent events will impact all aspects of the patient’s activities.
Alzheimer’s is a progressive deterioration.
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PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Box 16-1, Symptoms of Alzheimer’s
Disease; page 248
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders |
Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts
16. ANS: B
Aricept has been approved for the treatment of Alzheimer’s type dementia —not delirium or
pseudodementia.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Pharmacology Corner for Dementia;
page 251
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Pharmacology and
geriatrics: Pharmacology | Cognitive Level: Knowledge | Client Need: Physiological Integrity:
Pharmacological and parenteral therapies: Medication administration
17. ANS: C
Using antipsychotic medications to treat delirium has some risk because they can exacerbate
symptoms, but the most commonly used are low-dose antipsychotics if the patient is agitated.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Pharmacology Corner for Delirium;
page 246
KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Pharmacology |
Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral
therapies: Medication administration
18. ANS: B
Depressive symptoms in the elderly such as forgetfulness, withdrawal, and lack of involvement in
life can be confused with early dementia.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Dementia; page 247 and Glossary;
page 402
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders |
Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts
19. ANS: B
Alzheimer’s is a slow, progressive form of dementia where deterioration is expected consistently
over many years.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Nursing Care of Patients with
Delirium and Dementia; page 254
KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Cognitive
disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication
and environment
MULTIPLE RESPONSE
20. ANS: A, C
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B, D, E, and F incorporate added stimulation that can increase the stress level of a patient with
impaired memory.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Table 16-5 Characteristics of Delirium
and Dementia; page 254
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders |
Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts
21. ANS: B, C, D, F
Delirium is characterized by sudden onset and fluctuating mental status. Treating the cause such as
dehydration and electrolyte imbalance often improves symptoms. Psychological stress can contribute
to delirium.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Alzheimer’s disease; page 248
KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Cognitive
Disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental Health Concepts
TRUE/FALSE
22. ANS: F
Alzheimer’s disease is a specific type of dementia. There are several other types not considered to be
Alzheimer’s disease.
PTS: 1
REF: Chapter 16: Neurocognitive Disorders: Delirium and Dementia; Dementia; page 247
KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Cognitive disorders |
Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts
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