NCLEX Questions On Cognitive Impairment Disorder Quiz

1. Nurse Isabelle enters the room of a client with a cognitive impairment disorder and asks what day of the week it is; what the date, month, and year are; and where the client is. The nurse is attempting to assess the following:

Confabulation

Delirium

Orientation

Perseveration

The initial, most basic assessment of a client with cognitive impairment involves determining his level of orientation (awareness of time. place. and person). Options A and D: The nurse may also assess for confabulation and perseverance in a client with cognitive impairment, but the questions in this situation would not elicit a response to the symptoms. Option B: Delirium is a type of cognitive impairment, however. Other symptoms are necessary to establish this diagnosis.

Explanation

The initial, most basic assessment of a client with cognitive impairment involves determining his level of orientation (awareness of time. place. and person). Options A and D: The nurse may also assess for confabulation and perseverance in a client with cognitive impairment, but the questions in this situation would not elicit a response to the symptoms. Option B: Delirium is a type of cognitive impairment, however. Other symptoms are necessary to establish this diagnosis.

2. Which of the following will Nurse Dory use when communicating with a client who has cognitive impairment.

Complete explanations with multiple details

Pictures or gestures instead of words

Stimulating words and phrases to capture the client’s attention

Short words and simple sentences

Short words and simple sentences minimize client confusion and enhance communication.Options A and C: Complete explanations with multiple details and stimulating words and phrases would increase confusion in a client with short attention span and difficulty with comprehension.Option B: Although pictures and gestures may be helpful. they would not substitute for verbal communication.

Explanation

Short words and simple sentences minimize client confusion and enhance communication.Options A and C: Complete explanations with multiple details and stimulating words and phrases would increase confusion in a client with short attention span and difficulty with comprehension.Option B: Although pictures and gestures may be helpful. they would not substitute for verbal communication.

3. Mrs. Jordan is an elderly client diagnosed with Alzheimer's disease. She becomes agitated and combative when a nurse approaches to help with morning care. The most appropriate nursing intervention in this situation would be to:

Tell the client firmly that it is time to get dressed

Obtain assistance to restrain the client for safety

Remain calm and talk quietly to the client

Call the doctor and request an order for sedation

Maintaining a calm approach when intervening with an agitated client is extremely important.Option A: Telling the client firmly that it is time to get dressed may increase his agitation. especially if the nurse touches him.Option B: Restraints are a last resort to ensure client safety and are inappropriate in this situation.Option D: Sedation should be avoided. if possible. because it will interfere with CNS functioning and may contribute to the client’s confusion.

Explanation

Maintaining a calm approach when intervening with an agitated client is extremely important.Option A: Telling the client firmly that it is time to get dressed may increase his agitation. especially if the nurse touches him.Option B: Restraints are a last resort to ensure client safety and are inappropriate in this situation.Option D: Sedation should be avoided. if possible. because it will interfere with CNS functioning and may contribute to the client’s confusion.

4. Mrs. Mendoza is a 75-year-old client who has dementia of the Alzheimer's type and confabulates. The nurse understands that this client:

Denies confusion by being jovial

Pretends to be someone else

Rationalizes various behaviors

Fills in memory gaps with fantasy

Confabulation is a communication device used by patients with dementia to compensate for memory gaps.

Explanation

Confabulation is a communication device used by patients with dementia to compensate for memory gaps.

5. In clients with a cognitive impairment disorder. the phenomenon of increased confusion in the early evening hours is called:

Aphasia

Agnosia

Sundowning

Confabulation

Sundowning is a common phenomenon that occurs after daylight hours in a client with a cognitive impairment disorder.Options A. B. and D: The other options are incorrect responses. although all may be seen in this client.

Explanation

Sundowning is a common phenomenon that occurs after daylight hours in a client with a cognitive impairment disorder.Options A. B. and D: The other options are incorrect responses. although all may be seen in this client.

6. A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition?

Memory loss occurring as part of the natural consequence of aging

Difficulty coping with physical and psychological change

Severe cognitive impairment that occurs rapidly

Loss of cognitive abilities. impairing ability to perform activities of daily living

The impaired ability to perform self-care is an important measure of a client’s dementia progression and loss of cognitive abilities. Difficulty or impaired ability to perform normal activities of daily living. Such as maintaining hygiene and grooming. Toileting. Making meals. And maintaining a household. Are significant indications of dementia. The slowing of processes necessary for information retrieval is a normal consequence of aging. However, the global statement that memory loss occurs as part of natural aging is not true. Option A: Dementia is not normal; it is a disease.Option B: Any client can experience difficulty coping with changes. Not just one with dementia.Option C: The rapid occurrence of cognitive impairment refers to delirium.

Explanation

The impaired ability to perform self-care is an important measure of a client’s dementia progression and loss of cognitive abilities. Difficulty or impaired ability to perform normal activities of daily living. Such as maintaining hygiene and grooming. Toileting. Making meals. And maintaining a household. Are significant indications of dementia. The slowing of processes necessary for information retrieval is a normal consequence of aging. However, the global statement that memory loss occurs as part of natural aging is not true. Option A: Dementia is not normal; it is a disease.Option B: Any client can experience difficulty coping with changes. Not just one with dementia.Option C: The rapid occurrence of cognitive impairment refers to delirium.

7. Which goal is a priority for a client with a DSM-IV-TR diagnosis of delirium and the nursing diagnosis of Acute confusion related to recent surgery secondary to a traumatic hip fracture?

The client will complete activities of daily living.

The client will maintain safety.

The client will remain oriented.

The client will understand communication.

Maintaining safety is the priority goal for an acutely confused client who recently had surgery. All measures to promote physiologic safety and psychosocial well-being would be implemented. Option A: This client would not be able to complete daily living activities, and safety is a priority over these tasks. Options C and D: The goals of remaining oriented and understanding communication would be appropriate only after the client’s acute confusion has resolved.

Explanation

Maintaining safety is the priority goal for an acutely confused client who recently had surgery. All measures to promote physiologic safety and psychosocial well-being would be implemented. Option A: This client would not be able to complete daily living activities, and safety is a priority over these tasks. Options C and D: The goals of remaining oriented and understanding communication would be appropriate only after the client’s acute confusion has resolved.

8. 82-year-old Mr. Robeson together with his daughter arrived at the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client's daughter best supports the diagnosis?

“Maybe it’s just caused by aging. This usually happens by age 82.”

“The changes in his behavior came on so quickly! I wasn’t sure what was happening.”

“Dad just didn’t seem to know what he was doing. He would forget what he had for breakfast.”

“Dad has always been so independent. He’s lived alone for years since mom died.”

Delirium is an acute process characterized by abrupt. spontaneous cognitive dysfunction.Option A: Cognitive impairment disorders (dementia or delirium) are not normal consequences of aging.Option C would be characteristic of someone with dementia.Although Option D provides background data about the client. it is unrelated to the current problem of delirium.

Explanation

Delirium is an acute process characterized by abrupt. spontaneous cognitive dysfunction.Option A: Cognitive impairment disorders (dementia or delirium) are not normal consequences of aging.Option C would be characteristic of someone with dementia.Although Option D provides background data about the client. it is unrelated to the current problem of delirium.

9. Which ability should Nurse Rebecca expect from a client in the mild stage of dementia of the Alzheimer's type?

Remembering the daily schedule

Recalling past events

Coping the anxiety

Solving problems of daily living

Recent memory loss is the characteristic sign of cognitive difficulty in early Alzheimer’s disease. The ability to recall past events is usually retained until the later stages of this disorder.Options A. C. and D: Remembering daily schedules. coping with anxiety. and solving problems of daily living are areas that would pose difficulty in the early phase of Alzheimer’s disease.

Explanation

Recent memory loss is the characteristic sign of cognitive difficulty in early Alzheimer’s disease. The ability to recall past events is usually retained until the later stages of this disorder.Options A. C. and D: Remembering daily schedules. coping with anxiety. and solving problems of daily living are areas that would pose difficulty in the early phase of Alzheimer’s disease.

10. Which of the following is not included in the care plan of a client with a moderate cognitive impairment involving dementia of the Alzheimer's type?

Daily structured schedule

Positive reinforcement for performing activities of daily living

Stimulating environment

Use of validation techniques

A stimulating environment is a source of confusion and anxiety for a client with a moderate level of impairment and. therefore. would not be included in the plan of care.

Explanation

A stimulating environment is a source of confusion and anxiety for a client with a moderate level of impairment and. therefore. would not be included in the plan of care.