Chapter 10. Confusion in older adults
Multiple Choice
Identify the choice that best completes the statement or answers the question.
An 85-year-old female patient arrives by ambulance to the emergency department accompanied by her
husband. He reports that his wife had been ill with pneumonia and, 2 days ago, went to the family physician
who prescribed azithromycin twice a day. The husband reports that he is
making sure she gets the medicine. His wife has been staying in bed and resting. She awoke from sleep last
night and was extremely agitated, left the house, and was walking outside. She did not recognize her
husband and wanted to call the police. Which of the following is an appropriate question for the history?
A. Does your wife have dementia or frequent episodes of confusion?
B. Has your wife been running a fever?
C. Is your wife allergic to any medication?
D. Has your wife ever had a mental status exam?
PTS: 1
ANS: A
Delirium can be observed in both elderly and younger patients and is generally defined as an acute
confusional state, affecting all aspects of cognition and mentation. The signs and
symptoms of delirium generally have a more acute or rapidly progressive onset as opposed to the slow,
gradual decline noted in the organic dementias. The acute mental status change is often associated with other
signs or symptoms—such as hallucinations, illusions, incoherent speech, and constant aimless activity—that
help to narrow the differential diagnosis. Electrolyte disturbances, infection, and polypharmacy are frequent
causes of delirium in the elderly.
2. An older patient has been admitted to the intensive care unit (ICU) after falling at home. Within 8 hours,
his condition has stabilized and he is transferred to a medical unit. The family is wondering whether he will
be able to go back home. Which assessment instrument is most
appropriate for the nurse to choose at this time?
a. Lawton IADL instrument
b. Hospital Admission Risk Profile (HARP)
c. Mini-Cog
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, d. NEECHAM Confusion Scale
ANS: B
Hospital-acquired functional decline may occur within 2 days of a hospital admission. The
HARP helps identify older adults who are at greatest risk of losing their ability to perform ADLs
or mobility at this critical time. The Lawton IADL measures instrumental activities of daily living, which
may be difficult to observe in the hospital setting. The Mini-Cog is an assessment of mental status. The
NEECHAM Confusion Scale is used to assess for delirium.
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Multiple Choice
Identify the choice that best completes the statement or answers the question.
An 85-year-old female patient arrives by ambulance to the emergency department accompanied by her
husband. He reports that his wife had been ill with pneumonia and, 2 days ago, went to the family physician
who prescribed azithromycin twice a day. The husband reports that he is
making sure she gets the medicine. His wife has been staying in bed and resting. She awoke from sleep last
night and was extremely agitated, left the house, and was walking outside. She did not recognize her
husband and wanted to call the police. Which of the following is an appropriate question for the history?
A. Does your wife have dementia or frequent episodes of confusion?
B. Has your wife been running a fever?
C. Is your wife allergic to any medication?
D. Has your wife ever had a mental status exam?
PTS: 1
ANS: A
Delirium can be observed in both elderly and younger patients and is generally defined as an acute
confusional state, affecting all aspects of cognition and mentation. The signs and
symptoms of delirium generally have a more acute or rapidly progressive onset as opposed to the slow,
gradual decline noted in the organic dementias. The acute mental status change is often associated with other
signs or symptoms—such as hallucinations, illusions, incoherent speech, and constant aimless activity—that
help to narrow the differential diagnosis. Electrolyte disturbances, infection, and polypharmacy are frequent
causes of delirium in the elderly.
2. An older patient has been admitted to the intensive care unit (ICU) after falling at home. Within 8 hours,
his condition has stabilized and he is transferred to a medical unit. The family is wondering whether he will
be able to go back home. Which assessment instrument is most
appropriate for the nurse to choose at this time?
a. Lawton IADL instrument
b. Hospital Admission Risk Profile (HARP)
c. Mini-Cog
Downloaded by Ce Co ()
, d. NEECHAM Confusion Scale
ANS: B
Hospital-acquired functional decline may occur within 2 days of a hospital admission. The
HARP helps identify older adults who are at greatest risk of losing their ability to perform ADLs
or mobility at this critical time. The Lawton IADL measures instrumental activities of daily living, which
may be difficult to observe in the hospital setting. The Mini-Cog is an assessment of mental status. The
NEECHAM Confusion Scale is used to assess for delirium.
Downloaded by Ce Co ()
