Alzheimer's Disease, Dementia, and Delirium NCLEX
Style Questions || WITH A+ GRADED SOLUTIONS!!
1. A patient who is hospitalized with pneumonia is disoriented and confused 2 days after
admission. Which information obtained by the nurse about the patient indicates that the
patient is experiencing delirium rather than dementia?
a. The patient was oriented and alert when admitted.
b. The patient's speech is fragmented and incoherent.
c. The patient is disoriented to place and time but oriented to person.
d. The patient has a history of increasing confusion over several years. correct answers a. The
patient was oriented and alert when admitted.
The onset of delirium occurs acutely. The degree of disorientation does not differentiate
between delirium and dementia. Increasing confusion for several years is consistent with
dementia. Fragmented and incoherent speech may occur with either delirium or dementia.
2. When developing a plan of care for a hospitalized patient with moderate dementia, which
intervention will the nurse include?
a. Provide complete personal hygiene care for the patient.
b. Remind the patient frequently about being in the hospital.
c. Reposition the patient frequently to avoid skin breakdown.
d. Place suction at the bedside to decrease the risk for aspiration. correct answers b. Remind
the patient frequently about being in the hospital.
The patient with moderate dementia will have problems with short- and long-term memory
and will need reminding about the hospitalization. The other interventions would be used for
a patient with severe dementia, who would have difficulty with swallowing, self-care, and
immobility.
3. When administering a mental status examination to a patient with delirium, the nurse
should
a. medicate the patient first to reduce any anxiety.
b. give the examination when the patient is well-rested.
c. reorient the patient as needed during the examination.
d. choose a place without distracting environmental stimuli. correct answers d. choose a place
without distracting environmental stimuli.
Because overstimulation by environmental factors can distract the patient from the task of
answering the nurse's questions, these stimuli should be avoided. The nurse will not wait to
give the examination because action to correct the delirium should occur as soon as possible.
Reorienting the patient is not appropriate during the examination. Antianxiety medications
may increase the patient's delirium.
4. To protect a patient from injury during an episode of delirium, the most appropriate action
by the nurse is to
,a. secure the patient in bed using a soft chest restraint.
b. ask the health care provider about ordering an antipsychotic drug.
c. instruct family members to remain with the patient and prevent injury.
d. assign a nursing assistant to stay with the patient and offer frequent reorientation. correct
answers d. assign a nursing assistant to stay with the patient and offer frequent reorientation.
The priority goal is to protect the patient from harm, and a staff member will be most
experienced in providing safe care. Visits by family members are helpful in reorienting the
patient, but families should not be responsible for protecting patients from injury.
Antipsychotic medications may be ordered, but only if other measures are not effective
because these medications have multiple side effects. Restraints are sometimes used but tend
to increase agitation and disorientation.
5. Which action will the nurse in the outpatient clinic include in the plan of care for a patient
with mild cognitive impairment (MCI)?
a. Suggest a move into an assisted living facility.
b. Schedule the patient for more frequent appointments.
c. Ask family members to supervise the patient's daily activities.
d. Discuss the preventive use of acetylcholinesterase medications. correct answers b.
Schedule the patient for more frequent appointments.
Ongoing monitoring is recommended for patients with MCI. MCI does not interfere with
activities of daily living, acetylcholinesterase drugs are not used for MCI, and an assisted
living facility is not indicated for MCI.
6. When administering a mental status examination to a patient, the nurse suspects depression
when the patient responds with
a. "I don't know."
b. "Is that the right answer?"
c. "Wait, let me think about that."
d. "Who are those people over there? correct answers a. "I don't know."
Answers such as "I don't know" are more typical of depression. The response "Who are those
people over there?" is more typical of the distraction seen in a patient with delirium. The
remaining two answers are more typical of a patient with dementia.
7. A 72-year-old patient is diagnosed with moderate dementia as a result of multiple strokes.
During assessment of the patient, the nurse would expect to find
a. excessive nighttime sleepiness.
b. difficulty eating and swallowing.
c. variable ability to perform simple tasks.
d. loss of both recent and long-term memory. correct answers d. loss of both recent and long-
term memory.
, Loss of both recent and long-term memory is characteristic of moderate dementia. Patients
with dementia have frequent nighttime awakening. Dementia is progressive, and the patient's
ability to perform tasks would not have periods of improvement. Difficulty eating and
swallowing is characteristic of severe dementia.
8. To determine whether a new patient's confusion is caused by dementia or delirium, which
action should the nurse take?
a. Assess the patient using the Mini-Mental Status Exam.
b. Obtain a list of the medications that the patient usually takes.
c. Determine whether there is positive family history of dementia.
d. Use the Confusion Assessment Method tool to assess the patient. correct answers d. Use
the Confusion Assessment Method tool to assess the patient.
The Confusion Assessment Method tool has been extensively tested in assessing delirium.
The other actions will be helpful in determining cognitive function or risk factors for
dementia or delirium, but they will not be useful in differentiating between dementia and
delirium.
9. A 62-year-old patient is brought to the clinic by a family member who is concerned about
the patient's inability to solve common problems. To obtain information about the patient's
current mental status, which question should the nurse ask the patient?
a. "Where were you were born?"
b. "Do you have any feelings of sadness?"
c. "What did you have for breakfast?"
d. "How positive is your self-image?" correct answers c. "What did you have for breakfast?"
This question tests the patient's recent memory, which is decreased early in Alzheimer's
disease (AD) or dementia. Asking the patient about birthplace tests for remote memory,
which is intact in the early stages. Questions about the patient's emotions and self-image are
helpful in assessing emotional status, but they are not as helpful in assessing mental state.
10. When teaching the children of a patient who is being evaluated for Alzheimer's disease
(AD) about the disorder, the nurse explains that
a. the most important risk factor for AD is a family history of the disorder.
b. new drugs have been shown to reverse AD dramatically in some patients.
c. a diagnosis of AD can be made only when other causes of dementia have been ruled out.
d. the presence of brain atrophy detected by MRI confirms the diagnosis of AD in patients
with dementia. correct answers c. a diagnosis of AD can be made only when other causes of
dementia have been ruled out.
The diagnosis of AD is one of exclusion. Age is the most important risk factor for
development of AD. Drugs can slow the deterioration but do not dramatically reverse the
effects of AD. Brain atrophy is a common finding in AD, but it can occur in other diseases as
well and does not confirm an AD diagnosis.
11. A patient with mild dementia has a new prescription for donepezil (Aricept). Which
nursing action will be most effective in ensuring compliance with the medication?
Style Questions || WITH A+ GRADED SOLUTIONS!!
1. A patient who is hospitalized with pneumonia is disoriented and confused 2 days after
admission. Which information obtained by the nurse about the patient indicates that the
patient is experiencing delirium rather than dementia?
a. The patient was oriented and alert when admitted.
b. The patient's speech is fragmented and incoherent.
c. The patient is disoriented to place and time but oriented to person.
d. The patient has a history of increasing confusion over several years. correct answers a. The
patient was oriented and alert when admitted.
The onset of delirium occurs acutely. The degree of disorientation does not differentiate
between delirium and dementia. Increasing confusion for several years is consistent with
dementia. Fragmented and incoherent speech may occur with either delirium or dementia.
2. When developing a plan of care for a hospitalized patient with moderate dementia, which
intervention will the nurse include?
a. Provide complete personal hygiene care for the patient.
b. Remind the patient frequently about being in the hospital.
c. Reposition the patient frequently to avoid skin breakdown.
d. Place suction at the bedside to decrease the risk for aspiration. correct answers b. Remind
the patient frequently about being in the hospital.
The patient with moderate dementia will have problems with short- and long-term memory
and will need reminding about the hospitalization. The other interventions would be used for
a patient with severe dementia, who would have difficulty with swallowing, self-care, and
immobility.
3. When administering a mental status examination to a patient with delirium, the nurse
should
a. medicate the patient first to reduce any anxiety.
b. give the examination when the patient is well-rested.
c. reorient the patient as needed during the examination.
d. choose a place without distracting environmental stimuli. correct answers d. choose a place
without distracting environmental stimuli.
Because overstimulation by environmental factors can distract the patient from the task of
answering the nurse's questions, these stimuli should be avoided. The nurse will not wait to
give the examination because action to correct the delirium should occur as soon as possible.
Reorienting the patient is not appropriate during the examination. Antianxiety medications
may increase the patient's delirium.
4. To protect a patient from injury during an episode of delirium, the most appropriate action
by the nurse is to
,a. secure the patient in bed using a soft chest restraint.
b. ask the health care provider about ordering an antipsychotic drug.
c. instruct family members to remain with the patient and prevent injury.
d. assign a nursing assistant to stay with the patient and offer frequent reorientation. correct
answers d. assign a nursing assistant to stay with the patient and offer frequent reorientation.
The priority goal is to protect the patient from harm, and a staff member will be most
experienced in providing safe care. Visits by family members are helpful in reorienting the
patient, but families should not be responsible for protecting patients from injury.
Antipsychotic medications may be ordered, but only if other measures are not effective
because these medications have multiple side effects. Restraints are sometimes used but tend
to increase agitation and disorientation.
5. Which action will the nurse in the outpatient clinic include in the plan of care for a patient
with mild cognitive impairment (MCI)?
a. Suggest a move into an assisted living facility.
b. Schedule the patient for more frequent appointments.
c. Ask family members to supervise the patient's daily activities.
d. Discuss the preventive use of acetylcholinesterase medications. correct answers b.
Schedule the patient for more frequent appointments.
Ongoing monitoring is recommended for patients with MCI. MCI does not interfere with
activities of daily living, acetylcholinesterase drugs are not used for MCI, and an assisted
living facility is not indicated for MCI.
6. When administering a mental status examination to a patient, the nurse suspects depression
when the patient responds with
a. "I don't know."
b. "Is that the right answer?"
c. "Wait, let me think about that."
d. "Who are those people over there? correct answers a. "I don't know."
Answers such as "I don't know" are more typical of depression. The response "Who are those
people over there?" is more typical of the distraction seen in a patient with delirium. The
remaining two answers are more typical of a patient with dementia.
7. A 72-year-old patient is diagnosed with moderate dementia as a result of multiple strokes.
During assessment of the patient, the nurse would expect to find
a. excessive nighttime sleepiness.
b. difficulty eating and swallowing.
c. variable ability to perform simple tasks.
d. loss of both recent and long-term memory. correct answers d. loss of both recent and long-
term memory.
, Loss of both recent and long-term memory is characteristic of moderate dementia. Patients
with dementia have frequent nighttime awakening. Dementia is progressive, and the patient's
ability to perform tasks would not have periods of improvement. Difficulty eating and
swallowing is characteristic of severe dementia.
8. To determine whether a new patient's confusion is caused by dementia or delirium, which
action should the nurse take?
a. Assess the patient using the Mini-Mental Status Exam.
b. Obtain a list of the medications that the patient usually takes.
c. Determine whether there is positive family history of dementia.
d. Use the Confusion Assessment Method tool to assess the patient. correct answers d. Use
the Confusion Assessment Method tool to assess the patient.
The Confusion Assessment Method tool has been extensively tested in assessing delirium.
The other actions will be helpful in determining cognitive function or risk factors for
dementia or delirium, but they will not be useful in differentiating between dementia and
delirium.
9. A 62-year-old patient is brought to the clinic by a family member who is concerned about
the patient's inability to solve common problems. To obtain information about the patient's
current mental status, which question should the nurse ask the patient?
a. "Where were you were born?"
b. "Do you have any feelings of sadness?"
c. "What did you have for breakfast?"
d. "How positive is your self-image?" correct answers c. "What did you have for breakfast?"
This question tests the patient's recent memory, which is decreased early in Alzheimer's
disease (AD) or dementia. Asking the patient about birthplace tests for remote memory,
which is intact in the early stages. Questions about the patient's emotions and self-image are
helpful in assessing emotional status, but they are not as helpful in assessing mental state.
10. When teaching the children of a patient who is being evaluated for Alzheimer's disease
(AD) about the disorder, the nurse explains that
a. the most important risk factor for AD is a family history of the disorder.
b. new drugs have been shown to reverse AD dramatically in some patients.
c. a diagnosis of AD can be made only when other causes of dementia have been ruled out.
d. the presence of brain atrophy detected by MRI confirms the diagnosis of AD in patients
with dementia. correct answers c. a diagnosis of AD can be made only when other causes of
dementia have been ruled out.
The diagnosis of AD is one of exclusion. Age is the most important risk factor for
development of AD. Drugs can slow the deterioration but do not dramatically reverse the
effects of AD. Brain atrophy is a common finding in AD, but it can occur in other diseases as
well and does not confirm an AD diagnosis.
11. A patient with mild dementia has a new prescription for donepezil (Aricept). Which
nursing action will be most effective in ensuring compliance with the medication?
