A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90°F outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to what?

Age-related motor deficiencies that result in self-neglect

Age-related neurosensory changes that diminish awareness of temperature changes

Delirium-related to an acute illness that is affecting body heat production

Cognitive changes that diminish the individual's awareness of temperature changes

Answer and Explanation

The Correct Answer is B

A. Age-related motor deficiencies that result in self-neglect.

Explanation: While age-related motor deficiencies could potentially impact a person's ability to dress appropriately, the specific scenario described (wearing a sweater despite high temperatures) is more indicative of sensory awareness issues rather than motor deficiencies.

B. Age-related neurosensory changes that diminish awareness of temperature changes.

Explanation: As individuals age, there can be neurosensory changes that affect their ability to perceive temperature accurately. This can result in older adults being less aware of changes in temperature, leading to behaviors such as dressing inappropriately for the weather. In this scenario, the client wearing a sweater despite the high temperature outside may be attributed to diminished awareness of the actual environmental temperature.

C. Delirium related to an acute illness that is affecting body heat production.

Explanation: Delirium may indeed affect a person's cognitive and functional abilities, but the scenario does not provide evidence of delirium or an acute illness. The focus is on the client's behavior related to dressing inappropriately for the weather, which is more suggestive of sensory awareness issues.

D. Cognitive changes that diminish the individual's awareness of temperature changes.

Explanation: This option is similar to the correct answer (Option B). Cognitive changes, particularly in awareness, can contribute to inappropriate dressing for the weather in older adults. The primary distinction here is that the term "neurosensory changes" in Option B specifically highlights alterations in sensory perception.

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Correct Answer is ["A","B","D"]

Explanation

A. Comprehensive assessment

Explanation: A comprehensive assessment involves a thorough evaluation of various cognitive functions, including memory, attention, language, problem-solving, and executive functions. This allows for a comprehensive understanding of an individual's cognitive abilities.

B. Assessing for atypical presentation of illness

Explanation: Assessing for atypical presentation of illness is relevant in a cognitive assessment because some medical conditions or illnesses can manifest with cognitive symptoms. Recognizing atypical presentations helps in identifying potential underlying causes of cognitive changes.

C. Complete blood count

Explanation: While laboratory tests like a complete blood count (CBC) may be useful in identifying certain medical conditions that could affect cognition, it is not a direct component of a cognitive assessment. Cognitive assessments typically involve clinical interviews, neuropsychological testing, and observation of cognitive functions. Blood tests and other diagnostic tools may be used to complement the cognitive assessment but are not considered components of it.

D. Differentiating delirium, dementia, and depression

Explanation: Distinguishing between delirium, dementia, and depression is crucial in a cognitive assessment. Each condition has distinct characteristics, and accurate differentiation is necessary for appropriate intervention and management.

A. The Global Deterioration Scale B. Mini Mental State Exam (MMSE) C. Older American's Resources and Services (OARS) D. Mini-Cog E. The Barthel Index

Correct Answer is ["A","B","D"]

Explanation

A. The Global Deterioration Scale

Explanation: The Global Deterioration Scale (GDS) is a tool used to assess the cognitive function and stage of cognitive decline in individuals, especially those with dementia.

B. Mini Mental State Exam (MMSE)

Explanation: The Mini Mental State Exam (MMSE) is a widely used tool to assess cognitive function and screen for cognitive impairment. It evaluates various cognitive domains, including orientation, memory, attention, and language.

C. Older American's Resources and Services (OARS)

Explanation: The Older American's Resources and Services (OARS) is not a cognitive assessment tool. It is a comprehensive assessment tool that covers various domains, including physical health, mental health, and social resources.

D. Mini-Cog

Explanation: The Mini-Cog is a brief cognitive screening tool that includes a three-item recall test for memory and a clock-drawing task. It is used to quickly assess cognitive function and detect potential cognitive impairment.

E. The Barthel Index

Explanation: The Barthel Index is not a cognitive assessment tool. It is a tool used to assess an individual's ability to perform activities of daily living (ADLs), providing information about their functional independence rather than cognitive status.

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A 79-year-old client resides independently in the community. The visiting home health nurse finds that despite it being 90°F outside, the windows are closed and the client is wearing a sweater. The nurse initially recognizes that this behavior may be related to what?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Components to a cognitive assessment include which of the following? (Select all that apply.)

Correct Answer is ["A","B","D"]

Explanation

The nurse assesses an older adult's cognitive status using a standard assessment instrument. Which of the following are cognitive assessment tools? (Select all that apply.)

Correct Answer is ["A","B","D"]

Explanation

A resident's family member is concerned that the resident is not eating adequately and is at risk for malnutrition. The family member says to a nurse, "I heard that there are drugs that can make my mother eat better. Do you think she should be on one?" What is the best response by the nurse?

As a nurse caring for a cognitively impaired older adult client, you need to observe for which of the following? (Select all that apply.)

The nurse should encourage which of the following exercise(s) to assist with balance for a client who is at high risk for falls? (Select all that apply.

The health care provider has not ordered the use of a restraint for an alert patient at high risk for falling. The nurse should implement which side rail use?

What components are included in a person-centered community? (Select all that apply.)

A home health nurse is making a home visit to an older adult client. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. The nurse recommends that the client eliminate which of the following? (Select all that apply.)

Which recommendations for daily food intake is correct for older adults according to the MyPlate for Older Adults? (Select all that apply.)