A nurse is caring for a client who is experiencing delirium. Which of the following findings should the nurse expect?

Catatonia

Echopraxia

Agraphia

Illusions

Answer and Explanation

The Correct Answer is D

A. Catatonia. Catatonia involves significant motor disturbances such as rigidity, mutism, or excessive movement, commonly seen in schizophrenia or severe mood disorders. Delirium is characterized by acute confusion, fluctuating attention, and perceptual disturbances rather than motor abnormalities.
B. Echopraxia. Echopraxia is the involuntary repetition of another person’s movements, often linked to schizophrenia and autism spectrum disorders. Delirium primarily presents with disorientation, altered consciousness, and hallucinations rather than repetitive motor behaviors.
C. Agraphia. Agraphia is the loss of the ability to write due to neurological conditions like stroke or dementia. Delirium is an acute and reversible cognitive disturbance that affects attention and perception but does not typically result in isolated language deficits.
D. Illusions. Illusions involve the misinterpretation of real stimuli, such as mistaking a cord for a snake, and are common in delirium. This occurs due to the client's fluctuating mental status, impaired sensory perception, and difficulty distinguishing reality from distorted perceptions.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

A. Acute onset of confusion. Dementia is a progressive, chronic condition that develops gradually over time. An acute onset of confusion is more characteristic of delirium, which is a sudden, reversible condition often caused by infections, metabolic imbalances, or medications.
B. Illusions. While individuals with dementia may experience visual misperceptions, true illusions—misinterpretations of real external stimuli—are more commonly associated with delirium or psychiatric disorders. Dementia more often leads to problems with recognition (agnosia) rather than distorted perception.
C. Memory loss that disrupts ADLs. Dementia is characterized by progressive cognitive decline, including memory impairment severe enough to interfere with daily activities such as managing finances, preparing meals, or personal hygiene. As the disease progresses, individuals may struggle with problem-solving, language, and recognizing familiar people or places.
D. Catatonia. Catatonia is a state of motor dysfunction, often seen in severe psychiatric disorders like schizophrenia. While individuals with advanced dementia may become withdrawn or exhibit reduced movement, true catatonia, which involves stupor or repetitive movements, is not a hallmark of dementia.

A. Medical health insurance claims B. Physical assessment findings C. Family medical history D. Medications taken prior to admission

Correct Answer is B

Explanation

A. Medical health insurance claims. While insurance coverage is important for referral approval, the physical therapist primarily requires clinical information related to the client's mobility and functional status. Insurance details are handled by administrative staff rather than included in the clinical referral.
B. Physical assessment findings. The physical therapist needs relevant assessment findings, such as muscle strength, range of motion, balance, gait, and mobility limitations. These details help guide therapy goals and interventions to improve the client’s functional abilities.
C. Family medical history. While family history is useful for identifying genetic predispositions to conditions, it is not essential for a physical therapy referral. The focus should be on the client’s current physical status rather than hereditary factors.
D. Medications taken prior to admission. Although a client’s medication history is important for overall care, it is not the primary concern for a physical therapy referral unless specific medications affect mobility, such as muscle relaxants or sedatives. The therapist will rely more on current physical assessment findings to determine appropriate interventions.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is caring for a client who is experiencing delirium. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has dementia. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

A nurse in an acute care setting is assisting in collecting client information to include in a referral for a physical therapist. Which of the following information should the nurse plan to include?

Correct Answer is B

Explanation

A nurse is reinforcing teaching about sexual activity during pregnancy for a client in a monogamous, same-sex relationship. Which of the following statements should the nurse make?

A nurse is supervising an assistive personnel (AP) who is caring for a client who is at risk for falls. For which of the following actions by the AP should the nurse intervene?

A nurse is caring for a client who is 2 days postoperative following an above-the-knee amputation. Which of the following actions should the nurse take to promote progression toward independence and mobility for the client?

A nurse is applying a belt restraint to a client who has become physically aggressive. Which of the following actions should the nurse take?

A nurse is planning care for a client who is at 16 weeks of gestation and has hyperemesis gravidarum. Which of the following actions should the nurse anticipate taking?

Exhibits Which of the following findings requires further action by the nurse? Select all that apply.

A nurse is collecting data from a client who has thrombocytopenia. The nurse should identify that which of the following findings increases the client's risk for injury?

A nurse is assisting in the care of a newly admitted client. Exhibits Which of the following findings should the nurse report immédiately to the provider?Select all that apply.