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Loss of expressive language and comprehension: Prominent impairment in expressive language and comprehension is commonly associated with frontotemporal dementia, particularly variants affecting the frontal and temporal lobes. Cognitive changes in this condition often center on language rather than visuospatial or motor features.

Stepwise irregular cognitive decline: A stepwise pattern of cognitive decline is linked to repeated cerebrovascular events causing cumulative neurological damage. Cognitive changes often follow discrete episodes rather than fluctuating attention or alertness. Motor findings depend on the location of vascular injury rather than basal ganglia involvement.

Gradual memory decline without motor symptoms: Progressive memory impairment without early motor involvement aligns more closely with Alzheimer-type neurocognitive changes. Memory loss tends to be the primary early feature, with motor symptoms appearing later, if at all.

Pseudodementia: Pseudodementia is associated with depression and often presents with abrupt onset and fluctuating cognitive complaints. Clients are usually aware of and distressed by their deficits, and cognitive function may improve with treatment of the underlying mood disorder. The course is not typically progressive.

Delirium: Delirium is characterized by an acute onset of confusion, fluctuating levels of consciousness, and impaired attention. It is usually triggered by an underlying medical condition, medication, or infection. The rapid onset contrasts with the progressive changes described.

Mania: Mania presents with elevated mood, decreased need for sleep, pressured speech, and impulsive behavior. Cognitive impairment is not the primary feature, and memory loss is not typically progressive. Attention may be increased rather than shortened due to heightened activity.

Olanzapine (Zyprexa): Olanzapine is an atypical antipsychotic primarily used to manage psychosis and severe mood disorders. In older adults, it carries increased risks such as metabolic effects, sedation, and cerebrovascular events. It is not used as an initial treatment for depression in the elderly.

Memantine (Namenda): Memantine is indicated for moderate to severe Alzheimer’s disease and works by modulating glutamate activity. It does not target depressive symptoms such as anhedonia, low mood, or sleep disturbance. Its use is unrelated to treatment of mood disorders.

Haloperidol (Haldol): Haloperidol is a typical antipsychotic used to manage acute agitation or psychosis. In elderly clients, it is associated with extrapyramidal symptoms and increased mortality risk, particularly in those with dementia. It does not address the core features of depression.

Provide education on medication adherence: Education on medication adherence supports effective management of depressive symptoms and underlying Alzheimer’s disease. Clear instruction helps prevent missed doses and reduces the risk of symptom exacerbation. Involving caregivers enhances understanding and follow-through with treatment plans.

Monitor for suicidal ideation: Expressions of passive death wishes indicate increased risk for suicidal thinking. Ongoing monitoring allows early identification of escalating ideation or changes in intent. Regular assessment supports patient safety and timely intervention.

Encourage participation in groups and cognitive stimulation activities: Structured social and cognitive activities can improve mood, reduce isolation, and support cognitive functioning. Engagement in familiar group settings may help maintain routine and provide emotional support.

“The groups are optional. Only clients at high functioning levels would benefit.” Activity groups are beneficial across a wide range of functional levels in long-term care settings. Participation can be adapted to the individual’s physical and cognitive abilities. Limiting participation based on functioning may reduce opportunities for engagement and stimulation.

“If your father doesn't go to these activity groups, he will be at high risk for developing dementia.” Dementia is not caused by lack of participation in activity groups. This statement may create unnecessary fear and does not reflect understanding of neurocognitive disorders.

“I'm glad we discussed this. We'll excuse him from the activity groups.” Automatically excusing the client removes opportunities for meaningful engagement without exploring benefits or preferences. Nursing care emphasizes promoting independence, stimulation, and psychosocial health.

After taking medications: Medication administration does not consistently correspond with worsening Alzheimer’s symptoms. While side effects may occur with certain drugs, symptom fluctuation related to time of day is more strongly linked to circadian and environmental factors. Timing alone does not explain increased symptom severity.

In the middle of the night: Some clients may awaken confused at night, but symptom escalation is more commonly observed earlier in the evening rather than during deep nighttime hours. Nighttime disturbances are often related to sleep disruption rather than the typical daily pattern of symptom worsening.

When they first awaken: Morning hours are often associated with improved orientation and alertness in clients with Alzheimer’s disease. Cognitive fatigue has not yet accumulated, and environmental cues are usually clearer. Pronounced symptom worsening is less likely at this time.

The client will verbalize two positive self-attributes by day 3 in treatment: Identifying positive self-attributes focuses on self-esteem building rather than directly addressing coping with feelings of loneliness. While self-esteem is important, it does not target the maladaptive behavior linked to the nursing diagnosis.

The client will list five ways that the body reacts to bingeing and purging: Education about physical consequences addresses knowledge and awareness but does not provide alternative coping strategies for managing loneliness or preventing maladaptive behaviors. Knowledge alone may not change behavior.

The client will appropriately express angry feelings about lack of control by week 2 in treatment: Expressing anger relates to managing feelings of control, which is only partially related to coping with loneliness. The outcome does not directly target the identified trigger for bingeing and purging.