Review Practice Exercise 4

Dementia And Alzheimer’s Disease > Mental Health

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Practice Exercise 4

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Total Questions : 4

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Question 1:

A client who has a neurocognitive disorder due to Alzheimer’s disease, says to the nurse, “I have a date tonight. I always have a date on Christmas.” Which of the following is the most appropriate response?

A. “Don’t be silly. It’s not Christmas” B. “Today is Tuesday, Oct. 21. We will have supper soon, and then your daughter will come to visit.” C. “Who is your date with?” D. “I think you need some more medication. I’ll bring it to you now.”

Answer and Explanation

Choice A:

Telling the client “Don’t be silly” is dismissive and confrontational, which may increase frustration or agitation.

Choice B:

Providing the correct date and factual information about upcoming events gently reorients the client without confrontation. This approach reduces anxiety, maintains trust, and supports cognitive functioning while addressing the client’s confusion.

Choice C:

Asking about the date without clarification reinforces the client’s confabulation and does not provide orientation or reassurance.

Choice D:

Suggesting the client needs more medication is dismissive, nontherapeutic, and inappropriate, as it blames the client rather than addressing confusion with reality orientation.

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Question 2:

A nurse is teaching the wife of a client who has mild symptoms of dementia how to more effectively communicate with her spouse. The teaching would be considered successful if the nurse observed the wife:

A. Having a face-to-face conversation with her husband. B. Talking quietly into her husband’s ear. C. Discussing only events related to their past. D. Speaking loudly and enunciating each word.

Answer and Explanation

Choice A:

Face-to-face conversation allows the client to use visual cues such as facial expressions and lip movements, which improve understanding. It also fosters connection and reduces distraction, making communication clearer and more supportive in mild dementia.

Choice B:

Talking quietly into the ear may reduce clarity and eliminate visual reinforcement. Clients with dementia often rely on visual cues, so this method increases confusion and does not enhance comprehension.

Choice C:

Discussing only past events limits communication and does not support orientation to the present. While reminiscence can be comforting, effective communication requires addressing both current and past topics to maintain orientation and engagement.

Choice D:

Speaking loudly and enunciating each word may appear confrontational and can increase agitation. Dementia clients benefit more from calm, clear, and supportive communication rather than exaggerated speech patterns.

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Question 3:

A client is experiencing acute confusion due to poisoning from an accidental exposure to toxic chemicals in the workplace. What type of behavior should the nurse expect this client to demonstrate upon admission to the nursing unit?

A. Inability to eat without experiencing nausea. B. Frequently verbalizing ambivalent feelings. C. Difficulty expressing ideas and needs. D. Despondency in the presence of family members.

Answer and Explanation

Choice A:

Nausea may occur with chemical exposure but is a gastrointestinal symptom, not the defining feature of acute confusion. The stem emphasizes cognitive impairment, making this option less appropriate.

Choice B:

Ambivalent feelings reflect emotional conflict but are not typical of acute delirium. The primary issue is disorganized thought and impaired communication, not frequent verbalization of mixed emotions.

Choice C:

Toxic poisoning alters cognitive processing and language function, resulting in difficulty expressing ideas and needs. This is consistent with acute delirium, where impaired attention and disorganized thinking are hallmark features. The nurse should expect communication deficits upon admission.

Choice D:

Despondency in the presence of family suggests depression or withdrawal. Acute confusion from poisoning presents with fluctuating cognition and communication deficits, not sustained despondency.

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Question 4:

A client on an in-patient psychiatric unit is exhibiting extreme agitation. Using a behavioral approach, which nursing intervention should be implemented?

A. The nurse should role-play stressful situations to assist the client to cope with agitation. B. The nurse should develop a plan to deal with stressors during a family meeting. C. The nurse should give ordered PRN medications to decrease anxiety and agitation. D. The nurse should discuss emotional triggers, which precipitate angry outbursts.

Answer and Explanation

Choice A:

Role-playing stressful situations requires cognitive engagement and calmness. Attempting this during extreme agitation is unsafe and may escalate behaviors.

Choice B:

Developing a stressor plan in a family meeting is long-term planning. It does not address the immediate risk of harm posed by extreme agitation.

Choice C:

Administering PRN medications effectively decreases anxiety and agitation, lowering the risk of harm to the client and others. This rapid, evidence-based intervention allows the client to regain self-control, enabling future behavioral or therapeutic interventions.

Choice D:

Discussing emotional triggers requires reflection and cooperation, which is not possible during a hyperaroused state. Attempting this may increase agitation rather than reduce it.

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Practice Exercise 4

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