Answer each of the
following questions (there is only one correct answer to each question).
1
The relationship between acute confusion and delirium is that:
A. delirium is more likely to be seen among residents in long term care
B. symptoms of confusion precede the development of delirium
C. delirium is chronic in nature
D. the terms are used interchangeably to describe the same symptoms
2
Chronic confusion (dementia) is :
A. long-term
B. progressive
C. possibly degenerative
D. all of the above
3
Acute confusion in institutional settings such as hospitals and nursing homes is:
A. the most frequent diagnosis among the elderly
B. rare but easy to recognize
C. likely to complicate the course of treatment
D. all of the above
4
Assessment of the confused patient begins with:
A. establishment of a behavioral baseline
B. evaluation of results of laboratory tests
C. observation of interactions with family and friends
D. reduction of unnecessary medication
5
Normal , age-related changes seen in elderly patients may include:
A. medication effects
B. most reliable memory for recent events
C. diminished adaptability of the brain to change
D. disruptions in lifestyle
6
Physical conditions that are risk factors for the development of delirium include:
A. fluid and electrolyte imbalances
B. muscle weakness
C. osteoporosis
D. all of the above
7
The elderly are more likely to exhibit cognitive impairment from taking medications because:
A. they take too many medications
B. they are less compliant with medication regimens
C. their body’s ability to handle various drugs changes with age
D. caregivers are more sensitive to cognitive changes in this age group
8
In evaluating a patient’s medication history, the nurse should keep in mind that:
A. drug-induced confusion from non-psychoactive drugs is rare but easy to diagnose
B. narcotic agents are seldom the source of delirium in postoperative patients
C. total anticholinergic burden may be more important in development of confusion than any single medication
D. drugs have been implicated as the cause of confusion in over 60% of cases among the elderly
9
Mechanical causes of confusion would include:
A. damage from a stroke or traumatic injury
B. blood sugar abnormalities
C. anesthesia used during surgical procedures
D. changes in residential setting or circumstances
10
Belligerent and uncooperative behavior from confused patients is most likely due to:
A. resentment toward the nursing staff
B. communication and attention problems
C. family conflicts
D. a history of psychiatric illness
11
Specific etiologic factors in the development of sundown syndrome include all of the following except :
A. sleep apnea and other sleep disturbances
B. deterioration of the cerebellum
C. reduced levels of structured activities
D. decreased visual acuity
12
What variables must be considered when initially assessing confusion?
A. Age and sex
B. Culture
C. Race
D. All of the above affect perception of what words mean
13
All of the following are traditional ways to assure the safety of agitated patients except :
A. reality orientation
B. use of medication
C. supervision by sitters or family members
D. mechanical restraints
14
Use of a combination of lorazepam and risperidone for management of acute agitation may become the treatment of choice in the future because:
A. risperidone is better tolerated than haloperidol
B. lorazepam can be given orally or IM
C. these drugs are effective in preventing long term behavior problems
D. this combination is less costly than older alternatives
15
The probability of being mechanically restrained increases if the elderly patient:
A. has been on the unit for a week or less.
B. presents a risk for falls or other injuries.
C. requires more specialized nursing care than other patients.
D. all of the above.
16
When the elderly patient is restrained, the nursing staff may expect to see:
A. an increase in agitated behavior
B. a reduction in number of medications prescribed
C. an increase in respiratory complications
D. a decreased risk for development of pressure sores
17
What is true regarding the belief in the healing power of music :
A. It soothes the savage beast
B. It triggers positive emotions
C. It was used in the Bible
D. All of the above are true
18
If a confused patient becomes agitated and pulls continually at his urinary catheter, the staff should consider:
A. use of a leg bag
B. hiding the tubing between the legs
C. removal of the catheter as soon as possible
D. all of the above
19
Decisions regarding the number of visitors allowed a confused patient should be based primarily on:
A. facility visitation policies
B. the level of stimulation that the patient can tolerate
C. the judgment of family members
D. the patient’s wishes
20
When providing reality orientation to a confused patient, the staff should:
A. focus on reinforcement of details of recent events
B. patiently correct misstatements by the patient, even if the patient gets upset
C. evaluate the patient’s awareness of time of day; month or season, rather than specific date and time
D. remove clocks, calendars, and other clues to the answers to orientation questions
21
All of the following are appropriate interventions with the elderly confused patient except :
A. providing simple instructions and explanations for all treatments and procedures
B. encouraging the patient to complete one task before starting another
C. paying attention to all complaints, even if they seem unreasonable
D. persisting with the patient’s care even when the patient has become resistive and angry
22
Classification of spiritual distress for nursing diagnosis relates to which two phenomena?
A. conflict of wanting to pray and not knowing God
B. conflict between spiritual beliefs and health regimen & inability to practice spiritual rituals
C. conflict between believing they are unimportant to staff and family members
D. none of the above relate to spiritual distress
23
How many categories can serve as a guide for assessing spiritual needs of people?
A. two
B. four
C. six
D. eight
24
After hospitalization for an acute episode of confusion, the discharge plan should include:
A. patient and caregiver education
B. ways to avoid further episodes of confusion
C. recommendations for home health care if needed
D. all of the above
25
Interventions for the patient with dementia are generally geared toward:
A. treating the underlying cause of the dementia
B. keeping the patient as functional as possible
C. use of medication for behavior management
D. encouraging the family to consider placement options
26
What types of support are available to the family/caregiver?
A. Personal
B. Educational
C. Spiritual
D. all of the above
27
Practical tips for family members distressed by their loved one’s confusion include:
A. comfort with a touch or supportive word
B. referral to a support group
C. meeting with a lawyer for financial, legal and healthcare issues
D. all of the above
28
What are ways to make the home safe for the confused patient?
A. Remove throw rugs and clutter
B. Install locks on cabinets and bolt doors that lead to the outside
C. Post signs on doors that say “Stop”, “Closed”
D. All are ways to make the home safe
29
In light of the fact that Mr. Jones was eventually determined to have chronic confusion associated with dementia, the aggressive and comprehensive medical workup given him was:
A. expensive and of limited diagnostic use
B. unnecessary in light of the observations of the nurse who saw him regularly
C. appropriate to rule out treatable causes for his confusion
D. a major contributing factor to his cognitive decline
30
The progression of Mr. Jones’ disease from initial diagnosis to death is unusual in that:
A. his friend disagreed with his caregivers on the severity of his symptoms
B. his life span after diagnosis was so short
C. he developed balance problems in addition to his cognitive deficits
D. he was able to communicate his thoughts and needs to the very end
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