Cognitive Impairment Disorders Practice Quiz (15 Questions)

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Cognitive decline and loss of social functioning may constitute the biggest root of disability among persons in nursing facilities. Moreover, both impairments double over time in contrast to psychiatric symptoms, which appear to have a more variable course. This 15-item NCLEX practice exam may have implications for treatment interventions that attempt to heighten functioning in the skilled nursing setting.

“If you fail an examination, it means you have not yet master the subject. With diligent study and understanding, you will succeed in passing the exams.”
― Lailah Gifty Akita, Pearls of Wisdom: Great mind

Topics

Concepts and topics included in this practice exam are as follows:

Guidelines

Follow the guidelines below to make the most out of this exam:

  • Read each question carefully and choose the best answer.
  • You are given one minute per question. Spend your time wisely!
  • Answers and rationales are given below. Be sure to read them.
  • If you need more clarifications, please direct them to the comments section.

Questions

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Cognitive Impairment Disorders Practice Quiz (15 Questions)

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1. Nurse Isabelle enters the room of a client with a cognitive impairment disorder and asks what day of the week it is; what the date, month, and year are; and where the client is. The nurse is attempting to assess:

A. confabulation.
B. delirium.
C. orientation.
D. perseveration.

2. A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition?

A. Memory loss occurring as part of the natural consequence of aging
B. Difficulty coping with physical and psychological change
C. Severe cognitive impairment that occurs rapidly
D. Loss of cognitive abilities, impairing ability to perform activities of daily living

3. Which of the following will Nurse Dory use when communicating with a client who has cognitive impairment.

A. Complete explanations with multiple details
B. Pictures or gestures instead of words
C. Stimulating words and phrases to capture the client’s attention
D. Short words and simple sentences

4. Mrs. Mendoza is a 75-year-old client who has dementia of the Alzheimer’s type and confabulates. The nurse understands that this client:

A. Denies confusion by being jovial.
B. Pretends to be someone else.
C. Rationalizes various behaviors.
D. fills in memory gaps with fantasy.

5. Which ability should Nurse Rebecca expect from a client in the mild stage of dementia of the Alzheimer’s type?

A. Remembering the daily schedule
B. Recalling past events
C. Coping the anxiety
D. Solving problems of daily living

6. 82-year-old Mr. Robeson together with his daughter arrived at the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client’s daughter best supports the diagnosis?

A. “Maybe it’s just caused by aging. This usually happens by age 82.”
B. “The changes in his behavior came on so quickly! I wasn’t sure what was happening.”
C. “Dad just didn’t seem to know what he was doing. He would forget what he had for breakfast.”
D. “Dad has always been so independent. He’s lived alone for years since mom died.”

7. Mrs. Jordan is an elderly client diagnosed with Alzheimer’s disease. She becomes agitated and combative when a nurse approaches to help with morning care. The most appropriate nursing intervention in this situation would be to:

A. tell the client firmly that it is time to get dressed.
B. obtain assistance to restrain the client for safety.
C. remain calm and talk quietly to the client.
D. call the doctor and request an order for sedation.

8. Which goal is a priority for a client with a DSM-IV-TR diagnosis of delirium and the nursing diagnosis Acute confusion related to recent surgery secondary to traumatic hip fracture?

A. The client will complete activities of daily living.
B. The client will maintain safety.
C. The client will remain oriented.
D. The client will understand communication.

9. Which of the following is not included in the care of plan of a client with a moderate cognitive impairment involving dementia of the Alzheimer’s type?

A. Daily structured schedule
B. Positive reinforcement for performing activities of daily living
C. Stimulating environment
D. Use of validation techniques

10. In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called:

A. Aphasia.
B. Agnosia.
C. Sundowning.
D. Confabulation.

11. 80-year-old Mr. Stevens is accompanied to the clinic by his son, who tells the nurse that the client’s constant confusion, incontinence, and tendency to wander are intolerable. The client was diagnosed with chronic cognitive impairment disorder. Which nursing diagnosis is most appropriate for the client’s son?

A. Risk for other-directed violence
B. Disturbed sleep pattern
C. Caregiver role strain
D. Social isolation

12. Which of the following outcome criteria is appropriate for the client with dementia?

A. The client will return to an adequate level of self-functioning.
B. The client will learn new coping mechanisms to handle anxiety.
C. The client will seek out resources in the community for support.
D. The client will follow an established schedule for activities of daily living.

13. A family member expresses concern to a nurse about behavioral changes in an elderly aunt. Which would cause the nurse to suspect a cognitive impairment disorder?

A. Decreased interest in activities that she once enjoyed
B. Fearfulness of being alone at night
C. Increased complaints of physical ailments
D. Problems with preparing a meal or balancing her checkbook

14. During the home visit of a client with dementia, the nurse notes that an adult daughter persistently corrects her father’s misperceptions of reality, even when the father becomes upset and anxious. Which intervention should the nurse teach the caregiver?

A. Anxiety-reducing measures
B. Positive reinforcement
C. Reality orientation techniques
D. Validation techniques

15. Mr. Lim who is diagnosed with moderate dementia has frequent catastrophic reactions during shower time. Which of the following interventions should be implemented in the plan of care? Select all that apply.

A. Assign consistent staff members to assist the client.
B. Accomplish the task quickly, with several staff members assisting.
C. Schedule the client’s shower at the same time of day.
D. Sedate the client 30 minutes prior to showering.
E. Tell the client to remain calm while showering.
F. Use a calm, supportive, quiet manner when assisting the client.

Answers and Rationale


1.  Answer: C. Orientation.

The initial, most basic assessment of a client with cognitive impairment involves determining his level of orientation (awareness of time, place, and person).

  • Options A and D: The nurse may also assess for confabulation and perseveration in a client with cognitive impairment but the questions in this situation would not elicit the symptom response.
  • Option B: Delirium is a type of cognitive impairment; however, other symptoms are necessary to establish this diagnosis.

2. Answer: D. Loss of cognitive abilities, impairing ability to perform activities of daily living

The impaired ability to perform self-care is an important measure of a client’s dementia progression and loss of cognitive abilities. Difficulty or impaired ability to perform normal activities of daily living, such as maintaining hygiene and grooming, toileting,  making meals, and maintaining a household, are significant indications of dementia. Slowing of processes necessary for information retrieval is a normal consequence of aging. However, the global statement that memory loss occurs as part of natural aging is not true.

  • Option A: Dementia is not normal; it is a disease.
  • Option B: Difficulty coping with changes can be experienced by any client, not just one with dementia.
  • Option C: The rapid occurrence of cognitive impairment refers to delirium.

3. Answer: D. Short words and simple sentences

Short words and simple sentences minimize client confusion and enhance communication.

  • Options A and C: Complete explanations with multiple details and stimulating words and phrases would increase confusion in a client with short attention span and difficulty with comprehension.
  • Option B: Although pictures and gestures may be helpful, they would not substitute for verbal communication.

4. Answer: D. fills in memory gaps with fantasy.

Confabulation is a communication device used by patients with dementia to compensate for memory gaps.

5. Answer: B. Recalling past events

Recent memory loss is the characteristic sign of cognitive difficulty in early Alzheimer’s disease. The ability to recall past events is usually retained until the later stages of this disorder.

  • Options A, C, and D: Remembering daily schedules, coping with anxiety, and solving problems of daily living are areas that would pose difficulty in the early phase of Alzheimer’s disease.

6. Answer: B. “The changes in his behavior came on so quickly! I wasn’t sure what was happening.”

Delirium is an acute process characterized by abrupt, spontaneous cognitive dysfunction.

  • Option A: Cognitive impairment disorders (dementia or delirium) are not normal consequences of aging.
  • Option C would be characteristic of someone with dementia.
  • Although Option D provides background data about the client, it is unrelated to the current problem of delirium.

7. Answer: C. Remain calm and talk quietly to the client.

Maintaining a calm approach when intervening with an agitated client is extremely important.

  • Option A: Telling the client firmly that it is time to get dressed may increase his agitation, especially if the nurse touches him.
  • Option B: Restraints are a last resort to ensure client safety and are inappropriate in this situation.
  • Option D: Sedation should be avoided, if possible, because it will interfere with CNS functioning and may contribute to the client’s confusion.

8. Answer: B. The client will maintain safety.

Maintaining safety is the priority goal for an acutely confused client who recently had surgery. All measures to promote physiologic safety and psychosocial wellbeing would be implemented.

  • Option A: This client would not be able of completing activities of daily living, and safety is a priority over these tasks.
  • Options C and D: The goals of remaining oriented and understanding communication would be appropriate only after the client’s acute confusion has resolved.

9. Answer: C. Stimulating environment

A stimulating environment is a source of confusion and anxiety for a client with a moderate level of impairment and, therefore, would not be included in the plan of care.

10. Answer: C. Sundowning.

Sundowning is a common phenomenon that occurs after daylight hours in a client with a cognitive impairment disorder.

  • Options A, B, and D: The other options are incorrect responses, although all may be seen in this client.

11. Answer: C. Caregiver role strain

The son’s description exemplifies some of the problems commonly encountered by a primary caregiver who is caring for someone with a cognitive impairment disorder.

  • Options A, B, and D: Although the other nursing diagnoses are possibilities; the scenarios do not provide enough information to validate any of these.

12. Answer: D. The client will follow an established schedule for activities of daily living.

Following established activity schedules is a realistic expectation for clients with dementia.

  • Options A, B, and C: All of the remaining outcome statements require a higher level of cognitive ability that can be realistically expected of clients with this disorder.

13. Answer: D. Problems with preparing a meal or balancing her checkbook

Making a meal and balancing a checkbook are higher level cognitive functions that, when unable to be performed, may signal onset of a cognitive disorder.

  • Options A, B, and C: Although the remaining behaviors may occur, they are not associated only with cognitive impairment and may indicate depression or other problems.

14. Answer: D. Validation techniques

Validation techniques are useful measures for making emotional connections with a client who can no longer maintain reality orientation. These measures are also helpful in decreasing anxiety.

  • Options A and B: Anxiety-reducing measures and positive reinforcements will also be appropriate, but validation techniques will provide both anxiety reduction and positive reinforcement for the client.
  • Option B: Reality orientation techniques are not useful when the client can no longer maintain reality contact and becomes upset when misperceptions are corrected.

15. Answer: A, C, and F

Maintaining a consistent routine with the same staff members will help decrease the client’s anxiety that occurs whenever changes are made. A calm, quiet manner will be reassuring to the client, also helping to minimize anxiety.

  • Option B: Moving quickly with several staffs will increase the client’s anxiety and may precipitate a catastrophic reaction.
  • Option D: The use of sedation is not indicated and may increase the risk of client injury from the side effect of drowsiness.
  • Option E: Telling the client to remain calm is inappropriate because a client with dementia cannot respond to such a direction.

See Also


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2 COMMENTS

  1. in #15 , select all that apply, Why is the first choice wrong? Even in the rationale it states you should maintain consistent staff.

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