elderly

Question 1

Identify the three common cognitive disorders among the elderly. (3D)

Answer 1

i. Delirium (Acute Confusional State)
ii. Dementia
iii. Depression

Question 2

Describe the clinical presentations of delirium (3 disturbances + 2 other stuff)

Answer 2

• Acute onset AND Fluctuating consciousness
• impaired attention
• perceptual disturbance
• sleep-wake cycle disturbance (wake up at odd hours)
• psychomotor disturbance

can also test using The Confusion Assessment
Method (CAM) Diagnostic
Algorithm
Feature 1: Acute onset and fluctuating course
Feature 2: Inattention
Feature 3: Disorganized thinking
Feature 4: Altered level of consciousness
* present/abnormal rating for features 1 AND 2 and also for either feature 3 OR 4.

Question 3

Describe the BPSD of dementia +10 warning signs

Answer 3

BEHAVIORAL
 Aggression
 Wandering
 Sleep disturbances
 Inappropriate eating
behavior
 Constant questioning
 Shadowing
 Negativism

PSYCHOLOGICAL
 Hallucinations
 Delusions
 Depression
 Apathy
 Anxiety
 Misidentifications

10 warning signs of dementia
1. Recent memory loss that affects job skills
2. Misplacing things
3. Problems with language
4. Poor or decreased judgment
5. Problems with abstract thinking
6. Difficulty performing familiar tasks
7. Disorientation with time and place
8. Changes in mood or behavior
9. Changes in personality
10. Loss of initiative

Question 4

Describe the clinical presentations of depression

Answer 4

Atypical presentation:
- difficulty with concentration
* Pseudodementia (‘like dementia’)

• worries about health
• Preoccupation with health concerns or multiple vague physical complaints
• Signal or cry for help

Question 5

Discuss the management of delirium

Answer 5

 Admission
 Diagnostic tests (Identify treatable and reversible causes)
 Appropriate specific treatment
 Good supportive care (hydration, nutrition, avoidance of restrainers & bedsore prevention, bladder & bowel care &
speedier recovery)
 Quiet environment with good lighting & warm, friendly &
reassuring staff
 Sedatives to be used with caution

Question 6

Discuss the management of dementia

Answer 6

1. Identify any reversible causes of dementia
2. Exclude delirium and unmet needs
3. Identify and quantify common psychiatric
   syndromes
4. Identify target symptoms
5. Assess need for treatment
6. Non-pharmacological strategies:
    Cognitive retraining
    Reminiscence therapy
    Life review
    Art therapy
    Music therapy
    Aromatherapy
    Pet therapy
    Physiotherapy (physical
   exercise)
7. Pharmacological treatments:
   Disease modifying agents
8. Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine)
   *Common side effects: nausea, vomiting, agitation,
   giddiness, bradycardia
9. NMDA antagonist (memantine)
   *Common side effects: giddiness, nausea, vomiting

Other psychotropic medications
1. Antipsychotics (risperidone, quetiapine, olanzapine,
haloperidol)
*common side-effects: anticholinergic effects,
extrapyramidal side-effects
2. Antidepressants (fluvoxamine, escitalopram, mirtazapine)
*Common side-effects: anticholinergic effects,
hypotension
3. Mood stabilizers (sodium valporate)
*Thrombocytopenia, bleeding tendencies
4. Benzodiazepines (lorazepam, clonazepam)
*Hypotension, sedation

Question 7

Discuss the management of depression

Answer 7

Antidepressants
- Newer generations (SSRIs) used as first line * safer if overdosed
* fewer anticholinergic side effects
* E.g. fluoxetin, fluoxamine, escitalopram, sertraline

-Tricyclic antidepressants
*E.g. imipramine, amitriptyline, nortriptyline

• MAO inhibitors
• E.g. phenelzine, trancylopramine
• Response ~80%

Other psychotropic agents
- Benzodiazepines
E.g. lorazepam, clonazepam
- Antipsychotics
E.g. risperidone, quetiapine, olanzepine
- mood stabilizers
E.g. sodium valproate, lithium

Psychotherapy (Talk therapy/Counseling)
- Dealing with relationship difficulties
- Problem solving
- Change negative thinking
- Acceptance

ECT
- Severely suicidal
- Refusal to eat or drink
- Unable to tolerate side-effects of medications

Question 8

The nurse is talking with a woman who is worried that her mother has
Alzheimer disease. The nurse knows that the first sign of dementia is
a. disorientation to person, place, or time.
b. memory loss that is more than ordinary forgetfulness.
c. inability to perform self-care tasks without assistance.
d. variable with different people.

Answer 8

b

Question 9

The nurse has been teaching a caregiver about donepezil (Aricept). The
nurse knows that teaching has been effective when the caregiver makes
which statement?
a. “Let’s hope this medication will stop the Alzheimer disease from
progressing any further.”
b. “It is important to take this medication on an empty stomach.”
c. “I’ll be eager to see if this medication makes any improvement in
concentration.”
d. “This medication will slow the progress of Alzheimer disease
temporarily.”

Answer 9

d

Question 10

When teaching a client about memantine (Namenda), the nurse will include which information?
a. Lab tests to monitor the client’s liver function are needed.
b. Namenda can cause elevated blood pressure.
c. Taking Namenda will improve the client’s cognitive functioning.
d. The most common side effect of Namenda is gastrointestinal
bleeding.

Answer 10

b

Question 11

Which statement by the caregiver of a client newly diagnosed with
dementia requires further intervention by the nurse?
a. “I will remind Mother of things she has forgotten.”
b. “I will keep Mother busy with favorite activities as long as she can participate.”
c. “I will try to find new and different things to do every day.”
d. “I will encourage Mother to talk about her friends and family.”

Answer 11

c

Question 12

A client with delirium is attempting to remove the IV tubing from his
arm, saying to the nurse, “Get off me! Go away!” What is the client
experiencing?
a. Delusions
b. Hallucinations
c. Illusions
d. Disorientation

Answer 12

b

Question 13

Which statement indicates the caregiver’s accurate knowledge about the needs of a parent at the onset of the moderate stage of dementia?
a. “I need to give my parent a bath at the same time every day.”
b. “I need to postpone any vacations for 5 years.”
c. “I need to spend time with my parent doing things we both enjoy.”
d. “I need to stay with my parent 24 hours a day for supervision.”

Answer 13

c

Question 14

Which of the following interventions is most appropriate in helping a client with early-stage dementia complete ADLs?
a. Allow enough time for the client to complete ADLs as independently as possible.
b. Provide the client with a written list of all the steps needed to
complete ADLs.
c. Plan to provide step-by-step prompting to complete the ADLs.
d. Tell the client to finish ADLs before breakfast or the nursing
assistant will do them.

Answer 14

a

Question 15

A client with late moderate-stage dementia has been admitted to a
long-term care facility. Which nursing intervention will help the client maintain optimal cognitive function?
a. Discuss pictures of children and grandchildren with the client.
b. Do word games or crossword puzzles with the client.
c. Provide the client with a written list of daily activities.
d. Watch and discuss the evening news with the client.

Answer 15

a

Question 16

Select all that apply.
When assessing a client with delirium, the nurse will expect to see
a. aphasia.
b. confusion.
c. impaired level of consciousness.
d. long-term memory impairment.
e. mood fluctuations.
f. rapid onset of symptoms.

Answer 16

b, c, f

Question 17

Select all that apply.
Interventions for clients with dementia that follow the psychosocial
model of care include
a. asking the clients about the places where they were born.
b. correcting the any misperceptions or delusion.
c. finding activities that engage the clients’ attention.
d. introducing new topics of discussion at dinner.
e. processing behavioral problems to improve coping skills.
f. providing unrelated distractions when clients are agitated.

Answer 17

a, c, f