eBay:testbanks_and_xanax

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 23-22, 47 (Table 23-5) | Pages 23-24, 25, 53 (Table 23-8) | Page 23-30 (Case Study and Nursing Care Plan 23-1)

TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance eBay: testbanks_and_xanax a. Impaired level of consciousness b. Disorientation to place, time c. Wandering attention d. Apathy e. Agnosia

2. Which assessment findings would the nurse expect in a patient experiencing delirium? (Select all that apply.)

ANS: A, B, C

Disorientation to place and time is an expected finding. Orientation to person (self) usually remains intact. Attention span is short, and difficulty focusing or shifting attention as directed is often noted. Patients with delirium commonly experience illusions and hallucinations. Fluctuating levels of consciousness are expected. Agnosia occurs with dementia. Apathy is associated with depression.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 23-3, 4, 45 (Table 23-4) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Acute confusion b. Anticipatory grieving c. Urinary incontinence d. Disturbed sleep pattern e. Risk for caregiver role strain

3. Which nursing diagnoses are most applicable for a patient diagnosed with severe late stage Alzheimer’s disease? (Select all that apply.)

ANS: C, D, E

The correct answers are consistent with problems frequently identified for patients with late-stage Alzheimer’s disease. Confusion is chronic, not acute. The patient’s cognition is too impaired to grieve.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 23-21, 49 (Table 23-6) | Page 23-30 (Case Study and Nursing Care Plan 23-1)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity eBay: testbanks_and_xanax