Alzheimer’s Delirium and Dementia Q 34
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.
Correct Answer: D. Fills in memory gaps with fantasy.
Confabulation is a communication device used by patients with dementia to compensate for memory gaps. Confabulation is a type of memory error in which gaps in a person’s memory are unconsciously filled with fabricated, misinterpreted, or distorted information. When someone confabulates, they are confusing things they have imagined with real memories. A person who is confabulating is not lying. They are not making a conscious or intentional attempt to deceive. Rather, they are confident in the truth of their memories even when confronted with contradictory evidence.
Option A: Denial is a defense mechanism proposed by Anna Freud which involves a refusal to accept reality, thus blocking external events from awareness. If a situation is just too much to handle, the person may respond by refusing to perceive it or by denying that it exists.
Option B: Reaction formation is a psychological defense mechanism in which a person goes beyond denial and behaves in the opposite way to which he or she thinks or feels. Conscious behaviors are adopted to overcompensate for the anxiety a person feels regarding their socially unacceptable unconscious thoughts or emotions. Usually, a reaction formation is marked by exaggerated behavior, such as showiness and compulsiveness. By using the reaction formation, the id is satisfied while keeping the ego in ignorance of the true motives. Therapists often observe reaction formation in patients who claim to strongly believe in something and become angry at everyone who disagrees.
Option C: Rationalization is a defense mechanism proposed by Anna Freud involving a cognitive distortion of “the facts” to make an event or an impulse less threatening. We do it often enough on a fairly conscious level when we provide ourselves with excuses. But for many people, with sensitive egos, making excuses comes so easy that they never are truly aware of it. In other words, many of us are quite prepared to believe our lies.