Comprehensive exams for Mental Health Q 97
The nurse 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
Correct 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). Interviews to assess memory, behavior, mood and functional status (especially complex actions such as driving and managing money are best conducted with the patient alone, so that family members or companions cannot prompt the patient. Information can also be gleaned from the patient’s behavior on arrival in the doctor’s office and interactions with staff.
Option A: 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. Cognitive impairment in older adults has a variety of possible causes, including medication side effects, metabolic and/or endocrine derangements, delirium due to intercurrent illness, depression and dementia, with Alzheimer’s dementia being most common. Some causes, like medication side effects and depression, can be reversed with treatment. Others, such as Alzheimer’s disease, cannot be reversed, but symptoms can be treated for a period of time and families can be prepared for predictable changes.
Option B: Delirium is a type of cognitive impairment; however, other symptoms are necessary to establish this diagnosis. Delirium, also known as the acute confusional state, is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of consciousness and cognition with reduced ability to focus, sustain, or shift attention. It develops over a short period and fluctuates during the day. The clinical presentation can vary, but usually, it flourishes with psychomotor behavioral disturbances such as hyperactivity or hypoactivity with increased sympathetic activity and impairment in sleep duration and architecture.
Option D: The nurse may also assess for perseveration in a client with cognitive impairment, but the questions in this situation would not elicit the symptom response. Many people who are developing or have dementia do not receive a diagnosis. One study showed that physicians were unaware of cognitive impairment in more than 40 percent of their cognitively impaired patients. Another study found that more than half of patients with dementia had not received a clinical cognitive evaluation by a physician. The failure to evaluate memory or cognitive complaints is likely to hinder treatment of underlying disease and comorbid conditions, and may present safety issues for the patient and others. In many cases, the cognitive problem will worsen over time.