📘 Delirium
✅ Definition:
Delirium is an acute, fluctuating, and reversible disturbance of consciousness, attention, cognition, and perception, often associated with an underlying medical condition.
🎯 Prevalence:
- Common in elderly patients, especially those hospitalized or in intensive care units (ICUs).
- Prevalence:
- 10-30% in general hospital admissions.
- 30-80% in ICU and postoperative patients.
- More frequent in patients with dementia, infections, and chronic illnesses.
✅ Etiology (Causes):
📚 Mnemonic – DELIRIUM:
| D – Drugs/Withdrawal (alcohol, benzodiazepines, opioids)
| E – Electrolyte Imbalances (hyponatremia, hypercalcemia)
| L – Lack of Drugs (sudden withdrawal, undertreatment of pain)
| I – Infection (UTI, pneumonia, sepsis, meningitis)
| R – Reduced Sensory Input (blindness, deafness, isolation)
| I – Intracranial Causes (stroke, head injury, brain tumors)
| U – Urinary Retention and Fecal Impaction
| M – Metabolic Disorders (hypoglycemia, hepatic/renal failure, hypoxia)
✅ Risk Factors:
- Old age (>65 years)
- Dementia or cognitive impairment
- Post-surgery, especially orthopedic and cardiac surgeries
- Severe illness or ICU stay
- Alcohol or substance use/withdrawal
- Multiple medications (polypharmacy)
✅ Signs and Symptoms:
📌 Cognitive Symptoms:
- Impaired attention and concentration
- Disorientation (time, place, person)
- Memory disturbances (especially recent memory)
- Confusion
📌 Perceptual Disturbances:
- Visual hallucinations (common)
- Illusions and misinterpretation of stimuli
📌 Behavioral Symptoms:
- Restlessness, agitation, or aggression
- Sleep-wake cycle disturbances (reversed sleep patterns)
- Emotional lability (sudden mood changes)
📌 Types of Delirium:
| Hyperactive Type: Agitation, hallucinations, restlessness
| Hypoactive Type: Lethargy, reduced activity, withdrawn behavior
| Mixed Type: Fluctuations between hyperactive and hypoactive symptoms
✅ Prognosis:
- Generally reversible if underlying cause is identified and treated early.
- Delayed treatment can lead to permanent cognitive decline, especially in elderly patients with pre-existing dementia.
- High mortality risk if associated with severe medical conditions or ICU stay.
✅ Medical Management:
| 1. Identify and Treat Underlying Cause:
- Correct electrolyte imbalances.
- Treat infections with antibiotics.
- Manage hypoxia, hypoglycemia, or metabolic disturbances.
| 2. Pharmacological Management:
- Antipsychotics (for severe agitation):
- Haloperidol (preferred, low dose)
- Risperidone or Olanzapine (if Haloperidol is contraindicated)
- Avoid benzodiazepines, except in cases of alcohol withdrawal delirium.
- Provide adequate hydration and nutrition.
✅ Nursing Management:
| Assessment:
- Assess cognitive status (using MMSE or CAM – Confusion Assessment Method).
- Monitor vital signs and oxygen saturation.
- Identify potential environmental stressors.
| Interventions:
- Provide a calm, well-lit, and familiar environment.
- Reorient the patient frequently (use clocks, calendars, familiar objects).
- Ensure patient safety:
- Use bed alarms if needed.
- Avoid physical restraints unless absolutely necessary.
- Encourage family involvement for reassurance.
- Promote regular sleep patterns and minimize nighttime disturbances.
- Monitor medication side effects closely.
- Educate family members about the reversible nature of delirium with appropriate treatment.
📌 Golden One-Liners for Quick Revision:
- 🧠 “Delirium is acute, reversible, and fluctuates throughout the day.”
- 🧠 “Visual hallucinations are common in delirium.”
- 🧠 “The most common cause of delirium in the elderly is infection (UTI, pneumonia).”
- 🧠 “CAM (Confusion Assessment Method) is used for delirium diagnosis.”
- 🧠 “Haloperidol is the drug of choice for delirium with severe agitation.”
- ✅ 1. Which of the following is the most common perceptual disturbance seen in delirium?
- A) Auditory Hallucinations
B) Visual Hallucinations
C) Tactile Hallucinations
D) Olfactory Hallucinations
- Correct Answer: B) Visual Hallucinations
Rationale: Visual hallucinations are most common in delirium, especially in elderly and medically ill patients.
·
- ✅ 2. Which of the following is the preferred drug for managing severe agitation in delirium?
- A) Diazepam
B) Haloperidol
C) Lorazepam
D) Alprazolam
- Correct Answer: B) Haloperidol
Rationale: Haloperidol is the antipsychotic of choice for controlling agitation in delirium due to its effectiveness and low sedative properties.
·
- ✅ 3. Which tool is most commonly used to assess delirium in clinical practice?
- A) Glasgow Coma Scale
B) Confusion Assessment Method (CAM)
C) Mini-Mental Status Examination (MMSE)
D) Beck Depression Inventory
- Correct Answer: B) Confusion Assessment Method (CAM)
Rationale: CAM is a widely used, quick, and reliable tool for diagnosing delirium at the bedside.
·
- ✅ 4. In which type of delirium are patients most likely to appear quiet, withdrawn, and lethargic?
- A) Hyperactive Delirium
B) Hypoactive Delirium
C) Mixed Delirium
D) Excited Delirium
- Correct Answer: B) Hypoactive Delirium
Rationale: Hypoactive delirium presents with decreased motor activity, lethargy, and reduced responsiveness, often leading to delayed diagnosis.
·
- ✅ 5. Which of the following is a common cause of delirium in elderly hospitalized patients?
- A) Acute Myocardial Infarction
B) Urinary Tract Infection
C) Hyperthyroidism
D) Obsessive-Compulsive Disorder
- Correct Answer: B) Urinary Tract Infection
Rationale: UTIs are a very common precipitating factor for delirium in elderly patients, even in the absence of classical urinary symptoms.
- ✅ 1. What is the most common perceptual disturbance in delirium?
- A) Auditory Hallucinations
B) Visual Hallucinations
C) Olfactory Hallucinations
D) Tactile Hallucinations
- Correct Answer: B) Visual Hallucinations
Rationale: Visual hallucinations are the hallmark perceptual disturbances seen in delirium, especially in elderly patients.
·
- ✅ 2. Which clinical tool is most commonly used to assess delirium?
- A) Beck Depression Inventory
B) Confusion Assessment Method (CAM)
C) Glasgow Coma Scale
D) MMSE
- Correct Answer: B) Confusion Assessment Method (CAM)
Rationale: CAM is a validated, widely used bedside tool for diagnosing delirium.
·
- ✅ 3. Which of the following is the drug of choice for managing agitation in delirium?
- A) Lorazepam
B) Haloperidol
C) Diazepam
D) Lithium
- Correct Answer: B) Haloperidol
Rationale: Haloperidol is effective in controlling agitation without causing excessive sedation.
·
- ✅ 4. Delirium is characterized by:
- A) Chronic cognitive impairment
B) Acute onset and fluctuating consciousness
C) Gradual memory loss
D) Fixed false beliefs
- Correct Answer: B) Acute onset and fluctuating consciousness
Rationale: Delirium is an acute and reversible condition with fluctuating attention and awareness.
·
- ✅ 5. Which of the following is a common cause of delirium in the elderly?
- A) Urinary Tract Infection (UTI)
B) Schizophrenia
C) Hypothyroidism
D) Chronic Depression
- Correct Answer: A) Urinary Tract Infection (UTI)
Rationale: UTIs are a frequent cause of delirium in elderly patients, often presenting without typical urinary symptoms.
·
- ✅ 6. Which electrolyte imbalance is most commonly associated with delirium?
- A) Hypokalemia
B) Hyponatremia
C) Hypochloremia
D) Hypermagnesemia
- Correct Answer: B) Hyponatremia
Rationale: Low sodium levels can lead to cerebral edema and confusion, contributing to delirium.
·
- ✅ 7. Hypoactive delirium is often mistaken for:
- A) Mania
B) Depression
C) Schizophrenia
D) Anxiety Disorder
- Correct Answer: B) Depression
Rationale: Due to lethargy and decreased activity, hypoactive delirium may be misdiagnosed as depression.
·
- ✅ 8. Which of the following is NOT a characteristic feature of delirium?
- A) Acute Onset
B) Reversible Condition
C) Chronic Progression
D) Fluctuating Levels of Consciousness
- Correct Answer: C) Chronic Progression
Rationale: Delirium has an acute onset and is usually reversible, unlike dementia which is chronic and progressive.
·
- ✅ 9. In which condition should benzodiazepines be used cautiously for managing delirium?
- A) Alcohol Withdrawal Delirium
B) Hyperactive Delirium without substance use
C) Delirium associated with dementia
D) Postoperative Delirium
- Correct Answer: B) Hyperactive Delirium without substance use
Rationale: Benzodiazepines are mainly used in alcohol withdrawal delirium and should be avoided in other cases due to risk of worsening confusion.
·
- ✅ 10. Which factor increases the risk of developing delirium post-surgery?
- A) Young Age
B) Minimal Blood Loss
C) Prolonged Surgery Duration
D) Use of Local Anesthesia
- Correct Answer: C) Prolonged Surgery Duration
Rationale: Long surgeries, particularly with general anesthesia, increase the risk of postoperative delirium.
·
- ✅ 11. Which of the following is a cardinal feature of delirium?
- A) Sustained Attention
B) Impaired Consciousness and Attention
C) High Self-Esteem
D) Logical Thinking
- Correct Answer: B) Impaired Consciousness and Attention
Rationale: Impaired attention and fluctuating consciousness are core symptoms of delirium.
·
- ✅ 12. Which condition is most likely to cause delirium tremens?
- A) Benzodiazepine Overdose
B) Alcohol Withdrawal
C) Chronic Opioid Use
D) Caffeine Intoxication
- Correct Answer: B) Alcohol Withdrawal
Rationale: Delirium tremens is a severe form of alcohol withdrawal presenting with confusion and hallucinations.
·
- ✅ 13. Which nursing intervention is appropriate for managing a patient with delirium?
- A) Isolate the patient completely
B) Provide a calm and well-lit environment
C) Use physical restraints immediately
D) Avoid family involvement
- Correct Answer: B) Provide a calm and well-lit environment
Rationale: Environmental modifications help reduce anxiety and confusion in delirium.
·
- ✅ 14. Which of the following is a distinguishing feature of delirium compared to dementia?
- A) Chronic progressive decline
B) Reversible with treatment
C) Stable level of consciousness
D) No fluctuation in symptoms
- Correct Answer: B) Reversible with treatment
Rationale: Delirium is typically reversible once the underlying cause is addressed, while dementia is progressive.
·
- ✅ 15. What is the earliest sign of delirium?
- A) Disorientation to place
B) Impaired Attention
C) Delusions
D) Visual Hallucinations
- Correct Answer: B) Impaired Attention
Rationale: Difficulty maintaining and shifting attention is often the first observable symptom.
·
- ✅ 16. Which of the following conditions is a precipitating factor for postoperative delirium?
- A) Diabetes Mellitus
B) Sensory Deprivation
C) Early Mobilization
D) Good Pain Management
- Correct Answer: B) Sensory Deprivation
Rationale: Lack of sensory input, such as loss of hearing aids or glasses, can trigger confusion and delirium.
·
- ✅ 17. What is the first step in managing a patient with suspected delirium?
- A) Start sedatives immediately
B) Identify and treat the underlying cause
C) Transfer to a psychiatric facility
D) Use physical restraints
- Correct Answer: B) Identify and treat the underlying cause
Rationale: Delirium management begins with correcting the medical or environmental cause.
·
- ✅ 18. The confusion assessment method (CAM) focuses on assessing:
- A) Hallucinations only
B) Orientation and Memory Only
C) Acute Onset, Inattention, Disorganized Thinking, and Altered Consciousness
D) Intelligence and IQ
- Correct Answer: C) Acute Onset, Inattention, Disorganized Thinking, and Altered Consciousness
Rationale: These are the four main features assessed in CAM to diagnose delirium.
·
- ✅ 19. Which symptom differentiates hyperactive delirium from hypoactive delirium?
- A) Visual Hallucinations
B) Restlessness and Agitation
C) Disorientation
D) Poor Memory
- Correct Answer: B) Restlessness and Agitation
Rationale: Hyperactive delirium presents with increased motor activity and agitation, while hypoactive presents with lethargy.
·
- ✅ 20. Which of the following lab findings may contribute to delirium?
- A) Hypernatremia
B) Normal Sodium Levels
C) Hypoglycemia
D) Hyperthyroidism
- Correct Answer: C) Hypoglycemia
Rationale: Low blood sugar can impair brain function, contributing to confusion and delirium.
·
- ✅ 21. Which of the following is a modifiable risk factor for delirium?
- A) Old Age
B) Polypharmacy
C) Genetic Predisposition
D) Male Gender
- Correct Answer: B) Polypharmacy
Rationale: Reducing unnecessary medications can help prevent delirium.
·
- ✅ 22. Which of the following interventions helps improve the sleep pattern in a delirium patient?
- A) Administer high doses of caffeine
B) Keep bright lights on throughout the night
C) Reduce nighttime disturbances and maintain day-night orientation
D) Avoid daytime activity
- Correct Answer: C) Reduce nighttime disturbances and maintain day-night orientation
Rationale: Proper sleep hygiene and minimizing nighttime interruptions help regulate sleep-wake cycles.
·
- ✅ 23. What is the typical duration of delirium once the cause is treated?
- A) Hours to days
B) Weeks to months
C) Lifetime
D) It never resolves
- Correct Answer: A) Hours to days
Rationale: Delirium often resolves quickly after addressing the underlying cause.
·
- ✅ 24. Which of the following is NOT a feature of delirium?
- A) Acute Onset
B) Fluctuating Consciousness
C) Irreversible Cognitive Decline
D) Visual Hallucinations
- Correct Answer: C) Irreversible Cognitive Decline
Rationale: Irreversible decline is seen in dementia, not in delirium.
·
- ✅ 25. The preferred non-pharmacological nursing intervention to prevent delirium is:
- A) Physical Restraints
B) Isolation
C) Early Mobilization and Orientation Aids
D) Sedative Administration
- Correct Answer: C) Early Mobilization and Orientation Aids
Rationale: Early ambulation and use of clocks, calendars, and familiar objects help prevent and manage delirium.
📚 Dementia
✅ Definition:
Dementia is a progressive, chronic, irreversible decline in cognitive functions including memory, thinking, orientation, comprehension, judgment, and social functioning. It interferes significantly with daily activities and independence.
🎯 Prevalence:
- Worldwide Prevalence: Over 55 million people (WHO, 2024).
- In India: Approximately 4-5 million people affected.
- Common in Elderly: Prevalence increases after age 65; highest in those over 80 years.
- Most Common Types:
- Alzheimer’s Disease (60-70%)
- Vascular Dementia (15-20%)
- Lewy Body Dementia (10-15%)
- Frontotemporal Dementia (5-10%)
✅ Etiology (Causes):
| Primary Causes (Neurodegenerative) |
- Alzheimer’s Disease (most common)
- Parkinson’s Disease
- Lewy Body Dementia
- Huntington’s Disease
- Frontotemporal Lobar Degeneration
| Secondary Causes (Potentially Reversible) |
- Vitamin B12 Deficiency
- Hypothyroidism
- Chronic Alcoholism (Wernicke-Korsakoff Syndrome)
- Head Injury (Traumatic Brain Injury)
- Infections (HIV, Syphilis, Creutzfeldt-Jakob Disease)
- Brain Tumors
✅ Risk Factors:
- Age >65 years
- Family history and genetic predisposition (ApoE4 gene in Alzheimer’s)
- Hypertension, Diabetes, Atherosclerosis
- History of Stroke
- Smoking and Alcohol Abuse
- Sedentary lifestyle and low cognitive activity
✅ Signs and Symptoms:
| Cognitive Symptoms:
- Progressive memory loss (especially recent memory)
- Disorientation to time, place, person
- Difficulty in language (Aphasia), recognizing objects (Agnosia), and performing tasks (Apraxia)
- Poor judgment and decision-making
| Behavioral and Psychological Symptoms:
- Mood swings, depression, irritability
- Hallucinations and delusions (especially in Lewy Body Dementia)
- Wandering, aggression, social withdrawal
- Sleep disturbances
| Stages of Dementia (Global Deterioration Scale):
- No cognitive decline
- Very mild forgetfulness
- Mild cognitive impairment
- Moderate dementia (forgetting personal details)
- Moderately severe dementia (requires assistance for daily living)
- Severe dementia (loss of language and motor functions)
- Very severe dementia (bedridden, unresponsive)
✅ Prognosis:
- Chronic and Progressive Condition.
- Average survival time after diagnosis: 4-8 years, but may range up to 20 years.
- Prognosis depends on type (Alzheimer’s progresses slower; Vascular Dementia may progress in steps).
- Early intervention and management can improve quality of life but do not reverse the disease.
✅ Medical Management:
| 1. Pharmacological Treatment:
- Cholinesterase Inhibitors (Improve Memory):
- Donepezil, Rivastigmine, Galantamine
- NMDA Receptor Antagonist:
- Memantine (used in moderate to severe Alzheimer’s)
- Antipsychotics (For behavioral issues):
- Risperidone, Quetiapine (use cautiously due to risk of sedation and falls)
- Antidepressants:
- SSRIs like Sertraline or Citalopram for depression
| 2. Lifestyle Modifications:
- Healthy diet (Mediterranean diet recommended)
- Regular physical activity and brain exercises
- Management of comorbidities like hypertension and diabetes
✅ Nursing Management:
| Assessment:
- Cognitive function evaluation (MMSE, MoCA)
- Behavioral assessment and identifying triggers
- Risk assessment for falls and wandering
| Interventions:
- Environmental Management:
- Provide a safe, familiar, and structured environment.
- Use orientation aids: clocks, calendars, personal belongings.
- Communication Strategies:
- Speak slowly and clearly.
- Use simple, short sentences.
- Provide reassurance and avoid arguing with the patient.
- Safety Measures:
- Ensure proper lighting and remove fall hazards.
- Install safety locks and alarms for wandering prevention.
- Support Daily Living Activities:
- Assist with hygiene, nutrition, and medication compliance.
- Encourage independence as much as possible.
- Family Education and Support:
- Educate caregivers about disease progression and coping strategies.
- Encourage the use of caregiver support groups.
📌 Golden One-Liners for Quick Revision:
- 🧠 “Alzheimer’s Disease is the most common cause of dementia.”
- 🧠 “Donepezil and Memantine are the main drugs used in dementia management.”
- 🧠 “MMSE is used for cognitive assessment in dementia.”
- 🧠 “Behavioral disturbances like wandering and aggression are common in later stages.”
- 🧠 “Dementia is chronic, progressive, and irreversible.”
- ✅ 1. Which of the following is the most common cause of dementia worldwide?
- A) Vascular Dementia
B) Lewy Body Dementia
C) Alzheimer’s Disease
D) Frontotemporal Dementia
- Correct Answer: C) Alzheimer’s Disease
Rationale: Alzheimer’s Disease accounts for 60-70% of dementia cases globally, making it the most prevalent type.
·
- ✅ 2. Which neurotransmitter deficit is most commonly associated with Alzheimer’s Disease?
- A) Dopamine
B) Serotonin
C) Acetylcholine
D) GABA
- Correct Answer: C) Acetylcholine
Rationale: Reduced acetylcholine levels contribute to memory impairment in Alzheimer’s Disease. Cholinesterase inhibitors help by increasing its availability.
·
- ✅ 3. Which medication is classified as an NMDA receptor antagonist used in moderate to severe dementia?
- A) Donepezil
B) Memantine
C) Rivastigmine
D) Galantamine
- Correct Answer: B) Memantine
Rationale: Memantine blocks NMDA receptors and helps manage symptoms in moderate to severe Alzheimer’s dementia.
·
- ✅ 4. A patient with dementia frequently forgets to turn off the gas stove and leaves the house unlocked. This behavior reflects impairment in:
- A) Long-term Memory
B) Judgment and Safety Awareness
C) Language Comprehension
D) Fine Motor Skills
- Correct Answer: B) Judgment and Safety Awareness
Rationale: Patients with dementia often show poor judgment and lack awareness of safety, leading to risky behaviors.
·
- ✅ 5. Which of the following nursing interventions is most appropriate for managing wandering behavior in a patient with dementia?
- A) Apply physical restraints immediately
B) Allow free roaming without supervision
C) Use visual cues and safety locks, and maintain a structured routine
D) Confine the patient to bed
- Correct Answer: C) Use visual cues and safety locks, and maintain a structured routine
Rationale: Environmental modifications and structured routines help manage wandering behavior safely while promoting independence.
- ✅ 1. What is the most common type of dementia?
- A) Vascular Dementia
B) Alzheimer’s Disease
C) Lewy Body Dementia
D) Frontotemporal Dementia
- Correct Answer: B) Alzheimer’s Disease
Rationale: Alzheimer’s accounts for approximately 60-70% of all dementia cases globally.
·
- ✅ 2. Which neurotransmitter deficiency is most commonly associated with Alzheimer’s Disease?
- A) Dopamine
B) Acetylcholine
C) Serotonin
D) GABA
- Correct Answer: B) Acetylcholine
Rationale: Loss of cholinergic neurons leads to memory and cognitive decline in Alzheimer’s Disease.
·
- ✅ 3. Which medication is classified as a cholinesterase inhibitor used in Alzheimer’s Disease?
- A) Memantine
B) Risperidone
C) Donepezil
D) Haloperidol
- Correct Answer: C) Donepezil
Rationale: Donepezil enhances acetylcholine levels and helps improve memory in mild to moderate Alzheimer’s.
·
- ✅ 4. What is the primary difference between delirium and dementia?
- A) Dementia is reversible; delirium is irreversible.
B) Delirium has an acute onset; dementia is gradual and progressive.
C) Delirium is chronic; dementia is acute.
D) Delirium affects only elderly individuals.
- Correct Answer: B) Delirium has an acute onset; dementia is gradual and progressive.
Rationale: Delirium develops rapidly and is usually reversible, while dementia progresses slowly over time.
·
- ✅ 5. The Mini-Mental State Examination (MMSE) is primarily used to assess:
- A) Emotional Stability
B) Intelligence Quotient
C) Cognitive Function
D) Motor Coordination
- Correct Answer: C) Cognitive Function
Rationale: MMSE is a screening tool for assessing orientation, memory, attention, and language abilities.
·
- ✅ 6. Which vitamin deficiency is a reversible cause of dementia-like symptoms?
- A) Vitamin D
B) Vitamin C
C) Vitamin B12
D) Vitamin K
- Correct Answer: C) Vitamin B12
Rationale: B12 deficiency can cause reversible memory loss and confusion if treated early.
·
- ✅ 7. Which is a characteristic feature of Lewy Body Dementia?
- A) Rapid muscle weakness
B) Early visual hallucinations
C) Loss of peripheral vision
D) Severe anxiety attacks
- Correct Answer: B) Early visual hallucinations
Rationale: Visual hallucinations are a hallmark early symptom of Lewy Body Dementia.
·
- ✅ 8. Which brain area is most affected in Alzheimer’s Disease?
- A) Occipital Lobe
B) Hippocampus
C) Cerebellum
D) Basal Ganglia
- Correct Answer: B) Hippocampus
Rationale: The hippocampus is involved in memory formation and is the first area to show degenerative changes.
·
- ✅ 9. Which medication is used in moderate to severe dementia to regulate glutamate activity?
- A) Memantine
B) Donepezil
C) Haloperidol
D) Rivastigmine
- Correct Answer: A) Memantine
Rationale: Memantine blocks NMDA receptors and helps manage moderate to severe cognitive symptoms.
·
- ✅ 10. Which personality change is common in frontotemporal dementia?
- A) Increased sociability
B) Disinhibition and socially inappropriate behavior
C) Increased anxiety
D) Extreme emotional flatness
- Correct Answer: B) Disinhibition and socially inappropriate behavior
Rationale: Frontal lobe degeneration leads to poor impulse control and inappropriate social behavior.
·
- ✅ 11. Which cognitive function is affected first in Alzheimer’s Dementia?
- A) Long-term Memory
B) Language
C) Judgment
D) Recent Memory
- Correct Answer: D) Recent Memory
Rationale: Short-term or recent memory loss is the earliest sign of Alzheimer’s.
·
- ✅ 12. Which of the following is a key nursing intervention for dementia patients with wandering behavior?
- A) Apply physical restraints
B) Allow free roaming
C) Use safety alarms and maintain structured routines
D) Keep the patient in bed all day
- Correct Answer: C) Use safety alarms and maintain structured routines
Rationale: Safe environments and structured routines help reduce wandering and prevent injury.
·
- ✅ 13. What is the typical prognosis of Alzheimer’s Disease after diagnosis?
- A) 1-2 years survival
B) 4-8 years average survival
C) Completely curable within 5 years
D) 15-20 years full recovery
- Correct Answer: B) 4-8 years average survival
Rationale: Most patients survive between 4 to 8 years after diagnosis, although some may live longer.
·
- ✅ 14. Which of the following nursing interventions helps promote sleep in dementia patients?
- A) Encourage daytime napping
B) Keep lights on all night
C) Establish a regular bedtime routine and reduce nighttime disturbances
D) Increase caffeine intake
- Correct Answer: C) Establish a regular bedtime routine and reduce nighttime disturbances
Rationale: Sleep hygiene is essential in managing sleep-wake disturbances in dementia.
·
- ✅ 15. Which psychological symptom is most frequently associated with later stages of dementia?
- A) Euphoria
B) Hallucinations and Delusions
C) Hyperactivity
D) Increased Social Interaction
- Correct Answer: B) Hallucinations and Delusions
Rationale: Behavioral and psychological symptoms such as hallucinations become prominent in advanced dementia.
·
- ✅ 16. Which of the following is a reversible cause of dementia-like symptoms?
- A) Alzheimer’s Disease
B) Lewy Body Dementia
C) Hypothyroidism
D) Vascular Dementia
- Correct Answer: C) Hypothyroidism
Rationale: Cognitive impairment due to hypothyroidism can be reversed with appropriate thyroid hormone replacement.
·
- ✅ 17. Which scale is used to assess the severity of dementia?
- A) Glasgow Coma Scale
B) Geriatric Depression Scale
C) Global Deterioration Scale
D) Visual Analog Scale
- Correct Answer: C) Global Deterioration Scale
Rationale: This scale assesses the stages of cognitive decline from no cognitive impairment to very severe dementia.
·
- ✅ 18. Which of the following is NOT a goal of nursing care in dementia?
- A) Ensure patient safety
B) Promote independence in self-care
C) Improve cognitive functioning
D) Argue with patients to reorient them
- Correct Answer: D) Argue with patients to reorient them
Rationale: Arguing with dementia patients increases their agitation. Gentle reorientation is preferred.
·
- ✅ 19. Which communication technique is best when interacting with a patient with dementia?
- A) Speak rapidly to cover more information
B) Use simple sentences and repeat instructions gently
C) Avoid eye contact
D) Use medical jargon to explain
- Correct Answer: B) Use simple sentences and repeat instructions gently
Rationale: Simple, clear communication helps dementia patients understand instructions better.
·
- ✅ 20. Which activity is beneficial for cognitive stimulation in dementia patients?
- A) Isolating the patient
B) Watching violent movies
C) Engaging in puzzles, music therapy, and memory games
D) Keeping the patient in a dark, quiet room
- Correct Answer: C) Engaging in puzzles, music therapy, and memory games
Rationale: Cognitive stimulation activities help slow down memory decline.
·
- ✅ 21. Which of the following is a safety concern in dementia management?
- A) Social Isolation
B) Wandering and Falls
C) Excessive Physical Activity
D) Overeating
- Correct Answer: B) Wandering and Falls
Rationale: Patients with dementia are at high risk of falls and wandering, requiring environmental safety measures.
·
- ✅ 22. Which cognitive test helps assess orientation, memory, and attention in dementia?
- A) Apgar Score
B) MMSE (Mini-Mental State Examination)
C) Rinne’s Test
D) Weber’s Test
- Correct Answer: B) MMSE (Mini-Mental State Examination)
Rationale: MMSE is widely used to assess cognitive impairment in dementia patients.
·
- ✅ 23. Which of the following medications can help manage behavioral disturbances in dementia?
- A) Risperidone
B) Metformin
C) Propranolol
D) Diazepam
- Correct Answer: A) Risperidone
Rationale: Low-dose antipsychotics like Risperidone are used cautiously to manage aggression and psychotic symptoms.
·
- ✅ 24. Which of the following is a key sign of advanced dementia?
- A) Ability to perform self-care independently
B) Complete orientation to time and place
C) Total dependence on caregivers for basic activities
D) Good problem-solving ability
- Correct Answer: C) Total dependence on caregivers for basic activities
Rationale: In advanced stages, patients become completely dependent for all daily activities.
·
- ✅ 25. Which dietary intervention supports cognitive health in elderly individuals?
- A) High-sodium diet
B) Mediterranean diet (rich in fruits, vegetables, and omega-3)
C) Processed foods and high sugar intake
D) Starvation diets
- Correct Answer: B) Mediterranean diet (rich in fruits, vegetables, and omega-3)
Rationale: A balanced Mediterranean diet is associated with a lower risk of cognitive decline and better brain health.