Delirium:

Benzodiazepines are indicated in the treatment of delirium caused by which condition?

An older patient is admitted to the hospital with a urinary tract infection and possible bacterial sepsis. The family is
concerned because the patient is confused and not able to carry on a conversation. Which statement by the nurse is most
appropriate?
a. “Depression is a common cause of confusion in older adults in the hospital”
b. “It is normal for an older person to have cognitive problems while in the hospital”
c. “The mental changes are most likely caused by the infection and most often reversible”
d. “Drug therapy with antipsychotic agents is indicated to slow the progression of dementia”

80 year old Mr. Rogers, together with his daughter, arrived at the med-surg unit for diagnostic confirmation and
management of probable delirium. Which statement by the client's daughter best supports the diagnosis?
a. "Maybe it's just caused by aging. This usually happens at his age."
b. "The changes in his behavior came on so quickly! I wasn't sure what was happening."
c. "Dad just didn't seem to know what he was doing. He has been forgetful for years."
d. "Dad has always been so independent. He's lived alone for years since mom died."

A 91 year old female comes into the emergency room with symptoms of delirium. Which of the following would NOT be
a possible cause of her condition?
a. Urinary tract infection
b. Dehydration
c. Alzheimer's disease
d. Hypothyroidism

A nurse suspects her patient may be suffering from delirium. What signs does the nurse observe to support this diagnosis?
a. Slurred speech and one sided weakness
b. Mask-like face and tremors
c. Gradual onset of forgetfulness reported by family members
d. Confusion and visual hallucinations

An 80 year old client with an indwelling urinary catheter suddenly becomes confused and combative towards staff. Which
intervention is appropriate when providing care for this client?
a. Initiate restraints until the client calms down
b. Move the client to a room closer to the nurse's station for observation
c. Order a psychiatric consult to evaluate the client
d. Have a calendar, clock, and schedule for the day clearly visible to the client

An 84-year-old female patient is displaying signs of a delirium episode. To prevent the patient from injury, the most
appropriate action by the nurse is to:
a. Ask the provider about ordering an antipsychotic medication.
b. Have the patient's guardian stay with the patient and give reassurance.
c. Assign a staff member to remain with patient and provide frequent reorientation.
d. Use a soft chest restraint to secure the patient in bed.

Which action will help the nurse determine whether a patient's confusion is caused by delirium?
a. ask about family history of Dementia
b. the Confusion Assessment Method tool
c. ask the patient their birthday, name and the current president
d. ask the patient when they last took medications

When administering a mental status examination to a patient with delirium, the nurse should
a. wait until the patient is well-rested.
b. administer an anxiolytic medication.
c. choose a place without distracting stimuli.
d. reorient the patient during the examination.

The nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. The most appropriate
action by the nurse is to
a. secure the patient in bed using a soft chest restraint.
b. ask the health care provider to order an antipsychotic drug.
c. instruct family members to remain with the patient and prevent injury.
d. assign unlicensed assistive personnel (UAP) to stay with the patient and offer reorientation.

A patient diagnosed with delirium sees the intravenous (IV) tubing and believes it to be a snake. How should the
healthcare provider document this behavior?
a. hallucination
b. delusion
c. confusion
d. illusion

What manifestations of cognitive impairment are primarily characteristic of delirium? Select all that apply
a. reduced awareness
b. impaired judgements
c. words difficult to find
d. sleep/wake cycle reversed
e. distorted thinking and perception
f. insidious onset with prolonged duration

A 68 year old man is admitted to the ED with multiple blunt traumas following a one vehicle car accident. He is restless;
disoriented to person, place, and time; and agitated. He resists attempts at examination and calls out the name, "Janice".
Why should the nurse suspect delirium rather than dementia in this patient?
a. the fact that he should not have been allowed to drive if he had dementia
b. his hyperactive behavior, which differentiates his condition from the hypoactive behavior of dementia
c. the report of emergency personnel that he was noncommunicative when they arrived at the accident scene
d. the report of his family that, although he has heart disease and is "very hard of hearing," this behavior is unlike him

What should be included in the management of a patient with delirium?

A 78-yr-old woman was transferred to the intensive care unit after emergency abdominal surgery. The nurse notes the
patient is disoriented and confused, has incoherent speech, is restless, and agitated. Which action by the nurse is most
appropriate?
a. Reorient the patient.
b. Notify the physician.
c. Document the findings.
d. Administer lorazepam (Ativan).

A patient who is hospitalized with pneumonia is disoriented and confused 2 days after admission. Which information
obtained by the nurse about the patient indicates that the patient is experiencing delirium rather than dementia?
a. The patient was oriented and alert when admitted.
b. The patients speech is fragmented and incoherent.
c. The patient is disoriented to place and time but oriented to person.
d. The patient has a history of increasing confusion over several years.

When administering a mental status examination to a patient with delirium, the nurse should
a. medicate the patient first to reduce any anxiety.
b. give the examination when the patient is well-rested.
c. reorient the patient as needed during the examination.
d. choose a place without distracting environmental stimuli

To protect a patient from injury during an episode of delirium, the most appropriate action by the nurse is to
a. secure the patient in bed using a soft chest restraint.
b. ask the health care provider about ordering an antipsychotic drug.
c. instruct family members to remain with the patient and prevent injury.
d. assign a nursing assistant to stay with the patient and offer frequent reorientation.

The nurse is conducting a physical assessment on a 76 year old female. All of the following assessment findings would
warrant the nurse to suspect that the client is experiencing delirium except:
a. The client yells, "There are bugs crawling all over me! Get them off!"
b. The client exhibits a decreased startle reaction.
c. The client has a difficult time focusing and keeps staring off into space while the nurse is talking.
d. Altered level of consciousness.

A 68-year-old patient who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which
information indicates that the patient is experiencing delirium rather than dementia?
a. The patient was oriented and alert when admitted.
b. The patient's speech is fragmented and incoherent.
c. The patient is oriented to person but disoriented to place and time.
d. The patient has a history of increasing confusion over several years.