A 68-year-old client who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the client is experiencing delirium rather than dementia?
The client is oriented to person but disoriented to place and time
The client’s speech is fragmented and incoherent
The client has a history of increasing confusion over several years
The client was oriented and alert when admitted
The Correct Answer is D
Choice A reason: Orientation to person but disorientation to place and time occurs in both delirium and dementia. In delirium, acute cerebral dysfunction from causes like infection disrupts attention, while dementia’s gradual hippocampal loss affects memory. This symptom is non-specific, as it does not distinguish the acute onset critical to delirium diagnosis.
Choice B reason: Fragmented, incoherent speech can occur in delirium due to acute brain dysfunction or in advanced dementia from cortical degeneration. It reflects disrupted neural communication but is not specific to delirium’s rapid onset. This symptom alone does not differentiate the conditions, as both involve cognitive processing deficits.
Choice C reason: A history of increasing confusion over years indicates dementia, characterized by progressive neuronal loss, particularly in Alzheimer’s or vascular dementia. Delirium, conversely, has an acute onset due to reversible causes like infection. This chronic history rules out delirium, making this choice incorrect for identifying delirium.
Choice D reason: Being oriented and alert on admission, then developing confusion, indicates delirium’s acute onset, typically from pneumonia-related hypoxia or sepsis disrupting cerebral metabolism. Unlike dementia’s gradual progression, delirium’s rapid cognitive decline, often within days, reflects reversible brain dysfunction, making this the key differentiator in diagnosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Monitoring vital signs is critical in withdrawal delirium, as it is a medical emergency involving autonomic hyperactivity from alcohol or drug cessation. Dehydration and electrolyte imbalances elevate heart rate and blood pressure, risking seizures or cardiovascular collapse. Regular monitoring detects instability early, guiding fluid replacement and medication to stabilize cerebral and systemic function.
Choice B reason: Keeping the room dark may reduce sensory overload in withdrawal delirium, but it does not address physiologic instability like dehydration or autonomic hyperactivity. Darkness may calm agitation but risks disorientation in a confused patient, as visual cues aid reality testing. This choice is less critical than monitoring vital signs for ensuring systemic stability.
Choice C reason: Withholding oral fluids is contraindicated in withdrawal delirium, as dehydration exacerbates symptoms like confusion and autonomic instability. Fluid loss from sweating or vomiting, common in withdrawal, disrupts electrolyte balance and cerebral perfusion. Providing fluids corrects hypovolemia, making this choice scientifically inappropriate for maintaining physiologic stability in this critical condition.
Choice D reason: Applying ice to the tongue may reduce swelling from trauma, but it does not address the systemic instability of withdrawal delirium, such as dehydration or autonomic hyperactivity. Tongue swelling is a secondary issue compared to life-threatening risks like seizures or arrhythmias, which require monitoring vital signs and fluid management for stabilization.
Correct Answer is A
Explanation
Choice A reason: In severe PTSD exacerbation, flashbacks and hypervigilance indicate amygdala hyperactivity and impaired prefrontal cortex regulation, increasing risk of impulsive or self-harming behaviors. Ensuring safety addresses immediate dangers, as heightened arousal can lead to disorientation or panic, necessitating a secure environment to stabilize the client’s neurobiological stress response.
Choice B reason: Promoting self-esteem is valuable in PTSD but secondary to safety. Low self-esteem may stem from trauma-related guilt, linked to serotonin dysregulation, but does not pose immediate risk. Flashbacks and hypervigilance, driven by amygdala overactivity, require urgent safety measures to prevent harm during acute episodes.
Choice C reason: Helping cope with stress and emotions is important in PTSD management, addressing cortisol dysregulation and amygdala hyperactivity. However, during severe exacerbation with flashbacks, safety is the priority, as acute episodes can lead to disorientation or self-harm. Coping strategies are secondary to stabilizing the immediate neurobiological crisis.
Choice D reason: Establishing a community support system aids long-term PTSD recovery by enhancing oxytocin-mediated emotional regulation. However, during acute exacerbation with flashbacks, immediate safety is critical due to heightened amygdala-driven arousal. Community support is a secondary intervention, as it does not address the urgent risk of harm in acute episodes.
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