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: Lithium’s therapeutic range for maintenance in bipolar disorder is 0.5–1.2 mEq/L, balancing mood stabilization via sodium channel modulation and neuroprotection with safety. This range minimizes toxicity risks like tremors or renal damage, ensuring effective serotonin and dopamine regulation while maintaining safe serum concentrations.
Choice B reason: A 10–50 mEq/L lithium level is far above the therapeutic range, causing severe toxicity, including seizures or coma, due to excessive sodium channel inhibition and neuronal dysfunction. This range is lethal, disrupting renal and neurological function, making it scientifically inaccurate for maintenance or safety.
Choice C reason: A 0.1–1 mEq/L range is partially subtherapeutic, as levels below 0.5 mEq/L are ineffective for mood stabilization in bipolar disorder. Lithium requires 0.5–1.2 mEq/L to modulate sodium channels and serotonin, making this range inadequate for therapeutic efficacy while still posing minor toxicity risks.
Choice D reason: A 50–100 mEq/L lithium level is exponentially above safe limits, causing fatal toxicity, including renal failure and neurological damage, due to extreme sodium channel disruption. This range is not viable for maintenance, as it far exceeds the therapeutic window, leading to severe neurobiological and systemic harm.
Correct Answer is B
Explanation
Choice A reason: Previous psychiatric history increases PTSD risk, as pre-existing conditions like depression or anxiety indicate heightened amygdala sensitivity and dysregulated stress responses. These predispose individuals to exaggerated fear responses post-trauma, as the brain’s stress circuitry is already compromised, amplifying the impact of traumatic events on neural pathways.
Choice B reason: PTSD is not associated only with personal characteristics; it requires exposure to a traumatic event, as defined by DSM-5 criteria. Trauma triggers neurobiological changes, including amygdala hyperactivity and hippocampal volume reduction, causing symptoms like flashbacks. Personal characteristics modulate risk, but event exposure is essential, making this statement false.
Choice C reason: A causative trauma is required for PTSD, per DSM-5, involving exposure to actual or threatened death, serious injury, or sexual violence. This triggers neurobiological changes, such as elevated cortisol and amygdala activation, leading to intrusive memories and hyperarousal. This criterion is fundamental to the disorder’s pathophysiology and diagnosis.
Choice D reason: Lack of social support increases PTSD risk, as it exacerbates stress responses by reducing oxytocin-mediated emotional regulation and prefrontal cortex modulation. Social isolation heightens amygdala activity, prolonging trauma-related symptoms. Support systems buffer stress responses, making this a scientifically valid factor in the etiology of PTSD.
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