Liam, 12-year-old male

Patient: Liam, 12-year-old male

Presenting Concerns: Frequent involuntary movements and vocalizations for the past year. Mother reports Liam makes sudden shoulder jerks and occasionally blurts out words. Symptoms worsen with stress.

History: No substance use. No significant medical history.

Provider Notes: Diagnosed with Tourette's disorder. Discussing medication options and behavioral interventions. What characteristics define this diagnosis?

Vocal tics only

Obsessive handwashing

Persistent depressed mood

Motor tics and vocal tics

Answer and Explanation

The Correct Answer is D

A. Vocal tics only: Tourette’s disorder requires the presence of both motor and vocal tics. Vocal tics alone are insufficient for this diagnosis, though they may occur alongside motor tics.

B. Obsessive handwashing: Repetitive handwashing is a compulsive behavior associated with obsessive-compulsive disorder (OCD), not a defining feature of Tourette’s disorder. While comorbidity is possible, it does not define the diagnosis.

C. Persistent depressed mood: Depressed mood may occur as a comorbid condition but is not a core diagnostic criterion for Tourette’s disorder. The disorder is characterized by tics rather than mood disturbance.

D. Motor tics and vocal tics: The presence of multiple motor tics (e.g., shoulder jerks) and at least one vocal tic (e.g., word blurting) persisting for over a year meets the diagnostic criteria for Tourette’s disorder. Symptoms often fluctuate in severity and may worsen with stress.

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Correct Answer is A

Explanation

A. Vascular dementia symptoms can vary and may clear up, but there is an irregular pattern of decline: Cognitive changes in vascular dementia often occur in a stepwise manner, with periods of relative stability or temporary improvement. This fluctuation reflects the occurrence of new cerebrovascular events rather than continuous progressive decline.

B. Vascular dementia involves the development of Lewy Bodies: Lewy Bodies are abnormal protein deposits associated with Lewy Body dementia, not vascular dementia. Vascular dementia results from cerebrovascular disease affecting brain tissue.

C. Vascular dementia is not treatable with medication: While no cure exists, some medications may help manage symptoms or coexisting conditions. Symptom management and risk factor control can slow progression.

D. Vascular dementia has a slow, insidious (gradual) onset: Gradual onset is more characteristic of Alzheimer’s disease. Vascular dementia often presents with abrupt or stepwise cognitive changes following strokes or ischemic events.

A. Moderate stage B. Severe stage C. Mild stage D. Confabulation stage

Correct Answer is A

Explanation

A. Moderate stage: During the moderate stage of Alzheimer’s disease, clients typically experience noticeable decline in activities of daily living, disorientation to time and place, and increased social withdrawal. Frustration and behavioral changes become more prominent as cognitive deficits interfere with independence.

B. Severe stage: The severe stage is characterized by profound cognitive impairment, loss of communication, and total dependence for ADLs. Disorientation and frustration are present earlier, and clients may be nonverbal or bedridden in this stage.

C. Mild stage: In the mild stage, cognitive deficits are subtle, with mild memory loss and minor difficulties in complex tasks. Clients are generally able to maintain independence and social engagement, with minimal disorientation.

D. Confabulation stage: Confabulation is a coping mechanism sometimes seen in mild to moderate Alzheimer’s disease, where clients fill memory gaps with fabricated stories. It is not a distinct stage but rather a symptom that may appear intermittently.

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Naxlex Comprehensive Predictor Exams

The family members of a patient with vascular dementia note that the patient is acting like herself and that she has returned to baseline. As the nurse, you want to be sure that the family understands that:

Correct Answer is A

Explanation

A client diagnosed with neurocognitive disorder due to Alzheimer's disease has a decline in ADL, is disoriented to place and time, displays increasing frustration and social withdrawal. The nurse recognizes these symptoms as indicative of which stage of the illness?

Correct Answer is A

Explanation

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You would expect to include all of the following nursing interventions in Lily's plan of care EXCEPT:

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