Which is believed to be a risk factor specific to the development of delirium?

Gradual decline in functioning

Ineffective coping

Baseline cognitive impairment

Increased severity of physical illness

Answer and Explanation

The Correct Answer is C

Delirium is an acute neurocognitive disorder marked by altered consciousness, inattention, fluctuating cognition, and acute onset, commonly precipitated by physiologic stressors. Vulnerability increases with preexisting neurologic deficits, especially impaired baseline cognition and reduced cerebral reserve.

Rationale:

A. Gradual functional decline is more consistent with chronic neurodegenerative conditions rather than delirium. Progressive decline suggests dementia, which develops insidiously. Delirium presents abruptly with fluctuating symptoms, distinguishing it from long-term deterioration in cognitive or physical abilities.

B. Ineffective coping relates to psychological adaptation rather than neurologic vulnerability. Coping mechanisms influence emotional responses but are not primary etiologic factors in delirium, which is driven by acute physiologic disturbances such as infection, hypoxia, or metabolic imbalance.

C. Baseline cognitive impairment is a major predisposing factor. Cognitive impairment reduces neurologic reserve, increasing susceptibility to acute confusional states. Patients with dementia or prior cognitive deficits are significantly more likely to develop delirium during illness or hospitalization.

D. Increased severity of physical illness is a precipitating factor but not specific. Illness severity contributes to delirium risk through metabolic and inflammatory pathways; however, it is nonspecific and can affect individuals without underlying vulnerability, unlike baseline cognitive impairment.

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Correct Answer is A

Explanation

According to Maslow’s Hierarchy of Needs and standard nursing prioritization (the Safety/Risk Reduction framework), physical safety is always the primary concern. Children with ADHD often struggle with extreme impulsivity and poor judgment, which can lead to accidental self-harm or aggressive outbursts toward peers and staff.

Rationale:

A. Ensuring the child's safety and that of others is the absolute priority. Because ADHD involves a deficit in executive function, specifically inhibitory control, the child may act before thinking (e.g., running into a street or jumping from heights). Until a safe environment is established, no other therapeutic or educational interventions can be effectively implemented.

B. Simplifying instructions is a helpful behavioral intervention to manage the symptoms of inattention. It helps the child complete tasks and reduces frustration, but it is a secondary priority compared to preventing physical injury.

C. A structured daily routine is a cornerstone of long-term ADHD management. It provides the external organization that the child’s internal system lacks. Although vital for reducing anxiety and improving compliance, it does not address the immediate, acute need for physical safety.

D. Improving role performance such as academic success or social skills is a long-term goal of treatment. These outcomes are measured over weeks or months and are considered the final stage of the nursing care plan, once safety and behavioral stability are achieved.

A. Bupropion B. Lithium C. Anticonvulsants D. Fluoxetine

Correct Answer is B

Explanation

In the treatment of bipolar disorder, specifically during a downward spiral (depressive episode) or a manic phase, mood stabilizers are the gold standard. Lithium carbonate is unique because it is an element (a salt) with a remarkably narrow therapeutic index, meaning the difference between a therapeutic dose and a toxic dose is very small.

Rationale:

A. Bupropion is an atypical antidepressant. Although it is sometimes used in bipolar depression, it does not require routine serum level monitoring. Furthermore, antidepressants must be used with extreme caution in bipolar patients as they can overshoot the target and trigger a switch into mania.

B. Lithium is the correct answer. Because lithium is excreted almost entirely by the kidneys and is handled by the body similarly to sodium, factors like dehydration or changes in salt intake can cause levels to rise dangerously. Regular blood draws are mandatory to ensure the serum level remains within the therapeutic range of 0.6 to 1.2 mEq/L. Levels above 1.5 mEq/L can lead to severe toxicity, including tremors, confusion, seizures, and death.

C. Although some anticonvulsants used as mood stabilizers (like valproic acid or carbamazepine) do require serum monitoring, anticonvulsants is a broad category. In nursing board exams, if Lithium is an option alongside a general category, Lithium is the most correct answer because its monitoring is more frequent, critical, and specific to the drug's safety profile.

D. Fluoxetine is an SSRI. Like Bupropion, it does not require blood level monitoring. Its use in Bipolar Disorder is typically limited to being paired with an antipsychotic (like Olanzapine) to prevent the induction of mania.

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Which is believed to be a risk factor specific to the development of delirium?

Nursing Test Bank

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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