Question 1
Regular
During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium?
Correct!
Incorrect
The correct answer is: D
Rationale
Disoriented to person. This behavior indicates a disruption in cognitive function, which aligns with the fluctuating attention and confusion typical of delirium, reflecting the client's impaired ability to recognize familiar individuals.
A: Unable to identify a water pitcher. This behavior suggests a potential cognitive issue but does not specifically indicate the level of confusion or disorientation characteristic of delirium.
B: Unable to transfer to sitting position. This limitation pertains more to physical mobility and strength rather than the cognitive disturbances commonly associated with delirium.
C: Difficulty with verbal expression. While this may indicate cognitive issues, it does not directly reflect the disorientation to self or others that typifies delirium.
Correct Answer: D
Rationale: Disoriented to person. This behavior indicates a disruption in cognitive function, which aligns with the fluctuating attention and confusion typical of delirium, reflecting the client's impaired ability to recognize familiar individuals.
A: Unable to identify a water pitcher. This behavior suggests a potential cognitive issue but does not specifically indicate the level of confusion or disorientation characteristic of delirium.
B: Unable to transfer to sitting position. This limitation pertains more to physical mobility and strength rather than the cognitive disturbances commonly associated with delirium.
C: Difficulty with verbal expression. While this may indicate cognitive issues, it does not directly reflect the disorientation to self or others that typifies delirium.
Question 2
Regular
A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a postsets?
Correct!
Incorrect
The correct answer is: B
Rationale
B: The clients may not recognize their family when they come to visit. This behavior reflects cognitive deterioration in dementia, where memory impairment often leads to difficulty in recognizing familiar individuals, indicating a profound understanding of the condition.
A: The clients should be able to ask us for items they need. This expectation assumes a level of cognitive function that may not be present in individuals with dementia, as communication skills can decline.
C: The clients who are ambulatory can still carry out activities of daily living independently. This statement overlooks the reality that cognitive decline often impacts the ability to perform even basic tasks, regardless of physical mobility.
D: The clients should know when to come to the dining room for meals. This expectation presumes a level of cognitive awareness and memory that many individuals with dementia may not possess, leading to confusion.
Correct Answer: B
Rationale: B: The clients may not recognize their family when they come to visit. This behavior reflects cognitive deterioration in dementia, where memory impairment often leads to difficulty in recognizing familiar individuals, indicating a profound understanding of the condition.
A: The clients should be able to ask us for items they need. This expectation assumes a level of cognitive function that may not be present in individuals with dementia, as communication skills can decline.
C: The clients who are ambulatory can still carry out activities of daily living independently. This statement overlooks the reality that cognitive decline often impacts the ability to perform even basic tasks, regardless of physical mobility.
D: The clients should know when to come to the dining room for meals. This expectation presumes a level of cognitive awareness and memory that many individuals with dementia may not possess, leading to confusion.
Question 3
Regular
Which is believed to be a risk factor specific to the development of delirium?
Correct!
Incorrect
The correct answer is: A
Rationale
Increased severity of physical illness is believed to be a risk factor specific to the development of delirium. This connection arises from the understanding that more severe illnesses can disrupt homeostasis, leading to increased vulnerability to cognitive disturbances like delirium.
B: Older age does contribute to delirium risk but is a general factor, not specific to its development. Many older adults remain cognitively stable despite age-related changes.
C: Baseline cognitive impairment is associated with delirium, yet it is not exclusive; other factors also contribute to the condition's emergence, making it less specific than physical illness severity.
D: Gradual decline in functioning may indicate cognitive issues but does not directly correlate with the acute changes seen in delirium, thus lacking specificity as a risk factor.
Correct Answer: A
Rationale: Increased severity of physical illness is believed to be a risk factor specific to the development of delirium. This connection arises from the understanding that more severe illnesses can disrupt homeostasis, leading to increased vulnerability to cognitive disturbances like delirium.
B: Older age does contribute to delirium risk but is a general factor, not specific to its development. Many older adults remain cognitively stable despite age-related changes.
C: Baseline cognitive impairment is associated with delirium, yet it is not exclusive; other factors also contribute to the condition's emergence, making it less specific than physical illness severity.
D: Gradual decline in functioning may indicate cognitive issues but does not directly correlate with the acute changes seen in delirium, thus lacking specificity as a risk factor.
Question 4
Regular
Which patient is most likely suffering from dementia?
Correct!
Incorrect
The correct answer is: A
Rationale
A 90-year-old male who has experienced progressive mental decline that started with forgetfulness. This patient exemplifies typical symptoms of dementia, characterized by gradual cognitive deterioration, particularly memory loss, impacting daily functioning and behavior.
B: An 80-year-old female who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff. Acute confusion and anxiety stem from a medical condition, not cognitive decline.
C: A 6-year-old child who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that her parents have three sets of eyes. This child's unusual statement is likely a side effect of sedation, not indicative of dementia.
D: A 22-year-old male who was involved in a motorcycle crash without wearing a helmet now unable to remember where he is. His memory loss results from trauma-related cognitive impairment rather than a degenerative brain condition like dementia.
Correct Answer: A
Rationale: A 90-year-old male who has experienced progressive mental decline that started with forgetfulness. This patient exemplifies typical symptoms of dementia, characterized by gradual cognitive deterioration, particularly memory loss, impacting daily functioning and behavior.
B: An 80-year-old female who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff. Acute confusion and anxiety stem from a medical condition, not cognitive decline.
C: A 6-year-old child who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that her parents have three sets of eyes. This child's unusual statement is likely a side effect of sedation, not indicative of dementia.
D: A 22-year-old male who was involved in a motorcycle crash without wearing a helmet now unable to remember where he is. His memory loss results from trauma-related cognitive impairment rather than a degenerative brain condition like dementia.
Question 5
Regular
A client with dementia is unable to recognize ordinary objects, such as a pen or notebook. Which would this be a symptom of?
Correct!
Incorrect
The correct answer is: A
Rationale
Agnosia. This condition involves the inability to recognize and interpret sensory information, leading to difficulties in identifying common objects like a pen or notebook, which aligns with the client's symptoms.
B: Amnesia. This primarily affects memory, causing difficulty in recalling past events or information, rather than impairing object recognition as seen in this client.
C: Apraxia. This disorder involves challenges in planning and executing movements, such as using objects, but does not directly relate to the inability to recognize items.
D: Aphasia. This condition impacts communication abilities, including speaking and understanding language, but does not specifically interfere with the recognition of physical objects.
Correct Answer: A
Rationale: Agnosia. This condition involves the inability to recognize and interpret sensory information, leading to difficulties in identifying common objects like a pen or notebook, which aligns with the client's symptoms.
B: Amnesia. This primarily affects memory, causing difficulty in recalling past events or information, rather than impairing object recognition as seen in this client.
C: Apraxia. This disorder involves challenges in planning and executing movements, such as using objects, but does not directly relate to the inability to recognize items.
D: Aphasia. This condition impacts communication abilities, including speaking and understanding language, but does not specifically interfere with the recognition of physical objects.
Question 6
Regular
Which client would have an increased risk for delirium?
Correct!
Incorrect
The correct answer is: B
Rationale
A: An elderly woman with abdominal pain. While elderly individuals are generally at higher risk for delirium, abdominal pain alone does not significantly elevate this risk without other complicating factors.
C: A middle-aged woman newly diagnosed with multiple sclerosis. Multiple sclerosis can affect cognitive function, but the diagnosis alone does not create an immediate, heightened risk for delirium in this scenario.
D: A young adult male with gastroenteritis and dehydration. Although dehydration may contribute to confusion, it does not inherently increase the risk for delirium compared to a febrile child.
Correct Answer: B
Rationale: A: An elderly woman with abdominal pain. While elderly individuals are generally at higher risk for delirium, abdominal pain alone does not significantly elevate this risk without other complicating factors.
C: A middle-aged woman newly diagnosed with multiple sclerosis. Multiple sclerosis can affect cognitive function, but the diagnosis alone does not create an immediate, heightened risk for delirium in this scenario.
D: A young adult male with gastroenteritis and dehydration. Although dehydration may contribute to confusion, it does not inherently increase the risk for delirium compared to a febrile child.
Question 7
List Selection
The nurse is caring for a client with cognitive impairment. To determine whether the client is suffering from delirium or dementia, the nurse reviews the symptoms and course of each disorder.
| Rapid onset | |
|---|---|
| Progressive decline |
Correct!
Incorrect
The correct answer is: A : DELIRIUM, B: DEMENTIA, C: DEMENTIA, D: DELIRIUM ,E: DELIRIUM
Rationale
Rapid onset.
Delirium is characterized by a sudden change in mental status, often occurring within hours or days, which distinguishes it from dementia's gradual cognitive decline over time. Recognizing this rapid onset aids in accurate diagnosis and management.
B: Progressive decline. Dementia entails a slow, continuous deterioration of cognitive function over time, unlike delirium, which presents acutely and can fluctuate in severity.
C: Long-term memory impairment. While dementia affects long-term memory, delirium typically has an impact on attention and awareness rather than stable memory functions.
D: Slurred speech. Slurred speech may indicate various neurological conditions but is not a defining symptom of delirium; it primarily focuses on cognitive changes and altered consciousness.
E: Hallucinations. Hallucinations can occur in both delirium and dementia, but they do not exclusively indicate delirium, as dementia may also involve perceptual disturbances in later stages.
Correct Answer: A : DELIRIUM, B: DEMENTIA, C: DEMENTIA, D: DELIRIUM ,E: DELIRIUM
Rationale: Rapid onset.
Delirium is characterized by a sudden change in mental status, often occurring within hours or days, which distinguishes it from dementia's gradual cognitive decline over time. Recognizing this rapid onset aids in accurate diagnosis and management.
B: Progressive decline. Dementia entails a slow, continuous deterioration of cognitive function over time, unlike delirium, which presents acutely and can fluctuate in severity.
C: Long-term memory impairment. While dementia affects long-term memory, delirium typically has an impact on attention and awareness rather than stable memory functions.
D: Slurred speech. Slurred speech may indicate various neurological conditions but is not a defining symptom of delirium; it primarily focuses on cognitive changes and altered consciousness.
E: Hallucinations. Hallucinations can occur in both delirium and dementia, but they do not exclusively indicate delirium, as dementia may also involve perceptual disturbances in later stages.
Question 8
Regular
The daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. Which would be the most appropriate response?
Correct!
Incorrect
The correct answer is: C
Rationale
Symptoms of dementia gradually get worse. Unfortunately, she will not be independent again. This response provides a clear and honest assessment, helping the daughter understand the long-term implications of her mother's condition without giving false hope.
A: You sound like you aren't ready for her to be dependent on caregivers. This response shifts focus to the daughter's feelings rather than addressing the mother's actual condition and prognosis.
B: Her confusion is a temporary complication of her physical illness and should subside when the illness gets better. This statement inaccurately suggests that her confusion is transient, failing to recognize the progressive nature of dementia.
D: With early treatment, mild dementia can be reversed. It may be possible. This option misleadingly implies that dementia can be completely reversed, which contradicts current understanding of the condition’s irreversible progression.
Correct Answer: C
Rationale: Symptoms of dementia gradually get worse. Unfortunately, she will not be independent again. This response provides a clear and honest assessment, helping the daughter understand the long-term implications of her mother's condition without giving false hope.
A: You sound like you aren't ready for her to be dependent on caregivers. This response shifts focus to the daughter's feelings rather than addressing the mother's actual condition and prognosis.
B: Her confusion is a temporary complication of her physical illness and should subside when the illness gets better. This statement inaccurately suggests that her confusion is transient, failing to recognize the progressive nature of dementia.
D: With early treatment, mild dementia can be reversed. It may be possible. This option misleadingly implies that dementia can be completely reversed, which contradicts current understanding of the condition’s irreversible progression.
Question 9
Regular
Which statement made by the nurse would be most appropriate to an 89-year-old patient who is confused but has no history of dementia and is hospitalized for an acute urinary tract infection?
Correct!
Incorrect
The correct answer is: D
Rationale
D: I know things are upsetting and confusing right now, but your confusion should clear as you get better. This statement acknowledges the patient's feelings while providing reassurance that their confusion is likely temporary due to the acute illness. It promotes a supportive atmosphere, fostering trust between the patient and the nurse.
A: You are likely to become progressively more confused now. This statement creates unnecessary fear and anxiety, suggesting a worsening of the patient's condition rather than offering hope or reassurance during recovery.
B: This should be just a temporary situation. While somewhat reassuring, this statement lacks empathy and does not validate the patient's current emotional distress or confusion experienced during hospitalization.
C: Don't worry about it, everyone is confused when they are in the hospital. This statement trivializes the patient's feelings and implies that confusion is normal for everyone, potentially alienating the patient instead of providing comfort.
Correct Answer: D
Rationale: D: I know things are upsetting and confusing right now, but your confusion should clear as you get better. This statement acknowledges the patient's feelings while providing reassurance that their confusion is likely temporary due to the acute illness. It promotes a supportive atmosphere, fostering trust between the patient and the nurse.
A: You are likely to become progressively more confused now. This statement creates unnecessary fear and anxiety, suggesting a worsening of the patient's condition rather than offering hope or reassurance during recovery.
B: This should be just a temporary situation. While somewhat reassuring, this statement lacks empathy and does not validate the patient's current emotional distress or confusion experienced during hospitalization.
C: Don't worry about it, everyone is confused when they are in the hospital. This statement trivializes the patient's feelings and implies that confusion is normal for everyone, potentially alienating the patient instead of providing comfort.
Question 10
Regular
Which distinguishes delirium from dementia?
Correct!
Incorrect
The correct answer is: C
Rationale
Delirium is distinguished from dementia by the fact that dementia has a gradual onset and is progressive in course. This fundamental difference highlights how dementia develops slowly over time, leading to a continuous decline in cognitive function, unlike the abrupt changes seen in delirium.
A: Delirium has an acute onset and is progressive in course. The acute onset of delirium contrasts sharply with dementia, where symptoms develop gradually over an extended period.
B: Delirium has a gradual onset and can be resolved. Delirium typically appears suddenly, whereas dementia's gradual progression makes this option inaccurate in distinguishing the two conditions.
D: Dementia has an acute onset and can be resolved. Dementia consistently presents with gradual onset, and while it may have management strategies, it is generally not resolved like delirium.
Correct Answer: C
Rationale: Delirium is distinguished from dementia by the fact that dementia has a gradual onset and is progressive in course. This fundamental difference highlights how dementia develops slowly over time, leading to a continuous decline in cognitive function, unlike the abrupt changes seen in delirium.
A: Delirium has an acute onset and is progressive in course. The acute onset of delirium contrasts sharply with dementia, where symptoms develop gradually over an extended period.
B: Delirium has a gradual onset and can be resolved. Delirium typically appears suddenly, whereas dementia's gradual progression makes this option inaccurate in distinguishing the two conditions.
D: Dementia has an acute onset and can be resolved. Dementia consistently presents with gradual onset, and while it may have management strategies, it is generally not resolved like delirium.
Question 11
Multiple Choice
The nurse is performing a health history with a client exhibiting signs of delirium. The nurse asks the client and family members about possible causes of the delirious state. Which would the nurse likely attribute as underlying causes for the client's delirium? Select all that apply.
Correct!
Incorrect
The correct answer is: A,B,C,D,F
Rationale
Recent alcohol use, dehydration, use of antihistamines, sleep disturbances, and exposure to paint or gasoline are likely underlying causes for the client's delirium.
These factors can create metabolic imbalances, alter neurochemistry, or disrupt cognitive function, leading to the acute confusion and altered mental state characteristic of delirium. Understanding these causes is crucial for effective management and treatment.
E: Use of megadoses of vitamins Excessive vitamin intake generally does not cause delirium; instead, it may lead to other health issues, which are less directly linked to cognitive disturbances.
Correct Answer: A,B,C,D,F
Rationale: Recent alcohol use, dehydration, use of antihistamines, sleep disturbances, and exposure to paint or gasoline are likely underlying causes for the client's delirium.
These factors can create metabolic imbalances, alter neurochemistry, or disrupt cognitive function, leading to the acute confusion and altered mental state characteristic of delirium. Understanding these causes is crucial for effective management and treatment.
E: Use of megadoses of vitamins Excessive vitamin intake generally does not cause delirium; instead, it may lead to other health issues, which are less directly linked to cognitive disturbances.
Question 12
Regular
A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client approaches the nurse and states, 'I'm going to take a walk outside. I'll be back in about 10 minutes.' Which is the most appropriate nursing action?
Correct!
Incorrect
The correct answer is: D
Rationale
D: Designate a staff member to accompany the client on the walk. This option ensures the client's safety while allowing them to engage in a beneficial activity, which can help alleviate some symptoms of mild delirium. Supervision is essential to monitor the client's behavior and prevent potential risks associated with their condition.
A: Further assess the client's motives for wanting to walk. While understanding motives is important, immediate action is necessary to ensure safety in the context of mild delirium.
B: Give the client permission to go on a walk on the grounds. Allowing the client to walk unaccompanied increases the risk of potential harm due to their current state of delirium.
C: Tell the client the walk is not allowed and restrict him to the unit. This action could lead to increased agitation or frustration for the client, negatively impacting their mental health and cooperation.
Correct Answer: D
Rationale: D: Designate a staff member to accompany the client on the walk. This option ensures the client's safety while allowing them to engage in a beneficial activity, which can help alleviate some symptoms of mild delirium. Supervision is essential to monitor the client's behavior and prevent potential risks associated with their condition.
A: Further assess the client's motives for wanting to walk. While understanding motives is important, immediate action is necessary to ensure safety in the context of mild delirium.
B: Give the client permission to go on a walk on the grounds. Allowing the client to walk unaccompanied increases the risk of potential harm due to their current state of delirium.
C: Tell the client the walk is not allowed and restrict him to the unit. This action could lead to increased agitation or frustration for the client, negatively impacting their mental health and cooperation.
Question 13
Regular
A client with dementia is starting pharmacotherapy to slow the progression of cognitive decline. The client has a history of moderate but steady alcohol use over the past 45 years. Which medication should the nurse question as least suitable for this client?
Correct!
Incorrect
The correct answer is: A
Rationale
Tacrine (Cognex) should be questioned as least suitable for this client. Tacrine has the potential for hepatotoxicity, which can be more pronounced in individuals with a history of alcohol use, making it a risky choice.
B: Memantine (Namenda) This medication is generally well-tolerated and does not have significant interactions with alcohol, making it safer for clients with a history of substance use.
C: Donepezil (Aricept) Donepezil is commonly prescribed for dementia and is considered safe for those with alcohol use history, having a favorable safety profile in this context.
D: Rivastigmine (Exelon) Rivastigmine is another suitable option, as it has a low risk of adverse effects related to alcohol consumption, supporting its appropriateness for managing cognitive decline.
Correct Answer: A
Rationale: Tacrine (Cognex) should be questioned as least suitable for this client. Tacrine has the potential for hepatotoxicity, which can be more pronounced in individuals with a history of alcohol use, making it a risky choice.
B: Memantine (Namenda) This medication is generally well-tolerated and does not have significant interactions with alcohol, making it safer for clients with a history of substance use.
C: Donepezil (Aricept) Donepezil is commonly prescribed for dementia and is considered safe for those with alcohol use history, having a favorable safety profile in this context.
D: Rivastigmine (Exelon) Rivastigmine is another suitable option, as it has a low risk of adverse effects related to alcohol consumption, supporting its appropriateness for managing cognitive decline.
Question 14
Regular
The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment?
Correct!
Incorrect
The correct answer is: A
Rationale
Plan for the same caregivers to provide care to individuals as much as possible. Consistency in caregivers fosters familiarity and trust, which are crucial for individuals with dementia, helping to reduce anxiety and enhance comfort in their living environment.
B: Open the windows and doors to allow fresh air to circulate through the environment. While fresh air is beneficial, it does not directly address the emotional stability and routine needs of clients with dementia.
C: Provide a buffet-style menu with many food choices. A variety of food choices can overwhelm clients with dementia, who may benefit more from simplified and familiar meal options to reduce confusion.
D: Assign peer-led exercise activities on a daily basis. Although physical activity is important, peer-led activities may not provide the structured, familiar environment that clients with dementia require for comfort and security.
Correct Answer: A
Rationale: Plan for the same caregivers to provide care to individuals as much as possible. Consistency in caregivers fosters familiarity and trust, which are crucial for individuals with dementia, helping to reduce anxiety and enhance comfort in their living environment.
B: Open the windows and doors to allow fresh air to circulate through the environment. While fresh air is beneficial, it does not directly address the emotional stability and routine needs of clients with dementia.
C: Provide a buffet-style menu with many food choices. A variety of food choices can overwhelm clients with dementia, who may benefit more from simplified and familiar meal options to reduce confusion.
D: Assign peer-led exercise activities on a daily basis. Although physical activity is important, peer-led activities may not provide the structured, familiar environment that clients with dementia require for comfort and security.
Question 15
Regular
The nurse encourages the client with dementia to meet nutritional needs. Which is the best approach to assist in meeting adequate dietary intake?
Correct!
Incorrect
The correct answer is: D
Rationale
D: Serve meals in small, bite-size pieces. This approach is effective for clients with dementia as it simplifies eating, reduces overwhelm, and encourages self-feeding, ultimately enhancing their nutritional intake and meal enjoyment.
A: Sit with the client as long as necessary to complete the meal. While companionship is beneficial, it does not directly address the practical challenges of eating for individuals with dementia.
B: Provide entertainment during meals such as television or music. Although entertainment can create a pleasant atmosphere, it may distract the client from focusing on food consumption and recognizing their hunger cues.
C: Avoid between-meal snacks to encourage appetite. Skipping snacks can lead to decreased overall intake, as clients with dementia may benefit from smaller, frequent meals rather than larger ones to stimulate their appetite.
Correct Answer: D
Rationale: D: Serve meals in small, bite-size pieces. This approach is effective for clients with dementia as it simplifies eating, reduces overwhelm, and encourages self-feeding, ultimately enhancing their nutritional intake and meal enjoyment.
A: Sit with the client as long as necessary to complete the meal. While companionship is beneficial, it does not directly address the practical challenges of eating for individuals with dementia.
B: Provide entertainment during meals such as television or music. Although entertainment can create a pleasant atmosphere, it may distract the client from focusing on food consumption and recognizing their hunger cues.
C: Avoid between-meal snacks to encourage appetite. Skipping snacks can lead to decreased overall intake, as clients with dementia may benefit from smaller, frequent meals rather than larger ones to stimulate their appetite.
Question 16
Regular
The nurse caring for an elderly woman with dementia has asked the woman's children to bring old photo albums when they visit. Which best describes the usefulness of viewing photos when caring for the dementia client?
Correct!
Incorrect
The correct answer is: A
Rationale
Viewing photos is a form of reminiscence therapy for the client. This approach can stimulate memories, enhance emotional connections, and improve communication, all of which are beneficial for individuals with dementia by providing comfort and engagement during interactions.
B: Sharing photos will encourage interaction with other clients. The focus is on the elderly woman with dementia, not on interactions with other clients, making this option less relevant to her care.
C: This can help the children to correctly identify old photographs. While identification may occur, the primary goal is to stimulate memory and connection for the elderly woman, not to educate her children.
D: Talking about the photos will encourage the client to live in the past. The intent behind reminiscence therapy is to foster positive memories and connections rather than promote a fixation on the past.
Correct Answer: A
Rationale: Viewing photos is a form of reminiscence therapy for the client. This approach can stimulate memories, enhance emotional connections, and improve communication, all of which are beneficial for individuals with dementia by providing comfort and engagement during interactions.
B: Sharing photos will encourage interaction with other clients. The focus is on the elderly woman with dementia, not on interactions with other clients, making this option less relevant to her care.
C: This can help the children to correctly identify old photographs. While identification may occur, the primary goal is to stimulate memory and connection for the elderly woman, not to educate her children.
D: Talking about the photos will encourage the client to live in the past. The intent behind reminiscence therapy is to foster positive memories and connections rather than promote a fixation on the past.
Question 17
Regular
The nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation?
Correct!
Incorrect
The correct answer is: C
Rationale
Demonstrate the exercises while clients simultaneously perform them. This approach capitalizes on the benefits of visual learning and kinesthetic engagement, fostering increased participation and retention among clients with dementia during exercises.
A: Show an instructional video just prior to the activity. Video presentations may not capture attention effectively, leading to disengagement and reduced participation, particularly for individuals with cognitive challenges.
B: Describe the exercise immediately before performing it. Verbal instructions alone may not be sufficient for comprehension, as clients with dementia may struggle to retain information without simultaneous demonstration.
D: Perform the same routine daily to avoid the need for repeated instruction. Routine repetition can lead to boredom and lack of motivation, diminishing enthusiasm and participation in the exercise sessions over time.
Correct Answer: C
Rationale: Demonstrate the exercises while clients simultaneously perform them. This approach capitalizes on the benefits of visual learning and kinesthetic engagement, fostering increased participation and retention among clients with dementia during exercises.
A: Show an instructional video just prior to the activity. Video presentations may not capture attention effectively, leading to disengagement and reduced participation, particularly for individuals with cognitive challenges.
B: Describe the exercise immediately before performing it. Verbal instructions alone may not be sufficient for comprehension, as clients with dementia may struggle to retain information without simultaneous demonstration.
D: Perform the same routine daily to avoid the need for repeated instruction. Routine repetition can lead to boredom and lack of motivation, diminishing enthusiasm and participation in the exercise sessions over time.
Question 18
Regular
A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which of the following best explains the nurse's behavior?
Correct!
Incorrect
The correct answer is: C
Rationale
The nurse gave the client a chance to calm down before resuming the meal. This approach allows the client to regain composure, reducing agitation and creating a more conducive environment for eating.
A: The nurse was unsure of how to calm the client. This does not reflect the nurse's intent; stepping away suggests a purposeful strategy rather than uncertainty in handling the situation.
B: The nurse was frustrated and needed to take a time-out. The behavior indicates a focus on the client's needs, not personal frustration; the nurse aimed to facilitate a better dining experience.
D: The nurse stepped away to verify the safety of other clients. There is no indication of safety concerns mentioned; the context centers on addressing the specific situation with the agitated client.
Correct Answer: C
Rationale: The nurse gave the client a chance to calm down before resuming the meal. This approach allows the client to regain composure, reducing agitation and creating a more conducive environment for eating.
A: The nurse was unsure of how to calm the client. This does not reflect the nurse's intent; stepping away suggests a purposeful strategy rather than uncertainty in handling the situation.
B: The nurse was frustrated and needed to take a time-out. The behavior indicates a focus on the client's needs, not personal frustration; the nurse aimed to facilitate a better dining experience.
D: The nurse stepped away to verify the safety of other clients. There is no indication of safety concerns mentioned; the context centers on addressing the specific situation with the agitated client.
Question 19
Regular
Which is the most effective intervention for clients with delirium?
Correct!
Incorrect
The correct answer is: B
Rationale
Managing environmental stimuli is the most effective intervention for clients with delirium. This approach minimizes confusion and agitation by creating a calm atmosphere, which is crucial for stabilizing cognitive function and reducing distress in affected individuals.
A: Giving detailed explanations Overloading clients with information can exacerbate confusion. Delirium often impairs comprehension, making detailed explanations ineffective and potentially overwhelming for individuals experiencing cognitive disturbances.
C: Promoting rest with PRN medications While rest is important, relying solely on medications can lead to sedation and further cognitive impairment. Non-pharmacological strategies are generally preferred for managing delirium.
D: Providing activities for distraction Distraction activities may not address the underlying issues of delirium. Clients may struggle to engage meaningfully, leading to frustration rather than alleviating symptoms or promoting recovery.
Correct Answer: B
Rationale: Managing environmental stimuli is the most effective intervention for clients with delirium. This approach minimizes confusion and agitation by creating a calm atmosphere, which is crucial for stabilizing cognitive function and reducing distress in affected individuals.
A: Giving detailed explanations Overloading clients with information can exacerbate confusion. Delirium often impairs comprehension, making detailed explanations ineffective and potentially overwhelming for individuals experiencing cognitive disturbances.
C: Promoting rest with PRN medications While rest is important, relying solely on medications can lead to sedation and further cognitive impairment. Non-pharmacological strategies are generally preferred for managing delirium.
D: Providing activities for distraction Distraction activities may not address the underlying issues of delirium. Clients may struggle to engage meaningfully, leading to frustration rather than alleviating symptoms or promoting recovery.
Question 20
Regular
The nurse is assessing a client with early signs of dementia. What is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning?
Correct!
Incorrect
The correct answer is: C
Rationale
The nurse is assessing the client's recent memory. By asking about breakfast, she evaluates the client's ability to recall recent events, which is crucial in identifying cognitive decline associated with early dementia.
A: Orientation. This option pertains to the client's awareness of time, place, and person, rather than their ability to remember specific recent experiences like breakfast.
B: Food preferences. This focuses on the client's likes and dislikes regarding food, not their capacity to remember specific meals consumed earlier in the day.
D: Remote memory. This relates to the recollection of events from the distant past, which is not relevant when discussing what the client ate for breakfast that same morning.
Correct Answer: C
Rationale: The nurse is assessing the client's recent memory. By asking about breakfast, she evaluates the client's ability to recall recent events, which is crucial in identifying cognitive decline associated with early dementia.
A: Orientation. This option pertains to the client's awareness of time, place, and person, rather than their ability to remember specific recent experiences like breakfast.
B: Food preferences. This focuses on the client's likes and dislikes regarding food, not their capacity to remember specific meals consumed earlier in the day.
D: Remote memory. This relates to the recollection of events from the distant past, which is not relevant when discussing what the client ate for breakfast that same morning.
Question 21
Regular
The nurse is working with a client who has hallucinations and delusions. The client tells the nurse she cannot take a shower because she is waiting for her husband to take her home. Which response by the nurse is best in this situation?
Correct!
Incorrect
The correct answer is: C
Rationale
You have plenty of time to shower before it's time to go home. This response acknowledges the client's current focus on her husband while gently redirecting her attention to the task at hand, promoting a sense of time and normalcy. It validates her feelings without reinforcing her delusions, supporting her mental well-being.
A: It would be best if you just took your shower now. This response dismisses the client's concerns and does not address her underlying anxiety, potentially increasing her distress and resistance.
B: You seem anxious and upset. While this observation is accurate, it lacks direction and does not provide reassurance or guidance for the client, leaving her feelings unaddressed.
D: Why are you thinking you're going home? This inquiry may provoke defensiveness or confusion, failing to support the client’s emotional state. It does not encourage a constructive dialogue about her current experience.
Correct Answer: C
Rationale: You have plenty of time to shower before it's time to go home. This response acknowledges the client's current focus on her husband while gently redirecting her attention to the task at hand, promoting a sense of time and normalcy. It validates her feelings without reinforcing her delusions, supporting her mental well-being.
A: It would be best if you just took your shower now. This response dismisses the client's concerns and does not address her underlying anxiety, potentially increasing her distress and resistance.
B: You seem anxious and upset. While this observation is accurate, it lacks direction and does not provide reassurance or guidance for the client, leaving her feelings unaddressed.
D: Why are you thinking you're going home? This inquiry may provoke defensiveness or confusion, failing to support the client’s emotional state. It does not encourage a constructive dialogue about her current experience.
Question 22
Regular
The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which intervention should the nurse implement first?
Correct!
Incorrect
The correct answer is: D
Rationale
D: Move the client to a quieter area during these times. This intervention effectively reduces environmental stimuli that can exacerbate agitation in clients with Alzheimer's, promoting a calmer atmosphere conducive to eating and transitioning during shift changes.
A: Administer an antianxiety drug such as lorazepam (Ativan) at these times. Medication is a secondary approach and may not address the immediate environmental triggers causing the client’s distress.
B: Explain the unit routine and the reasons for increased activity to the client. Cognitive challenges in Alzheimer's may hinder understanding, making explanations ineffective in alleviating anxiety during mealtimes and shift changes.
C: Keep unit activity to a minimum. While reducing activity might help, it does not target the specific issue of increased pacing and mumbling, which requires a more direct intervention.
Correct Answer: D
Rationale: D: Move the client to a quieter area during these times. This intervention effectively reduces environmental stimuli that can exacerbate agitation in clients with Alzheimer's, promoting a calmer atmosphere conducive to eating and transitioning during shift changes.
A: Administer an antianxiety drug such as lorazepam (Ativan) at these times. Medication is a secondary approach and may not address the immediate environmental triggers causing the client’s distress.
B: Explain the unit routine and the reasons for increased activity to the client. Cognitive challenges in Alzheimer's may hinder understanding, making explanations ineffective in alleviating anxiety during mealtimes and shift changes.
C: Keep unit activity to a minimum. While reducing activity might help, it does not target the specific issue of increased pacing and mumbling, which requires a more direct intervention.
Question 23
Regular
The nurse is developing interventions to promote socialization in a client with moderate dementia. Which would provide a safe and secure environment for the client?
Correct!
Incorrect
The correct answer is: B
Rationale
B: An activity with the nurse. This option ensures a personalized and secure setting where the nurse can monitor the client's well-being, facilitating social interaction while minimizing anxiety and confusion associated with larger groups.
A: A card game with other clients. This option may introduce unpredictable dynamics that could overwhelm the client, potentially leading to frustration or confusion, which is not ideal for someone with moderate dementia.
C: Decorating a bulletin board with the group. While this promotes interaction, it may not provide the necessary security and support that a one-on-one activity with the nurse can offer, which is crucial for this client.
D: Morning stretch group with music. Although stimulating, this option may lack the structured supervision that a one-on-one activity provides, possibly leaving the client feeling insecure in a larger, less controlled environment.
Correct Answer: B
Rationale: B: An activity with the nurse. This option ensures a personalized and secure setting where the nurse can monitor the client's well-being, facilitating social interaction while minimizing anxiety and confusion associated with larger groups.
A: A card game with other clients. This option may introduce unpredictable dynamics that could overwhelm the client, potentially leading to frustration or confusion, which is not ideal for someone with moderate dementia.
C: Decorating a bulletin board with the group. While this promotes interaction, it may not provide the necessary security and support that a one-on-one activity with the nurse can offer, which is crucial for this client.
D: Morning stretch group with music. Although stimulating, this option may lack the structured supervision that a one-on-one activity provides, possibly leaving the client feeling insecure in a larger, less controlled environment.
Question 24
Regular
The daughter of a client with dementia has been the primary caregiver for 5 months. The daughter expresses to the nurse, 'At times it is so overwhelming! I feel I do not have a life anymore!' Which is the most helpful response by the nurse?
Correct!
Incorrect
The correct answer is: D
Rationale
Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?
This response encourages the daughter to seek support from others experiencing similar challenges, which can alleviate feelings of isolation and overwhelm. It validates her feelings while promoting community and connection, essential for caregivers managing the stress of dementia care.
A: Are you saying you don't want to care for your mother anymore? This response can provoke defensiveness and guilt, diverting from the daughter's need for emotional support and understanding during a challenging time.
B: I know it is really hard. It takes a lot of work and you are doing such a good job. While this acknowledges her efforts, it lacks actionable support and may not address her feelings of being overwhelmed effectively.
C: Your mother really appreciates what you do for her. You are the best one to care for her. This statement might add pressure by suggesting she must continue without addressing her emotional struggles and the need for caregiver support.
Correct Answer: D
Rationale: Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?
This response encourages the daughter to seek support from others experiencing similar challenges, which can alleviate feelings of isolation and overwhelm. It validates her feelings while promoting community and connection, essential for caregivers managing the stress of dementia care.
A: Are you saying you don't want to care for your mother anymore? This response can provoke defensiveness and guilt, diverting from the daughter's need for emotional support and understanding during a challenging time.
B: I know it is really hard. It takes a lot of work and you are doing such a good job. While this acknowledges her efforts, it lacks actionable support and may not address her feelings of being overwhelmed effectively.
C: Your mother really appreciates what you do for her. You are the best one to care for her. This statement might add pressure by suggesting she must continue without addressing her emotional struggles and the need for caregiver support.
Question 25
Regular
Which statement by the nurse would be most appropriate to the family member who is the primary caregiver to a client with dementia?
Correct!
Incorrect
The correct answer is: D
Rationale
Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role.
This response acknowledges the caregiver's needs, emphasizing self-care as essential for maintaining their well-being. It encourages the caregiver to prioritize relaxation, which ultimately enhances their ability to provide quality care for their family member with dementia.
A: Most people seek help when they really need it. This statement lacks empathy and does not address the caregiver's immediate struggles or encourage proactive support and self-care.
B: What is wrong with your family? Can't they see you need help? This approach is accusatory and dismissive, failing to provide the caregiver with understanding or constructive advice regarding their situation.
C: You should be grateful that you still have your family member around. This statement minimizes the caregiver's challenges and emotional burden, overlooking their need for support and recognition of their efforts.
Correct Answer: D
Rationale: Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role.
This response acknowledges the caregiver's needs, emphasizing self-care as essential for maintaining their well-being. It encourages the caregiver to prioritize relaxation, which ultimately enhances their ability to provide quality care for their family member with dementia.
A: Most people seek help when they really need it. This statement lacks empathy and does not address the caregiver's immediate struggles or encourage proactive support and self-care.
B: What is wrong with your family? Can't they see you need help? This approach is accusatory and dismissive, failing to provide the caregiver with understanding or constructive advice regarding their situation.
C: You should be grateful that you still have your family member around. This statement minimizes the caregiver's challenges and emotional burden, overlooking their need for support and recognition of their efforts.
Question 26
Regular
A client with moderate Alzheimer's disease is living with her grown daughter. Which statement by the daughter would indicate the need for intervention by the nurse?
Correct!
Incorrect
The correct answer is: C
Rationale
C: Mother won't let anyone else do anything for her. This statement reveals a potential issue of caregiver burden and resistance to assistance, which may hinder the daughter's wellbeing and the mother's care. Intervention by the nurse is necessary to address these dynamics and ensure both the mother and daughter receive appropriate support.
A: It's distressing when my mother forgets my name. This reflects the emotional challenges faced by caregivers, but it doesn’t indicate a critical situation requiring immediate nursing intervention.
B: I wish my sister would come to visit more often. This statement expresses a desire for family support, indicating a need for social interaction rather than an urgent concern needing intervention from a nurse.
D: Taking care of my mother is a big responsibility. While this acknowledges the challenges of caregiving, it does not highlight an immediate concern that necessitates nursing intervention or support.
Correct Answer: C
Rationale: C: Mother won't let anyone else do anything for her. This statement reveals a potential issue of caregiver burden and resistance to assistance, which may hinder the daughter's wellbeing and the mother's care. Intervention by the nurse is necessary to address these dynamics and ensure both the mother and daughter receive appropriate support.
A: It's distressing when my mother forgets my name. This reflects the emotional challenges faced by caregivers, but it doesn’t indicate a critical situation requiring immediate nursing intervention.
B: I wish my sister would come to visit more often. This statement expresses a desire for family support, indicating a need for social interaction rather than an urgent concern needing intervention from a nurse.
D: Taking care of my mother is a big responsibility. While this acknowledges the challenges of caregiving, it does not highlight an immediate concern that necessitates nursing intervention or support.
Question 27
Regular
A nurse is educating a group of elderly community members about cognitive disorders. Which would the nurse include as a measure most likely to prevent Alzheimer's disease and other dementias?
Correct!
Incorrect
The correct answer is: D
Rationale
Reading is a measure most likely to prevent Alzheimer's disease and other dementias.
Engaging in reading stimulates cognitive function, enhances memory, and promotes mental agility, which are crucial in maintaining brain health. It fosters lifelong learning and social interaction, reducing the risk of cognitive decline associated with age.
A: Crafts involve creativity but may not offer the same cognitive stimulation as reading, lacking the depth of comprehension and analytical skills that reading promotes.
B: Cooking can enhance social and practical skills but does not inherently provide the cognitive engagement necessary to significantly impact long-term brain health compared to reading.
C: Watching television often leads to passive consumption of information, lacking the active mental engagement and critical thinking that reading provides, which are vital for preventing cognitive decline.
Correct Answer: D
Rationale: Reading is a measure most likely to prevent Alzheimer's disease and other dementias.
Engaging in reading stimulates cognitive function, enhances memory, and promotes mental agility, which are crucial in maintaining brain health. It fosters lifelong learning and social interaction, reducing the risk of cognitive decline associated with age.
A: Crafts involve creativity but may not offer the same cognitive stimulation as reading, lacking the depth of comprehension and analytical skills that reading promotes.
B: Cooking can enhance social and practical skills but does not inherently provide the cognitive engagement necessary to significantly impact long-term brain health compared to reading.
C: Watching television often leads to passive consumption of information, lacking the active mental engagement and critical thinking that reading provides, which are vital for preventing cognitive decline.
Question 28
Regular
The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. Which response would be best to teach as an example of this technique?
Correct!
Incorrect
The correct answer is: A
Rationale
Let's look at what is on television. This response effectively diverts the client's attention from their anger by introducing an engaging external stimulus, promoting a calmer atmosphere and fostering a more positive dining experience.
B: If you stop yelling, I will get your dessert. This approach conditions behavior through a reward, potentially escalating frustration rather than providing immediate distraction and calming influence during meals.
C: Don't you want to finish your meal? This question may provoke further agitation, as it focuses on the meal and can lead to feelings of pressure or resistance in the client.
D: I don't understand what you are saying. This response dismisses the client's feelings, potentially increasing anger and confusion rather than providing the necessary distraction to refocus their attention and emotions.
Correct Answer: A
Rationale: Let's look at what is on television. This response effectively diverts the client's attention from their anger by introducing an engaging external stimulus, promoting a calmer atmosphere and fostering a more positive dining experience.
B: If you stop yelling, I will get your dessert. This approach conditions behavior through a reward, potentially escalating frustration rather than providing immediate distraction and calming influence during meals.
C: Don't you want to finish your meal? This question may provoke further agitation, as it focuses on the meal and can lead to feelings of pressure or resistance in the client.
D: I don't understand what you are saying. This response dismisses the client's feelings, potentially increasing anger and confusion rather than providing the necessary distraction to refocus their attention and emotions.
Question 29
Regular
The adult son of a client with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. The mother has not worked in over 20 years. Which is the best guidance that the nurse could offer?
Correct!
Incorrect
The correct answer is: B
Rationale
Going along with her thought of it having been a busy day, but not referring to her work, allows for validation of her feelings without confronting her reality, promoting comfort and reducing distress.
A: Ask her to explain what she did at work today that kept her busy. This could lead to confusion and frustration, as she may struggle to recall specifics, increasing her anxiety.
C: Reorient her that she is at home and did not go to work. This approach may cause agitation and distress, as it challenges her reality and can result in feelings of invalidation.
D: Give her 5 to 10 minutes of rest, and she will have no memory of the incident. This option overlooks the emotional aspect of her expression and does not address her feelings or offer support.
Correct Answer: B
Rationale: Going along with her thought of it having been a busy day, but not referring to her work, allows for validation of her feelings without confronting her reality, promoting comfort and reducing distress.
A: Ask her to explain what she did at work today that kept her busy. This could lead to confusion and frustration, as she may struggle to recall specifics, increasing her anxiety.
C: Reorient her that she is at home and did not go to work. This approach may cause agitation and distress, as it challenges her reality and can result in feelings of invalidation.
D: Give her 5 to 10 minutes of rest, and she will have no memory of the incident. This option overlooks the emotional aspect of her expression and does not address her feelings or offer support.
Question 30
Regular
The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. Which will be accomplished by this intervention?
Correct!
Incorrect
The correct answer is: C
Rationale
Asking questions may inadvertently increase frustration for a person with Alzheimer's, as it can highlight their cognitive difficulties and lead to feelings of inadequacy or confusion during interactions.
A: Decrease environmental misinterpretation. This approach does not address environmental factors; rather, it centers on cognitive engagement, which does not mitigate misinterpretation of surroundings in those with Alzheimer's.
B: Improve memory retention. Engaging in questioning may not foster memory improvement, as Alzheimer's primarily affects memory capabilities, making retention unlikely despite repeated questioning.
D: Slow the progress of the disease. Questioning does not alter the biological progression of Alzheimer's; it merely influences the emotional experience of the individual without affecting the disease's advancement.
Correct Answer: C
Rationale: Asking questions may inadvertently increase frustration for a person with Alzheimer's, as it can highlight their cognitive difficulties and lead to feelings of inadequacy or confusion during interactions.
A: Decrease environmental misinterpretation. This approach does not address environmental factors; rather, it centers on cognitive engagement, which does not mitigate misinterpretation of surroundings in those with Alzheimer's.
B: Improve memory retention. Engaging in questioning may not foster memory improvement, as Alzheimer's primarily affects memory capabilities, making retention unlikely despite repeated questioning.
D: Slow the progress of the disease. Questioning does not alter the biological progression of Alzheimer's; it merely influences the emotional experience of the individual without affecting the disease's advancement.
Question 31
Regular
A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, 'I feel like all my work doesn't do them any good.' Which should the nurse's supervisor encourage the nurse to do?
Correct!
Incorrect
The correct answer is: B
Rationale
Try to stay supportive and meet the clients' needs at the current moment.
Encouraging the nurse to remain supportive emphasizes the importance of providing consistent care to clients with Alzheimer's, recognizing their unique needs and the value of daily interactions, even if progress seems minimal. This approach fosters patience and resilience, essential qualities in nursing, especially when working with individuals facing cognitive challenges.
A: Cease giving instructions because the clients will not remember them anyway. Stopping instructions undermines the therapeutic process, denying clients the opportunity to engage and learn, which is crucial for their well-being.
C: Seek counseling if personal feelings get in the way of client care. While addressing personal feelings is important, it may distract from focusing on the immediate needs of clients and effective caregiving strategies.
D: Consider transferring to a different client care specialty area. Transferring may avoid current frustrations but does not address essential skills needed to work with Alzheimer's clients, potentially leaving unresolved challenges.
Correct Answer: B
Rationale: Try to stay supportive and meet the clients' needs at the current moment.
Encouraging the nurse to remain supportive emphasizes the importance of providing consistent care to clients with Alzheimer's, recognizing their unique needs and the value of daily interactions, even if progress seems minimal. This approach fosters patience and resilience, essential qualities in nursing, especially when working with individuals facing cognitive challenges.
A: Cease giving instructions because the clients will not remember them anyway. Stopping instructions undermines the therapeutic process, denying clients the opportunity to engage and learn, which is crucial for their well-being.
C: Seek counseling if personal feelings get in the way of client care. While addressing personal feelings is important, it may distract from focusing on the immediate needs of clients and effective caregiving strategies.
D: Consider transferring to a different client care specialty area. Transferring may avoid current frustrations but does not address essential skills needed to work with Alzheimer's clients, potentially leaving unresolved challenges.
Question 32
Multiple Choice
Which are possible sources of frustrations for nurses caring for persons with dementia? Select all that apply.
Correct!
Incorrect
The correct answer is: A,B,C,E
Rationale
Clients do not retain explanations or instructions, so the nurse must repeat the same things continually; the nurse may get little or no positive response or feedback; it can be difficult to remain positive due to bleak outcomes; and clients may seem unresponsive to the nurse's actions, all contributing to frustrations faced by nurses.
D: It can be helpful for the nurse to talk to colleagues or even a counselor about personal feelings of depression and grief. This option suggests a coping mechanism rather than a source of frustration.
Correct Answer: A,B,C,E
Rationale: Clients do not retain explanations or instructions, so the nurse must repeat the same things continually; the nurse may get little or no positive response or feedback; it can be difficult to remain positive due to bleak outcomes; and clients may seem unresponsive to the nurse's actions, all contributing to frustrations faced by nurses.
D: It can be helpful for the nurse to talk to colleagues or even a counselor about personal feelings of depression and grief. This option suggests a coping mechanism rather than a source of frustration.