Mental Health CH 18 Review Summer 2025

An older adult takes digoxin and hydrochlorothiazide daily, as well as lorazepam as needed for anxiety. Over 2 days, this adult developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of which adverse reaction to the medication therapy?

• Delirium

• Dementia

• Amnestic syndrome

• Alzheimer’s disease

Answer explanation

The symptoms of confusion, slurred speech, and fluctuating orientation are indicative of delirium, which can occur due to medication effects, especially in older adults. Dementia and Alzheimer's disease present differently.

A patient experiencing fluctuating levels of awareness, confusion, and disturbed orientation shouts, “Bugs are crawling on my legs! Get them off!” Which problem is the patient experiencing?

• A. Aphasia

• B. Dystonia

• C. Tactile hallucinations

• D. Mnemonic disturbance

Answer explanation

The patient is experiencing tactile hallucinations, as indicated by the sensation of "bugs crawling on my legs," which is a false perception of touch. This aligns with choice C, distinguishing it from the other options.

A patient experiencing fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, “Someone get these bugs off me.” What is the nurse’s best response?

• There are no bugs on your legs. Your imagination is playing tricks on you.

• Try to relax. The crawling sensation will go away sooner if you can relax.

• Don’t worry. I will have someone stay here and brush off the bugs for you.

Answer explanation

The best response is to encourage relaxation, as it helps the patient cope with their hallucinations. Acknowledging their feelings without dismissing them can provide comfort and support.

What is the priority nursing diagnosis for a patient experiencing fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations?

• Bathing/hygiene self-care deficit related to altered cerebral function as evidenced by confusion and inability to perform personal hygiene tasks

• Risk for injury related to altered cerebral function, misperception of the environment, and unsteady gait

• Disturbed thought processes related to medication intoxication as evidenced by confusion, disorientation, and hallucinations

• Fear related to sensory perceptual alterations as evidenced by hiding from imagined ferocious dogs

Answer explanation

The priority nursing diagnosis is 'Risk for injury' due to altered cerebral function and misperceptions, which can lead to unsafe behaviors and falls, especially with fluctuating consciousness and hallucinations.

What is the priority nursing intervention for a patient diagnosed with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations?

• Avoidance of physical contact

• High level of sensory stimulation

• Careful observation and supervision

• Application of wrist and ankle restraints

Answer explanation

The priority nursing intervention for a patient with delirium is careful observation and supervision. This ensures safety and allows for timely intervention due to their fluctuating consciousness and perceptual alterations.

Which environmental adjustment should the nurse make for a patient experiencing delirium with perceptual alterations?

• Keep the patient by the nurse’s desk while the patient is awake. Provide rest periods in a room with a television on.

• Light the room brightly, day and night. Awaken the patient hourly to assess mental status.

• Maintain soft lighting day and night. Keep a radio on low volume continuously.

• Provide a well-lit room without glare or shadows. Limit noise and stimulation.

Answer explanation

Providing a well-lit room without glare or shadows while limiting noise and stimulation helps reduce confusion and anxiety in patients with delirium, making it the best choice for their comfort and safety.

Which description of patient behavior best applies to a hallucination?

• Looking at shadows on a wall and says, “I see scary faces”

• Stating, “I feel bugs crawling on my legs and biting me”

• Becoming anxious when the nurse leaves his or her bedside

• Trying to hit the nurse when vital signs are taken

Answer explanation

The correct choice, "Stating, 'I feel bugs crawling on my legs and biting me,'" describes a tactile hallucination, where the patient perceives sensations that are not present, unlike the other options which do not indicate hallucinations.

Consider these health problems: Lewy body disease, Pick disease, and Parkinson’s disease. Which term unifies these problems?

• Intoxication

• Dementia

• Delirium

• Amnesia

Answer explanation

Lewy body disease, Pick disease, and Parkinson’s disease are all types of dementia, which is characterized by cognitive decline. Therefore, the term that unifies these health problems is 'Dementia'.

When used for treatment of patients diagnosed with Alzheimer’s disease, which medication would be expected to antagonize N-methyl-D-aspartate (NMDA) channels rather than cholinesterase?

• Donepezil

• Rivastigmine

Answer explanation

Rivastigmine is a cholinesterase inhibitor, but it also has NMDA receptor antagonistic properties. In contrast, Donepezil primarily inhibits cholinesterase, making Rivastigmine the correct choice for antagonizing NMDA channels.

Memantine blocks the NMDA channels and is used in moderate-to-late stages of the disease. Donepezil, rivastigmine, and galantamine are all cholinesterase inhibitors. These drugs increase the availability of acetylcholine and are most often used to treat mild-to-moderate Alzheimer’s disease.

• Memantine

• Galantamine

Answer explanation

Memantine is the correct choice as it blocks NMDA channels and is used in moderate-to-late Alzheimer's disease. In contrast, galantamine is a cholinesterase inhibitor for mild-to-moderate stages.