An elderly patient is brought to the clinic for confusion, horizontal eye movement bilaterally, and intermittent disorientation to time and place over the past 3 months. The patient has a history of alcoholism for 30 years. Which dementia type is the patient most likely experiencing?

Correct Answer: A

Rationale: The correct answer is A: Wernicke's encephalopathy. This patient's history of chronic alcoholism puts them at risk for thiamine deficiency, leading to Wernicke's encephalopathy. Symptoms such as confusion, horizontal eye movement abnormalities (nystagmus), and disorientation are classic features. Pick's disease (B) is a rare form of frontotemporal dementia with distinct pathological features. Lewy bodies (C) are associated with dementia with Lewy bodies, characterized by visual hallucinations and parkinsonism. Parkinson's disease (D) primarily presents with motor symptoms like tremors and rigidity, not cognitive deficits like this patient.

Correct Answer: B

Rationale: The correct answer is B: Illness anxiety disorder (hypochondriasis). This disorder involves excessive worry about having a serious illness despite medical reassurance. In this case, the patient's persistent fear of cervical cancer despite normal Pap smear results and attributing them to laboratory errors aligns with the characteristic of illness anxiety disorder. Other choices: A: Functional neurologic (conversion) disorder - This disorder involves physical symptoms without a medical explanation. The patient in the question does not exhibit physical symptoms. C: Body dysmorphic disorder - This disorder involves preoccupation with perceived defects in physical appearance. The patient's concern is not related to body image. D: Dissociative amnesia with fugue - This disorder involves memory loss with sudden travel or wandering. The patient does not display memory loss or wandering behavior in the scenario.

Correct Answer: B

Rationale: In this scenario, the correct answer is option B: Assess the patient's neurologic status for changes. This task requires a higher level of assessment skill and critical thinking, which is typically within the scope of practice of a registered nurse rather than an LPN/LVN. The LPN/LVN can assist with tasks that are more routine and do not require advanced assessment skills. Option A, checking the patient's skin for pressure from the device, is a task that can be safely delegated to the LPN/LVN as it involves basic assessment and monitoring of skin integrity. Option C, observing the halo insertion sites for signs of infection, requires a higher level of assessment to differentiate between normal healing and signs of infection. This task is more appropriate for a registered nurse. Option D, cleaning the halo insertion sites with hydrogen peroxide, involves a specific procedure that may require specialized training or knowledge. It is best performed by a healthcare provider with the appropriate skill set, such as a registered nurse. In an educational context, it is important to understand the principles of delegation in nursing practice. Delegation is a critical skill that ensures safe and efficient patient care delivery. Understanding the scope of practice for different healthcare team members helps in assigning tasks appropriately to optimize patient outcomes and utilize the skills of each team member effectively.

Correct Answer: C

Rationale: In this scenario, option C, "Remind the patient to allow adequate time for meals," is the appropriate task to delegate to a nursing assistant (NA). Delegating this task to the NA is suitable as it involves providing reminders and assistance with activities of daily living, which falls within the NA's scope of practice and does not require specialized nursing knowledge or skills. Options A, B, and D involve more complex nursing assessments and interventions that require a higher level of nursing knowledge and skill. Checking for orthostatic changes in pulse and blood pressure, monitoring tremor improvement after medication, and observing for abnormal involuntary movements are tasks that require critical thinking, clinical judgment, and the ability to make appropriate decisions based on the assessment findings. These tasks are best performed by a registered nurse who has the necessary training and expertise to interpret and respond to the assessment data effectively. From an educational perspective, understanding the principles of delegation is crucial for nursing students and practicing nurses. It is essential to recognize the scope of practice for different members of the healthcare team and delegate tasks appropriately based on individual competencies and responsibilities. By delegating tasks effectively, nurses can optimize patient care outcomes, promote teamwork, and ensure safe and efficient delivery of care.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) large output of low specific gravity urine. The pituitary gland plays a crucial role in regulating the body's water balance through the secretion of antidiuretic hormone (ADH). When the pituitary gland is injured, it may affect the production or release of ADH, leading to decreased reabsorption of water in the kidneys and subsequently causing a large output of diluted urine with low specific gravity. Option B) watery nasal discharge positive for glucose is incorrect because this symptom is more indicative of conditions affecting the nasal passages or sinuses, such as a nasal infection or diabetes insipidus. Option C) pupils failing to react to light is incorrect because it is more suggestive of a neurological issue involving the optic nerve or brain, rather than a pituitary gland injury. Option D) positive Babinski reflex is incorrect as it is a response seen in neurological conditions affecting the corticospinal tract, not related to pituitary gland function. Educationally, understanding the signs and symptoms of pituitary gland dysfunction is essential for nurses and healthcare professionals, especially when assessing patients with suspected endocrine disorders. This knowledge helps in early identification, appropriate referral, and management of pituitary gland-related conditions, contributing to better patient outcomes and care.