NCLEX-RN practice › Psychosocial Integrity
NCLEX question: postoperative delirium in an older adult
Psychosocial Integrity · Multiple choice · Clinical judgment step: Analyze cues
Client record
Nursing notes
- Night
- pulling at IV, believes it is 1985, falls asleep mid-sentence.
- Day
- calm, oriented to person only, cannot count backward from 10.
- Family
- was independent and managed own finances 1 week ago.
Medications
Oxycodone 10 mg every 4 hours — 6 doses in 24 hours
Diphenhydramine 25 mg at bedtime for sleep
Foley catheter in place
Laboratory results
Sodium 131 mEq/L
WBC 13,200/mm³
- Urinalysis
- positive nitrites and leukocytes
A 79-year-old client is 2 days after hip fracture repair. The family says the client "is not themself". Based on the client record, which conclusion is most accurate?
- A. The client has early dementia revealed by hospitalization
- B. The confusion is expected after anaesthesia and will resolve without action
- C. The client has delirium with several reversible contributors
- D. The client is depressed and withdrawn
Show the answer and rationales
Answer: C
Delirium is acute, fluctuating and marked by inattention. In older adults after surgery, look for drugs (opioids, anticholinergics), infection, electrolyte imbalance and catheters.
- A. Incorrect. Dementia develops over months to years; this client was independent a week ago.
- B. Incorrect. Delirium is a medical emergency with higher mortality; causes must be found and treated.
- C. Correct. Correct. Acute onset, fluctuating course, inattention and disorganised thinking meet the criteria for delirium. Opioids, an anticholinergic, a catheter-associated urinary infection and hyponatremia are reversible contributors the nurse reports.
- D. Incorrect. Depression does not cause fluctuating consciousness and inattention.
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