Kernig’s sign is positive if pain occurs on flexion of the hip and knee. Kernig’s sign is one of the physically demonstrable symptoms of meningitis. Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.

Option B: The Brudzinski reflex is positive if pain occurs on flexion of the head and neck onto the chest. Brudzinski’s sign is one of the physically demonstrable symptoms of meningitis. Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed. Brudzinski’s sign is used to diagnose meningitis.
Option C: A tension headache may cause pain on the left side and behind the eyes, and may be linked to stress. Tension headaches account for up to 42 percent of headaches worldwide. They may occur on one side so could be the cause of a headache on the left side.
Option D: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you’re spinning or that the inside of your head is spinning. BPPV causes brief episodes of mild to intense dizziness. It is usually triggered by specific changes in the head’s position. This might occur when one tips their head up or down, when the client lies down, or when he turns over or sits up in bed.

Agnosia is the term used to describe the loss of the ability to recognize what objects are and what they are used for. For an instance, a person with agnosia might try to use a fork instead of a spoon, a shoe instead of a cup or a knife instead of a pencil etc. With regard to people, this might involve failing to recognize who people are, not due to memory loss but rather as a result of the brain not working out the identity of a person on the basis of the information supplied by the eyes.

Option B: Apraxia is the term used to describe the failure to carry out voluntary and purposeful movements notwithstanding the fact that muscular power, sensibility, and coordination are intact. In everyday terms, this might involve the inability to tie shoelaces, turn a tap on, fasten buttons or switch on a radio.
Option C: Aphasia is the term used to describe a difficulty or loss of the ability to speak or understand spoken, written or sign language as a result of damage to the corresponding nervous center. This can become apparent in a number of ways. It might involve exchanging a word which is linked by meaning (e.g. time instead of clock), using the wrong word but one which sounds alike (e.g. boat instead of coat) or using a totally different word with no apparent connection. When accompanied by echolalia (the involuntary repetition of words or phrases spoken by another person) and the constant repetition of a word or phrase, the result can be a form of speech which is difficult for others to understand or a kind of jargon.
Option D: Anomia is a form of aphasia in which the patient is unable to recall the names of everyday objects. Anomic aphasia is a language disorder that leads to trouble naming objects when speaking and writing. Brain damage caused by stroke, traumatic injury, or tumors can lead to anomic aphasia.

Increased confusion at night is known as “sundowning” syndrome. This increased confusion occurs when the sun begins to set and continues during the night. The term “sundowning” refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.

Option A: Fatigue is not necessarily present. Sundowning isn’t a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer’s disease. The exact cause of this behavior is unknown.
Option B: Increased confusion at night is not part of normal aging. Some research suggests that a low dose of melatonin — a naturally occurring hormone that induces sleepiness — alone or in combination with exposure to bright light during the day may help ease sundowning.
Option D: A delusion is a firm, fixed belief. Delusions are defined as fixed, false beliefs that conflict with reality. Despite contrary evidence, a person in a delusional state can’t let go of their convictions. Delusions are often reinforced by the misinterpretation of events. Many delusions also involve some level of paranoia. For example, someone might contend that the government is controlling our every move via radio waves despite evidence to the contrary.

The client who is confused might forget that he ate earlier. Don’t argue with the client. Simply get him something to eat that will satisfy him until lunch. Avoid challenging illogical thinking. Challenges to the patient’s thinking can be perceived as threatening and result in a defensive reaction. Maintain normal fluid and electrolyte balance; establish/maintain normal nutrition, body temperature, oxygenation (if patients experience low oxygen saturation treat with supplemental oxygen), blood glucose levels, blood pressure.

Option A: Orient patient to surroundings, staff, necessary activities as needed. Present reality concisely and briefly. Avoid challenging illogical thinking—defensive reactions may result. Increased orientation ensures a greater degree of safety for the patient.
Option B: This statement is validating the delusion. Encourage family/SO(s) to participate in reorientation as well as providing ongoing input (e.g., current news and family happenings). The confused patient may not completely understand what is happening. The presence of family and significant others may enhance the patient’s level of comfort.
Option D: Communicate patient’s status, cognition, and behavioral manifestations to all necessary providers. Recognize that a patient’s fluctuating cognition and behavior is a hallmark for delirium and is not to be construed as a patient preference for caregivers.

Nausea and gastrointestinal upset are very common in clients taking acetylcholinesterase inhibitors such as Exelon. Other side effects include liver toxicity, dizziness, unsteadiness, and clumsiness. The main adverse effects associated with the use of rivastigmine are gastrointestinal. The primary symptoms are nausea and vomiting. These acute effects primarily occur during the initial dose-escalation phase of therapy upward dose titration of the drug to achieve a therapeutic dose. These events can be minimized by using a slow titration schedule and taking the medication with food if prescribing an oral formulation.

Option A: Toxicity to the drug, while rare, should be carefully monitored. Common manifestations of toxicity include the presence of severe gastrointestinal reactions, allergic cutaneous reactions, as well as central nervous system effects. Classic manifestations of a patient in crisis can be remembered by the mnemonic DUMBELS – diarrhea, urination, miosis, bradycardia, excitability, lacrimation, salivation/excessive sweating prior to treatment.
Option B: The client might already be experiencing urinary incontinence or headaches, but they are not necessarily associated. Patients that are experiencing a cholinergic crisis should have atropine followed by pralidoxime to reverse the anticholinergic effects of rivastigmine. While the usual treatment of the crisis involves giving atropine before pralidoxime, a case study done in 2009 showed a successful reversal of cholinergic crisis with just pralidoxime without atropine pretreatment.
Option C: The client with Alzheimer’s disease is already confused. With its approval by the FDA, rivastigmine is indicated to treat mild to moderate dementia of the Alzheimer’s type. Its indications also include the treatment of mild to moderate dementia that is associated with Parkinson’s disease.