NR548 EXAM 3 LATEST 2026/2027 | Psychiatric
Assessment for PMHNP | Weeks 5-6 Covered |
Questions & Verified Answers | Chamberlain | Pass
Guaranteed - A+ Graded
Section 1: Neurocognitive Disorders Assessment (Questions 1-12)
Q1. A 78-year-old man hospitalized for hip fracture repair becomes acutely confused
on postoperative day 2. He is inattentive, unable to follow conversations, and
believes the hospital is his childhood home. Symptoms fluctuate throughout the day,
worsening at night. Which assessment tool is most appropriate for initial screening?
A. Mini-Mental State Examination (MMSE)
B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM) [CORRECT]
D. Geriatric Depression Scale (GDS)
Rationale: The CAM is the validated screening instrument specifically designed to
detect delirium in acute care settings, assessing acute onset/fluctuating course,
inattention, disorganized thinking, and altered level of consciousness. MMSE and
MoCA assess chronic cognitive impairment but cannot distinguish delirium from
dementia without clinical context. GDS screens for depression, not cognitive status.
Correct Answer: C
Q2. Which feature most reliably distinguishes delirium from major neurocognitive
disorder (dementia)?
A. Presence of memory impairment
B. Acute onset with fluctuating course and disturbance in attention [CORRECT]
C. Age of patient
D. Presence of behavioral symptoms
,Rationale: Delirium is defined by acute onset (hours to days), fluctuating course, and
core disturbance in attention and awareness superimposed on additional cognitive
deficits. Dementia has insidious onset, progressive course, and relatively stable
attention early in the disease. Both can affect elderly patients and produce behavioral
symptoms, making temporal course and attention the critical differentiators.
Correct Answer: B
Q3. A patient with delirium is lethargic, has minimal verbal responses, and shows
decreased motor activity. Family reports he was "perfectly fine" three days ago.
Which subtype of delirium is present, and why is it clinically significant?
A. Hyperactive delirium; associated with increased fall risk
B. Hypoactive delirium; frequently missed and associated with worse prognosis
[CORRECT]
C. Mixed delirium; most common subtype
D. Delirium tremens; requires benzodiazepine treatment
Rationale: Hypoactive delirium presents with lethargy, psychomotor slowing, and
decreased responsiveness; it is often overlooked by clinicians and carries higher
morbidity and mortality than hyperactive forms due to delayed recognition and
association with underlying medical severity. Hyperactive delirium features agitation
and hallucinations, while mixed types alternate between states.
Correct Answer: B
Q4. A 72-year-old woman with Alzheimer's disease is admitted with pneumonia and
develops worsening confusion. Her family notes this is "different from her usual
memory problems." Which pathophysiologic mechanism best explains this acute
change?
A. Progression of underlying neurodegeneration
B. Superimposed delirium from infection and physiological stress [CORRECT]
,C. Development of a new primary psychiatric disorder
D. Normal aging process
Rationale: Patients with dementia have significantly increased vulnerability to
delirium due to diminished cerebral reserve. Acute infections, metabolic
disturbances, and medications can precipitate delirium superimposed on dementia
(DSD), producing an acute change in baseline cognition that is distinct from the
progressive course of the underlying neurodegenerative disease.
Correct Answer: B
Q5. Which neuroimaging finding is most characteristic of Alzheimer's disease?
A. Frontal lobe atrophy with Pick bodies
B. Hippocampal and temporoparietal atrophy with amyloid plaques and
neurofibrillary tangles [CORRECT]
C. Basal ganglia calcification
D. Diffuse white matter disease without cortical involvement
Rationale: Alzheimer's disease is neuropathologically characterized by extracellular
amyloid-beta plaques and intracellular neurofibrillary tangles composed of
hyperphosphorylated tau protein. Neuroimaging demonstrates progressive atrophy
of the medial temporal lobes (hippocampus) and temporoparietal association
cortices. Frontal atrophy with Pick bodies indicates frontotemporal dementia, while
diffuse white matter disease suggests vascular cognitive impairment.
Correct Answer: B
Q6. A 68-year-old man presents with stepwise decline in cognition over two years.
He has a history of hypertension, diabetes, and two prior strokes with residual right
hemiparesis. Brain MRI shows multiple cortical and subcortical infarcts with extensive
white matter hyperintensities. Which diagnosis is most likely?
, A. Alzheimer's disease
B. Vascular neurocognitive disorder [CORRECT]
C. Dementia with Lewy bodies
D. Frontotemporal dementia
Rationale: Vascular neurocognitive disorder is characterized by cognitive decline
temporally related to cerebrovascular events, stepwise deterioration, focal
neurological signs, and neuroimaging evidence of infarcts or significant white matter
disease. The patient's vascular risk factors, stroke history, and stepwise course
distinguish this from the insidious progression of Alzheimer's or the fluctuating
cognition and hallucinations of DLB.
Correct Answer: B
Q7. A 65-year-old man presents with progressive behavioral changes including
disinhibition, apathy, loss of empathy, compulsive overeating, and socially
inappropriate comments. Memory is relatively preserved. Brain MRI shows frontal
and anterior temporal atrophy. Which diagnosis is most appropriate?
A. Alzheimer's disease
B. Behavioral variant frontotemporal dementia [CORRECT]
C. Vascular dementia
D. Normal pressure hydrocephalus
Rationale: Behavioral variant frontotemporal dementia (bvFTD) presents with early
and prominent personality changes, disinhibition, apathy, loss of empathy,
compulsive behaviors, and hyperorality with relative sparing of episodic memory.
Frontal and temporal atrophy on imaging supports the diagnosis. Alzheimer's
disease typically presents with amnestic syndrome, and vascular dementia shows
stepwise decline with focal signs.
Correct Answer: B
Assessment for PMHNP | Weeks 5-6 Covered |
Questions & Verified Answers | Chamberlain | Pass
Guaranteed - A+ Graded
Section 1: Neurocognitive Disorders Assessment (Questions 1-12)
Q1. A 78-year-old man hospitalized for hip fracture repair becomes acutely confused
on postoperative day 2. He is inattentive, unable to follow conversations, and
believes the hospital is his childhood home. Symptoms fluctuate throughout the day,
worsening at night. Which assessment tool is most appropriate for initial screening?
A. Mini-Mental State Examination (MMSE)
B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM) [CORRECT]
D. Geriatric Depression Scale (GDS)
Rationale: The CAM is the validated screening instrument specifically designed to
detect delirium in acute care settings, assessing acute onset/fluctuating course,
inattention, disorganized thinking, and altered level of consciousness. MMSE and
MoCA assess chronic cognitive impairment but cannot distinguish delirium from
dementia without clinical context. GDS screens for depression, not cognitive status.
Correct Answer: C
Q2. Which feature most reliably distinguishes delirium from major neurocognitive
disorder (dementia)?
A. Presence of memory impairment
B. Acute onset with fluctuating course and disturbance in attention [CORRECT]
C. Age of patient
D. Presence of behavioral symptoms
,Rationale: Delirium is defined by acute onset (hours to days), fluctuating course, and
core disturbance in attention and awareness superimposed on additional cognitive
deficits. Dementia has insidious onset, progressive course, and relatively stable
attention early in the disease. Both can affect elderly patients and produce behavioral
symptoms, making temporal course and attention the critical differentiators.
Correct Answer: B
Q3. A patient with delirium is lethargic, has minimal verbal responses, and shows
decreased motor activity. Family reports he was "perfectly fine" three days ago.
Which subtype of delirium is present, and why is it clinically significant?
A. Hyperactive delirium; associated with increased fall risk
B. Hypoactive delirium; frequently missed and associated with worse prognosis
[CORRECT]
C. Mixed delirium; most common subtype
D. Delirium tremens; requires benzodiazepine treatment
Rationale: Hypoactive delirium presents with lethargy, psychomotor slowing, and
decreased responsiveness; it is often overlooked by clinicians and carries higher
morbidity and mortality than hyperactive forms due to delayed recognition and
association with underlying medical severity. Hyperactive delirium features agitation
and hallucinations, while mixed types alternate between states.
Correct Answer: B
Q4. A 72-year-old woman with Alzheimer's disease is admitted with pneumonia and
develops worsening confusion. Her family notes this is "different from her usual
memory problems." Which pathophysiologic mechanism best explains this acute
change?
A. Progression of underlying neurodegeneration
B. Superimposed delirium from infection and physiological stress [CORRECT]
,C. Development of a new primary psychiatric disorder
D. Normal aging process
Rationale: Patients with dementia have significantly increased vulnerability to
delirium due to diminished cerebral reserve. Acute infections, metabolic
disturbances, and medications can precipitate delirium superimposed on dementia
(DSD), producing an acute change in baseline cognition that is distinct from the
progressive course of the underlying neurodegenerative disease.
Correct Answer: B
Q5. Which neuroimaging finding is most characteristic of Alzheimer's disease?
A. Frontal lobe atrophy with Pick bodies
B. Hippocampal and temporoparietal atrophy with amyloid plaques and
neurofibrillary tangles [CORRECT]
C. Basal ganglia calcification
D. Diffuse white matter disease without cortical involvement
Rationale: Alzheimer's disease is neuropathologically characterized by extracellular
amyloid-beta plaques and intracellular neurofibrillary tangles composed of
hyperphosphorylated tau protein. Neuroimaging demonstrates progressive atrophy
of the medial temporal lobes (hippocampus) and temporoparietal association
cortices. Frontal atrophy with Pick bodies indicates frontotemporal dementia, while
diffuse white matter disease suggests vascular cognitive impairment.
Correct Answer: B
Q6. A 68-year-old man presents with stepwise decline in cognition over two years.
He has a history of hypertension, diabetes, and two prior strokes with residual right
hemiparesis. Brain MRI shows multiple cortical and subcortical infarcts with extensive
white matter hyperintensities. Which diagnosis is most likely?
, A. Alzheimer's disease
B. Vascular neurocognitive disorder [CORRECT]
C. Dementia with Lewy bodies
D. Frontotemporal dementia
Rationale: Vascular neurocognitive disorder is characterized by cognitive decline
temporally related to cerebrovascular events, stepwise deterioration, focal
neurological signs, and neuroimaging evidence of infarcts or significant white matter
disease. The patient's vascular risk factors, stroke history, and stepwise course
distinguish this from the insidious progression of Alzheimer's or the fluctuating
cognition and hallucinations of DLB.
Correct Answer: B
Q7. A 65-year-old man presents with progressive behavioral changes including
disinhibition, apathy, loss of empathy, compulsive overeating, and socially
inappropriate comments. Memory is relatively preserved. Brain MRI shows frontal
and anterior temporal atrophy. Which diagnosis is most appropriate?
A. Alzheimer's disease
B. Behavioral variant frontotemporal dementia [CORRECT]
C. Vascular dementia
D. Normal pressure hydrocephalus
Rationale: Behavioral variant frontotemporal dementia (bvFTD) presents with early
and prominent personality changes, disinhibition, apathy, loss of empathy,
compulsive behaviors, and hyperorality with relative sparing of episodic memory.
Frontal and temporal atrophy on imaging supports the diagnosis. Alzheimer's
disease typically presents with amnestic syndrome, and vascular dementia shows
stepwise decline with focal signs.
Correct Answer: B
