NSG 3280 Exam 4 with 58 Questions and 100% Correct
Answers with Rationales Latest Fall 2026/2027 Update –
Galen.
Section 1: Neurocognitive Disorders & Geriatric Psychiatry
1. A nurse is assessing an older adult client whose family reports a sudden onset of
confusion, severe disorientation, and vivid visual hallucinations over the past 48
hours. Which of the following conditions should the nurse suspect?
A) Alzheimer's disease
B) Vascular dementia
C) Delirium
D) Major depressive disorder
Delirium is characterized by an acute onset, fluctuating course, altered level of
consciousness, and disturbances in attention, typically triggered by an underlying medical
cause (e.g., UTI, dehydration, or drug toxicity).
2. What is the primary mechanism of action of the anti-Alzheimer's medication
Donepezil?
A) Direct destruction of beta-amyloid plaques in the cerebral cortex
B) Reversible inhibition of acetylcholinesterase, increasing acetylcholine levels in the
synaptic cleft
C) Antagonism of central dopamine D2 pathways to reduce agitation
D) Stimulation of active GABA synthesis loops across the blood-brain barrier
Donepezil is a cholinesterase inhibitor. By slowing down the enzymatic breakdown of
acetylcholine, it increases the concentration of this neurotransmitter in the brain, helping
temporarily improve or stabilize cognitive function.
,3. A nurse is establishing a care plan for a client with moderate Alzheimer's disease
who frequently exhibits "confabulation." How should the nurse interpret this
behavior?
A) A deliberate, malicious attempt to lie to staff to gain attention
B) The unconscious filling in of memory gaps with fabricated stories to maintain self-
esteem
C) A severe extrapyramidal motor side effect from neuroleptic medications
D) A persistent presentation of complex, persecutory delusional networks
Confabulation is an unconscious defense mechanism where a client with memory loss fills
in gaps with made-up stories. This helps them maintain a sense of reality and protects them
from the anxiety of memory failure.
4. A client with severe dementia demonstrates "sundown syndrome," becoming
increasingly agitated, confused, and restless at 5:00 PM daily. Which of the following
interventions should the nurse include in the plan of care?
A) Keep the client's bedroom dark and unlit during afternoon hours.
B) Maintain a consistent daily routine, turn on overhead lights before dusk, and
provide a low-stimulus environment.
C) Schedule high-intensity physical exercise sessions at 8:00 PM.
D) Change the physical layout of the furniture in the dayroom weekly to promote sensory
interest.
Sundowning involves increased confusion and agitation during late afternoon and evening
hours. Providing a structured routine, adjusting lighting before darkness falls, and
minimizing ambient noise can reduce confusion and ease anxiety.
5. What is the mechanism of action of the medication Memantine, used to manage
moderate-to-severe Alzheimer's disease?
, A) Increasing the synthesis of dopamine in the basal ganglia
B) Acting as an uncompetitive NMDA receptor antagonist, protecting neurons from
excessive glutamate-induced excitotoxicity
C) Irreversible destruction of central muscarinic M1 receptor sites
D) Enhancing the reuptake of serotonin and norepinephrine across the blood-brain barrier
Persistent, low-level overactivation of NMDA receptors by glutamate can lead to calcium
influx and cellular damage (excitotoxicity). Memantine partially blocks these receptors,
helping to protect neurons from this destructive process.
6. A nurse is caring for an older adult client on a medical-surgical floor who has a
high risk for developing delirium. Which of the following environmental modifications
should the nurse implement? [1]
A) Turn off all lights and keep the window blinds permanently closed day and night.
B) Provide clear orientation cues, keep a clock and calendar visible, and encourage
the use of personal glasses and hearing aids.
C) Play a continuous loop of loud, high-intensity television programming to keep the client
awake.
D) Restrict all family visits to a maximum of 5 minutes once per week.
Preventing or managing delirium relies heavily on non-pharmacological interventions.
Providing orientation cues, maintaining a natural light-dark cycle, and ensuring the client
can see and hear properly helps reduce sensory deprivation and confusion. [1]
7. Which of the following characteristics is a classic feature of Vascular Dementia,
differentiating it from Alzheimer's disease?
A) A gradual, insidious, and uniform decline in cognitive function over 10 years
B) An abrupt onset with a "stepwise" or jagged pattern of cognitive decline following
localized cerebrovascular events
Answers with Rationales Latest Fall 2026/2027 Update –
Galen.
Section 1: Neurocognitive Disorders & Geriatric Psychiatry
1. A nurse is assessing an older adult client whose family reports a sudden onset of
confusion, severe disorientation, and vivid visual hallucinations over the past 48
hours. Which of the following conditions should the nurse suspect?
A) Alzheimer's disease
B) Vascular dementia
C) Delirium
D) Major depressive disorder
Delirium is characterized by an acute onset, fluctuating course, altered level of
consciousness, and disturbances in attention, typically triggered by an underlying medical
cause (e.g., UTI, dehydration, or drug toxicity).
2. What is the primary mechanism of action of the anti-Alzheimer's medication
Donepezil?
A) Direct destruction of beta-amyloid plaques in the cerebral cortex
B) Reversible inhibition of acetylcholinesterase, increasing acetylcholine levels in the
synaptic cleft
C) Antagonism of central dopamine D2 pathways to reduce agitation
D) Stimulation of active GABA synthesis loops across the blood-brain barrier
Donepezil is a cholinesterase inhibitor. By slowing down the enzymatic breakdown of
acetylcholine, it increases the concentration of this neurotransmitter in the brain, helping
temporarily improve or stabilize cognitive function.
,3. A nurse is establishing a care plan for a client with moderate Alzheimer's disease
who frequently exhibits "confabulation." How should the nurse interpret this
behavior?
A) A deliberate, malicious attempt to lie to staff to gain attention
B) The unconscious filling in of memory gaps with fabricated stories to maintain self-
esteem
C) A severe extrapyramidal motor side effect from neuroleptic medications
D) A persistent presentation of complex, persecutory delusional networks
Confabulation is an unconscious defense mechanism where a client with memory loss fills
in gaps with made-up stories. This helps them maintain a sense of reality and protects them
from the anxiety of memory failure.
4. A client with severe dementia demonstrates "sundown syndrome," becoming
increasingly agitated, confused, and restless at 5:00 PM daily. Which of the following
interventions should the nurse include in the plan of care?
A) Keep the client's bedroom dark and unlit during afternoon hours.
B) Maintain a consistent daily routine, turn on overhead lights before dusk, and
provide a low-stimulus environment.
C) Schedule high-intensity physical exercise sessions at 8:00 PM.
D) Change the physical layout of the furniture in the dayroom weekly to promote sensory
interest.
Sundowning involves increased confusion and agitation during late afternoon and evening
hours. Providing a structured routine, adjusting lighting before darkness falls, and
minimizing ambient noise can reduce confusion and ease anxiety.
5. What is the mechanism of action of the medication Memantine, used to manage
moderate-to-severe Alzheimer's disease?
, A) Increasing the synthesis of dopamine in the basal ganglia
B) Acting as an uncompetitive NMDA receptor antagonist, protecting neurons from
excessive glutamate-induced excitotoxicity
C) Irreversible destruction of central muscarinic M1 receptor sites
D) Enhancing the reuptake of serotonin and norepinephrine across the blood-brain barrier
Persistent, low-level overactivation of NMDA receptors by glutamate can lead to calcium
influx and cellular damage (excitotoxicity). Memantine partially blocks these receptors,
helping to protect neurons from this destructive process.
6. A nurse is caring for an older adult client on a medical-surgical floor who has a
high risk for developing delirium. Which of the following environmental modifications
should the nurse implement? [1]
A) Turn off all lights and keep the window blinds permanently closed day and night.
B) Provide clear orientation cues, keep a clock and calendar visible, and encourage
the use of personal glasses and hearing aids.
C) Play a continuous loop of loud, high-intensity television programming to keep the client
awake.
D) Restrict all family visits to a maximum of 5 minutes once per week.
Preventing or managing delirium relies heavily on non-pharmacological interventions.
Providing orientation cues, maintaining a natural light-dark cycle, and ensuring the client
can see and hear properly helps reduce sensory deprivation and confusion. [1]
7. Which of the following characteristics is a classic feature of Vascular Dementia,
differentiating it from Alzheimer's disease?
A) A gradual, insidious, and uniform decline in cognitive function over 10 years
B) An abrupt onset with a "stepwise" or jagged pattern of cognitive decline following
localized cerebrovascular events
