NSG 526 Exam 3 Questions &
Verified Answers with Rationale
Latest Edition 2026/2027
Question 1
A PMHNP is evaluating an older adult client who presents with
memory impairment, confusion that worsens in the evening
hours, and fluctuating levels of alertness over the past 48 hours.
The client has a recent urinary tract infection. Which condition
is the most likely diagnosis?
A. Major neurocognitive disorder due to Alzheimer disease
B. Vascular dementia
C. Delirium
D. Major depressive disorder with pseudodementia
Correct Answer: C
Rationale: Delirium is characterized by an acute onset,
fluctuating course, altered level of consciousness, and disturbed
attention, often triggered by a physiological stressor such as a
urinary tract infection in older adults. Alzheimer disease and
vascular dementia feature a gradual onset and progressive
decline without acute fluctuations in alertness.
Question 2
Which neurotransmitter abnormality is most consistently
implicated in the pathophysiology of Alzheimer disease and
,serves as the primary target for acetylcholinesterase inhibitor
medications?
A. Excess dopamine in the mesolimbic pathway
B. Deficit of acetylcholine in the cerebral cortex and
hippocampus
C. Elevation of serotonin in the synaptic cleft
D. Depletion of GABA in the basal ganglia
Correct Answer: B
Rationale: Alzheimer disease is marked by a significant
degeneration of cholinergic neurons, leading to a deficit of
acetylcholine, which is critical for memory and learning.
Acetylcholinesterase inhibitors work by preventing the
breakdown of available acetylcholine in the synaptic cleft.
Question 3
An older adult client diagnosed with mild cognitive impairment
is prescribed memantine (Namenda). What is the primary
mechanism of action of this medication?
A. Irreversible inhibition of monoamine oxidase
B. Blockade of NMDA receptors to prevent excitotoxic cell
damage caused by excess glutamate
C. Stimulation of nicotinic acetylcholine receptors in the
hippocampus
D. Blockade of post-synaptic dopamine D2 receptors
Correct Answer: B
,Rationale: Memantine is an uncompetitive NMDA receptor
antagonist that blocks pathological overstimulation by
glutamate, which can lead to calcium influx and neuronal
excitotoxicity in neurodegenerative disorders like Alzheimer
disease.
Question 4
A PMHNP is assessing a child brought in by school officials due
to severe academic underachievement, constant fidgeting,
impulsivity, and blurting out answers in class before questions
are finished. These symptoms have been present since age 6
across both home and school environments. Which diagnosis is
most appropriate?
A. Oppositional defiant disorder
B. Attention-deficit/hyperactivity disorder (ADHD),
combined presentation
C. Generalized anxiety disorder
D. Disruptive mood dysregulation disorder
Correct Answer: B
Rationale: The presentation of both persistent inattention and
hyperactive-impulsive symptoms that interfere with functioning
in multiple settings (home and school) prior to age 12 meets the
diagnostic criteria for ADHD, combined presentation.
Question 5
Which medication class is considered first-line pharmacotherapy
for the management of core symptoms of attention-
deficit/hyperactivity disorder (ADHD) in children and adults?
, A. Selective serotonin reuptake inhibitors (SSRIs)
B. Atypical antipsychotics
C. Psychostimulants (e.g., methylphenidate, amphetamines)
D. Mood stabilizers (e.g., lithium)
Correct Answer: C
Rationale: Psychostimulants are the gold standard, first-line
pharmacological treatment for ADHD because they effectively
block the reuptake of and increase the availability of dopamine
and norepinephrine in the prefrontal cortex, improving attention
and impulse control.
Question 6
A child is diagnosed with autism spectrum disorder (ASD).
Which core behavioral domains must be impaired to meet the
DSM-5 diagnostic criteria for this condition?
A. Impairments in social communication and social
interaction, alongside restricted, repetitive patterns of
behavior, interests, or activities
B. Severe motor tics and involuntary vocalizations lasting
more than one year
C. Persistent defiance of authority figures and vindictive
behavior toward adults
D. Chronic, severe recurrent temper outbursts manifested
verbally and behaviorally
Correct Answer: A
Rationale: ASD diagnosis requires the presence of persistent
deficits in social communication/interaction across multiple
Verified Answers with Rationale
Latest Edition 2026/2027
Question 1
A PMHNP is evaluating an older adult client who presents with
memory impairment, confusion that worsens in the evening
hours, and fluctuating levels of alertness over the past 48 hours.
The client has a recent urinary tract infection. Which condition
is the most likely diagnosis?
A. Major neurocognitive disorder due to Alzheimer disease
B. Vascular dementia
C. Delirium
D. Major depressive disorder with pseudodementia
Correct Answer: C
Rationale: Delirium is characterized by an acute onset,
fluctuating course, altered level of consciousness, and disturbed
attention, often triggered by a physiological stressor such as a
urinary tract infection in older adults. Alzheimer disease and
vascular dementia feature a gradual onset and progressive
decline without acute fluctuations in alertness.
Question 2
Which neurotransmitter abnormality is most consistently
implicated in the pathophysiology of Alzheimer disease and
,serves as the primary target for acetylcholinesterase inhibitor
medications?
A. Excess dopamine in the mesolimbic pathway
B. Deficit of acetylcholine in the cerebral cortex and
hippocampus
C. Elevation of serotonin in the synaptic cleft
D. Depletion of GABA in the basal ganglia
Correct Answer: B
Rationale: Alzheimer disease is marked by a significant
degeneration of cholinergic neurons, leading to a deficit of
acetylcholine, which is critical for memory and learning.
Acetylcholinesterase inhibitors work by preventing the
breakdown of available acetylcholine in the synaptic cleft.
Question 3
An older adult client diagnosed with mild cognitive impairment
is prescribed memantine (Namenda). What is the primary
mechanism of action of this medication?
A. Irreversible inhibition of monoamine oxidase
B. Blockade of NMDA receptors to prevent excitotoxic cell
damage caused by excess glutamate
C. Stimulation of nicotinic acetylcholine receptors in the
hippocampus
D. Blockade of post-synaptic dopamine D2 receptors
Correct Answer: B
,Rationale: Memantine is an uncompetitive NMDA receptor
antagonist that blocks pathological overstimulation by
glutamate, which can lead to calcium influx and neuronal
excitotoxicity in neurodegenerative disorders like Alzheimer
disease.
Question 4
A PMHNP is assessing a child brought in by school officials due
to severe academic underachievement, constant fidgeting,
impulsivity, and blurting out answers in class before questions
are finished. These symptoms have been present since age 6
across both home and school environments. Which diagnosis is
most appropriate?
A. Oppositional defiant disorder
B. Attention-deficit/hyperactivity disorder (ADHD),
combined presentation
C. Generalized anxiety disorder
D. Disruptive mood dysregulation disorder
Correct Answer: B
Rationale: The presentation of both persistent inattention and
hyperactive-impulsive symptoms that interfere with functioning
in multiple settings (home and school) prior to age 12 meets the
diagnostic criteria for ADHD, combined presentation.
Question 5
Which medication class is considered first-line pharmacotherapy
for the management of core symptoms of attention-
deficit/hyperactivity disorder (ADHD) in children and adults?
, A. Selective serotonin reuptake inhibitors (SSRIs)
B. Atypical antipsychotics
C. Psychostimulants (e.g., methylphenidate, amphetamines)
D. Mood stabilizers (e.g., lithium)
Correct Answer: C
Rationale: Psychostimulants are the gold standard, first-line
pharmacological treatment for ADHD because they effectively
block the reuptake of and increase the availability of dopamine
and norepinephrine in the prefrontal cortex, improving attention
and impulse control.
Question 6
A child is diagnosed with autism spectrum disorder (ASD).
Which core behavioral domains must be impaired to meet the
DSM-5 diagnostic criteria for this condition?
A. Impairments in social communication and social
interaction, alongside restricted, repetitive patterns of
behavior, interests, or activities
B. Severe motor tics and involuntary vocalizations lasting
more than one year
C. Persistent defiance of authority figures and vindictive
behavior toward adults
D. Chronic, severe recurrent temper outbursts manifested
verbally and behaviorally
Correct Answer: A
Rationale: ASD diagnosis requires the presence of persistent
deficits in social communication/interaction across multiple
