NR601 Week 5 Questions With Answers and Explanations
600-Question Comprehensive Mock Exam | Neurologic, Cognitive, Mood, Sensory, Safety & Geriatric Clinical Reasoning
Question 1. An older adult develops acute fluctuating confusion and inattention over several hours. Which
diagnosis is most likely?
A. Delirium
B. Alzheimer disease
C. Normal aging
D. Persistent depressive disorder
Correct Answer: A. Delirium
Explanation: Delirium is characterized by an acute change in attention and awareness with a fluctuating course. Dementia usually
develops gradually and is not defined by abrupt fluctuations in attention. In older adults, delirium should trigger a search for an
underlying medical, medication-related, toxic, or metabolic cause. Prompt recognition matters because delirium can signal serious
illness.
Question 2. Which feature most strongly distinguishes delirium from dementia?
A. Difficulty with complex tasks
B. Acute onset with fluctuating attention
C. Impaired memory
D. Older age
Correct Answer: B. Acute onset with fluctuating attention
Explanation: Both delirium and dementia can affect cognition, but delirium typically begins acutely and fluctuates. Inattention is a
core feature of delirium. Dementia generally reflects a chronic decline from prior cognitive function. A patient with baseline dementia
can also develop superimposed delirium.
Question 3. An older adult with dementia suddenly becomes much more confused after starting a new medication.
What is the priority?
A. Assume inevitable dementia progression
B. Wait several months before reassessment
C. Evaluate for superimposed delirium and medication effects
D. Increase all psychoactive medications
Correct Answer: C. Evaluate for superimposed delirium and medication effects
Explanation: A sudden change from cognitive baseline is not typical of uncomplicated dementia progression. Medication adverse
effects are common reversible contributors to delirium in older adults. The clinician should review recent drug changes and assess for
infection, dehydration, metabolic abnormalities, pain, and other causes. Treating the precipitant is central to delirium management.
Question 4. Which tool is commonly used to help identify delirium?
A. Wells score
B. APGAR score
C. FRAX alone
D. Confusion Assessment Method
Correct Answer: D. Confusion Assessment Method
Explanation: The Confusion Assessment Method is a widely used structured approach to delirium identification. It focuses on
features such as acute change, fluctuating course, inattention, disorganized thinking, and altered level of consciousness. A screening
tool supports but does not replace clinical evaluation. Positive findings should prompt assessment for the underlying cause.
NR601 Week 5 | Standard older-adult primary-care review Page 1
, Question 5. Which finding is most consistent with Alzheimer-type dementia?
A. Gradual progressive decline in memory and other cognitive domains
B. Isolated positional vertigo
C. Sudden focal weakness lasting 20 minutes
D. Abrupt fluctuating inattention over hours
Correct Answer: A. Gradual progressive decline in memory and other cognitive domains
Explanation: Alzheimer disease usually has an insidious onset and progressive course. Memory impairment is common early,
followed by broader cognitive and functional decline. Acute fluctuation should raise concern for delirium or another superimposed
process. Diagnosis requires history, functional assessment, examination, and evaluation for alternative causes.
Question 6. What feature differentiates major neurocognitive disorder from mild cognitive impairment?
A. Age older than 65 years
B. Cognitive deficits interfere with independent daily function
C. Any complaint of forgetfulness
D. A single low screening score
Correct Answer: B. Cognitive deficits interfere with independent daily function
Explanation: Major neurocognitive disorder involves cognitive decline severe enough to interfere with independent functioning. Mild
cognitive impairment can involve objective cognitive decline while basic independence is largely preserved. Screening scores alone
do not establish either diagnosis. Functional history from the patient and a knowledgeable informant is often essential.
Question 7. An older adult has a positive brief cognitive screen. What should the clinician do next?
A. Ignore functional history
B. Immediately declare permanent incapacity
C. Perform a broader clinical evaluation rather than diagnose dementia from the screen alone
D. Start multiple dementia drugs without assessment
Correct Answer: C. Perform a broader clinical evaluation rather than diagnose dementia from the screen alone
Explanation: Cognitive screening tools identify patients who may need further evaluation; they are not stand-alone diagnostic tests.
Assessment should consider history, functional decline, medications, mood, sensory impairment, neurologic findings, and potentially
reversible contributors. Collateral information can be especially helpful. Acute delirium should be excluded before interpreting chronic
cognitive decline.
Question 8. Which reversible contributor should be considered during evaluation of cognitive decline?
A. Normal age-related skin changes
B. Gray hair
C. Presbyopia corrected with lenses
D. Medication effects, thyroid dysfunction, vitamin B12 deficiency, or depression
Correct Answer: D. Medication effects, thyroid dysfunction, vitamin B12 deficiency, or depression
Explanation: Several medical and medication-related conditions can worsen cognition or mimic a neurocognitive disorder. Evaluation
commonly considers medication burden, mood, thyroid disease, vitamin deficiencies, metabolic abnormalities, and other clinically
indicated causes. The exact workup depends on the presentation. Finding a treatable contributor can improve function even when
chronic neurodegeneration is also present.
NR601 Week 5 | Standard older-adult primary-care review Page 2
, Question 9. Why should hearing and vision be assessed before interpreting cognitive testing?
A. Sensory impairment can falsely worsen apparent cognitive performance
B. Hearing loss prevents all cognitive assessment
C. Vision determines decision-making capacity
D. Sensory loss proves dementia
Correct Answer: A. Sensory impairment can falsely worsen apparent cognitive performance
Explanation: A patient who cannot adequately hear instructions or see testing materials may perform poorly for reasons unrelated to
cognition. Sensory impairment also affects communication and daily function. Clinicians should optimize hearing, vision, language,
and testing conditions when possible. Results must be interpreted in the broader clinical context.
Question 10. Which statement about decision-making capacity in a patient with dementia is correct?
A. A cognitive screening score alone determines legal competence
B. Capacity is decision-specific and is not automatically absent because of the diagnosis
C. Every dementia diagnosis eliminates capacity permanently
D. Capacity is determined only by age
Correct Answer: B. Capacity is decision-specific and is not automatically absent because of the diagnosis
Explanation: Decision-making capacity is assessed for a specific decision and can vary with complexity and clinical circumstances.
A diagnosis of dementia does not automatically mean the person lacks capacity. Clinicians generally assess the ability to understand,
appreciate, reason, and communicate a choice. Legal competence is a separate legal determination.
Question 11. An older adult with dementia is still driving but has had several near-collisions. What is the best
approach?
A. Recommend driving only at higher speeds
B. Ignore the issue to preserve independence
C. Assess driving safety, cognition, vision, function, medications, and applicable reporting requirements
D. Reassure solely because the patient has a license
Correct Answer: C. Assess driving safety, cognition, vision, function, medications, and applicable reporting
requirements
Explanation: Driving is a complex instrumental activity requiring cognition, vision, motor function, and judgment. Near-collisions are a
meaningful safety signal and warrant further assessment. The clinician should discuss risk respectfully and consider formal driving
evaluation or local requirements when appropriate. Preserving autonomy does not mean ignoring substantial safety concerns.
Question 12. An older adult with dementia repeatedly wanders from home. Which intervention is most appropriate?
A. Lock the patient alone in a room
B. Use physical restraints routinely
C. Rely only on verbal promises not to wander
D. Develop a safety plan using supervision, identification strategies, and environmental measures
Correct Answer: D. Develop a safety plan using supervision, identification strategies, and environmental measures
Explanation: Wandering creates risks of injury, exposure, and becoming lost. Safety planning may include supervision, door alerts,
identification programs, structured activity, and caregiver education. Restrictive measures can cause harm and should not be routine.
The plan should preserve dignity while reducing foreseeable risk.
NR601 Week 5 | Standard older-adult primary-care review Page 3
, Question 13. A caregiver for a patient with dementia reports exhaustion and inability to sleep. What should the
clinician do?
A. Assess caregiver burden and connect the caregiver with respite and support resources
B. Tell the caregiver stress is unavoidable and needs no attention
C. Recommend social isolation
D. Focus only on the patient's medications
Correct Answer: A. Assess caregiver burden and connect the caregiver with respite and support resources
Explanation: Caregiver strain can affect the health of both the caregiver and patient. Assessment should explore sleep, mood,
physical health, safety, financial strain, and available support. Respite services, education, support groups, home resources, and care
coordination may help. Sustainable caregiving is part of comprehensive dementia care.
Question 14. An older adult with dementia becomes agitated every evening. What is the best initial approach?
A. Punish the behavior
B. Look for triggers such as pain, overstimulation, unmet needs, medication effects, or disrupted routine
C. Immediately use long-term physical restraints
D. Assume all agitation requires an antipsychotic
Correct Answer: B. Look for triggers such as pain, overstimulation, unmet needs, medication effects, or disrupted
routine
Explanation: Behavioral symptoms in dementia often have environmental, medical, or unmet-need triggers. Nonpharmacologic
assessment and intervention are generally first-line when immediate danger is absent. Pain, constipation, infection, sleep disruption,
sensory impairment, and medication effects should be considered. Psychoactive medications can carry substantial risks in older
adults.
Question 15. Which nonpharmacologic strategy can help a person with dementia who becomes anxious in
unfamiliar settings?
A. Use complex multi-step instructions
B. Frequently change caregivers without warning
C. Maintain a predictable routine and provide calm, simple cues
D. Increase background noise
Correct Answer: C. Maintain a predictable routine and provide calm, simple cues
Explanation: Predictability and simple communication can reduce cognitive load and distress. Familiar routines, environmental cues,
adequate lighting, and calm reassurance often support function. Complex instructions and excessive stimulation may worsen
confusion. Interventions should be tailored to the individual's abilities and preferences.
Question 16. Which symptom cluster most strongly suggests depression in an older adult?
A. Stable preference for quiet activities
B. Need for reading glasses
C. Gray hair and wrinkles
D. Persistent loss of interest, low mood, sleep or appetite change, and functional decline
Correct Answer: D. Persistent loss of interest, low mood, sleep or appetite change, and functional decline
Explanation: Depression is not a normal consequence of aging. Older adults may present with anhedonia, mood changes, sleep
disturbance, appetite change, fatigue, cognitive complaints, or somatic symptoms. Screening can identify possible depression but
should be followed by clinical assessment. Suicide risk must be evaluated when indicated.
NR601 Week 5 | Standard older-adult primary-care review Page 4
600-Question Comprehensive Mock Exam | Neurologic, Cognitive, Mood, Sensory, Safety & Geriatric Clinical Reasoning
Question 1. An older adult develops acute fluctuating confusion and inattention over several hours. Which
diagnosis is most likely?
A. Delirium
B. Alzheimer disease
C. Normal aging
D. Persistent depressive disorder
Correct Answer: A. Delirium
Explanation: Delirium is characterized by an acute change in attention and awareness with a fluctuating course. Dementia usually
develops gradually and is not defined by abrupt fluctuations in attention. In older adults, delirium should trigger a search for an
underlying medical, medication-related, toxic, or metabolic cause. Prompt recognition matters because delirium can signal serious
illness.
Question 2. Which feature most strongly distinguishes delirium from dementia?
A. Difficulty with complex tasks
B. Acute onset with fluctuating attention
C. Impaired memory
D. Older age
Correct Answer: B. Acute onset with fluctuating attention
Explanation: Both delirium and dementia can affect cognition, but delirium typically begins acutely and fluctuates. Inattention is a
core feature of delirium. Dementia generally reflects a chronic decline from prior cognitive function. A patient with baseline dementia
can also develop superimposed delirium.
Question 3. An older adult with dementia suddenly becomes much more confused after starting a new medication.
What is the priority?
A. Assume inevitable dementia progression
B. Wait several months before reassessment
C. Evaluate for superimposed delirium and medication effects
D. Increase all psychoactive medications
Correct Answer: C. Evaluate for superimposed delirium and medication effects
Explanation: A sudden change from cognitive baseline is not typical of uncomplicated dementia progression. Medication adverse
effects are common reversible contributors to delirium in older adults. The clinician should review recent drug changes and assess for
infection, dehydration, metabolic abnormalities, pain, and other causes. Treating the precipitant is central to delirium management.
Question 4. Which tool is commonly used to help identify delirium?
A. Wells score
B. APGAR score
C. FRAX alone
D. Confusion Assessment Method
Correct Answer: D. Confusion Assessment Method
Explanation: The Confusion Assessment Method is a widely used structured approach to delirium identification. It focuses on
features such as acute change, fluctuating course, inattention, disorganized thinking, and altered level of consciousness. A screening
tool supports but does not replace clinical evaluation. Positive findings should prompt assessment for the underlying cause.
NR601 Week 5 | Standard older-adult primary-care review Page 1
, Question 5. Which finding is most consistent with Alzheimer-type dementia?
A. Gradual progressive decline in memory and other cognitive domains
B. Isolated positional vertigo
C. Sudden focal weakness lasting 20 minutes
D. Abrupt fluctuating inattention over hours
Correct Answer: A. Gradual progressive decline in memory and other cognitive domains
Explanation: Alzheimer disease usually has an insidious onset and progressive course. Memory impairment is common early,
followed by broader cognitive and functional decline. Acute fluctuation should raise concern for delirium or another superimposed
process. Diagnosis requires history, functional assessment, examination, and evaluation for alternative causes.
Question 6. What feature differentiates major neurocognitive disorder from mild cognitive impairment?
A. Age older than 65 years
B. Cognitive deficits interfere with independent daily function
C. Any complaint of forgetfulness
D. A single low screening score
Correct Answer: B. Cognitive deficits interfere with independent daily function
Explanation: Major neurocognitive disorder involves cognitive decline severe enough to interfere with independent functioning. Mild
cognitive impairment can involve objective cognitive decline while basic independence is largely preserved. Screening scores alone
do not establish either diagnosis. Functional history from the patient and a knowledgeable informant is often essential.
Question 7. An older adult has a positive brief cognitive screen. What should the clinician do next?
A. Ignore functional history
B. Immediately declare permanent incapacity
C. Perform a broader clinical evaluation rather than diagnose dementia from the screen alone
D. Start multiple dementia drugs without assessment
Correct Answer: C. Perform a broader clinical evaluation rather than diagnose dementia from the screen alone
Explanation: Cognitive screening tools identify patients who may need further evaluation; they are not stand-alone diagnostic tests.
Assessment should consider history, functional decline, medications, mood, sensory impairment, neurologic findings, and potentially
reversible contributors. Collateral information can be especially helpful. Acute delirium should be excluded before interpreting chronic
cognitive decline.
Question 8. Which reversible contributor should be considered during evaluation of cognitive decline?
A. Normal age-related skin changes
B. Gray hair
C. Presbyopia corrected with lenses
D. Medication effects, thyroid dysfunction, vitamin B12 deficiency, or depression
Correct Answer: D. Medication effects, thyroid dysfunction, vitamin B12 deficiency, or depression
Explanation: Several medical and medication-related conditions can worsen cognition or mimic a neurocognitive disorder. Evaluation
commonly considers medication burden, mood, thyroid disease, vitamin deficiencies, metabolic abnormalities, and other clinically
indicated causes. The exact workup depends on the presentation. Finding a treatable contributor can improve function even when
chronic neurodegeneration is also present.
NR601 Week 5 | Standard older-adult primary-care review Page 2
, Question 9. Why should hearing and vision be assessed before interpreting cognitive testing?
A. Sensory impairment can falsely worsen apparent cognitive performance
B. Hearing loss prevents all cognitive assessment
C. Vision determines decision-making capacity
D. Sensory loss proves dementia
Correct Answer: A. Sensory impairment can falsely worsen apparent cognitive performance
Explanation: A patient who cannot adequately hear instructions or see testing materials may perform poorly for reasons unrelated to
cognition. Sensory impairment also affects communication and daily function. Clinicians should optimize hearing, vision, language,
and testing conditions when possible. Results must be interpreted in the broader clinical context.
Question 10. Which statement about decision-making capacity in a patient with dementia is correct?
A. A cognitive screening score alone determines legal competence
B. Capacity is decision-specific and is not automatically absent because of the diagnosis
C. Every dementia diagnosis eliminates capacity permanently
D. Capacity is determined only by age
Correct Answer: B. Capacity is decision-specific and is not automatically absent because of the diagnosis
Explanation: Decision-making capacity is assessed for a specific decision and can vary with complexity and clinical circumstances.
A diagnosis of dementia does not automatically mean the person lacks capacity. Clinicians generally assess the ability to understand,
appreciate, reason, and communicate a choice. Legal competence is a separate legal determination.
Question 11. An older adult with dementia is still driving but has had several near-collisions. What is the best
approach?
A. Recommend driving only at higher speeds
B. Ignore the issue to preserve independence
C. Assess driving safety, cognition, vision, function, medications, and applicable reporting requirements
D. Reassure solely because the patient has a license
Correct Answer: C. Assess driving safety, cognition, vision, function, medications, and applicable reporting
requirements
Explanation: Driving is a complex instrumental activity requiring cognition, vision, motor function, and judgment. Near-collisions are a
meaningful safety signal and warrant further assessment. The clinician should discuss risk respectfully and consider formal driving
evaluation or local requirements when appropriate. Preserving autonomy does not mean ignoring substantial safety concerns.
Question 12. An older adult with dementia repeatedly wanders from home. Which intervention is most appropriate?
A. Lock the patient alone in a room
B. Use physical restraints routinely
C. Rely only on verbal promises not to wander
D. Develop a safety plan using supervision, identification strategies, and environmental measures
Correct Answer: D. Develop a safety plan using supervision, identification strategies, and environmental measures
Explanation: Wandering creates risks of injury, exposure, and becoming lost. Safety planning may include supervision, door alerts,
identification programs, structured activity, and caregiver education. Restrictive measures can cause harm and should not be routine.
The plan should preserve dignity while reducing foreseeable risk.
NR601 Week 5 | Standard older-adult primary-care review Page 3
, Question 13. A caregiver for a patient with dementia reports exhaustion and inability to sleep. What should the
clinician do?
A. Assess caregiver burden and connect the caregiver with respite and support resources
B. Tell the caregiver stress is unavoidable and needs no attention
C. Recommend social isolation
D. Focus only on the patient's medications
Correct Answer: A. Assess caregiver burden and connect the caregiver with respite and support resources
Explanation: Caregiver strain can affect the health of both the caregiver and patient. Assessment should explore sleep, mood,
physical health, safety, financial strain, and available support. Respite services, education, support groups, home resources, and care
coordination may help. Sustainable caregiving is part of comprehensive dementia care.
Question 14. An older adult with dementia becomes agitated every evening. What is the best initial approach?
A. Punish the behavior
B. Look for triggers such as pain, overstimulation, unmet needs, medication effects, or disrupted routine
C. Immediately use long-term physical restraints
D. Assume all agitation requires an antipsychotic
Correct Answer: B. Look for triggers such as pain, overstimulation, unmet needs, medication effects, or disrupted
routine
Explanation: Behavioral symptoms in dementia often have environmental, medical, or unmet-need triggers. Nonpharmacologic
assessment and intervention are generally first-line when immediate danger is absent. Pain, constipation, infection, sleep disruption,
sensory impairment, and medication effects should be considered. Psychoactive medications can carry substantial risks in older
adults.
Question 15. Which nonpharmacologic strategy can help a person with dementia who becomes anxious in
unfamiliar settings?
A. Use complex multi-step instructions
B. Frequently change caregivers without warning
C. Maintain a predictable routine and provide calm, simple cues
D. Increase background noise
Correct Answer: C. Maintain a predictable routine and provide calm, simple cues
Explanation: Predictability and simple communication can reduce cognitive load and distress. Familiar routines, environmental cues,
adequate lighting, and calm reassurance often support function. Complex instructions and excessive stimulation may worsen
confusion. Interventions should be tailored to the individual's abilities and preferences.
Question 16. Which symptom cluster most strongly suggests depression in an older adult?
A. Stable preference for quiet activities
B. Need for reading glasses
C. Gray hair and wrinkles
D. Persistent loss of interest, low mood, sleep or appetite change, and functional decline
Correct Answer: D. Persistent loss of interest, low mood, sleep or appetite change, and functional decline
Explanation: Depression is not a normal consequence of aging. Older adults may present with anhedonia, mood changes, sleep
disturbance, appetite change, fatigue, cognitive complaints, or somatic symptoms. Screening can identify possible depression but
should be followed by clinical assessment. Suicide risk must be evaluated when indicated.
NR601 Week 5 | Standard older-adult primary-care review Page 4
