NCLEX Alzheimer’s Disease Study Guide
|Dementia and Delirium Challenge
Exam Questions and Correct Accurate
Answers Graded A+
1. 1. Question
Nurse Isabelle enters the room of a client with a cognitive impairment disorder
and asks what day of the week it is; what the date, month, and year are; and
where the client is. The nurse is attempting to assess:
A. Confabulation.
B. Delirium.
C. Orientation.
D. Perseveration.
Correct Answer: C. Orientation.
The initial, most basic assessment of a client with cognitive impairment involves
determining his level of orientation (awareness of time, place, and person). The
tools for reality orientation aim to reinforce the naming of objects and people as
well as a timeline of events, past or present. Multiple studies have demonstrated
that the use of reality orientation has improved cognitive functioning for people
living with dementia when compared to control groups who did not receive it. As
a rule, reality orientation must be mixed with compassion and used appropriately
to benefit someone living with the confusion of dementia. Applying it without
evaluating if it might cause emotional distress to the individual since there are
some times when it would not be appropriate.
2. 2. Question
A student nurse was asked which of the following best describes dementia.
Which of the following best describes the condition?
A. Memory loss occurring as part of the natural consequence of aging.
Page 1 of 38
, B. Difficulty coping with physical and psychological change.
C. Severe cognitive impairment that occurs rapidly.
D. Loss of cognitive abilities, impairing ability to perform activities of daily
living.
Correct Answer: D. Loss of cognitive abilities, impairing ability to perform
activities of daily living.
The impaired ability to perform self-care is an important measure of a client’s
dementia progression and loss of cognitive abilities. Difficulty or impaired ability
to perform normal activities of daily living, such as maintaining hygiene and
grooming, toileting, making meals, and maintaining a household, are significant
indications of dementia. Slowing of processes necessary for information retrieval
is a normal consequence of aging. However, the global statement that memory
loss occurs as part of natural aging is not true.
3. 3. Question
Which of the following will Nurse Dory use when communicating with a client
who has cognitive impairment?
A. Complete explanations with multiple details.
B. Pictures or gestures instead of words.
C. Stimulating words and phrases to capture the client's attention.
D. Short words and simple sentences.
Correct Answer: D. Short words and simple sentences.
Short words and simple sentences minimize client confusion and enhance
communication. Assess the patient’s ability to speak, language deficit, cognitive
or sensory impairment, presence of aphasia, dysarthria, aphonia, dyslalia, or
apraxia. Presence of psychosis, and/or other neurologic disorders affecting
speech. This identifies problem areas and speech patterns to help establish a plan
of care.
4. 4. Question
Mrs. Mendoza is a 75-year-old client who has dementia of the Alzheimer’s type
and confabulates. The nurse understands that this client:
Page 2 of 38
, A. Denies confusion by being jovial.
B. Pretends to be someone else.
C. Rationalizes various behaviors.
D. Fills in memory gaps with fantasy.
Correct Answer: D. Fills in memory gaps with fantasy.
Confabulation is a communication device used by patients with dementia to
compensate for memory gaps. Confabulation is a type of memory error in which
gaps in a person’s memory are unconsciously filled with fabricated,
misinterpreted, or distorted information. When someone confabulates, they are
confusing things they have imagined with real memories. A person who is
confabulating is not lying. They are not making a conscious or intentional
attempt to deceive. Rather, they are confident in the truth of their memories even
when confronted with contradictory evidence.
5. 5. Question
Which ability should Nurse Rebecca expect from a client in the mild stage of
dementia of the Alzheimer’s type?
A. Remembering the daily schedule.
B. Recalling past events.
Correct answer
C. Coping the anxiety.
D. Solving problems of daily living.
Correct Answer: B. Recalling past events
Recent memory loss is the characteristic sign of cognitive difficulty in early
Alzheimer’s disease. The ability to recall past events is usually retained until the
later stages of this disorder. Symptoms of Alzheimer’s disease depend on the
stage of the disease. Alzheimer’s disease is classified into preclinical or
presymptomatic, mild, and dementia-stage depending on the degree of cognitive
impairment. These stages are different from the DSM-5 classification of
Alzheimer’s disease. The initial and most common presenting symptom is
episodic short-term memory loss with relative sparing of long-term memory and
can be elicited in most patients even when not the presenting symptom.
Page 3 of 38
, 6. 6. Question
82-year-old Mr. Robeson together with his daughter arrived at the medical-
surgical unit for diagnostic confirmation and management of probable delirium.
Which statement by the client’s daughter best supports the diagnosis?
A. "Maybe it's just caused by aging. This usually happens by age 82."
B. "The changes in his behavior came on so quickly! I wasn't sure what was
happening."
Correct answer
C. "Dad just didn't seem to know what he was doing. He would forget what
he had for breakfast."
D. "Dad has always been so independent. He's lived alone for years since
mom died."
Correct Answer: B. “The changes in his behavior came on so quickly! I wasn’t
sure what was happening.”
Delirium is an acute process characterized by abrupt, spontaneous cognitive
dysfunction. Delirium, also known as the acute confusional state, is a clinical
syndrome that usually develops in the elderly. It is characterized by an alteration
of consciousness and cognition with reduced ability to focus, sustain, or shift
attention. It develops over a short period and fluctuates during the day.
Option A: Cognitive impairment disorders (dementia or delirium) are not
normal consequences of aging. There are two groups of risk factors related to
delirium: predisposing and precipitant factors. The most common predisposing
factors are older age (older than 70 years), dementia (often not recognized
clinically), functional disabilities, male gender, poor vision and hearing, and
mild cognitive impairment. Alcohol use disorder and laboratory abnormalities
have been associated with an increased risk.
Option C: Option C would be characteristic of someone with dementia. The
clinical presentation of delirium can vary, but usually, it flourishes with
psychomotor behavioral disturbances such as hyperactivity or hypoactivity
with increased sympathetic activity and impairment in sleep duration and
architecture. It is caused by a medical condition, substance intoxication, or
withdrawal in addition to the medication side effects, as well as; it is no better
explained by another preexisting, involving, or established neurocognitive
disorder.
Page 4 of 38
|Dementia and Delirium Challenge
Exam Questions and Correct Accurate
Answers Graded A+
1. 1. Question
Nurse Isabelle enters the room of a client with a cognitive impairment disorder
and asks what day of the week it is; what the date, month, and year are; and
where the client is. The nurse is attempting to assess:
A. Confabulation.
B. Delirium.
C. Orientation.
D. Perseveration.
Correct Answer: C. Orientation.
The initial, most basic assessment of a client with cognitive impairment involves
determining his level of orientation (awareness of time, place, and person). The
tools for reality orientation aim to reinforce the naming of objects and people as
well as a timeline of events, past or present. Multiple studies have demonstrated
that the use of reality orientation has improved cognitive functioning for people
living with dementia when compared to control groups who did not receive it. As
a rule, reality orientation must be mixed with compassion and used appropriately
to benefit someone living with the confusion of dementia. Applying it without
evaluating if it might cause emotional distress to the individual since there are
some times when it would not be appropriate.
2. 2. Question
A student nurse was asked which of the following best describes dementia.
Which of the following best describes the condition?
A. Memory loss occurring as part of the natural consequence of aging.
Page 1 of 38
, B. Difficulty coping with physical and psychological change.
C. Severe cognitive impairment that occurs rapidly.
D. Loss of cognitive abilities, impairing ability to perform activities of daily
living.
Correct Answer: D. Loss of cognitive abilities, impairing ability to perform
activities of daily living.
The impaired ability to perform self-care is an important measure of a client’s
dementia progression and loss of cognitive abilities. Difficulty or impaired ability
to perform normal activities of daily living, such as maintaining hygiene and
grooming, toileting, making meals, and maintaining a household, are significant
indications of dementia. Slowing of processes necessary for information retrieval
is a normal consequence of aging. However, the global statement that memory
loss occurs as part of natural aging is not true.
3. 3. Question
Which of the following will Nurse Dory use when communicating with a client
who has cognitive impairment?
A. Complete explanations with multiple details.
B. Pictures or gestures instead of words.
C. Stimulating words and phrases to capture the client's attention.
D. Short words and simple sentences.
Correct Answer: D. Short words and simple sentences.
Short words and simple sentences minimize client confusion and enhance
communication. Assess the patient’s ability to speak, language deficit, cognitive
or sensory impairment, presence of aphasia, dysarthria, aphonia, dyslalia, or
apraxia. Presence of psychosis, and/or other neurologic disorders affecting
speech. This identifies problem areas and speech patterns to help establish a plan
of care.
4. 4. Question
Mrs. Mendoza is a 75-year-old client who has dementia of the Alzheimer’s type
and confabulates. The nurse understands that this client:
Page 2 of 38
, A. Denies confusion by being jovial.
B. Pretends to be someone else.
C. Rationalizes various behaviors.
D. Fills in memory gaps with fantasy.
Correct Answer: D. Fills in memory gaps with fantasy.
Confabulation is a communication device used by patients with dementia to
compensate for memory gaps. Confabulation is a type of memory error in which
gaps in a person’s memory are unconsciously filled with fabricated,
misinterpreted, or distorted information. When someone confabulates, they are
confusing things they have imagined with real memories. A person who is
confabulating is not lying. They are not making a conscious or intentional
attempt to deceive. Rather, they are confident in the truth of their memories even
when confronted with contradictory evidence.
5. 5. Question
Which ability should Nurse Rebecca expect from a client in the mild stage of
dementia of the Alzheimer’s type?
A. Remembering the daily schedule.
B. Recalling past events.
Correct answer
C. Coping the anxiety.
D. Solving problems of daily living.
Correct Answer: B. Recalling past events
Recent memory loss is the characteristic sign of cognitive difficulty in early
Alzheimer’s disease. The ability to recall past events is usually retained until the
later stages of this disorder. Symptoms of Alzheimer’s disease depend on the
stage of the disease. Alzheimer’s disease is classified into preclinical or
presymptomatic, mild, and dementia-stage depending on the degree of cognitive
impairment. These stages are different from the DSM-5 classification of
Alzheimer’s disease. The initial and most common presenting symptom is
episodic short-term memory loss with relative sparing of long-term memory and
can be elicited in most patients even when not the presenting symptom.
Page 3 of 38
, 6. 6. Question
82-year-old Mr. Robeson together with his daughter arrived at the medical-
surgical unit for diagnostic confirmation and management of probable delirium.
Which statement by the client’s daughter best supports the diagnosis?
A. "Maybe it's just caused by aging. This usually happens by age 82."
B. "The changes in his behavior came on so quickly! I wasn't sure what was
happening."
Correct answer
C. "Dad just didn't seem to know what he was doing. He would forget what
he had for breakfast."
D. "Dad has always been so independent. He's lived alone for years since
mom died."
Correct Answer: B. “The changes in his behavior came on so quickly! I wasn’t
sure what was happening.”
Delirium is an acute process characterized by abrupt, spontaneous cognitive
dysfunction. Delirium, also known as the acute confusional state, is a clinical
syndrome that usually develops in the elderly. It is characterized by an alteration
of consciousness and cognition with reduced ability to focus, sustain, or shift
attention. It develops over a short period and fluctuates during the day.
Option A: Cognitive impairment disorders (dementia or delirium) are not
normal consequences of aging. There are two groups of risk factors related to
delirium: predisposing and precipitant factors. The most common predisposing
factors are older age (older than 70 years), dementia (often not recognized
clinically), functional disabilities, male gender, poor vision and hearing, and
mild cognitive impairment. Alcohol use disorder and laboratory abnormalities
have been associated with an increased risk.
Option C: Option C would be characteristic of someone with dementia. The
clinical presentation of delirium can vary, but usually, it flourishes with
psychomotor behavioral disturbances such as hyperactivity or hypoactivity
with increased sympathetic activity and impairment in sleep duration and
architecture. It is caused by a medical condition, substance intoxication, or
withdrawal in addition to the medication side effects, as well as; it is no better
explained by another preexisting, involving, or established neurocognitive
disorder.
Page 4 of 38
