NUR 343 FINAL EXAM-NEUROCOGNITIVE DISORDERS –
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1. A 78-year-old male is brought to the memory clinic by his daughter, who reports
progressive memory loss over the past two years, difficulty managing his checkbook, and
getting lost while driving in his familiar neighborhood. His neurological examination is
otherwise non-focal. Which of the following neuropathological hallmarks is most
characteristically associated with this patient's underlying condition?
A. Lewy bodies composed of alpha-synuclein in the brainstem
B. Extracellular beta-amyloid plaques and intracellular neurofibrillary tangles of
hyperphosphorylated tau protein
C. Multiple focal areas of ischemic infarction involving deep white matter tracts
D. Spongiform encephalopathy with rapid accumulation of prion proteins
This patient presents with classic clinical features of major neurocognitive disorder due to
Alzheimer's disease. The definitive neuropathological diagnosis rests on the accumulation of
extracellular beta-amyloid plaques and intracellular neurofibrillary tangles composed of
hyperphosphorylated tau. Option A describes dementia with Lewy bodies. Option C points to
vascular neurocognitive disorder. Option D describes Creutzfeldt-Jakob disease.
2. A 65-year-old female is evaluated for fluctuating cognitive impairment, recurrent visual
hallucinations of children playing in her living room, and repeated episodes of unprovoked
falls. Her family notes that her alertness and attention level vary drastically throughout the
day. Which diagnostic finding would best support the suspected diagnosis?
A. Marked generalized cerebral atrophy without focal lesions
B. Decreased dopamine transporter uptake in the basal ganglia on SPECT imaging
C. Severe periventricular white matter demyelination on MRI
D. Diffuse sharp-wave complexes on standard electroencephalography
The clinical presentation of fluctuating cognition, visual hallucinations, and spontaneous
parkinsonism strongly suggests dementia with Lewy bodies (DLB). Reduced dopamine
transporter (DaT) uptake in the basal ganglia is a validated supportive biomarker for DLB.
Option A is non-specific for Alzheimer's. Option C points to vascular causes. Option D is
characteristic of prion disease.
3. A 72-year-old male with a history of hypertension and type 2 diabetes mellitus
experiences a sudden, stepwise cognitive decline following a minor focal neurological event.
,His family notes that his executive functioning is disproportionately impaired relative to his
memory. Which imaging finding is most consistent with this presentation?
A. Isolated atrophy of the bilateral hippocampi and medial temporal lobes
B. Multiple subcortical infarcts and extensive white matter ischemic changes
C. Profound cerebellar and brainstem volume loss
D. Focal temporal-parietal hypometabolism on PET scan
This patient exhibits vascular neurocognitive disorder, which typically presents with a stepwise
decline, executive dysfunction, and neuroimaging evidence of cerebrovascular disease such as
subcortical infarcts and leukoaraiosis. Option A is classic for Alzheimer's disease. Option C
suggests spinocerebellar degeneration. Option D is common in frontotemporal or Alzheimer's
pathology.
4. A 58-year-old female is brought in by her spouse due to profound personality changes,
loss of social decorum, inappropriate jocularity, and severe apathy that began insidiously
over the past year. Memory remains relatively intact compared to her behavioral shifts.
Which anatomical region is primarily affected in this variant of frontotemporal
neurocognitive disorder?
A. Bilateral parieto-occipital cortices
B. Frontal and anterior temporal lobes
C. Hippocampus and entorhinal cortex
D. Substantia nigra and locus coeruleus
The behavioral variant of frontotemporal neurocognitive disorder (bvFTD) is characterized by
early deterioration in personality, empathy, and social conduct, driven by degeneration
localized to the frontal and anterior temporal lobes. Option A is associated with posterior
cortical atrophy. Option C points to Alzheimer's disease. Option D is linked to Parkinson's
pathology.
5. A 70-year-old man is admitted to the medical-surgical unit for pneumonia. On the
second hospital day, he becomes acutely agitated, pulls at his intravenous lines, believes the
nurses are plotting against him, and demonstrates a severe deficit in attention and a
fluctuating level of consciousness. This state is absent during previous clinic visits. What is
the most appropriate initial nursing and medical priority?
A. Immediately restrain all four limbs and administer a high-dose long-acting benzodiazepine
B. Investigate and treat the underlying medical trigger while implementing non-
pharmacological reorientation strategies
C. Diagnose the patient with permanent end-stage Alzheimer's dementia and initiate hospice
consultation
D. Discharge the patient immediately to a long-term care memory unit without further workup
The acute onset, fluctuating course, disturbed consciousness, and inattention point directly to
delirium secondary to a medical illness (pneumonia). Delirium is a medical emergency
,requiring identification and treatment of the underlying cause, combined with supportive care.
Option A can worsen delirium. Options C and D misdiagnose an acute, reversible condition as
chronic dementia.
6. A nurse is conducting a cognitive screening assessment for an 80-year-old resident in an
assisted living facility. The resident scores 24 out of 30 on the Mini-Mental State
Examination (MMSE), showing mild deficits in delayed recall and serial sevens, but
successfully manages personal hygiene, medications, and independent living tasks. How
should the nurse categorize this cognitive status?
A. Major neurocognitive disorder (Dementia)
B. Mild cognitive impairment (MCI)
C. Normal age-related cognitive decline with complete independence
D. Acute delirium secondary to infection
Mild cognitive impairment involves a modest cognitive decline from a previous level of
performance in one or more domains, but the cognitive deficits are insufficient to interfere
with independence in everyday activities. Option A requires impairment in instrumental
activities of daily living. Option C underestimates the measurable deficit. Option D lacks acute
fluctuations and medical triggers.
7. A 62-year-old male with a known history of behavioral variant frontotemporal
degeneration is admitted to a residential facility. He repeatedly attempts to consume
inedible objects, exhibits compulsive pacing, and demonstrates a marked dietary
preference for sweets. What term best describes this constellation of behavioral symptoms?
A. Sundowning syndrome
B. Kluver-Bucy syndrome
C. Capgras delusion
D. Wernicke-Korsakoff syndrome
Kluver-Bucy syndrome, often associated with temporal lobe pathology in frontotemporal
neurocognitive disorder, includes hyperorality (tendency to examine objects by mouth or eat
inappropriate items), dietary changes, hypermetamorphosis, and placidity. Option A refers to
late-day behavioral worsening. Option C is a misidentification syndrome. Option D is
thiamine-deficiency encephalopathy.
8. An advanced practice registered nurse is prescribing a cholinesterase inhibitor for a
patient with mild-to-moderate Alzheimer's disease. Which of the following mechanisms
best describes the therapeutic action of medications in this class?
A. Blocking N-methyl-D-aspartate (NMDA) receptor-mediated excitotoxicity
B. Inhibiting acetylcholinesterase to increase the availability of acetylcholine in synaptic
clefts
C. Stimulating central nervous system dopamine synthesis in the striatum
D. Antagonizing peripheral muscarinic receptors to prevent gastrointestinal upset
, Cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) inhibit the enzyme
acetylcholinesterase, thereby slowing the degradation of acetylcholine and compensating for
cholinergic deficits in Alzheimer's disease. Option A describes memantine. Option C describes
levodopa therapy. Option D describes peripheral anticholinergic effects, which are
undesirable.
9. A 75-year-old female with moderate Alzheimer's dementia is prescribed memantine.
What is the primary pharmacodynamic mechanism of this medication?
A. Irreversible inhibition of monoamine oxidase B
B. Modulation of glutamatergic neurotransmission by acting as an uncompetitive NMDA
receptor antagonist
C. Potent stimulation of post-synaptic nicotinic acetylcholine receptors
D. Selective serotonin reuptake inhibition to treat concomitant depression
Memantine is an uncompetitive NMDA receptor antagonist that protects neurons against
glutamate-mediated excitotoxicity without disrupting normal physiological neurotransmission.
Option A is used for Parkinson's disease. Option C describes nicotine agonists. Option D
describes SSRIs.
10. A nurse is developing a plan of care for a hospitalized older adult experiencing acute
delirium. Which nursing intervention is most effective for reducing environmental
confusion and promoting orientation?
A. Keeping the patient's room dimly lit and quiet 24 hours a day to encourage uninterrupted
sleep
B. Providing a visible wall clock, a calendar with large print, and consistent reorientation
during staff interactions
C. Rotating nursing staff members every four hours to prevent emotional attachment
D. Restricting family visits entirely to prevent sensory overload and agitation
Environmental structuring, including clocks, calendars, familiar objects, and frequent gentle
reorientation, is a cornerstone of non-pharmacological delirium management. Option A can
worsen disorientation. Option C increases confusion due to unfamiliar faces. Option D
deprives the patient of grounding support systems.
11. A 67-year-old male is evaluated for progressive cognitive decline characterized by
prominent visual hallucinations, fluctuating alertness, and spontaneous motor features of
parkinsonism that began simultaneously with cognitive symptoms. According to consensus
criteria, how should this temporal relationship be classified regarding diagnosis?
A. Exclusively as Parkinson's disease dementia because motor symptoms appeared first
B. As dementia with Lewy bodies because cognitive and motor symptoms occurred
concurrently or within a year of each other
C. As vascular dementia due to secondary brain hypoperfusion
D. As normal pressure hydrocephalus because gait abnormalities are present
QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS PLUS RATIONALES | GUARANTEED PASS | LATEST
EXAM UPDATE | EXAM PREP | STUDY GUIDE | PRACTICE
TEST| DOWNLOAD INSTANT PDF
1. A 78-year-old male is brought to the memory clinic by his daughter, who reports
progressive memory loss over the past two years, difficulty managing his checkbook, and
getting lost while driving in his familiar neighborhood. His neurological examination is
otherwise non-focal. Which of the following neuropathological hallmarks is most
characteristically associated with this patient's underlying condition?
A. Lewy bodies composed of alpha-synuclein in the brainstem
B. Extracellular beta-amyloid plaques and intracellular neurofibrillary tangles of
hyperphosphorylated tau protein
C. Multiple focal areas of ischemic infarction involving deep white matter tracts
D. Spongiform encephalopathy with rapid accumulation of prion proteins
This patient presents with classic clinical features of major neurocognitive disorder due to
Alzheimer's disease. The definitive neuropathological diagnosis rests on the accumulation of
extracellular beta-amyloid plaques and intracellular neurofibrillary tangles composed of
hyperphosphorylated tau. Option A describes dementia with Lewy bodies. Option C points to
vascular neurocognitive disorder. Option D describes Creutzfeldt-Jakob disease.
2. A 65-year-old female is evaluated for fluctuating cognitive impairment, recurrent visual
hallucinations of children playing in her living room, and repeated episodes of unprovoked
falls. Her family notes that her alertness and attention level vary drastically throughout the
day. Which diagnostic finding would best support the suspected diagnosis?
A. Marked generalized cerebral atrophy without focal lesions
B. Decreased dopamine transporter uptake in the basal ganglia on SPECT imaging
C. Severe periventricular white matter demyelination on MRI
D. Diffuse sharp-wave complexes on standard electroencephalography
The clinical presentation of fluctuating cognition, visual hallucinations, and spontaneous
parkinsonism strongly suggests dementia with Lewy bodies (DLB). Reduced dopamine
transporter (DaT) uptake in the basal ganglia is a validated supportive biomarker for DLB.
Option A is non-specific for Alzheimer's. Option C points to vascular causes. Option D is
characteristic of prion disease.
3. A 72-year-old male with a history of hypertension and type 2 diabetes mellitus
experiences a sudden, stepwise cognitive decline following a minor focal neurological event.
,His family notes that his executive functioning is disproportionately impaired relative to his
memory. Which imaging finding is most consistent with this presentation?
A. Isolated atrophy of the bilateral hippocampi and medial temporal lobes
B. Multiple subcortical infarcts and extensive white matter ischemic changes
C. Profound cerebellar and brainstem volume loss
D. Focal temporal-parietal hypometabolism on PET scan
This patient exhibits vascular neurocognitive disorder, which typically presents with a stepwise
decline, executive dysfunction, and neuroimaging evidence of cerebrovascular disease such as
subcortical infarcts and leukoaraiosis. Option A is classic for Alzheimer's disease. Option C
suggests spinocerebellar degeneration. Option D is common in frontotemporal or Alzheimer's
pathology.
4. A 58-year-old female is brought in by her spouse due to profound personality changes,
loss of social decorum, inappropriate jocularity, and severe apathy that began insidiously
over the past year. Memory remains relatively intact compared to her behavioral shifts.
Which anatomical region is primarily affected in this variant of frontotemporal
neurocognitive disorder?
A. Bilateral parieto-occipital cortices
B. Frontal and anterior temporal lobes
C. Hippocampus and entorhinal cortex
D. Substantia nigra and locus coeruleus
The behavioral variant of frontotemporal neurocognitive disorder (bvFTD) is characterized by
early deterioration in personality, empathy, and social conduct, driven by degeneration
localized to the frontal and anterior temporal lobes. Option A is associated with posterior
cortical atrophy. Option C points to Alzheimer's disease. Option D is linked to Parkinson's
pathology.
5. A 70-year-old man is admitted to the medical-surgical unit for pneumonia. On the
second hospital day, he becomes acutely agitated, pulls at his intravenous lines, believes the
nurses are plotting against him, and demonstrates a severe deficit in attention and a
fluctuating level of consciousness. This state is absent during previous clinic visits. What is
the most appropriate initial nursing and medical priority?
A. Immediately restrain all four limbs and administer a high-dose long-acting benzodiazepine
B. Investigate and treat the underlying medical trigger while implementing non-
pharmacological reorientation strategies
C. Diagnose the patient with permanent end-stage Alzheimer's dementia and initiate hospice
consultation
D. Discharge the patient immediately to a long-term care memory unit without further workup
The acute onset, fluctuating course, disturbed consciousness, and inattention point directly to
delirium secondary to a medical illness (pneumonia). Delirium is a medical emergency
,requiring identification and treatment of the underlying cause, combined with supportive care.
Option A can worsen delirium. Options C and D misdiagnose an acute, reversible condition as
chronic dementia.
6. A nurse is conducting a cognitive screening assessment for an 80-year-old resident in an
assisted living facility. The resident scores 24 out of 30 on the Mini-Mental State
Examination (MMSE), showing mild deficits in delayed recall and serial sevens, but
successfully manages personal hygiene, medications, and independent living tasks. How
should the nurse categorize this cognitive status?
A. Major neurocognitive disorder (Dementia)
B. Mild cognitive impairment (MCI)
C. Normal age-related cognitive decline with complete independence
D. Acute delirium secondary to infection
Mild cognitive impairment involves a modest cognitive decline from a previous level of
performance in one or more domains, but the cognitive deficits are insufficient to interfere
with independence in everyday activities. Option A requires impairment in instrumental
activities of daily living. Option C underestimates the measurable deficit. Option D lacks acute
fluctuations and medical triggers.
7. A 62-year-old male with a known history of behavioral variant frontotemporal
degeneration is admitted to a residential facility. He repeatedly attempts to consume
inedible objects, exhibits compulsive pacing, and demonstrates a marked dietary
preference for sweets. What term best describes this constellation of behavioral symptoms?
A. Sundowning syndrome
B. Kluver-Bucy syndrome
C. Capgras delusion
D. Wernicke-Korsakoff syndrome
Kluver-Bucy syndrome, often associated with temporal lobe pathology in frontotemporal
neurocognitive disorder, includes hyperorality (tendency to examine objects by mouth or eat
inappropriate items), dietary changes, hypermetamorphosis, and placidity. Option A refers to
late-day behavioral worsening. Option C is a misidentification syndrome. Option D is
thiamine-deficiency encephalopathy.
8. An advanced practice registered nurse is prescribing a cholinesterase inhibitor for a
patient with mild-to-moderate Alzheimer's disease. Which of the following mechanisms
best describes the therapeutic action of medications in this class?
A. Blocking N-methyl-D-aspartate (NMDA) receptor-mediated excitotoxicity
B. Inhibiting acetylcholinesterase to increase the availability of acetylcholine in synaptic
clefts
C. Stimulating central nervous system dopamine synthesis in the striatum
D. Antagonizing peripheral muscarinic receptors to prevent gastrointestinal upset
, Cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) inhibit the enzyme
acetylcholinesterase, thereby slowing the degradation of acetylcholine and compensating for
cholinergic deficits in Alzheimer's disease. Option A describes memantine. Option C describes
levodopa therapy. Option D describes peripheral anticholinergic effects, which are
undesirable.
9. A 75-year-old female with moderate Alzheimer's dementia is prescribed memantine.
What is the primary pharmacodynamic mechanism of this medication?
A. Irreversible inhibition of monoamine oxidase B
B. Modulation of glutamatergic neurotransmission by acting as an uncompetitive NMDA
receptor antagonist
C. Potent stimulation of post-synaptic nicotinic acetylcholine receptors
D. Selective serotonin reuptake inhibition to treat concomitant depression
Memantine is an uncompetitive NMDA receptor antagonist that protects neurons against
glutamate-mediated excitotoxicity without disrupting normal physiological neurotransmission.
Option A is used for Parkinson's disease. Option C describes nicotine agonists. Option D
describes SSRIs.
10. A nurse is developing a plan of care for a hospitalized older adult experiencing acute
delirium. Which nursing intervention is most effective for reducing environmental
confusion and promoting orientation?
A. Keeping the patient's room dimly lit and quiet 24 hours a day to encourage uninterrupted
sleep
B. Providing a visible wall clock, a calendar with large print, and consistent reorientation
during staff interactions
C. Rotating nursing staff members every four hours to prevent emotional attachment
D. Restricting family visits entirely to prevent sensory overload and agitation
Environmental structuring, including clocks, calendars, familiar objects, and frequent gentle
reorientation, is a cornerstone of non-pharmacological delirium management. Option A can
worsen disorientation. Option C increases confusion due to unfamiliar faces. Option D
deprives the patient of grounding support systems.
11. A 67-year-old male is evaluated for progressive cognitive decline characterized by
prominent visual hallucinations, fluctuating alertness, and spontaneous motor features of
parkinsonism that began simultaneously with cognitive symptoms. According to consensus
criteria, how should this temporal relationship be classified regarding diagnosis?
A. Exclusively as Parkinson's disease dementia because motor symptoms appeared first
B. As dementia with Lewy bodies because cognitive and motor symptoms occurred
concurrently or within a year of each other
C. As vascular dementia due to secondary brain hypoperfusion
D. As normal pressure hydrocephalus because gait abnormalities are present
