NURS 623 Adult/Gerontology Health Care II Exam 4 Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed Rationales | 100% Verified | Pass
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Section A: Neurological Disorders — Delirium, Dementia, &
Cerebrovascular Conditions (12 Questions)
Q1: A 78-year-old male is hospitalized for pneumonia and develops acute confusion on
hospital day 3. His family reports he was alert and oriented at baseline. He is
inattentive, has fluctuating awareness, and is disoriented to place and time. His vital
signs show a low-grade fever. Which diagnosis is MOST likely?
A. Alzheimer's disease
B. Vascular dementia
C. Delirium
D. Lewy body dementia
Correct Answer: C
Rationale: Delirium is characterized by acute onset (hours to days), fluctuating course,
inattention, and altered level of consciousness due to an underlying acute cause such
as infection—distinguishing it from dementia, which has an insidious, progressive
course. Alzheimer's (A) and Lewy body dementia (D) are chronic and progressive;
vascular dementia (B) has a stepwise decline associated with cerebrovascular events.
Evidence-based practice: Delirium is reversible when the underlying cause is treated.
Q2: A nurse practitioner is evaluating a hospitalized 82-year-old female with sudden
confusion. Which assessment tool is MOST appropriate for rapid delirium screening at
the bedside?
A. Mini-Mental State Examination (MMSE)
,B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM)
D. Mini-Cog
Correct Answer: C
Rationale: The Confusion Assessment Method (CAM) is the validated tool specifically
designed for rapid delirium detection, assessing acute onset, fluctuating course,
inattention, and either disorganized thinking or altered consciousness. MMSE (A) and
MoCA (B) screen for cognitive impairment/dementia; Mini-Cog (D) is a brief dementia
screening tool. Evidence-based practice: CAM has high sensitivity and specificity for
delirium in hospitalized older adults.
Q3: A 76-year-old male with progressive memory loss over 3 years is diagnosed with
Alzheimer's disease. His family asks about the pathophysiology. Which finding is MOST
characteristic of Alzheimer's disease at the cellular level?
A. Alpha-synuclein protein aggregates in the cortex
B. Amyloid plaques and neurofibrillary tangles
C. Stepwise infarctions in cortical and subcortical regions
D. Pick bodies in the frontal and temporal lobes
Correct Answer: B
Rationale: Alzheimer's disease is pathologically characterized by extracellular
amyloid-beta plaques and intracellular neurofibrillary tangles composed of
hyperphosphorylated tau protein. Alpha-synuclein aggregates (A) are seen in Lewy body
dementia; stepwise infarctions (C) define vascular dementia; Pick bodies (D) are found
in frontotemporal dementia. Evidence-based practice: These pathologic changes
correlate with progressive synaptic dysfunction and neuronal loss.
,Q4: A 68-year-old female presents with visual hallucinations, fluctuating cognition,
Parkinsonism (rigidity and bradykinesia), and REM sleep behavior disorder. Which type
of dementia is MOST likely?
A. Alzheimer's disease
B. Vascular dementia
C. Lewy body dementia
D. Frontotemporal dementia
Correct Answer: C
Rationale: Lewy body dementia is characterized by the core features of fluctuating
cognition, recurrent visual hallucinations, and spontaneous Parkinsonism, along with
REM sleep behavior disorder and severe neuroleptic sensitivity. Alzheimer's (A) presents
with progressive amnestic syndrome; vascular dementia (B) has stepwise decline with
focal neurologic signs; frontotemporal dementia (D) presents with
behavioral/personality changes or language impairment. Evidence-based practice: DLB
clinical criteria require two of three core features for probable diagnosis.
Q5: A 72-year-old male with hypertension and diabetes has experienced three discrete
episodes of sudden cognitive decline over the past 2 years, each associated with a
documented stroke. His cognition plateaus between events. Which dementia syndrome
does this pattern describe?
A. Alzheimer's disease
B. Vascular dementia
C. Lewy body dementia
D. Creutzfeldt-Jakob disease
Correct Answer: B
, Rationale: Vascular dementia classically demonstrates a stepwise decline in cognitive
function associated with cerebrovascular events (strokes or TIAs), with periods of
relative stability between events. Alzheimer's (A) has a gradually progressive course;
Lewy body dementia (C) features hallucinations and Parkinsonism; CJD (D) has rapid
progression over months. Evidence-based practice: Vascular cognitive impairment
requires evidence of cerebrovascular disease temporally related to cognitive decline.
Q6: A 65-year-old male presents with progressive personality changes, disinhibition,
compulsive behaviors, and language difficulties. His memory remains relatively intact.
Brain MRI shows frontal and temporal lobe atrophy. Which dementia is MOST likely?
A. Alzheimer's disease
B. Vascular dementia
C. Lewy body dementia
D. Frontotemporal dementia
Correct Answer: D
Rationale: Frontotemporal dementia (behavioral variant) presents with prominent
changes in personality, social conduct, and executive function with relative preservation
of memory early in the disease, along with frontal/temporal atrophy on imaging.
Alzheimer's (A) presents with amnestic syndrome; vascular dementia (B) has stepwise
decline; Lewy body dementia (C) features fluctuating cognition and hallucinations.
Evidence-based practice: FTD typically has earlier onset (45-65 years) compared to
Alzheimer's.
Q7: A nurse practitioner is initiating pharmacologic therapy for a patient with
mild-to-moderate Alzheimer's disease. Which medication class is considered
FIRST-LINE treatment?
Complete Exam-Style Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Section A: Neurological Disorders — Delirium, Dementia, &
Cerebrovascular Conditions (12 Questions)
Q1: A 78-year-old male is hospitalized for pneumonia and develops acute confusion on
hospital day 3. His family reports he was alert and oriented at baseline. He is
inattentive, has fluctuating awareness, and is disoriented to place and time. His vital
signs show a low-grade fever. Which diagnosis is MOST likely?
A. Alzheimer's disease
B. Vascular dementia
C. Delirium
D. Lewy body dementia
Correct Answer: C
Rationale: Delirium is characterized by acute onset (hours to days), fluctuating course,
inattention, and altered level of consciousness due to an underlying acute cause such
as infection—distinguishing it from dementia, which has an insidious, progressive
course. Alzheimer's (A) and Lewy body dementia (D) are chronic and progressive;
vascular dementia (B) has a stepwise decline associated with cerebrovascular events.
Evidence-based practice: Delirium is reversible when the underlying cause is treated.
Q2: A nurse practitioner is evaluating a hospitalized 82-year-old female with sudden
confusion. Which assessment tool is MOST appropriate for rapid delirium screening at
the bedside?
A. Mini-Mental State Examination (MMSE)
,B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM)
D. Mini-Cog
Correct Answer: C
Rationale: The Confusion Assessment Method (CAM) is the validated tool specifically
designed for rapid delirium detection, assessing acute onset, fluctuating course,
inattention, and either disorganized thinking or altered consciousness. MMSE (A) and
MoCA (B) screen for cognitive impairment/dementia; Mini-Cog (D) is a brief dementia
screening tool. Evidence-based practice: CAM has high sensitivity and specificity for
delirium in hospitalized older adults.
Q3: A 76-year-old male with progressive memory loss over 3 years is diagnosed with
Alzheimer's disease. His family asks about the pathophysiology. Which finding is MOST
characteristic of Alzheimer's disease at the cellular level?
A. Alpha-synuclein protein aggregates in the cortex
B. Amyloid plaques and neurofibrillary tangles
C. Stepwise infarctions in cortical and subcortical regions
D. Pick bodies in the frontal and temporal lobes
Correct Answer: B
Rationale: Alzheimer's disease is pathologically characterized by extracellular
amyloid-beta plaques and intracellular neurofibrillary tangles composed of
hyperphosphorylated tau protein. Alpha-synuclein aggregates (A) are seen in Lewy body
dementia; stepwise infarctions (C) define vascular dementia; Pick bodies (D) are found
in frontotemporal dementia. Evidence-based practice: These pathologic changes
correlate with progressive synaptic dysfunction and neuronal loss.
,Q4: A 68-year-old female presents with visual hallucinations, fluctuating cognition,
Parkinsonism (rigidity and bradykinesia), and REM sleep behavior disorder. Which type
of dementia is MOST likely?
A. Alzheimer's disease
B. Vascular dementia
C. Lewy body dementia
D. Frontotemporal dementia
Correct Answer: C
Rationale: Lewy body dementia is characterized by the core features of fluctuating
cognition, recurrent visual hallucinations, and spontaneous Parkinsonism, along with
REM sleep behavior disorder and severe neuroleptic sensitivity. Alzheimer's (A) presents
with progressive amnestic syndrome; vascular dementia (B) has stepwise decline with
focal neurologic signs; frontotemporal dementia (D) presents with
behavioral/personality changes or language impairment. Evidence-based practice: DLB
clinical criteria require two of three core features for probable diagnosis.
Q5: A 72-year-old male with hypertension and diabetes has experienced three discrete
episodes of sudden cognitive decline over the past 2 years, each associated with a
documented stroke. His cognition plateaus between events. Which dementia syndrome
does this pattern describe?
A. Alzheimer's disease
B. Vascular dementia
C. Lewy body dementia
D. Creutzfeldt-Jakob disease
Correct Answer: B
, Rationale: Vascular dementia classically demonstrates a stepwise decline in cognitive
function associated with cerebrovascular events (strokes or TIAs), with periods of
relative stability between events. Alzheimer's (A) has a gradually progressive course;
Lewy body dementia (C) features hallucinations and Parkinsonism; CJD (D) has rapid
progression over months. Evidence-based practice: Vascular cognitive impairment
requires evidence of cerebrovascular disease temporally related to cognitive decline.
Q6: A 65-year-old male presents with progressive personality changes, disinhibition,
compulsive behaviors, and language difficulties. His memory remains relatively intact.
Brain MRI shows frontal and temporal lobe atrophy. Which dementia is MOST likely?
A. Alzheimer's disease
B. Vascular dementia
C. Lewy body dementia
D. Frontotemporal dementia
Correct Answer: D
Rationale: Frontotemporal dementia (behavioral variant) presents with prominent
changes in personality, social conduct, and executive function with relative preservation
of memory early in the disease, along with frontal/temporal atrophy on imaging.
Alzheimer's (A) presents with amnestic syndrome; vascular dementia (B) has stepwise
decline; Lewy body dementia (C) features fluctuating cognition and hallucinations.
Evidence-based practice: FTD typically has earlier onset (45-65 years) compared to
Alzheimer's.
Q7: A nurse practitioner is initiating pharmacologic therapy for a patient with
mild-to-moderate Alzheimer's disease. Which medication class is considered
FIRST-LINE treatment?
