NU 176 GERIATRIC NURSING EXAM 4 180
Questions, Answers & Rationales
The document covers :
Table of contents
1.Delirium, dementia & depression (25)
2.Death, dying, palliative & hospice care (25)
3.Legal & ethical issues (20)
4.Elder abuse & neglect (15)
5.Sexuality & intimacy in older adults (10)
6.Spirituality & religion (10)
7.Family caregiving & psychosocial support (15)
8 Long-term care & continuum of care settings (20)
9.Sleep, rest & comfort (10)
10.Loss, grief & bereavement (10)
11.Anxiety, substance use & other mental health disorders (10)
12.Comprehensive mixed review (10)
1. What is the hallmark feature that distinguishes delirium from dementia?
Correct Answer: Acute onset with a fluctuating course and impaired attention
Rationale: Delirium develops suddenly (hours to days) and fluctuates throughout the day, with a
core feature of impaired attention/awareness, whereas dementia develops gradually over months
to years with attention relatively preserved until late stages.
2. Which assessment tool is considered the gold-standard bedside instrument for diagnosing
delirium?
Correct Answer: Confusion Assessment Method (CAM)
1
, Rationale: The CAM requires acute onset/fluctuating course AND inattention, plus either
disorganized thinking or an altered level of consciousness, and provides high sensitivity and
specificity for diagnosing delirium at the bedside.
3. A hospitalized older adult becomes withdrawn, lethargic, and difficult to arouse rather than
agitated. What type of delirium does this represent?
Correct Answer: Hypoactive delirium
Rationale: Hypoactive delirium is the most common subtype in hospitalized older adults but is
frequently underrecognized because it is mistaken for depression or fatigue, and it carries a
worse prognosis due to delayed detection.
4. What is the most important initial nursing action when a patient develops acute delirium?
Correct Answer: Identify and address the underlying precipitating cause(s)
Rationale: Delirium is a medical emergency signaling an acute physiologic disturbance
(infection, medication effect, metabolic derangement, hypoxia); nursing priorities include a
thorough assessment to identify and help correct the reversible underlying cause.
5. Which class of medications is most commonly associated with precipitating delirium in older
adults?
Correct Answer: Anticholinergics and benzodiazepines
Rationale: Anticholinergic burden and benzodiazepine use are leading pharmacologic
contributors to delirium due to their central nervous system effects, and are flagged in the Beers
Criteria as high-risk for older adults.
6. What is the priority nursing intervention for a patient at risk for delirium during hospitalization?
Correct Answer: Implementing nonpharmacologic prevention strategies such as
reorientation, promoting sleep-wake cycles, early mobilization, and minimizing sensory
deprivation
Rationale: Multicomponent nonpharmacologic prevention protocols (e.g., the Hospital Elder Life
Program model) have the strongest evidence for reducing delirium incidence, focusing on
maintaining orientation, normal sleep patterns, mobility, hydration, and sensory aids (glasses,
hearing aids).
7. A patient with early Alzheimer's disease has short-term memory loss but retains social skills and
remote memory. What best explains this pattern?
2
, Correct Answer: Alzheimer's disease characteristically begins with episodic short-term
memory impairment while preserving social graces and long-term memory until later
stages
Rationale: This typical early presentation helps differentiate Alzheimer's disease from other
dementia subtypes, such as frontotemporal dementia, which presents with early personality and
behavioral changes rather than prominent memory loss.
8. Which dementia subtype presents early with personality change, disinhibition, and executive
dysfunction, with memory relatively preserved initially?
Correct Answer: Frontotemporal dementia
Rationale: Frontotemporal dementia primarily affects the frontal and temporal lobes, producing
early behavioral and language changes; memory impairment typically develops later in the
disease course, distinguishing it from Alzheimer's disease.
9. A patient with dementia has fluctuating cognition, visual hallucinations, and parkinsonian
features. Which dementia type is most likely?
Correct Answer: Dementia with Lewy bodies
Rationale: The core triad of fluctuating cognition, recurrent visual hallucinations, and
spontaneous parkinsonism is characteristic of Lewy body dementia, and these patients have
marked sensitivity to antipsychotic medications.
10. Why should antipsychotic medications be used with extreme caution in a patient with dementia
with Lewy bodies?
Correct Answer: Risk of severe neuroleptic sensitivity reaction, including worsening
rigidity and altered consciousness
Rationale: Patients with Lewy body dementia have profound sensitivity to antipsychotics due to
underlying dopaminergic vulnerability, risking severe extrapyramidal reactions and increased
mortality if these medications are used.
11. A patient's dementia symptoms worsened suddenly following a stroke and have progressed in a
stepwise fashion since. What type of dementia does this suggest?
Correct Answer: Vascular dementia
Rationale: Vascular dementia results from cumulative ischemic brain injury and classically
progresses in a stepwise rather than gradual pattern, corresponding to the timing and location of
cerebrovascular events.
3
, 12. Which medication class is considered first-line pharmacologic therapy for mild-to-moderate
Alzheimer's disease?
Correct Answer: Cholinesterase inhibitors (e.g., donepezil)
Rationale: Cholinesterase inhibitors increase available acetylcholine in the brain and are FDA-
approved for mild-to-moderate Alzheimer's disease, modestly slowing symptom progression
without altering the underlying disease process.
13. What is the mechanism of action of memantine, and for which stage of Alzheimer's disease is it
indicated?
Correct Answer: NMDA receptor antagonism; indicated for moderate-to-severe
Alzheimer's disease
Rationale: Memantine blocks excess NMDA-receptor-mediated glutamate excitotoxicity and is
approved for moderate-to-severe disease, often used alongside a cholinesterase inhibitor for
combined symptomatic benefit.
14. An older adult presents with low mood, poor appetite, and cognitive complaints shortly after
the death of a spouse. What condition must be distinguished from true dementia?
Correct Answer: Pseudodementia (depression-related cognitive impairment)
Rationale: Depression in older adults can mimic dementia, producing complaints of memory loss
and poor concentration; unlike true dementia, patients with pseudodementia often emphasize
their deficits, and cognition may improve with treatment of the underlying depression.
15. Which symptom pattern is more common in older adults with depression than the classic 'sad
mood' typically seen in younger adults?
Correct Answer: Vague physical complaints, fatigue, and anhedonia rather than overtly
expressed sadness
Rationale: Late-life depression often presents atypically with somatic complaints and decreased
energy/interest rather than an expressed depressed mood, making it easy to overlook or
misattribute to physical illness or normal aging.
16. Which population has the highest completed suicide rate of any demographic group in the
United States?
Correct Answer: Older adult white men, particularly those living alone with access to
firearms
Rationale: Older men, especially white men who are socially isolated and have access to lethal
means (firearms), have disproportionately high suicide completion rates, underscoring the need
for depression screening and lethal-means restriction in this population.
4
Questions, Answers & Rationales
The document covers :
Table of contents
1.Delirium, dementia & depression (25)
2.Death, dying, palliative & hospice care (25)
3.Legal & ethical issues (20)
4.Elder abuse & neglect (15)
5.Sexuality & intimacy in older adults (10)
6.Spirituality & religion (10)
7.Family caregiving & psychosocial support (15)
8 Long-term care & continuum of care settings (20)
9.Sleep, rest & comfort (10)
10.Loss, grief & bereavement (10)
11.Anxiety, substance use & other mental health disorders (10)
12.Comprehensive mixed review (10)
1. What is the hallmark feature that distinguishes delirium from dementia?
Correct Answer: Acute onset with a fluctuating course and impaired attention
Rationale: Delirium develops suddenly (hours to days) and fluctuates throughout the day, with a
core feature of impaired attention/awareness, whereas dementia develops gradually over months
to years with attention relatively preserved until late stages.
2. Which assessment tool is considered the gold-standard bedside instrument for diagnosing
delirium?
Correct Answer: Confusion Assessment Method (CAM)
1
, Rationale: The CAM requires acute onset/fluctuating course AND inattention, plus either
disorganized thinking or an altered level of consciousness, and provides high sensitivity and
specificity for diagnosing delirium at the bedside.
3. A hospitalized older adult becomes withdrawn, lethargic, and difficult to arouse rather than
agitated. What type of delirium does this represent?
Correct Answer: Hypoactive delirium
Rationale: Hypoactive delirium is the most common subtype in hospitalized older adults but is
frequently underrecognized because it is mistaken for depression or fatigue, and it carries a
worse prognosis due to delayed detection.
4. What is the most important initial nursing action when a patient develops acute delirium?
Correct Answer: Identify and address the underlying precipitating cause(s)
Rationale: Delirium is a medical emergency signaling an acute physiologic disturbance
(infection, medication effect, metabolic derangement, hypoxia); nursing priorities include a
thorough assessment to identify and help correct the reversible underlying cause.
5. Which class of medications is most commonly associated with precipitating delirium in older
adults?
Correct Answer: Anticholinergics and benzodiazepines
Rationale: Anticholinergic burden and benzodiazepine use are leading pharmacologic
contributors to delirium due to their central nervous system effects, and are flagged in the Beers
Criteria as high-risk for older adults.
6. What is the priority nursing intervention for a patient at risk for delirium during hospitalization?
Correct Answer: Implementing nonpharmacologic prevention strategies such as
reorientation, promoting sleep-wake cycles, early mobilization, and minimizing sensory
deprivation
Rationale: Multicomponent nonpharmacologic prevention protocols (e.g., the Hospital Elder Life
Program model) have the strongest evidence for reducing delirium incidence, focusing on
maintaining orientation, normal sleep patterns, mobility, hydration, and sensory aids (glasses,
hearing aids).
7. A patient with early Alzheimer's disease has short-term memory loss but retains social skills and
remote memory. What best explains this pattern?
2
, Correct Answer: Alzheimer's disease characteristically begins with episodic short-term
memory impairment while preserving social graces and long-term memory until later
stages
Rationale: This typical early presentation helps differentiate Alzheimer's disease from other
dementia subtypes, such as frontotemporal dementia, which presents with early personality and
behavioral changes rather than prominent memory loss.
8. Which dementia subtype presents early with personality change, disinhibition, and executive
dysfunction, with memory relatively preserved initially?
Correct Answer: Frontotemporal dementia
Rationale: Frontotemporal dementia primarily affects the frontal and temporal lobes, producing
early behavioral and language changes; memory impairment typically develops later in the
disease course, distinguishing it from Alzheimer's disease.
9. A patient with dementia has fluctuating cognition, visual hallucinations, and parkinsonian
features. Which dementia type is most likely?
Correct Answer: Dementia with Lewy bodies
Rationale: The core triad of fluctuating cognition, recurrent visual hallucinations, and
spontaneous parkinsonism is characteristic of Lewy body dementia, and these patients have
marked sensitivity to antipsychotic medications.
10. Why should antipsychotic medications be used with extreme caution in a patient with dementia
with Lewy bodies?
Correct Answer: Risk of severe neuroleptic sensitivity reaction, including worsening
rigidity and altered consciousness
Rationale: Patients with Lewy body dementia have profound sensitivity to antipsychotics due to
underlying dopaminergic vulnerability, risking severe extrapyramidal reactions and increased
mortality if these medications are used.
11. A patient's dementia symptoms worsened suddenly following a stroke and have progressed in a
stepwise fashion since. What type of dementia does this suggest?
Correct Answer: Vascular dementia
Rationale: Vascular dementia results from cumulative ischemic brain injury and classically
progresses in a stepwise rather than gradual pattern, corresponding to the timing and location of
cerebrovascular events.
3
, 12. Which medication class is considered first-line pharmacologic therapy for mild-to-moderate
Alzheimer's disease?
Correct Answer: Cholinesterase inhibitors (e.g., donepezil)
Rationale: Cholinesterase inhibitors increase available acetylcholine in the brain and are FDA-
approved for mild-to-moderate Alzheimer's disease, modestly slowing symptom progression
without altering the underlying disease process.
13. What is the mechanism of action of memantine, and for which stage of Alzheimer's disease is it
indicated?
Correct Answer: NMDA receptor antagonism; indicated for moderate-to-severe
Alzheimer's disease
Rationale: Memantine blocks excess NMDA-receptor-mediated glutamate excitotoxicity and is
approved for moderate-to-severe disease, often used alongside a cholinesterase inhibitor for
combined symptomatic benefit.
14. An older adult presents with low mood, poor appetite, and cognitive complaints shortly after
the death of a spouse. What condition must be distinguished from true dementia?
Correct Answer: Pseudodementia (depression-related cognitive impairment)
Rationale: Depression in older adults can mimic dementia, producing complaints of memory loss
and poor concentration; unlike true dementia, patients with pseudodementia often emphasize
their deficits, and cognition may improve with treatment of the underlying depression.
15. Which symptom pattern is more common in older adults with depression than the classic 'sad
mood' typically seen in younger adults?
Correct Answer: Vague physical complaints, fatigue, and anhedonia rather than overtly
expressed sadness
Rationale: Late-life depression often presents atypically with somatic complaints and decreased
energy/interest rather than an expressed depressed mood, making it easy to overlook or
misattribute to physical illness or normal aging.
16. Which population has the highest completed suicide rate of any demographic group in the
United States?
Correct Answer: Older adult white men, particularly those living alone with access to
firearms
Rationale: Older men, especially white men who are socially isolated and have access to lethal
means (firearms), have disproportionately high suicide completion rates, underscoring the need
for depression screening and lethal-means restriction in this population.
4
