Question 1: John Kelly is a 77-year-old male, post-operative day one from a right
total hip arthroplasty. He is agitated, combative, and attempting to climb out of
bed. He pulled out his Foley catheter, IV catheter, and surgical dressing. What is
the primary problem John is most likely presenting with?
A. Acute dementia
B. Acute delirium
C. Post-operative infection
D. Acute pain crisis
CORRECT ANSWER: B. Acute delirium
Rationale: John is presenting with acute delirium, which is a temporary cognitive
impairment causing psychological or behavioral dysfunction. This encompasses a
change in level of consciousness and cognition for a temporary period. His sudden
onset of agitation, disorientation, and combative behavior after surgery is classic for
acute delirium .
Question 2: What are the most common signs and symptoms of acute delirium?
A. Gradual progressive memory loss and personality changes
B. Perceptual disturbances, hallucinations, agitation, restlessness, and combative
behavior
C. Stable cognitive impairment with no fluctuation
D. Long-standing confusion with slow progression
CORRECT ANSWER: B. Perceptual disturbances, hallucinations, agitation,
restlessness, and combative behavior
Rationale: Acute delirium presents with perceptual disturbances, hallucinations,
agitation, restless behavior, combative behavior, distractibility, slowed movement, and
disturbed sleep. These symptoms develop acutely and fluctuate throughout the day.
The key feature is the abrupt onset and fluctuating course .
Question 3: What signs and symptoms is John presenting with that are consistent
with acute delirium?
A. Disoriented, agitated, combative, resistant behavior, and disorganized thinking
B. Gradual memory loss over several years
C. Stable confusion with no behavioral changes
D. Calm and cooperative behavior with occasional forgetfulness
CORRECT ANSWER: A. Disoriented, agitated, combative, resistant behavior, and
disorganized thinking
Rationale: John is presenting with disorientation (oriented to self only), agitation,
combative and resistive behavior, and disorganized thinking. He insists he is at home
,and yells at sta . These symptoms developed acutely after surgery and represent a
significant change from his baseline .
Question 4: What is the underlying cause/pathophysiology of acute delirium in
John's case?
A. Progressive neurodegenerative disease
B. Surgical stress, age, catheterization, and increased risk for infection
C. Chronic cognitive decline unrelated to surgery
D. Psychological reaction to hospitalization
CORRECT ANSWER: B. Surgical stress, age, catheterization, and increased risk for
infection
Rationale: John is one day postoperative from right hip surgery. His age (77), surgery,
and catheterization increase his risk for infection and therefore acute delirium. Acute
delirium includes postoperative states, stress, sensory deprivation or overload, and
sleep deprivation as contributing factors .
Question 5: What is the Confusion Assessment Method (CAM) assessment and how
will it help assess delirium in John?
A. A tool to assess depression in older adults
B. A standardized tool used to diagnose delirium in nonpsychiatric patients
C. A tool to measure dementia severity
D. A tool to assess pain levels in confused patients
CORRECT ANSWER: B. A standardized tool used to diagnose delirium in
nonpsychiatric patients
Rationale: The Confusion Assessment Method is a standardized tool used to diagnose
delirium in nonpsychiatric patients. It assesses acute onset and fluctuating course,
inattention, disorganized thinking, and altered level of consciousness. John meets the
diagnostic criteria for acute delirium using the CAM assessment .
Question 6: Using the CAM assessment tool, does John meet diagnostic criteria for
acute delirium?
A. No, because he is oriented to self
B. Yes, he meets the diagnostic criteria for acute delirium
C. No, because his symptoms are from dementia
D. Cannot be determined without further testing
CORRECT ANSWER: B. Yes, he meets the diagnostic criteria for acute delirium
Rationale: John meets the CAM criteria for acute delirium: acute onset and fluctuating
course (sudden change after surgery), inattention (unable to focus), disorganized
,thinking (does not know where he is), and altered level of consciousness. His
disorientation, agitation, and combative behavior confirm the diagnosis .
Question 7: What is the key di erence between delirium and dementia?
A. Delirium has a gradual onset; dementia has an acute onset
B. Delirium has an acute onset and is reversible; dementia has a gradual onset and is
irreversible
C. Both have the same onset pattern
D. Dementia is reversible; delirium is irreversible
CORRECT ANSWER: B. Delirium has an acute onset and is reversible; dementia has
a gradual onset and is irreversible
Rationale: The onset of delirium occurs acutely, while dementia develops gradually over
time. Delirium is usually reversible if the underlying cause is treated, whereas dementia
is typically irreversible and progressive. John's acute onset after surgery and his
baseline of only early-stage dementia support delirium as the primary problem .
Question 8: What is an illusion?
A. Seeing or hearing something that is not actually present
B. A misinterpretation of a real object
C. A false belief that is firmly held despite evidence
D. A sudden change in consciousness
CORRECT ANSWER: B. A misinterpretation of a real object
Rationale: An illusion is a misinterpretation of a real object, such as seeing a coat on a
chair and thinking it is a person. This is distinct from a hallucination, which is perceiving
something that is not there, and a delusion, which is a false belief .
Question 9: What is a hallucination?
A. A misinterpretation of a real object
B. A false belief that is firmly held despite evidence
C. Seeing or hearing something that is not actually present
D. A sudden change in level of consciousness
CORRECT ANSWER: C. Seeing or hearing something that is not actually present
Rationale: A hallucination is seeing or hearing something that is not actually present.
This is a perceptual disturbance commonly seen in delirium. Patients may see bugs
crawling on them or hear voices that are not there .
Question 10: What is a delusion?
, A. A misinterpretation of a real object
B. Seeing something that is not present
C. A false belief that is firmly held despite evidence that it is incorrect
D. A temporary state of confusion
CORRECT ANSWER: C. A false belief that is firmly held despite evidence that it is
incorrect
Rationale: A delusion is a false belief that is firmly held despite evidence that it is
incorrect. For example, John insists he is at home when he is clearly in the hospital. This
is a common feature of delirium .
Question 11: What is a key nursing priority when delirium is suspected?
A. Administer antipsychotic medication immediately
B. Identify and treat the underlying cause immediately
C. Apply restraints to prevent injury
D. Wait for the provider to assess the patient
CORRECT ANSWER: B. Identify and treat the underlying cause immediately
Rationale: The key nursing priority when delirium is suspected is to identify and treat the
underlying cause immediately. Delirium is a symptom of an underlying problem such as
infection, electrolyte imbalance, medication toxicity, or hypoxia. Treating the cause
resolves the delirium .
Question 12: What nursing intervention helps reduce delirium?
A. Provide frequent reorientation to person, place, and time
B. Keep the room dark and quiet at all times
C. Limit family visits to prevent overstimulation
D. Restrict all activity
CORRECT ANSWER: A. Provide frequent reorientation to person, place, and time
Rationale: Providing frequent reorientation to person, place, and time helps reduce
delirium by keeping the patient grounded in reality. This is a core nonpharmacologic
intervention for delirium management .
Question 13: What environmental intervention helps delirium?
A. Maintain a calm and quiet environment
B. Keep the television on constantly for distraction
C. Move the patient to di erent rooms frequently
D. Keep the room brightly lit at all times
CORRECT ANSWER: A. Maintain a calm and quiet environment
total hip arthroplasty. He is agitated, combative, and attempting to climb out of
bed. He pulled out his Foley catheter, IV catheter, and surgical dressing. What is
the primary problem John is most likely presenting with?
A. Acute dementia
B. Acute delirium
C. Post-operative infection
D. Acute pain crisis
CORRECT ANSWER: B. Acute delirium
Rationale: John is presenting with acute delirium, which is a temporary cognitive
impairment causing psychological or behavioral dysfunction. This encompasses a
change in level of consciousness and cognition for a temporary period. His sudden
onset of agitation, disorientation, and combative behavior after surgery is classic for
acute delirium .
Question 2: What are the most common signs and symptoms of acute delirium?
A. Gradual progressive memory loss and personality changes
B. Perceptual disturbances, hallucinations, agitation, restlessness, and combative
behavior
C. Stable cognitive impairment with no fluctuation
D. Long-standing confusion with slow progression
CORRECT ANSWER: B. Perceptual disturbances, hallucinations, agitation,
restlessness, and combative behavior
Rationale: Acute delirium presents with perceptual disturbances, hallucinations,
agitation, restless behavior, combative behavior, distractibility, slowed movement, and
disturbed sleep. These symptoms develop acutely and fluctuate throughout the day.
The key feature is the abrupt onset and fluctuating course .
Question 3: What signs and symptoms is John presenting with that are consistent
with acute delirium?
A. Disoriented, agitated, combative, resistant behavior, and disorganized thinking
B. Gradual memory loss over several years
C. Stable confusion with no behavioral changes
D. Calm and cooperative behavior with occasional forgetfulness
CORRECT ANSWER: A. Disoriented, agitated, combative, resistant behavior, and
disorganized thinking
Rationale: John is presenting with disorientation (oriented to self only), agitation,
combative and resistive behavior, and disorganized thinking. He insists he is at home
,and yells at sta . These symptoms developed acutely after surgery and represent a
significant change from his baseline .
Question 4: What is the underlying cause/pathophysiology of acute delirium in
John's case?
A. Progressive neurodegenerative disease
B. Surgical stress, age, catheterization, and increased risk for infection
C. Chronic cognitive decline unrelated to surgery
D. Psychological reaction to hospitalization
CORRECT ANSWER: B. Surgical stress, age, catheterization, and increased risk for
infection
Rationale: John is one day postoperative from right hip surgery. His age (77), surgery,
and catheterization increase his risk for infection and therefore acute delirium. Acute
delirium includes postoperative states, stress, sensory deprivation or overload, and
sleep deprivation as contributing factors .
Question 5: What is the Confusion Assessment Method (CAM) assessment and how
will it help assess delirium in John?
A. A tool to assess depression in older adults
B. A standardized tool used to diagnose delirium in nonpsychiatric patients
C. A tool to measure dementia severity
D. A tool to assess pain levels in confused patients
CORRECT ANSWER: B. A standardized tool used to diagnose delirium in
nonpsychiatric patients
Rationale: The Confusion Assessment Method is a standardized tool used to diagnose
delirium in nonpsychiatric patients. It assesses acute onset and fluctuating course,
inattention, disorganized thinking, and altered level of consciousness. John meets the
diagnostic criteria for acute delirium using the CAM assessment .
Question 6: Using the CAM assessment tool, does John meet diagnostic criteria for
acute delirium?
A. No, because he is oriented to self
B. Yes, he meets the diagnostic criteria for acute delirium
C. No, because his symptoms are from dementia
D. Cannot be determined without further testing
CORRECT ANSWER: B. Yes, he meets the diagnostic criteria for acute delirium
Rationale: John meets the CAM criteria for acute delirium: acute onset and fluctuating
course (sudden change after surgery), inattention (unable to focus), disorganized
,thinking (does not know where he is), and altered level of consciousness. His
disorientation, agitation, and combative behavior confirm the diagnosis .
Question 7: What is the key di erence between delirium and dementia?
A. Delirium has a gradual onset; dementia has an acute onset
B. Delirium has an acute onset and is reversible; dementia has a gradual onset and is
irreversible
C. Both have the same onset pattern
D. Dementia is reversible; delirium is irreversible
CORRECT ANSWER: B. Delirium has an acute onset and is reversible; dementia has
a gradual onset and is irreversible
Rationale: The onset of delirium occurs acutely, while dementia develops gradually over
time. Delirium is usually reversible if the underlying cause is treated, whereas dementia
is typically irreversible and progressive. John's acute onset after surgery and his
baseline of only early-stage dementia support delirium as the primary problem .
Question 8: What is an illusion?
A. Seeing or hearing something that is not actually present
B. A misinterpretation of a real object
C. A false belief that is firmly held despite evidence
D. A sudden change in consciousness
CORRECT ANSWER: B. A misinterpretation of a real object
Rationale: An illusion is a misinterpretation of a real object, such as seeing a coat on a
chair and thinking it is a person. This is distinct from a hallucination, which is perceiving
something that is not there, and a delusion, which is a false belief .
Question 9: What is a hallucination?
A. A misinterpretation of a real object
B. A false belief that is firmly held despite evidence
C. Seeing or hearing something that is not actually present
D. A sudden change in level of consciousness
CORRECT ANSWER: C. Seeing or hearing something that is not actually present
Rationale: A hallucination is seeing or hearing something that is not actually present.
This is a perceptual disturbance commonly seen in delirium. Patients may see bugs
crawling on them or hear voices that are not there .
Question 10: What is a delusion?
, A. A misinterpretation of a real object
B. Seeing something that is not present
C. A false belief that is firmly held despite evidence that it is incorrect
D. A temporary state of confusion
CORRECT ANSWER: C. A false belief that is firmly held despite evidence that it is
incorrect
Rationale: A delusion is a false belief that is firmly held despite evidence that it is
incorrect. For example, John insists he is at home when he is clearly in the hospital. This
is a common feature of delirium .
Question 11: What is a key nursing priority when delirium is suspected?
A. Administer antipsychotic medication immediately
B. Identify and treat the underlying cause immediately
C. Apply restraints to prevent injury
D. Wait for the provider to assess the patient
CORRECT ANSWER: B. Identify and treat the underlying cause immediately
Rationale: The key nursing priority when delirium is suspected is to identify and treat the
underlying cause immediately. Delirium is a symptom of an underlying problem such as
infection, electrolyte imbalance, medication toxicity, or hypoxia. Treating the cause
resolves the delirium .
Question 12: What nursing intervention helps reduce delirium?
A. Provide frequent reorientation to person, place, and time
B. Keep the room dark and quiet at all times
C. Limit family visits to prevent overstimulation
D. Restrict all activity
CORRECT ANSWER: A. Provide frequent reorientation to person, place, and time
Rationale: Providing frequent reorientation to person, place, and time helps reduce
delirium by keeping the patient grounded in reality. This is a core nonpharmacologic
intervention for delirium management .
Question 13: What environmental intervention helps delirium?
A. Maintain a calm and quiet environment
B. Keep the television on constantly for distraction
C. Move the patient to di erent rooms frequently
D. Keep the room brightly lit at all times
CORRECT ANSWER: A. Maintain a calm and quiet environment
