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NCLEX RN Exam Bank: Cognitive Impairment—
Delirium, Depression & Dementia Care
Table of Contents
Subtopic 1: Differentiating Delirium, Dementia, and Depression ...................................... 2
Subtopic 2: Delirium—Causes, Prevention, and Acute Management............................... 10
Subtopic 3: Depression in Older Adults—Identification, Treatment & Monitoring ............. 19
Subtopic 4: Dementia—Progression, Stages & Care Planning ......................................... 28
Subtopic 5: Behavioral and Psychological Symptoms of Dementia (BPSD) & Nursing
Interventions .............................................................................................................. 36
Subtopic 6: Nursing Care and Safety Measures for Patients with Cognitive Impairment .... 45
Subtopic 7: Pharmacologic Management of Cognitive Impairment & Medication Safety ... 53
Subtopic 8: Delirium—Assessment, Prevention, and Management ................................. 61
Subtopic 9: Depression in Older Adults—Recognition and Nursing Management ............. 70
Subtopic 10: Caregiver Support and Ethical Considerations in Cognitive Impairment ....... 78
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Subtopic 1: Differentiating Delirium, Dementia, and
Depression
Question 1:
A nurse is assessing an older adult who presents with acute confusion, agitation, and
fluctuating levels of consciousness. Which condition does the nurse most likely suspect?
A. Delirium
B. Depression
C. Dementia
D. Schizophrenia
Correct Answer: A. Delirium
Rationale: Delirium has a sudden onset and is characterized by fluctuating levels of
consciousness and cognitive impairment. In contrast, dementia is chronic and progressive,
and depression typically doesn’t cause fluctuating consciousness.
Question 2:
Which distinguishing feature best differentiates depression from dementia in elderly
patients?
A. Sudden onset
B. Poor attention span
C. Patient expresses sadness and hopelessness
D. Impaired long-term memory
Correct Answer: C. Patient expresses sadness and hopelessness
Rationale: Depression presents with persistent sadness, feelings of worthlessness, and
often reversible cognitive impairment, unlike the gradual memory loss of dementia.
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Question 3:
Which of the following best describes a hallmark symptom of Alzheimer’s disease?
A. Progressive memory loss affecting recent events first
B. Sudden personality changes
C. Constant visual hallucinations
D. Impulsivity and disinhibition
Correct Answer: A. Progressive memory loss affecting recent events first
Rationale: Alzheimer’s disease typically begins with loss of short-term memory, gradually
progressing to include long-term memory and functional decline.
Question 4:
A nurse is caring for a patient diagnosed with delirium. Which is the priority nursing
intervention?
A. Administer antidepressants
B. Ensure a safe environment to prevent injury
C. Encourage reminiscence therapy
D. Offer excessive stimulation to improve orientation
Correct Answer: B. Ensure a safe environment to prevent injury
Rationale: Delirium increases fall and injury risk due to confusion and disorientation.
Ensuring safety is the primary concern.
Question 5:
Which symptom is least likely to be associated with dementia?
A. Impaired reasoning
B. Language disturbances
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C. Hallucinations
D. Reversible cognitive decline
Correct Answer: D. Reversible cognitive decline
Rationale: Dementia involves irreversible and progressive cognitive decline. Reversible
impairment is more consistent with delirium or depression.
Question 6:
An elderly patient says, “I just don’t enjoy anything anymore.” Which condition does this
most indicate?
A. Dementia
B. Depression
C. Delirium
D. Schizophrenia
Correct Answer: B. Depression
Rationale: Anhedonia, or loss of interest in previously enjoyable activities, is a cardinal
symptom of depression.
Question 7:
What is the most sensitive screening tool for early-stage dementia?
A. PHQ-9
B. Geriatric Depression Scale
C. Mini-Mental State Examination (MMSE)
D. Braden Scale
Correct Answer: C. Mini-Mental State Examination (MMSE)
NCLEX RN Exam Bank: Cognitive Impairment—
Delirium, Depression & Dementia Care
Table of Contents
Subtopic 1: Differentiating Delirium, Dementia, and Depression ...................................... 2
Subtopic 2: Delirium—Causes, Prevention, and Acute Management............................... 10
Subtopic 3: Depression in Older Adults—Identification, Treatment & Monitoring ............. 19
Subtopic 4: Dementia—Progression, Stages & Care Planning ......................................... 28
Subtopic 5: Behavioral and Psychological Symptoms of Dementia (BPSD) & Nursing
Interventions .............................................................................................................. 36
Subtopic 6: Nursing Care and Safety Measures for Patients with Cognitive Impairment .... 45
Subtopic 7: Pharmacologic Management of Cognitive Impairment & Medication Safety ... 53
Subtopic 8: Delirium—Assessment, Prevention, and Management ................................. 61
Subtopic 9: Depression in Older Adults—Recognition and Nursing Management ............. 70
Subtopic 10: Caregiver Support and Ethical Considerations in Cognitive Impairment ....... 78
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Subtopic 1: Differentiating Delirium, Dementia, and
Depression
Question 1:
A nurse is assessing an older adult who presents with acute confusion, agitation, and
fluctuating levels of consciousness. Which condition does the nurse most likely suspect?
A. Delirium
B. Depression
C. Dementia
D. Schizophrenia
Correct Answer: A. Delirium
Rationale: Delirium has a sudden onset and is characterized by fluctuating levels of
consciousness and cognitive impairment. In contrast, dementia is chronic and progressive,
and depression typically doesn’t cause fluctuating consciousness.
Question 2:
Which distinguishing feature best differentiates depression from dementia in elderly
patients?
A. Sudden onset
B. Poor attention span
C. Patient expresses sadness and hopelessness
D. Impaired long-term memory
Correct Answer: C. Patient expresses sadness and hopelessness
Rationale: Depression presents with persistent sadness, feelings of worthlessness, and
often reversible cognitive impairment, unlike the gradual memory loss of dementia.
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Question 3:
Which of the following best describes a hallmark symptom of Alzheimer’s disease?
A. Progressive memory loss affecting recent events first
B. Sudden personality changes
C. Constant visual hallucinations
D. Impulsivity and disinhibition
Correct Answer: A. Progressive memory loss affecting recent events first
Rationale: Alzheimer’s disease typically begins with loss of short-term memory, gradually
progressing to include long-term memory and functional decline.
Question 4:
A nurse is caring for a patient diagnosed with delirium. Which is the priority nursing
intervention?
A. Administer antidepressants
B. Ensure a safe environment to prevent injury
C. Encourage reminiscence therapy
D. Offer excessive stimulation to improve orientation
Correct Answer: B. Ensure a safe environment to prevent injury
Rationale: Delirium increases fall and injury risk due to confusion and disorientation.
Ensuring safety is the primary concern.
Question 5:
Which symptom is least likely to be associated with dementia?
A. Impaired reasoning
B. Language disturbances
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C. Hallucinations
D. Reversible cognitive decline
Correct Answer: D. Reversible cognitive decline
Rationale: Dementia involves irreversible and progressive cognitive decline. Reversible
impairment is more consistent with delirium or depression.
Question 6:
An elderly patient says, “I just don’t enjoy anything anymore.” Which condition does this
most indicate?
A. Dementia
B. Depression
C. Delirium
D. Schizophrenia
Correct Answer: B. Depression
Rationale: Anhedonia, or loss of interest in previously enjoyable activities, is a cardinal
symptom of depression.
Question 7:
What is the most sensitive screening tool for early-stage dementia?
A. PHQ-9
B. Geriatric Depression Scale
C. Mini-Mental State Examination (MMSE)
D. Braden Scale
Correct Answer: C. Mini-Mental State Examination (MMSE)
