NR 547 Differential Diagnosis Week 6: Questions & Answers
(Clinical Management of Dementia-Related Psychosis)
Clinical Case Studies & Differential Diagnosis
1. Pete, a 69-year-old post-surgical patient, develops nighttime disorientation
and visual hallucinations (seeing people in balloons) after receiving zolpidem. In
the morning, he is alert and cooperative. What is the most likely diagnosis?
• A. Alzheimer's Disease
• B. Major Neurocognitive Disorder
• C. Moderate delirium due to sedative
• D. Schizophrenia
• Correct Answer: C
• Rationale: Pete meets diagnostic criteria for medication-induced acute
hyperactive delirium due to the administration of zolpidem, evidenced by
acute onset, fluctuating symptoms, and disorientation following medication
use.
2. Lisheng, 77, has become increasingly forgetful over 12 months and now
requires her daughter to manage her finances. Which classification is most
appropriate?
• A. Mild Neurocognitive Disorder
• B. Major Neurocognitive Disorder
• C. Normal aging
• D. Delirium
• Correct Answer: B
• Rationale: Cognitive deficits that interfere with independence, such as
difficulty paying bills or managing medications, meet the criteria for major
neurocognitive disorder.
,3. Regarding Lisheng (Question 2), her daughter reports no apathy, depression,
or agitation. How should her symptoms be classified?
• A. Moderate – with behavioral disturbance
• B. Mild – with behavioral disturbance
• C. Mild – without behavioral disturbance
• D. Severe – without behavioral disturbance
• Correct Answer: C
• Rationale: Lisheng has difficulty with instrumental ADLs (finances, driving),
indicating mild severity, but lacks behavioral symptoms like agitation or
apathy.
4. Tonia, 66, presents with a 6-week history of memory difficulty and a total loss
of interest in her usual social clubs. She feels "down" every day. What is the
priority differential?
• A. Vascular Neurocognitive Disorder
• B. Major Depressive Disorder (MDD)
• C. Frontotemporal Neurocognitive Disorder
• D. Lewy Body Dementia
• Correct Answer: B
• Rationale: The hallmark features for Tonia are depressed mood and loss of
interest; while memory loss can occur in MDD, it is not the predominant
feature in this timeframe.
5. Daron, 72, has hypertension and a history of carotid endarterectomy. He
presents with word-finding difficulties and executive function deficits but can
still pay his bills. What is the likely diagnosis?
• A. Mild Vascular Neurocognitive Disorder
• B. Alzheimer’s Disease
, • C. Major Depressive Disorder
• D. Delirium
• Correct Answer: A
• Rationale: Daron’s cardiovascular risk factors and specific deficits in
executive function and memory suggest vascular involvement.
6. Trent, 75, experiences vivid visual hallucinations and frequent falls. His
cognitive functioning seems to fluctuate significantly from day to day. What
diagnosis is suspected?
• A. Frontotemporal NCD
• B. NCD with Lewy bodies
• C. Parkinson’s Disease
• D. Vascular NCD
• Correct Answer: B
• Rationale: Hallmark features of Lewy body dementia include fluctuating
cognition, vivid visual hallucinations, and repeated falls/motor instability.
7. Cassie, 56, has begun hoarding food and refusing to throw items away. Her
partner notes she is socially inappropriate, though her memory is intact. What is
the most likely diagnosis?
• A. Frontotemporal Neurocognitive Disorder
• B. Alzheimer’s Disease
• C. Delirium
• D. Vascular NCD
• Correct Answer: A
• Rationale: Frontotemporal NCD is characterized by behavioral disturbances
(hoarding, impulsivity), personality changes, and language decline, often
with memory initially intact.
, 8. Dae, 72, was diagnosed with Parkinson’s 3 years ago. He now has new-onset
memory loss, apathy, and daytime sleepiness. What is the diagnosis?
• A. NCD with Lewy Bodies
• B. Neurocognitive disorder due to Parkinson's disease
• C. Alzheimer’s Disease
• D. MDD
• Correct Answer: B
• Rationale: When a client with existing Parkinson's develops cognitive
symptoms like memory loss and apathy, they meet the criteria for NCD due
to Parkinson's disease.
9. Isaiah, 28, hit his head in a car accident two days ago. He now has difficulty
concentrating and is irritable. What is the diagnosis?
• A. Major NCD due to TBI
• B. Mild NCD due to traumatic brain injury
• C. Delirium
• D. Social cognition impairment
• Correct Answer: B
• Rationale: Mild NCD due to TBI involves post-injury attention deficits and
irritability that typically resolve within weeks to months.
10. Bob, 87, wants to live alone, but his daughter disagrees. What is the most
important factor for the PMHNP to consider?
• A. Family dynamics
• B. Economic status
• C. Cognitive function of the patient
• D. Cultural background
(Clinical Management of Dementia-Related Psychosis)
Clinical Case Studies & Differential Diagnosis
1. Pete, a 69-year-old post-surgical patient, develops nighttime disorientation
and visual hallucinations (seeing people in balloons) after receiving zolpidem. In
the morning, he is alert and cooperative. What is the most likely diagnosis?
• A. Alzheimer's Disease
• B. Major Neurocognitive Disorder
• C. Moderate delirium due to sedative
• D. Schizophrenia
• Correct Answer: C
• Rationale: Pete meets diagnostic criteria for medication-induced acute
hyperactive delirium due to the administration of zolpidem, evidenced by
acute onset, fluctuating symptoms, and disorientation following medication
use.
2. Lisheng, 77, has become increasingly forgetful over 12 months and now
requires her daughter to manage her finances. Which classification is most
appropriate?
• A. Mild Neurocognitive Disorder
• B. Major Neurocognitive Disorder
• C. Normal aging
• D. Delirium
• Correct Answer: B
• Rationale: Cognitive deficits that interfere with independence, such as
difficulty paying bills or managing medications, meet the criteria for major
neurocognitive disorder.
,3. Regarding Lisheng (Question 2), her daughter reports no apathy, depression,
or agitation. How should her symptoms be classified?
• A. Moderate – with behavioral disturbance
• B. Mild – with behavioral disturbance
• C. Mild – without behavioral disturbance
• D. Severe – without behavioral disturbance
• Correct Answer: C
• Rationale: Lisheng has difficulty with instrumental ADLs (finances, driving),
indicating mild severity, but lacks behavioral symptoms like agitation or
apathy.
4. Tonia, 66, presents with a 6-week history of memory difficulty and a total loss
of interest in her usual social clubs. She feels "down" every day. What is the
priority differential?
• A. Vascular Neurocognitive Disorder
• B. Major Depressive Disorder (MDD)
• C. Frontotemporal Neurocognitive Disorder
• D. Lewy Body Dementia
• Correct Answer: B
• Rationale: The hallmark features for Tonia are depressed mood and loss of
interest; while memory loss can occur in MDD, it is not the predominant
feature in this timeframe.
5. Daron, 72, has hypertension and a history of carotid endarterectomy. He
presents with word-finding difficulties and executive function deficits but can
still pay his bills. What is the likely diagnosis?
• A. Mild Vascular Neurocognitive Disorder
• B. Alzheimer’s Disease
, • C. Major Depressive Disorder
• D. Delirium
• Correct Answer: A
• Rationale: Daron’s cardiovascular risk factors and specific deficits in
executive function and memory suggest vascular involvement.
6. Trent, 75, experiences vivid visual hallucinations and frequent falls. His
cognitive functioning seems to fluctuate significantly from day to day. What
diagnosis is suspected?
• A. Frontotemporal NCD
• B. NCD with Lewy bodies
• C. Parkinson’s Disease
• D. Vascular NCD
• Correct Answer: B
• Rationale: Hallmark features of Lewy body dementia include fluctuating
cognition, vivid visual hallucinations, and repeated falls/motor instability.
7. Cassie, 56, has begun hoarding food and refusing to throw items away. Her
partner notes she is socially inappropriate, though her memory is intact. What is
the most likely diagnosis?
• A. Frontotemporal Neurocognitive Disorder
• B. Alzheimer’s Disease
• C. Delirium
• D. Vascular NCD
• Correct Answer: A
• Rationale: Frontotemporal NCD is characterized by behavioral disturbances
(hoarding, impulsivity), personality changes, and language decline, often
with memory initially intact.
, 8. Dae, 72, was diagnosed with Parkinson’s 3 years ago. He now has new-onset
memory loss, apathy, and daytime sleepiness. What is the diagnosis?
• A. NCD with Lewy Bodies
• B. Neurocognitive disorder due to Parkinson's disease
• C. Alzheimer’s Disease
• D. MDD
• Correct Answer: B
• Rationale: When a client with existing Parkinson's develops cognitive
symptoms like memory loss and apathy, they meet the criteria for NCD due
to Parkinson's disease.
9. Isaiah, 28, hit his head in a car accident two days ago. He now has difficulty
concentrating and is irritable. What is the diagnosis?
• A. Major NCD due to TBI
• B. Mild NCD due to traumatic brain injury
• C. Delirium
• D. Social cognition impairment
• Correct Answer: B
• Rationale: Mild NCD due to TBI involves post-injury attention deficits and
irritability that typically resolve within weeks to months.
10. Bob, 87, wants to live alone, but his daughter disagrees. What is the most
important factor for the PMHNP to consider?
• A. Family dynamics
• B. Economic status
• C. Cognitive function of the patient
• D. Cultural background
