GALEN COLLEGE OF NURSING – NU 176
GERIATRIC NURSING EXAM 4 – QUESTIONS
AND ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: COGNITIVE CHANGES, DELIRIUM, AND DEMENTIA
Questions 1–20
1. Which finding most strongly distinguishes delirium from dementia in an older adult?
A) Acute onset with fluctuating attention and awareness
B) Gradual decline in memory over several years
C) Persistent impairment in activities of daily living
D) Progressive loss of executive functioning
Correct Answer: Acute onset with fluctuating attention and awareness
Rationale: Delirium is characterized by an acute change in attention, awareness, and
cognition that commonly fluctuates during the day. Dementia generally develops gradually
and produces a progressive cognitive decline. Identifying the rapid onset of altered attention
is especially important because delirium often indicates an underlying medical problem
requiring prompt assessment and treatment.
2. An older adult becomes suddenly confused several hours after admission for
pneumonia. Which nursing action is most appropriate initially?
A) Assume the change represents irreversible dementia
B) Assess for reversible causes of the acute cognitive change
C) Encourage the patient to remain in bed continuously
D) Administer a sedative before completing an assessment
Correct Answer: Assess for reversible causes of the acute cognitive change
Rationale: Sudden confusion in an older adult should be considered delirium until reversible
causes are investigated. Infection, hypoxia, dehydration, medication effects, pain, urinary
retention, and metabolic disturbances can precipitate delirium. The nurse should assess the
patient systematically rather than labeling the change as dementia or immediately using
sedating medications that may worsen cognition.
,3. What environmental intervention is most appropriate for an older adult experiencing
confusion?
A) Frequently changing caregivers to increase stimulation
B) Keeping the television on continuously
C) Maintaining familiar routines and surroundings
D) Restricting family visits completely
Correct Answer: Maintaining familiar routines and surroundings
Rationale: Familiar routines and surroundings can decrease disorientation and anxiety in
cognitively impaired older adults. Excessive stimulation, frequent environmental changes,
and unfamiliar caregivers may increase confusion. Consistency helps the patient recognize
patterns and people. Appropriate family involvement can also provide reassurance and
orientation when it is calming and supportive.
4. Which assessment finding would be most concerning for delirium?
A) Mild forgetfulness over several months
B) Difficulty recalling a distant childhood event
C) Gradual difficulty managing finances
D) New disorientation developing over several hours
Correct Answer: New disorientation developing over several hours
Rationale: Delirium commonly develops rapidly, sometimes within hours, and produces
altered attention, awareness, and cognition. Gradual memory and executive-function
changes are more consistent with dementia. A new, abrupt change should prompt
assessment for underlying causes such as infection, medication effects, hypoxia, dehydration,
metabolic abnormalities, pain, or urinary retention.
5. Which communication technique is most appropriate when caring for a patient with
moderate dementia?
A) Use short, simple statements and allow time for responses
B) Ask several questions simultaneously
C) Correct every inaccurate statement immediately
D) Speak rapidly to prevent loss of attention
Correct Answer: Use short, simple statements and allow time for responses
Rationale: Patients with dementia often have difficulty processing complex information and
responding quickly. Short, concrete statements and adequate response time reduce cognitive
demands. The nurse should communicate respectfully and avoid unnecessary confrontation.
,Correcting every inaccurate statement can increase distress, whereas calm redirection and
reassurance often support safer communication.
6. A patient with dementia repeatedly asks when her daughter will arrive. Which response
is best?
A) “I already told you that several times.”
B) “You need to remember what we discussed.”
C) “Your daughter is expected later today. Let’s look at this calendar together.”
D) “You should stop asking the same question.”
Correct Answer: “Your daughter is expected later today. Let’s look at this calendar
together.”
Rationale: Repeated questioning is common in dementia and should be addressed with
reassurance and gentle redirection rather than criticism. A calm response acknowledges the
concern while using an external cue such as a calendar. Shaming the patient or demanding
that the person remember information can increase anxiety without improving cognitive
function.
7. Which finding is most characteristic of advanced dementia?
A) Independent management of medications
B) Increasing dependence for basic activities of daily living
C) Improved short-term memory
D) Consistently intact judgment
Correct Answer: Increasing dependence for basic activities of daily living
Rationale: As dementia progresses, cognitive and functional abilities commonly decline.
Patients may eventually require assistance with bathing, dressing, eating, toileting, mobility,
and medication management. The nurse should continually evaluate functional ability rather
than assuming that cognitive impairment alone determines care needs. Maintaining
independence in remaining abilities remains an important goal.
8. Which intervention best promotes orientation for a confused older adult?
A) Keep the room completely dark throughout the day
B) Avoid discussing the date because it may cause frustration
C) Frequently relocate personal belongings
D) Provide clocks, calendars, and familiar objects
Correct Answer: Provide clocks, calendars, and familiar objects
, Rationale: External orientation cues can help patients recognize time, place, and familiar
surroundings. Clearly visible clocks and calendars, along with meaningful personal objects,
provide consistent reminders without demanding excessive cognitive effort. Orientation
should be offered calmly and repeatedly as needed. Environmental consistency is particularly
helpful for patients with dementia or delirium.
9. Which statement about dementia is most accurate?
A) It is always rapidly reversible
B) It is synonymous with delirium
C) It involves progressive impairment that interferes with functioning
D) It affects only short-term memory
Correct Answer: It involves progressive impairment that interferes with functioning
Rationale: Dementia refers to a syndrome involving cognitive impairment significant enough
to interfere with daily functioning. Depending on the cause, memory, language, executive
function, visuospatial ability, or judgment may be affected. Dementia usually develops
progressively, whereas delirium has an acute onset and fluctuating course and should
prompt evaluation for reversible causes.
10. Which nursing observation would provide the strongest evidence that confusion is
fluctuating?
A) Cognitive performance varies substantially between morning and evening
B) The patient has had memory loss for five years
C) The patient consistently cannot recall family names
D) The patient gradually stopped managing finances
Correct Answer: Cognitive performance varies substantially between morning and evening
Rationale: Fluctuation in cognition and attention is a classic feature of delirium. A patient
may appear relatively clear at one time and significantly confused later. Progressive memory
and functional decline over months or years is more characteristic of dementia. Recognizing
fluctuation helps the nurse distinguish an acute confusional state from chronic cognitive
impairment.
11. An older adult with dementia becomes agitated during bathing. Which intervention is
most appropriate?
A) Complete the bath as quickly as possible despite resistance
B) Identify possible triggers and modify the approach
C) Use physical restraints immediately
GERIATRIC NURSING EXAM 4 – QUESTIONS
AND ANSWERS | 2026/2027 LATEST UPDATE
SECTION 1: COGNITIVE CHANGES, DELIRIUM, AND DEMENTIA
Questions 1–20
1. Which finding most strongly distinguishes delirium from dementia in an older adult?
A) Acute onset with fluctuating attention and awareness
B) Gradual decline in memory over several years
C) Persistent impairment in activities of daily living
D) Progressive loss of executive functioning
Correct Answer: Acute onset with fluctuating attention and awareness
Rationale: Delirium is characterized by an acute change in attention, awareness, and
cognition that commonly fluctuates during the day. Dementia generally develops gradually
and produces a progressive cognitive decline. Identifying the rapid onset of altered attention
is especially important because delirium often indicates an underlying medical problem
requiring prompt assessment and treatment.
2. An older adult becomes suddenly confused several hours after admission for
pneumonia. Which nursing action is most appropriate initially?
A) Assume the change represents irreversible dementia
B) Assess for reversible causes of the acute cognitive change
C) Encourage the patient to remain in bed continuously
D) Administer a sedative before completing an assessment
Correct Answer: Assess for reversible causes of the acute cognitive change
Rationale: Sudden confusion in an older adult should be considered delirium until reversible
causes are investigated. Infection, hypoxia, dehydration, medication effects, pain, urinary
retention, and metabolic disturbances can precipitate delirium. The nurse should assess the
patient systematically rather than labeling the change as dementia or immediately using
sedating medications that may worsen cognition.
,3. What environmental intervention is most appropriate for an older adult experiencing
confusion?
A) Frequently changing caregivers to increase stimulation
B) Keeping the television on continuously
C) Maintaining familiar routines and surroundings
D) Restricting family visits completely
Correct Answer: Maintaining familiar routines and surroundings
Rationale: Familiar routines and surroundings can decrease disorientation and anxiety in
cognitively impaired older adults. Excessive stimulation, frequent environmental changes,
and unfamiliar caregivers may increase confusion. Consistency helps the patient recognize
patterns and people. Appropriate family involvement can also provide reassurance and
orientation when it is calming and supportive.
4. Which assessment finding would be most concerning for delirium?
A) Mild forgetfulness over several months
B) Difficulty recalling a distant childhood event
C) Gradual difficulty managing finances
D) New disorientation developing over several hours
Correct Answer: New disorientation developing over several hours
Rationale: Delirium commonly develops rapidly, sometimes within hours, and produces
altered attention, awareness, and cognition. Gradual memory and executive-function
changes are more consistent with dementia. A new, abrupt change should prompt
assessment for underlying causes such as infection, medication effects, hypoxia, dehydration,
metabolic abnormalities, pain, or urinary retention.
5. Which communication technique is most appropriate when caring for a patient with
moderate dementia?
A) Use short, simple statements and allow time for responses
B) Ask several questions simultaneously
C) Correct every inaccurate statement immediately
D) Speak rapidly to prevent loss of attention
Correct Answer: Use short, simple statements and allow time for responses
Rationale: Patients with dementia often have difficulty processing complex information and
responding quickly. Short, concrete statements and adequate response time reduce cognitive
demands. The nurse should communicate respectfully and avoid unnecessary confrontation.
,Correcting every inaccurate statement can increase distress, whereas calm redirection and
reassurance often support safer communication.
6. A patient with dementia repeatedly asks when her daughter will arrive. Which response
is best?
A) “I already told you that several times.”
B) “You need to remember what we discussed.”
C) “Your daughter is expected later today. Let’s look at this calendar together.”
D) “You should stop asking the same question.”
Correct Answer: “Your daughter is expected later today. Let’s look at this calendar
together.”
Rationale: Repeated questioning is common in dementia and should be addressed with
reassurance and gentle redirection rather than criticism. A calm response acknowledges the
concern while using an external cue such as a calendar. Shaming the patient or demanding
that the person remember information can increase anxiety without improving cognitive
function.
7. Which finding is most characteristic of advanced dementia?
A) Independent management of medications
B) Increasing dependence for basic activities of daily living
C) Improved short-term memory
D) Consistently intact judgment
Correct Answer: Increasing dependence for basic activities of daily living
Rationale: As dementia progresses, cognitive and functional abilities commonly decline.
Patients may eventually require assistance with bathing, dressing, eating, toileting, mobility,
and medication management. The nurse should continually evaluate functional ability rather
than assuming that cognitive impairment alone determines care needs. Maintaining
independence in remaining abilities remains an important goal.
8. Which intervention best promotes orientation for a confused older adult?
A) Keep the room completely dark throughout the day
B) Avoid discussing the date because it may cause frustration
C) Frequently relocate personal belongings
D) Provide clocks, calendars, and familiar objects
Correct Answer: Provide clocks, calendars, and familiar objects
, Rationale: External orientation cues can help patients recognize time, place, and familiar
surroundings. Clearly visible clocks and calendars, along with meaningful personal objects,
provide consistent reminders without demanding excessive cognitive effort. Orientation
should be offered calmly and repeatedly as needed. Environmental consistency is particularly
helpful for patients with dementia or delirium.
9. Which statement about dementia is most accurate?
A) It is always rapidly reversible
B) It is synonymous with delirium
C) It involves progressive impairment that interferes with functioning
D) It affects only short-term memory
Correct Answer: It involves progressive impairment that interferes with functioning
Rationale: Dementia refers to a syndrome involving cognitive impairment significant enough
to interfere with daily functioning. Depending on the cause, memory, language, executive
function, visuospatial ability, or judgment may be affected. Dementia usually develops
progressively, whereas delirium has an acute onset and fluctuating course and should
prompt evaluation for reversible causes.
10. Which nursing observation would provide the strongest evidence that confusion is
fluctuating?
A) Cognitive performance varies substantially between morning and evening
B) The patient has had memory loss for five years
C) The patient consistently cannot recall family names
D) The patient gradually stopped managing finances
Correct Answer: Cognitive performance varies substantially between morning and evening
Rationale: Fluctuation in cognition and attention is a classic feature of delirium. A patient
may appear relatively clear at one time and significantly confused later. Progressive memory
and functional decline over months or years is more characteristic of dementia. Recognizing
fluctuation helps the nurse distinguish an acute confusional state from chronic cognitive
impairment.
11. An older adult with dementia becomes agitated during bathing. Which intervention is
most appropriate?
A) Complete the bath as quickly as possible despite resistance
B) Identify possible triggers and modify the approach
C) Use physical restraints immediately
