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GALEN NUR 253 EXAM 4 STUDY GUIDE 2026 :
300 QUESTIONS WITH ANSWERS &
RATIONALES | MENTAL HEALTH NURSING
# Table of Contents
| Section | Topic | Question Count |
|---------|-------|----------------|
| 1 | Cognitive Disorders (Delirium, Dementia, Alzheimer's,
Neurocognitive Disorders) | 60 |
| 2 | Advanced Psychiatric Emergencies (NMS, Serotonin Syndrome,
Malignant Catatonia, Withdrawal) | 40 |
| 3 | Forensic Psychiatry (Competency, Insanity, Risk Assessment, Civil
Commitment) | 35 |
| 4 | Violence & Aggression Management (De-escalation, Restraints,
Workplace Violence) | 30 |
| 5 | End-of-Life & Palliative Care in Psychiatry (Grief, Terminal Illness,
Assisted Dying) | 25 |
| 6 | Telepsychiatry & Digital Mental Health | 20 |
| 7 | Professional Burnout, Self-Care, & Resilience | 20 |
| 8 | Quality Improvement, Patient Safety, & Ethics (Advanced) | 30 |
| 9 | Emerging Topics (Psychedelics, Precision Psychiatry, AI in Mental
Health) | 15 |
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| 10 | High-Yield Clinical Case Questions | 25 |
| **Total** | | **300** |
---
# SECTION 1: Cognitive Disorders (Delirium, Dementia, Alzheimer's,
Neurocognitive Disorders) – 60 Questions
**1. A 78-year-old patient with sudden onset of confusion,
disorientation, and hallucinations has a urinary tract infection. The most
likely diagnosis is:**
A. Delirium (acute, fluctuating, caused by medical condition)
B. Alzheimer's dementia (chronic, progressive)
C. Vascular dementia (stepwise decline)
D. Frontotemporal dementia
**Answer: A – Delirium**
*Rationale:* Delirium is acute (<1 week), fluctuating, caused by
medical condition (UTI, medications, dehydration). Dementia is chronic,
progressive.
**2. Which of the following is a key feature distinguishing delirium
from dementia?**
A. Acute onset and fluctuating course
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B. Chronic onset
C. No change in attention
D. Normal level of consciousness
**Answer: A – Acute onset, fluctuating course**
*Rationale:* Delirium: acute (hours to days), fluctuating, inattention,
altered consciousness. Dementia: insidious onset, progressive, attention
intact until late.
**3. A patient with Alzheimer's dementia has difficulty finding words
(aphasia), difficulty with motor tasks (apraxia), and inability to
recognize familiar objects (agnosia). These are examples of:**
A. Core cognitive deficits in major neurocognitive disorder
B. Positive symptoms
C. Negative symptoms
D. Extrapyramidal symptoms
**Answer: A – Core cognitive deficits**
*Rationale:* Major neurocognitive disorder (dementia) requires decline
in at least one cognitive domain: learning/memory, language (aphasia),
executive function, complex attention, perceptual-motor (apraxia), social
cognition (agnosia).
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**4. Which medication is an acetylcholinesterase inhibitor approved for
mild-to-moderate Alzheimer's dementia?**
A. Donepezil (Aricept)
B. Memantine (Namenda)
C. Rivastigmine (Exelon)
D. Both A and C
**Answer: D – Donepezil and rivastigmine (and galantamine)**
*Rationale:* Cholinesterase inhibitors (donepezil, rivastigmine,
galantamine) are first-line for mild-moderate Alzheimer's. Memantine
(NMDA antagonist) for moderate-severe.
**5. A patient with Alzheimer's dementia is started on donepezil. The
nurse should monitor for:**
A. Bradycardia, syncope (vagotonic effect)
B. Tachycardia
C. Hypertension
D. Weight gain
**Answer: A – Bradycardia, syncope**
*Rationale:* Donepezil increases vagal tone → bradycardia, heart block,
syncope. Monitor heart rate, especially in patients with cardiac disease.
GALEN NUR 253 EXAM 4 STUDY GUIDE 2026 :
300 QUESTIONS WITH ANSWERS &
RATIONALES | MENTAL HEALTH NURSING
# Table of Contents
| Section | Topic | Question Count |
|---------|-------|----------------|
| 1 | Cognitive Disorders (Delirium, Dementia, Alzheimer's,
Neurocognitive Disorders) | 60 |
| 2 | Advanced Psychiatric Emergencies (NMS, Serotonin Syndrome,
Malignant Catatonia, Withdrawal) | 40 |
| 3 | Forensic Psychiatry (Competency, Insanity, Risk Assessment, Civil
Commitment) | 35 |
| 4 | Violence & Aggression Management (De-escalation, Restraints,
Workplace Violence) | 30 |
| 5 | End-of-Life & Palliative Care in Psychiatry (Grief, Terminal Illness,
Assisted Dying) | 25 |
| 6 | Telepsychiatry & Digital Mental Health | 20 |
| 7 | Professional Burnout, Self-Care, & Resilience | 20 |
| 8 | Quality Improvement, Patient Safety, & Ethics (Advanced) | 30 |
| 9 | Emerging Topics (Psychedelics, Precision Psychiatry, AI in Mental
Health) | 15 |
,2|Page
| 10 | High-Yield Clinical Case Questions | 25 |
| **Total** | | **300** |
---
# SECTION 1: Cognitive Disorders (Delirium, Dementia, Alzheimer's,
Neurocognitive Disorders) – 60 Questions
**1. A 78-year-old patient with sudden onset of confusion,
disorientation, and hallucinations has a urinary tract infection. The most
likely diagnosis is:**
A. Delirium (acute, fluctuating, caused by medical condition)
B. Alzheimer's dementia (chronic, progressive)
C. Vascular dementia (stepwise decline)
D. Frontotemporal dementia
**Answer: A – Delirium**
*Rationale:* Delirium is acute (<1 week), fluctuating, caused by
medical condition (UTI, medications, dehydration). Dementia is chronic,
progressive.
**2. Which of the following is a key feature distinguishing delirium
from dementia?**
A. Acute onset and fluctuating course
,3|Page
B. Chronic onset
C. No change in attention
D. Normal level of consciousness
**Answer: A – Acute onset, fluctuating course**
*Rationale:* Delirium: acute (hours to days), fluctuating, inattention,
altered consciousness. Dementia: insidious onset, progressive, attention
intact until late.
**3. A patient with Alzheimer's dementia has difficulty finding words
(aphasia), difficulty with motor tasks (apraxia), and inability to
recognize familiar objects (agnosia). These are examples of:**
A. Core cognitive deficits in major neurocognitive disorder
B. Positive symptoms
C. Negative symptoms
D. Extrapyramidal symptoms
**Answer: A – Core cognitive deficits**
*Rationale:* Major neurocognitive disorder (dementia) requires decline
in at least one cognitive domain: learning/memory, language (aphasia),
executive function, complex attention, perceptual-motor (apraxia), social
cognition (agnosia).
, 4|Page
**4. Which medication is an acetylcholinesterase inhibitor approved for
mild-to-moderate Alzheimer's dementia?**
A. Donepezil (Aricept)
B. Memantine (Namenda)
C. Rivastigmine (Exelon)
D. Both A and C
**Answer: D – Donepezil and rivastigmine (and galantamine)**
*Rationale:* Cholinesterase inhibitors (donepezil, rivastigmine,
galantamine) are first-line for mild-moderate Alzheimer's. Memantine
(NMDA antagonist) for moderate-severe.
**5. A patient with Alzheimer's dementia is started on donepezil. The
nurse should monitor for:**
A. Bradycardia, syncope (vagotonic effect)
B. Tachycardia
C. Hypertension
D. Weight gain
**Answer: A – Bradycardia, syncope**
*Rationale:* Donepezil increases vagal tone → bradycardia, heart block,
syncope. Monitor heart rate, especially in patients with cardiac disease.
