ELITE COMPREHENSIVE
VARCAROLIS — CHAPTER 23 NEUROCOGNITIVE
DISORDERS
Advanced Comprehensive Psychiatric–Mental Health
Nursing Review
Delirium • Dementia • Alzheimer Disease • Major and
Mild Neurocognitive Disorders
SPRING SEMESTER EXAMINATION MAY
2026
1. An older adult patient takes multiple medications daily. Over 2 days, the patient
developed confusion, slurred speech, an unsteady gait, and fluctuating levels of
orientation. These findings are most characteristic of:
a. delirium.
c. amnestic syndrome.
b. dementia.
d. Alzheimers disease.
• delirium.
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, • Delirium is characterized by an abrupt onset of fluctuating levels of
awareness, clouded consciousness, perceptual disturbances, and
disturbed memory and orientation. The onset of dementia or
Alzheimers disease, a type of dementia, is more insidious. Amnestic
syndrome involves memory impairment without other cognitive
problems.
2. A patient with fluctuating levels of awareness, confusion, and disturbed orientation
shouts, Bugs are crawling on my legs. Get them off! Which problem is the patient
experiencing?
a. Aphasia
c. Tactile hallucinations
b. Dystonia
d. Mnemonic disturbance
• c. Tactile hallucinations
• The patient feels bugs crawling on both legs, even though no sensory
stimulus is actually present. This description meets the definition of a
hallucination, a false sensory perception. Tactile hallucinations may
be part of the symptom constellation of delirium. Aphasia refers to a
speech disorder. Dystonia refers to excessive muscle tonus.
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, Mnemonic disturbance is associated with dementia rather than
delirium.
3. A patient with fluctuating levels of consciousness, disturbed orientation, and
perceptual alteration begs, Someone get these bugs off me. What is the nurses best
response?
a. No bugs are on your legs. You are having hallucinations.
b. I will have someone stay here and brush off the bugs for you.
c. Try to relax. The crawling sensation will go away sooner if you can relax.
d. I dont see any bugs, but I can tell you are frightened. I will stay with you.
• d. I dont see any bugs, but I can tell you are frightened. I will stay with
you.
• When hallucinations are present, the nurse should acknowledge the
patients feelings and state the nurses perception of reality, but not
argue. Staying with the patient increases feelings of security, reduces
anxiety, offers the opportunity for reinforcing reality, and provides a
measure of physical safety. Denying the patients perception without
offering help does not support the patient emotionally. Telling the
patient to relax makes the patient responsible for self-soothing.
Telling the patient that someone will brush the bugs away supports
the perceptual distortions.
3|Page
VARCAROLIS — CHAPTER 23 NEUROCOGNITIVE
DISORDERS
Advanced Comprehensive Psychiatric–Mental Health
Nursing Review
Delirium • Dementia • Alzheimer Disease • Major and
Mild Neurocognitive Disorders
SPRING SEMESTER EXAMINATION MAY
2026
1. An older adult patient takes multiple medications daily. Over 2 days, the patient
developed confusion, slurred speech, an unsteady gait, and fluctuating levels of
orientation. These findings are most characteristic of:
a. delirium.
c. amnestic syndrome.
b. dementia.
d. Alzheimers disease.
• delirium.
1|Page
, • Delirium is characterized by an abrupt onset of fluctuating levels of
awareness, clouded consciousness, perceptual disturbances, and
disturbed memory and orientation. The onset of dementia or
Alzheimers disease, a type of dementia, is more insidious. Amnestic
syndrome involves memory impairment without other cognitive
problems.
2. A patient with fluctuating levels of awareness, confusion, and disturbed orientation
shouts, Bugs are crawling on my legs. Get them off! Which problem is the patient
experiencing?
a. Aphasia
c. Tactile hallucinations
b. Dystonia
d. Mnemonic disturbance
• c. Tactile hallucinations
• The patient feels bugs crawling on both legs, even though no sensory
stimulus is actually present. This description meets the definition of a
hallucination, a false sensory perception. Tactile hallucinations may
be part of the symptom constellation of delirium. Aphasia refers to a
speech disorder. Dystonia refers to excessive muscle tonus.
2|Page
, Mnemonic disturbance is associated with dementia rather than
delirium.
3. A patient with fluctuating levels of consciousness, disturbed orientation, and
perceptual alteration begs, Someone get these bugs off me. What is the nurses best
response?
a. No bugs are on your legs. You are having hallucinations.
b. I will have someone stay here and brush off the bugs for you.
c. Try to relax. The crawling sensation will go away sooner if you can relax.
d. I dont see any bugs, but I can tell you are frightened. I will stay with you.
• d. I dont see any bugs, but I can tell you are frightened. I will stay with
you.
• When hallucinations are present, the nurse should acknowledge the
patients feelings and state the nurses perception of reality, but not
argue. Staying with the patient increases feelings of security, reduces
anxiety, offers the opportunity for reinforcing reality, and provides a
measure of physical safety. Denying the patients perception without
offering help does not support the patient emotionally. Telling the
patient to relax makes the patient responsible for self-soothing.
Telling the patient that someone will brush the bugs away supports
the perceptual distortions.
3|Page
