Page 1 of 20
Neurocognitive Disorders Practice Questions & Verified
Answers | Psychiatric Nursing Review
1. A 78-year-old patient is admitted to the medical unit with
pneumonia. On day 2, the nurse notes the patient is confused,
disoriented, has fluctuating attention, and is picking at the
bedclothes. The nurse suspects:
a. Alzheimer’s disease
b. Delirium
c. Frontotemporal dementia
d. Major depressive disorder
Answer: b. Delirium
Rationale: Delirium is characterized by acute onset (hours to
days), fluctuating course, inattention, disorganized thinking, and
altered level of consciousness, often triggered by an acute
medical illness (pneumonia). Alzheimer’s has insidious onset.
2. The most important first step in managing a patient with
suspected delirium is:
a. Administer haloperidol immediately
b. Identify and treat the underlying cause
c. Restrain the patient to prevent falls
d. Obtain a brain MRI
Answer: b. Identify and treat the underlying cause
Rationale: Delirium is a medical emergency. The priority is to
find and correct the precipitating factor (e.g., infection,
electrolyte imbalance, medication). Antipsychotics are adjunctive,
not first-line.
3. Which of the following is a core feature of delirium according
to DSM-5-TR?
,Page 2 of 20
a. Insidious onset over months
b. Memory impairment without attention deficit
c. Disturbance in attention and awareness that develops over a
short period
d. Persistent personality change
Answer: c. Disturbance in attention and awareness that develops
over a short period
Rationale: The essential feature of delirium is an acute
disturbance in attention (reduced ability to focus, sustain, or shift
attention) and awareness (reduced orientation to environment),
with additional cognitive changes.
4. The Confusion Assessment Method (CAM) is a validated tool to
screen for:
a. Dementia
b. Delirium
c. Depression
d. Anxiety
Answer: b. Delirium
Rationale: The CAM assesses four features: acute onset and
fluctuating course, inattention, disorganized thinking, and altered
level of consciousness. It is the most widely used bedside delirium
assessment.
5. A patient with delirium is pulling at IV lines and attempting to
get out of bed. The nurse’s priority intervention is:
a. Apply wrist restraints
b. Administer lorazepam 2 mg IV
c. Provide a sitter, reorient frequently, and address underlying
cause
d. Turn off lights and leave the patient alone
, Page 3 of 20
Answer: c. Provide a sitter, reorient frequently, and address
underlying cause
Rationale: Non-pharmacologic interventions (reorientation,
frequent reassurance, presence of a sitter, reducing stimuli) are
first-line. Restraints are a last resort. Benzodiazepines can worsen
delirium except in alcohol withdrawal.
6. Which medication class is most likely to precipitate delirium in
older adults?
a. Anticholinergics
b. Beta-blockers
c. Statins
d. Proton pump inhibitors
Answer: a. Anticholinergics (e.g., diphenhydramine, oxybutynin,
tricyclics, atropine)
Rationale: Anticholinergic burden is a major risk factor for
delirium in the elderly, causing confusion, urinary retention, and
dry mouth. Other common precipitants include benzodiazepines,
opioids, and corticosteroids.
7. A patient with delirium has a fluctuating level of consciousness,
from hyperalert to lethargic. This pattern is best described as:
a. Sundowning
b. Diurnal variation
c. Fluctuating course
d. Circadian reversal
Answer: c. Fluctuating course
Rationale: A hallmark of delirium is that symptoms come and go
(fluctuate) over a 24-hour period, often worse at night
(sundowning), but the term “fluctuating course” is the DSM-5
descriptor.
Neurocognitive Disorders Practice Questions & Verified
Answers | Psychiatric Nursing Review
1. A 78-year-old patient is admitted to the medical unit with
pneumonia. On day 2, the nurse notes the patient is confused,
disoriented, has fluctuating attention, and is picking at the
bedclothes. The nurse suspects:
a. Alzheimer’s disease
b. Delirium
c. Frontotemporal dementia
d. Major depressive disorder
Answer: b. Delirium
Rationale: Delirium is characterized by acute onset (hours to
days), fluctuating course, inattention, disorganized thinking, and
altered level of consciousness, often triggered by an acute
medical illness (pneumonia). Alzheimer’s has insidious onset.
2. The most important first step in managing a patient with
suspected delirium is:
a. Administer haloperidol immediately
b. Identify and treat the underlying cause
c. Restrain the patient to prevent falls
d. Obtain a brain MRI
Answer: b. Identify and treat the underlying cause
Rationale: Delirium is a medical emergency. The priority is to
find and correct the precipitating factor (e.g., infection,
electrolyte imbalance, medication). Antipsychotics are adjunctive,
not first-line.
3. Which of the following is a core feature of delirium according
to DSM-5-TR?
,Page 2 of 20
a. Insidious onset over months
b. Memory impairment without attention deficit
c. Disturbance in attention and awareness that develops over a
short period
d. Persistent personality change
Answer: c. Disturbance in attention and awareness that develops
over a short period
Rationale: The essential feature of delirium is an acute
disturbance in attention (reduced ability to focus, sustain, or shift
attention) and awareness (reduced orientation to environment),
with additional cognitive changes.
4. The Confusion Assessment Method (CAM) is a validated tool to
screen for:
a. Dementia
b. Delirium
c. Depression
d. Anxiety
Answer: b. Delirium
Rationale: The CAM assesses four features: acute onset and
fluctuating course, inattention, disorganized thinking, and altered
level of consciousness. It is the most widely used bedside delirium
assessment.
5. A patient with delirium is pulling at IV lines and attempting to
get out of bed. The nurse’s priority intervention is:
a. Apply wrist restraints
b. Administer lorazepam 2 mg IV
c. Provide a sitter, reorient frequently, and address underlying
cause
d. Turn off lights and leave the patient alone
, Page 3 of 20
Answer: c. Provide a sitter, reorient frequently, and address
underlying cause
Rationale: Non-pharmacologic interventions (reorientation,
frequent reassurance, presence of a sitter, reducing stimuli) are
first-line. Restraints are a last resort. Benzodiazepines can worsen
delirium except in alcohol withdrawal.
6. Which medication class is most likely to precipitate delirium in
older adults?
a. Anticholinergics
b. Beta-blockers
c. Statins
d. Proton pump inhibitors
Answer: a. Anticholinergics (e.g., diphenhydramine, oxybutynin,
tricyclics, atropine)
Rationale: Anticholinergic burden is a major risk factor for
delirium in the elderly, causing confusion, urinary retention, and
dry mouth. Other common precipitants include benzodiazepines,
opioids, and corticosteroids.
7. A patient with delirium has a fluctuating level of consciousness,
from hyperalert to lethargic. This pattern is best described as:
a. Sundowning
b. Diurnal variation
c. Fluctuating course
d. Circadian reversal
Answer: c. Fluctuating course
Rationale: A hallmark of delirium is that symptoms come and go
(fluctuate) over a 24-hour period, often worse at night
(sundowning), but the term “fluctuating course” is the DSM-5
descriptor.
