NUR255 Exam 4 V2 | Aging &
Mental Health Nursing Q&A with
Rationale | Galen College of
Nursing
1. An 82-year-old patient is admitted with acute confusion and a suspected urinary tract
infection. Which condition is the patient most likely experiencing?
A. Dementia
B. Schizophrenia
C. Depression
D. Delirium
Correct Answer: D
Expert Explanation: Delirium is characterized by an acute, sudden onset of confusion
often triggered by an underlying medical condition like an infection. Unlike dementia,
delirium is usually reversible once the primary cause is treated. The nurse must prioritize
identifying and treating the physiological trigger to restore cognitive baseline.
2. Which assessment tool is specifically designed to detect delirium in the clinical setting?
A. Confusion Assessment Method (CAM)
B. Geriatric Depression Scale (GDS)
,C. Mini-Mental State Exam (MMSE)
D. Braden Scale
Correct Answer: A
Expert Explanation: The Confusion Assessment Method (CAM) is the gold standard for
identifying delirium symptoms quickly. It focuses on four features: acute onset, inattention,
disorganized thinking, and altered level of consciousness. Regular use of this tool helps
nurses differentiate between chronic cognitive decline and acute changes.
3. A nurse is caring for an older adult with Alzheimer’s disease who becomes increasingly
agitated in the late afternoon. This phenomenon is known as:
A. Respite care
B. Shadowing
C. Aphasia
D. Sundowning
Correct Answer: D
Expert Explanation: Sundowning refers to the increased confusion and agitation that
occurs as daylight fades into evening. It is commonly observed in patients with mid-to-late
stage dementia. Environmental modifications, such as keeping the room well-lit, can help
reduce the severity of these symptoms.
, 4. What is the primary goal of validation therapy when communicating with a patient with
advanced dementia?
A. To acknowledge and respect the patient’s feelings and meanings
B. To correct the patient’s misconceptions of reality
C. To improve the patient’s short-term memory
D. To ensure the patient follows a strict medication schedule
Correct Answer: A
Expert Explanation: Validation therapy focuses on the emotional truth of the patient’s
experience rather than factual accuracy. By validating their feelings, the nurse helps reduce
the patient’s anxiety and builds a sense of security. Attempting to force reality orientation
on a patient with advanced dementia often leads to increased agitation.
5. When assessing an older adult for depression, which symptom is most likely to be
misinterpreted as a normal part of aging?
A. Auditory hallucinations
B. Grandiosity
C. Fatigue and lack of energy
D. Pressured speech
Correct Answer: C
Mental Health Nursing Q&A with
Rationale | Galen College of
Nursing
1. An 82-year-old patient is admitted with acute confusion and a suspected urinary tract
infection. Which condition is the patient most likely experiencing?
A. Dementia
B. Schizophrenia
C. Depression
D. Delirium
Correct Answer: D
Expert Explanation: Delirium is characterized by an acute, sudden onset of confusion
often triggered by an underlying medical condition like an infection. Unlike dementia,
delirium is usually reversible once the primary cause is treated. The nurse must prioritize
identifying and treating the physiological trigger to restore cognitive baseline.
2. Which assessment tool is specifically designed to detect delirium in the clinical setting?
A. Confusion Assessment Method (CAM)
B. Geriatric Depression Scale (GDS)
,C. Mini-Mental State Exam (MMSE)
D. Braden Scale
Correct Answer: A
Expert Explanation: The Confusion Assessment Method (CAM) is the gold standard for
identifying delirium symptoms quickly. It focuses on four features: acute onset, inattention,
disorganized thinking, and altered level of consciousness. Regular use of this tool helps
nurses differentiate between chronic cognitive decline and acute changes.
3. A nurse is caring for an older adult with Alzheimer’s disease who becomes increasingly
agitated in the late afternoon. This phenomenon is known as:
A. Respite care
B. Shadowing
C. Aphasia
D. Sundowning
Correct Answer: D
Expert Explanation: Sundowning refers to the increased confusion and agitation that
occurs as daylight fades into evening. It is commonly observed in patients with mid-to-late
stage dementia. Environmental modifications, such as keeping the room well-lit, can help
reduce the severity of these symptoms.
, 4. What is the primary goal of validation therapy when communicating with a patient with
advanced dementia?
A. To acknowledge and respect the patient’s feelings and meanings
B. To correct the patient’s misconceptions of reality
C. To improve the patient’s short-term memory
D. To ensure the patient follows a strict medication schedule
Correct Answer: A
Expert Explanation: Validation therapy focuses on the emotional truth of the patient’s
experience rather than factual accuracy. By validating their feelings, the nurse helps reduce
the patient’s anxiety and builds a sense of security. Attempting to force reality orientation
on a patient with advanced dementia often leads to increased agitation.
5. When assessing an older adult for depression, which symptom is most likely to be
misinterpreted as a normal part of aging?
A. Auditory hallucinations
B. Grandiosity
C. Fatigue and lack of energy
D. Pressured speech
Correct Answer: C
