Cognitive Disorders: Dementia and Delirium Practice Questions
20 free Cognitive Disorders: Dementia and Delirium practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which statement best differentiates delirium from dementia?
- A Delirium has a gradual onset, while dementia develops suddenly.
- B Delirium is usually reversible, while dementia is typically irreversible.
- C Both delirium and dementia are permanent cognitive impairments.
- D Dementia is caused by infection, while delirium is caused by aging.
Correct answer: Delirium is usually reversible, while dementia is typically irreversible.
Delirium is an acute, reversible disturbance in attention and cognition, often caused by medical conditions or medications, whereas dementia involves chronic, progressive cognitive decline that is irreversible.
Which of the following findings is most characteristic of delirium?
- A Slow, progressive memory loss
- B Fluctuating levels of consciousness
- C Consistent personality changes
- D Gradual impairment of long-term memory
Correct answer: Fluctuating levels of consciousness
Delirium presents with an acute onset and fluctuating levels of consciousness and attention throughout the day, unlike dementia’s stable cognitive decline.
Which nursing intervention is most appropriate for a hospitalized patient with delirium?
- A Limit visitors to the room to reduce overstimulation
- B Keep the room completely dark and quiet at all times
- C Frequently reorient the patient to time, place, and situation
- D Encourage full independence in all decision-making
Correct answer: Frequently reorient the patient to time, place, and situation
Frequent reorientation helps reduce confusion and anxiety in delirious patients, promoting a sense of safety and stability.
A patient with dementia frequently wanders at night. What is the best nursing action?
- A Apply physical restraints to keep the patient in bed
- B Leave all the lights off to encourage night-time sleep
- C Provide a safe, well-lit environment and redirect calmly
- D Administer a routine sedative every single night
Correct answer: Provide a safe, well-lit environment and redirect calmly
A structured, safe environment with calm redirection helps reduce agitation and prevents injury in patients with dementia who wander.
Which factor most commonly contributes to delirium in older adults?
- A Gradual neuronal degeneration
- B Alzheimer’s disease
- C Medication side effects or infection
- D Chronic sleep deprivation
Correct answer: Medication side effects or infection
In older adults, delirium often results from acute medical conditions like infection or the effects of medications, making it potentially reversible.
Which assessment finding supports a diagnosis of dementia rather than delirium?
- A Acute confusion and disorientation
- B Fluctuating attention levels
- C Steady decline in memory and judgment
- D Rapid onset of hallucinations
Correct answer: Steady decline in memory and judgment
Dementia is characterized by a gradual decline in memory, problem-solving, and judgment over months or years, without abrupt fluctuations.
What is the primary nursing goal for a patient experiencing delirium?
- A Promote reality orientation and patient safety
- B Encourage independent decision-making
- C Maintain strict sensory deprivation
- D Encourage deep emotional expression
Correct answer: Promote reality orientation and patient safety
The priority in delirium care is ensuring safety while gently reorienting the patient to reality to minimize confusion and prevent harm.
Which of the following patients is most at risk for developing delirium?
- A A 60-year-old with well-controlled diabetes
- B A 78-year-old recovering from surgery with a urinary tract infection
- C A 55-year-old with mild depression
- D A 40-year-old with chronic insomnia
Correct answer: A 78-year-old recovering from surgery with a urinary tract infection
Elderly post-operative patients with infections are at high risk for delirium due to metabolic changes, infection, and medication effects.
What is the most appropriate nursing action when a patient with Alzheimer’s disease becomes agitated during bathing?
- A Continue the bath quickly to finish the care task
- B Stop and reattempt later with a calm approach
- C Firmly scold the patient for being noncompliant
- D Increase stimulation by talking loudly and briskly
Correct answer: Stop and reattempt later with a calm approach
Stopping and reattempting care later with a calm, reassuring approach reduces agitation and respects the patient’s emotional state.
Which medication class is most likely to worsen confusion in elderly patients with cognitive impairment?
- A Antipsychotics
- B Anticholinergics
- C Antidepressants
- D Antihypertensives
Correct answer: Anticholinergics
Anticholinergic drugs can cause or worsen confusion and delirium, especially in older adults, due to their effects on neurotransmission.
Which nursing strategy best supports independence in a patient with mild dementia?
- A Completing all activities for the patient
- B Providing step-by-step instructions for tasks
- C Avoiding reminders to prevent frustration
- D Encouraging the patient to make all decisions alone
Correct answer: Providing step-by-step instructions for tasks
Providing clear, simple instructions allows patients with mild dementia to function independently while reducing frustration and confusion.
Which environmental modification best supports a patient with dementia?
- A Frequently rearranging furniture to stimulate awareness
- B Removing clocks and calendars to lessen daily stress
- C Keeping familiar items and a consistent routine
- D Using bright lights and loud sounds for engagement
Correct answer: Keeping familiar items and a consistent routine
A consistent, familiar environment helps reduce confusion and anxiety in dementia patients by maintaining orientation and security.
What is the nurse’s best initial response when a patient with delirium says, “There are snakes in my bed”?
- A “There are no snakes here, so please stop imagining things.”
- B “You are hallucinating because of your current illness.”
- C “I can see you’re frightened. Let’s look together so you feel safe.”
- D “You really need to calm down now and go back to sleep.”
Correct answer: “I can see you’re frightened. Let’s look together so you feel safe.”
Acknowledging the patient’s fear and providing reassurance without reinforcing the delusion promotes trust and reduces anxiety.
Which type of memory is typically lost first in Alzheimer’s disease?
- A Long-term autobiographical memory
- B Recent short-term memory
- C Procedural motor memory
- D Deep emotional memory
Correct answer: Recent short-term memory
Short-term memory deteriorates early in Alzheimer’s disease due to neuronal loss in areas of the brain responsible for new information processing.
A nurse suspects delirium in a patient. Which finding supports this suspicion?
- A Oriented to person but not place
- B Steady cognitive decline over two years
- C Disorientation developing within hours
- D Forgetting family members’ names gradually
Correct answer: Disorientation developing within hours
Delirium develops rapidly—often within hours or days—and fluctuates, distinguishing it from the slow, progressive decline of dementia.
Which nursing intervention helps prevent delirium in an elderly hospitalized patient?
- A Reducing mobility to help prevent falls
- B Providing frequent reorientation and hydration
- C Minimizing communication to reduce confusion
- D Encouraging long uninterrupted daytime naps
Correct answer: Providing frequent reorientation and hydration
Reorientation, hydration, and maintaining sensory input help prevent delirium by addressing common reversible causes.
Which communication technique is most effective for interacting with a patient with moderate dementia?
- A Asking broad open-ended questions
- B Speaking slowly using simple sentences
- C Giving several choices all at once
- D Using medical terms to explain the care
Correct answer: Speaking slowly using simple sentences
Simple, slow communication with short phrases reduces confusion and supports comprehension in patients with moderate cognitive impairment.
Which physiological change most commonly contributes to delirium in hospitalized elderly patients?
- A Increased central serotonin activity
- B Hypoxia or electrolyte imbalance
- C Reduced central dopamine levels
- D Mild chronic dehydration
Correct answer: Hypoxia or electrolyte imbalance
Delirium often results from acute metabolic disturbances such as hypoxia, dehydration, or electrolyte imbalances.
What is the best nursing approach for a family frustrated with a loved one’s dementia-related forgetfulness?
- A Emphasize patient discipline and personal effort
- B Encourage reorientation through firm argument
- C Provide emotional support and disease education
- D Recommend complete isolation of the patient
Correct answer: Provide emotional support and disease education
Education and empathy help families understand that cognitive decline is due to neurodegenerative changes, not intentional behavior.
A nurse observes that a patient with delirium is attempting to climb out of bed repeatedly. What is the priority action?
- A Apply physical restraints to the patient
- B Move the patient closer to the nurse’s station for supervision
- C Administer sedative medication immediately
- D Leave the patient alone in bed to rest
Correct answer: Move the patient closer to the nurse’s station for supervision
Close observation and environmental adjustments ensure safety while minimizing restraint use and preserving dignity.