NCLEX-PN® ExaminationPsychosocial IntegrityMedium
A practical nurse is providing care for an older adult client who is exhibiting sudden onset confusion, disorientation, and fluctuating levels of consciousness. The client's family reports these symptoms appeared rapidly over the past 24 hours. The client is also restless and has difficulty focusing attention. What is the most likely medical condition the client is experiencing?
- ADelirium
- BAlzheimer's disease
- CSchizophrenia
- DMajor depressive disorder
Show answer & explanationAnswer & explanation
Correct answer: A. Delirium
The sudden onset, fluctuating level of consciousness, disorientation, and difficulty focusing attention are classic signs of delirium. Unlike dementia, which has a gradual onset, delirium is acute and often reversible, frequently caused by underlying medical conditions.
Why the other options are wrong
- B. Alzheimer's disease (a type of dementia) has a gradual onset and progressive decline, not a sudden onset with fluctuating consciousness.
- C. Schizophrenia is a chronic mental illness with symptoms like hallucinations and delusions, but typically does not present with a sudden, fluctuating level of consciousness in older adults.
- D. Major depressive disorder primarily affects mood, although cognitive symptoms can occur, they do not typically include acute disorientation and fluctuating consciousness.
Delirium vs. Dementia
Delirium is an acute, fluctuating disturbance of cognition, often reversible, caused by medical conditions. Dementia is a chronic, progressive cognitive decline.
- Delirium: sudden onset, fluctuating course, impaired attention.
- Dementia: gradual onset, progressive decline, intact attention early on.
- Both involve cognitive impairment but differ in onset, course, and reversibility.
Memory trick: Sudden confusion, fluctuating mind, a medical cause you must find.