NLE Psychiatric Disorders — Cognitive, Organic, and Neurodevelopmental DisordersExam Answer Templates

Marks

1

Topic

Delirium

Difficulty

easy

Template Id

T1

Examiner Tip

The single mark hinges on the word 'acute' and the word 'reversible' — both must appear. Examiners reject answers that describe only confusion or altered behavior without the temporal and etiological components.

Model Answer

Delirium is an acute, reversible neuropsychiatric syndrome characterized by sudden onset of disturbed consciousness, impaired attention, and fluctuating cognitive changes, caused by an underlying medical condition.

Question Type

very_short_answer

Answer Structure

• One complete sentence: State that it is acute + reversible + includes disturbed consciousness and impaired attention + caused by a medical condition [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing only 'confusion' without specifying acute onset or medical cause — too vague for full credit
• Confusing delirium with dementia by writing 'progressive' or 'chronic'
• Omitting the reversibility component, which is clinically essential

Key Phrases To Include

• acute onset
• reversible
• disturbed consciousness
• impaired attention
• fluctuating
• underlying medical condition

Marks

2

Topic

Delirium

Difficulty

easy

Template Id

T2

Examiner Tip

Any two well-recognized medical causes earn full marks. Adding a brief parenthetical explanation (as modeled) demonstrates clinical understanding and protects against partial credit disputes.

Model Answer

1. Urinary tract infection (UTI) — a leading cause of acute confusional states in the elderly, often presenting without classic urinary symptoms. 2. Electrolyte imbalance (e.g., hyponatremia or hypernatremia) — disrupts neuronal function, producing acute cognitive changes.

Question Type

very_short_answer

Answer Structure

• Cause 1: Name the medical etiology clearly [1 mark]
• Cause 2: Name a second distinct medical etiology clearly [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing psychological stress or depression as a cause — these are not direct medical causes of delirium
• Listing two causes from the same category (e.g., UTI and pneumonia both labeled as 'infection') without distinguishing them as separate medical etiologies — may only earn 1 mark
• Leaving the answer as a single word without any clinical detail

Key Phrases To Include

• urinary tract infection
• electrolyte imbalance
• hypoxia
• hypoglycemia
• dehydration
• polypharmacy
• drug or alcohol withdrawal

Marks

2

Topic

Delirium versus Dementia

Difficulty

easy

Template Id

T3

Examiner Tip

Comparison questions always require BOTH sides. Structure your answer as 'In delirium… whereas in dementia…' for every feature to ensure you do not lose marks by inadvertently omitting one side.

Model Answer

Onset: Delirium has a sudden onset developing over hours to days, whereas dementia has a gradual onset occurring over months to years. Level of Consciousness: In delirium, consciousness is altered and clouded (the patient may be hyperalert or drowsy and shifts between states). In dementia, consciousness remains essentially clear and normal until the very late stages of the disease.

Question Type

short_answer

Answer Structure

• Compare onset for BOTH conditions in one paired statement [1 mark]
• Compare level of consciousness for BOTH conditions in one paired statement [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing only delirium or only dementia without completing the comparison — 1 mark maximum
• Mixing up the two conditions (e.g., stating that delirium has gradual onset)
• Using the word 'memory' to describe consciousness — these are different clinical dimensions

Key Phrases To Include

• sudden onset
• gradual onset
• hours to days
• months to years
• altered consciousness
• clouded
• normal consciousness
• clear until late

Marks

2

Topic

Delirium

Difficulty

medium

Template Id

T4

Examiner Tip

In case-based questions, the examiner rewards clinical reasoning. Show that you understand delirium is a medical emergency requiring cause identification — not just behavioral management. Mention both the medical priority AND the safety priority.

Model Answer

Most Likely Condition: Delirium (acute confusional state superimposed on or triggered by the underlying pneumonia infection). Priority Nursing Action: Identify and address the underlying medical cause — in this case, ensure adequate oxygenation (monitor SpO2, administer prescribed supplemental oxygen), and report assessment findings to the physician to facilitate prompt medical management, while maintaining patient safety through fall precautions and a calm, well-lit, oriented environment.

Question Type

short_answer

Answer Structure

• Correctly identify the condition as delirium with brief rationale [1 mark]
• State the priority nursing action: treat/address the underlying cause AND ensure safety [1 mark]

Scoring Breakdown

Common Mark Deductions

• Identifying the condition as dementia — factual error, loses the first mark
• Stating only 'reorient the patient' as the priority action — reorientation is supportive, not the clinical priority; identifying the cause is
• Omitting safety measures entirely from the nursing action

Key Phrases To Include

• delirium
• underlying medical cause
• oxygenation
• safety
• report to physician
• acute confusional state
• fall precautions

Marks

3

Topic

Alzheimer's Disease — Nursing Care

Difficulty

medium

Template Id

T5

Examiner Tip

For 3-mark listing questions, aim for three distinct categories of intervention (environmental, identification, behavioral) rather than three items from the same category. Each item should be specific and directly linked to the stated risk.

Model Answer

1. Secure the environment: Ensure all exit doors are locked, alarmed, or fitted with safety latches at non-eye-level heights to prevent undetected wandering and elopement. 2. Apply an identification bracelet: Ensure the patient wears a clearly labeled ID bracelet with name, diagnosis, unit, and contact information at all times, facilitating safe return if the patient does wander. 3. Maintain a consistent, structured daily routine: A predictable schedule of activities reduces anxiety and restlessness that often triggers wandering behavior in patients with Alzheimer's disease.

Question Type

short_answer

Answer Structure

• Intervention 1: Environmental safety measure specifically targeting wandering prevention [1 mark]
• Intervention 2: Identification or tracking measure to enable safe return [1 mark]
• Intervention 3: Behavioral/routine-based intervention to reduce wandering triggers [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'monitor the patient' without specifying how — too vague to earn a mark
• Listing three variations of the same intervention (e.g., lock door, alarm door, fence the area) — may only earn 1 mark as they are the same category
• Writing interventions not specific to wandering (e.g., 'provide nutrition') — off-topic and does not earn marks

Key Phrases To Include

• secured or alarmed doors
• identification bracelet
• consistent routine
• structured environment
• wandering
• elopement prevention
• safety

Marks

3

Topic

Alzheimer's Disease — Pharmacology

Difficulty

medium

Template Id

T6

Examiner Tip

Drug questions in NLE psychiatric nursing typically follow this pattern: class → example → mechanism → nursing consideration → patient teaching. Hitting all five points guarantees full marks even in a 3-mark question if you are concise.

Model Answer

Alzheimer's disease is managed pharmacologically with two main drug classes: 1. Cholinesterase Inhibitors (mild-to-moderate disease): Examples include donepezil, rivastigmine, and galantamine. These drugs inhibit the enzyme acetylcholinesterase, thereby increasing available acetylcholine in the brain. Nursing considerations: monitor for cholinergic side effects — bradycardia, nausea, vomiting, diarrhea, and increased salivation; check heart rate before administration. 2. NMDA-Receptor Antagonist (moderate-to-severe disease): Memantine blocks excessive NMDA-receptor activation. It may be combined with a cholinesterase inhibitor. Nursing consideration: monitor for dizziness and confusion. Important Teaching Point: These drugs slow the progression of decline — they do NOT cure or reverse Alzheimer's disease.

Question Type

short_answer

Answer Structure

• Drug Class 1: Name cholinesterase inhibitors + give at least one example + one nursing consideration [1 mark]
• Drug Class 2: Name memantine (NMDA antagonist) + stage of use + one nursing consideration [1 mark]
• Critical teaching point: Drugs slow but do not cure or reverse the disease [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing drug names without identifying the drug class — partial credit at best
• Stating that these drugs cure Alzheimer's disease — factual error that may negate the pharmacology mark
• Omitting nursing considerations entirely — loses practical nursing marks

Key Phrases To Include

• cholinesterase inhibitor
• donepezil
• rivastigmine
• galantamine
• acetylcholine
• NMDA-receptor antagonist
• memantine
• bradycardia
• slow progression
• does not cure

Marks

3

Topic

Alzheimer's Disease — Clinical Features

Difficulty

medium

Template Id

T7

Examiner Tip

Mnemonics earn marks only if you can unpack them into full clinical definitions. 'The four A's are amnesia, aphasia, apraxia, agnosia' is worth zero marks on its own — the definition and example are what earn the marks.

Model Answer

The four A's of Alzheimer's disease are: 1. Amnesia — progressive memory loss, beginning with recent memory. Example: the patient cannot recall what he ate for breakfast but can still recall his childhood home address. 2. Aphasia — impairment of language (speaking, understanding, reading, or writing). Example: the patient struggles to find the right word during conversation (word-finding difficulty). 3. Apraxia — inability to perform previously learned voluntary motor tasks despite intact motor function. Example: the patient cannot button a shirt or use a spoon correctly, although there is no physical weakness. 4. Agnosia — inability to recognize familiar objects, faces, or sounds despite intact sensory function. Example: the patient no longer recognizes the faces of close family members.

Question Type

short_answer

Answer Structure

• Define Amnesia + give one clinical example [0.75 mark — in practice, 3 of the 4 A's fully answered earns 3 marks]
• Define Aphasia + give one clinical example
• Define Apraxia + give one clinical example
• Define Agnosia + give one clinical example

Scoring Breakdown

Common Mark Deductions

• Defining only 2 or 3 of the four A's and leaving the rest blank — each missing definition loses proportional marks
• Confusing apraxia with paralysis (apraxia is motor planning failure, not weakness)
• Providing definitions without examples when examples are explicitly requested

Key Phrases To Include

• amnesia
• recent memory impaired first
• aphasia
• word-finding difficulty
• apraxia
• learned motor tasks
• agnosia
• cannot recognize

Marks

3

Topic

Alzheimer's Disease — Nursing Process

Difficulty

hard

Template Id

T8

Examiner Tip

Prioritization questions are NLE favorites. The answer 'safety first because of Maslow' is the expected clinical reasoning pattern. Demonstrating knowledge of RA 9173 adds professional depth and signals board-level competence.

Model Answer

Priority Nursing Diagnosis: Risk for Injury related to cognitive impairment (disorientation and wandering behavior) and unsafe home environment as evidenced by history of wandering and living alone without supervision. Rationale for Prioritization (Maslow's Hierarchy): According to Maslow's hierarchy of needs, physiologic safety and prevention of injury represent the most basic survival-level concern. In a patient with Alzheimer's who wanders — particularly one who lives alone without a caregiver or supervision — the immediate risk of physical harm (falls, traffic accidents, exposure to extremes of temperature, elopement into dangerous environments) poses a life-threatening threat. This physiologic safety need must be addressed before psychosocial needs such as social isolation or self-esteem. Under RA 9173 (Philippine Nursing Act of 2002), the nurse is professionally and legally accountable for the physical safety of patients in their care.

Question Type

short_answer

Answer Structure

• State the complete NANDA nursing diagnosis using the three-part format (Problem + Etiology + Evidence) [1 mark]
• Cite Maslow's hierarchy to justify why safety is the first priority [1 mark]
• Explain the specific dangers that make this patient's safety risk immediate and life-threatening [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'Altered Thought Process' as the priority diagnosis — while valid, it is a cognitive diagnosis and does not capture the immediate physical safety threat; Safety is always first
• Citing Maslow's hierarchy by name but not explaining HOW it applies to this specific patient
• Using incomplete NANDA format (e.g., stating only 'Risk for Injury' without the 'related to' and 'as evidenced by' components)

Key Phrases To Include

• Risk for Injury
• related to cognitive impairment
• wandering behavior
• Maslow's hierarchy
• physiologic safety
• life-threatening
• priority
• RA 9173

Marks

3

Topic

ADHD

Difficulty

medium

Template Id

T9

Examiner Tip

ADHD questions frequently test the paradox of stimulant use. If asked why stimulants are used for a hyperactive child, the answer is that they enhance activity in the prefrontal cortex, improving self-regulation and focus — this level of rationale earns bonus credit.

Model Answer

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder of childhood (often persisting into adulthood) characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning and development across multiple settings. Two Main Behavioral Domains: 1. Inattention — difficulty sustaining attention, careless mistakes, distractibility, and failure to follow through on tasks. 2. Hyperactivity-Impulsivity — excessive motor activity (fidgeting, unable to stay seated), acting before thinking, and difficulty waiting turns. Two Nursing Management Strategies: 1. Provide a structured, consistent, and distraction-reduced environment with clear, simple rules and step-by-step instructions to support the child's ability to focus and complete tasks. 2. Administer stimulant medications (e.g., methylphenidate) in the morning only, and monitor appetite, weight, height, heart rate, and blood pressure for medication-related side effects.

Question Type

short_answer

Answer Structure

• Define ADHD as a neurodevelopmental disorder with the two core domains named [1 mark]
• Briefly describe each domain (inattention and hyperactivity-impulsivity) [1 mark]
• State two distinct, specific nursing management strategies [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing ADHD as a 'behavior problem' without identifying it as a neurodevelopmental disorder — missed classification
• Listing only one behavioral domain instead of two
• Stating 'give medication' without specifying timing or monitoring — too vague for full credit

Key Phrases To Include

• neurodevelopmental disorder
• inattention
• hyperactivity-impulsivity
• multiple settings
• structured environment
• methylphenidate
• morning administration
• appetite suppression
• monitor growth

Marks

3

Topic

ADHD — Pharmacology and Teaching

Difficulty

medium

Template Id

T10

Examiner Tip

Patient/family teaching questions reward specificity. 'Give the medication in the morning to prevent insomnia' is exam-perfect. Saying 'give at the right time' earns nothing. Every teaching point should be specific: WHAT to do, WHEN, and WHY.

Model Answer

When teaching the parents of a child prescribed methylphenidate, the nurse should include the following instructions: 1. Timing of administration: Give the medication in the morning (and if a second dose is needed, no later than early afternoon) to prevent insomnia at night. Do NOT give the medication in the late afternoon or evening. 2. Monitor appetite and nutrition: Methylphenidate suppresses appetite. Offer a nutritious breakfast before the medication is given, as appetite will be best at this time. Monitor the child's weight and height regularly and report any significant loss or growth concerns to the physician. 3. Do not abruptly stop the medication: Stopping stimulants suddenly can lead to rebound irritability and behavioral changes. Always consult the physician before adjusting the dose or stopping the medication. Additional points: Monitor for increased heart rate and blood pressure; report palpitations, chest pain, or unusual mood changes immediately.

Question Type

short_answer

Answer Structure

• Instruction 1: Timing — morning only, not late afternoon or evening (insomnia prevention) [1 mark]
• Instruction 2: Appetite/nutrition monitoring — give before medication, monitor weight and height [1 mark]
• Instruction 3: Do not stop abruptly + monitor cardiovascular signs [1 mark]

Scoring Breakdown

Common Mark Deductions

• Generic medication safety instructions not specific to methylphenidate (e.g., 'store in a safe place') — may not earn marks without the specific teaching points
• Omitting the timing instruction entirely — this is the most distinctive and high-yield teaching point for stimulants
• Not addressing appetite suppression and growth monitoring — a key pediatric safety concern

Key Phrases To Include

• morning administration
• prevent insomnia
• appetite suppression
• monitor weight and height
• do not stop abruptly
• heart rate
• blood pressure
• breakfast before medication

Marks

3

Topic

Autism Spectrum Disorder

Difficulty

medium

Template Id

T11

Examiner Tip

The NLE differentiates ASD from intellectual disability. Know that ASD is defined by the two DSM-based domains above — not by IQ level. A child with ASD can have average or above-average intelligence. The defining feature is the social-communication impairment combined with restricted, repetitive behavior.

Model Answer

Autism Spectrum Disorder (ASD) is defined by two core diagnostic domains: 1. Persistent deficits in social communication and social interaction: The child demonstrates poor eye contact, difficulty with social-emotional reciprocity (unable to engage in back-and-forth conversation or share emotions), impaired development of relationships, and impaired use of verbal and nonverbal communication. 2. Restricted, repetitive patterns of behavior, interests, or activities: This includes stereotyped or repetitive movements (e.g., hand-flapping, rocking), intense insistence on sameness and routine (any change causes marked distress), highly fixated interests, and unusual sensory sensitivities (hyper- or hypo-reactivity to sensory input). Two Priority Nursing Interventions: 1. Maintain a consistent, predictable routine and environment: Sudden changes provoke significant distress in children with ASD; prepare the child for any transitions in advance using clear, concrete language and visual cues. 2. Ensure safety and reduce sensory overload: The care environment should minimize excessive noise, light, and stimulation; assess for sensory triggers and implement a calm, structured setting to prevent agitation and self-injurious behavior.

Question Type

short_answer

Answer Structure

• Core Domain 1: Social communication and social interaction deficits — describe with at least two specific features [1 mark]
• Core Domain 2: Restricted, repetitive behavior — describe with at least two specific features including insistence on sameness [1 mark]
• Two nursing interventions: consistency/routine AND safety/sensory reduction [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing ASD as primarily an intellectual disability — ASD and intellectual disability are separate diagnoses, though they can co-occur
• Mentioning only one core domain instead of both
• Stating interventions that are too vague (e.g., 'be kind and supportive') without clinical specificity

Key Phrases To Include

• social communication deficits
• social interaction
• poor eye contact
• social-emotional reciprocity
• restricted repetitive behavior
• insistence on sameness
• stereotyped movements
• hand-flapping
• consistent routine
• sensory overload

Marks

5

Topic

Intellectual Disability

Difficulty

hard

Template Id

T12

Examiner Tip

Five-mark long-answer questions in NLE psychiatric nursing reward structured depth, Philippine context, and nursing-process language. Organize your answer with clear headings (Definition, Causes, Nursing Management). Reference Philippine law and healthcare programs (RA 7277, DSWD, SPED) — this is a high-yield differentiator that shows board-level professional competence beyond textbook knowledge.

Model Answer

Definition of Intellectual Disability (1 mark): Intellectual disability is a neurodevelopmental disorder with onset during the developmental period, characterized by significant deficits in both intellectual functioning (e.g., reasoning, learning, problem-solving, abstract thinking) and adaptive functioning (e.g., communication, self-care, social skills, and practical daily living skills). Severity is classified as mild, moderate, severe, or profound, and is determined primarily by the level of adaptive functioning and the support needs of the individual — not by IQ score alone. Causes to be aware of (contextual knowledge — adds depth, 1 mark): Common causes include chromosomal disorders (e.g., Down syndrome, fragile X syndrome), prenatal exposures (fetal alcohol syndrome, TORCH infections), perinatal hypoxia or birth injury, postnatal infections (e.g., bacterial meningitis), and severe nutritional deprivation. Prevention is a major public health role, encompassing prenatal care, genetic counseling, newborn screening programs, and immunization. Three Components of Community Nursing Management: 1. Promote maximum independence through consistent, individualized skill training (1 mark): Using the principles of habilitation (developing skills not yet acquired), the nurse teaches ADL skills (bathing, dressing, feeding, toileting) using simple, concrete, step-by-step instructions with repetition and positive reinforcement. Communicate at the child's developmental — not chronological — age level. Break tasks into the smallest achievable steps and celebrate each success to build confidence and reinforce learning. 2. Ensure safety and protect from exploitation (1 mark): Children with intellectual disability are at higher risk for physical injury (due to impaired judgment and safety awareness) and for exploitation and abuse. The nurse assesses the home environment for physical hazards, educates caregivers on supervision strategies, teaches the child age-appropriate personal safety concepts in concrete, understandable terms, and is alert for signs of abuse or neglect as required by the nurse's duty under RA 9173 and Philippine child protection laws. 3. Support and educate the family/caregiver (1 mark): Caregiver education is central to community-based nursing. The nurse provides realistic, strength-based education about the child's diagnosis and potential, demonstrates therapeutic interaction techniques, connects the family with available community resources (Barangay Health Centers, DSWD services, Special Education programs — SPED under DepEd), and provides emotional support to address caregiver stress and grief reactions. Encouraging community integration and advocacy for the child's rights (consistent with the Philippine Magna Carta for Disabled Persons, RA 7277) is part of the nurse's expanded community role.

Question Type

long_answer

Answer Structure

• Paragraph 1: Complete definition including intellectual AND adaptive functioning deficits, onset in developmental period, classification [1 mark]
• Paragraph 2 (optional depth): Major etiologic categories and prevention role [1 mark — for comprehensiveness in a 5-mark question]
• Component 1: Individualized skill training — concrete, step-by-step, habilitation approach [1 mark]
• Component 2: Safety and protection from exploitation — specific strategies and legal duty [1 mark]
• Component 3: Family/caregiver support — education, community resources, RA 7277 reference [1 mark]

Scoring Breakdown

Common Mark Deductions

• Defining intellectual disability using IQ numbers alone without mentioning adaptive functioning — misses the contemporary diagnostic definition and loses the definition mark
• Writing only generic nursing care (e.g., 'provide care and support') without specifying habilitation techniques — not specific enough for marks
• Omitting the Philippine healthcare context (community resources, DSWD, SPED) — missed opportunity for full marks in a long-answer question
• Failing to distinguish between intellectual disability and ASD — confusing these conditions in the answer may cost marks
• Writing only one or two management components when three are explicitly requested

Key Phrases To Include

• neurodevelopmental disorder
• intellectual functioning
• adaptive functioning
• developmental period
• habilitation
• step-by-step instruction
• repetition
• positive reinforcement
• safety
• exploitation
• RA 9173
• RA 7277
• SPED
• DSWD
• community integration
• caregiver support

Marks

5

Topic

Delirium versus Dementia — Comparison

Difficulty

hard

Template Id

T13

Examiner Tip

In a 5-mark comparison question, use a clear parallel structure for each feature: 'In delirium… whereas in dementia…' This ensures you address both sides for each feature and demonstrates organized clinical thinking. The nursing implication paragraph is where candidates differentiate themselves — go beyond 'monitor' to specify WHAT to assess and WHY.

Model Answer

Introduction (1 mark for establishing the clinical importance): Delirium and dementia are both disorders of cognition that are frequently encountered in Filipino elderly patients in acute care and community settings. Differentiating them is a critical patient-safety competency: delirium is a medical emergency requiring urgent investigation and treatment, whereas dementia is a chronic disease requiring supportive, rehabilitative nursing care. Comparison of Four Clinical Features: 1. Onset: Delirium: Sudden, acute onset — develops over hours to days. The patient's family or staff can often identify exactly when the change began. Dementia: Gradual, insidious onset — develops over months to years, often undetected in early stages. 2. Course and Pattern: Delirium: Fluctuating course — the patient's mental status changes throughout the day, characteristically worsening in the evening and at night (sundowning pattern). A single reassessment may show the patient to be temporarily lucid. Dementia: Slowly progressive but stable within any given day — the patient does not have hour-to-hour fluctuations. 3. Level of Consciousness: Delirium: Consciousness is altered and clouded — the patient may be hyperalert and agitated or lethargic and drowsy, and may shift between these states rapidly. Dementia: Consciousness is essentially clear and normal until the very late (end-stage) disease — the patient is typically alert and responsive to the environment even as cognitive function declines. 4. Reversibility: Delirium: Usually REVERSIBLE once the underlying cause (e.g., infection, electrolyte imbalance, hypoxia) is identified and corrected. Dementia: Generally IRREVERSIBLE and progressive — most forms (including Alzheimer's) cannot be cured, though a few reversible causes (B12 deficiency, hypothyroidism) should always be excluded. Nursing Implications of the Differences (1 mark): Because delirium is acute and reversible, the priority nursing action is to IDENTIFY AND TREAT THE UNDERLYING CAUSE — this is a nursing emergency. The nurse must perform rapid assessment (vital signs, SpO2, blood glucose, medication review), notify the physician, and correct immediate physiologic imbalances while maintaining patient safety. In contrast, the nursing priority for dementia is long-term supportive care: a consistent environment, simple communication, safety from wandering, and caregiver/family support. Critical Clinical Point: A patient with known dementia who shows a SUDDEN WORSENING in cognition must be evaluated for SUPERIMPOSED DELIRIUM — the presence of chronic dementia does NOT protect against acute delirium and can actually increase vulnerability. This is a commonly tested NLE scenario.

Question Type

long_answer

Answer Structure

• Introduction: Establish clinical significance of distinguishing the two conditions [1 mark]
• Feature 1: Onset — sudden vs. gradual, with time frames [1 mark]
• Feature 2 + 3: Course/pattern (fluctuating vs. stable) AND consciousness (altered vs. clear) [1 mark]
• Feature 4: Reversibility — reversible vs. irreversible [1 mark]
• Nursing implications: Emergency response for delirium vs. supportive care for dementia, including superimposed delirium point [1 mark]

Scoring Breakdown

Common Mark Deductions

• Comparing fewer than four features when four are explicitly requested — loses proportional marks
• Describing the features without linking to nursing implications — misses the last mark entirely
• Omitting the superimposed delirium concept — this is a frequently tested high-yield point that distinguishes prepared candidates
• Writing the nursing implication as 'monitor the patient' for delirium — must specify identifying the cause as the priority

Key Phrases To Include

• medical emergency
• acute onset
• gradual onset
• fluctuating course
• sundowning
• altered consciousness
• clear consciousness
• reversible
• irreversible
• identify and treat the underlying cause
• superimposed delirium
• sudden worsening

Marks

5

Topic

Alzheimer's Disease — Comprehensive Nursing Care

Difficulty

hard

Template Id

T14

Examiner Tip

Five-mark care plan questions in NLE psychiatric nursing are won by breadth AND specificity. Cover all problems stated in the question, use NANDA language, apply Maslow's framework visibly, and incorporate Philippine healthcare resources. The mention of validation therapy (not just reorientation) for advanced Alzheimer's is a high-yield clinical nuance that rewards prepared candidates.

Model Answer

Assessment and Priority Setting (using Maslow's Hierarchy): Three priority nursing problems are identified: (1) safety and behavioral disturbance from sundowning, (2) altered nutrition and hydration from poor oral intake, and (3) caregiver role strain from family exhaustion. Physiologic needs (nutrition, safety) are prioritized first, followed by caregiver support as a psychosocial need. Nursing Diagnosis 1 (Safety): Risk for Injury related to confusion and agitation during sundowning as evidenced by increased disorientation and restlessness in the late afternoon and evening. Interventions (1 mark): - Increase daytime light exposure and structured daytime activity to promote a normal circadian rhythm and reduce evening agitation. - Reduce environmental stimulation in the evening — dim lighting (but not darkness), low noise, calm routine — beginning at late afternoon. - Administer low-dose antipsychotics only if prescribed, for dangerous agitation; avoid benzodiazepines as they worsen confusion. - Implement fall prevention: padded side rails, low bed position, non-slip footwear, call light within reach. - Maintain secured, alarmed doors to prevent nocturnal wandering. Nursing Diagnosis 2 (Nutrition): Imbalanced Nutrition: Less than Body Requirements related to cognitive inability to recognize hunger and initiate eating as evidenced by poor oral intake and weight loss. Interventions (1 mark): - Offer small, frequent, nutritious meals in a calm, distraction-free setting; present one food item at a time. - Use finger foods or adaptive utensils to promote self-feeding and preserve dignity. - Assess for dysphagia (swallowing difficulty), which is common in advancing Alzheimer's; position upright at 90 degrees during meals; refer to speech therapy if needed. - Monitor daily weight and fluid intake; document and report progressive weight loss or dehydration to the physician. - Provide favorite foods and ensure adequate oral hygiene to maximize appetite. Nursing Diagnosis 3 (Communication and Behavior): Impaired Verbal Communication related to progressive aphasia as evidenced by word-finding difficulty and decreased verbal output. Interventions (1 mark): - Speak slowly in short, simple sentences; ask only one question or give one instruction at a time. - Allow adequate time for the patient to respond; never finish sentences or pressure the patient. - Use validation therapy as the disease advances — acknowledge feelings rather than repeatedly correcting confusion (e.g., if the patient says he is waiting for his deceased mother, do not correct; instead say 'You are thinking of your mother; tell me about her'). - Use non-verbal communication: calm tone, eye contact, gentle touch, facial expression. Nursing Diagnosis 4 (Caregiver Support): Caregiver Role Strain related to prolonged caregiving for a family member with Alzheimer's disease as evidenced by expressed family exhaustion. Interventions (1 mark): - Provide empathic counseling and normalize the caregiver's feelings of grief, frustration, and fatigue. - Educate the family about the progressive nature of Alzheimer's, what to expect, and when to seek help. - Connect the family with available community resources: Alzheimer's Disease Association Philippines, DSWD respite care programs, barangay health center support, and occupational therapy services. - Encourage caregiver self-care and rest; discuss respite care options (temporary residential or day-care programs). - Screen for caregiver depression and refer for professional counseling if indicated. Evaluation: The nurse evaluates whether: sundowning episodes decrease in frequency and severity; oral intake and weight stabilize; communication interactions remain positive and dignified; and caregiver reports reduced strain and increased coping capacity.

Question Type

long_answer

Answer Structure

• Priority assessment using Maslow's hierarchy — identifies three problems in order of priority [1 mark]
• Sundowning/safety interventions — specific, environmental, behavioral, and pharmacologic strategies [1 mark]
• Nutrition interventions — specific feeding strategies, dysphagia assessment, monitoring [1 mark]
• Communication/behavioral interventions — validation therapy, simple language, non-verbal strategies [1 mark]
• Caregiver support — empathy, education, community resources, respite, RA 9173 professional role [1 mark]

Scoring Breakdown

Common Mark Deductions

• Addressing only one or two of the three presenting problems — loses marks for each omitted problem
• Stating 'reorient the patient' as the communication strategy for advanced Alzheimer's — validation, not repeated reorientation, is evidence-based in moderate-to-severe disease
• Omitting caregiver support entirely — this is explicitly stated in the question and worth a full mark
• Writing generic nursing care without linking interventions to the specific problems presented (sundowning, poor intake, caregiver exhaustion)

Key Phrases To Include

• Maslow's hierarchy
• sundowning
• circadian rhythm
• fall prevention
• validation therapy
• dysphagia
• finger foods
• caregiver role strain
• respite care
• DSWD
• NANDA nursing diagnosis
• simple sentences
• one instruction at a time

Marks

1

Topic

ASD vs. Intellectual Disability — Differentiation

Difficulty

medium

Template Id

T15

Examiner Tip

This distinction is frequently tested because students confuse the two. The key: IQ level does NOT define ASD. ASD is about social-communication impairment + repetitive behavior. A person with ASD can have high intelligence. A person with intellectual disability may have warm social skills without repetitive behavior.

Model Answer

The defining characteristic that differentiates Autism Spectrum Disorder (ASD) from Intellectual Disability is the presence — in ASD — of persistent, marked deficits in social communication and social interaction, combined with restricted, repetitive patterns of behavior. Intellectual disability is defined by deficits in intellectual and adaptive functioning but does NOT require the social-communication and repetitive behavior criteria that define ASD. (Note: the two conditions can co-occur.)

Question Type

very_short_answer

Answer Structure

• State the defining feature of ASD (social-communication deficits + repetitive behavior) that is NOT present by definition in intellectual disability alone [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating that ASD involves lower intelligence — many individuals with ASD have average or above-average IQ; this is a common misconception
• Saying that intellectual disability is caused by brain damage and ASD is not — etiology is not the distinguishing diagnostic criterion

Key Phrases To Include

• social communication deficits
• restricted repetitive behavior
• not required for intellectual disability
• diagnostic criteria