# Situation: A 76-year-old retired teacher is brought to the medical ward by her daughter because of 2 days of confusion. Before this she lived independently and managed her own money. The nurse assesses her cognition as part of the mental status examination (MSE). Per unit protocol, a date off by more than 1 day is scored as incorrect. Findings: Where she is: names the hospital correctly Today's date: gives a date 3 days earlier Person: recognizes her daughter by name Three words after 5 minutes: recalls none Her wedding day: describes it in accurate detail, confirmed by her daughter Which interpretation is accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630087  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 76-year-old retired teacher is brought to the medical ward by her daughter because of 2 days of confusion. Before this she lived independently and managed her own money. The nurse assesses her cognition as part of the mental status examination (MSE).

Per unit protocol, a date off by more than 1 day is scored as incorrect. Findings:
Where she is: names the hospital correctly
Today's date: gives a date 3 days earlier
Person: recognizes her daughter by name
Three words after 5 minutes: recalls none
Her wedding day: describes it in accurate detail, confirmed by her daughter
Which interpretation is accurate?

## 보기

1. Disoriented to place; remote memory impaired, recent memory intact
2. Disoriented to time and place; recent and remote memory impaired
3. Disoriented to time; recent memory impaired, remote memory intact **✔ 정답**
4. Oriented in all spheres; recent memory impaired, remote memory intact

**정답: 3**

## 해설

She knows place and person but misses the date by more than the allowed 1 day, so she is disoriented to time only. Failing delayed recall of three words shows impaired recent memory, while an accurate, confirmed account of her wedding shows intact remote memory.

## 심화 해설

Orientation and memory in the mental status examination

The patient correctly identifies the hospital and recognizes her daughter by name, so orientation to place and person is intact. However, she gives a date that is 3 days earlier than the actual date. Because the unit protocol allows an error of no more than 1 day, this response is scored as incorrect. She is therefore disoriented to time only.

Memory is assessed in two distinct time frames. Recent memory refers to the ability to register and retain new information over a short interval, typically minutes to days. In this case, the patient is asked to repeat three words and then recall them after 5 minutes. She recalls none of the words, which indicates impaired recent memory. This finding is clinically meaningful because recent memory depends on intact encoding and consolidation functions involving the hippocampus and related medial temporal lobe structures. A failure of delayed recall after distraction suggests that new information is not being effectively stored or retrieved.

Remote memory refers to recall of well-established, long-consolidated information such as personal history, education, or major life events. The patient describes her wedding day in accurate detail, and her daughter confirms the account. This demonstrates intact remote memory. Remote memories are distributed across cortical networks and are generally more resistant to early cognitive decline than recent memory.

The pattern of impaired recent memory with preserved remote memory is characteristic of early cognitive impairment, including early Alzheimer-type dementia, and reflects the vulnerability of medial temporal lobe structures before widespread cortical involvement occurs.

Watch out! Disorientation to time is often the earliest orientation domain to fail. A patient may remain fully oriented to place and person while losing track of the date, day of week, or season. Do not assume global disorientation based on time errors alone.

Key point! Recent memory is tested by delayed recall of newly learned words or events, while remote memory is tested by asking about well-known personal or historical facts. The distinction matters because recent memory impairment appears earlier in most dementing illnesses.

| Domain | Finding | Interpretation |
| --- | --- | --- |
| Orientation to place | Names the hospital correctly | Intact |
| Orientation to time | Date off by 3 days (allowed error: 1 day) | Impaired |
| Orientation to person | Recognizes daughter by name | Intact |
| Recent memory | Recalls none of 3 words after 5 minutes | Impaired |
| Remote memory | Accurate, confirmed account of wedding day | Intact |

In the broader clinical picture, brief cognitive screening tools such as the MMSE are frequently used to estimate global cognition, but they do not directly measure functional safety in real-world tasks. A low score on a cognitive screen does not by itself confirm that a patient cannot perform critical everyday activities, yet it should prompt a closer look at executive function and safety-related judgment. The cited study examined the relationship between MMSE performance and emergency-response ability using a performance-based measure, noting that even mild impairment can be associated with failure to relay critical information or take appropriate action during an emergency. This reinforces the nursing responsibility to assess not only orientation and memory but also the patient's capacity to function safely in the home environment, especially when recent memory deficits are present.

For nursing licensure examinations, the key distinction is that orientation is assessed in three spheres (time, place, person) and memory in two time frames (recent, remote). A patient who knows where she is and who others are, but misses the date beyond the allowed error, is disoriented to time only. A patient who cannot recall newly presented words after a delay has impaired recent memory. A patient who accurately recalls long-standing personal history has intact remote memory. These are separate judgments, and the correct interpretation combines them without overgeneralizing.

## 임상 시나리오

MSE: Orientation vs. Memory in Acute ConfusionTime disorientation with recent memory loss in an older adult
In an older adult with acute confusion, assess orientation to time, place, and person separately. A date error greater than 1 day by unit protocol is scored as disoriented to time, even if the patient knows the hospital and family members.

Recent memory is tested by delayed recall of three words after 5 minutes. Recalling none suggests impaired encoding or consolidation, often involving hippocampal function. Remote memory is tested by asking about well-established life events, such as a wedding date; accurate, family-confirmed recall indicates intact remote memory.

CautionThe pattern of impaired recent memory with intact remote memory and time disorientation is common in delirium and early dementia. Always compare findings to the patient's baseline and look for an underlying medical cause in acute confusion.

## 핵심 개념

- **Orientation** — Awareness of time, place, and person; assessed by asking date, location, and identity.
- **Recent memory** — Ability to register and recall new information over minutes to days; tested by delayed recall of words.
- **Remote memory** — Recall of long-consolidated personal or historical information; tested by asking about life events.
- **Mental status examination** — Structured assessment of cognition, including orientation, memory, attention, and language.
- **Delayed recall** — Remembering information after a distraction interval, typically 5 minutes.

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