Gerontological Nursing Certification Exam — Questions and Answers

Question 1: A patient using a standard walker for ambulation is at increased fall risk if they:

Lift and advance the walker before stepping
Use the walker as a support when rising from a chair (Correct answer)
Hold the walker with both hands at all times
Wear non-slip footwear while ambulating

Correct answer: Use the walker as a support when rising from a chair

Using a walker as a support to push up from a seated position is dangerous because walkers can tip or roll forward, causing the patient to fall; chairs with armrests should be used for rising.

Question 2: An older adult patient with chronic kidney disease requires pain management. Which opioid analgesic is considered SAFEST in this population?

Codeine
Meperidine
Morphine
Hydromorphone (low dose) (Correct answer)

Correct answer: Hydromorphone (low dose)

Hydromorphone at low doses is preferred in renal impairment because its active metabolites accumulate less than those of morphine; meperidine and codeine are contraindicated due to toxic metabolite accumulation.

Question 3: An older adult patient with terminal cancer rates their pain as 8/10. The nurse administers the ordered PRN morphine. This action reflects which principle of palliative care?

Hastening death to relieve suffering
Autonomy in decision-making
Limiting opioid use due to addiction risk in older adults
Aggressive symptom management to promote comfort (Correct answer)

Correct answer: Aggressive symptom management to promote comfort

In palliative care, effective and timely symptom management—including adequate analgesia—is a core ethical obligation to maintain patient comfort and dignity.

Question 4: The nurse notes that a dying patient's respirations have become irregular with periods of apnea. The nurse recognizes this pattern as:

Cheyne-Stokes respirations, a normal end-of-life change (Correct answer)
Kussmaul respirations indicating metabolic acidosis
Biot's respirations indicating neurological emergency
Tachypnea requiring immediate oxygen therapy

Correct answer: Cheyne-Stokes respirations, a normal end-of-life change

Cheyne-Stokes respirations—cyclic periods of increasing then decreasing breathing depth with apneic episodes—are a normal physiologic sign of imminent death as brain stem regulation declines.

Question 5: A nurse notes that a patient with dementia has been refusing meals for 3 days. The most therapeutic initial nursing action is to:

Explore potential causes such as pain, medication side effects, or depression (Correct answer)
Restrict fluids to stimulate appetite
Document the refusal and reassess in one week
Insert a nasogastric tube for enteral nutrition immediately

Correct answer: Explore potential causes such as pain, medication side effects, or depression

Identifying and addressing reversible underlying causes of decreased appetite—such as oral pain, constipation, or depression—is the priority before escalating to invasive interventions.

Question 6: Which type of exercise has the strongest evidence for reducing fall risk in community-dwelling older adults?

Stretching and flexibility exercises alone
Balance and strength training exercises such as Tai Chi (Correct answer)
Aerobic exercise only
Swimming and water aerobics exclusively

Correct answer: Balance and strength training exercises such as Tai Chi

Tai Chi and other balance and strength training programs have robust evidence for reducing fall frequency and improving postural stability in older adults.

Question 7: Lewy body dementia is distinguished from Alzheimer's disease by the presence of which hallmark feature?

Recurrent vivid visual hallucinations (Correct answer)
Memory loss as the first symptom
Aphasia occurring early in the disease
Rapid onset over days to weeks

Correct answer: Recurrent vivid visual hallucinations

Recurrent, well-formed visual hallucinations are a core diagnostic feature of Lewy body dementia and are not typically prominent early in Alzheimer's disease.

Question 8: A patient with osteoporosis suffers a vertebral compression fracture. The nurse expects which symptom as a primary complaint?

Gradual leg weakness over several weeks
Sudden acute back pain with height loss (Correct answer)
Bilateral hip pain aggravated by weight bearing
Fever and localized spinal tenderness

Correct answer: Sudden acute back pain with height loss

Vertebral compression fractures typically present with sudden acute back pain, and the cumulative effect of multiple fractures leads to progressive loss of height and kyphosis.

Question 9: A gerontological nurse advocates for a patient with terminal illness by ensuring their expressed wishes regarding life-sustaining treatment are documented and honored. This reflects which ethical principle?

Beneficence
Non-maleficence
Autonomy (Correct answer)
Justice

Correct answer: Autonomy

Respecting and upholding a patient's self-determined wishes regarding their own medical care directly reflects the ethical principle of autonomy.

Question 10: Which feature best distinguishes delirium from dementia in an older adult?

Memory impairment
Acute onset with fluctuating course (Correct answer)
Personality changes
Language difficulties

Correct answer: Acute onset with fluctuating course

Delirium is characterized by acute onset and a fluctuating level of consciousness, whereas dementia typically has a gradual, progressive onset without acute fluctuation.

Question 11: Which laboratory value is the most reliable indicator of renal function for dosing medications in older adults?

24-hour urine protein
Blood urea nitrogen (BUN)
Creatinine clearance calculated using the Cockcroft-Gault equation (Correct answer)
Serum creatinine alone

Correct answer: Creatinine clearance calculated using the Cockcroft-Gault equation

Serum creatinine alone overestimates renal function in older adults due to decreased muscle mass; the Cockcroft-Gault equation provides a more accurate creatinine clearance estimate.

Question 12: A nurse notices an older adult patient is taking both warfarin and aspirin. The priority nursing action is to:

Administer a vitamin K supplement immediately
Administer both medications as prescribed without concern
Monitor for signs of bleeding and notify the provider of the potential interaction (Correct answer)
Hold warfarin until aspirin therapy is complete

Correct answer: Monitor for signs of bleeding and notify the provider of the potential interaction

Combining warfarin and aspirin significantly increases bleeding risk; the nurse must monitor for bleeding signs and communicate this high-risk interaction to the prescriber.

Question 13: An older adult states, 'I don't want any heroic measures done when I die.' The nurse's most appropriate action is to:

Document the statement as a formal DNR order
Encourage the patient to discuss their wishes with their physician and complete a formal advance directive (Correct answer)
Assure the patient that the nursing staff will honor their wishes informally
Notify the family of the patient's wishes without involving the physician

Correct answer: Encourage the patient to discuss their wishes with their physician and complete a formal advance directive

Informal verbal statements do not constitute a legally binding order; the nurse should facilitate a formal advance directive discussion with the physician to ensure the patient's wishes are legally documented.

Question 14: Sarcopenia in older adults is best described as:

Inflammation of the sarcomeres in cardiac muscle
Increased fat mass with decreased bone density
Excessive protein accumulation in muscle tissue
Progressive loss of skeletal muscle mass and strength with aging (Correct answer)

Correct answer: Progressive loss of skeletal muscle mass and strength with aging

Sarcopenia is the progressive, age-related loss of skeletal muscle mass and strength that contributes to functional decline, increased fall risk, and malnutrition.

Question 15: A gerontological nurse is reviewing an older adult's medications and notes decreased serum albumin. What is the primary clinical concern?

Reduced drug absorption from the GI tract
Decreased drug distribution to target tissues
Slower onset of drug action
Increased free (unbound) drug concentration leading to toxicity (Correct answer)

Correct answer: Increased free (unbound) drug concentration leading to toxicity

Low serum albumin means fewer protein-binding sites, so more free drug circulates in the bloodstream, increasing the risk of adverse effects and toxicity.

Question 16: An older adult patient with Parkinson's disease is at increased risk for aspiration pneumonia primarily due to:

Decreased appetite leading to malnutrition
Immunosuppressive medications used to treat Parkinson's
Increased gastric acid production
Reduced cough reflex and dysphagia from motor dysfunction (Correct answer)

Correct answer: Reduced cough reflex and dysphagia from motor dysfunction

Parkinson's disease causes progressive motor dysfunction affecting swallowing muscles and reduces the protective cough reflex, making aspiration of food, liquid, or saliva common.

Question 17: If a gerontological nurse neglects to notify a doctor of a significant change in a patient's status, this is referred to as:

Criminal negligence
Malfeasance
Misfeasance
Nonfeasance (Correct answer)

Correct answer: Nonfeasance

Nonfeasance, or failing to act appropriately, is the term used to describe this kind of negligence. Malfeasance is the practice of an act that is not within the bounds of one's profession, such as a procedure that is not permitted for a nurse. Misfeasance is the inappropriate performance of an action. Criminal negligence is any behavior that disregards the patient's health or safety.

Question 18: Reminiscence therapy is used with older adults with dementia because it:

Promotes well-being by engaging intact long-term memories and sense of identity (Correct answer)
Restores long-term memory to its previous capacity
Helps patients relearn forgotten procedural skills
Evaluates the progression of cognitive decline over time

Correct answer: Promotes well-being by engaging intact long-term memories and sense of identity

Reminiscence therapy leverages the relative preservation of long-term autobiographical memory in dementia patients to enhance self-esteem, social engagement, and emotional well-being.

Question 19: A family member asks the nurse why their dying parent is no longer accepting food or water. The most accurate and therapeutic response is:

'Decreased intake is a natural part of the dying process and does not cause suffering.' (Correct answer)
'Your parent is giving up on life and we must encourage them to eat.'
'We need to start IV fluids immediately to prevent dehydration.'
'This is a sign that death is weeks away and you should prepare.'

Correct answer: 'Decreased intake is a natural part of the dying process and does not cause suffering.'

Decreased appetite and fluid intake in the active dying phase are normal physiologic changes; the body no longer needs nutrition and forced feeding can increase discomfort.

Question 20: An 80-year-old patient develops acute confusion, agitation, and disorganized thinking 48 hours after hip replacement surgery. What condition does the nurse FIRST suspect?

Sundowning syndrome
Acute psychosis
New-onset dementia
Postoperative delirium (Correct answer)

Correct answer: Postoperative delirium

The acute onset, fluctuating course, and temporal relationship to surgery are classic features of postoperative delirium, which is distinct from dementia (gradual onset) and sundowning (occurs at a specific time of day).

Question 21: A gerontological nurse is assessing a 78-year-old patient for dehydration. Which clinical finding is MOST reliable in older adults?

Orthostatic hypotension (Correct answer)
Absence of thirst sensation
Skin turgor on the forearm
Dry mucous membranes

Correct answer: Orthostatic hypotension

Orthostatic hypotension (a drop in systolic BP ≥20 mmHg or diastolic ≥10 mmHg upon standing) is a reliable indicator of dehydration in older adults; skin turgor and thirst are less reliable due to age-related changes.

Question 22: Which non-pharmacological intervention can help manage dyspnea (breathlessness) in a dying patient?

Placing the patient in a supine position to maximize comfort
Restricting visitors to reduce oxygen demand in the room
Positioning a small fan to direct airflow across the patient's face (Correct answer)
Encouraging deep breathing exercises

Correct answer: Positioning a small fan to direct airflow across the patient's face

Cool airflow across the face from a small fan stimulates the trigeminal nerve and facial cold receptors, reducing the sensation of breathlessness even without changing actual oxygen levels.

Question 23: Which of the following is a hallmark distinction between delirium and dementia?

Delirium is irreversible; dementia may be reversible
Dementia always causes visual hallucinations; delirium does not
Delirium has a gradual onset; dementia is acute
Delirium involves fluctuating consciousness; dementia typically does not (Correct answer)

Correct answer: Delirium involves fluctuating consciousness; dementia typically does not

Delirium is characterized by acute onset and fluctuating levels of consciousness and attention, while dementia typically develops gradually without disturbances in consciousness.

Question 24: Which non-pharmacological intervention is most appropriate for managing agitation in a patient with moderate dementia?

Restraint application to prevent injury
Consistent routine, familiar music, and a calm environment (Correct answer)
Increasing stimulation with bright lighting and television
Encouraging the patient to recall distressing events to process emotions

Correct answer: Consistent routine, familiar music, and a calm environment

Consistent routines, familiar sensory stimuli like music, and a calm low-stimulation environment are evidence-based non-pharmacological interventions for dementia-related agitation.

Question 25: A nurse is educating an older adult with hypertension on dietary modifications. The DASH diet primarily recommends:

High-protein diet with no sodium restrictions
Elimination of all fats and dairy products
High fat intake with restricted carbohydrates
Increased fruits, vegetables, low-fat dairy, and reduced sodium (Correct answer)

Correct answer: Increased fruits, vegetables, low-fat dairy, and reduced sodium

The DASH (Dietary Approaches to Stop Hypertension) diet emphasizes fruits, vegetables, low-fat dairy, whole grains, lean proteins, and reduced sodium to lower blood pressure.

Question 26: Which statement best describes the physiological basis for thermoregulatory dysfunction in older adults?

Enhanced sweating mechanisms increase heat dissipation efficiency
Peripheral vasodilation is more pronounced in older adults during cold exposure
Older adults produce more heat due to increased basal metabolic rate
Reduced subcutaneous fat and impaired shivering decrease cold tolerance (Correct answer)

Correct answer: Reduced subcutaneous fat and impaired shivering decrease cold tolerance

Aging reduces subcutaneous fat insulation, impairs shivering thermogenesis, and decreases peripheral vasoconstriction, making older adults vulnerable to both hypothermia and hyperthermia.

Question 27: Which medication class listed in the Beers Criteria is most associated with causing falls in older adults?

Statins
Benzodiazepines (Correct answer)
ACE inhibitors
Beta-blockers

Correct answer: Benzodiazepines

Benzodiazepines cause sedation, cognitive impairment, and impaired balance in older adults, significantly increasing fall risk.

Question 28: The gerontological nurse should do the following if she sees a certified nursing assistant (CNA) she has assigned personal care to massaging the immobile patient's inflamed heels:

Take no action, as this is part of routine care.
File a complaint about the CNA’s lack of competence.
Compliment the CNA for providing good preventive care.
Explain how massaging reddened tissue may cause tissue damage. (Correct answer)

Correct answer: Explain how massaging reddened tissue may cause tissue damage.

The best course of action is to explain to the CNA how stroking inflamed tissue may result in tissue injury. The gerontological nurse should take advantage of this chance to inform the CNA about evidence-based skin care recommendations and to advise her on pressure relief techniques, such as the use of heel protectors, posture, and regular turning. Massage was once a popular practice.

Question 29: A patient taking metformin for type 2 diabetes is admitted with acute kidney injury. The nurse's priority action regarding metformin is to:

Switch to a sliding scale insulin regimen without notifying the provider
Increase the dose to compensate for altered glucose metabolism during illness
Continue the medication as prescribed to maintain glucose control
Hold metformin and notify the provider due to risk of lactic acidosis (Correct answer)

Correct answer: Hold metformin and notify the provider due to risk of lactic acidosis

Metformin is contraindicated in significant renal impairment because decreased excretion causes drug accumulation and life-threatening lactic acidosis.

Question 30: Which age-related change increases the volume of distribution for fat-soluble drugs in older adults?

Reduced gastric pH
Increased hepatic enzyme activity
Increased proportion of body fat relative to lean muscle mass (Correct answer)
Decreased total body water

Correct answer: Increased proportion of body fat relative to lean muscle mass

Because older adults have a higher ratio of body fat to lean mass, fat-soluble drugs distribute more widely, prolonging their duration of action.

Question 31: Which age-related change in the older adult contributes most to increased risk for hypoglycemia when using insulin or sulfonylureas?

Enhanced hepatic glucose production
Increased renal threshold for glucose
Increased glucagon response to hypoglycemia
Impaired hypoglycemic awareness and diminished counterregulatory hormone response (Correct answer)

Correct answer: Impaired hypoglycemic awareness and diminished counterregulatory hormone response

Older adults often have blunted awareness of hypoglycemic symptoms and a diminished counterregulatory hormone response, making hypoglycemia both more likely and harder to detect.

Question 32: Which medication class most commonly causes xerostomia (dry mouth) that contributes to nutritional problems in older adults?

ACE inhibitors
Statins
Anticholinergic medications (Correct answer)
Beta-blockers

Correct answer: Anticholinergic medications

Anticholinergic medications reduce parasympathetic stimulation of salivary glands, causing dry mouth that impairs chewing, swallowing, and appetite.

Question 33: Which clinical findings are most characteristic of zinc deficiency in older adults?

Impaired wound healing and altered taste (Correct answer)
Peripheral neuropathy and ataxia
Hypoglycemia and fatigue
Hypertension and edema

Correct answer: Impaired wound healing and altered taste

Zinc deficiency characteristically causes impaired wound healing, dysgeusia (altered taste), and decreased immune function, all of which are clinically significant in older adults.

Question 34: The official relationship between the newly certified gerontological nurse and the preceptor has ended, but the nurse found the three months of preceptorship to be very helpful. The gerontological nurse believes that occasionally there may be nursing care areas for which guidance would be beneficial. The best course of action is probably:

Ask that the preceptorship be continued.
Request a mentor. (Correct answer)
Notify administration of concerns.
Continue without assistance.

Correct answer: Request a mentor.

Preceptoring is more formal than mentoring, which entails a continuing relationship the nurse can utilize to talk about problems or concerns. Meetings often occur once a week, which is less frequently than preceptoring.

Question 35: What is the recommended daily protein intake for healthy older adults?

2.5–3.0 g/kg body weight
0.4–0.5 g/kg body weight
0.8–1.2 g/kg body weight (Correct answer)
1.5–2.0 g/kg body weight

Correct answer: 0.8–1.2 g/kg body weight

Current evidence supports 0.8–1.2 g/kg/day for healthy older adults, which is at or slightly above the standard adult RDA to preserve muscle mass.

Question 36: After a patient fall in a hospital, which nursing action takes the highest priority?

Notify the patient's family immediately
Assess the patient for injuries (Correct answer)
Reposition the patient to bed
Complete the incident report

Correct answer: Assess the patient for injuries

The immediate priority after any fall is assessing the patient for injuries, including head injury, fractures, and bleeding, before moving them or completing administrative tasks.

Question 37: Which intervention is the highest priority in preventing pressure injuries in an older adult with limited mobility due to severe osteoarthritis?

Repositioning the patient at least every 2 hours (Correct answer)
Using a heel lift to elevate the feet above bed level
Applying moisture barrier creams to bony prominences
Providing a high-protein diet to support wound healing

Correct answer: Repositioning the patient at least every 2 hours

Regular repositioning every two hours relieves sustained pressure over bony prominences, which is the primary mechanism of pressure injury development, making it the highest-priority prevention intervention.

Question 38: Hip protector pads are a secondary fall prevention strategy designed to:

Improve balance and proprioception
Prevent falls from occurring
Reduce the risk of hip fracture if a fall does occur (Correct answer)
Alert staff when a patient attempts to ambulate

Correct answer: Reduce the risk of hip fracture if a fall does occur

Hip protectors are secondary prevention devices that absorb or deflect impact forces during a fall, reducing hip fracture risk without preventing the fall itself.

Question 39: Which intervention is MOST effective in preventing pressure injuries in an immobile older adult patient?

Using a standard hospital mattress with heel protectors only
Applying barrier cream every shift
Turning and repositioning every 2 hours (Correct answer)
Massaging bony prominences to increase circulation

Correct answer: Turning and repositioning every 2 hours

Repositioning every 2 hours relieves sustained pressure on bony prominences, which is the primary cause of pressure injuries; massaging bony prominences is actually contraindicated.

Question 40: Validation therapy, developed by Naomi Feil, is primarily used to:

Teach cognitive strategies to slow memory decline
Assess the stage and severity of dementia progression
Reorient patients with dementia to current time and place
Acknowledge and communicate with patients in their own reality (Correct answer)

Correct answer: Acknowledge and communicate with patients in their own reality

Validation therapy focuses on empathetically acknowledging the feelings and subjective reality of a person with dementia rather than correcting or reorienting them.

Question 41: Which complication of heart failure is most commonly assessed in older adults by monitoring daily weight?

Hypertensive crisis
Fluid retention and early decompensation (Correct answer)
Reduced ejection fraction progression
Cardiac arrhythmias

Correct answer: Fluid retention and early decompensation

Daily weight monitoring detects early fluid accumulation in heart failure; a weight gain of 2–3 pounds in 24 hours or 5 pounds in a week typically signals fluid retention and worsening heart failure.

Question 42: An older adult with rheumatoid arthritis has been on methotrexate therapy for several years. Which laboratory test should be routinely monitored?

Serum calcium and vitamin D levels
Coagulation studies (PT/INR)
Complete blood count (CBC) and liver function tests (Correct answer)
Thyroid function tests

Correct answer: Complete blood count (CBC) and liver function tests

Methotrexate can cause bone marrow suppression and hepatotoxicity; regular CBC and liver function tests are essential safety monitoring requirements for patients on long-term therapy.

Question 43: A nurse is reviewing the care plan for an older adult with both heart failure and CKD. The nurse recognizes that diuretic therapy in this patient requires monitoring for:

Hypernatremia and fluid overload
Electrolyte imbalances, particularly hypokalemia, and worsening renal function (Correct answer)
Increased urine specific gravity
Hypercalcemia and metabolic alkalosis

Correct answer: Electrolyte imbalances, particularly hypokalemia, and worsening renal function

Loop diuretics used in heart failure can cause hypokalemia and worsen renal perfusion in patients with CKD, requiring careful electrolyte and creatinine monitoring.

Question 44: A nurse notes that a 79-year-old patient has lost 5% of body weight unintentionally over the past month. What is the PRIORITY nursing action?

Immediately start enteral nutrition
Document the weight loss and reassess in one month
Obtain a dietary consult and assess for dysphagia and depression (Correct answer)
Recommend high-calorie supplement drinks only

Correct answer: Obtain a dietary consult and assess for dysphagia and depression

Unintentional weight loss in older adults warrants a thorough multidisciplinary assessment, including dietary evaluation, screening for dysphagia, depression, malignancy, and social factors before initiating any intervention.

Question 45: Which nursing intervention BEST supports older adults with age-related macular degeneration (AMD) during hospitalization?

Avoid written materials and rely solely on verbal instruction
Place the patient near a window with direct sunlight exposure
Dim the room lighting to reduce glare
Use large-print materials and ensure adequate room lighting (Correct answer)

Correct answer: Use large-print materials and ensure adequate room lighting

Large-print materials and adequate (but not glaring) room lighting maximize residual central vision for patients with AMD, supporting safety and comprehension during hospitalization.

Question 46: The unit is so noisy during the day, and the patient complains to the gerontological nurse that she is frequently awakened during the night for treatments. Which of the following best exemplifies a team effort to meet the patient's needs?

“We can provide you with a sedative at night to help you sleep better.”
“Let’s talk about ways to allow you to get more rest.” (Correct answer)
“I understand your concerns, but there is little that can be done.”
“I’ll talk about this with staff members.”

Correct answer: “Let’s talk about ways to allow you to get more rest.”

The most collaborative response is one that includes ""you"": ""Let's talk about ways to allow you to get more rest."" The patient has a valid worry and should be encouraged to contribute rather than the nurse merely expressing a solution or lack of solution. Sometimes, rearranging the schedule for drugs or treatments can help to solve the problem. Even if there isn't a true remedy, talking with the patient about the problem can at least make her feel like her concerns are taken seriously.

Question 47: In older adults with type 2 diabetes, which HbA1c target is generally recommended to reduce hypoglycemia risk while maintaining glycemic control?

Below 6.5%
7.0–8.0% for older adults with multiple comorbidities (Correct answer)
Below 7.0%
Below 9.0% for all older adults

Correct answer: 7.0–8.0% for older adults with multiple comorbidities

The American Geriatrics Society recommends a target HbA1c of 7.0–8.0% for older adults with multiple comorbidities, prioritizing hypoglycemia prevention over tight glycemic control.

Question 48: Which electrolyte imbalance is the hallmark finding of refeeding syndrome in a severely malnourished older adult?

Hyperkalemia
Hypophosphatemia (Correct answer)
Hypernatremia
Hypercalcemia

Correct answer: Hypophosphatemia

Hypophosphatemia is the hallmark of refeeding syndrome because insulin released during carbohydrate refeeding drives phosphate into cells, causing a dangerous drop in serum phosphate levels.

Question 49: The nurse understands that providing adequate opioid analgesia to a dying patient may secondarily hasten death. This ethical concept is known as:

The principle of double effect (Correct answer)
Physician-assisted suicide
Active euthanasia
Beneficent deception

Correct answer: The principle of double effect

The doctrine of double effect justifies an action with a good intended outcome (pain relief) even if a foreseeable but unintended secondary effect (hastened death) may result.

Question 50: Which vitamin deficiency is most commonly associated with macrocytic anemia and peripheral neuropathy in older adults?

Vitamin K
Vitamin A
Vitamin B12 (Correct answer)
Vitamin C

Correct answer: Vitamin B12

Vitamin B12 deficiency is common in older adults due to reduced gastric acid and intrinsic factor production, causing macrocytic anemia and neurological symptoms including peripheral neuropathy.

Question 51: A nurse is implementing universal fall precautions for all hospitalized older adults. Which intervention is a component of universal fall precautions?

Limiting all ambulation to physical therapy sessions only
Applying bilateral wrist restraints at night
Ensuring call lights are within reach and beds are in the lowest position (Correct answer)
Requiring one-to-one observation for all older adults

Correct answer: Ensuring call lights are within reach and beds are in the lowest position

Universal fall precautions include keeping beds in the lowest position, call lights within reach, non-slip footwear provided, and bed brakes locked—applied to all patients regardless of assessed risk level.

Question 52: Which of the following best describes 'presbycusis' as it relates to gerontological nursing?

Age-related decline in near vision
Age-related sensorineural hearing loss affecting high frequencies (Correct answer)
Increased cerumen production causing conductive hearing loss
Loss of taste and smell associated with aging

Correct answer: Age-related sensorineural hearing loss affecting high frequencies

Presbycusis is the gradual, bilateral, symmetrical sensorineural hearing loss associated with aging, primarily affecting high-frequency sounds.

Question 53: Which pharmacological intervention is most commonly used to manage the death rattle (noisy breathing) in the final hours of life?

Glycopyrrolate (Robinul) or hyoscine (scopolamine) (Correct answer)
Nebulized albuterol
High-dose diuretics
Oral antihistamines

Correct answer: Glycopyrrolate (Robinul) or hyoscine (scopolamine)

Anticholinergic agents such as glycopyrrolate or scopolamine reduce secretions causing the death rattle, improving comfort for the patient and reducing distress for families present.

Question 54: The nurse is performing a medication reconciliation for a newly admitted older adult. Which finding is most concerning and requires immediate provider notification?

Patient takes a statin at bedtime
Patient takes both a tricyclic antidepressant and an SSRI (Correct answer)
Patient takes calcium with vitamin D
Patient takes a daily multivitamin

Correct answer: Patient takes both a tricyclic antidepressant and an SSRI

Combining a tricyclic antidepressant with an SSRI increases the risk of serotonin syndrome and significant anticholinergic burden, requiring urgent provider review.

Question 55: Which complication of long-term corticosteroid use in older adults requires routine bone health monitoring and preventive treatment?

Hypokalemia-induced cardiac arrhythmias
Peripheral neuropathy
Renal tubular acidosis
Glucocorticoid-induced osteoporosis and fracture risk (Correct answer)

Correct answer: Glucocorticoid-induced osteoporosis and fracture risk

Long-term corticosteroid use suppresses osteoblast activity and accelerates bone resorption, placing older adults at high risk for glucocorticoid-induced osteoporosis and fragility fractures.

Question 56: An older adult reports a fear of falling that has caused them to restrict their activities. The nurse recognizes this as:

Appropriate and adaptive caution that should be encouraged
Post-fall syndrome, which can lead to deconditioning and increased fall risk (Correct answer)
A normal part of aging that requires no intervention
Anxiety disorder requiring psychiatric evaluation

Correct answer: Post-fall syndrome, which can lead to deconditioning and increased fall risk

Fear of falling leading to activity restriction creates a vicious cycle of deconditioning, muscle weakness, and balance deterioration that paradoxically increases fall risk.

Question 57: A nurse is caring for a patient with vascular dementia. Which risk factor most directly contributes to the development of this type of dementia?

Frontotemporal lobe atrophy
Cerebrovascular disease and multiple small strokes (Correct answer)
Lewy body protein deposits in neurons
Accumulation of amyloid plaques

Correct answer: Cerebrovascular disease and multiple small strokes

Vascular dementia results from cerebrovascular disease, where reduced blood flow to the brain due to small strokes or ischemia causes progressive cognitive decline.

Question 58: Which assessment finding would MOST likely indicate elder mistreatment and require mandatory reporting by the nurse?

An 83-year-old who is incontinent of urine
An 80-year-old with multiple bruises in various stages of healing on the trunk (Correct answer)
A 75-year-old who refuses to take blood pressure medications
An elderly patient with poor dentition and gum disease

Correct answer: An 80-year-old with multiple bruises in various stages of healing on the trunk

Multiple bruises in various stages of healing on the trunk are a red flag for physical abuse, as accidental bruising in ambulatory older adults typically occurs on the extremities, not the trunk.

Question 59: A cancer patient who is receiving treatment frequently makes jokes about "getting skinny," "being bald," and "dying," yet hardly ever expresses any complaints. This response most likely signifies:

fear of dying
denial
a coping mechanism (Correct answer)
sublimation

Correct answer: a coping mechanism

Some people can reduce their stress and anxiety by laughing. Individuals' coping mechanisms differ greatly, although adopting many coping mechanisms is frequently more beneficial than doing so just. A patient who cracks jokes all the time might be erecting walls that keep them from effectively managing their anxiety.

Question 60: Which nutritional deficiency is most commonly identified in older adults residing in long-term care facilities?

Vitamin D deficiency (Correct answer)
Zinc deficiency
Thiamine deficiency
Iron deficiency

Correct answer: Vitamin D deficiency

Vitamin D deficiency is extremely prevalent in institutionalized elderly due to limited sun exposure and decreased skin synthesis capacity with aging.

Question 61: An older adult with hypertension has a consistently elevated blood pressure despite adherence to antihypertensive medications. The nurse should first assess for:

White coat hypertension requiring no intervention
Secondary causes such as sleep apnea, medication interactions, or excessive sodium intake (Correct answer)
Medication-seeking behavior
The need to immediately escalate to IV antihypertensive therapy

Correct answer: Secondary causes such as sleep apnea, medication interactions, or excessive sodium intake

Resistant hypertension warrants investigation for secondary causes including obstructive sleep apnea, pain, NSAIDs or other medications that raise blood pressure, and excessive dietary sodium.

Question 62: A 76-year-old patient who takes several medications for heart disease and chronic obstructive pulmonary disease (COPD), including warfarin and theophylline, is discussing the medication list with the gerontological nurse. Which of the following OTC medications that the patient claims to regularly use is most likely to cause trouble?

Acetaminophen
Docusate sodium stool softener
Topical cortisone cream
Cimetidine (Correct answer)

Correct answer: Cimetidine

Because it binds hepatic enzymes that metabolize numerous different medicines, cimetidine poses a significant risk of drug interactions, particularly in older persons. Cimetidine may increase blood concentrations by preventing medication oxidation. It is particularly problematic with medications like warfarin and theophylline that have a limited therapeutic index. Like all H2 antagonists, cimetidine may prevent the absorption of medications that need an acidic stomach environment. The most established H2 antagonist is cimetidine, but newer medications like ranitidine have significantly less drug interactions.

Question 63: Which stage of the Global Deterioration Scale (GDS) indicates moderate Alzheimer's disease where patients require assistance with activities of daily living?

Stage 5 (Correct answer)
Stage 7
Stage 3
Stage 2

Correct answer: Stage 5

GDS Stage 5 represents moderate Alzheimer's disease; patients need assistance with ADLs such as choosing appropriate clothing but can still recall their own name.

Question 64: Which intervention is the MOST important to include in the care plan for a patient with dementia who is at high risk for wandering?

Keeping the patient in bed throughout the day
Sedating medications to prevent nighttime ambulation
Environmental modifications with door alarms and secured exits (Correct answer)
Physical restraints applied at night

Correct answer: Environmental modifications with door alarms and secured exits

Environmental safety measures such as alarmed doors, secured exits, and visual barriers are the safest evidence-based interventions to prevent elopement and injury from wandering.

Question 65: Which of the following behaviors might be seen as an infringement on a patient's privacy?

Reporting a patient’s communicable disease to the public health department
Reporting a patient’s statements regarding treatment in the electronic health record
Reporting suspicion of abuse to adult protective services
Allowing a visiting student nurse to observe a patient’s wound care (Correct answer)

Correct answer: Allowing a visiting student nurse to observe a patient’s wound care

Allowing a visiting student nurse to witness a patient's wound care is a practice that can be regarded as invading their privacy, especially if the patient didn't consent or didn't think it was appropriate to decline (leading in coercion). Patients are told about the prospect of receiving care from students at the time of admission in healthcare organizations that use student healthcare personnel (student nurses, interns, and residents).

Question 66: Which assessment finding in an older adult requires the nurse to immediately implement fall precautions beyond universal measures?

Patient has been hospitalized for fewer than 24 hours
Patient scores 45 or above on the Morse Fall Scale (Correct answer)
Patient is continent and ambulates independently
Patient reports no history of previous falls

Correct answer: Patient scores 45 or above on the Morse Fall Scale

A Morse Fall Scale score of 45 or above indicates high fall risk, triggering enhanced fall precautions such as increased monitoring, bed alarms, and closer supervision during ambulation.

Question 67: The nurse is assessing a patient suspected of having mild cognitive impairment (MCI). Which characteristic differentiates MCI from dementia?

MCI is a reversible condition in all cases
Activities of daily living are preserved in MCI despite cognitive changes (Correct answer)
MCI exclusively affects attention rather than memory
No memory complaints are present in MCI

Correct answer: Activities of daily living are preserved in MCI despite cognitive changes

In MCI, cognitive changes are measurable but functional independence in daily activities is largely preserved, distinguishing it from dementia where ADL impairment is significant.

Question 68: An older adult with a history of falls is started on a new antihypertensive. The nurse should prioritize teaching the patient to:

Restrict fluid intake to prevent blood pressure fluctuations
Measure blood pressure only when symptomatic
Rise slowly from sitting or lying positions and sit at the bedside before standing (Correct answer)
Take blood pressure medications on an empty stomach

Correct answer: Rise slowly from sitting or lying positions and sit at the bedside before standing

Antihypertensives can cause or worsen orthostatic hypotension; teaching patients to change positions slowly allows time for compensatory cardiovascular adjustments and reduces fall risk.

Question 69: Which pharmacokinetic change is most common in older adults that affects drug clearance?

Decreased hepatic blood flow and renal function (Correct answer)
Enhanced protein binding
Increased gastric acid secretion
Increased renal clearance

Correct answer: Decreased hepatic blood flow and renal function

Aging reduces hepatic blood flow and glomerular filtration rate, leading to decreased drug clearance and increased risk of toxicity.

Question 70: An aware elderly patient appears frightened and withdraws when her daughter, who is caring for her, is present. The patient has numerous bruises on her chest, back, belly, and both arms in various states of healing. When asked about the bruises, the patient claims that she "fell." The nurse should:

Report observations to administration.
Report the observations to adult protective services. (Correct answer)
Question the daughter about the bruising.
Ask the hospital social worker to speak with the patient.

Correct answer: Report the observations to adult protective services.

Although state laws may differ slightly, nurses are required to report allegations of both child and elder abuse, thus the nurse should contact adult protective services. Bruises on areas of the body hidden by clothing are indicative of abuser-inflicted injuries intended to cover up physical proof of abuse. Arm bruises are frequently protective. The nurse shouldn't approach the alleged abuser because doing so could endanger both the nurse and the patient.

Question 71: Which symptom is most common and distressing for older adults in the final days of life that requires active nursing management?

Hypertension
Pain and dyspnea (Correct answer)
Hyperglycemia
Increased appetite

Correct answer: Pain and dyspnea

Pain and dyspnea are the most prevalent and distressing symptoms at end of life, and their proactive management is a central nursing responsibility in end-of-life care.

Question 72: Which finding in an older adult with diabetes indicates peripheral neuropathy and increased risk for diabetic foot complications?

Loss of protective sensation detected by 10-gram monofilament testing (Correct answer)
Presence of microalbuminuria on urinalysis
Reduced ankle-brachial index
Elevated fasting blood glucose

Correct answer: Loss of protective sensation detected by 10-gram monofilament testing

Failure to sense a 10-gram monofilament indicates loss of protective sensation, a key finding that predicts high risk for undetected foot injuries and diabetic foot ulcers.

Question 73: The Centers for Disease Control and Prevention (CDC) STEADI initiative is a clinical tool designed to:

Certify nursing homes on fall prevention standards
Track fall-related hospitalizations at the national level
Help healthcare providers identify and address fall risk in older adult patients (Correct answer)
Train physical therapists in geriatric rehabilitation

Correct answer: Help healthcare providers identify and address fall risk in older adult patients

The CDC's STEADI (Stopping Elderly Accidents, Deaths & Injuries) toolkit provides healthcare providers with algorithms, risk screening tools, and intervention strategies for fall prevention.

Question 74: An 88-year-old resident in a long-term care facility wants to continue smoking despite having COPD. Which response by the nurse BEST reflects ethical gerontological nursing practice?

Inform the family so they can enforce cessation
Document that the resident is non-compliant and limit outdoor privileges
Acknowledge the resident's right to make autonomous decisions while discussing risks and cessation resources (Correct answer)
Confiscate all cigarettes to protect the resident's health

Correct answer: Acknowledge the resident's right to make autonomous decisions while discussing risks and cessation resources

Respecting patient autonomy means honoring competent adults' right to make decisions about their own lives, including lifestyle choices, while ensuring they have accurate information about risks and available cessation support.

Question 75: When a conflict arises between two team members and the gerontological nurse (team leader) moves one of the parties to another team, the following conflict resolution technique is used:

Suppression (Correct answer)
Negotiation
Compromise
Accommodation

Correct answer: Suppression

quarrel resolution in the form of suppression occurs when one side of a quarrel is moved to another team. The geriatric nurse is only avoiding situations where the conflict arises. This is frequently a band-aid fix for an issue that may later recur in another situation. The best way to resolve a problem is typically to come to a compromise or an agreement.

Question 76: How frequently should a 65-year-old patient still get a cervical check with Pap smear if her Papanicolaou tests (Pap smears) have consistently come back negative?

once every 2 years
twice a year
Pap smear is no longer required (Correct answer)
once a year

Correct answer: Pap smear is no longer required

A 65-year-old patient is no longer required to undergo a cervical check and Pap smear if she has previously had negative Pap tests. If the patient had a positive Pap test during the previous 20 years or any other abnormalities, she should continue to get routine Pap tests for another 20 years following the abnormal finding, even if she is older than 65. Testing is advised by the American Cancer Society every three years, while people with weakened immune systems could require more regular testing.

Question 77: The gerontological nurse made a note in the patient's plan of care that the patient has specified he does not want to be revived in the case of a life-threatening event, but she did not get a doctor's DNR order. If a distant relative is present when the patient experiences cardiac arrest, the personnel should:

Withhold resuscitation efforts.
Call the physician for guidance.
Ask the relative’s preference for resuscitation.
Carry out resuscitation efforts. (Correct answer)

Correct answer: Carry out resuscitation efforts.

Due to the fact that a DNR order must be granted by the doctor and be a part of the medical orders, the staff members should perform resuscitation procedures. When the patient didn't want resuscitation, the gerontological nurse should have gone to the doctor and demanded an order.

Question 78: An older adult with dysphagia can manage soft, moist foods cut into small pieces but cannot handle hard or crunchy textures. Which IDDSI diet level is most appropriate?

Minced and moist (Level 5) (Correct answer)
Thin liquids (Level 1)
Regular (Level 7)
Pureed (Level 4)

Correct answer: Minced and moist (Level 5)

IDDSI Level 5 (Minced and Moist) is designed for patients who require foods cut into small pieces and need moist textures to facilitate safe swallowing.

Question 79: A gerontological nurse is developing a care plan for an older adult with multiple chronic conditions. Which approach best represents the principle of individualized chronic disease management?

Treating each chronic disease in isolation according to specialty guidelines
Prioritizing conditions based on the patient's goals, function, and life expectancy (Correct answer)
Applying standard disease-specific guidelines uniformly to all patients
Focusing exclusively on the most recently diagnosed condition

Correct answer: Prioritizing conditions based on the patient's goals, function, and life expectancy

Effective chronic disease management in older adults requires individualization based on the patient's personal goals, functional status, prognosis, and values—not rigid application of single-disease guidelines.

Question 80: Which class of medications commonly causes anticholinergic side effects that are particularly harmful in older adults?

First-generation antihistamines (Correct answer)
Proton pump inhibitors
Beta-blockers
ACE inhibitors

Correct answer: First-generation antihistamines

First-generation antihistamines like diphenhydramine have strong anticholinergic properties, causing confusion, urinary retention, and constipation in older adults.

Question 81: When initiating a new medication in an older adult, which prescribing principle should guide dosing?

Double the dose if no effect is seen within 24 hours
'Start low, go slow' to minimize adverse effects (Correct answer)
Use standard adult doses unless the patient weighs less than 60 kg
'Start high, taper down' to achieve faster therapeutic effect

Correct answer: 'Start low, go slow' to minimize adverse effects

The 'start low, go slow' principle accounts for age-related pharmacokinetic changes, allowing clinicians to monitor for adverse effects before increasing the dose.

Question 82: An 82-year-old patient is prescribed a new benzodiazepine for anxiety. According to the Beers Criteria, what is the primary concern with this medication in older adults?

Increased risk of hypertension
Increased risk of falls and cognitive impairment (Correct answer)
Excessive sedation only during daytime hours
Reduced efficacy compared to younger patients

Correct answer: Increased risk of falls and cognitive impairment

The Beers Criteria lists benzodiazepines as potentially inappropriate for older adults due to increased risk of falls, fractures, motor vehicle accidents, and cognitive impairment.

Question 83: Which age-related gastrointestinal change affects oral drug absorption in older adults?

Decreased splanchnic blood flow and delayed gastric emptying (Correct answer)
Increased intestinal motility
Increased gastric acid production
Enhanced small intestinal absorption surface

Correct answer: Decreased splanchnic blood flow and delayed gastric emptying

Reduced splanchnic blood flow and delayed gastric emptying slow the rate of drug absorption but generally do not significantly reduce total drug absorbed.

Question 84: A nurse is caring for an older adult receiving continuous enteral tube feeding via a nasogastric tube. Which complication requires the highest priority monitoring?

Metabolic alkalosis
Hypoglycemia
Aspiration pneumonia (Correct answer)
Hyperkalemia

Correct answer: Aspiration pneumonia

Aspiration pneumonia is the most serious and life-threatening complication of enteral tube feeding in elderly patients, particularly those with impaired gag reflex, reduced mobility, or cognitive impairment.

Question 85: A nurse is performing a home safety assessment for an older adult at risk for falls. Which finding requires the most urgent intervention?

A non-slip bath mat in the shower
Loose throw rugs throughout the hallways (Correct answer)
Night lights installed in the bedroom and hallway
Grab bars installed beside the toilet

Correct answer: Loose throw rugs throughout the hallways

Loose throw rugs are a major fall hazard because they can slip, bunch, or catch a shuffling foot; removing them is an immediate and high-priority intervention.

Question 86: Which clinical sign is most reliable for assessing dehydration in older adults when skin turgor is unreliable due to normal age-related changes?

Pitting edema
Dry axillae (Correct answer)
Increased respiratory rate
Decreased urine output

Correct answer: Dry axillae

Dry axillae (armpits) is a more reliable indicator of dehydration in elderly patients than skin turgor because axillary skin is less affected by age-related elasticity loss.

Question 87: Which footwear recommendation is most appropriate for fall prevention in older adults?

High-top shoes to prevent ankle sprains
Walking barefoot to improve proprioceptive feedback
Well-fitting, low-heeled shoes with non-slip soles (Correct answer)
Loose-fitting slippers for comfort during ambulation

Correct answer: Well-fitting, low-heeled shoes with non-slip soles

Well-fitted shoes with low heels and non-slip soles provide optimal stability, traction, and foot support to reduce slip-and-fall risk in older adults.

Question 88: When communicating with a patient who has moderate Alzheimer's disease, the nurse should:

Avoid eye contact to prevent overstimulation
Correct the patient each time they make a factual error
Use short, simple sentences and allow extra time for responses (Correct answer)
Use complex sentences to stimulate cognitive function

Correct answer: Use short, simple sentences and allow extra time for responses

Short, simple sentences reduce cognitive load for patients with dementia, and allowing extra response time respects their slowed processing without adding pressure.

Question 89: A nurse is caring for a 75-year-old patient who scores 20 on the Mini-Mental State Examination (MMSE). How should the nurse interpret this score?

Normal cognitive function for age
Mild cognitive impairment
Moderate cognitive impairment (Correct answer)
Severe cognitive impairment

Correct answer: Moderate cognitive impairment

MMSE scores of 18–23 indicate mild impairment, while scores of 10–17 indicate moderate impairment; a score of 20 falls in the mild-to-moderate range and most guidelines classify it as moderate impairment.

Question 90: According to the Mini Nutritional Assessment (MNA), a score of 17 to 23.5 indicates which nutritional status?

Malnourished
Well-nourished
Normal nutritional status
At risk for malnutrition (Correct answer)

Correct answer: At risk for malnutrition

MNA scores of 17–23.5 indicate risk for malnutrition; scores below 17 indicate malnutrition and scores of 24 or above indicate normal nutritional status.

Question 91: An older adult presents with confusion, muscle weakness, and a serum sodium of 128 mEq/L. Which dietary/fluid modification is most appropriate for managing dilutional hyponatremia?

Increased dietary sodium supplementation
Fluid restriction (Correct answer)
High-protein diet
High-fiber diet

Correct answer: Fluid restriction

Dilutional hyponatremia (serum Na <135 mEq/L with excess free water) is treated with fluid restriction to correct the water-to-sodium ratio and restore eunatremia.

Question 92: An older adult with COPD is prescribed a long-acting bronchodilator. The nurse recognizes that the primary goals of COPD management in older adults include:

Complete reversal of airflow obstruction and lung function restoration
Symptom relief, prevention of exacerbations, and maintaining functional independence (Correct answer)
Aggressive antibiotic therapy to prevent all respiratory infections
Supplemental oxygen therapy to maintain SpO2 above 99%

Correct answer: Symptom relief, prevention of exacerbations, and maintaining functional independence

COPD in older adults is irreversible; management focuses on optimizing symptom control, preventing exacerbations, and preserving quality of life and functional ability.

Question 93: In accordance with the patient's advance request, the family of a severely ill patient has decided to withdraw all care and feedings. Although the gerontological nurse strongly disagrees with the decision to remove life support, she supports the patient's family nonetheless, offers only comfort measures, and directs the patient's family to hospice. According to the nurse, this is an illustration of:

Justice
Moral agency
Advocacy (Correct answer)
Agency

Correct answer: Advocacy

Working for the patient's best interests despite competing personal ideals and facilitating access to the right resources are both aspects of advocacy. Agency is the capacity for transparency, problem-solving, and issue awareness. The capacity to identify needs and take action to affect a conflict's or decision's outcome is known as moral agency. The ethical rule that governs how society's finite supply of healthcare benefits is distributed is called justice. Fair distribution of these assets is necessary.

Question 94: The primary goal of hospice care for an older adult with a terminal illness is to:

Provide comfort-focused care to maximize quality of life (Correct answer)
Aggressively treat the underlying disease to extend life
Ensure the patient dies in a hospital setting
Limit family involvement to reduce emotional distress

Correct answer: Provide comfort-focused care to maximize quality of life

Hospice care is a philosophy and service that focuses on comfort, symptom management, and quality of life rather than curative treatment, supporting both patient and family.

Question 95: Which standardized tool is most widely used in clinical settings to assess fall risk in hospitalized older adults?

Morse Fall Scale (Correct answer)
Braden Scale
Glasgow Coma Scale
Norton Scale

Correct answer: Morse Fall Scale

The Morse Fall Scale assesses six risk factors—fall history, secondary diagnosis, ambulatory aids, IV therapy, gait, and mental status—to quantify fall risk in hospitalized patients.

Question 96: The gerontological nurse anticipates that following a stroke on the left side of the patient's brain, the patient may display:

Impulsivity
Impaired concept of time
Special perceptual deficits
Impaired speech (Correct answer)

Correct answer: Impaired speech

Possible signs of a left-sided brain stroke include speech impairment. Other symptoms include right-side paresis or paralysis, difficulty telling the difference between the left and right, sluggishness and caution, melancholy and anxiety linked to knowledge of limitations, and poor language and math comprehension. Left-sided neglect, spatial-perceptual deficiencies, impulsivity, impaired judgment, and altered concept of time are the effects of a right-sided stroke.

Question 97: Which cholinesterase inhibitor is FDA-approved for the treatment of both mild-to-moderate AND severe Alzheimer's disease?

Galantamine (Razadyne)
Rivastigmine (Exelon)
Donepezil (Aricept) (Correct answer)
Memantine (Namenda)

Correct answer: Donepezil (Aricept)

Donepezil (Aricept) is unique among cholinesterase inhibitors in being FDA-approved for all stages of Alzheimer's disease, from mild to severe.

Question 98: Which laboratory value best reflects chronic protein-calorie malnutrition in an older adult?

Blood glucose
Serum albumin (Correct answer)
Hemoglobin
Serum sodium

Correct answer: Serum albumin

Serum albumin has a half-life of approximately 20 days and reflects long-term protein status; levels below 3.5 g/dL indicate protein-calorie malnutrition.

Question 99: Which age-related gastrointestinal change most directly reduces calcium absorption in older adults?

Accelerated gastric emptying
Increased gastric acid production
Decreased renal activation of vitamin D and reduced intestinal calcium transport (Correct answer)
Enhanced small intestinal motility

Correct answer: Decreased renal activation of vitamin D and reduced intestinal calcium transport

Aging reduces the kidney's ability to convert vitamin D to its active form (calcitriol) and decreases intestinal calcium transport efficiency, resulting in lower net calcium absorption.

Question 100: Which condition is most directly associated with inadequate calcium and vitamin D intake in older adults?

Hyponatremia
Osteoporosis (Correct answer)
Peripheral neuropathy
Anemia

Correct answer: Osteoporosis

Calcium and vitamin D are essential for maintaining bone mineral density; chronic deficiency leads to osteoporosis and increased fracture risk in older adults.

Question 101: Which assessment tool is specifically designed to identify pain in patients with advanced dementia who cannot self-report?

PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
Visual Analog Scale (VAS)
Numeric Rating Scale (NRS)
Wong-Baker FACES Scale

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

The PAINAD scale assesses behavioral indicators of pain—breathing, vocalization, facial expression, body language, and consolability—in patients unable to self-report.

Question 102: Which dietary recommendation is the most important for an older adult with stage 3 chronic kidney disease (CKD)?

High-calcium supplementation to prevent bone disease
Potassium and phosphorus restriction with adequate hydration (Correct answer)
Unrestricted sodium intake to maintain blood pressure
High-protein diet to prevent muscle wasting

Correct answer: Potassium and phosphorus restriction with adequate hydration

In CKD stage 3, the kidneys cannot adequately excrete potassium and phosphorus; dietary restriction of these electrolytes prevents dangerous hyperkalemia and hyperphosphatemia.

Question 103: NSAIDs are generally considered inappropriate for older adults primarily because they increase risk of:

GI bleeding, renal impairment, and fluid retention (Correct answer)
Serotonin syndrome
Hypoglycemia
Respiratory depression

Correct answer: GI bleeding, renal impairment, and fluid retention

NSAIDs inhibit prostaglandins that protect the gastric mucosa and maintain renal perfusion, placing older adults at significantly higher risk for GI bleeding and kidney injury.

Question 104: A 73-year-old patient with type 2 diabetes is being managed with glipizide. What is the PRIMARY concern when using sulfonylureas in older adults?

Prolonged hypoglycemia due to extended half-life (Correct answer)
Severe hepatotoxicity in those over age 70
Increased risk of hyperglycemic hyperosmolar state
Inadequate blood glucose control compared to insulin

Correct answer: Prolonged hypoglycemia due to extended half-life

Sulfonylureas such as glipizide can cause prolonged hypoglycemia in older adults because of decreased renal clearance and decreased counterregulatory hormonal responses, making hypoglycemia harder to recognize and recover from.

Question 105: A patient with frontotemporal dementia (FTD) exhibits disinhibited behavior and inappropriate social conduct. The nurse understands this is primarily due to:

Degeneration of the frontal and temporal lobes affecting personality and behavior (Correct answer)
Memory centers being affected first
Cholinergic deficit similar to Alzheimer's disease
Subcortical white matter damage from hypertension

Correct answer: Degeneration of the frontal and temporal lobes affecting personality and behavior

FTD primarily affects the frontal and temporal lobes, which regulate behavior, personality, and social conduct, resulting in disinhibition and inappropriate social behavior.

Question 106: The gerontological nurse wants to make adjustments, but staff members are opposed because they believe the burden will rise. The ideal strategy is to:

Wait until ready to implement before announcing change.
Explain the rationale and benefits of change. (Correct answer)
Rely on administrative authority to force change.
Promise staff change will be effortless.

Correct answer: Explain the rationale and benefits of change.

The best course of action in this situation is to explain the justification and advantages of the change. Additionally, it's a good idea to start with simple adjustments that the employees can readily see the results of. In the beginning, the gerontological nurse should work to win over a select group of influential people's cooperation.

Question 107: A nurse is using the Katz Index of Independence in Activities of Daily Living. Which activity is included in this assessment?

Preparing a meal from raw ingredients
Operating a telephone independently
Managing finances independently
Bathing without assistance (Correct answer)

Correct answer: Bathing without assistance

The Katz Index assesses six basic ADLs: bathing, dressing, toileting, transferring, continence, and feeding — financial management and meal preparation are instrumental ADLs (IADLs) assessed by a different scale.

Question 108: A nurse is discussing advance directives with an older adult patient. The POLST (Physician Orders for Life-Sustaining Treatment) form differs from a living will in that POLST:

Is a physician order that is actionable across all healthcare settings (Correct answer)
Can only be completed by patients with dementia
Is a legal document requiring a notary
Designates a healthcare proxy for decision-making

Correct answer: Is a physician order that is actionable across all healthcare settings

POLST is a physician order that translates patient wishes into actionable medical orders honored across all care settings, unlike a living will which is a legal directive that must be interpreted.

Question 109: What is the recommended daily calcium intake for adults aged 71 and older according to the National Academy of Medicine?

1,200 mg/day (Correct answer)
1,500 mg/day
1,000 mg/day
800 mg/day

Correct answer: 1,200 mg/day

The National Academy of Medicine recommends 1,200 mg/day of calcium for adults over 70 years to help offset decreased absorption efficiency and maintain bone density.

Question 110: A nurse is assessing an older adult's vision as part of a fall risk evaluation. Which visual change associated with aging most directly increases fall risk?

Increased sensitivity to blue wavelengths
Decreased ability to distinguish colors
Improved near vision due to lens changes
Reduced contrast sensitivity and depth perception (Correct answer)

Correct answer: Reduced contrast sensitivity and depth perception

Reduced contrast sensitivity impairs the ability to detect edges and surface changes, while decreased depth perception makes it difficult to judge distances and step heights, both directly contributing to falls.

Question 111: A gerontological nurse is educating a patient about digoxin therapy. Which sign of digoxin toxicity should the patient report immediately?

Mild constipation
Mild ankle swelling
Visual disturbances such as yellow-green halos (Correct answer)
Occasional headache

Correct answer: Visual disturbances such as yellow-green halos

Yellow-green visual halos are a classic sign of digoxin toxicity, which is more common in older adults due to reduced renal clearance.

Question 112: Which nursing intervention is most effective for promoting adequate nutrition in a hospitalized older adult with poor appetite?

Offering small, frequent meals with preferred foods (Correct answer)
Restricting meals to scheduled times only
Inserting a nasogastric tube immediately
Providing high-calorie protein shakes exclusively

Correct answer: Offering small, frequent meals with preferred foods

Small, frequent meals of preferred foods improve palatability, reduce feelings of early satiety, and increase overall caloric and protein intake in elderly patients with poor appetite.

Question 113: The Mini-Mental State Examination (MMSE) is used in gerontological nursing primarily to:

Diagnose Alzheimer's disease definitively
Screen for and monitor cognitive impairment (Correct answer)
Evaluate activities of daily living function
Assess a patient's capacity for informed consent

Correct answer: Screen for and monitor cognitive impairment

The MMSE is a standardized screening tool that assesses multiple cognitive domains and tracks changes over time; it cannot independently diagnose a specific dementia type.

Question 114: A 70-year-old woman with minor dyspareunia and vaginal dryness consults the gerontological nurse for suggestions on how to lessen her suffering. The geriatric nurse should advise:

Petrolatum jelly lubricant
Water-based (K-Y Jelly) lubricant (Correct answer)
Acetaminophen for pain relief
NSAID for pain relief

Correct answer: Water-based (K-Y Jelly) lubricant

As dryness of the vaginal tissues is frequently a contributing factor to dyspareunia in older adults, the gerontological nurse should advise the patient to try using a water-based lubricant (like K-Y Jelly). Petrolatum jelly shouldn't be used on the patient since it doesn't get absorbed by the tissues. The gerontological nurse should advise the patient to ask the doctor about an estrogen-based lubricant if the issue worsens or the lubricant is insufficient.

Question 115: The Timed Up and Go (TUG) test is used in gerontological nursing to assess:

Upper extremity strength
Cognitive function and reaction time
Mobility, balance, and fall risk (Correct answer)
Cardiovascular endurance

Correct answer: Mobility, balance, and fall risk

The TUG test measures the time for a patient to rise from a chair, walk 3 meters, turn, walk back, and sit down, providing a quick functional assessment of mobility and fall risk.

Question 116: Terminal sedation (palliative sedation) is ethically appropriate when:

The patient is expected to live more than six months
The patient has refractory, uncontrollable suffering near the end of life (Correct answer)
The nursing staff finds the patient's symptoms difficult to manage
The family requests it to hasten the patient's death

Correct answer: The patient has refractory, uncontrollable suffering near the end of life

Palliative sedation is ethically justified for patients with refractory symptoms causing intolerable suffering at end of life when all other symptom management strategies have failed.

Question 117: The Beers Criteria is a clinical tool used specifically to:

Determine drug interactions in polypharmacy patients
Identify potentially inappropriate medications for adults aged 65 and older (Correct answer)
Screen for medication allergies in nursing home residents
Calculate safe medication doses for elderly patients

Correct answer: Identify potentially inappropriate medications for adults aged 65 and older

The Beers Criteria, maintained by the American Geriatrics Society, lists medications considered potentially inappropriate for older adults due to higher risk of adverse effects.

Question 118: Grief that persists longer than expected and significantly impairs functioning is classified as:

Anticipatory grief
Complicated grief (prolonged grief disorder) (Correct answer)
Disenfranchised grief
Abbreviated grief

Correct answer: Complicated grief (prolonged grief disorder)

Complicated grief, now recognized as prolonged grief disorder in DSM-5-TR, is characterized by persistent and disabling grief symptoms lasting beyond the expected period of adjustment.

Question 119: In a Catholic hospital that has crucifixes hanging on the walls of each patient room, a Muslim patient is being treated. Which answer from the gerontological nurse demonstrates the greatest respect for the patient's religious beliefs?

Apologizing to the patient for the presence of the crucifix
Reminding the patient that this is a Catholic hospital
Covering or removing the crucifix (Correct answer)
Asking the patient if the crucifix should be removed

Correct answer: Covering or removing the crucifix

A patient could be reluctant to express wishes if prompted. While it is not essential to apologize for a Catholic institution's use of a religious emblem linked with the Catholic faith, covering or removing it is quite easy and demonstrates respect for other worldviews.

Question 120: Which age-related physiological change most directly contributes to increased drug toxicity in older adults?

Decreased total body water and lean muscle mass (Correct answer)
Faster glomerular filtration rate
Increased gastric acid production
Increased hepatic enzyme activity

Correct answer: Decreased total body water and lean muscle mass

Decreased lean muscle mass and total body water in older adults reduce the volume of distribution for water-soluble drugs, leading to higher plasma concentrations and increased toxicity risk.

Question 121: A nurse is reviewing the medication list of an older adult using the STOPP criteria. STOPP stands for:

Systematic Tool for Older Persons' Prescribing
Safe Therapy Optimization Protocol for Prescribers
Standard Treatment Options for Pharmacy Practice
Screening Tool of Older Persons' Prescriptions (Correct answer)

Correct answer: Screening Tool of Older Persons' Prescriptions

STOPP (Screening Tool of Older Persons' Prescriptions) is a European evidence-based tool that identifies potentially inappropriate prescribing in older adults.

Question 122: Under the Medicare Hospice Benefit in the United States, a patient must have a life expectancy of how long to qualify for hospice enrollment?

6 months or less if the disease runs its natural course (Correct answer)
3 months or less
2 years or less
1 year or less

Correct answer: 6 months or less if the disease runs its natural course

Medicare Hospice Benefit requires physician certification that the patient has a life expectancy of 6 months or less if the terminal illness follows its normal course.

Question 123: A nurse is implementing a person-centered care approach for a patient with dementia. This approach is primarily characterized by:

Prioritizing medical management over psychosocial needs
Minimizing patient autonomy to ensure safety
Focusing care on the individual's life history, preferences, and preserved abilities (Correct answer)
Following a standardized dementia care protocol for all patients

Correct answer: Focusing care on the individual's life history, preferences, and preserved abilities

Person-centered dementia care tailors interventions to the individual's unique biography, personal preferences, and remaining strengths rather than applying a one-size-fits-all protocol.

Question 124: Which nursing diagnosis is HIGHEST priority for an 81-year-old patient admitted with pneumonia, confusion, and a serum albumin of 2.8 g/dL?

Risk for Social Isolation related to hospitalization
Deficient Knowledge related to antibiotic therapy
Impaired Gas Exchange related to infectious process (Correct answer)
Imbalanced Nutrition: Less than Body Requirements related to chronic malnutrition

Correct answer: Impaired Gas Exchange related to infectious process

Using Maslow's hierarchy, impaired gas exchange is a physiological survival need and takes priority over nutritional deficits and psychosocial concerns in an acutely ill patient with pneumonia.

Question 125: Which of the following SSRIs may have a longer half-life that causes agitation, sleeplessness, and anorexia in older adults?

Fluoxetine (Correct answer)
Duloxetine
Paroxetine
Sertraline

Correct answer: Fluoxetine

Older adults who need an SSRI should be prescribed a different one, such as paroxetine, duloxetine, or sertraline, as fluoxetine may have an extended half-life that might cause agitation, sleeplessness, and anorexia. The starting dosage should be low and then gradually increased if necessary because older persons are more sensitive to SSRIs than younger adults.

Question 126: An 80-year-old patient is prescribed a new medication. Which age-related change most significantly increases the risk of drug accumulation?

Increased gastric motility
Reduced serum albumin levels
Decreased creatinine clearance (Correct answer)
Decreased body fat percentage

Correct answer: Decreased creatinine clearance

Decreased creatinine clearance in older adults slows renal excretion of drugs and their metabolites, leading to accumulation and potential toxicity.

Question 127: When assessing pain in an older adult with moderate dementia who cannot self-report, which validated tool should the nurse use?

Wong-Baker FACES Scale
PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
Numeric Rating Scale (NRS)
Visual Analog Scale (VAS)

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

The PAINAD scale is specifically designed and validated for assessing pain in non-verbal patients with advanced dementia by observing behaviors such as breathing, vocalization, facial expression, body language, and consolability.

Question 128: An older adult with atrial fibrillation is anticoagulated with warfarin. Which INR range represents the therapeutic target for stroke prevention in this condition?

1.0–1.5
2.0–3.0 (Correct answer)
1.5–2.0
3.5–4.5

Correct answer: 2.0–3.0

The therapeutic INR range of 2.0–3.0 is recommended for atrial fibrillation to balance stroke prevention against bleeding risk in older adults.

Question 129: A patient at end of life expresses spiritual distress and asks the nurse, 'Why is God doing this to me?' The nurse's most therapeutic response is to:

Listen attentively, acknowledge the distress, and offer to arrange a chaplain visit (Correct answer)
Reassure the patient that God has a plan
Change the subject to discuss physical symptoms
Offer a theological explanation of suffering

Correct answer: Listen attentively, acknowledge the distress, and offer to arrange a chaplain visit

Acknowledging spiritual distress and facilitating access to chaplaincy is within nursing scope; imposing theological interpretations or dismissing the concern is inappropriate.

Question 130: A patient underwent colon resection and colostomy surgery, but in the six hours after returning from the recovery room to his room on the surgical unit, he has not asked for any pain medicine. The geriatric nurse should presume the following about the patient:

Is insensitive to pain
Has not recovered from anesthesia
Is reluctant to complain of pain (Correct answer)
Has no pain

Correct answer: Is reluctant to complain of pain

It's conceivable the patient is reluctant to report their pain. The gerontological nurse should ask the patient to rate or describe his pain rather than asking if they are in pain because some patients may have cultural, social, or familial stigmas about showing pain or seeking pain relief.

Question 131: Which physical sign indicates that death is likely within hours for an older adult patient receiving end-of-life care?

Mottling of the knees and lower extremities with cool, clammy skin (Correct answer)
Decreased appetite for 24 hours
A request to speak with family members
Mild confusion in the morning that resolves by afternoon

Correct answer: Mottling of the knees and lower extremities with cool, clammy skin

Mottling (livedo reticularis) of the extremities with cool, clammy skin reflects circulatory shutdown and peripheral vasoconstriction, indicating death is imminent within hours.

Question 132: A nurse is supporting a family whose loved one died in the hospital. Which action best demonstrates compassionate end-of-life nursing care?

Rushing to clean the room immediately after the patient's death
Allowing the family adequate private time with the deceased and offering condolences (Correct answer)
Removing IV lines and equipment before the family enters the room and without asking
Limiting family presence during the final hours due to staffing constraints

Correct answer: Allowing the family adequate private time with the deceased and offering condolences

Providing uninterrupted private time with the deceased, demonstrating empathy, and supporting the family's grieving process are hallmarks of compassionate end-of-life nursing care.

Question 133: Polypharmacy in older adults is generally defined as the concurrent use of how many or more medications?

3 or more
5 or more (Correct answer)
10 or more
8 or more

Correct answer: 5 or more

Polypharmacy is typically defined as the concurrent use of five or more medications, which substantially increases the risk of adverse drug reactions and interactions.

Question 134: Which vitamin deficiency is strongly associated with increased fall risk in older adults due to its role in muscle strength and neuromuscular function?

Vitamin A
Vitamin B12
Vitamin C
Vitamin D (Correct answer)

Correct answer: Vitamin D

Vitamin D deficiency is associated with proximal muscle weakness, impaired balance, and increased fall risk; supplementation in deficient older adults is an evidence-based fall prevention strategy.

Question 135: Which condition causing gait disturbance significantly increases fall risk in older adults and is characterized by a broad-based, shuffling gait and urinary incontinence?

Parkinson's disease
Peripheral neuropathy
Normal pressure hydrocephalus (NPH) (Correct answer)
Cervical myelopathy

Correct answer: Normal pressure hydrocephalus (NPH)

Normal pressure hydrocephalus presents with the classic triad of gait disturbance (magnetic gait), urinary incontinence, and cognitive decline, and is a treatable cause of falls in older adults.

Question 136: A hospice patient claims she had intended to write her autobiography but never found the time. Though she wishes she could leave them for her kids, she is currently too exhausted to write. Which of the following displays the most consideration for the patient's requirements on the part of the gerontological nurse?

Asking a volunteer to take notes of memories
Suggesting the patient write one or two paragraphs a day
Reassuring the patient that her family will understand
Providing a tape recorder to record patient memories (Correct answer)

Correct answer: Providing a tape recorder to record patient memories

The nurse providing a tape recorder to record patient memories shows the most sensitivity to the patient’s needs. This helps the patient to leave a history for her children and facilitates a life review to benefit the patient.

Question 137: Which analgesic is considered potentially inappropriate for older adults and should generally be avoided due to hepatotoxicity risk with chronic use?

Ibuprofen
Acetaminophen (exceeding 3g/day) (Correct answer)
Naproxen
Celecoxib

Correct answer: Acetaminophen (exceeding 3g/day)

Acetaminophen exceeding 3 grams per day in older adults, especially those with liver disease or heavy alcohol use, poses a significant hepatotoxicity risk.

Question 138: How does normal aging affect the sensation of thirst in older adults?

Thirst sensation fluctuates based on ambient temperature only
Thirst sensation remains unchanged throughout the lifespan
Thirst sensation decreases, increasing the risk of dehydration (Correct answer)
Thirst sensation increases significantly with age

Correct answer: Thirst sensation decreases, increasing the risk of dehydration

Aging causes a blunting of the hypothalamic thirst mechanism, making older adults less likely to perceive or respond to dehydration cues.

Question 139: According to the FANCAPES assessment framework used in gerontological nursing, what does the 'A' stand for?

Ambulation
Aeration (Correct answer)
Appetite
Assessment

Correct answer: Aeration

FANCAPES stands for Fluids, Aeration, Nutrition, Communication, Activity, Pain, Elimination, and Socialization — a geriatric nursing assessment framework addressing functional health needs.

Question 140: Which document allows an older adult to designate a person to make healthcare decisions on their behalf if they become incapacitated?

Living will
Do Not Resuscitate (DNR) order
Durable power of attorney for healthcare (healthcare proxy) (Correct answer)
POLST form

Correct answer: Durable power of attorney for healthcare (healthcare proxy)

A durable power of attorney for healthcare designates a specific individual as the healthcare proxy to make medical decisions when the patient lacks decision-making capacity.

Question 141: Orthostatic hypotension is a significant fall risk factor in older adults. It is defined as a drop of at least:

20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing (Correct answer)
30 mmHg systolic or 15 mmHg diastolic upon sitting
10 mmHg systolic or 5 mmHg diastolic upon standing
5 mmHg systolic or 3 mmHg diastolic upon standing

Correct answer: 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing

Orthostatic hypotension is defined as a systolic BP decrease of ≥20 mmHg or diastolic decrease of ≥10 mmHg within three minutes of moving from lying or sitting to standing.

Question 142: Which patient factor is the single strongest predictor of future falls in an older adult?

Age older than 80 years
Female sex
Diagnosis of osteoporosis
History of one or more previous falls (Correct answer)

Correct answer: History of one or more previous falls

A history of previous falls is the strongest single predictor of future falls, making fall history a critical component of every older adult assessment.

Question 143: The American Cancer Society advises: If a 65-year-old patient has prostate-specific antigen (PSA) levels of 3.0 ng/mL:

Testing every 2 years
Testing every year (Correct answer)
Testing every 3 years
No further testing

Correct answer: Testing every year

The American Cancer Society advises yearly screening for patients over 65 who have PSA levels of at least 2.5 ng/mL (in this case, 3.0 ng/mL). A patient only needs to be retested every two years if their PSA is less than 2.5 ng/mL. It is advised against offering testing to older patients who have a life expectancy of fewer than 10 years because prostate cancer typically spreads relatively slowly.

Question 144: According to Erikson's theory of psychosocial development, the primary developmental task of older adulthood is achieving:

Ego integrity versus despair (Correct answer)
Generativity versus stagnation
Identity versus role confusion
Intimacy versus isolation

Correct answer: Ego integrity versus despair

Erikson's final stage (late adulthood) involves ego integrity — a sense of fulfillment and acceptance of one's life — versus despair over missed opportunities and the fear of death.

Question 145: A family caregiver reports exhaustion and describes feeling overwhelmed caring for a parent with Alzheimer's. The nurse's priority intervention is to:

Advise the caregiver to consider immediate nursing home placement
Assess for caregiver burnout and provide information about respite care resources (Correct answer)
Prescribe antidepressants for the caregiver
Tell the caregiver this is normal and to persevere

Correct answer: Assess for caregiver burnout and provide information about respite care resources

Caregiver burnout assessment and connection to respite care and community resources addresses both the caregiver's well-being and the sustainability of home-based dementia care.

Question 146: The nurse is caring for an older adult patient at end of life who is experiencing Cheyne-Stokes respirations. How should the nurse interpret this finding?

Place the patient in Trendelenburg position to improve cerebral perfusion
Administer supplemental oxygen at 10 L/min via non-rebreather mask
Immediately initiate CPR as this indicates cardiac arrest
Document as a normal expected physiological change in the dying process (Correct answer)

Correct answer: Document as a normal expected physiological change in the dying process

Cheyne-Stokes respirations — a cyclic pattern of waxing and waning breathing with apneic pauses — are a common and expected physiological sign in the final hours to days of life, not a medical emergency.

Question 147: Which finding on a medication reconciliation is MOST concerning in a newly admitted 84-year-old patient?

Using a calcium supplement with vitamin D
Taking a daily aspirin 81 mg for cardiac prophylaxis
Taking diphenhydramine nightly as a sleep aid (Correct answer)
Taking metoprolol succinate for hypertension

Correct answer: Taking diphenhydramine nightly as a sleep aid

Diphenhydramine is on the Beers Criteria as a potentially inappropriate medication for older adults due to its strong anticholinergic properties, which can cause confusion, urinary retention, constipation, and increased fall risk.

Question 148: A nurse is teaching an older adult patient with heart failure about the 'rule of 5' for fluid restriction. The patient should report weight gain of more than how many pounds in 24 hours?

10 pounds in 24 hours
1 pound in 24 hours
5 pounds in 24 hours
2–3 pounds in 24 hours (Correct answer)

Correct answer: 2–3 pounds in 24 hours

A weight gain of 2–3 pounds in 24 hours in a heart failure patient typically indicates significant fluid retention and warrants prompt notification of the healthcare provider.

Question 149: An older adult patient has a serum sodium of 128 mEq/L and is symptomatic with confusion. Which condition should the nurse suspect first?

Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone (SIADH) (Correct answer)
Addisonian crisis
Hypernatremia secondary to dehydration

Correct answer: Syndrome of inappropriate antidiuretic hormone (SIADH)

SIADH is a common cause of hyponatremia in older adults and presents with low serum sodium, concentrated urine, and neurological symptoms like confusion; it is frequently precipitated by medications, CNS disorders, or pulmonary disease.

Question 150: An older adult with COPD is receiving supplemental oxygen. The nurse monitors for oxygen-induced hypercapnia primarily in patients who:

Are newly diagnosed with COPD
Have concurrent pneumonia
Have a SpO2 above 95%
Are chronic CO2 retainers with a hypoxic drive for breathing (Correct answer)

Correct answer: Are chronic CO2 retainers with a hypoxic drive for breathing

Patients with severe COPD who chronically retain CO2 may rely on hypoxic drive for respiration; administering high-flow oxygen can suppress this drive and cause dangerous CO2 retention.

Gerontological Nursing Certification Exam

The Gerontological Nursing Certification Exam is offered by the American Nurses Credentialing Center (ANCC) and validates expertise in caring for older adult populations. The exam covers pharmacology in older adults, management of dementia and cognitive disorders, chronic disease management, falls prevention and safety, and end-of-life and palliative care. Candidates must hold a current RN license and demonstrate clinical experience in gerontological nursing.

150

Questions

180 min

Time Limit

70%

To Pass

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