Gerontological Nursing Certification Exam — Questions and Answers

Question 1: The Centers for Disease Control and Prevention (CDC) STEADI initiative is a clinical tool designed to:

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

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

1,000 mg/day
1,500 mg/day
1,200 mg/day (Correct answer)
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 3: Which intervention is the MOST important to include in the care plan for a patient with dementia who is at high risk for wandering?

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

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

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

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 5: 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
Providing a tape recorder to record patient memories (Correct answer)
Reassuring the patient that her family will understand

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 6: 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?

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

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

3 or more
8 or more
5 or more (Correct answer)
10 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 8: A nurse is caring for a patient with vascular dementia. Which risk factor most directly contributes to the development of this type of dementia?

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

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

Testing every year (Correct answer)
Testing every 3 years
Testing every 2 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 10: Which standardized tool is most widely used in clinical settings to assess fall risk in hospitalized older adults?

Norton Scale
Morse Fall Scale (Correct answer)
Glasgow Coma Scale
Braden 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 11: 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
MCI exclusively affects attention rather than memory
Activities of daily living are preserved in MCI despite cognitive changes (Correct answer)
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 12: Grief that persists longer than expected and significantly impairs functioning is classified as:

Abbreviated grief
Anticipatory grief
Complicated grief (prolonged grief disorder) (Correct answer)
Disenfranchised 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 13: Which document allows an older adult to designate a person to make healthcare decisions on their behalf if they become incapacitated?

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

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

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

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 15: 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?

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

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

ACE inhibitors
Beta-blockers
First-generation antihistamines (Correct answer)
Proton pump 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 17: Which pharmacokinetic change is most common in older adults that affects drug clearance?

Enhanced protein binding
Decreased hepatic blood flow and renal function (Correct answer)
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 18: Which feature best distinguishes delirium from dementia in an older adult?

Acute onset with fluctuating course (Correct answer)
Memory impairment
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 19: Which condition is most directly associated with inadequate calcium and vitamin D intake in older adults?

Hyponatremia
Osteoporosis (Correct answer)
Anemia
Peripheral neuropathy

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

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

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

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

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

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

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

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

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

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

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

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 26: 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?

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

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 27: 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:

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

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

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

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

Measure blood pressure only when symptomatic
Rise slowly from sitting or lying positions and sit at the bedside before standing (Correct answer)
Restrict fluid intake to prevent blood pressure fluctuations
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 30: An older adult with hypertension has a consistently elevated blood pressure despite adherence to antihypertensive medications. The nurse should first assess for:

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

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 31: 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
High-protein diet to prevent muscle wasting
Potassium and phosphorus restriction with adequate hydration (Correct answer)
Unrestricted sodium intake to maintain blood pressure

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 32: Terminal sedation (palliative sedation) is ethically appropriate when:

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

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

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

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

1.5–2.0
1.0–1.5
2.0–3.0 (Correct answer)
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 35: The Beers Criteria is a clinical tool used specifically to:

Identify potentially inappropriate medications for adults aged 65 and older (Correct answer)
Determine drug interactions in polypharmacy patients
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 36: Which assessment tool is specifically designed to identify pain in patients with advanced dementia who cannot self-report?

Numeric Rating Scale (NRS)
PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
Visual Analog Scale (VAS)
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 37: An older adult with COPD is receiving supplemental oxygen. The nurse monitors for oxygen-induced hypercapnia primarily in patients who:

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

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.

Question 38: Which vitamin deficiency is most commonly associated with macrocytic anemia and peripheral neuropathy in older adults?

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

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 39: 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)
High-dose diuretics
Nebulized albuterol
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 40: Which clinical findings are most characteristic of zinc deficiency in older adults?

Hypoglycemia and fatigue
Peripheral neuropathy and ataxia
Impaired wound healing and altered taste (Correct answer)
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 41: Which medication class listed in the Beers Criteria is most associated with causing falls in older adults?

ACE inhibitors
Statins
Beta-blockers
Benzodiazepines (Correct answer)

Correct answer: Benzodiazepines

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

Question 42: 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?

High-fiber diet
Increased dietary sodium supplementation
Fluid restriction (Correct answer)
High-protein 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 43: A patient with frontotemporal dementia (FTD) exhibits disinhibited behavior and inappropriate social conduct. The nurse understands this is primarily due to:

Cholinergic deficit similar to Alzheimer's disease
Degeneration of the frontal and temporal lobes affecting personality and behavior (Correct answer)
Memory centers being affected first
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 44: A nurse is caring for an older adult receiving continuous enteral tube feeding via a nasogastric tube. Which complication requires the highest priority monitoring?

Aspiration pneumonia (Correct answer)
Metabolic alkalosis
Hyperkalemia
Hypoglycemia

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

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

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

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

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

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

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

Iron deficiency
Zinc deficiency
Vitamin D deficiency (Correct answer)
Thiamine 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 49: Which complication of long-term corticosteroid use in older adults requires routine bone health monitoring and preventive treatment?

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

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

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

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

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

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 52: 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?

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

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 53: 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 54: What is the recommended daily protein intake for healthy older adults?

0.8–1.2 g/kg body weight (Correct answer)
0.4–0.5 g/kg body weight
1.5–2.0 g/kg body weight
2.5–3.0 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 55: 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
Reduced contrast sensitivity and depth perception (Correct answer)
Improved near vision due to lens changes

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

Screen for and monitor cognitive impairment (Correct answer)
Evaluate activities of daily living function
Diagnose Alzheimer's disease definitively
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 57: A nurse is performing a home safety assessment for an older adult at risk for falls. Which finding requires the most urgent intervention?

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

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

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

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

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

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

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

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

Hypertension
Hyperglycemia
Increased appetite
Pain and dyspnea (Correct answer)

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 62: 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
Hold metformin and notify the provider due to risk of lactic acidosis (Correct answer)
Continue the medication as prescribed to maintain glucose control
Increase the dose to compensate for altered glucose metabolism during illness

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

Impulsivity
Special perceptual deficits
Impaired concept of time
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 64: Which assessment finding in an older adult requires the nurse to immediately implement fall precautions beyond universal measures?

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

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

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

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

Use the walker as a support when rising from a chair (Correct answer)
Lift and advance the walker before stepping
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 67: 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)
Designates a healthcare proxy for decision-making
Is a legal document requiring a notary
Can only be completed by patients with dementia

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

Hypernatremia
Hyperkalemia
Hypercalcemia
Hypophosphatemia (Correct answer)

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

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

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

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

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 71: 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
once a year
Pap smear is no longer required (Correct answer)
twice 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 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)
Reduced ankle-brachial index
Presence of microalbuminuria on urinalysis
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 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:

Call the physician for guidance.
Withhold resuscitation efforts.
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 74: When initiating a new medication in an older adult, which prescribing principle should guide dosing?

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

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

Blood glucose
Serum sodium
Serum albumin (Correct answer)
Hemoglobin

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

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

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 77: 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:

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

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 78: 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:

Agency
Advocacy (Correct answer)
Justice
Moral 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 79: 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?

“I understand your concerns, but there is little that can be done.”
“I’ll talk about this with staff members.”
“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)

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 80: The following is the most significant factor linked to nonadherence in older adults:

Low health literacy (Correct answer)
Advanced age
Chronic disease
Lack of social support

Correct answer: Low health literacy

Health literacy is directly related to a lack of understanding about the purpose of the therapy and the significance of sustaining adherence, even though many other variables (such as lack of insurance) may also play a role in nonadherence. Patients who are unfamiliar with anatomy, bodily processes, or disease frequently struggle to understand instructions or the advantages of doing so.

Question 81: A nurse notes that a patient with dementia has been refusing meals for 3 days. The most therapeutic initial nursing action is to:

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

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

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

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 83: A patient with Alzheimer's disease exhibits sundowning. The nurse should anticipate that this behavior typically occurs:

Late afternoon and evening hours (Correct answer)
After taking medications
Only during medical procedures
Early morning upon waking

Correct answer: Late afternoon and evening hours

Sundowning refers to increased confusion, agitation, and behavioral disturbances that commonly occur in late afternoon and evening in patients with dementia.

Question 84: A family caregiver reports exhaustion and describes feeling overwhelmed caring for a parent with Alzheimer's. The nurse's priority intervention is to:

Prescribe antidepressants for the caregiver
Assess for caregiver burnout and provide information about respite care resources (Correct answer)
Advise the caregiver to consider immediate nursing home placement
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 85: An older adult reports a fear of falling that has caused them to restrict their activities. The nurse recognizes this as:

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

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

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

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

Misfeasance
Criminal negligence
Nonfeasance (Correct answer)
Malfeasance

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

Walking barefoot to improve proprioceptive feedback
Well-fitting, low-heeled shoes with non-slip soles (Correct answer)
High-top shoes to prevent ankle sprains
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 89: After a patient fall in a hospital, which nursing action takes the highest priority?

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

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 90: 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 91: Hip protector pads are a secondary fall prevention strategy designed to:

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

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

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

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

Coagulation studies (PT/INR)
Complete blood count (CBC) and liver function tests (Correct answer)
Serum calcium and vitamin D levels
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 94: Which non-pharmacological intervention is most appropriate for managing agitation in a patient with moderate dementia?

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

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 95: 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)
Regular (Level 7)
Thin liquids (Level 1)
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 96: Which of the following SSRIs may have a longer half-life that causes agitation, sleeplessness, and anorexia in older adults?

Sertraline
Duloxetine
Paroxetine
Fluoxetine (Correct answer)

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

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

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

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

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 99: 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
NSAID for pain relief
Acetaminophen for pain relief
Water-based (K-Y Jelly) lubricant (Correct answer)

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 100: 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 101: Which physical sign indicates that death is likely within hours for an older adult patient receiving end-of-life care?

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

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

Increased hepatic enzyme activity
Increased proportion of body fat relative to lean muscle mass (Correct answer)
Reduced gastric pH
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 103: 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
sublimation
a coping mechanism (Correct answer)
denial

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

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

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 105: 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
Increased fruits, vegetables, low-fat dairy, and reduced sodium (Correct answer)
High fat intake with restricted carbohydrates

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 106: 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 107: Under the Medicare Hospice Benefit in the United States, a patient must have a life expectancy of how long to qualify for hospice enrollment?

1 year or less
6 months or less if the disease runs its natural course (Correct answer)
2 years or less
3 months 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 108: 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:

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

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 109: 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 110: 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
Requiring one-to-one observation for all older adults
Ensuring call lights are within reach and beds are in the lowest position (Correct answer)

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

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

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 112: 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
2–3 pounds in 24 hours (Correct answer)
5 pounds in 24 hours

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 113: 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)
Biot's respirations indicating neurological emergency
Kussmaul respirations indicating metabolic acidosis
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 114: Reminiscence therapy is used with older adults with dementia because it:

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

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

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

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

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

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

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

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

Vitamin B12
Vitamin C
Vitamin A
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 119: 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:

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

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 120: 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:

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

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 121: 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 122: 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 calcium with vitamin D
Patient takes both a tricyclic antidepressant and an SSRI (Correct answer)
Patient takes a statin at bedtime
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 123: 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)
Active euthanasia
Beneficent deception
Physician-assisted suicide

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

Limiting family presence during the final hours due to staffing constraints
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

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

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

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.

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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Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

nursingworld.org — Test delivery, eligibility, exam format, test dates, time limit, score validity, passing score, score release · verified Oct 2026