Gerontological Nurse Test Gerontological Nursing 3 — Questions and Answers
Question 1: When assessing pain in an older adult with moderate dementia who cannot self-report, which validated tool should the nurse use?
- 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 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 2: Which age-related physiological change most directly contributes to increased drug toxicity in older adults?
- Increased hepatic enzyme activity
- Decreased total body water and lean muscle mass (Correct answer)
- Increased gastric acid production
- Faster glomerular filtration rate
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 3: 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?
- Document the weight loss and reassess in one month
- Obtain a dietary consult and assess for dysphagia and depression (Correct answer)
- Immediately start enteral nutrition
- 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 4: Which statement best describes the physiological basis for thermoregulatory dysfunction in older adults?
- Older adults produce more heat due to increased basal metabolic rate
- Reduced subcutaneous fat and impaired shivering decrease cold tolerance (Correct answer)
- Enhanced sweating mechanisms increase heat dissipation efficiency
- Peripheral vasodilation is more pronounced in older adults during cold exposure
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 5: 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?
- New-onset dementia
- Postoperative delirium (Correct answer)
- Sundowning syndrome
- Acute psychosis
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 6: According to the FANCAPES assessment framework used in gerontological nursing, what does the 'A' stand for?
- Ambulation
- Aeration (Correct answer)
- Assessment
- Appetite
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 7: A gerontological nurse is teaching about fall prevention. Which environmental modification has the STRONGEST evidence for reducing falls in community-dwelling older adults?
- Installing grab bars in bathrooms and removing trip hazards (Correct answer)
- Prescribing bed alarms for all patients over age 75
- Recommending older adults avoid exercise to prevent fatigue
- Using restraints at nighttime to prevent falls during sleep
Correct answer: Installing grab bars in bathrooms and removing trip hazards
Home safety modifications such as grab bars, removal of loose rugs, adequate lighting, and non-slip surfaces are strongly evidence-based interventions for fall prevention in community-dwelling older adults.
Gerontological Nurse Test Gerontological Nursing 3
When assessing pain in an older adult with moderate dementia who cannot self-report, which validated tool should the nurse use?