Gerontological Nurse Test Gerontological Nursing 4 — Questions and Answers
Question 1: Which of the following is a hallmark distinction between delirium and dementia?
- Delirium has a gradual onset; dementia is acute
- Delirium involves fluctuating consciousness; dementia typically does not (Correct answer)
- Dementia always causes visual hallucinations; delirium does not
- Delirium is irreversible; dementia may be reversible
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 2: 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?
- Increased risk of hyperglycemic hyperosmolar state
- Prolonged hypoglycemia due to extended half-life (Correct answer)
- Severe hepatotoxicity in those over age 70
- 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 3: The nurse is reviewing lab results for a 76-year-old patient. Which laboratory value change is a NORMAL age-related finding?
- Elevated serum creatinine above 2.0 mg/dL
- Decreased creatinine clearance (Correct answer)
- Elevated serum albumin above 5.0 g/dL
- Elevated BUN above 40 mg/dL
Correct answer: Decreased creatinine clearance
Creatinine clearance normally decreases with age due to reduced glomerular filtration rate, even when serum creatinine remains within normal limits because of decreased muscle mass producing less creatinine.
Question 4: Which nursing intervention BEST supports older adults with age-related macular degeneration (AMD) during hospitalization?
- Dim the room lighting to reduce glare
- Use large-print materials and ensure adequate room lighting (Correct answer)
- Place the patient near a window with direct sunlight exposure
- Avoid written materials and rely solely on verbal instruction
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 5: A nurse is using the Katz Index of Independence in Activities of Daily Living. Which activity is included in this assessment?
- Managing finances independently
- Preparing a meal from raw ingredients
- Bathing without assistance (Correct answer)
- Operating a telephone independently
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 6: An older adult patient has a serum sodium of 128 mEq/L and is symptomatic with confusion. Which condition should the nurse suspect first?
- Syndrome of inappropriate antidiuretic hormone (SIADH) (Correct answer)
- Diabetes insipidus
- Hypernatremia secondary to dehydration
- Addisonian crisis
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 7: According to Erikson's theory of psychosocial development, the primary developmental task of older adulthood is achieving:
- Generativity versus stagnation
- Ego integrity versus despair (Correct answer)
- 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.
Gerontological Nurse Test Gerontological Nursing 4
Which of the following is a hallmark distinction between delirium and dementia?