NCLEX-PN Test #11 3 — Questions and Answers
Question 1: An 82-year-old client is admitted with a new diagnosis of urinary tract infection (UTI). Which presentation is atypical and commonly seen in older adults?
- Dysuria and urinary frequency
- Sudden onset of confusion (delirium) (Correct answer)
- High fever of 39.5°C
- Foul-smelling, cloudy urine
Correct answer: Sudden onset of confusion (delirium)
Older adults with UTI often present with atypical symptoms: acute confusion (delirium), falls, incontinence, or general malaise without the classic dysuria and frequency. This atypical presentation is due to blunted immune response and altered pain perception. Delirium in the elderly should always prompt a search for an underlying cause.
Question 2: The PN is assessing an 80-year-old client on multiple medications (polypharmacy). Which drug combination poses the greatest fall risk?
- Lisinopril + metformin
- Lorazepam + terazosin + oxycodone (Correct answer)
- Atorvastatin + amlodipine
- Metoprolol + aspirin
Correct answer: Lorazepam + terazosin + oxycodone
Polypharmacy with CNS depressants, alpha-blockers, and opioids significantly increases fall risk in the elderly through multiple mechanisms: sedation, orthostatic hypotension, and impaired balance. The Beers Criteria flags benzodiazepines, opioids, and alpha-blockers as high-risk medications in older adults for fall-related injuries.
Question 3: When caring for an elderly client, the nurse recognizes which physiological change of aging directly increases the risk for drug toxicity?
- Increased lean body mass
- Decreased renal creatinine clearance (Correct answer)
- Increased gastric acid production
- Increased hepatic enzyme activity
Correct answer: Decreased renal creatinine clearance
Renal clearance of medications decreases by approximately 1% per year after age 40. The decline in GFR means renally-excreted drugs (digoxin, lithium, aminoglycosides, NSAIDs) accumulate to toxic levels at standard adult doses. Serum creatinine may be normal despite decreased GFR in the elderly due to reduced muscle mass.
Question 4: A client with dementia is being repositioned and becomes agitated, calling out and striking at the nurse. What is the best response?
- Apply soft restraints to prevent the client from falling during repositioning
- Use a calm voice, provide reassurance, and redirect using familiar objects or music (Correct answer)
- Administer a PRN antipsychotic before all repositioning
- Document as combative and assign one-to-one observation
Correct answer: Use a calm voice, provide reassurance, and redirect using familiar objects or music
Non-pharmacological approaches are first-line for behavioral symptoms of dementia. A calm, reassuring tone, simple clear communication, and redirection with meaningful stimuli (familiar music, objects) are evidence-based strategies. Physical restraints increase agitation, confusion, and risk of injury and should be avoided.
Question 5: An 85-year-old client is at high risk for skin breakdown. Which intervention is most important for pressure injury prevention?
- Massage reddened bony prominences vigorously to stimulate circulation
- Reposition the client every 2 hours using a turn schedule and use a pressure-redistributing mattress (Correct answer)
- Keep the head of the bed elevated to 60 degrees at all times
- Apply heat packs to bony prominences to increase tissue perfusion
Correct answer: Reposition the client every 2 hours using a turn schedule and use a pressure-redistributing mattress
Pressure injury prevention requires: repositioning every 2 hours (or more frequently based on risk), pressure-redistributing mattresses/overlays, keeping skin clean and dry, maintaining nutrition, and using transfer aids to reduce shear. Massaging reddened skin is contraindicated as it can worsen tissue damage by increasing capillary disruption.
Question 6: The nurse is assessing an elderly client for depression. Which screening tool is most appropriate for older adults?
- Beck Depression Inventory (BDI-II)
- Geriatric Depression Scale (GDS) (Correct answer)
- Hamilton Anxiety Rating Scale
- PHQ-2 alone without further assessment
Correct answer: Geriatric Depression Scale (GDS)
The Geriatric Depression Scale (GDS) was specifically developed and validated for use in older adults. It uses simple yes/no questions and avoids questions about somatic symptoms (fatigue, appetite, sleep) that are common in the elderly regardless of depression, making it more specific for this population than tools developed for general adults.
NCLEX-PN Test #11 3
An 82-year-old client is admitted with a new diagnosis of urinary tract infection (UTI).
Which presentation is atypical and commonly seen in older adults?