SCFHS Saudi Prometric Nursing Exam Gerontological Nursing — Questions and Answers
Question 1: An 80-year-old male patient admitted to a Saudi hospital is found confused at night, agitated, and pulling at his IV line. He was alert on admission 2 days ago. Which condition should the nurse suspect FIRST?
- Delirium (Correct answer)
- Dementia
- Depression
- Normal aging
Correct answer: Delirium
The acute onset of confusion in a previously alert elderly patient is characteristic of delirium, not dementia (which has a gradual onset) or depression. Night-time worsening (sundowning pattern) is common in delirium. Immediate assessment for underlying causes — infection, medication toxicity, electrolyte imbalance, and hypoxia — is required. This is never 'normal aging.'
Question 2: When administering medications to elderly patients in a Saudi long-term care setting, the nurse should be aware that age-related changes in renal function primarily affect which pharmacokinetic parameter?
- Drug excretion (Correct answer)
- Drug absorption
- Drug distribution
- Drug metabolism in the liver
Correct answer: Drug excretion
Aging causes a progressive decline in glomerular filtration rate (GFR), reducing renal drug excretion. This leads to drug accumulation and toxicity risk, especially with renally cleared drugs (e.g., digoxin, aminoglycosides, metformin). Absorption changes are minor; distribution is affected by body composition changes; hepatic metabolism declines but less predictably than renal excretion.
Question 3: A nurse in a Saudi geriatric ward is using the Braden Scale for an 85-year-old bedridden patient with urinary incontinence and poor nutrition. A Braden score of 14 indicates the patient is at which level of pressure injury risk?
- No risk (score 19–23)
- Mild risk (score 15–18)
- Moderate risk (score 13–14) (Correct answer)
- High risk (score 10–12)
Correct answer: Moderate risk (score 13–14)
On the Braden Scale, a score of 13–14 indicates moderate risk for pressure injury development. Given the patient's incontinence, poor nutrition, and immobility, preventive measures (repositioning every 2 hours, moisture barrier creams, nutritional support) should be implemented immediately per Saudi MOH Pressure Injury Prevention guidelines.
Question 4: Which physiological change of normal aging MOST directly increases an elderly patient's risk for hypothermia in air-conditioned Saudi hospital environments?
- Decreased subcutaneous fat and impaired thermoregulatory mechanisms (Correct answer)
- Increased basal metabolic rate
- Increased sensitivity of peripheral thermoreceptors
- Thickening of the skin epidermis
Correct answer: Decreased subcutaneous fat and impaired thermoregulatory mechanisms
Normal aging leads to loss of subcutaneous adipose tissue (which provides insulation) and impaired hypothalamic thermoregulation, reducing the body's ability to generate and retain heat. This makes elderly patients in heavily air-conditioned Saudi hospital rooms particularly vulnerable to hypothermia. Basal metabolic rate decreases (not increases) with age; peripheral thermoreceptor sensitivity diminishes; skin becomes thinner, not thicker.
Question 5: An elderly Saudi woman is admitted after a fall at home. Assessment reveals she takes multiple medications including a calcium channel blocker, a diuretic, and a sleeping tablet. Which factor from her medication list MOST contributes to fall risk?
- The sleeping tablet (sedative/hypnotic) (Correct answer)
- The calcium channel blocker alone
- The diuretic alone
- Taking three medications simultaneously
Correct answer: The sleeping tablet (sedative/hypnotic)
Sedative and hypnotic medications are classified as high-risk 'Beers Criteria' drugs for elderly patients because they cause excessive sedation, impaired balance, and psychomotor slowing — all direct fall risk factors. While calcium channel blockers may cause orthostatic hypotension and diuretics may cause dehydration/electrolyte imbalance, the sedative is the single greatest fall risk in this scenario. Polypharmacy in general also increases risk, but the question asks for the single MOST contributing factor.
Question 6: When assessing cognitive status in an elderly Saudi patient using the Mini-Mental State Examination (MMSE), a score of 20 out of 30 suggests:
- Normal cognition (24–30)
- Mild cognitive impairment (18–23) (Correct answer)
- Moderate cognitive impairment (10–17)
- Severe cognitive impairment (<10)
Correct answer: Mild cognitive impairment (18–23)
MMSE interpretation: 24–30 = normal; 18–23 = mild cognitive impairment; 10–17 = moderate; <10 = severe. A score of 20 falls in the mild cognitive impairment range. This finding should prompt further evaluation, a safety assessment, and a care plan that includes fall prevention, medication review, and family education in accordance with Saudi MOH geriatric care standards.
