NUR 218 GERONTOLOGICAL NURSING EXAM GUIDE
2026 EDITION Q&A
An 82-year-old patient with Alzheimer's disease is exhibiting
sundowning behavior. Which intervention should the nurse prioritize?
A. Restraining the patient during evening hours
B. Increasing lighting in the evening and maintaining a calm routine
C. Administering sedatives before sunset
D. Isolating the patient in a dark room
Correct Answer: B
Explanation: Sundowning is characterized by increased confusion and
agitation in the evening. Increasing lighting and maintaining a calm
routine helps reduce confusion. Restraints and isolation are
inappropriate, and sedatives can worsen confusion in elderly patients
with dementia.
A 78-year-old patient with advanced kidney disease presents with
altered mental status. Which age-related change most significantly
affects drug metabolism in this patient?
A. Increased hepatic blood flow
B. Decreased glomerular filtration rate
C. Increased protein binding capacity
D. Enhanced first-pass metabolism
Correct Answer: B
Explanation: Age-related decline in glomerular filtration rate (GFR)
significantly reduces drug clearance, leading to drug accumulation and
toxicity. Hepatic blood flow decreases with age, protein binding capacity
typically decreases, and first-pass metabolism is reduced, not enhanced.
,An 85-year-old patient presents with hip fracture after a fall at home.
Which factor is MOST predictive of future falls in this patient?
A. Age over 80 years
B. History of previous falls
C. Use of walking aid
D. Living alone
Correct Answer: B
Explanation: History of previous falls is the single strongest predictor of
future falls in older adults. While age, use of walking aids, and living
situation are risk factors, prior fall history has the highest predictive
value.
A 79-year-old patient with heart failure is prescribed digoxin. Which
laboratory value requires the MOST careful monitoring due to age-
related changes?
A. Serum sodium
B. Serum potassium
C. Blood glucose
D. Serum calcium
Correct Answer: B
Explanation: Hypokalemia increases the risk of digoxin toxicity, which is
particularly dangerous in elderly patients due to decreased renal
clearance. Age-related decline in kidney function makes potassium
monitoring critical for safe digoxin therapy.
,An 88-year-old patient with dementia becomes increasingly aggressive
when family members leave. What is the best nursing intervention?
A. Sedate the patient before family visits
B. Use distraction techniques and acknowledge the patient's feelings
C. Restrict family visits to short periods
D. Tell the patient the family will return immediately
Correct Answer: B
Explanation: Distraction techniques and validation therapy
(acknowledging feelings) are evidence-based approaches for managing
separation anxiety in dementia patients. Sedation is inappropriate,
restricting visits isolates the patient, and false reassurance undermines
trust.
Which age-related physiological change most contributes to increased
risk of pressure ulcers in older adults?
A. Increased subcutaneous fat
B. Decreased skin elasticity and thinning of epidermis
C. Enhanced wound healing capacity
D. Increased sebaceous gland activity
Correct Answer: B
Explanation: Age-related skin changes include decreased elasticity,
epidermal thinning, and reduced subcutaneous fat, all of which increase
vulnerability to pressure ulcers. Wound healing is delayed, not
enhanced, and sebaceous gland activity decreases with age.
A 76-year-old patient with pneumonia presents with atypical symptoms.
Which manifestation is MOST common in elderly patients with
, pneumonia?
A. High fever and productive cough
B. Confusion and functional decline
C. Chest pain and hemoptysis
D. Severe dyspnea and wheezing
Correct Answer: B
Explanation: Elderly patients often present with atypical symptoms like
confusion, delirium, and functional decline rather than classic signs like
fever and productive cough. This atypical presentation is due to blunted
immune response and age-related changes.
An 83-year-old patient with osteoporosis is prescribed
bisphosphonates. Which instruction is MOST important for the nurse to
provide?
A. Take with food to reduce stomach upset
B. Remain upright for 30 minutes after taking the medication
C. Take at bedtime for better absorption
D. Crush the tablet for easier swallowing
Correct Answer: B
Explanation: Bisphosphonates must be taken on an empty stomach with
full glass of water, and patients must remain upright for 30 minutes to
prevent esophageal irritation and ulceration. Taking with food, at
bedtime, or crushing the tablet reduces effectiveness or causes harm.
A 90-year-old patient exhibits urinary incontinence. Which type is MOST
common in this age group?
A. Stress incontinence
2026 EDITION Q&A
An 82-year-old patient with Alzheimer's disease is exhibiting
sundowning behavior. Which intervention should the nurse prioritize?
A. Restraining the patient during evening hours
B. Increasing lighting in the evening and maintaining a calm routine
C. Administering sedatives before sunset
D. Isolating the patient in a dark room
Correct Answer: B
Explanation: Sundowning is characterized by increased confusion and
agitation in the evening. Increasing lighting and maintaining a calm
routine helps reduce confusion. Restraints and isolation are
inappropriate, and sedatives can worsen confusion in elderly patients
with dementia.
A 78-year-old patient with advanced kidney disease presents with
altered mental status. Which age-related change most significantly
affects drug metabolism in this patient?
A. Increased hepatic blood flow
B. Decreased glomerular filtration rate
C. Increased protein binding capacity
D. Enhanced first-pass metabolism
Correct Answer: B
Explanation: Age-related decline in glomerular filtration rate (GFR)
significantly reduces drug clearance, leading to drug accumulation and
toxicity. Hepatic blood flow decreases with age, protein binding capacity
typically decreases, and first-pass metabolism is reduced, not enhanced.
,An 85-year-old patient presents with hip fracture after a fall at home.
Which factor is MOST predictive of future falls in this patient?
A. Age over 80 years
B. History of previous falls
C. Use of walking aid
D. Living alone
Correct Answer: B
Explanation: History of previous falls is the single strongest predictor of
future falls in older adults. While age, use of walking aids, and living
situation are risk factors, prior fall history has the highest predictive
value.
A 79-year-old patient with heart failure is prescribed digoxin. Which
laboratory value requires the MOST careful monitoring due to age-
related changes?
A. Serum sodium
B. Serum potassium
C. Blood glucose
D. Serum calcium
Correct Answer: B
Explanation: Hypokalemia increases the risk of digoxin toxicity, which is
particularly dangerous in elderly patients due to decreased renal
clearance. Age-related decline in kidney function makes potassium
monitoring critical for safe digoxin therapy.
,An 88-year-old patient with dementia becomes increasingly aggressive
when family members leave. What is the best nursing intervention?
A. Sedate the patient before family visits
B. Use distraction techniques and acknowledge the patient's feelings
C. Restrict family visits to short periods
D. Tell the patient the family will return immediately
Correct Answer: B
Explanation: Distraction techniques and validation therapy
(acknowledging feelings) are evidence-based approaches for managing
separation anxiety in dementia patients. Sedation is inappropriate,
restricting visits isolates the patient, and false reassurance undermines
trust.
Which age-related physiological change most contributes to increased
risk of pressure ulcers in older adults?
A. Increased subcutaneous fat
B. Decreased skin elasticity and thinning of epidermis
C. Enhanced wound healing capacity
D. Increased sebaceous gland activity
Correct Answer: B
Explanation: Age-related skin changes include decreased elasticity,
epidermal thinning, and reduced subcutaneous fat, all of which increase
vulnerability to pressure ulcers. Wound healing is delayed, not
enhanced, and sebaceous gland activity decreases with age.
A 76-year-old patient with pneumonia presents with atypical symptoms.
Which manifestation is MOST common in elderly patients with
, pneumonia?
A. High fever and productive cough
B. Confusion and functional decline
C. Chest pain and hemoptysis
D. Severe dyspnea and wheezing
Correct Answer: B
Explanation: Elderly patients often present with atypical symptoms like
confusion, delirium, and functional decline rather than classic signs like
fever and productive cough. This atypical presentation is due to blunted
immune response and age-related changes.
An 83-year-old patient with osteoporosis is prescribed
bisphosphonates. Which instruction is MOST important for the nurse to
provide?
A. Take with food to reduce stomach upset
B. Remain upright for 30 minutes after taking the medication
C. Take at bedtime for better absorption
D. Crush the tablet for easier swallowing
Correct Answer: B
Explanation: Bisphosphonates must be taken on an empty stomach with
full glass of water, and patients must remain upright for 30 minutes to
prevent esophageal irritation and ulceration. Taking with food, at
bedtime, or crushing the tablet reduces effectiveness or causes harm.
A 90-year-old patient exhibits urinary incontinence. Which type is MOST
common in this age group?
A. Stress incontinence
