GERONTOLOGICAL NURSING-BOARD CERTIFIED (GERO-BC) QUESTIONS AND CORRECT ANSWERS WITH
DETAILED RATIONALES | LATEST VERSION PDF
SECTION ONE: QUESTIONS 1-100
1. A 78-year-old patient is admitted with delirium secondary to a urinary tract infection. Which nursing
intervention is most appropriate to manage this patient's acute cognitive changes?
A. Apply bilateral soft wrist restraints to prevent injury.
B. Assign a sitter to provide one-on-one supervision and reorientation.
C. Move the patient to a room at the end of the hall to minimize noise.
D. Administer haloperidol as a first-line treatment for agitation.
🟢B
🔴 RATIONALE: Delirium is a medical emergency often caused by infection. The priority is to ensure patient
safety and provide supportive care. Assigning a sitter for supervision and frequent reorientation is the least
restrictive and most appropriate intervention to manage acute confusion while addressing the underlying cause.
Restraints should be avoided, medication is not first-line, and moving the patient can worsen disorientation.
2. When assessing an 85-year-old patient for polypharmacy, which action is most critical for the nurse to
perform?
A. Request the patient bring all prescription bottles to each appointment.
B. Instruct the patient to stop taking any medication not prescribed by the primary care physician.
C. Implement a "brown bag" review, including all prescription, over-the-counter, and herbal supplements.
D. Verify the patient's medication list with the pharmacy database annually.
🟢C
,🔴 RATIONALE: A comprehensive "brown bag" review is the gold standard for assessing polypharmacy as it
accounts for all substances the patient ingests, including OTC drugs and supplements which are often
overlooked but can cause significant interactions. While a medication list is important, it may be incomplete.
3. An older adult with advanced dementia is admitted to the hospital from a long-term care facility. The
facility reports the patient has been refusing food and fluids. The patient's advance directive states "No
Artificial Nutrition or Hydration." What is the nurse's most appropriate initial action?
A. Initiate IV fluids to prevent dehydration.
B. Request a speech therapy consult for a swallowing evaluation.
C. Offer the patient small, frequent amounts of preferred foods and fluids by mouth.
D. Notify the healthcare provider to place a percutaneous endoscopic gastrostomy (PEG) tube.
🟢C
🔴 RATIONALE: The nurse must respect the patient's advance directive and focus on comfort and dignity.
Offering food and fluids by mouth, as tolerated, is appropriate. Forcing nutrition via IV or PEG tube violates the
patient's documented wishes. A speech consult is premature if the patient is refusing care and has clearly stated
wishes.
4. A caregiver expresses frustration and guilt about placing their spouse in a skilled nursing facility. Which
response by the nurse best reflects a therapeutic approach to support the caregiver?
A. "You did the right thing. You couldn't have managed her care at home anymore."
B. "It’s important to remember that you are doing what is best for your family."
C. "Many caregivers experience these feelings. It can be a very difficult transition."
D. "You should focus on the positive aspects of the care she is receiving here."
🟢C
🔴 RATIONALE: This response validates the caregiver's feelings of frustration and guilt, normalizing their
experience. Therapeutic communication involves acknowledging and accepting the patient's feelings without
,judgment. The other options are dismissive or offer false reassurance, which can undermine the caregiver's
sense of validation.
5. A 72-year-old patient is newly diagnosed with osteoporosis. In addition to calcium and vitamin D, which
exercise recommendation is most appropriate?
A. Swimming for 30 minutes, three times per week.
B. Progressive weight-bearing and resistance exercises.
C. Daily stretching and flexibility exercises.
D. Stationary cycling for 30 minutes daily.
🟢B
🔴 RATIONALE: Weight-bearing and resistance exercises are the most effective for stimulating bone formation
and slowing bone loss, directly addressing osteoporosis. While swimming and cycling are good cardiovascular
exercises, they do not provide the necessary mechanical stress to strengthen bones. Stretching improves
flexibility but doesn't build bone density.
6. A patient has just been informed by the primary care provider that they have a terminal illness. The
patient's initial response is "No, that can't be right. The tests must have been mixed up." This reaction is
most consistent with which stage of grief, according to Kubler-Ross?
A. Denial
B. Anger
C. Bargaining
D. Depression
🟢A
🔴 RATIONALE: The patient's statement reflects a refusal to accept the diagnosis and a questioning of the tests,
which is the classic presentation of the denial stage. This is a common initial defense mechanism that provides a
buffer against the overwhelming news of a terminal illness.
, 7. Which assessment finding in an older adult is most indicative of dehydration?
A. Skin tenting on the forehead.
B. A history of decreased oral intake.
C. A heart rate of 110 beats per minute and a blood pressure of 100/60 mmHg.
D. Dryness of the axillae.
🟢C
🔴 RATIONALE: Tachycardia and hypotension are late and serious signs of hypovolemia. They indicate a
significant decrease in circulating blood volume and are the most accurate clinical indicators of severe
dehydration. Other signs like skin turgor and mucous membrane dryness are less reliable in older adults due to
age-related skin changes.
8. An 80-year-old patient is newly prescribed a cholinesterase inhibitor. What is the priority teaching point
for this patient and their family regarding this medication?
A. The medication should be taken with meals to decrease GI upset.
B. Report any bradycardia, syncope, or dizziness to the healthcare provider.
C. The medication may cause weight loss and should be taken with a snack.
D. Taking the medication at bedtime is best for improving sleep quality.
🟢B
🔴 RATIONALE: Cholinesterase inhibitors (e.g., donepezil, rivastigmine) can cause significant bradycardia and
syncope, increasing the risk of falls and cardiac events. Reporting these symptoms is a critical safety priority.
While GI upset and weight loss are side effects, the risk of cardiac issues and syncope is the most serious and
immediate concern.
9. Which federal regulation serves as the primary legislation to prevent elder abuse, neglect, and
exploitation in nursing homes that receive Medicare or Medicaid funding?
A. The Health Insurance Portability and Accountability Act (HIPAA)
DETAILED RATIONALES | LATEST VERSION PDF
SECTION ONE: QUESTIONS 1-100
1. A 78-year-old patient is admitted with delirium secondary to a urinary tract infection. Which nursing
intervention is most appropriate to manage this patient's acute cognitive changes?
A. Apply bilateral soft wrist restraints to prevent injury.
B. Assign a sitter to provide one-on-one supervision and reorientation.
C. Move the patient to a room at the end of the hall to minimize noise.
D. Administer haloperidol as a first-line treatment for agitation.
🟢B
🔴 RATIONALE: Delirium is a medical emergency often caused by infection. The priority is to ensure patient
safety and provide supportive care. Assigning a sitter for supervision and frequent reorientation is the least
restrictive and most appropriate intervention to manage acute confusion while addressing the underlying cause.
Restraints should be avoided, medication is not first-line, and moving the patient can worsen disorientation.
2. When assessing an 85-year-old patient for polypharmacy, which action is most critical for the nurse to
perform?
A. Request the patient bring all prescription bottles to each appointment.
B. Instruct the patient to stop taking any medication not prescribed by the primary care physician.
C. Implement a "brown bag" review, including all prescription, over-the-counter, and herbal supplements.
D. Verify the patient's medication list with the pharmacy database annually.
🟢C
,🔴 RATIONALE: A comprehensive "brown bag" review is the gold standard for assessing polypharmacy as it
accounts for all substances the patient ingests, including OTC drugs and supplements which are often
overlooked but can cause significant interactions. While a medication list is important, it may be incomplete.
3. An older adult with advanced dementia is admitted to the hospital from a long-term care facility. The
facility reports the patient has been refusing food and fluids. The patient's advance directive states "No
Artificial Nutrition or Hydration." What is the nurse's most appropriate initial action?
A. Initiate IV fluids to prevent dehydration.
B. Request a speech therapy consult for a swallowing evaluation.
C. Offer the patient small, frequent amounts of preferred foods and fluids by mouth.
D. Notify the healthcare provider to place a percutaneous endoscopic gastrostomy (PEG) tube.
🟢C
🔴 RATIONALE: The nurse must respect the patient's advance directive and focus on comfort and dignity.
Offering food and fluids by mouth, as tolerated, is appropriate. Forcing nutrition via IV or PEG tube violates the
patient's documented wishes. A speech consult is premature if the patient is refusing care and has clearly stated
wishes.
4. A caregiver expresses frustration and guilt about placing their spouse in a skilled nursing facility. Which
response by the nurse best reflects a therapeutic approach to support the caregiver?
A. "You did the right thing. You couldn't have managed her care at home anymore."
B. "It’s important to remember that you are doing what is best for your family."
C. "Many caregivers experience these feelings. It can be a very difficult transition."
D. "You should focus on the positive aspects of the care she is receiving here."
🟢C
🔴 RATIONALE: This response validates the caregiver's feelings of frustration and guilt, normalizing their
experience. Therapeutic communication involves acknowledging and accepting the patient's feelings without
,judgment. The other options are dismissive or offer false reassurance, which can undermine the caregiver's
sense of validation.
5. A 72-year-old patient is newly diagnosed with osteoporosis. In addition to calcium and vitamin D, which
exercise recommendation is most appropriate?
A. Swimming for 30 minutes, three times per week.
B. Progressive weight-bearing and resistance exercises.
C. Daily stretching and flexibility exercises.
D. Stationary cycling for 30 minutes daily.
🟢B
🔴 RATIONALE: Weight-bearing and resistance exercises are the most effective for stimulating bone formation
and slowing bone loss, directly addressing osteoporosis. While swimming and cycling are good cardiovascular
exercises, they do not provide the necessary mechanical stress to strengthen bones. Stretching improves
flexibility but doesn't build bone density.
6. A patient has just been informed by the primary care provider that they have a terminal illness. The
patient's initial response is "No, that can't be right. The tests must have been mixed up." This reaction is
most consistent with which stage of grief, according to Kubler-Ross?
A. Denial
B. Anger
C. Bargaining
D. Depression
🟢A
🔴 RATIONALE: The patient's statement reflects a refusal to accept the diagnosis and a questioning of the tests,
which is the classic presentation of the denial stage. This is a common initial defense mechanism that provides a
buffer against the overwhelming news of a terminal illness.
, 7. Which assessment finding in an older adult is most indicative of dehydration?
A. Skin tenting on the forehead.
B. A history of decreased oral intake.
C. A heart rate of 110 beats per minute and a blood pressure of 100/60 mmHg.
D. Dryness of the axillae.
🟢C
🔴 RATIONALE: Tachycardia and hypotension are late and serious signs of hypovolemia. They indicate a
significant decrease in circulating blood volume and are the most accurate clinical indicators of severe
dehydration. Other signs like skin turgor and mucous membrane dryness are less reliable in older adults due to
age-related skin changes.
8. An 80-year-old patient is newly prescribed a cholinesterase inhibitor. What is the priority teaching point
for this patient and their family regarding this medication?
A. The medication should be taken with meals to decrease GI upset.
B. Report any bradycardia, syncope, or dizziness to the healthcare provider.
C. The medication may cause weight loss and should be taken with a snack.
D. Taking the medication at bedtime is best for improving sleep quality.
🟢B
🔴 RATIONALE: Cholinesterase inhibitors (e.g., donepezil, rivastigmine) can cause significant bradycardia and
syncope, increasing the risk of falls and cardiac events. Reporting these symptoms is a critical safety priority.
While GI upset and weight loss are side effects, the risk of cardiac issues and syncope is the most serious and
immediate concern.
9. Which federal regulation serves as the primary legislation to prevent elder abuse, neglect, and
exploitation in nursing homes that receive Medicare or Medicaid funding?
A. The Health Insurance Portability and Accountability Act (HIPAA)
