GALEN COLLEGE OF NURSING – NU 176 GERIATRIC
NURSING EXAM 4 – QUESTIONS AND ANSWERS |
2026/2027 LATEST UPDATE
SECTION 1: Mental Health in Older Adults
Questions 1–15
1. Which assessment finding most strongly suggests depression rather than a normal
response to an isolated disappointing event?
A) Persistent loss of interest in previously enjoyable activities
B) Occasional sadness after receiving bad news
C) Temporary frustration with a family member
D) Mild concern about an upcoming appointment
Correct Answer: Persistent loss of interest in previously enjoyable activities
Rationale: Persistent loss of interest or pleasure is a central feature of depressive illness and
deserves further assessment in an older adult. Depression should not be dismissed as an
inevitable consequence of aging. Nurses should evaluate mood, function, sleep, appetite,
cognition, medications, social circumstances, and suicidal thoughts when depression is
suspected.
2. Why can depression in an older adult be difficult to recognize?
A) Older adults never experience depression
B) Symptoms may appear primarily as physical or cognitive complaints
C) Depression always produces obvious sadness
D) Depression has no effect on function
Correct Answer: Symptoms may appear primarily as physical or cognitive complaints
Rationale: Older adults may report fatigue, sleep disturbance, appetite changes, pain, or
cognitive difficulties rather than describing sadness directly. These manifestations can be
mistaken for physical illness or normal aging. A comprehensive assessment helps distinguish
depression from medical conditions and recognizes potentially treatable mental-health problems.
, 3. Which statement best describes an appropriate approach to suicide assessment?
A) Asking about suicide increases the likelihood of suicide
B) Suicidal thoughts should be discussed only after discharge
C) Directly assess for suicidal thoughts, plans, means, and intent
D) Suicide risk can be excluded when the person denies sadness
Correct Answer: Directly assess for suicidal thoughts, plans, means, and intent
Rationale: Direct questioning about suicidal thoughts does not cause suicide and is an important
component of safety assessment. Nurses should determine whether thoughts are present and
assess planning, access to means, intent, previous attempts, and protective factors. Any
significant risk requires prompt intervention and appropriate safety measures.
4. Which medication class is often preferred for depression in older adults because it
generally produces fewer anticholinergic effects than tricyclic antidepressants?
A) Selective serotonin reuptake inhibitors
B) Barbiturates
C) First-generation antihistamines
D) Anticholinergic agents
Correct Answer: Selective serotonin reuptake inhibitors
Rationale: Selective serotonin reuptake inhibitors are commonly used in older adults because
they generally have fewer anticholinergic effects than tricyclic antidepressants. Anticholinergic
effects can worsen constipation, urinary retention, dry mouth, blurred vision, and cognitive
impairment. Medication selection still requires individualized evaluation of interactions, adverse
effects, and comorbidities.
5. An older adult has recently lost a spouse and reports loneliness but continues eating,
sleeping, socializing, and managing daily responsibilities. Which nursing interpretation is
most appropriate?
A) The individual necessarily has major depression
B) The response may represent an expected grief reaction
C) Immediate psychiatric hospitalization is required
D) Antidepressant therapy is automatically indicated
Correct Answer: The response may represent an expected grief reaction
,Rationale: Grief is a normal response to significant loss and does not automatically represent a
depressive disorder. Nurses should assess the person’s functioning, duration and intensity of
symptoms, coping mechanisms, and safety. Persistent functional impairment, severe
hopelessness, suicidal thinking, or other concerning features require further evaluation.
6. Which environmental intervention is most appropriate for reducing anxiety in an older
adult experiencing stress from hospitalization?
A) Frequently changing caregivers
B) Moving the individual between rooms
C) Maintaining familiar routines and surroundings when possible
D) Providing continuous unfamiliar stimulation
Correct Answer: Maintaining familiar routines and surroundings when possible
Rationale: Hospitalization can be stressful because it disrupts routines, surroundings, sleep,
independence, and familiar relationships. Maintaining predictable routines and familiar objects
can promote orientation and reduce anxiety. NIA similarly emphasizes familiar environments,
meaningful activities, and caregiver support when caring for people with cognitive impairment.
7. What is the primary nursing goal when caring for an older adult experiencing acute
agitation?
A) Preserve safety while identifying and addressing the underlying cause
B) Immediately apply restraints
C) Argue with the individual about the behavior
D) Ignore the behavior until it resolves
Correct Answer: Preserve safety while identifying and addressing the underlying cause
Rationale: Agitation may result from delirium, dementia, pain, medication effects, fear, infection,
environmental stress, or other conditions. Safety comes first, but simply suppressing behavior
does not address its cause. Calm communication, environmental modification, assessment for
reversible causes, and least-restrictive interventions are preferred.
8. Which behavior should alert the nurse to a possible escalation toward violence?
A) Quiet reading
B) Slow speech
C) Increased pacing and threatening comments
, D) Asking for assistance
Correct Answer: Increased pacing and threatening comments
Rationale: Escalating agitation may appear as increased pacing, louder speech, irritability,
threatening comments, clenched fists, or increasingly rapid movements. Early recognition
provides an opportunity to de-escalate before violence occurs. The nurse should maintain a calm
approach, provide appropriate space, remove others from danger, and summon assistance when
needed.
9. A nursing intervention for an older adult experiencing anxiety should emphasize which
principle?
A) Increasing environmental stimulation
B) Using calm communication and predictable routines
C) Avoiding all conversation
D) Changing caregivers frequently
Correct Answer: Using calm communication and predictable routines
Rationale: Predictability and calm communication can reduce anxiety, especially when cognitive
impairment or unfamiliar surroundings are present. Nurses should speak clearly, allow adequate
processing time, and avoid overwhelming the individual with multiple instructions. Consistent
caregivers and familiar routines can further support emotional stability.
10. Which finding warrants the most immediate follow-up during a mental-health
assessment?
A) Occasional boredom
B) Mild frustration with an activity
C) Preference for spending time alone
D) Giving away possessions while expressing hopelessness
Correct Answer: Giving away possessions while expressing hopelessness
Rationale: Giving away possessions can be a warning sign of suicidal intent, particularly when
accompanied by hopelessness or withdrawal. The nurse should immediately assess suicidal
thoughts, plans, means, and intent and implement appropriate safety precautions. Older adults
may have substantial suicide risk even when obvious emotional distress is not initially reported.
NURSING EXAM 4 – QUESTIONS AND ANSWERS |
2026/2027 LATEST UPDATE
SECTION 1: Mental Health in Older Adults
Questions 1–15
1. Which assessment finding most strongly suggests depression rather than a normal
response to an isolated disappointing event?
A) Persistent loss of interest in previously enjoyable activities
B) Occasional sadness after receiving bad news
C) Temporary frustration with a family member
D) Mild concern about an upcoming appointment
Correct Answer: Persistent loss of interest in previously enjoyable activities
Rationale: Persistent loss of interest or pleasure is a central feature of depressive illness and
deserves further assessment in an older adult. Depression should not be dismissed as an
inevitable consequence of aging. Nurses should evaluate mood, function, sleep, appetite,
cognition, medications, social circumstances, and suicidal thoughts when depression is
suspected.
2. Why can depression in an older adult be difficult to recognize?
A) Older adults never experience depression
B) Symptoms may appear primarily as physical or cognitive complaints
C) Depression always produces obvious sadness
D) Depression has no effect on function
Correct Answer: Symptoms may appear primarily as physical or cognitive complaints
Rationale: Older adults may report fatigue, sleep disturbance, appetite changes, pain, or
cognitive difficulties rather than describing sadness directly. These manifestations can be
mistaken for physical illness or normal aging. A comprehensive assessment helps distinguish
depression from medical conditions and recognizes potentially treatable mental-health problems.
, 3. Which statement best describes an appropriate approach to suicide assessment?
A) Asking about suicide increases the likelihood of suicide
B) Suicidal thoughts should be discussed only after discharge
C) Directly assess for suicidal thoughts, plans, means, and intent
D) Suicide risk can be excluded when the person denies sadness
Correct Answer: Directly assess for suicidal thoughts, plans, means, and intent
Rationale: Direct questioning about suicidal thoughts does not cause suicide and is an important
component of safety assessment. Nurses should determine whether thoughts are present and
assess planning, access to means, intent, previous attempts, and protective factors. Any
significant risk requires prompt intervention and appropriate safety measures.
4. Which medication class is often preferred for depression in older adults because it
generally produces fewer anticholinergic effects than tricyclic antidepressants?
A) Selective serotonin reuptake inhibitors
B) Barbiturates
C) First-generation antihistamines
D) Anticholinergic agents
Correct Answer: Selective serotonin reuptake inhibitors
Rationale: Selective serotonin reuptake inhibitors are commonly used in older adults because
they generally have fewer anticholinergic effects than tricyclic antidepressants. Anticholinergic
effects can worsen constipation, urinary retention, dry mouth, blurred vision, and cognitive
impairment. Medication selection still requires individualized evaluation of interactions, adverse
effects, and comorbidities.
5. An older adult has recently lost a spouse and reports loneliness but continues eating,
sleeping, socializing, and managing daily responsibilities. Which nursing interpretation is
most appropriate?
A) The individual necessarily has major depression
B) The response may represent an expected grief reaction
C) Immediate psychiatric hospitalization is required
D) Antidepressant therapy is automatically indicated
Correct Answer: The response may represent an expected grief reaction
,Rationale: Grief is a normal response to significant loss and does not automatically represent a
depressive disorder. Nurses should assess the person’s functioning, duration and intensity of
symptoms, coping mechanisms, and safety. Persistent functional impairment, severe
hopelessness, suicidal thinking, or other concerning features require further evaluation.
6. Which environmental intervention is most appropriate for reducing anxiety in an older
adult experiencing stress from hospitalization?
A) Frequently changing caregivers
B) Moving the individual between rooms
C) Maintaining familiar routines and surroundings when possible
D) Providing continuous unfamiliar stimulation
Correct Answer: Maintaining familiar routines and surroundings when possible
Rationale: Hospitalization can be stressful because it disrupts routines, surroundings, sleep,
independence, and familiar relationships. Maintaining predictable routines and familiar objects
can promote orientation and reduce anxiety. NIA similarly emphasizes familiar environments,
meaningful activities, and caregiver support when caring for people with cognitive impairment.
7. What is the primary nursing goal when caring for an older adult experiencing acute
agitation?
A) Preserve safety while identifying and addressing the underlying cause
B) Immediately apply restraints
C) Argue with the individual about the behavior
D) Ignore the behavior until it resolves
Correct Answer: Preserve safety while identifying and addressing the underlying cause
Rationale: Agitation may result from delirium, dementia, pain, medication effects, fear, infection,
environmental stress, or other conditions. Safety comes first, but simply suppressing behavior
does not address its cause. Calm communication, environmental modification, assessment for
reversible causes, and least-restrictive interventions are preferred.
8. Which behavior should alert the nurse to a possible escalation toward violence?
A) Quiet reading
B) Slow speech
C) Increased pacing and threatening comments
, D) Asking for assistance
Correct Answer: Increased pacing and threatening comments
Rationale: Escalating agitation may appear as increased pacing, louder speech, irritability,
threatening comments, clenched fists, or increasingly rapid movements. Early recognition
provides an opportunity to de-escalate before violence occurs. The nurse should maintain a calm
approach, provide appropriate space, remove others from danger, and summon assistance when
needed.
9. A nursing intervention for an older adult experiencing anxiety should emphasize which
principle?
A) Increasing environmental stimulation
B) Using calm communication and predictable routines
C) Avoiding all conversation
D) Changing caregivers frequently
Correct Answer: Using calm communication and predictable routines
Rationale: Predictability and calm communication can reduce anxiety, especially when cognitive
impairment or unfamiliar surroundings are present. Nurses should speak clearly, allow adequate
processing time, and avoid overwhelming the individual with multiple instructions. Consistent
caregivers and familiar routines can further support emotional stability.
10. Which finding warrants the most immediate follow-up during a mental-health
assessment?
A) Occasional boredom
B) Mild frustration with an activity
C) Preference for spending time alone
D) Giving away possessions while expressing hopelessness
Correct Answer: Giving away possessions while expressing hopelessness
Rationale: Giving away possessions can be a warning sign of suicidal intent, particularly when
accompanied by hopelessness or withdrawal. The nurse should immediately assess suicidal
thoughts, plans, means, and intent and implement appropriate safety precautions. Older adults
may have substantial suicide risk even when obvious emotional distress is not initially reported.
