NU 176 GERIATRIC NURSING EXAM 4 (GALEN COLLEGE OF NURSING) |
COMPREHENSIVE EXAM PRACTICE | ACTUAL STUDY GUIDE & FULL TESTBANK | 150
ADVANCED PRACTICE QUESTIONS WITH CORRECT ANSWERS & RATIONALES |
2026/2027 LATEST UPDATE
I. Comprehensive Geriatric Assessment and Functional Status
II. Neurocognitive Disorders, Delirium, and Dementia
III. Medication Management and Polypharmacy
IV. Cardiovascular, Respiratory, and Renal Disorders
V. Endocrine, Metabolic, and Nutritional Concerns
VI. Mobility, Falls, Osteoporosis, and Musculoskeletal Health
VII. Skin Integrity, Wounds, and Pressure Injuries
VIII. Sensory, Communication, and Psychosocial Health
IX. Infection Prevention and Immune Function
X. Palliative Care, End-of-Life Care, and Ethical Decision-Making
XI. Safety, Abuse, Neglect, and Health Promotion
XII. Complex Clinical Decision-Making in Older Adults
DESCRIPTION
This comprehensive NU 176 Geriatric Nursing Exam 4 practice resource evaluates
advanced knowledge and clinical judgment in the care of older adults. It covers geriatric
assessment, cognition, delirium, dementia, pharmacology, chronic illness, mobility,
nutrition, skin integrity, sensory changes, psychosocial health, safety, ethics, palliative
care, and end-of-life management. Designed for nursing students preparing for
advanced examinations, the resource emphasizes application, prioritization, clinical
reasoning, and evidence-based decision-making rather than simple recall. Students
should expect 100+ questions and answers with a rationale addressing realistic geriatric
scenarios and complex nursing decisions. Purchase and instantly get a downloadable
and editable PDF for convenient study and review.
QUESTIONS 1–150
QUESTION 1
An 82-year-old hospitalized patient becomes acutely confused overnight. The patient's
family reports that the patient was oriented and independent two days ago. Assessment
reveals fluctuating attention, disorganized thinking, and visual hallucinations. Which
nursing action is the priority?
A. Arrange formal cognitive testing for dementia.
B. Assess for reversible causes of acute confusion.
C. Place the patient in a dark, quiet room.
D. Explain that hallucinations are expected with aging.
,🔴 Correct Answer: B. Assess for reversible causes of acute confusion.
🔵 Explanation: Acute onset, fluctuating attention, and altered cognition strongly suggest
delirium rather than normal aging or established dementia. The nurse should immediately
investigate reversible causes such as infection, hypoxia, medication effects, dehydration,
metabolic abnormalities, pain, or urinary retention.
QUESTION 2
A 79-year-old patient with dementia repeatedly attempts to leave the unit. The patient
is not physically aggressive but cannot explain where they are going. Which intervention
should the nurse implement first?
A. Apply wrist restraints.
B. Administer a sedative medication.
C. Identify and address the patient's underlying need.
D. Prevent all ambulation until the behavior stops.
🔴 Correct Answer: C. Identify and address the patient's underlying need.
🔵 Explanation: Wandering may reflect unmet needs such as toileting, hunger, pain,
anxiety, boredom, or a desire for a familiar environment. Nonpharmacologic assessment
and redirection are preferred before restrictive interventions or sedating medications.
QUESTION 3
An older adult taking digoxin, furosemide, and lisinopril reports anorexia, nausea, and
new visual disturbances. The apical pulse is 54/min. Which action should the nurse take
first?
A. Administer the scheduled digoxin.
B. Encourage increased dietary sodium.
C. Hold digoxin and notify the provider.
D. Administer an additional dose of furosemide.
🔴 Correct Answer: C. Hold digoxin and notify the provider.
🔵 Explanation: Bradycardia, gastrointestinal symptoms, and visual changes are
concerning for digoxin toxicity. Older adults are particularly vulnerable because of altered
renal clearance and polypharmacy. The medication should be withheld and the provider
notified for further evaluation.
QUESTION 4
An 88-year-old patient with heart failure has gained 2.5 kg over four days. Which
finding most strongly indicates fluid retention?
,A. Dry oral mucosa
B. Decreased jugular venous pressure
C. Bilateral dependent edema and increasing dyspnea
D. Reduced blood pressure with orthostatic symptoms
🔴 Correct Answer: C. Bilateral dependent edema and increasing dyspnea.
🔵 Explanation: Rapid weight gain accompanied by edema and dyspnea strongly
suggests fluid accumulation associated with worsening heart failure. Daily weight is one
of the most sensitive indicators of changes in fluid status.
QUESTION 5
A nurse is assessing an 84-year-old who reports dizziness immediately after standing.
Which intervention is most appropriate?
A. Encourage rapid position changes to improve tolerance.
B. Assess orthostatic vital signs and medication effects.
C. Restrict oral fluids.
D. Recommend prolonged bed rest.
🔴 Correct Answer: B. Assess orthostatic vital signs and medication effects.
🔵 Explanation: Orthostatic hypotension is common in older adults and may be
associated with dehydration, autonomic dysfunction, or medications such as
antihypertensives and diuretics. Assessment should precede targeted intervention.
QUESTION 6
An older adult with diabetes has an HbA1c of 6.0% while taking multiple glucose-
lowering medications. The patient has experienced several episodes of symptomatic
hypoglycemia. Which principle should guide nursing advocacy?
A. Tight glycemic control is always the primary goal.
B. Older adults should maintain the same glucose targets as young adults.
C. Treatment goals should be individualized according to risks and overall health.
D. Hypoglycemia is preferable to mild hyperglycemia.
🔴 Correct Answer: C. Treatment goals should be individualized according to risks
and overall health.
🔵 Explanation: Glycemic targets in older adults should account for comorbidities,
functional status, life expectancy, treatment burden, and hypoglycemia risk. Avoiding
recurrent hypoglycemia is particularly important because it can cause falls, cardiovascular
events, and cognitive impairment.
QUESTION 7
, A 76-year-old patient with pneumonia is receiving oxygen. Which assessment finding
requires immediate nursing intervention?
A. Respiratory rate of 22/min
B. Oxygen saturation of 88% despite prescribed oxygen
C. Productive cough with yellow sputum
D. Temperature of 37.8°C
🔴 Correct Answer: B. Oxygen saturation of 88% despite prescribed oxygen.
🔵 Explanation: Persistent hypoxemia despite supplemental oxygen requires immediate
assessment and intervention. Older adults may deteriorate rapidly with respiratory
compromise, so airway, breathing, oxygen delivery, and the underlying cause must be
evaluated promptly.
QUESTION 8
An 81-year-old patient has chronic kidney disease and is prescribed a medication
primarily eliminated by the kidneys. Which nursing consideration is most important?
A. Renal function may require dosage adjustment.
B. Age eliminates the need for medication monitoring.
C. The medication should automatically be discontinued.
D. Serum creatinine is irrelevant in older adults.
🔴 Correct Answer: A. Renal function may require dosage adjustment.
🔵 Explanation: Declining renal function is common with aging and can substantially
increase exposure to renally cleared medications. Medication dosing should be based on
appropriate renal function estimates and the patient's clinical status.
QUESTION 9
A 90-year-old patient has an elevated serum creatinine that appears only mildly
abnormal. Why should the nurse avoid assuming renal function is normal?
A. Older adults always have elevated creatinine.
B. Reduced muscle mass can mask decreased renal function.
C. Creatinine has no relationship to kidney function.
D. Serum creatinine increases only with dehydration.
🔴 Correct Answer: B. Reduced muscle mass can mask decreased renal function.
🔵 Explanation: Serum creatinine is influenced by muscle mass. Sarcopenia in older adults
may produce a deceptively low or modest creatinine concentration despite reduced
glomerular filtration, making clinical interpretation and estimated renal function
important.
COMPREHENSIVE EXAM PRACTICE | ACTUAL STUDY GUIDE & FULL TESTBANK | 150
ADVANCED PRACTICE QUESTIONS WITH CORRECT ANSWERS & RATIONALES |
2026/2027 LATEST UPDATE
I. Comprehensive Geriatric Assessment and Functional Status
II. Neurocognitive Disorders, Delirium, and Dementia
III. Medication Management and Polypharmacy
IV. Cardiovascular, Respiratory, and Renal Disorders
V. Endocrine, Metabolic, and Nutritional Concerns
VI. Mobility, Falls, Osteoporosis, and Musculoskeletal Health
VII. Skin Integrity, Wounds, and Pressure Injuries
VIII. Sensory, Communication, and Psychosocial Health
IX. Infection Prevention and Immune Function
X. Palliative Care, End-of-Life Care, and Ethical Decision-Making
XI. Safety, Abuse, Neglect, and Health Promotion
XII. Complex Clinical Decision-Making in Older Adults
DESCRIPTION
This comprehensive NU 176 Geriatric Nursing Exam 4 practice resource evaluates
advanced knowledge and clinical judgment in the care of older adults. It covers geriatric
assessment, cognition, delirium, dementia, pharmacology, chronic illness, mobility,
nutrition, skin integrity, sensory changes, psychosocial health, safety, ethics, palliative
care, and end-of-life management. Designed for nursing students preparing for
advanced examinations, the resource emphasizes application, prioritization, clinical
reasoning, and evidence-based decision-making rather than simple recall. Students
should expect 100+ questions and answers with a rationale addressing realistic geriatric
scenarios and complex nursing decisions. Purchase and instantly get a downloadable
and editable PDF for convenient study and review.
QUESTIONS 1–150
QUESTION 1
An 82-year-old hospitalized patient becomes acutely confused overnight. The patient's
family reports that the patient was oriented and independent two days ago. Assessment
reveals fluctuating attention, disorganized thinking, and visual hallucinations. Which
nursing action is the priority?
A. Arrange formal cognitive testing for dementia.
B. Assess for reversible causes of acute confusion.
C. Place the patient in a dark, quiet room.
D. Explain that hallucinations are expected with aging.
,🔴 Correct Answer: B. Assess for reversible causes of acute confusion.
🔵 Explanation: Acute onset, fluctuating attention, and altered cognition strongly suggest
delirium rather than normal aging or established dementia. The nurse should immediately
investigate reversible causes such as infection, hypoxia, medication effects, dehydration,
metabolic abnormalities, pain, or urinary retention.
QUESTION 2
A 79-year-old patient with dementia repeatedly attempts to leave the unit. The patient
is not physically aggressive but cannot explain where they are going. Which intervention
should the nurse implement first?
A. Apply wrist restraints.
B. Administer a sedative medication.
C. Identify and address the patient's underlying need.
D. Prevent all ambulation until the behavior stops.
🔴 Correct Answer: C. Identify and address the patient's underlying need.
🔵 Explanation: Wandering may reflect unmet needs such as toileting, hunger, pain,
anxiety, boredom, or a desire for a familiar environment. Nonpharmacologic assessment
and redirection are preferred before restrictive interventions or sedating medications.
QUESTION 3
An older adult taking digoxin, furosemide, and lisinopril reports anorexia, nausea, and
new visual disturbances. The apical pulse is 54/min. Which action should the nurse take
first?
A. Administer the scheduled digoxin.
B. Encourage increased dietary sodium.
C. Hold digoxin and notify the provider.
D. Administer an additional dose of furosemide.
🔴 Correct Answer: C. Hold digoxin and notify the provider.
🔵 Explanation: Bradycardia, gastrointestinal symptoms, and visual changes are
concerning for digoxin toxicity. Older adults are particularly vulnerable because of altered
renal clearance and polypharmacy. The medication should be withheld and the provider
notified for further evaluation.
QUESTION 4
An 88-year-old patient with heart failure has gained 2.5 kg over four days. Which
finding most strongly indicates fluid retention?
,A. Dry oral mucosa
B. Decreased jugular venous pressure
C. Bilateral dependent edema and increasing dyspnea
D. Reduced blood pressure with orthostatic symptoms
🔴 Correct Answer: C. Bilateral dependent edema and increasing dyspnea.
🔵 Explanation: Rapid weight gain accompanied by edema and dyspnea strongly
suggests fluid accumulation associated with worsening heart failure. Daily weight is one
of the most sensitive indicators of changes in fluid status.
QUESTION 5
A nurse is assessing an 84-year-old who reports dizziness immediately after standing.
Which intervention is most appropriate?
A. Encourage rapid position changes to improve tolerance.
B. Assess orthostatic vital signs and medication effects.
C. Restrict oral fluids.
D. Recommend prolonged bed rest.
🔴 Correct Answer: B. Assess orthostatic vital signs and medication effects.
🔵 Explanation: Orthostatic hypotension is common in older adults and may be
associated with dehydration, autonomic dysfunction, or medications such as
antihypertensives and diuretics. Assessment should precede targeted intervention.
QUESTION 6
An older adult with diabetes has an HbA1c of 6.0% while taking multiple glucose-
lowering medications. The patient has experienced several episodes of symptomatic
hypoglycemia. Which principle should guide nursing advocacy?
A. Tight glycemic control is always the primary goal.
B. Older adults should maintain the same glucose targets as young adults.
C. Treatment goals should be individualized according to risks and overall health.
D. Hypoglycemia is preferable to mild hyperglycemia.
🔴 Correct Answer: C. Treatment goals should be individualized according to risks
and overall health.
🔵 Explanation: Glycemic targets in older adults should account for comorbidities,
functional status, life expectancy, treatment burden, and hypoglycemia risk. Avoiding
recurrent hypoglycemia is particularly important because it can cause falls, cardiovascular
events, and cognitive impairment.
QUESTION 7
, A 76-year-old patient with pneumonia is receiving oxygen. Which assessment finding
requires immediate nursing intervention?
A. Respiratory rate of 22/min
B. Oxygen saturation of 88% despite prescribed oxygen
C. Productive cough with yellow sputum
D. Temperature of 37.8°C
🔴 Correct Answer: B. Oxygen saturation of 88% despite prescribed oxygen.
🔵 Explanation: Persistent hypoxemia despite supplemental oxygen requires immediate
assessment and intervention. Older adults may deteriorate rapidly with respiratory
compromise, so airway, breathing, oxygen delivery, and the underlying cause must be
evaluated promptly.
QUESTION 8
An 81-year-old patient has chronic kidney disease and is prescribed a medication
primarily eliminated by the kidneys. Which nursing consideration is most important?
A. Renal function may require dosage adjustment.
B. Age eliminates the need for medication monitoring.
C. The medication should automatically be discontinued.
D. Serum creatinine is irrelevant in older adults.
🔴 Correct Answer: A. Renal function may require dosage adjustment.
🔵 Explanation: Declining renal function is common with aging and can substantially
increase exposure to renally cleared medications. Medication dosing should be based on
appropriate renal function estimates and the patient's clinical status.
QUESTION 9
A 90-year-old patient has an elevated serum creatinine that appears only mildly
abnormal. Why should the nurse avoid assuming renal function is normal?
A. Older adults always have elevated creatinine.
B. Reduced muscle mass can mask decreased renal function.
C. Creatinine has no relationship to kidney function.
D. Serum creatinine increases only with dehydration.
🔴 Correct Answer: B. Reduced muscle mass can mask decreased renal function.
🔵 Explanation: Serum creatinine is influenced by muscle mass. Sarcopenia in older adults
may produce a deceptively low or modest creatinine concentration despite reduced
glomerular filtration, making clinical interpretation and estimated renal function
important.
