Gerontology Nursing Case Studies and Clinical
Judgment Workbook 2026/2027 | ACTUAL-Style
Practice Questions & Answers, Older Adult
Assessment, Geriatric Syndromes, Dementia, Fall
Prevention, Polypharmacy, Chronic Disease
Management, Patient Safety, and Detailed Nursing
Rationales
Question 1: An 82-year-old client is admitted with dehydration and a
history of a recent fall. Which assessment finding should the
gerontological nurse prioritize as the most significant indicator of
increased fall risk?
A. Blood pressure of 138/76 mmHg
B. Serum sodium level of 136 mEq/L
C. Orthostatic hypotension upon standing
D. Mild bilateral knee osteoarthritis
CORRECT ANSWER: C. Orthostatic hypotension upon standing
Rationale: Orthostatic hypotension is a well-established and modifiable
intrinsic risk factor for falls in older adults, reflecting impaired baroreceptor
sensitivity and volume depletion. While osteoarthritis contributes to gait
instability, orthostatic hypotension can cause syncope and is directly
related to the current dehydration admission, making it the priority
concern.
Question 2: A 78-year-old client with dementia repeatedly attempts to
get out of bed unassisted. Which nursing intervention best
demonstrates the principle of least restraint?
A. Apply a vest restraint to prevent falls
B. Raise all four side rails and document every 15 minutes
C. Place a chair alarm and engage the client in supervised activities
D. Administer a PRN sedative to promote sleep
CORRECT ANSWER: C. Place a chair alarm and engage the client in
supervised activities
Rationale: The least restrictive alternative involves environmental
modification and meaningful engagement, which address the underlying
need for movement while maintaining safety. Physical restraints, side rails,
,and chemical sedation increase risk of injury, delirium, and functional
decline in older adults.
Question 3: An 85-year-old client is prescribed digoxin for heart failure.
Which assessment finding should alert the nurse to possible digoxin
toxicity?
A. Heart rate of 88 beats per minute
B. Serum potassium of 4.2 mEq/L
C. Anorexia and visual disturbances
D. Blood pressure of 128/72 mmHg
CORRECT ANSWER: C. Anorexia and visual disturbances
Rationale: Anorexia, nausea, and visual changes such as yellow-green
halos are classic early signs of digoxin toxicity in older adults. Age-related
decline in renal clearance increases digoxin levels, and subtle
gastrointestinal or visual symptoms often precede arrhythmias.
Question 4: A 79-year-old client reports difficulty swallowing pills and
asks about crushing medications. Which medication should the nurse
instruct the client never to crush?
A. Acetaminophen tablet
B. Extended-release nifedipine
C. Furosemide tablet
D. Metformin immediate-release tablet
CORRECT ANSWER: B. Extended-release nifedipine
Rationale: Crushing extended-release formulations causes dose dumping,
leading to rapid absorption, severe hypotension, and potential
cardiovascular collapse. Immediate-release tablets may often be crushed
with provider approval, but extended-release forms must remain intact.
Question 5: An 80-year-old client is diagnosed with delirium. Which
factor is the most common precipitant of delirium in hospitalized older
adults?
A. Chronic dementia
B. Sensory impairment
C. Polypharmacy and infection
D. Normal aging changes
,CORRECT ANSWER: C. Polypharmacy and infection
Rationale: Delirium is multifactorial, but medications (especially
anticholinergics, sedatives, and opioids) and infections (particularly urinary
tract and respiratory) are the most frequent and reversible precipitants.
Dementia and sensory impairment are predisposing factors rather than
direct precipitants.
Question 6: A 76-year-old client with pressure injury on the sacrum has
a Braden Scale score of 12. Which nursing action is most appropriate?
A. Reposition every 4 hours
B. Apply a hydrocolloid dressing and reposition every 2 hours
C. Massage the reddened area vigorously
D. Keep the head of bed elevated at 45 degrees continuously
CORRECT ANSWER: B. Apply a hydrocolloid dressing and reposition
every 2 hours
Rationale: A Braden score of 12 indicates moderate-to-high risk.
Repositioning every 2 hours reduces shear and pressure, and hydrocolloid
dressings maintain a moist wound environment. Massaging reddened
areas can damage capillaries, and prolonged high Fowler's position
increases sacral pressure.
Question 7: An 88-year-old client is admitted with failure to thrive.
Which laboratory value should the nurse monitor most closely for
nutritional status?
A. Serum creatinine
B. Prealbumin
C. Hemoglobin A1c
D. Brain natriuretic peptide
CORRECT ANSWER: B. Prealbumin
Rationale: Prealbumin has a short half-life of approximately 2 days, making
it the most sensitive indicator of acute changes in protein and nutritional
status. Creatinine reflects renal function, HbA1c reflects long-term glucose
control, and BNP reflects cardiac strain.
, Question 8: A 74-year-old client with osteoarthritis reports chronic
pain. Which nonpharmacologic intervention should the nurse
recommend first?
A. Complete bed rest
B. Application of cold packs to affected joints
C. Gentle range-of-motion exercises and warm compresses
D. High-impact aerobic exercise
CORRECT ANSWER: C. Gentle range-of-motion exercises and warm
compresses
Rationale: Warm compresses reduce joint stiffness, and gentle range-of-
motion exercises maintain mobility and function without excessive joint
stress. Bed rest promotes deconditioning, cold is more useful for acute
inflammation, and high-impact exercise worsens osteoarthritis.
Question 9: An 81-year-old client is receiving furosemide. Which
assessment finding indicates a potential adverse effect requiring
immediate intervention?
A. Urine output of 50 mL/hour
B. Serum potassium of 2.9 mEq/L
C. Blood pressure of 134/80 mmHg
D. Weight loss of 0.5 kg in 24 hours
CORRECT ANSWER: B. Serum potassium of 2.9 mEq/L
Rationale: Loop diuretics cause significant potassium loss, and
hypokalemia below 3.0 mEq/L increases risk of cardiac arrhythmias,
especially in older adults with cardiac disease. The other findings are within
expected therapeutic parameters.
Question 10: A 77-year-old client with diabetes has an HbA1c of 8.5%.
Which consideration is most important in the gerontological nurse's
plan of care?
A. Tight glycemic control with target HbA1c below 6.5%
B. Individualized glycemic goals to avoid hypoglycemia
C. Discontinuation of all glucose-lowering medications
D. Initiation of intensive insulin therapy
Judgment Workbook 2026/2027 | ACTUAL-Style
Practice Questions & Answers, Older Adult
Assessment, Geriatric Syndromes, Dementia, Fall
Prevention, Polypharmacy, Chronic Disease
Management, Patient Safety, and Detailed Nursing
Rationales
Question 1: An 82-year-old client is admitted with dehydration and a
history of a recent fall. Which assessment finding should the
gerontological nurse prioritize as the most significant indicator of
increased fall risk?
A. Blood pressure of 138/76 mmHg
B. Serum sodium level of 136 mEq/L
C. Orthostatic hypotension upon standing
D. Mild bilateral knee osteoarthritis
CORRECT ANSWER: C. Orthostatic hypotension upon standing
Rationale: Orthostatic hypotension is a well-established and modifiable
intrinsic risk factor for falls in older adults, reflecting impaired baroreceptor
sensitivity and volume depletion. While osteoarthritis contributes to gait
instability, orthostatic hypotension can cause syncope and is directly
related to the current dehydration admission, making it the priority
concern.
Question 2: A 78-year-old client with dementia repeatedly attempts to
get out of bed unassisted. Which nursing intervention best
demonstrates the principle of least restraint?
A. Apply a vest restraint to prevent falls
B. Raise all four side rails and document every 15 minutes
C. Place a chair alarm and engage the client in supervised activities
D. Administer a PRN sedative to promote sleep
CORRECT ANSWER: C. Place a chair alarm and engage the client in
supervised activities
Rationale: The least restrictive alternative involves environmental
modification and meaningful engagement, which address the underlying
need for movement while maintaining safety. Physical restraints, side rails,
,and chemical sedation increase risk of injury, delirium, and functional
decline in older adults.
Question 3: An 85-year-old client is prescribed digoxin for heart failure.
Which assessment finding should alert the nurse to possible digoxin
toxicity?
A. Heart rate of 88 beats per minute
B. Serum potassium of 4.2 mEq/L
C. Anorexia and visual disturbances
D. Blood pressure of 128/72 mmHg
CORRECT ANSWER: C. Anorexia and visual disturbances
Rationale: Anorexia, nausea, and visual changes such as yellow-green
halos are classic early signs of digoxin toxicity in older adults. Age-related
decline in renal clearance increases digoxin levels, and subtle
gastrointestinal or visual symptoms often precede arrhythmias.
Question 4: A 79-year-old client reports difficulty swallowing pills and
asks about crushing medications. Which medication should the nurse
instruct the client never to crush?
A. Acetaminophen tablet
B. Extended-release nifedipine
C. Furosemide tablet
D. Metformin immediate-release tablet
CORRECT ANSWER: B. Extended-release nifedipine
Rationale: Crushing extended-release formulations causes dose dumping,
leading to rapid absorption, severe hypotension, and potential
cardiovascular collapse. Immediate-release tablets may often be crushed
with provider approval, but extended-release forms must remain intact.
Question 5: An 80-year-old client is diagnosed with delirium. Which
factor is the most common precipitant of delirium in hospitalized older
adults?
A. Chronic dementia
B. Sensory impairment
C. Polypharmacy and infection
D. Normal aging changes
,CORRECT ANSWER: C. Polypharmacy and infection
Rationale: Delirium is multifactorial, but medications (especially
anticholinergics, sedatives, and opioids) and infections (particularly urinary
tract and respiratory) are the most frequent and reversible precipitants.
Dementia and sensory impairment are predisposing factors rather than
direct precipitants.
Question 6: A 76-year-old client with pressure injury on the sacrum has
a Braden Scale score of 12. Which nursing action is most appropriate?
A. Reposition every 4 hours
B. Apply a hydrocolloid dressing and reposition every 2 hours
C. Massage the reddened area vigorously
D. Keep the head of bed elevated at 45 degrees continuously
CORRECT ANSWER: B. Apply a hydrocolloid dressing and reposition
every 2 hours
Rationale: A Braden score of 12 indicates moderate-to-high risk.
Repositioning every 2 hours reduces shear and pressure, and hydrocolloid
dressings maintain a moist wound environment. Massaging reddened
areas can damage capillaries, and prolonged high Fowler's position
increases sacral pressure.
Question 7: An 88-year-old client is admitted with failure to thrive.
Which laboratory value should the nurse monitor most closely for
nutritional status?
A. Serum creatinine
B. Prealbumin
C. Hemoglobin A1c
D. Brain natriuretic peptide
CORRECT ANSWER: B. Prealbumin
Rationale: Prealbumin has a short half-life of approximately 2 days, making
it the most sensitive indicator of acute changes in protein and nutritional
status. Creatinine reflects renal function, HbA1c reflects long-term glucose
control, and BNP reflects cardiac strain.
, Question 8: A 74-year-old client with osteoarthritis reports chronic
pain. Which nonpharmacologic intervention should the nurse
recommend first?
A. Complete bed rest
B. Application of cold packs to affected joints
C. Gentle range-of-motion exercises and warm compresses
D. High-impact aerobic exercise
CORRECT ANSWER: C. Gentle range-of-motion exercises and warm
compresses
Rationale: Warm compresses reduce joint stiffness, and gentle range-of-
motion exercises maintain mobility and function without excessive joint
stress. Bed rest promotes deconditioning, cold is more useful for acute
inflammation, and high-impact exercise worsens osteoarthritis.
Question 9: An 81-year-old client is receiving furosemide. Which
assessment finding indicates a potential adverse effect requiring
immediate intervention?
A. Urine output of 50 mL/hour
B. Serum potassium of 2.9 mEq/L
C. Blood pressure of 134/80 mmHg
D. Weight loss of 0.5 kg in 24 hours
CORRECT ANSWER: B. Serum potassium of 2.9 mEq/L
Rationale: Loop diuretics cause significant potassium loss, and
hypokalemia below 3.0 mEq/L increases risk of cardiac arrhythmias,
especially in older adults with cardiac disease. The other findings are within
expected therapeutic parameters.
Question 10: A 77-year-old client with diabetes has an HbA1c of 8.5%.
Which consideration is most important in the gerontological nurse's
plan of care?
A. Tight glycemic control with target HbA1c below 6.5%
B. Individualized glycemic goals to avoid hypoglycemia
C. Discontinuation of all glucose-lowering medications
D. Initiation of intensive insulin therapy
