HESI Gerontology Exam V3 | 2026 Q&A
with Rationale (HESI Gerontology Exam
2026)
1. An 82-year-old client is admitted to the medical-surgical unit with a diagnosis of
pneumonia. The nurse notices the client is experiencing new-onset confusion and
restlessness. Which action should the nurse take first?
A. Administer a prescribed PRN sedative to ensure safety.
B. Notify the family that the client’s condition is deteriorating.
C. Request a psychiatric consultation for suspected dementia.
D. Obtain an oxygen saturation level and assess respiratory rate.
Correct Answer: D
Rationale: In older adults, confusion and restlessness are often the first signs of hypoxia or
infection rather than a primary psychiatric issue. Assessing the respiratory status is the
priority to identify physiological distress. Early intervention for hypoxia can prevent
further cognitive decline and physiological instability.
2. A nurse is teaching an older adult client about preventing osteoporosis. Which lifestyle
modification should the nurse emphasize as the most effective for maintaining bone density?
A. Increasing intake of citrus fruits and Vitamin C.
B. Engaging in daily swimming for thirty minutes.
,C. Participating in weight-bearing exercises like walking.
D. Restricting caffeine and carbonated beverage intake.
Correct Answer: C
Rationale: Weight-bearing exercises stimulate osteoblast activity and help maintain bone
mass in older adults. While nutrition is important, mechanical loading on the bones is the
most direct way to prevent bone density loss. Walking or light resistance training is
specifically recommended for this population to reduce fracture risk.
3. A nurse is reviewing the medication list of a 78-year-old client who reports frequent falls.
Which medication is most likely contributing to this client’s risk for falls?
A. Lisinopril
B. Diphenhydramine
C. Metformin
D. Calcium carbonate
Correct Answer: B
Rationale: Diphenhydramine is a first-generation antihistamine included in the Beers
Criteria for potentially inappropriate medication use in older adults. It causes significant
anticholinergic effects, including drowsiness, blurred vision, and orthostatic hypotension.
These side effects drastically increase the risk of falls and injury in the elderly.
, 4. Which assessment finding in an 85-year-old client is considered an age-related
physiological change rather than a pathological condition?
A. Occasional urinary incontinence when coughing.
B. Rapid cognitive decline over the past three months.
C. Presence of a stage II pressure injury on the coccyx.
D. Reduced sensitivity to high-pitched sounds.
Correct Answer: D
Rationale: Presbycusis, the age-related loss of hearing for high-pitched sounds, is a
common physiological change due to changes in the inner ear. Urinary incontinence,
pressure injuries, and rapid cognitive decline are always considered pathological and
require further investigation. Understanding normal aging helps the nurse distinguish
between expected changes and those requiring clinical intervention.
5. A home health nurse is visiting an older adult client. Which finding suggests that the client
may be a victim of physical elder abuse? (Select All That Apply)
A. Bilaterally symmetrical bruises on the inner thighs.
B. The client appears fearful or hesitant to speak in front of the caregiver.
C. The client has dry, cracked skin on the heels and elbows.
D. Multiple fractures at various stages of healing noted on imaging.
E. The caregiver provides all medications as scheduled.
with Rationale (HESI Gerontology Exam
2026)
1. An 82-year-old client is admitted to the medical-surgical unit with a diagnosis of
pneumonia. The nurse notices the client is experiencing new-onset confusion and
restlessness. Which action should the nurse take first?
A. Administer a prescribed PRN sedative to ensure safety.
B. Notify the family that the client’s condition is deteriorating.
C. Request a psychiatric consultation for suspected dementia.
D. Obtain an oxygen saturation level and assess respiratory rate.
Correct Answer: D
Rationale: In older adults, confusion and restlessness are often the first signs of hypoxia or
infection rather than a primary psychiatric issue. Assessing the respiratory status is the
priority to identify physiological distress. Early intervention for hypoxia can prevent
further cognitive decline and physiological instability.
2. A nurse is teaching an older adult client about preventing osteoporosis. Which lifestyle
modification should the nurse emphasize as the most effective for maintaining bone density?
A. Increasing intake of citrus fruits and Vitamin C.
B. Engaging in daily swimming for thirty minutes.
,C. Participating in weight-bearing exercises like walking.
D. Restricting caffeine and carbonated beverage intake.
Correct Answer: C
Rationale: Weight-bearing exercises stimulate osteoblast activity and help maintain bone
mass in older adults. While nutrition is important, mechanical loading on the bones is the
most direct way to prevent bone density loss. Walking or light resistance training is
specifically recommended for this population to reduce fracture risk.
3. A nurse is reviewing the medication list of a 78-year-old client who reports frequent falls.
Which medication is most likely contributing to this client’s risk for falls?
A. Lisinopril
B. Diphenhydramine
C. Metformin
D. Calcium carbonate
Correct Answer: B
Rationale: Diphenhydramine is a first-generation antihistamine included in the Beers
Criteria for potentially inappropriate medication use in older adults. It causes significant
anticholinergic effects, including drowsiness, blurred vision, and orthostatic hypotension.
These side effects drastically increase the risk of falls and injury in the elderly.
, 4. Which assessment finding in an 85-year-old client is considered an age-related
physiological change rather than a pathological condition?
A. Occasional urinary incontinence when coughing.
B. Rapid cognitive decline over the past three months.
C. Presence of a stage II pressure injury on the coccyx.
D. Reduced sensitivity to high-pitched sounds.
Correct Answer: D
Rationale: Presbycusis, the age-related loss of hearing for high-pitched sounds, is a
common physiological change due to changes in the inner ear. Urinary incontinence,
pressure injuries, and rapid cognitive decline are always considered pathological and
require further investigation. Understanding normal aging helps the nurse distinguish
between expected changes and those requiring clinical intervention.
5. A home health nurse is visiting an older adult client. Which finding suggests that the client
may be a victim of physical elder abuse? (Select All That Apply)
A. Bilaterally symmetrical bruises on the inner thighs.
B. The client appears fearful or hesitant to speak in front of the caregiver.
C. The client has dry, cracked skin on the heels and elbows.
D. Multiple fractures at various stages of healing noted on imaging.
E. The caregiver provides all medications as scheduled.
