HESI Gerontology Practice Exams
v1-v4 2024 (With NGN Cases &
Verified Rationales)
Question 1
,An 81-year-old client with a history of heart failure is admitted with general malaise. The
nurse reviews the client's home medications and notes the client takes digoxin 0.125 mg
daily. Which age-related physiological change increases this client's risk for digoxin toxicity?
A. Increased total body water
B. Decreased glomerular filtration rate
C. Increased hepatic blood flow
D. Decreased percentage of body fat
VERIFIED ANSWER: B
EXPLANATION: Aging is associated with a natural decline in renal function, specifically
a decreased glomerular filtration rate (GFR) and reduced renal blood flow. Digoxin is
primarily excreted by the kidneys. A lower GFR leads to prolonged clearance and drug
accumulation, increasing the risk of toxicity. Total body water decreases with age, while
body fat percentage increases. Hepatic blood flow typically decreases rather than increases.
Question 2
The nurse is assessing an 85-year-old client who was admitted to the medical unit 24 hours
ago for a urinary tract infection. The client's daughter states, "My father was completely
clear-minded yesterday, but today he is seeing things on the wall and doesn't know where he
is." Which condition is the client most likely experiencing?
A. Stage 1 Alzheimer’s disease
B. Vascular dementia
C. Delirium
D. Age-associated memory impairment
VERIFIED ANSWER: C
EXPLANATION: Delirium is characterized by an acute, rapid onset of fluctuating
cognitive impairment, altered levels of consciousness, and hallucinations, often triggered
by an underlying systemic illness like an infection. Dementia (both Alzheimer's and
vascular) involves a gradual, progressive decline in cognition without sudden fluctuations
in consciousness. Normal aging does not cause sudden confusion or hallucinations.
,Question 3
Which cardiovascular change is considered a normal, expected consequence of the
physiological aging process in an older adult?
A. Decreased left ventricular wall thickness
B. Increased baroreceptor sensitivity
C. Increased rigidity and stiffening of large arteries
D. Increased maximal exercise heart rate
VERIFIED ANSWER: C
EXPLANATION: Stiffening and loss of elasticity in the large arteries (arteriosclerosis)
occur naturally due to collagen cross-linking and calcification. This leads to increased
peripheral vascular resistance and increased systolic blood pressure. Left ventricular wall
thickness increases (hypertrophies) to compensate for this resistance. Baroreceptor
sensitivity decreases with age, and maximal heart rate declines.
Question 4
An older adult client is prescribed a new oral medication that is highly lipophilic (lipid-
soluble). How does the typical age-related change in body composition affect the
pharmacokinetics of this drug?
A. The drug will have a decreased volume of distribution.
B. The half-life of the drug will be prolonged.
C. The drug will be excreted more rapidly by the kidneys.
D. Higher loading doses will be required to avoid toxic reactions.
VERIFIED ANSWER: B
EXPLANATION: Older adults experience a relative decrease in lean body mass and total
body water alongside an increase in adipose tissue (body fat). Lipid-soluble drugs dissolve
in fat deposits, creating a wider volume of distribution. This sequesters the drug in fat
tissue, slows its return to the circulation, and significantly prolongs its elimination half-
life.
, Question 5
The nurse completes a respiratory assessment on a healthy 78-year-old client. Which finding
represents an expected age-related change in the respiratory system?
A. Decreased residual volume
B. Increased chest wall compliance
C. Increased anteroposterior (AP) chest diameter
D. Heightened sensitivity of central chemoreceptors
VERIFIED ANSWER: C
EXPLANATION: Costal cartilage calcification and kyphoscoliotic changes in the spine
lead to structural stiffening of the chest wall (decreased compliance). This causes a mild
increase in the anteroposterior (AP) diameter of the chest. Residual volume increases
because the lungs lose elastic recoil and trap more air; vital capacity decreases.
Chemoreceptor response to hypoxia and hypercapnia declines with age.
Question 6
An older adult client is evaluated for atypical signs of a myocardial infarction (MI). Which
presentation should the nurse recognize as a common atypical manifestation of an MI in this
population?
A. Severe, crushing substernal chest pain radiating down the left arm
B. Acute onset of confusion, weakness, and worsening dyspnea
C. Predictable exertional chest tightness relieved by rest
D. Sharp pleuritic pain that worsens with deep inspiration
VERIFIED ANSWER: B
EXPLANATION: Due to age-related changes in the autonomic nervous system and altered
pain perception, older adults frequently present without classic chest pain during an MI.
Instead, they present atypically with sudden confusion (delirium), profound weakness,
syncope, or isolated progressive dyspnea. Crushing substernal chest pain is the classic
presentation. Sharp pleuritic pain indicates pulmonary or pleural irritation.
v1-v4 2024 (With NGN Cases &
Verified Rationales)
Question 1
,An 81-year-old client with a history of heart failure is admitted with general malaise. The
nurse reviews the client's home medications and notes the client takes digoxin 0.125 mg
daily. Which age-related physiological change increases this client's risk for digoxin toxicity?
A. Increased total body water
B. Decreased glomerular filtration rate
C. Increased hepatic blood flow
D. Decreased percentage of body fat
VERIFIED ANSWER: B
EXPLANATION: Aging is associated with a natural decline in renal function, specifically
a decreased glomerular filtration rate (GFR) and reduced renal blood flow. Digoxin is
primarily excreted by the kidneys. A lower GFR leads to prolonged clearance and drug
accumulation, increasing the risk of toxicity. Total body water decreases with age, while
body fat percentage increases. Hepatic blood flow typically decreases rather than increases.
Question 2
The nurse is assessing an 85-year-old client who was admitted to the medical unit 24 hours
ago for a urinary tract infection. The client's daughter states, "My father was completely
clear-minded yesterday, but today he is seeing things on the wall and doesn't know where he
is." Which condition is the client most likely experiencing?
A. Stage 1 Alzheimer’s disease
B. Vascular dementia
C. Delirium
D. Age-associated memory impairment
VERIFIED ANSWER: C
EXPLANATION: Delirium is characterized by an acute, rapid onset of fluctuating
cognitive impairment, altered levels of consciousness, and hallucinations, often triggered
by an underlying systemic illness like an infection. Dementia (both Alzheimer's and
vascular) involves a gradual, progressive decline in cognition without sudden fluctuations
in consciousness. Normal aging does not cause sudden confusion or hallucinations.
,Question 3
Which cardiovascular change is considered a normal, expected consequence of the
physiological aging process in an older adult?
A. Decreased left ventricular wall thickness
B. Increased baroreceptor sensitivity
C. Increased rigidity and stiffening of large arteries
D. Increased maximal exercise heart rate
VERIFIED ANSWER: C
EXPLANATION: Stiffening and loss of elasticity in the large arteries (arteriosclerosis)
occur naturally due to collagen cross-linking and calcification. This leads to increased
peripheral vascular resistance and increased systolic blood pressure. Left ventricular wall
thickness increases (hypertrophies) to compensate for this resistance. Baroreceptor
sensitivity decreases with age, and maximal heart rate declines.
Question 4
An older adult client is prescribed a new oral medication that is highly lipophilic (lipid-
soluble). How does the typical age-related change in body composition affect the
pharmacokinetics of this drug?
A. The drug will have a decreased volume of distribution.
B. The half-life of the drug will be prolonged.
C. The drug will be excreted more rapidly by the kidneys.
D. Higher loading doses will be required to avoid toxic reactions.
VERIFIED ANSWER: B
EXPLANATION: Older adults experience a relative decrease in lean body mass and total
body water alongside an increase in adipose tissue (body fat). Lipid-soluble drugs dissolve
in fat deposits, creating a wider volume of distribution. This sequesters the drug in fat
tissue, slows its return to the circulation, and significantly prolongs its elimination half-
life.
, Question 5
The nurse completes a respiratory assessment on a healthy 78-year-old client. Which finding
represents an expected age-related change in the respiratory system?
A. Decreased residual volume
B. Increased chest wall compliance
C. Increased anteroposterior (AP) chest diameter
D. Heightened sensitivity of central chemoreceptors
VERIFIED ANSWER: C
EXPLANATION: Costal cartilage calcification and kyphoscoliotic changes in the spine
lead to structural stiffening of the chest wall (decreased compliance). This causes a mild
increase in the anteroposterior (AP) diameter of the chest. Residual volume increases
because the lungs lose elastic recoil and trap more air; vital capacity decreases.
Chemoreceptor response to hypoxia and hypercapnia declines with age.
Question 6
An older adult client is evaluated for atypical signs of a myocardial infarction (MI). Which
presentation should the nurse recognize as a common atypical manifestation of an MI in this
population?
A. Severe, crushing substernal chest pain radiating down the left arm
B. Acute onset of confusion, weakness, and worsening dyspnea
C. Predictable exertional chest tightness relieved by rest
D. Sharp pleuritic pain that worsens with deep inspiration
VERIFIED ANSWER: B
EXPLANATION: Due to age-related changes in the autonomic nervous system and altered
pain perception, older adults frequently present without classic chest pain during an MI.
Instead, they present atypically with sudden confusion (delirium), profound weakness,
syncope, or isolated progressive dyspnea. Crushing substernal chest pain is the classic
presentation. Sharp pleuritic pain indicates pulmonary or pleural irritation.
