HESI PN Gerontology Practice Exam
(2026–2027 Edition)
Question 1
A nurse is caring for an 82-year-old client recovering from a hip fracture repair. Which
finding should the nurse report to the provider immediately?
A. Mild incisional pain rated 3/10
B. Urine output of 25 mL over the last hour
C. Slight redness at the pin sites
D. Client reports feeling tired after physical therapy
Answer:
B
Rationale:
Urine output below 30 mL/hr may indicate inadequate renal perfusion or early acute kidney
injury, both of which are common postoperative risks in older adults and require prompt
provider notification.
Question 2
Which age-related change explains why older adults are at higher risk for orthostatic
hypotension?
A. Increased baroreceptor sensitivity
B. Decreased baroreceptor sensitivity
C. Increased vascular elasticity
D. Decreased peripheral vascular resistance
Answer:
B
Rationale:
Aging reduces baroreceptor responsiveness, slowing the compensatory heart rate and
vasoconstriction response needed to maintain blood pressure when changing position.
Question 3
,A licensed practical nurse is reviewing the medication list of an older adult and notes an
order for diphenhydramine for sleep. Which action is most appropriate?
A. Administer the medication as ordered
B. Notify the provider of a potential Beers Criteria concern
C. Give the medication with food
D. Withhold all bedtime medications
Answer:
B
Rationale:
Diphenhydramine is a first-generation antihistamine with strong anticholinergic effects and
is listed on the Beers Criteria as potentially inappropriate for older adults due to increased
fall and confusion risk.
Question 4
An older adult client with dementia becomes agitated during evening hours, a pattern
known as:
A. Delirium
B. Sundowning
C. Anosognosia
D. Perseveration
Answer:
B
Rationale:
Sundowning refers to increased confusion, restlessness, and agitation that occurs in the
late afternoon or evening in clients with dementia.
Question 5
Select all findings that are expected age-related changes in the respiratory system. (Select
all that apply.)
A. Decreased chest wall compliance
B. Increased alveolar surface area
C. Decreased cough reflex effectiveness
D. Increased residual volume
, E. Increased ciliary action
Answer:
A, C, D
Rationale:
Normal aging decreases chest wall compliance, weakens cough reflex effectiveness, and
increases residual volume, all of which raise the risk for respiratory infection and impaired
gas exchange.
Question 6
A nurse is teaching an older client about preventing constipation. Which statement by the
client indicates a need for further teaching?
A. I will drink at least 6 to 8 glasses of water daily
B. I will increase my intake of fiber-rich foods
C. I will use laxatives every day to stay regular
D. I will try to walk for 20 minutes most days
Answer:
C
Rationale:
Daily laxative use can cause dependence and worsen bowel function over time; older
adults should be taught to rely on fluids, fiber, and activity as first-line prevention
strategies.
Question 7
Which of the following is the priority nursing action when an older adult client reports
sudden onset of confusion that was not previously present?
A. Document the finding and reassess in 8 hours
B. Assume this is early dementia and continue routine care
C. Assess for an underlying acute cause such as infection or medication effect
D. Restrain the client to prevent falls
Answer:
C
Rationale:
, A sudden change in mental status suggests delirium, which is often caused by a reversible
underlying condition such as infection, dehydration, or adverse medication effect and
requires prompt assessment.
Question 8
A nurse notes that an older adult client's skin tears easily during routine care. This finding is
best explained by which age-related change?
A. Increased subcutaneous fat
B. Thinning of the epidermis and decreased collagen
C. Increased sebaceous gland activity
D. Increased skin turgor
Answer:
B
Rationale:
Aging causes thinning of the epidermis and dermis along with reduced collagen and elastin,
making the skin fragile and prone to tearing with minimal trauma.
Question 9
An older adult client taking warfarin reports new bruising and gum bleeding. What is the
nurse's priority action?
A. Reassure the client this is normal with age
B. Notify the provider and review the most recent INR
C. Encourage increased vitamin K intake
D. Discontinue the medication independently
Answer:
B
Rationale:
New bruising and bleeding in a client on warfarin may indicate supratherapeutic
anticoagulation, so the provider should be notified and the INR reviewed promptly.
Question 10
(2026–2027 Edition)
Question 1
A nurse is caring for an 82-year-old client recovering from a hip fracture repair. Which
finding should the nurse report to the provider immediately?
A. Mild incisional pain rated 3/10
B. Urine output of 25 mL over the last hour
C. Slight redness at the pin sites
D. Client reports feeling tired after physical therapy
Answer:
B
Rationale:
Urine output below 30 mL/hr may indicate inadequate renal perfusion or early acute kidney
injury, both of which are common postoperative risks in older adults and require prompt
provider notification.
Question 2
Which age-related change explains why older adults are at higher risk for orthostatic
hypotension?
A. Increased baroreceptor sensitivity
B. Decreased baroreceptor sensitivity
C. Increased vascular elasticity
D. Decreased peripheral vascular resistance
Answer:
B
Rationale:
Aging reduces baroreceptor responsiveness, slowing the compensatory heart rate and
vasoconstriction response needed to maintain blood pressure when changing position.
Question 3
,A licensed practical nurse is reviewing the medication list of an older adult and notes an
order for diphenhydramine for sleep. Which action is most appropriate?
A. Administer the medication as ordered
B. Notify the provider of a potential Beers Criteria concern
C. Give the medication with food
D. Withhold all bedtime medications
Answer:
B
Rationale:
Diphenhydramine is a first-generation antihistamine with strong anticholinergic effects and
is listed on the Beers Criteria as potentially inappropriate for older adults due to increased
fall and confusion risk.
Question 4
An older adult client with dementia becomes agitated during evening hours, a pattern
known as:
A. Delirium
B. Sundowning
C. Anosognosia
D. Perseveration
Answer:
B
Rationale:
Sundowning refers to increased confusion, restlessness, and agitation that occurs in the
late afternoon or evening in clients with dementia.
Question 5
Select all findings that are expected age-related changes in the respiratory system. (Select
all that apply.)
A. Decreased chest wall compliance
B. Increased alveolar surface area
C. Decreased cough reflex effectiveness
D. Increased residual volume
, E. Increased ciliary action
Answer:
A, C, D
Rationale:
Normal aging decreases chest wall compliance, weakens cough reflex effectiveness, and
increases residual volume, all of which raise the risk for respiratory infection and impaired
gas exchange.
Question 6
A nurse is teaching an older client about preventing constipation. Which statement by the
client indicates a need for further teaching?
A. I will drink at least 6 to 8 glasses of water daily
B. I will increase my intake of fiber-rich foods
C. I will use laxatives every day to stay regular
D. I will try to walk for 20 minutes most days
Answer:
C
Rationale:
Daily laxative use can cause dependence and worsen bowel function over time; older
adults should be taught to rely on fluids, fiber, and activity as first-line prevention
strategies.
Question 7
Which of the following is the priority nursing action when an older adult client reports
sudden onset of confusion that was not previously present?
A. Document the finding and reassess in 8 hours
B. Assume this is early dementia and continue routine care
C. Assess for an underlying acute cause such as infection or medication effect
D. Restrain the client to prevent falls
Answer:
C
Rationale:
, A sudden change in mental status suggests delirium, which is often caused by a reversible
underlying condition such as infection, dehydration, or adverse medication effect and
requires prompt assessment.
Question 8
A nurse notes that an older adult client's skin tears easily during routine care. This finding is
best explained by which age-related change?
A. Increased subcutaneous fat
B. Thinning of the epidermis and decreased collagen
C. Increased sebaceous gland activity
D. Increased skin turgor
Answer:
B
Rationale:
Aging causes thinning of the epidermis and dermis along with reduced collagen and elastin,
making the skin fragile and prone to tearing with minimal trauma.
Question 9
An older adult client taking warfarin reports new bruising and gum bleeding. What is the
nurse's priority action?
A. Reassure the client this is normal with age
B. Notify the provider and review the most recent INR
C. Encourage increased vitamin K intake
D. Discontinue the medication independently
Answer:
B
Rationale:
New bruising and bleeding in a client on warfarin may indicate supratherapeutic
anticoagulation, so the provider should be notified and the INR reviewed promptly.
Question 10
