NUR 257 EXAMS 1 to 4 2026 GERIATRIC
NCLEX MASTER EVALUATION GRADE A
MATERIAL 150 CLINICAL SCENARIOS
WITH DETAILED CORRECT ANSWERS
WITH RATIONALES CORRECT VERIFIED
ANSWERS 100% PASS GUARANTEE |
INSTANT DOWNLOAD
NUR 257: Geriatric NCLEX Mastery Exam
Question 1
An 84-year-old female patient with a history of moderate
chronic kidney disease and osteoarthritis is admitted to the
medical-surgical unit. During the initial shift assessment, the
nurse notes that the patient is increasingly lethargic and
disoriented to time and place, representing an acute shift from
her baseline orientation. Her morning laboratory results reveal
a serum sodium level of 150 mEq/L. The nurse documents this
finding as hypernatremia. Which of the following normal, age-
related physiological alterations contributes most directly to
this electrolyte imbalance in older adults?
• Option A: Excessive structural cell multiplication within
the thyroid follicular networks. Rationale:InCorrect.
Thyroid cell proliferation alters core metabolic rates but
does not cause a primary extracellular fluid solute shift.
• Option B: A blunted sensation of thirst
(hypodipsia) and a diminished renal
concentrating capacity. Rationale: Correct. Age-
related changes include a decrease in hypothalamic thirst
perception and a drop in nephron filtration efficiency,
making older adults highly susceptible to dehydration
and hypernatremia.
, • Option C: Overproduction of aldosterone by the anterior
pituitary gland matrix. Rationale:InCorrect.
Aldosterone is synthesized and released by the adrenal
cortex, not the anterior pituitary gland.
• Option D: Rapid overproduction of circulating white blood
cells within the long bones. Rationale:InCorrect.
White blood cell counts react to infection or inflammation
and carry no baseline osmotic function for fluid
matching.
Question 2
The nurse is reviewing the medication profile of a 73-year-old
male patient who reports chronic insomnia and generalized
anxiety. The profile reveals a current prescription for
diphenhydramine 50 mg orally at bedtime. According to the
current American Geriatrics Society (AGS) Beers Criteria for
Potentially Inappropriate Medication Use in Older Adults, why
should this medication be strictly avoided or discontinued?
• Option A: It causes acute renal papillary necrosis and
accelerates glomerular filtration failure.
Rationale:InCorrect. Diphenhydramine does not
carry a direct black-box structural risk for inducing renal
tissue destruction.
• Option B: It induces severe iron deficiency anemia by
binding to mucosal receptors in the duodenum.
Rationale:InCorrect. Antihistamines do not block
the dietary absorption of micronutrients or elemental
iron.
• Option C: It possesses potent anticholinergic
properties that significantly increase the risks of
confusion, blurred vision, urinary retention, dry
mouth, and falls. Rationale: Correct. First-
generation antihistamines like diphenhydramine are
, highly anticholinergic, posing severe safety, cognitive,
and balance risks to the gerontological population.
• Option D: It triggers dangerous systemic hyperkalemia
when taken alongside regular dietary sodium sources.
Rationale:InCorrect. Potassium homeostasis is
independent of standard diphenhydramine
pharmacodynamics.
Question 3
A 79-year-old female patient with a history of long-standing
hypertension presents to the clinic for a routine check-up. The
nurse notes that the patient's gait is slow, her steps are short
and shuffling, and she exhibits a resting tremor in her right
hand. A review of her history shows these symptoms developed
gradually over the past year. What neurodegenerative condition
do these clinical signs suggest?
• Option A: Huntington's disease.
Rationale:InCorrect. Huntington's disease is an
autosomal dominant disorder presenting with chorea
(rapid, involuntary movements), typical in younger
demographics.
• Option B: Parkinson's disease. Rationale:
Correct. Parkinson's disease is characterized by a
classic triad of motor symptoms: bradykinesia
(slowness), resting tremor, and rigidity, often presenting
with a shuffling gait.
• Option C: Amyotrophic lateral sclerosis (ALS).
Rationale:InCorrect. ALS causes progressive muscle
weakness and fasciculations through upper and lower
motor neuron degeneration, lacking typical Parkinsonian
resting tremors.
, • Option D: Multiple sclerosis. Rationale:InCorrect.
MS involves demyelination within the central nervous
system, often presenting with optic neuritis or sensory
deficits in younger adults.
Question 4
An 82-year-old male patient is admitted to the hospital with a
diagnosis of acute urosepsis. Over a 12-hour period, the nurse
notes that the patient has become increasingly agitated, is
experiencing vivid visual hallucinations of insects on the wall,
and exhibits a fluctuating level of consciousness. A review of his
baseline chart reveals he was fully oriented upon admission.
What acute medical condition is this clinical change indicative
of, and what is the standard tool used to confirm it?
• Option A: Major Neurocognitive Disorder (Dementia),
confirmed via the Mini-Mental State Examination
(MMSE). Rationale:InCorrect. Dementia features a
slow, progressive, irreversible structural decline in
memory, completely lacking the rapid, fluctuating onset
described here.
• Option B: Acute Schizophrenia spectrum flare, confirmed
using the Patient Health Questionnaire-9 (PHQ-9).
Rationale:InCorrect. Late-onset schizophrenia is
highly uncommon, and the PHQ-9 is a specific mood
assessment tool for depression, not active psychosis
screening.
• Option C: Delirium, confirmed via the Confusion
Assessment Method (CAM). Rationale: Correct.
Delirium is characterized by an acute, fluctuating onset
of altered cognition and orientation, often triggered by
underlying systemic infections like a UTI. The CAM is the
definitive screening instrument used to identify it.
NCLEX MASTER EVALUATION GRADE A
MATERIAL 150 CLINICAL SCENARIOS
WITH DETAILED CORRECT ANSWERS
WITH RATIONALES CORRECT VERIFIED
ANSWERS 100% PASS GUARANTEE |
INSTANT DOWNLOAD
NUR 257: Geriatric NCLEX Mastery Exam
Question 1
An 84-year-old female patient with a history of moderate
chronic kidney disease and osteoarthritis is admitted to the
medical-surgical unit. During the initial shift assessment, the
nurse notes that the patient is increasingly lethargic and
disoriented to time and place, representing an acute shift from
her baseline orientation. Her morning laboratory results reveal
a serum sodium level of 150 mEq/L. The nurse documents this
finding as hypernatremia. Which of the following normal, age-
related physiological alterations contributes most directly to
this electrolyte imbalance in older adults?
• Option A: Excessive structural cell multiplication within
the thyroid follicular networks. Rationale:InCorrect.
Thyroid cell proliferation alters core metabolic rates but
does not cause a primary extracellular fluid solute shift.
• Option B: A blunted sensation of thirst
(hypodipsia) and a diminished renal
concentrating capacity. Rationale: Correct. Age-
related changes include a decrease in hypothalamic thirst
perception and a drop in nephron filtration efficiency,
making older adults highly susceptible to dehydration
and hypernatremia.
, • Option C: Overproduction of aldosterone by the anterior
pituitary gland matrix. Rationale:InCorrect.
Aldosterone is synthesized and released by the adrenal
cortex, not the anterior pituitary gland.
• Option D: Rapid overproduction of circulating white blood
cells within the long bones. Rationale:InCorrect.
White blood cell counts react to infection or inflammation
and carry no baseline osmotic function for fluid
matching.
Question 2
The nurse is reviewing the medication profile of a 73-year-old
male patient who reports chronic insomnia and generalized
anxiety. The profile reveals a current prescription for
diphenhydramine 50 mg orally at bedtime. According to the
current American Geriatrics Society (AGS) Beers Criteria for
Potentially Inappropriate Medication Use in Older Adults, why
should this medication be strictly avoided or discontinued?
• Option A: It causes acute renal papillary necrosis and
accelerates glomerular filtration failure.
Rationale:InCorrect. Diphenhydramine does not
carry a direct black-box structural risk for inducing renal
tissue destruction.
• Option B: It induces severe iron deficiency anemia by
binding to mucosal receptors in the duodenum.
Rationale:InCorrect. Antihistamines do not block
the dietary absorption of micronutrients or elemental
iron.
• Option C: It possesses potent anticholinergic
properties that significantly increase the risks of
confusion, blurred vision, urinary retention, dry
mouth, and falls. Rationale: Correct. First-
generation antihistamines like diphenhydramine are
, highly anticholinergic, posing severe safety, cognitive,
and balance risks to the gerontological population.
• Option D: It triggers dangerous systemic hyperkalemia
when taken alongside regular dietary sodium sources.
Rationale:InCorrect. Potassium homeostasis is
independent of standard diphenhydramine
pharmacodynamics.
Question 3
A 79-year-old female patient with a history of long-standing
hypertension presents to the clinic for a routine check-up. The
nurse notes that the patient's gait is slow, her steps are short
and shuffling, and she exhibits a resting tremor in her right
hand. A review of her history shows these symptoms developed
gradually over the past year. What neurodegenerative condition
do these clinical signs suggest?
• Option A: Huntington's disease.
Rationale:InCorrect. Huntington's disease is an
autosomal dominant disorder presenting with chorea
(rapid, involuntary movements), typical in younger
demographics.
• Option B: Parkinson's disease. Rationale:
Correct. Parkinson's disease is characterized by a
classic triad of motor symptoms: bradykinesia
(slowness), resting tremor, and rigidity, often presenting
with a shuffling gait.
• Option C: Amyotrophic lateral sclerosis (ALS).
Rationale:InCorrect. ALS causes progressive muscle
weakness and fasciculations through upper and lower
motor neuron degeneration, lacking typical Parkinsonian
resting tremors.
, • Option D: Multiple sclerosis. Rationale:InCorrect.
MS involves demyelination within the central nervous
system, often presenting with optic neuritis or sensory
deficits in younger adults.
Question 4
An 82-year-old male patient is admitted to the hospital with a
diagnosis of acute urosepsis. Over a 12-hour period, the nurse
notes that the patient has become increasingly agitated, is
experiencing vivid visual hallucinations of insects on the wall,
and exhibits a fluctuating level of consciousness. A review of his
baseline chart reveals he was fully oriented upon admission.
What acute medical condition is this clinical change indicative
of, and what is the standard tool used to confirm it?
• Option A: Major Neurocognitive Disorder (Dementia),
confirmed via the Mini-Mental State Examination
(MMSE). Rationale:InCorrect. Dementia features a
slow, progressive, irreversible structural decline in
memory, completely lacking the rapid, fluctuating onset
described here.
• Option B: Acute Schizophrenia spectrum flare, confirmed
using the Patient Health Questionnaire-9 (PHQ-9).
Rationale:InCorrect. Late-onset schizophrenia is
highly uncommon, and the PHQ-9 is a specific mood
assessment tool for depression, not active psychosis
screening.
• Option C: Delirium, confirmed via the Confusion
Assessment Method (CAM). Rationale: Correct.
Delirium is characterized by an acute, fluctuating onset
of altered cognition and orientation, often triggered by
underlying systemic infections like a UTI. The CAM is the
definitive screening instrument used to identify it.
