RN Geriatric Nursing Competency Exam
— Code: RN-GERO-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. An 82-year-old patient with heart failure is admitted with increasing
fatigue, confusion, and decreased appetite. The patient has gained 2.5 kg
(5.5 lb) in 4 days but denies dyspnea. Which assessment finding should the
nurse recognize as the most concerning indicator of worsening heart
failure?
A. Heart rate of 88/min
B. Mild bilateral ankle edema
C. New confusion and decreased oxygen saturation
D. Blood pressure of 138/76 mm Hg
Answer: New confusion and decreased oxygen saturation
,Rationale: New confusion and hypoxemia can indicate impaired cardiac output
and pulmonary congestion in an older adult. Older adults may not report classic
dyspnea despite significant heart failure deterioration.
2. A 79-year-old patient becomes acutely disoriented and agitated on the
second postoperative day. The patient alternates between lethargy and
agitation. Which finding most strongly supports delirium rather than
dementia?
A. Progressive memory loss over several years
B. Acute onset with fluctuating attention
C. Difficulty recalling names for several months
D. Long-standing impairment in executive functioning
Answer: Acute onset with fluctuating attention
Rationale: Delirium is characterized by an acute and fluctuating disturbance in
attention and cognition. Dementia generally develops gradually and does not
typically cause dramatic hour-to-hour fluctuations early in the course.
3. An 88-year-old patient takes digoxin, furosemide, lisinopril, and warfarin.
Which nursing action is most important before administering the morning
medications?
A. Encourage the patient to ambulate
B. Assess the patient's medication adherence history
C. Review renal function, electrolyte levels, and medication-related laboratory
results
D. Administer all medications with breakfast
Answer: Review renal function, electrolyte levels, and medication-related
laboratory results
Rationale: Aging commonly reduces renal clearance and increases susceptibility
to adverse drug effects. Digoxin toxicity is particularly concerning with renal
impairment and electrolyte abnormalities, while warfarin requires monitoring of
anticoagulation status.
, 4. An older adult reports dizziness when standing. Supine blood pressure is
138/72 mm Hg and standing blood pressure is 108/60 mm Hg. Which
intervention is most appropriate?
A. Restrict all oral fluids
B. Teach the patient to rise slowly and sit at the bedside before standing
C. Encourage rapid position changes to improve circulation
D. Keep the patient on strict bed rest indefinitely
Answer: Teach the patient to rise slowly and sit at the bedside before standing
Rationale: The blood pressure decrease is consistent with orthostatic
hypotension. Gradual position changes, adequate hydration when not
contraindicated, medication review, and fall precautions reduce injury risk.
5. A 76-year-old patient with chronic kidney disease is prescribed a
medication primarily eliminated by the kidneys. Which age-related change
should the nurse anticipate?
A. Increased renal clearance
B. Increased glomerular filtration rate
C. Reduced renal drug clearance
D. Increased renal blood flow
Answer: Reduced renal drug clearance
Rationale: Aging is associated with decreased renal blood flow, renal mass, and
glomerular filtration. Medications eliminated renally may accumulate and
require dosage adjustment.
6. A nurse is evaluating an older adult's nutritional status. Which finding most
strongly suggests protein-calorie malnutrition?
A. Body mass index of 24 kg/m²
B. Decreased serum albumin with muscle wasting and unintentional weight loss
C. Preference for smaller meals
D. Increased thirst
, Answer: Decreased serum albumin with muscle wasting and unintentional
weight loss
Rationale: Unintentional weight loss and loss of muscle mass are important
indicators of malnutrition. Laboratory values should be interpreted with the
overall clinical picture rather than used alone.
7. A 91-year-old patient with dementia repeatedly attempts to leave the unit.
Which nursing intervention should be implemented first?
A. Apply wrist restraints
B. Administer a sedative immediately
C. Identify triggers and provide a safe, structured environment
D. Place the patient in a locked room alone
Answer: Identify triggers and provide a safe, structured environment
Rationale: Nonpharmacologic approaches are first-line interventions for
behavioral symptoms of dementia. The nurse should assess unmet needs,
environmental triggers, pain, toileting needs, hunger, fear, and overstimulation
before considering restrictive interventions.
8. A patient with Parkinson disease has difficulty swallowing. Which
intervention is most appropriate during meals?
A. Encourage thin liquids rapidly
B. Place the patient flat after eating
C. Provide upright positioning and allow adequate time for swallowing
D. Encourage talking while chewing
Answer: Provide upright positioning and allow adequate time for swallowing
Rationale: Dysphagia increases aspiration risk. Upright positioning, slow
feeding, appropriate food consistency, and swallowing strategies reduce
aspiration complications.
— Code: RN-GERO-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. An 82-year-old patient with heart failure is admitted with increasing
fatigue, confusion, and decreased appetite. The patient has gained 2.5 kg
(5.5 lb) in 4 days but denies dyspnea. Which assessment finding should the
nurse recognize as the most concerning indicator of worsening heart
failure?
A. Heart rate of 88/min
B. Mild bilateral ankle edema
C. New confusion and decreased oxygen saturation
D. Blood pressure of 138/76 mm Hg
Answer: New confusion and decreased oxygen saturation
,Rationale: New confusion and hypoxemia can indicate impaired cardiac output
and pulmonary congestion in an older adult. Older adults may not report classic
dyspnea despite significant heart failure deterioration.
2. A 79-year-old patient becomes acutely disoriented and agitated on the
second postoperative day. The patient alternates between lethargy and
agitation. Which finding most strongly supports delirium rather than
dementia?
A. Progressive memory loss over several years
B. Acute onset with fluctuating attention
C. Difficulty recalling names for several months
D. Long-standing impairment in executive functioning
Answer: Acute onset with fluctuating attention
Rationale: Delirium is characterized by an acute and fluctuating disturbance in
attention and cognition. Dementia generally develops gradually and does not
typically cause dramatic hour-to-hour fluctuations early in the course.
3. An 88-year-old patient takes digoxin, furosemide, lisinopril, and warfarin.
Which nursing action is most important before administering the morning
medications?
A. Encourage the patient to ambulate
B. Assess the patient's medication adherence history
C. Review renal function, electrolyte levels, and medication-related laboratory
results
D. Administer all medications with breakfast
Answer: Review renal function, electrolyte levels, and medication-related
laboratory results
Rationale: Aging commonly reduces renal clearance and increases susceptibility
to adverse drug effects. Digoxin toxicity is particularly concerning with renal
impairment and electrolyte abnormalities, while warfarin requires monitoring of
anticoagulation status.
, 4. An older adult reports dizziness when standing. Supine blood pressure is
138/72 mm Hg and standing blood pressure is 108/60 mm Hg. Which
intervention is most appropriate?
A. Restrict all oral fluids
B. Teach the patient to rise slowly and sit at the bedside before standing
C. Encourage rapid position changes to improve circulation
D. Keep the patient on strict bed rest indefinitely
Answer: Teach the patient to rise slowly and sit at the bedside before standing
Rationale: The blood pressure decrease is consistent with orthostatic
hypotension. Gradual position changes, adequate hydration when not
contraindicated, medication review, and fall precautions reduce injury risk.
5. A 76-year-old patient with chronic kidney disease is prescribed a
medication primarily eliminated by the kidneys. Which age-related change
should the nurse anticipate?
A. Increased renal clearance
B. Increased glomerular filtration rate
C. Reduced renal drug clearance
D. Increased renal blood flow
Answer: Reduced renal drug clearance
Rationale: Aging is associated with decreased renal blood flow, renal mass, and
glomerular filtration. Medications eliminated renally may accumulate and
require dosage adjustment.
6. A nurse is evaluating an older adult's nutritional status. Which finding most
strongly suggests protein-calorie malnutrition?
A. Body mass index of 24 kg/m²
B. Decreased serum albumin with muscle wasting and unintentional weight loss
C. Preference for smaller meals
D. Increased thirst
, Answer: Decreased serum albumin with muscle wasting and unintentional
weight loss
Rationale: Unintentional weight loss and loss of muscle mass are important
indicators of malnutrition. Laboratory values should be interpreted with the
overall clinical picture rather than used alone.
7. A 91-year-old patient with dementia repeatedly attempts to leave the unit.
Which nursing intervention should be implemented first?
A. Apply wrist restraints
B. Administer a sedative immediately
C. Identify triggers and provide a safe, structured environment
D. Place the patient in a locked room alone
Answer: Identify triggers and provide a safe, structured environment
Rationale: Nonpharmacologic approaches are first-line interventions for
behavioral symptoms of dementia. The nurse should assess unmet needs,
environmental triggers, pain, toileting needs, hunger, fear, and overstimulation
before considering restrictive interventions.
8. A patient with Parkinson disease has difficulty swallowing. Which
intervention is most appropriate during meals?
A. Encourage thin liquids rapidly
B. Place the patient flat after eating
C. Provide upright positioning and allow adequate time for swallowing
D. Encourage talking while chewing
Answer: Provide upright positioning and allow adequate time for swallowing
Rationale: Dysphagia increases aspiration risk. Upright positioning, slow
feeding, appropriate food consistency, and swallowing strategies reduce
aspiration complications.
