Rasmussen University NUR 2214 Nursing Care of the
Older Adult – NUR 2214 Study Guide, Original
Practice Questions & Answers, Comprehensive
Geriatric Nursing Exam Preparation, Older Adult
Nursing Review, Aging Theories, Normal Aging,
Health Promotion, Chronic Conditions,
Polypharmacy, Medication Safety, Cognitive &
Mental Health, Dementia, Delirium, Falls &
Mobility, Nutrition, Functional Assessment, End-of-
Life Care, Palliative Care, Long-Term Care &
Clinical Judgment
Question 1: A 78-year-old male patient with a history of hypertension and type
2 diabetes presents to the clinic with complaints of progressive hearing loss
over the past five years. He notes difficulty understanding conversation in
noisy environments and reports that his family complains the television is too
loud. Which type of hearing loss is most consistent with this clinical
presentation?
A. Conductive hearing loss
B. Mixed hearing loss
C. Sensorineural hearing loss
D. Central auditory processing disorder
CORRECT ANSWER: C. Sensorineural hearing loss
Rationale: Presbycusis, or age-related sensorineural hearing loss, is the most common
type of hearing loss in older adults. It is characterized by a gradual, bilateral, and
symmetric loss of high-frequency sounds, leading to difficulty understanding speech,
especially in the presence of background noise. This is in contrast to conductive hearing
loss, which is often due to problems in the outer or middle ear (e.g., cerumen impaction,
otosclerosis). Central auditory processing disorder involves the brain's ability to process
sound, not the inner ear's ability to detect it.
Question 2: An 82-year-old female is admitted with a hip fracture after a fall.
She is started on a patient-controlled analgesia (PCA) pump for pain
management. Which physiological change associated with aging is most
important for the nurse to consider when monitoring this patient's response to
opioid analgesics?
A. Increased glomerular filtration rate
B. Decreased total body water
C. Increased hepatic blood flow
D. Decreased gastric pH
CORRECT ANSWER: B. Decreased total body water
,Rationale: Aging is associated with a decrease in total body water and an increase in
body fat. This change alters the volume of distribution for medications. Lipophilic drugs,
such as opioids, have a larger volume of distribution, leading to a prolonged half-life and
increased risk of accumulation and adverse effects. While hepatic and renal function
decline with age, the primary pharmacokinetic concern with opioid use in older adults
related to body composition changes is the increased fat-to-water ratio.
Question 3: A 75-year-old patient is brought to the emergency department by
his daughter because of a sudden onset of confusion and agitation. His
daughter reports he has had a fever and a cough for the past two days. His
vital signs are: HR 110, RR 22, BP 140/90, and temperature 101.2°F. What is
the priority nursing action?
A. Administer a sedative to reduce agitation
B. Obtain a sputum culture and start antibiotics
C. Restrain the patient to prevent injury
D. Perform a comprehensive geriatric assessment
CORRECT ANSWER: B. Obtain a sputum culture and start antibiotics
Rationale: This patient is presenting with signs of a urinary tract infection or
pneumonia, which can manifest as delirium (acute confusion) in the older adult. The
priority is to treat the underlying infection. "Delirium" is an acute, fluctuating change in
mental status that is often a manifestation of a physiological disturbance. While the
mental status changes must be managed, the immediate priority is to identify and treat
the cause. Restraints are not the first line of treatment for agitation, and a sedative may
worsen the confusion. A comprehensive assessment is important but should not delay
treatment for the suspected infection.
Question 4: A 68-year-old female patient is brought to the clinic by her
daughter, who is concerned about her mother's memory. The patient is able to
recall the names of her grandchildren and the events of her day but often
forgets where she placed her keys or what day of the week it is. She is still able
to manage her finances and cook independently. What is the most appropriate
initial action by the nurse?
A. Refer the patient to a neurologist for an MRI
B. Administer a Mini-Mental State Examination (MMSE)
C. Educate the patient and family on normal age-related changes
D. Start the patient on donepezil
CORRECT ANSWER: C. Educate the patient and family on normal age-related
changes
Rationale: The patient's symptoms are consistent with normal age-related cognitive
changes (forgetfulness that does not interfere with daily function). It is important to
differentiate this from Mild Cognitive Impairment (MCI) or dementia. Before initiating
invasive testing or medication, the nurse should reassure the patient and family, provide
, education on what is typical for aging, and potentially suggest cognitive stimulation
activities. The MMSE is a screening tool, but the first step is to educate that these
changes are often benign.
Question 5: A 70-year-old male is recovering from a total knee replacement.
He complains of pain in his left calf, which is tender, warm, and swollen. What
is the most important nursing intervention?
A. Encourage ambulation to prevent further complications
B. Apply a warm compress to the leg to relieve pain
C. Elevate the leg and apply ice
D. Do not massage the leg and prepare for a Doppler ultrasound
CORRECT ANSWER: D. Do not massage the leg and prepare for a Doppler
ultrasound
Rationale: The patient's symptoms—pain, tenderness, warmth, and swelling in the
calf—are classic signs of a Deep Vein Thrombosis (DVT). This is a medical emergency.
The primary nursing action is to prevent the clot from dislodging (embolization) which
could lead to a pulmonary embolism. The leg must not be massaged, and the patient
should be placed on bed rest with the leg elevated. The healthcare provider should be
notified immediately to arrange for a Doppler ultrasound to confirm the diagnosis.
Question 6: An 80-year-old female with Alzheimer's disease is wandering the
halls of the long-term care facility. She appears restless and anxious. What is
the most therapeutic nursing intervention?
A. Administer a PRN dose of haloperidol to calm her down
B. Escort her back to her room and close the door to prevent elopement
C. Take her for a supervised walk to a quiet area
D. Ignore the behavior to avoid reinforcing it
CORRECT ANSWER: C. Take her for a supervised walk to a quiet area
Rationale: Wandering is a common behavioral symptom in Alzheimer's disease. The
best approach is to redirect the patient to a safe, calm activity. Physical activity, such as
walking, can be therapeutic and helps to address the underlying need (e.g., need for
exercise, sensory stimulation). Sedatives should be avoided as a first-line intervention
due to the risk of adverse effects and increased confusion. Confining the patient to her
room or ignoring the behavior can increase agitation and is not therapeutic.
Question 7: A 72-year-old patient is being assessed for osteoporosis. Which of
the following laboratory values is most useful in monitoring the effectiveness
of her treatment?
A. Serum calcium
B. Serum phosphorus
C. Urine calcium
D. Serum Vitamin D
Older Adult – NUR 2214 Study Guide, Original
Practice Questions & Answers, Comprehensive
Geriatric Nursing Exam Preparation, Older Adult
Nursing Review, Aging Theories, Normal Aging,
Health Promotion, Chronic Conditions,
Polypharmacy, Medication Safety, Cognitive &
Mental Health, Dementia, Delirium, Falls &
Mobility, Nutrition, Functional Assessment, End-of-
Life Care, Palliative Care, Long-Term Care &
Clinical Judgment
Question 1: A 78-year-old male patient with a history of hypertension and type
2 diabetes presents to the clinic with complaints of progressive hearing loss
over the past five years. He notes difficulty understanding conversation in
noisy environments and reports that his family complains the television is too
loud. Which type of hearing loss is most consistent with this clinical
presentation?
A. Conductive hearing loss
B. Mixed hearing loss
C. Sensorineural hearing loss
D. Central auditory processing disorder
CORRECT ANSWER: C. Sensorineural hearing loss
Rationale: Presbycusis, or age-related sensorineural hearing loss, is the most common
type of hearing loss in older adults. It is characterized by a gradual, bilateral, and
symmetric loss of high-frequency sounds, leading to difficulty understanding speech,
especially in the presence of background noise. This is in contrast to conductive hearing
loss, which is often due to problems in the outer or middle ear (e.g., cerumen impaction,
otosclerosis). Central auditory processing disorder involves the brain's ability to process
sound, not the inner ear's ability to detect it.
Question 2: An 82-year-old female is admitted with a hip fracture after a fall.
She is started on a patient-controlled analgesia (PCA) pump for pain
management. Which physiological change associated with aging is most
important for the nurse to consider when monitoring this patient's response to
opioid analgesics?
A. Increased glomerular filtration rate
B. Decreased total body water
C. Increased hepatic blood flow
D. Decreased gastric pH
CORRECT ANSWER: B. Decreased total body water
,Rationale: Aging is associated with a decrease in total body water and an increase in
body fat. This change alters the volume of distribution for medications. Lipophilic drugs,
such as opioids, have a larger volume of distribution, leading to a prolonged half-life and
increased risk of accumulation and adverse effects. While hepatic and renal function
decline with age, the primary pharmacokinetic concern with opioid use in older adults
related to body composition changes is the increased fat-to-water ratio.
Question 3: A 75-year-old patient is brought to the emergency department by
his daughter because of a sudden onset of confusion and agitation. His
daughter reports he has had a fever and a cough for the past two days. His
vital signs are: HR 110, RR 22, BP 140/90, and temperature 101.2°F. What is
the priority nursing action?
A. Administer a sedative to reduce agitation
B. Obtain a sputum culture and start antibiotics
C. Restrain the patient to prevent injury
D. Perform a comprehensive geriatric assessment
CORRECT ANSWER: B. Obtain a sputum culture and start antibiotics
Rationale: This patient is presenting with signs of a urinary tract infection or
pneumonia, which can manifest as delirium (acute confusion) in the older adult. The
priority is to treat the underlying infection. "Delirium" is an acute, fluctuating change in
mental status that is often a manifestation of a physiological disturbance. While the
mental status changes must be managed, the immediate priority is to identify and treat
the cause. Restraints are not the first line of treatment for agitation, and a sedative may
worsen the confusion. A comprehensive assessment is important but should not delay
treatment for the suspected infection.
Question 4: A 68-year-old female patient is brought to the clinic by her
daughter, who is concerned about her mother's memory. The patient is able to
recall the names of her grandchildren and the events of her day but often
forgets where she placed her keys or what day of the week it is. She is still able
to manage her finances and cook independently. What is the most appropriate
initial action by the nurse?
A. Refer the patient to a neurologist for an MRI
B. Administer a Mini-Mental State Examination (MMSE)
C. Educate the patient and family on normal age-related changes
D. Start the patient on donepezil
CORRECT ANSWER: C. Educate the patient and family on normal age-related
changes
Rationale: The patient's symptoms are consistent with normal age-related cognitive
changes (forgetfulness that does not interfere with daily function). It is important to
differentiate this from Mild Cognitive Impairment (MCI) or dementia. Before initiating
invasive testing or medication, the nurse should reassure the patient and family, provide
, education on what is typical for aging, and potentially suggest cognitive stimulation
activities. The MMSE is a screening tool, but the first step is to educate that these
changes are often benign.
Question 5: A 70-year-old male is recovering from a total knee replacement.
He complains of pain in his left calf, which is tender, warm, and swollen. What
is the most important nursing intervention?
A. Encourage ambulation to prevent further complications
B. Apply a warm compress to the leg to relieve pain
C. Elevate the leg and apply ice
D. Do not massage the leg and prepare for a Doppler ultrasound
CORRECT ANSWER: D. Do not massage the leg and prepare for a Doppler
ultrasound
Rationale: The patient's symptoms—pain, tenderness, warmth, and swelling in the
calf—are classic signs of a Deep Vein Thrombosis (DVT). This is a medical emergency.
The primary nursing action is to prevent the clot from dislodging (embolization) which
could lead to a pulmonary embolism. The leg must not be massaged, and the patient
should be placed on bed rest with the leg elevated. The healthcare provider should be
notified immediately to arrange for a Doppler ultrasound to confirm the diagnosis.
Question 6: An 80-year-old female with Alzheimer's disease is wandering the
halls of the long-term care facility. She appears restless and anxious. What is
the most therapeutic nursing intervention?
A. Administer a PRN dose of haloperidol to calm her down
B. Escort her back to her room and close the door to prevent elopement
C. Take her for a supervised walk to a quiet area
D. Ignore the behavior to avoid reinforcing it
CORRECT ANSWER: C. Take her for a supervised walk to a quiet area
Rationale: Wandering is a common behavioral symptom in Alzheimer's disease. The
best approach is to redirect the patient to a safe, calm activity. Physical activity, such as
walking, can be therapeutic and helps to address the underlying need (e.g., need for
exercise, sensory stimulation). Sedatives should be avoided as a first-line intervention
due to the risk of adverse effects and increased confusion. Confining the patient to her
room or ignoring the behavior can increase agitation and is not therapeutic.
Question 7: A 72-year-old patient is being assessed for osteoporosis. Which of
the following laboratory values is most useful in monitoring the effectiveness
of her treatment?
A. Serum calcium
B. Serum phosphorus
C. Urine calcium
D. Serum Vitamin D
