NUR 257 EXAM 1-4 ACTUAL EXAMS 2026/2027 GERIATRIC NCLEX
QUESTIONS COMPLETE ACCURATE EXAM
1. An 82-year-old client is admitted to a medical unit after experiencing
increasing difficulty managing medications and preparing meals
independently. During the nursing assessment, the client is able to bathe,
dress, and feed herself but reports that she has recently missed several
medication doses and has forgotten to pay household bills. Which
assessment finding most specifically indicates impairment in instrumental
activities of daily living rather than basic activities of daily living?
A. Needing assistance to transfer from the bed to a chair
B. Requiring help with medication management and financial
responsibilities
C. Needing assistance to complete a shower safely
D. Requiring another person to assist with feeding
Answer: B
2. An older adult who has been hospitalized for pneumonia suddenly becomes
disoriented, repeatedly attempts to remove the oxygen cannula, and
alternates between periods of agitation and drowsiness. The client's
daughter states that this behavior is very different from the client's usual
baseline. Which condition should the nurse suspect first?
A. Normal age-related cognitive slowing
B. Major depressive disorder
C. Progressive dementia
D. Acute delirium
Answer: D
3. A nurse is completing a medication reconciliation for an 80-year-old client
who reports dizziness and two recent falls. The client takes several
prescription medications as well as an over-the-counter sleep aid every
night. Which medication-related concern should the nurse investigate most
carefully?
pg. 1
, A. Use of potentially inappropriate sedating or anticholinergic medications
B. Taking medications at different times of the day
C. Taking prescribed medications with meals
D. Using a weekly pill organizer
Answer: A
4. An 87-year-old client with osteoarthritis reports increasing difficulty walking
because of pain and weakness. The client lives alone and has fallen twice
during the past month. Which nursing assessment provides the most useful
information for developing an individualized fall-prevention plan?
A. Asking only whether the client has previously fractured a bone
B. Determining the client's favorite physical activities
C. Assessing gait, balance, strength, medications, vision, footwear, and
environmental hazards
D. Determining whether the client has a family history of dementia
Answer: C
5. An older adult with a history of mild cognitive impairment becomes acutely
confused several hours after surgery. The client is unable to maintain
attention, alternates between lethargy and agitation, and repeatedly asks
where the client is. Which nursing action is the priority?
A. Assume that the client's dementia has suddenly progressed
B. Assess for reversible causes such as hypoxia, infection, pain, dehydration,
and medication effects
C. Place the client in a dark room to reduce environmental stimulation
D. Explain to the family that confusion is an expected consequence of aging
Answer: B
6. A 79-year-old client reports that hearing conversations has become
increasingly difficult, particularly when several people are speaking
simultaneously. Which nursing intervention best supports effective
communication?
A. Speak rapidly so the conversation is completed before the client becomes
pg. 2
, tired
B. Raise the pitch of the voice substantially
C. Face the client directly, reduce background noise, and speak clearly in a
lower-pitched voice
D. Speak only with the client's family because communication is difficult
Answer: C
7. A nurse is teaching an older adult about preventing falls at home after
discharge. Which statement by the client demonstrates the best
understanding of environmental fall prevention?
A. "I will keep frequently used items where I can reach them without
climbing."
B. "I will use a small step stool whenever I need something from a high
cabinet."
C. "I will keep the hallway dark at night so I can sleep better."
D. "I will remove my nonskid shoes whenever I walk around the house."
Answer: A
8. An older adult with chronic heart failure tells the nurse, "I have not been as
hungry lately, and my clothes have become loose over the past several
months." Which nursing assessment is most important?
A. Ask only about the client's favorite foods
B. Determine whether the client prefers eating alone
C. Assess weight trends, food intake, oral health, swallowing ability,
medications, and access to food
D. Explain that appetite reduction is an unavoidable part of aging
Answer: C
9. A nurse is caring for an older adult who has limited mobility and is
incontinent of urine. The client has fragile skin and spends most of the day
in bed. Which intervention is most appropriate for preventing pressure
injury?
A. Massage reddened areas over bony prominences
pg. 3
, B. Reposition regularly, manage moisture, inspect the skin, and use
pressure-redistributing strategies
C. Keep the client in one position to avoid friction
D. Restrict fluid intake to decrease incontinence
Answer: B
10. A 76-year-old client states, "I sometimes forget where I put my keys, but I
remember important events from many years ago and manage my finances
independently." Which interpretation is most appropriate?
A. The client necessarily has advanced dementia
B. The client is experiencing delirium
C. Occasional minor forgetfulness can occur with aging when cognition and
function remain intact
D. The client requires immediate institutional placement
Answer: C
11. A nurse is assessing an older adult who reports dizziness after standing from
a chair. The client takes several antihypertensive medications. Which
assessment should the nurse prioritize?
A. Compare blood pressure and pulse while lying, sitting, and standing
B. Determine the client's preferred sleeping position
C. Assess the client's ability to distinguish colors
D. Ask whether the client prefers morning or evening medications
Answer: A
12. An older adult with diabetes has recently begun eating less because of
dental pain. The client has lost 8 pounds unintentionally in two months.
Which nursing intervention is most appropriate?
A. Encourage the client to skip meals until the dental problem resolves
B. Assess oral health and nutritional status and coordinate appropriate
dental and nutrition support
C. Tell the client that weight loss is expected in advanced age
D. Recommend eliminating protein from the diet
pg. 4
QUESTIONS COMPLETE ACCURATE EXAM
1. An 82-year-old client is admitted to a medical unit after experiencing
increasing difficulty managing medications and preparing meals
independently. During the nursing assessment, the client is able to bathe,
dress, and feed herself but reports that she has recently missed several
medication doses and has forgotten to pay household bills. Which
assessment finding most specifically indicates impairment in instrumental
activities of daily living rather than basic activities of daily living?
A. Needing assistance to transfer from the bed to a chair
B. Requiring help with medication management and financial
responsibilities
C. Needing assistance to complete a shower safely
D. Requiring another person to assist with feeding
Answer: B
2. An older adult who has been hospitalized for pneumonia suddenly becomes
disoriented, repeatedly attempts to remove the oxygen cannula, and
alternates between periods of agitation and drowsiness. The client's
daughter states that this behavior is very different from the client's usual
baseline. Which condition should the nurse suspect first?
A. Normal age-related cognitive slowing
B. Major depressive disorder
C. Progressive dementia
D. Acute delirium
Answer: D
3. A nurse is completing a medication reconciliation for an 80-year-old client
who reports dizziness and two recent falls. The client takes several
prescription medications as well as an over-the-counter sleep aid every
night. Which medication-related concern should the nurse investigate most
carefully?
pg. 1
, A. Use of potentially inappropriate sedating or anticholinergic medications
B. Taking medications at different times of the day
C. Taking prescribed medications with meals
D. Using a weekly pill organizer
Answer: A
4. An 87-year-old client with osteoarthritis reports increasing difficulty walking
because of pain and weakness. The client lives alone and has fallen twice
during the past month. Which nursing assessment provides the most useful
information for developing an individualized fall-prevention plan?
A. Asking only whether the client has previously fractured a bone
B. Determining the client's favorite physical activities
C. Assessing gait, balance, strength, medications, vision, footwear, and
environmental hazards
D. Determining whether the client has a family history of dementia
Answer: C
5. An older adult with a history of mild cognitive impairment becomes acutely
confused several hours after surgery. The client is unable to maintain
attention, alternates between lethargy and agitation, and repeatedly asks
where the client is. Which nursing action is the priority?
A. Assume that the client's dementia has suddenly progressed
B. Assess for reversible causes such as hypoxia, infection, pain, dehydration,
and medication effects
C. Place the client in a dark room to reduce environmental stimulation
D. Explain to the family that confusion is an expected consequence of aging
Answer: B
6. A 79-year-old client reports that hearing conversations has become
increasingly difficult, particularly when several people are speaking
simultaneously. Which nursing intervention best supports effective
communication?
A. Speak rapidly so the conversation is completed before the client becomes
pg. 2
, tired
B. Raise the pitch of the voice substantially
C. Face the client directly, reduce background noise, and speak clearly in a
lower-pitched voice
D. Speak only with the client's family because communication is difficult
Answer: C
7. A nurse is teaching an older adult about preventing falls at home after
discharge. Which statement by the client demonstrates the best
understanding of environmental fall prevention?
A. "I will keep frequently used items where I can reach them without
climbing."
B. "I will use a small step stool whenever I need something from a high
cabinet."
C. "I will keep the hallway dark at night so I can sleep better."
D. "I will remove my nonskid shoes whenever I walk around the house."
Answer: A
8. An older adult with chronic heart failure tells the nurse, "I have not been as
hungry lately, and my clothes have become loose over the past several
months." Which nursing assessment is most important?
A. Ask only about the client's favorite foods
B. Determine whether the client prefers eating alone
C. Assess weight trends, food intake, oral health, swallowing ability,
medications, and access to food
D. Explain that appetite reduction is an unavoidable part of aging
Answer: C
9. A nurse is caring for an older adult who has limited mobility and is
incontinent of urine. The client has fragile skin and spends most of the day
in bed. Which intervention is most appropriate for preventing pressure
injury?
A. Massage reddened areas over bony prominences
pg. 3
, B. Reposition regularly, manage moisture, inspect the skin, and use
pressure-redistributing strategies
C. Keep the client in one position to avoid friction
D. Restrict fluid intake to decrease incontinence
Answer: B
10. A 76-year-old client states, "I sometimes forget where I put my keys, but I
remember important events from many years ago and manage my finances
independently." Which interpretation is most appropriate?
A. The client necessarily has advanced dementia
B. The client is experiencing delirium
C. Occasional minor forgetfulness can occur with aging when cognition and
function remain intact
D. The client requires immediate institutional placement
Answer: C
11. A nurse is assessing an older adult who reports dizziness after standing from
a chair. The client takes several antihypertensive medications. Which
assessment should the nurse prioritize?
A. Compare blood pressure and pulse while lying, sitting, and standing
B. Determine the client's preferred sleeping position
C. Assess the client's ability to distinguish colors
D. Ask whether the client prefers morning or evening medications
Answer: A
12. An older adult with diabetes has recently begun eating less because of
dental pain. The client has lost 8 pounds unintentionally in two months.
Which nursing intervention is most appropriate?
A. Encourage the client to skip meals until the dental problem resolves
B. Assess oral health and nutritional status and coordinate appropriate
dental and nutrition support
C. Tell the client that weight loss is expected in advanced age
D. Recommend eliminating protein from the diet
pg. 4
