,Hondros College NUR 163 Geriatric Nursing
Exam 2 Practice Questions 2026–2027 | Older
Adult Care, Safety & Rationales
Q1. A nurse is caring for an 84-year-old client who was admitted with dehydration. The
client's serum sodium is 152 mEq/L. Which action should the nurse take first?
A. Administer 0.45% sodium chloride IV as prescribed
B. Encourage the client to drink water
C. Assess the client's level of consciousness
D. Notify the provider immediately
Correct Answer: C. Assess the client's level of consciousness
Rationale: The client has hypernatremia, which can cause neurological changes ranging from
confusion to seizures and coma. The priority is to assess neurological status first to establish a
baseline and detect deterioration. Administering hypotonic fluids is appropriate but must be
done cautiously to avoid rapid correction. Encouraging oral fluids is helpful for mild
dehydration but is not the first action for significant hypernatremia. Notifying the provider is
important but follows assessment.
Key Takeaway: Hypernatremia means check neuro status first.
Q2. A nurse is teaching an 80-year-old client about preventing heat-related illness. Which
statement by the client indicates a need for further teaching?
A. "I will drink fluids frequently, even if I don't feel thirsty."
B. "I will wear light-colored, loose-fitting clothing."
C. "I will stay indoors during the hottest part of the day."
D. "I will take a hot bath if I feel overheated."
Correct Answer: D. "I will take a hot bath if I feel overheated."
Rationale: Older adults have decreased sweating ability, slower metabolism, and decreased
vasoconstriction response, making thermoregulation less effective. Taking a hot bath would
,further raise body temperature and increase the risk of heat-related illness. Drinking fluids
frequently, wearing light clothing, and staying indoors during peak heat are all appropriate
prevention strategies.
Key Takeaway: Hot baths worsen overheating in older adults.
Q3. A nurse is assessing a 78-year-old client who is immobile following a hip fracture. Which
complication should the nurse monitor for most closely?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
Correct Answer: A. Hypercalcemia
Rationale: Immobility causes bone breakdown and release of calcium into the bloodstream,
leading to hypercalcemia. This can cause confusion, lethargy, and cardiac dysrhythmias.
Hypokalemia, hypernatremia, and hypoglycemia are not direct complications of immobility.
The nurse should also monitor for pressure injuries, deep vein thrombosis, and pneumonia.
Key Takeaway: Immobility breaks down bone and raises calcium.
Q4. A nurse is assessing an older adult client who has been under chronic stress. Which
finding should the nurse expect?
A. Decreased cortisol levels
B. Increased immune function
C. Elevated blood glucose
D. Bradycardia
Correct Answer: C. Elevated blood glucose
Rationale: Chronic stress activates the sympathetic nervous system and the hypothalamic-
pituitary-adrenal axis, leading to increased cortisol secretion. Cortisol raises blood glucose
through gluconeogenesis. Chronic stress also suppresses immune function, not increases it.
Cortisol levels are elevated, not decreased. Tachycardia, not bradycardia, is typical.
, Key Takeaway: Chronic stress raises cortisol and blood sugar.
Q5. A nurse is reviewing the medication list for an 82-year-old client. Which medication
should the nurse question if prescribed?
A. Lisinopril
B. Diphenhydramine
C. Metformin
D. Acetaminophen
Correct Answer: B. Diphenhydramine
Rationale: Diphenhydramine is a first-generation antihistamine with strong anticholinergic
effects, including confusion, urinary retention, and falls. It is listed on the Beers Criteria as
potentially inappropriate for older adults. Lisinopril, metformin, and acetaminophen are
generally safe for older adults when used appropriately. The nurse should question the
diphenhydramine prescription.
Key Takeaway: Avoid diphenhydramine in older adults per Beers Criteria.
Q6. A nurse is assessing a 76-year-old client with fluid volume excess. Which finding should
the nurse expect?
A. Dry mucous membranes
B. Decreased blood pressure
C. Lung crackles
D. Poor skin turgor
Correct Answer: C. Lung crackles
Rationale: Fluid volume excess causes increased circulating volume, leading to pulmonary
congestion and crackles in the lung bases. Dry mucous membranes, decreased blood pressure,
and poor skin turgor are signs of fluid volume deficit. The nurse should also assess for jugular
venous distention, edema, and weight gain.
Key Takeaway: Fluid excess causes crackles in the lungs.
Exam 2 Practice Questions 2026–2027 | Older
Adult Care, Safety & Rationales
Q1. A nurse is caring for an 84-year-old client who was admitted with dehydration. The
client's serum sodium is 152 mEq/L. Which action should the nurse take first?
A. Administer 0.45% sodium chloride IV as prescribed
B. Encourage the client to drink water
C. Assess the client's level of consciousness
D. Notify the provider immediately
Correct Answer: C. Assess the client's level of consciousness
Rationale: The client has hypernatremia, which can cause neurological changes ranging from
confusion to seizures and coma. The priority is to assess neurological status first to establish a
baseline and detect deterioration. Administering hypotonic fluids is appropriate but must be
done cautiously to avoid rapid correction. Encouraging oral fluids is helpful for mild
dehydration but is not the first action for significant hypernatremia. Notifying the provider is
important but follows assessment.
Key Takeaway: Hypernatremia means check neuro status first.
Q2. A nurse is teaching an 80-year-old client about preventing heat-related illness. Which
statement by the client indicates a need for further teaching?
A. "I will drink fluids frequently, even if I don't feel thirsty."
B. "I will wear light-colored, loose-fitting clothing."
C. "I will stay indoors during the hottest part of the day."
D. "I will take a hot bath if I feel overheated."
Correct Answer: D. "I will take a hot bath if I feel overheated."
Rationale: Older adults have decreased sweating ability, slower metabolism, and decreased
vasoconstriction response, making thermoregulation less effective. Taking a hot bath would
,further raise body temperature and increase the risk of heat-related illness. Drinking fluids
frequently, wearing light clothing, and staying indoors during peak heat are all appropriate
prevention strategies.
Key Takeaway: Hot baths worsen overheating in older adults.
Q3. A nurse is assessing a 78-year-old client who is immobile following a hip fracture. Which
complication should the nurse monitor for most closely?
A. Hypercalcemia
B. Hypokalemia
C. Hypernatremia
D. Hypoglycemia
Correct Answer: A. Hypercalcemia
Rationale: Immobility causes bone breakdown and release of calcium into the bloodstream,
leading to hypercalcemia. This can cause confusion, lethargy, and cardiac dysrhythmias.
Hypokalemia, hypernatremia, and hypoglycemia are not direct complications of immobility.
The nurse should also monitor for pressure injuries, deep vein thrombosis, and pneumonia.
Key Takeaway: Immobility breaks down bone and raises calcium.
Q4. A nurse is assessing an older adult client who has been under chronic stress. Which
finding should the nurse expect?
A. Decreased cortisol levels
B. Increased immune function
C. Elevated blood glucose
D. Bradycardia
Correct Answer: C. Elevated blood glucose
Rationale: Chronic stress activates the sympathetic nervous system and the hypothalamic-
pituitary-adrenal axis, leading to increased cortisol secretion. Cortisol raises blood glucose
through gluconeogenesis. Chronic stress also suppresses immune function, not increases it.
Cortisol levels are elevated, not decreased. Tachycardia, not bradycardia, is typical.
, Key Takeaway: Chronic stress raises cortisol and blood sugar.
Q5. A nurse is reviewing the medication list for an 82-year-old client. Which medication
should the nurse question if prescribed?
A. Lisinopril
B. Diphenhydramine
C. Metformin
D. Acetaminophen
Correct Answer: B. Diphenhydramine
Rationale: Diphenhydramine is a first-generation antihistamine with strong anticholinergic
effects, including confusion, urinary retention, and falls. It is listed on the Beers Criteria as
potentially inappropriate for older adults. Lisinopril, metformin, and acetaminophen are
generally safe for older adults when used appropriately. The nurse should question the
diphenhydramine prescription.
Key Takeaway: Avoid diphenhydramine in older adults per Beers Criteria.
Q6. A nurse is assessing a 76-year-old client with fluid volume excess. Which finding should
the nurse expect?
A. Dry mucous membranes
B. Decreased blood pressure
C. Lung crackles
D. Poor skin turgor
Correct Answer: C. Lung crackles
Rationale: Fluid volume excess causes increased circulating volume, leading to pulmonary
congestion and crackles in the lung bases. Dry mucous membranes, decreased blood pressure,
and poor skin turgor are signs of fluid volume deficit. The nurse should also assess for jugular
venous distention, edema, and weight gain.
Key Takeaway: Fluid excess causes crackles in the lungs.
