,Comprehensive Geriatric Care Review:
NCLEX & NP-Style Questions with
Rationales
📘 Table of Contents
Unit I: The Healthy Older Adult
1. Changes with Aging
2. Health Promotion
3. Exercise in Older Adults
4. Nutritional Support in the Older Adult
5. Settings of Care (new chapter in this edition)
Unit II: Assessment
6. Comprehensive Geriatric Assessment
7. Symptoms and Syndromes (covers common geriatric
syndromes and their atypical presentations)
Unit III: Treating Disorders
(Returns to system-based chapters with signal-symptoms, SORT
evidence ratings, in-text case studies)
8. Dermatologic Disorders
9. Head, Neck, and Face Disorders
10. Cardiovascular Disorders
11. Respiratory Disorders
12. Peripheral Vascular Disorders
,13. Gastrointestinal Disorders
14. Urologic and Renal Disorders
15. Gynecologic Disorders
16. Musculoskeletal Disorders
17. Central and Peripheral Nervous System Disorders
18. Endocrine and Metabolic Disorders
19. Hematologic Disorders
20. Psychosocial Disorders
Unit IV: Complex Illness
21. Polypharmacy
22. Chronic Illness and the APRN
23. Palliative Care and End-of-Life
,Chapter 1 “Changes With Aging” from Advanced Practice
Nursing in the Care of Older Adults, 3rd Ed.
Question 1
A 78-year-old patient presents for an annual wellness visit.
Which of the following statements BEST reflects a
fundamental principle in gerontology?
A. Chronological age alone is the strongest predictor of
health status.
B. Functional age may differ significantly from
chronological age.
C. Older adults universally experience cognitive decline by
the seventh decade.
D. Sensory impairment is an inevitable consequence of
aging.
Answer: B
Rationale:
Functional age—how well a person performs daily tasks—
often diverges from chronological age; many older adults
remain highly functional despite advanced years.
Chronological age alone (A) is a poor predictor of
individual health. Cognitive decline (C) and sensory
impairments (D) are not universal but vary widely among
older adults.
Question 2
A 70-year-old male has an echocardiogram showing left
,ventricular wall thickening without clinical heart failure.
Which age-related change MOST likely explains this
finding?
A. Decreased myocardial collagen deposition
B. Decline in cardiomyocyte size
C. Increased left ventricular stiffness
D. Enhanced beta-adrenergic receptor sensitivity
Answer: C
Rationale:
Aging leads to increased myocardial fibrosis and stiffness,
causing wall thickening without overt failure. Collagen
deposition actually increases (opposite of A), and
cardiomyocyte size may increase or remain stable (B is
incorrect). Beta-adrenergic sensitivity declines, not
enhances (D).
Question 3
An older adult demonstrates a serum creatinine of 1.1
mg/dL. Which interpretation is MOST appropriate?
A. Renal function is normal; no action needed.
B. Glomerular filtration rate (GFR) is likely underestimated
by creatinine alone.
C. Serum creatinine overestimates renal function in older
adults due to decreased muscle mass.
D. Immediate referral for dialysis is indicated.
,Answer: C
Rationale:
In older adults, decreased muscle mass can lower
creatinine production, so a normal or low creatinine may
mask reduced GFR (C). Thus, relying solely on creatinine
can overestimate renal function. GFR estimation (e.g., via
MDRD) is more accurate. A is false because renal function
may be impaired despite normal creatinine. B is
backwards. D is not indicated without further evidence.
Question 4
A 82-year-old woman presents with urinary tract infection
(UTI) symptoms without fever or dysuria but with sudden
confusion. This represents which concept?
A. Typical presentation of UTI in older adults
B. Atypical presentation of infection in geriatric patients
C. Age-related immunocompromise leading to false-
negative cultures
D. Confusion as a side effect of antibiotics
Answer: B
Rationale:
Older adults often present atypically with infections—
confusion rather than localized signs (B). This is not the
typical young adult presentation (A). Immunocompromise
does not produce false-negative cultures (C). Confusion
precedes treatment, so D is incorrect.
,Question 5
A 75-year-old with chronic osteoarthritis complains of
increased difficulty rising from chairs. Which statement
MOST accurately links chronic disease with functional
capacity?
A. Chronic illness always leads to dependency in ADLs.
B. Pain and joint stiffness reduce mobility and compromise
function.
C. Disease duration has no impact on functional status.
D. Functional capacity declines only due to aging, not
chronic conditions.
Answer: B
Rationale:
Chronic joint pain and stiffness directly impair mobility and
activities of daily living (B). Chronic illness does not
inevitably cause dependency (A). Duration does influence
function (C false), and functional decline stems from both
aging and comorbidities (D false).
Question 6
When planning care for an 80-year-old patient, which lab
value change is expected as part of normal aging?
A. Increased serum albumin levels
B. Reduced hemoglobin concentration within mild limits
C. Elevated white blood cell count at baseline
,D. Hypoglycemia after fasting
Answer: B
Rationale:
Mild anemia is common with aging; hemoglobin may
decrease modestly (B). Albumin typically decreases, not
increases (A). WBC counts generally remain stable (C).
Glucose regulation can be impaired leading to
hyperglycemia, not hypoglycemia (D).
Question 7
A frail 85-year-old presents with chest pain but has a
normal ECG and no troponin elevation. Which
consideration is MOST important?
A. Exclude coronary artery disease due to normal tests.
B. Recognize potential atypical angina presentation.
C. Discharge with reassurance.
D. Initiate aggressive diuretic therapy.
Answer: B
Rationale:
Elderly patients often have atypical ischemic symptoms;
further evaluation may be needed despite normal
ECG/troponins (B). Coronary disease cannot be excluded
(A). Reassurance without investigation (C) could miss MI.
Diuretics (D) are unrelated unless heart failure signs are
present.
,Question 8
An 82-year-old patient’s serum sodium is 132 mEq/L. Which
interpretation is most appropriate? A. True hyponatremia
requiring hypertonic saline B. Dilutional hyponatremia often
seen with aging and thiazide use C. Pseudohyponatremia due to
hyperlipidemia D. Laboratory error; no clinical significance
Answer: B Rationale: Older adults, especially on thiazide
diuretics, often develop dilutional hyponatremia (B). True
hyponatremia requiring hypertonic saline (A) is less common.
Pseudohyponatremia (C) is rare. Lab error (D) should be
considered only after clinical correlation.
Question 9
A 79-year-old woman with chronic kidney disease has a
BUN:creatinine ratio of 25:1. Which age-related factor may
contribute? A. Increased muscle mass elevating creatinine B.
Decreased hepatic metabolism of urea C. Reduced renal
reserve leading to BUN retention D. Enhanced tubular secretion
of creatinine
Answer: C Rationale: Aging reduces nephron number and renal
reserve, elevating BUN relative to creatinine (C). Muscle mass
decreases (A false), hepatic metabolism does not significantly
affect urea (B), and creatinine secretion declines with age (D
false).
Question 10
, An 85-year-old falls frequently. Which musculoskeletal change
BEST explains his risk? A. Increased bone density B. Decreased
muscle mass and strength C. Enhanced proprioception D.
Greater joint range of motion
Answer: B Rationale: Sarcopenia — loss of muscle mass and
strength — increases fall risk (B). Bone density declines (A
false), proprioception worsens (C false), and joint range often
decreases (D false).
Question 11
A 77-year-old presents with depression but no sadness, only
apathy and anorexia. This represents: A. Typical presentation of
geriatric depression B. Masked affect presentation C. Delirium
subtype D. Normal aging mood change
Answer: B Rationale: Older adults often exhibit masked
depression — presenting with somatic or behavioral changes
rather than overt sadness (B). It is not the normal affective
presentation (A), delirium (C), nor a normal aging change (D).
Question 12
Which cardiovascular change is expected in a healthy
80-year-old? A. Resting tachycardia due to SA node
hypertrophy B. Increased systolic blood pressure from arterial
stiffening C. Decreased end-diastolic volume from myocardial
hypertrophy D. Enhanced automaticity causing frequent PVCs
Answer: B Rationale: Arterial stiffening raises systolic pressure
with age (B). Resting heart rate remains stable or decreases (A
NCLEX & NP-Style Questions with
Rationales
📘 Table of Contents
Unit I: The Healthy Older Adult
1. Changes with Aging
2. Health Promotion
3. Exercise in Older Adults
4. Nutritional Support in the Older Adult
5. Settings of Care (new chapter in this edition)
Unit II: Assessment
6. Comprehensive Geriatric Assessment
7. Symptoms and Syndromes (covers common geriatric
syndromes and their atypical presentations)
Unit III: Treating Disorders
(Returns to system-based chapters with signal-symptoms, SORT
evidence ratings, in-text case studies)
8. Dermatologic Disorders
9. Head, Neck, and Face Disorders
10. Cardiovascular Disorders
11. Respiratory Disorders
12. Peripheral Vascular Disorders
,13. Gastrointestinal Disorders
14. Urologic and Renal Disorders
15. Gynecologic Disorders
16. Musculoskeletal Disorders
17. Central and Peripheral Nervous System Disorders
18. Endocrine and Metabolic Disorders
19. Hematologic Disorders
20. Psychosocial Disorders
Unit IV: Complex Illness
21. Polypharmacy
22. Chronic Illness and the APRN
23. Palliative Care and End-of-Life
,Chapter 1 “Changes With Aging” from Advanced Practice
Nursing in the Care of Older Adults, 3rd Ed.
Question 1
A 78-year-old patient presents for an annual wellness visit.
Which of the following statements BEST reflects a
fundamental principle in gerontology?
A. Chronological age alone is the strongest predictor of
health status.
B. Functional age may differ significantly from
chronological age.
C. Older adults universally experience cognitive decline by
the seventh decade.
D. Sensory impairment is an inevitable consequence of
aging.
Answer: B
Rationale:
Functional age—how well a person performs daily tasks—
often diverges from chronological age; many older adults
remain highly functional despite advanced years.
Chronological age alone (A) is a poor predictor of
individual health. Cognitive decline (C) and sensory
impairments (D) are not universal but vary widely among
older adults.
Question 2
A 70-year-old male has an echocardiogram showing left
,ventricular wall thickening without clinical heart failure.
Which age-related change MOST likely explains this
finding?
A. Decreased myocardial collagen deposition
B. Decline in cardiomyocyte size
C. Increased left ventricular stiffness
D. Enhanced beta-adrenergic receptor sensitivity
Answer: C
Rationale:
Aging leads to increased myocardial fibrosis and stiffness,
causing wall thickening without overt failure. Collagen
deposition actually increases (opposite of A), and
cardiomyocyte size may increase or remain stable (B is
incorrect). Beta-adrenergic sensitivity declines, not
enhances (D).
Question 3
An older adult demonstrates a serum creatinine of 1.1
mg/dL. Which interpretation is MOST appropriate?
A. Renal function is normal; no action needed.
B. Glomerular filtration rate (GFR) is likely underestimated
by creatinine alone.
C. Serum creatinine overestimates renal function in older
adults due to decreased muscle mass.
D. Immediate referral for dialysis is indicated.
,Answer: C
Rationale:
In older adults, decreased muscle mass can lower
creatinine production, so a normal or low creatinine may
mask reduced GFR (C). Thus, relying solely on creatinine
can overestimate renal function. GFR estimation (e.g., via
MDRD) is more accurate. A is false because renal function
may be impaired despite normal creatinine. B is
backwards. D is not indicated without further evidence.
Question 4
A 82-year-old woman presents with urinary tract infection
(UTI) symptoms without fever or dysuria but with sudden
confusion. This represents which concept?
A. Typical presentation of UTI in older adults
B. Atypical presentation of infection in geriatric patients
C. Age-related immunocompromise leading to false-
negative cultures
D. Confusion as a side effect of antibiotics
Answer: B
Rationale:
Older adults often present atypically with infections—
confusion rather than localized signs (B). This is not the
typical young adult presentation (A). Immunocompromise
does not produce false-negative cultures (C). Confusion
precedes treatment, so D is incorrect.
,Question 5
A 75-year-old with chronic osteoarthritis complains of
increased difficulty rising from chairs. Which statement
MOST accurately links chronic disease with functional
capacity?
A. Chronic illness always leads to dependency in ADLs.
B. Pain and joint stiffness reduce mobility and compromise
function.
C. Disease duration has no impact on functional status.
D. Functional capacity declines only due to aging, not
chronic conditions.
Answer: B
Rationale:
Chronic joint pain and stiffness directly impair mobility and
activities of daily living (B). Chronic illness does not
inevitably cause dependency (A). Duration does influence
function (C false), and functional decline stems from both
aging and comorbidities (D false).
Question 6
When planning care for an 80-year-old patient, which lab
value change is expected as part of normal aging?
A. Increased serum albumin levels
B. Reduced hemoglobin concentration within mild limits
C. Elevated white blood cell count at baseline
,D. Hypoglycemia after fasting
Answer: B
Rationale:
Mild anemia is common with aging; hemoglobin may
decrease modestly (B). Albumin typically decreases, not
increases (A). WBC counts generally remain stable (C).
Glucose regulation can be impaired leading to
hyperglycemia, not hypoglycemia (D).
Question 7
A frail 85-year-old presents with chest pain but has a
normal ECG and no troponin elevation. Which
consideration is MOST important?
A. Exclude coronary artery disease due to normal tests.
B. Recognize potential atypical angina presentation.
C. Discharge with reassurance.
D. Initiate aggressive diuretic therapy.
Answer: B
Rationale:
Elderly patients often have atypical ischemic symptoms;
further evaluation may be needed despite normal
ECG/troponins (B). Coronary disease cannot be excluded
(A). Reassurance without investigation (C) could miss MI.
Diuretics (D) are unrelated unless heart failure signs are
present.
,Question 8
An 82-year-old patient’s serum sodium is 132 mEq/L. Which
interpretation is most appropriate? A. True hyponatremia
requiring hypertonic saline B. Dilutional hyponatremia often
seen with aging and thiazide use C. Pseudohyponatremia due to
hyperlipidemia D. Laboratory error; no clinical significance
Answer: B Rationale: Older adults, especially on thiazide
diuretics, often develop dilutional hyponatremia (B). True
hyponatremia requiring hypertonic saline (A) is less common.
Pseudohyponatremia (C) is rare. Lab error (D) should be
considered only after clinical correlation.
Question 9
A 79-year-old woman with chronic kidney disease has a
BUN:creatinine ratio of 25:1. Which age-related factor may
contribute? A. Increased muscle mass elevating creatinine B.
Decreased hepatic metabolism of urea C. Reduced renal
reserve leading to BUN retention D. Enhanced tubular secretion
of creatinine
Answer: C Rationale: Aging reduces nephron number and renal
reserve, elevating BUN relative to creatinine (C). Muscle mass
decreases (A false), hepatic metabolism does not significantly
affect urea (B), and creatinine secretion declines with age (D
false).
Question 10
, An 85-year-old falls frequently. Which musculoskeletal change
BEST explains his risk? A. Increased bone density B. Decreased
muscle mass and strength C. Enhanced proprioception D.
Greater joint range of motion
Answer: B Rationale: Sarcopenia — loss of muscle mass and
strength — increases fall risk (B). Bone density declines (A
false), proprioception worsens (C false), and joint range often
decreases (D false).
Question 11
A 77-year-old presents with depression but no sadness, only
apathy and anorexia. This represents: A. Typical presentation of
geriatric depression B. Masked affect presentation C. Delirium
subtype D. Normal aging mood change
Answer: B Rationale: Older adults often exhibit masked
depression — presenting with somatic or behavioral changes
rather than overt sadness (B). It is not the normal affective
presentation (A), delirium (C), nor a normal aging change (D).
Question 12
Which cardiovascular change is expected in a healthy
80-year-old? A. Resting tachycardia due to SA node
hypertrophy B. Increased systolic blood pressure from arterial
stiffening C. Decreased end-diastolic volume from myocardial
hypertrophy D. Enhanced automaticity causing frequent PVCs
Answer: B Rationale: Arterial stiffening raises systolic pressure
with age (B). Resting heart rate remains stable or decreases (A
