HESI Gerontology Exam V1 | 2026 Q&A
with Rationale (HESI Gerontology Exam
2026)
1. An 82-year-old client is admitted to the medical unit with a sudden onset of confusion and
visual hallucinations. Which action should the nurse prioritize?
A. Review the client’s current medication list for potential interactions.
B. Assess for signs of a urinary tract infection or electrolyte imbalance.
C. Request a psychiatric consultation for late-onset schizophrenia.
D. Perform a Mini-Mental State Examination (MMSE) to determine the stage of dementia.
Correct Answer: B
Rationale: Sudden confusion in an older adult is often a symptom of delirium rather than
dementia, which is typically a slow decline. Physiological stressors such as a urinary tract
infection (UTI), dehydration, or electrolyte imbalances are common triggers for acute
mental status changes in this population. Prioritizing physiological assessment allows the
nurse to identify and treat the reversible cause of the confusion promptly.
2. A nurse is teaching a group of older adults at a community center about age-related
changes in the integumentary system. Which statement should the nurse include?
A. Increased subcutaneous fat improves temperature regulation.
B. Increased production of sebum prevents skin dryness.
,C. Thickening of the dermis makes the skin more resistant to shear.
D. Reduced epidermal cell turnover leads to delayed wound healing.
Correct Answer: D
Rationale: As people age, the rate of epidermal cell replacement slows down significantly,
which contributes to a thinner skin layer and delayed healing. There is actually a decrease
in subcutaneous fat and sebum production, which leads to increased sensitivity to cold and
drier skin. The dermis also becomes thinner and less elastic, increasing the risk for skin
tears and pressure injuries.
3. The nurse is assessing an 88-year-old client for risk of falls. Which findings increase the
client’s risk? (Select all that apply)
A. History of a fall within the last 6 months.
B. Use of a multi-focal lens for distance and reading.
C. Current prescription for a benzodiazepine.
D. Orthostatic hypotension.
E. Regular participation in a Tai Chi class.
F. Diagnosis of osteoarthritis in the knees.
Correct Answer: A,B,C,D,F
Rationale: A history of recent falls is one of the strongest predictors of future falls in the
geriatric population. Sensory impairments like multi-focal lenses and pharmacological
,interventions like benzodiazepines significantly impair balance and reaction time. Physical
conditions like orthostatic hypotension and osteoarthritis also compromise stability,
whereas Tai Chi is actually a protective factor that improves balance.
4. An older adult client reports difficulty sleeping and asks about taking an over-the-counter
sleep aid containing diphenhydramine. What is the best response by the nurse?
A. ‘It is safe to use for short periods, but avoid using it every night.’
B. ‘You should take it with a full glass of water to prevent kidney damage.’
C. ‘Diphenhydramine is the preferred sleep aid for individuals over the age of 65.’
D. ‘This medication can cause significant side effects like confusion and urinary retention.’
Correct Answer: D
Rationale: Diphenhydramine is an anticholinergic medication that is listed on the Beers
Criteria as potentially inappropriate for older adults. It increases the risk of falls, delirium,
blurred vision, and urinary retention due to the age-related decline in drug metabolism.
The nurse should educate the client on these risks and suggest non-pharmacological sleep
hygiene techniques instead.
5. A nurse is caring for a client with end-stage Alzheimer’s disease who is exhibiting
‘sundowning’ behavior. Which intervention is most appropriate?
A. Increase the brightness of the room lights in the late afternoon.
B. Apply physical restraints to prevent the client from wandering.
C. Administer a high dose of a sedative at 4:00 PM.
, D. Limit daytime activities so the client is well-rested for the evening.
Correct Answer: A
Rationale: Sundowning is characterized by increased confusion and agitation during the
late afternoon and evening hours. Providing adequate lighting can help minimize shadows
and reduce the fear or disorientation that triggers these behaviors. Restraints and heavy
sedation are generally discouraged as they can exacerbate agitation and lead to further
complications.
6. Which age-related cardiovascular change should the nurse expect when assessing an older
adult?
A. Increased sensitivity of baroreceptors.
B. Decreased peripheral vascular resistance.
C. Increased rigidity of the heart valves.
D. Decreased systolic blood pressure.
Correct Answer: C
Rationale: Aging leads to the calcification and stiffening of heart valves, which can result in
murmurs or impaired blood flow. Baroreceptor sensitivity actually decreases, making the
older adult more prone to orthostatic hypotension. Furthermore, peripheral vascular
resistance typically increases due to arterial stiffening, often leading to higher systolic
blood pressure.
with Rationale (HESI Gerontology Exam
2026)
1. An 82-year-old client is admitted to the medical unit with a sudden onset of confusion and
visual hallucinations. Which action should the nurse prioritize?
A. Review the client’s current medication list for potential interactions.
B. Assess for signs of a urinary tract infection or electrolyte imbalance.
C. Request a psychiatric consultation for late-onset schizophrenia.
D. Perform a Mini-Mental State Examination (MMSE) to determine the stage of dementia.
Correct Answer: B
Rationale: Sudden confusion in an older adult is often a symptom of delirium rather than
dementia, which is typically a slow decline. Physiological stressors such as a urinary tract
infection (UTI), dehydration, or electrolyte imbalances are common triggers for acute
mental status changes in this population. Prioritizing physiological assessment allows the
nurse to identify and treat the reversible cause of the confusion promptly.
2. A nurse is teaching a group of older adults at a community center about age-related
changes in the integumentary system. Which statement should the nurse include?
A. Increased subcutaneous fat improves temperature regulation.
B. Increased production of sebum prevents skin dryness.
,C. Thickening of the dermis makes the skin more resistant to shear.
D. Reduced epidermal cell turnover leads to delayed wound healing.
Correct Answer: D
Rationale: As people age, the rate of epidermal cell replacement slows down significantly,
which contributes to a thinner skin layer and delayed healing. There is actually a decrease
in subcutaneous fat and sebum production, which leads to increased sensitivity to cold and
drier skin. The dermis also becomes thinner and less elastic, increasing the risk for skin
tears and pressure injuries.
3. The nurse is assessing an 88-year-old client for risk of falls. Which findings increase the
client’s risk? (Select all that apply)
A. History of a fall within the last 6 months.
B. Use of a multi-focal lens for distance and reading.
C. Current prescription for a benzodiazepine.
D. Orthostatic hypotension.
E. Regular participation in a Tai Chi class.
F. Diagnosis of osteoarthritis in the knees.
Correct Answer: A,B,C,D,F
Rationale: A history of recent falls is one of the strongest predictors of future falls in the
geriatric population. Sensory impairments like multi-focal lenses and pharmacological
,interventions like benzodiazepines significantly impair balance and reaction time. Physical
conditions like orthostatic hypotension and osteoarthritis also compromise stability,
whereas Tai Chi is actually a protective factor that improves balance.
4. An older adult client reports difficulty sleeping and asks about taking an over-the-counter
sleep aid containing diphenhydramine. What is the best response by the nurse?
A. ‘It is safe to use for short periods, but avoid using it every night.’
B. ‘You should take it with a full glass of water to prevent kidney damage.’
C. ‘Diphenhydramine is the preferred sleep aid for individuals over the age of 65.’
D. ‘This medication can cause significant side effects like confusion and urinary retention.’
Correct Answer: D
Rationale: Diphenhydramine is an anticholinergic medication that is listed on the Beers
Criteria as potentially inappropriate for older adults. It increases the risk of falls, delirium,
blurred vision, and urinary retention due to the age-related decline in drug metabolism.
The nurse should educate the client on these risks and suggest non-pharmacological sleep
hygiene techniques instead.
5. A nurse is caring for a client with end-stage Alzheimer’s disease who is exhibiting
‘sundowning’ behavior. Which intervention is most appropriate?
A. Increase the brightness of the room lights in the late afternoon.
B. Apply physical restraints to prevent the client from wandering.
C. Administer a high dose of a sedative at 4:00 PM.
, D. Limit daytime activities so the client is well-rested for the evening.
Correct Answer: A
Rationale: Sundowning is characterized by increased confusion and agitation during the
late afternoon and evening hours. Providing adequate lighting can help minimize shadows
and reduce the fear or disorientation that triggers these behaviors. Restraints and heavy
sedation are generally discouraged as they can exacerbate agitation and lead to further
complications.
6. Which age-related cardiovascular change should the nurse expect when assessing an older
adult?
A. Increased sensitivity of baroreceptors.
B. Decreased peripheral vascular resistance.
C. Increased rigidity of the heart valves.
D. Decreased systolic blood pressure.
Correct Answer: C
Rationale: Aging leads to the calcification and stiffening of heart valves, which can result in
murmurs or impaired blood flow. Baroreceptor sensitivity actually decreases, making the
older adult more prone to orthostatic hypotension. Furthermore, peripheral vascular
resistance typically increases due to arterial stiffening, often leading to higher systolic
blood pressure.
