HESI Gerontology Exam 2026/2027 |
Accurate & Frequently Tested Questions
with Answers
EXAM
1. Pneumonia Assessment in Frail Elderly
A frail, elderly client is admitted to the unit with a diagnosis of pneumonia. Which
finding is most important for the registered nurse (RN) to report to the healthcare
provider?
A. Fever and chills
B. Confusion and dehydration
C. Crackles in the lung fields
D. Nausea and vomiting
Answer: B. Confusion and dehydration
Rationale: In the frail elderly population, typical signs of infection like fever may be
absent. Confusion and dehydration are often the primary indicators of inadequate
oxygenation and perfusion, making them the most critical findings to report .
2. Age-Related Taste Changes
A frail elderly couple asks the registered nurse (RN) if they have to watch their salt intake
because food does not taste as good as it used to, so they have to season most foods.
What information should the RN offer the couple?
A. Boredom may influence how the taste of food is perceived, and different seasonings
can stimulate taste.
B. With age, an increase in sodium intake is needed to compensate for a decrease in
renal function.
C. Short-term memory loss and confusion may be the reason they want to over-season
their food.
D. Taste buds often are dull due to atrophy, so older clients should use other seasonings
instead of salt.
Answer: D. Taste buds are often dull due to atrophy, so older clients should use
other seasonings instead of salt.
,Rationale: A normal age-related change is the atrophy of taste buds, which diminishes
sensitivity to taste. The best advice is to use alternative seasonings (like herbs and
spices) to enhance flavor without increasing sodium intake, which is important for
managing conditions like hypertension .
3. Priority Action After Pacemaker Insertion
An older client is transferred to a telemetry unit after placement of a pacemaker. What
action should the registered nurse (RN) take first?
A. View the incision site
B. Obtain a blood pressure
C. Establish telemetry monitoring
D. Evaluate the client for pain
Answer: C. Establish telemetry monitoring
Rationale: The priority action is to establish continuous cardiac monitoring to
immediately verify the pacemaker is functioning correctly and capturing the heart
rhythm effectively. Other assessments, while important, come after ensuring
physiological stability .
4. Sundowning Syndrome
An older client with chronic kidney disease (CKD) has an arteriovenous fistula (AV) in the
left forearm for hemodialysis. After palpating the AV fistula, which finding is an
indication that the AV fistula is functioning properly?
A family member brings their aging father to the clinic because he has been alert and
oriented during the day but agitated and disoriented in the evening. The registered nurse
(RN) reviews the client's list of current medications with the client and family. Which
action taken by the RN is most important?
A. Medication review with family caregivers is the PN's responsibility
B. Multiple medications can contribute to sundowner-like symptoms
C. Medication recall is the best way to evaluate the client's memory
D. Reviewing medication actions is a component of effective client care
Answer: B. Multiple medications can contribute to sundowner-like symptoms
Rationale: "Sundowning" refers to increased confusion, agitation, and disorientation that
occurs in the evening. Polypharmacy (taking multiple medications) is a significant
contributing factor due to drug interactions and cumulative effects, especially as
metabolic processes slow with age. Reviewing medications is a critical intervention .
5. Pain Assessment in End-Stage Alzheimer's
The hospice nurse is completing a focused assessment of an older female client with
end-stage Alzheimer's disease, who recently fractured her hip. What technique should
, the registered nurse (RN) use to determine the client's pain?
A. Use the FACE pain scale
B. Ask the client to rate pain on a scale of 1 to 10
C. Observe for facial grimacing
D. Review documentation of recent eating habits
Answer: C. Observe for facial grimacing
Rationale: Clients with end-stage Alzheimer's disease often lose the ability to
communicate verbally or understand abstract concepts like pain scales. Observing for
non-verbal cues such as facial grimacing, guarding, or restlessness is the most reliable
method for pain assessment in this population .
6. Risk Factors for Elder Abuse
Older clients are at highest risk for abuse and neglect due to which factors? (Select all
that apply)
A. Needs are greater than the caretaker's ability
B. Client's declining strength
C. Fixed income
D. Longer life expectancy
E. Lack of exposure to technology and trends
Answer: A. Needs are greater than the caretaker's ability, and B. Client's declining
strength
Rationale: Abuse and neglect often occur when caregiver stress and feelings of being
overwhelmed (due to the high needs of the client) combine with the client's increased
physical vulnerability and inability to defend themselves or escape the situation .
7. Reality Orientation for Confused Clients
An older female client recently moved to an assisted living facility. The family explains to
the registered nurse (RN) that the client is unmanageable and always confused,
disoriented, and depressed. The client asks the RN repeatedly, "Where am I?". How
should the RN respond?
A. Explain that she is in a new home called an assisted living community
B. Question the client about her perception of where she might be now.
C. Distract the client with a scenario that she is on an outing with her family.
D. Reassure the client not to worry because she will meet new friends.
Answer: A. Explain that she is in a new home called an assisted living community
Rationale: Providing simple, calm, and factual reality orientation is the most appropriate
response. It offers consistency and truth, which can help reduce anxiety in a confused
client. Avoiding the question or providing false information can increase disorientation .
Accurate & Frequently Tested Questions
with Answers
EXAM
1. Pneumonia Assessment in Frail Elderly
A frail, elderly client is admitted to the unit with a diagnosis of pneumonia. Which
finding is most important for the registered nurse (RN) to report to the healthcare
provider?
A. Fever and chills
B. Confusion and dehydration
C. Crackles in the lung fields
D. Nausea and vomiting
Answer: B. Confusion and dehydration
Rationale: In the frail elderly population, typical signs of infection like fever may be
absent. Confusion and dehydration are often the primary indicators of inadequate
oxygenation and perfusion, making them the most critical findings to report .
2. Age-Related Taste Changes
A frail elderly couple asks the registered nurse (RN) if they have to watch their salt intake
because food does not taste as good as it used to, so they have to season most foods.
What information should the RN offer the couple?
A. Boredom may influence how the taste of food is perceived, and different seasonings
can stimulate taste.
B. With age, an increase in sodium intake is needed to compensate for a decrease in
renal function.
C. Short-term memory loss and confusion may be the reason they want to over-season
their food.
D. Taste buds often are dull due to atrophy, so older clients should use other seasonings
instead of salt.
Answer: D. Taste buds are often dull due to atrophy, so older clients should use
other seasonings instead of salt.
,Rationale: A normal age-related change is the atrophy of taste buds, which diminishes
sensitivity to taste. The best advice is to use alternative seasonings (like herbs and
spices) to enhance flavor without increasing sodium intake, which is important for
managing conditions like hypertension .
3. Priority Action After Pacemaker Insertion
An older client is transferred to a telemetry unit after placement of a pacemaker. What
action should the registered nurse (RN) take first?
A. View the incision site
B. Obtain a blood pressure
C. Establish telemetry monitoring
D. Evaluate the client for pain
Answer: C. Establish telemetry monitoring
Rationale: The priority action is to establish continuous cardiac monitoring to
immediately verify the pacemaker is functioning correctly and capturing the heart
rhythm effectively. Other assessments, while important, come after ensuring
physiological stability .
4. Sundowning Syndrome
An older client with chronic kidney disease (CKD) has an arteriovenous fistula (AV) in the
left forearm for hemodialysis. After palpating the AV fistula, which finding is an
indication that the AV fistula is functioning properly?
A family member brings their aging father to the clinic because he has been alert and
oriented during the day but agitated and disoriented in the evening. The registered nurse
(RN) reviews the client's list of current medications with the client and family. Which
action taken by the RN is most important?
A. Medication review with family caregivers is the PN's responsibility
B. Multiple medications can contribute to sundowner-like symptoms
C. Medication recall is the best way to evaluate the client's memory
D. Reviewing medication actions is a component of effective client care
Answer: B. Multiple medications can contribute to sundowner-like symptoms
Rationale: "Sundowning" refers to increased confusion, agitation, and disorientation that
occurs in the evening. Polypharmacy (taking multiple medications) is a significant
contributing factor due to drug interactions and cumulative effects, especially as
metabolic processes slow with age. Reviewing medications is a critical intervention .
5. Pain Assessment in End-Stage Alzheimer's
The hospice nurse is completing a focused assessment of an older female client with
end-stage Alzheimer's disease, who recently fractured her hip. What technique should
, the registered nurse (RN) use to determine the client's pain?
A. Use the FACE pain scale
B. Ask the client to rate pain on a scale of 1 to 10
C. Observe for facial grimacing
D. Review documentation of recent eating habits
Answer: C. Observe for facial grimacing
Rationale: Clients with end-stage Alzheimer's disease often lose the ability to
communicate verbally or understand abstract concepts like pain scales. Observing for
non-verbal cues such as facial grimacing, guarding, or restlessness is the most reliable
method for pain assessment in this population .
6. Risk Factors for Elder Abuse
Older clients are at highest risk for abuse and neglect due to which factors? (Select all
that apply)
A. Needs are greater than the caretaker's ability
B. Client's declining strength
C. Fixed income
D. Longer life expectancy
E. Lack of exposure to technology and trends
Answer: A. Needs are greater than the caretaker's ability, and B. Client's declining
strength
Rationale: Abuse and neglect often occur when caregiver stress and feelings of being
overwhelmed (due to the high needs of the client) combine with the client's increased
physical vulnerability and inability to defend themselves or escape the situation .
7. Reality Orientation for Confused Clients
An older female client recently moved to an assisted living facility. The family explains to
the registered nurse (RN) that the client is unmanageable and always confused,
disoriented, and depressed. The client asks the RN repeatedly, "Where am I?". How
should the RN respond?
A. Explain that she is in a new home called an assisted living community
B. Question the client about her perception of where she might be now.
C. Distract the client with a scenario that she is on an outing with her family.
D. Reassure the client not to worry because she will meet new friends.
Answer: A. Explain that she is in a new home called an assisted living community
Rationale: Providing simple, calm, and factual reality orientation is the most appropriate
response. It offers consistency and truth, which can help reduce anxiety in a confused
client. Avoiding the question or providing false information can increase disorientation .
