GERIATRIC NURSING MIDTERM EXAM
2026 Practice Questions & Correct Answers
(100% Verified)
Total Questions: 200
Format: Multiple Choice
Topics: Normal Aging, Geriatric Syndromes, Pharmacology, Functional
Assessment, Ethics, Common Diseases, Palliative Care
Passing Score: 85% (170 correct)
Time Limit: 4 hours
Section 1: Normal Aging vs. Disease (Questions 1–30)
1. Which of the following is a NORMAL age-related change in the
cardiovascular system?
A) Decreased compliance of the aorta (increased stiffness)
B) Orthostatic hypotension (abnormal, not normal)
C) Heart failure
D) Atrial fibrillation
Answer: A
Rationale: With aging, the aorta and large arteries become stiffer
(arteriosclerosis), increasing pulse wave velocity and systolic blood pressure.
Orthostatic hypotension, heart failure, and atrial fibrillation are not normal
aging—they are pathological conditions requiring intervention.
2. A normal age-related change in the respiratory system is:
A) Increased vital capacity
B) Decreased chest wall compliance and decreased elastic recoil
C) Increased number of alveoli
D) Increased PaO₂
Answer: B
*Rationale: The aging lung shows decreased chest wall compliance (stiffer rib
,cage) and decreased elastic recoil (loss of elastin), leading to increased
residual volume and decreased vital capacity. PaO₂ decreases slightly with age
(normal formula: 100 – age/4).*
3. Which of the following is a normal age-related change in renal function?
A) Increased creatinine clearance
B) Decreased glomerular filtration rate (GFR)
C) Increased ability to concentrate urine
D) Increased renal blood flow
Answer: B
*Rationale: GFR declines approximately 1 mL/min/year after age 40 due to
loss of nephrons. Serum creatinine may remain normal due to decreased
muscle mass, masking kidney disease. Urine concentrating ability also
decreases.*
4. A normal finding in an older adult's neurological exam is:
A) New-onset confusion
B) Slowed reaction time and decreased vibratory sensation in lower
extremities
C) Loss of short-term memory
D) Tremor at rest
Answer: B
Rationale: Slowed reaction time, decreased vibratory sense (especially in
lower extremities), and mild decrease in deep tendon reflexes are normal age-
related changes. Confusion, memory loss interfering with daily function, and
resting tremor are NOT normal and require evaluation.
5. Which of the following is a normal age-related change in the
musculoskeletal system?
A) Increased bone density
B) Decreased muscle mass (sarcopenia) and strength
C) Increased height
D) Increased joint flexibility
Answer: B
*Rationale: Sarcopenia (age-related loss of muscle mass and strength) begins
around age 30 and accelerates after 60. Bone density decreases
,(osteopenia/osteoporosis), height decreases (vertebral compression), and
joints lose flexibility.*
6. A normal age-related change in the gastrointestinal system is:
A) Increased gastric emptying time
B) Increased nutrient absorption
C) Increased liver size
D) Increased saliva production
Answer: A
Rationale: Gastric emptying slows with age. Liver size and blood flow
decrease, affecting drug metabolism. Saliva production decreases
(xerostomia), and nutrient absorption (calcium, B12) decreases.
7. Which statement about aging and the immune system is TRUE?
A) Older adults have increased T-cell function
B) Immunosenescence leads to decreased response to vaccines and increased
infection risk
C) Autoantibodies decrease with age
D) Older adults do not need flu vaccines
Answer: B
Rationale: Immunosenescence (aging immune system) results in decreased T-
cell function, reduced antibody response to vaccines, and increased
susceptibility to infections (pneumonia, influenza, UTIs).
8. A normal age-related change in the integumentary system is:
A) Increased sweat gland function
B) Thinning of the epidermis and decreased dermal thickness
C) Increased melanocyte activity
D) Increased skin turgor
Answer: B
Rationale: Aging skin shows epidermal thinning, decreased dermal collagen
and elastin, decreased sweat and sebaceous gland activity, and decreased
melanocytes (gray hair). Skin turgor decreases, increasing risk of pressure
injuries.
, 9. Which of the following sensory changes is NORMAL with aging?
A) Presbyopia (difficulty focusing on near objects)
B) Sudden hearing loss
C) Acute glaucoma
D) Floaters and flashes of light
Answer: A
*Rationale: Presbyopia (loss of lens elasticity) is universal by age 45-50.
Sudden hearing loss, acute glaucoma, and new floaters/flashes are
pathological and require immediate evaluation.*
10. A normal age-related change in the endocrine system is:
A) Increased insulin sensitivity
B) Decreased growth hormone and sex hormone production
C) Increased thyroid hormone levels
D) Increased cortisol clearance
Answer: B
Rationale: Growth hormone, estrogen, testosterone, and DHEA decline with
age. Insulin resistance increases (not sensitivity). Thyroid function remains
normal, though TSH may increase slightly.
11. Which of the following is a normal change in sleep patterns with aging?
A) Increased slow-wave (deep) sleep
B) Decreased total sleep time but increased nighttime awakenings
C) Increased REM sleep
D) Falling asleep more quickly
Answer: B
Rationale: Older adults spend more time in lighter sleep stages (N1, N2) and
less in deep sleep (N3) and REM. They have more frequent awakenings and
may have decreased total sleep time. Sleep efficiency declines.
12. A normal finding in an older adult's hematologic system is:
A) Anemia (Hgb <12 g/dL) – NOT normal, requires workup
B) Mild increase in fibrinogen (clotting factors)
C) Decreased platelet count
D) Leukocytosis
Answer: B
2026 Practice Questions & Correct Answers
(100% Verified)
Total Questions: 200
Format: Multiple Choice
Topics: Normal Aging, Geriatric Syndromes, Pharmacology, Functional
Assessment, Ethics, Common Diseases, Palliative Care
Passing Score: 85% (170 correct)
Time Limit: 4 hours
Section 1: Normal Aging vs. Disease (Questions 1–30)
1. Which of the following is a NORMAL age-related change in the
cardiovascular system?
A) Decreased compliance of the aorta (increased stiffness)
B) Orthostatic hypotension (abnormal, not normal)
C) Heart failure
D) Atrial fibrillation
Answer: A
Rationale: With aging, the aorta and large arteries become stiffer
(arteriosclerosis), increasing pulse wave velocity and systolic blood pressure.
Orthostatic hypotension, heart failure, and atrial fibrillation are not normal
aging—they are pathological conditions requiring intervention.
2. A normal age-related change in the respiratory system is:
A) Increased vital capacity
B) Decreased chest wall compliance and decreased elastic recoil
C) Increased number of alveoli
D) Increased PaO₂
Answer: B
*Rationale: The aging lung shows decreased chest wall compliance (stiffer rib
,cage) and decreased elastic recoil (loss of elastin), leading to increased
residual volume and decreased vital capacity. PaO₂ decreases slightly with age
(normal formula: 100 – age/4).*
3. Which of the following is a normal age-related change in renal function?
A) Increased creatinine clearance
B) Decreased glomerular filtration rate (GFR)
C) Increased ability to concentrate urine
D) Increased renal blood flow
Answer: B
*Rationale: GFR declines approximately 1 mL/min/year after age 40 due to
loss of nephrons. Serum creatinine may remain normal due to decreased
muscle mass, masking kidney disease. Urine concentrating ability also
decreases.*
4. A normal finding in an older adult's neurological exam is:
A) New-onset confusion
B) Slowed reaction time and decreased vibratory sensation in lower
extremities
C) Loss of short-term memory
D) Tremor at rest
Answer: B
Rationale: Slowed reaction time, decreased vibratory sense (especially in
lower extremities), and mild decrease in deep tendon reflexes are normal age-
related changes. Confusion, memory loss interfering with daily function, and
resting tremor are NOT normal and require evaluation.
5. Which of the following is a normal age-related change in the
musculoskeletal system?
A) Increased bone density
B) Decreased muscle mass (sarcopenia) and strength
C) Increased height
D) Increased joint flexibility
Answer: B
*Rationale: Sarcopenia (age-related loss of muscle mass and strength) begins
around age 30 and accelerates after 60. Bone density decreases
,(osteopenia/osteoporosis), height decreases (vertebral compression), and
joints lose flexibility.*
6. A normal age-related change in the gastrointestinal system is:
A) Increased gastric emptying time
B) Increased nutrient absorption
C) Increased liver size
D) Increased saliva production
Answer: A
Rationale: Gastric emptying slows with age. Liver size and blood flow
decrease, affecting drug metabolism. Saliva production decreases
(xerostomia), and nutrient absorption (calcium, B12) decreases.
7. Which statement about aging and the immune system is TRUE?
A) Older adults have increased T-cell function
B) Immunosenescence leads to decreased response to vaccines and increased
infection risk
C) Autoantibodies decrease with age
D) Older adults do not need flu vaccines
Answer: B
Rationale: Immunosenescence (aging immune system) results in decreased T-
cell function, reduced antibody response to vaccines, and increased
susceptibility to infections (pneumonia, influenza, UTIs).
8. A normal age-related change in the integumentary system is:
A) Increased sweat gland function
B) Thinning of the epidermis and decreased dermal thickness
C) Increased melanocyte activity
D) Increased skin turgor
Answer: B
Rationale: Aging skin shows epidermal thinning, decreased dermal collagen
and elastin, decreased sweat and sebaceous gland activity, and decreased
melanocytes (gray hair). Skin turgor decreases, increasing risk of pressure
injuries.
, 9. Which of the following sensory changes is NORMAL with aging?
A) Presbyopia (difficulty focusing on near objects)
B) Sudden hearing loss
C) Acute glaucoma
D) Floaters and flashes of light
Answer: A
*Rationale: Presbyopia (loss of lens elasticity) is universal by age 45-50.
Sudden hearing loss, acute glaucoma, and new floaters/flashes are
pathological and require immediate evaluation.*
10. A normal age-related change in the endocrine system is:
A) Increased insulin sensitivity
B) Decreased growth hormone and sex hormone production
C) Increased thyroid hormone levels
D) Increased cortisol clearance
Answer: B
Rationale: Growth hormone, estrogen, testosterone, and DHEA decline with
age. Insulin resistance increases (not sensitivity). Thyroid function remains
normal, though TSH may increase slightly.
11. Which of the following is a normal change in sleep patterns with aging?
A) Increased slow-wave (deep) sleep
B) Decreased total sleep time but increased nighttime awakenings
C) Increased REM sleep
D) Falling asleep more quickly
Answer: B
Rationale: Older adults spend more time in lighter sleep stages (N1, N2) and
less in deep sleep (N3) and REM. They have more frequent awakenings and
may have decreased total sleep time. Sleep efficiency declines.
12. A normal finding in an older adult's hematologic system is:
A) Anemia (Hgb <12 g/dL) – NOT normal, requires workup
B) Mild increase in fibrinogen (clotting factors)
C) Decreased platelet count
D) Leukocytosis
Answer: B
