NUR 257 Exams 2026 Geriatric NCLEX Questions. 200 practice questions with
answers and correct rationales
Exam 1 – Foundations of Geriatric Nursing & Normal Aging Changes (Questions 1–
50)
1. An 82-year-old patient’s skin remains tented for several seconds after being
pinched on the forearm. What is the nurse’s best interpretation?
A. Normal age-related change
B. Sign of severe dehydration
C. Indicator of thyroid disease
D. Reaction to a diuretic medication
Answer: A
Rationale: Loss of elastin and collagen with aging reduces skin turgor, causing
tenting. While dehydration worsens tenting, mild tenting without other signs is a
normal finding.
2. A 77-year-old reports feeling dizzy when standing up quickly. Which physiologic
change most contributes to this?
A. Increased baroreceptor sensitivity
B. Decreased baroreceptor responsiveness
,C. Enhanced vagal tone
D. Increased blood volume
Answer: B
Rationale: Aging blunts baroreceptor reflexes, leading to orthostatic hypotension.
Baroreceptor sensitivity decreases, not increases.
3. An older adult has difficulty reading a menu in a dimly lit restaurant. This is
most likely due to:
A. Presbyopia
B. Cataracts
C. Decreased rod function
D. Glaucoma
Answer: C
Rationale: Rods mediate night/dim light vision and decrease with age. Presbyopia
affects near vision in good light.
4. A nurse expects which change in gastric pH in a healthy 80-year-old?
A. Decreased pH (more acidic)
,B. Increased pH (less acidic)
C. No change
D. Highly variable, no pattern
Answer: B
Rationale: Gastric pH rises (becomes less acidic) due to chronic atrophic gastritis,
increasing risk for bacterial overgrowth and infections.
5. An 85-year-old has a new onset of urinary incontinence. The priority nursing
action is:
A. Begin bladder training
B. Assess for reversible causes
C. Insert an indwelling catheter
D. Recommend adult briefs
Answer: B
Rationale: Incontinence is often reversible; assess for DIAPPERS (Delirium,
Infection, Atrophic vaginitis, Pharmaceuticals, Psychological, Endocrine, Restricted
mobility, Stool impaction).
, 6. Which sleep pattern change is considered normal with aging?
A. Increased slow-wave sleep
B. Longer time in REM sleep
C. More frequent nighttime awakenings
D. Decreased total sleep time to <4 hours
Answer: C
Rationale: Older adults have more awakenings and less stage 3/4 (slow-wave)
sleep. Total sleep time decreases slightly but remains 6–8 hours usually.
7. An older adult’s serum creatinine is 0.9 mg/dL. The nurse understands that:
A. Renal function is excellent
B. Creatinine may be falsely low due to low muscle mass
C. The patient is in kidney failure
D. Urine output must be <400 mL/day
Answer: B
Rationale: Low muscle mass reduces creatinine production; a “normal” creatinine
can hide significantly reduced GFR. Always calculate eGFR.
answers and correct rationales
Exam 1 – Foundations of Geriatric Nursing & Normal Aging Changes (Questions 1–
50)
1. An 82-year-old patient’s skin remains tented for several seconds after being
pinched on the forearm. What is the nurse’s best interpretation?
A. Normal age-related change
B. Sign of severe dehydration
C. Indicator of thyroid disease
D. Reaction to a diuretic medication
Answer: A
Rationale: Loss of elastin and collagen with aging reduces skin turgor, causing
tenting. While dehydration worsens tenting, mild tenting without other signs is a
normal finding.
2. A 77-year-old reports feeling dizzy when standing up quickly. Which physiologic
change most contributes to this?
A. Increased baroreceptor sensitivity
B. Decreased baroreceptor responsiveness
,C. Enhanced vagal tone
D. Increased blood volume
Answer: B
Rationale: Aging blunts baroreceptor reflexes, leading to orthostatic hypotension.
Baroreceptor sensitivity decreases, not increases.
3. An older adult has difficulty reading a menu in a dimly lit restaurant. This is
most likely due to:
A. Presbyopia
B. Cataracts
C. Decreased rod function
D. Glaucoma
Answer: C
Rationale: Rods mediate night/dim light vision and decrease with age. Presbyopia
affects near vision in good light.
4. A nurse expects which change in gastric pH in a healthy 80-year-old?
A. Decreased pH (more acidic)
,B. Increased pH (less acidic)
C. No change
D. Highly variable, no pattern
Answer: B
Rationale: Gastric pH rises (becomes less acidic) due to chronic atrophic gastritis,
increasing risk for bacterial overgrowth and infections.
5. An 85-year-old has a new onset of urinary incontinence. The priority nursing
action is:
A. Begin bladder training
B. Assess for reversible causes
C. Insert an indwelling catheter
D. Recommend adult briefs
Answer: B
Rationale: Incontinence is often reversible; assess for DIAPPERS (Delirium,
Infection, Atrophic vaginitis, Pharmaceuticals, Psychological, Endocrine, Restricted
mobility, Stool impaction).
, 6. Which sleep pattern change is considered normal with aging?
A. Increased slow-wave sleep
B. Longer time in REM sleep
C. More frequent nighttime awakenings
D. Decreased total sleep time to <4 hours
Answer: C
Rationale: Older adults have more awakenings and less stage 3/4 (slow-wave)
sleep. Total sleep time decreases slightly but remains 6–8 hours usually.
7. An older adult’s serum creatinine is 0.9 mg/dL. The nurse understands that:
A. Renal function is excellent
B. Creatinine may be falsely low due to low muscle mass
C. The patient is in kidney failure
D. Urine output must be <400 mL/day
Answer: B
Rationale: Low muscle mass reduces creatinine production; a “normal” creatinine
can hide significantly reduced GFR. Always calculate eGFR.
