PNR 108/PNR108 Final Exam V2 |
Gerontological Nursing Q&A with
Rationale | Fortis College
1. A nurse is assessing an 82-year-old client for signs of depression. Which clinical
manifestation is often mistaken for dementia in the geriatric population?
A. Consistent memory loss of recent events
B. Irreversible decline in executive functioning
C. Pseudodementia involving cognitive slowing and decreased concentration
D. Sun-downing behavior in the late afternoon
Correct Answer: C
Expert Explanation: In older adults, depression can present as ‘pseudodementia’ where
the client exhibits cognitive slowing and poor concentration that improves with treatment.
Unlike true dementia, which is progressive and irreversible, depression-related cognitive
impairment is often reversible. It is critical for the nurse to distinguish between these two
conditions to ensure the client receives appropriate psychiatric intervention rather than
just supportive memory care.
2. An elderly patient is prescribed a new medication that is primarily excreted by the kidneys.
Which laboratory value should the nurse prioritize checking to determine safe dosing?
A. Serum Potassium
,B. Glomerular Filtration Rate (GFR)
C. Blood Urea Nitrogen (BUN)
D. Serum Albumin
Correct Answer: B
Expert Explanation: Age-related changes in the renal system include a decrease in blood
flow and a reduction in the number of functioning nephrons. GFR is the most reliable
indicator of renal function in the elderly because serum creatinine levels can remain
deceptively normal due to decreased muscle mass. Monitoring GFR helps prevent drug
toxicity by allowing for appropriate dose adjustments based on the patient’s actual
clearance capacity.
3. A nurse is providing discharge instructions to a client with presbycusis. Which
communication technique should the nurse employ to ensure the client understands the
instructions?
A. Speak in a high-pitched, loud voice directly into the ear
B. Provide only written instructions to avoid communication errors
C. Speak rapidly to minimize the time spent on instructions
D. Use a low-pitched voice while facing the client directly
Correct Answer: D
,Expert Explanation: Presbycusis is the age-related loss of hearing, typically affecting the
ability to hear high-frequency sounds. Speaking in a low-pitched tone and facing the client
allows them to use visual cues and hear the deeper tones more clearly. High-pitched
shouting is often counterproductive as it distorts sound and can be perceived as aggressive
by the patient.
4. Which of the following is considered a normal physiological change associated with aging
in the integumentary system?
A. Increased subcutaneous fat over the bony prominences
B. Thickening of the epidermal layer
C. Increased activity of sebaceous and sweat glands
D. Decreased number of melanocytes leading to uneven pigmentation
Correct Answer: D
Expert Explanation: As the skin ages, the number of melanocytes decreases, which can
lead to pale skin or ‘age spots’ due to uneven distribution. There is also a significant loss of
subcutaneous fat and thinning of the epidermis, making the elderly more susceptible to
skin tears and pressure ulcers. These changes reduce the skin’s ability to regulate
temperature and protect against external trauma.
5. A nurse is caring for an older adult who reports waking up several times during the night
and feeling unrefreshed. Which sleep change is expected in this age group?
A. An increase in Stage 4 deep sleep
, B. A decrease in the time spent in REM sleep
C. An increase in sleep latency and more frequent awakenings
D. A total sleep requirement of 12 hours per night
Correct Answer: C
Expert Explanation: Elderly patients often experience changes in sleep architecture,
including longer periods to fall asleep (sleep latency) and more frequent nighttime
awakenings. They typically spend less time in deep, restorative sleep (Stages 3 and 4).
Educating the patient that these changes are common can help manage expectations and
direct focus toward improved sleep hygiene.
6. When assessing an older adult for fall risk, which finding is the most significant predictor of
a future fall?
A. A history of a fall within the last 6 months
B. The use of bifocal eyeglasses
C. Living in a single-story home
D. A body mass index (BMI) within the normal range
Correct Answer: A
Expert Explanation: A history of previous falls is one of the strongest predictors for future
falls in the geriatric population. This history often indicates underlying issues with balance,
gait, or polypharmacy that require thorough investigation. Nurses must implement
Gerontological Nursing Q&A with
Rationale | Fortis College
1. A nurse is assessing an 82-year-old client for signs of depression. Which clinical
manifestation is often mistaken for dementia in the geriatric population?
A. Consistent memory loss of recent events
B. Irreversible decline in executive functioning
C. Pseudodementia involving cognitive slowing and decreased concentration
D. Sun-downing behavior in the late afternoon
Correct Answer: C
Expert Explanation: In older adults, depression can present as ‘pseudodementia’ where
the client exhibits cognitive slowing and poor concentration that improves with treatment.
Unlike true dementia, which is progressive and irreversible, depression-related cognitive
impairment is often reversible. It is critical for the nurse to distinguish between these two
conditions to ensure the client receives appropriate psychiatric intervention rather than
just supportive memory care.
2. An elderly patient is prescribed a new medication that is primarily excreted by the kidneys.
Which laboratory value should the nurse prioritize checking to determine safe dosing?
A. Serum Potassium
,B. Glomerular Filtration Rate (GFR)
C. Blood Urea Nitrogen (BUN)
D. Serum Albumin
Correct Answer: B
Expert Explanation: Age-related changes in the renal system include a decrease in blood
flow and a reduction in the number of functioning nephrons. GFR is the most reliable
indicator of renal function in the elderly because serum creatinine levels can remain
deceptively normal due to decreased muscle mass. Monitoring GFR helps prevent drug
toxicity by allowing for appropriate dose adjustments based on the patient’s actual
clearance capacity.
3. A nurse is providing discharge instructions to a client with presbycusis. Which
communication technique should the nurse employ to ensure the client understands the
instructions?
A. Speak in a high-pitched, loud voice directly into the ear
B. Provide only written instructions to avoid communication errors
C. Speak rapidly to minimize the time spent on instructions
D. Use a low-pitched voice while facing the client directly
Correct Answer: D
,Expert Explanation: Presbycusis is the age-related loss of hearing, typically affecting the
ability to hear high-frequency sounds. Speaking in a low-pitched tone and facing the client
allows them to use visual cues and hear the deeper tones more clearly. High-pitched
shouting is often counterproductive as it distorts sound and can be perceived as aggressive
by the patient.
4. Which of the following is considered a normal physiological change associated with aging
in the integumentary system?
A. Increased subcutaneous fat over the bony prominences
B. Thickening of the epidermal layer
C. Increased activity of sebaceous and sweat glands
D. Decreased number of melanocytes leading to uneven pigmentation
Correct Answer: D
Expert Explanation: As the skin ages, the number of melanocytes decreases, which can
lead to pale skin or ‘age spots’ due to uneven distribution. There is also a significant loss of
subcutaneous fat and thinning of the epidermis, making the elderly more susceptible to
skin tears and pressure ulcers. These changes reduce the skin’s ability to regulate
temperature and protect against external trauma.
5. A nurse is caring for an older adult who reports waking up several times during the night
and feeling unrefreshed. Which sleep change is expected in this age group?
A. An increase in Stage 4 deep sleep
, B. A decrease in the time spent in REM sleep
C. An increase in sleep latency and more frequent awakenings
D. A total sleep requirement of 12 hours per night
Correct Answer: C
Expert Explanation: Elderly patients often experience changes in sleep architecture,
including longer periods to fall asleep (sleep latency) and more frequent nighttime
awakenings. They typically spend less time in deep, restorative sleep (Stages 3 and 4).
Educating the patient that these changes are common can help manage expectations and
direct focus toward improved sleep hygiene.
6. When assessing an older adult for fall risk, which finding is the most significant predictor of
a future fall?
A. A history of a fall within the last 6 months
B. The use of bifocal eyeglasses
C. Living in a single-story home
D. A body mass index (BMI) within the normal range
Correct Answer: A
Expert Explanation: A history of previous falls is one of the strongest predictors for future
falls in the geriatric population. This history often indicates underlying issues with balance,
gait, or polypharmacy that require thorough investigation. Nurses must implement
