GERO-BC Gerontological nursing
certification validating specialized knowledge
caring for aging populations, chronic
conditions, and age-related healthcare needs.
Question 1
An 82-year-old patient reports difficulty hearing during conversations, especially
in crowded rooms. Which nursing action best distinguishes age-related hearing loss
from a treatable cause?
A) Refer the patient to an audiologist for hearing aid evaluation
B) Perform the whispered voice test and inspect the ear canal for cerumen
impaction
C) Schedule a comprehensive audiology assessment
D) Advise the patient to use a pocket talker device
Rationale: Age-related hearing loss (presbycusis) must be distinguished from
reversible causes such as cerumen impaction, which is common in older adults.
The whispered voice test is a simple screening tool, and ear canal inspection can
identify cerumen impaction as a treatable cause. While audiology referral and
hearing aids may be appropriate, the initial assessment should rule out reversible
causes.
Question 2
An 80-year-old patient with a history of hypertension reports dizziness when
standing up from a seated position. The nurse notes a blood pressure drop from
142/88 mmHg supine to 110/72 mmHg standing. Which intervention should the
nurse implement?
A) Administer a fluid bolus
B) Instruct the patient to rise slowly and dangle feet before standing
C) Increase the antihypertensive medication dose
D) Place the patient on bed rest
,Rationale: Orthostatic hypotension (postural drop ≥20 mmHg systolic or ≥10
mmHg diastolic) is common in older adults due to decreased baroreceptor
sensitivity. The safest initial intervention is teaching the patient to rise slowly and
dangle feet before standing to allow cardiovascular compensation. Increasing
antihypertensives would worsen the condition, and bed rest is not appropriate.
Question 3
A 78-year-old patient scores 24/30 on the Mini-Mental State Examination
(MMSE) with deficits in recall and visuospatial skills. Which assessment finding
warrants further evaluation?
A) The patient lives alone and manages finances independently
B) The patient's spouse reports recent difficulty managing medications and
getting lost in familiar places
C) The patient reports occasional forgetfulness of names
D) The patient can perform all activities of daily living without assistance
Rationale: An MMSE score of 24/30 suggests possible cognitive impairment
(scores < 24 are often indicative of dementia). Reports of difficulty managing
medications and getting lost in familiar places are functional deficits that support
further evaluation for cognitive impairment. Occasional forgetfulness and
independent function are less concerning.
Question 4
A 72-year-old patient with type 2 diabetes is being evaluated for chronic pain. The
patient reports burning and tingling in both feet. Which assessment tool should the
nurse use to further evaluate this symptom?
A) Wong-Baker FACES Pain Rating Scale
B) Neuropathy-specific pain scale (e.g., DN4 or Leeds Assessment of
Neuropathic Symptoms and Signs)
C) Numeric Rating Scale (0-10)
D) Pain Assessment in Advanced Dementia (PAINAD) scale
Rationale: Burning and tingling in the feet in a patient with diabetes suggests
neuropathic pain. Neuropathy-specific assessment tools such as the DN4 or
LANSS are designed to distinguish neuropathic from nociceptive pain. General
,pain scales may not capture the quality of neuropathic pain, and PAINAD is
specific to patients with dementia.
Question 5
An 85-year-old patient is admitted with confusion, urinary incontinence, and
unsteady gait. The family reports these symptoms developed over the past 2 days.
Which condition should the nurse suspect?
A) Alzheimer's disease
B) Delirium
C) Vascular dementia
D) Parkinson's disease
Rationale: Delirium is characterized by acute onset (hours to days), fluctuating
course, inattention, and disorganized thinking. The sudden onset of confusion,
incontinence, and gait disturbance in an older adult should prompt evaluation for
delirium, often triggered by infection, medication changes, or metabolic
disturbances. Alzheimer's and dementia develop gradually over months to years.
Question 6
A 75-year-old patient with osteoarthritis reports knee pain rated 7/10 that worsens
with activity and improves with rest. Which assessment finding is most consistent
with osteoarthritis?
A) Morning stiffness lasting more than 60 minutes
B) Joint pain that worsens with use and improves with rest
C) Symmetrical joint involvement
D) Systemic symptoms such as fever and malaise
Rationale: Osteoarthritis is characterized by joint pain that worsens with activity
and improves with rest, typically affecting weight-bearing joints asymmetrically.
Morning stiffness lasting >60 minutes and symmetrical joint involvement are more
consistent with rheumatoid arthritis. Systemic symptoms are not typical of
osteoarthritis.
, Question 7
An 88-year-old patient with a history of falls is being assessed for fall risk. Which
assessment tool should the nurse prioritize?
A) Morse Fall Scale
B) Timed Up and Go (TUG) test
C) Braden Scale
D) Mini-Cog
Rationale: The Timed Up and Go (TUG) test assesses mobility, balance, and fall
risk in older adults. A TUG time > 12-14 seconds indicates increased fall risk. The
Morse Fall Scale is a fall risk assessment tool but is more commonly used in acute
care. The Braden Scale assesses pressure injury risk, and Mini-Cog assesses
cognitive impairment.
Question 8
A 76-year-old patient is being screened for depression. Which screening tool is
most appropriate for use in the older adult population?
A) Beck Depression Inventory-II (BDI-II)
B) Patient Health Questionnaire-9 (PHQ-9)
C) Hamilton Depression Rating Scale (HAM-D)
D) Zung Self-Rating Depression Scale
Rationale: The PHQ-9 is a validated, brief screening tool for depression that is
widely used in older adult populations. It assesses the nine DSM-5 criteria for
depression and is easy to administer in various settings. While other tools are also
valid, the PHQ-9 is particularly practical for routine screening.
Question 9
An 82-year-old patient with chronic kidney disease stage 3 has a serum creatinine
of 1.8 mg/dL. The healthcare provider orders a medication that is renally cleared.
Which action should the nurse take?
A) Administer the medication as ordered
B) Verify the dose against renal dosing guidelines and consult the pharmacist
C) Hold the medication and document the reason
D) Administer a reduced dose without consulting the provider
certification validating specialized knowledge
caring for aging populations, chronic
conditions, and age-related healthcare needs.
Question 1
An 82-year-old patient reports difficulty hearing during conversations, especially
in crowded rooms. Which nursing action best distinguishes age-related hearing loss
from a treatable cause?
A) Refer the patient to an audiologist for hearing aid evaluation
B) Perform the whispered voice test and inspect the ear canal for cerumen
impaction
C) Schedule a comprehensive audiology assessment
D) Advise the patient to use a pocket talker device
Rationale: Age-related hearing loss (presbycusis) must be distinguished from
reversible causes such as cerumen impaction, which is common in older adults.
The whispered voice test is a simple screening tool, and ear canal inspection can
identify cerumen impaction as a treatable cause. While audiology referral and
hearing aids may be appropriate, the initial assessment should rule out reversible
causes.
Question 2
An 80-year-old patient with a history of hypertension reports dizziness when
standing up from a seated position. The nurse notes a blood pressure drop from
142/88 mmHg supine to 110/72 mmHg standing. Which intervention should the
nurse implement?
A) Administer a fluid bolus
B) Instruct the patient to rise slowly and dangle feet before standing
C) Increase the antihypertensive medication dose
D) Place the patient on bed rest
,Rationale: Orthostatic hypotension (postural drop ≥20 mmHg systolic or ≥10
mmHg diastolic) is common in older adults due to decreased baroreceptor
sensitivity. The safest initial intervention is teaching the patient to rise slowly and
dangle feet before standing to allow cardiovascular compensation. Increasing
antihypertensives would worsen the condition, and bed rest is not appropriate.
Question 3
A 78-year-old patient scores 24/30 on the Mini-Mental State Examination
(MMSE) with deficits in recall and visuospatial skills. Which assessment finding
warrants further evaluation?
A) The patient lives alone and manages finances independently
B) The patient's spouse reports recent difficulty managing medications and
getting lost in familiar places
C) The patient reports occasional forgetfulness of names
D) The patient can perform all activities of daily living without assistance
Rationale: An MMSE score of 24/30 suggests possible cognitive impairment
(scores < 24 are often indicative of dementia). Reports of difficulty managing
medications and getting lost in familiar places are functional deficits that support
further evaluation for cognitive impairment. Occasional forgetfulness and
independent function are less concerning.
Question 4
A 72-year-old patient with type 2 diabetes is being evaluated for chronic pain. The
patient reports burning and tingling in both feet. Which assessment tool should the
nurse use to further evaluate this symptom?
A) Wong-Baker FACES Pain Rating Scale
B) Neuropathy-specific pain scale (e.g., DN4 or Leeds Assessment of
Neuropathic Symptoms and Signs)
C) Numeric Rating Scale (0-10)
D) Pain Assessment in Advanced Dementia (PAINAD) scale
Rationale: Burning and tingling in the feet in a patient with diabetes suggests
neuropathic pain. Neuropathy-specific assessment tools such as the DN4 or
LANSS are designed to distinguish neuropathic from nociceptive pain. General
,pain scales may not capture the quality of neuropathic pain, and PAINAD is
specific to patients with dementia.
Question 5
An 85-year-old patient is admitted with confusion, urinary incontinence, and
unsteady gait. The family reports these symptoms developed over the past 2 days.
Which condition should the nurse suspect?
A) Alzheimer's disease
B) Delirium
C) Vascular dementia
D) Parkinson's disease
Rationale: Delirium is characterized by acute onset (hours to days), fluctuating
course, inattention, and disorganized thinking. The sudden onset of confusion,
incontinence, and gait disturbance in an older adult should prompt evaluation for
delirium, often triggered by infection, medication changes, or metabolic
disturbances. Alzheimer's and dementia develop gradually over months to years.
Question 6
A 75-year-old patient with osteoarthritis reports knee pain rated 7/10 that worsens
with activity and improves with rest. Which assessment finding is most consistent
with osteoarthritis?
A) Morning stiffness lasting more than 60 minutes
B) Joint pain that worsens with use and improves with rest
C) Symmetrical joint involvement
D) Systemic symptoms such as fever and malaise
Rationale: Osteoarthritis is characterized by joint pain that worsens with activity
and improves with rest, typically affecting weight-bearing joints asymmetrically.
Morning stiffness lasting >60 minutes and symmetrical joint involvement are more
consistent with rheumatoid arthritis. Systemic symptoms are not typical of
osteoarthritis.
, Question 7
An 88-year-old patient with a history of falls is being assessed for fall risk. Which
assessment tool should the nurse prioritize?
A) Morse Fall Scale
B) Timed Up and Go (TUG) test
C) Braden Scale
D) Mini-Cog
Rationale: The Timed Up and Go (TUG) test assesses mobility, balance, and fall
risk in older adults. A TUG time > 12-14 seconds indicates increased fall risk. The
Morse Fall Scale is a fall risk assessment tool but is more commonly used in acute
care. The Braden Scale assesses pressure injury risk, and Mini-Cog assesses
cognitive impairment.
Question 8
A 76-year-old patient is being screened for depression. Which screening tool is
most appropriate for use in the older adult population?
A) Beck Depression Inventory-II (BDI-II)
B) Patient Health Questionnaire-9 (PHQ-9)
C) Hamilton Depression Rating Scale (HAM-D)
D) Zung Self-Rating Depression Scale
Rationale: The PHQ-9 is a validated, brief screening tool for depression that is
widely used in older adult populations. It assesses the nine DSM-5 criteria for
depression and is easy to administer in various settings. While other tools are also
valid, the PHQ-9 is particularly practical for routine screening.
Question 9
An 82-year-old patient with chronic kidney disease stage 3 has a serum creatinine
of 1.8 mg/dL. The healthcare provider orders a medication that is renally cleared.
Which action should the nurse take?
A) Administer the medication as ordered
B) Verify the dose against renal dosing guidelines and consult the pharmacist
C) Hold the medication and document the reason
D) Administer a reduced dose without consulting the provider
