1
Page | 1
Ham’s Primary Care Geriatrics Test Bank
2025–2026 | NCLEX RN & HESI Verified
Questions + Rationales | 7th Edition
1. Which of the following is the most important factor when determining the functional
status of a geriatric patient?
A. Age
B. Laboratory values
✔ C. Ability to perform activities of daily living (ADLs)
D. Number of chronic conditions
, 2
Rationale:
The ability to perform activities of daily living (ADLs) is a primary indicator of a geriatric
patient’s functional status. These include tasks such as bathing, dressing, eating, toileting, and
Page | 2
transferring. While age, lab values, and chronic conditions are important clinical data points,
they do not directly reflect the individual’s day-to-day independence or quality of life. Loss
of ADL function often signals the need for increased care, rehabilitation, or placement in
assisted living or long-term care. Maintaining or restoring ADL independence is a core goal
in geriatric care planning.
2. Which screening tool is most appropriate for detecting cognitive impairment in older
adults?
A. PHQ-9
✔ B. Mini-Cog
C. GAD-7
D. Katz Index
Rationale:
The Mini-Cog is a validated, quick screening tool for detecting cognitive impairment and
early dementia in older adults. It combines a three-item recall test with a clock-drawing test,
offering good sensitivity and specificity. Unlike PHQ-9 or GAD-7, which assess depression
and anxiety respectively, the Mini-Cog focuses on memory and executive function. The Katz
Index, meanwhile, assesses functional ability in ADLs, not cognition. Early detection of
cognitive decline allows for timely intervention, care planning, and possible reversible
condition treatment.
, 3
3. Which of the following is a common age-related physiological change in the renal
Page | 3
system?
A. Increased glomerular filtration rate (GFR)
B. Increased renal blood flow
✔ C. Decreased GFR
D. Increased creatinine clearance
Rationale:
Aging is associated with a gradual decline in renal function, including a decrease in
glomerular filtration rate (GFR) and renal blood flow. This occurs due to nephron loss and
vascular changes within the kidneys. A lower GFR affects the pharmacokinetics of many
medications, increasing the risk of drug accumulation and toxicity in older adults. Creatinine
clearance also decreases, even though serum creatinine may appear normal due to reduced
muscle mass. Therefore, drug dosing and hydration management require careful attention in
elderly patients.
4. Which of the following is considered a geriatric syndrome?
A. Hypertension
✔ B. Delirium
C. Hypothyroidism
D. Chronic bronchitis
Rationale:
Delirium is classified as a geriatric syndrome—a multifactorial condition common in older
, 4
adults that does not fit into discrete disease categories. Geriatric syndromes, such as delirium,
falls, incontinence, and frailty, often arise from multiple underlying causes and contribute
significantly to morbidity and mortality. Unlike single-organ diseases such as hypertension or
Page | 4
bronchitis, geriatric syndromes require a broad, interdisciplinary approach to diagnosis,
prevention, and treatment. Delirium, in particular, is an acute cognitive disturbance often
triggered by illness, medications, or environmental changes.
5. Which of the following medications is most commonly associated with causing
delirium in older adults?
✔ A. Diphenhydramine
B. Acetaminophen
C. Lisinopril
D. Omeprazole
Rationale:
Diphenhydramine, a first-generation antihistamine, has strong anticholinergic properties and
is a well-known cause of delirium in older adults. The elderly are particularly sensitive to
anticholinergic burden, which impairs cognition and contributes to confusion, falls, and
urinary retention. Acetaminophen, lisinopril, and omeprazole are generally safer in terms of
cognitive side effects. Diphenhydramine is on the Beers Criteria list of potentially
inappropriate medications for older adults, and safer alternatives should be considered
whenever possible.
Page | 1
Ham’s Primary Care Geriatrics Test Bank
2025–2026 | NCLEX RN & HESI Verified
Questions + Rationales | 7th Edition
1. Which of the following is the most important factor when determining the functional
status of a geriatric patient?
A. Age
B. Laboratory values
✔ C. Ability to perform activities of daily living (ADLs)
D. Number of chronic conditions
, 2
Rationale:
The ability to perform activities of daily living (ADLs) is a primary indicator of a geriatric
patient’s functional status. These include tasks such as bathing, dressing, eating, toileting, and
Page | 2
transferring. While age, lab values, and chronic conditions are important clinical data points,
they do not directly reflect the individual’s day-to-day independence or quality of life. Loss
of ADL function often signals the need for increased care, rehabilitation, or placement in
assisted living or long-term care. Maintaining or restoring ADL independence is a core goal
in geriatric care planning.
2. Which screening tool is most appropriate for detecting cognitive impairment in older
adults?
A. PHQ-9
✔ B. Mini-Cog
C. GAD-7
D. Katz Index
Rationale:
The Mini-Cog is a validated, quick screening tool for detecting cognitive impairment and
early dementia in older adults. It combines a three-item recall test with a clock-drawing test,
offering good sensitivity and specificity. Unlike PHQ-9 or GAD-7, which assess depression
and anxiety respectively, the Mini-Cog focuses on memory and executive function. The Katz
Index, meanwhile, assesses functional ability in ADLs, not cognition. Early detection of
cognitive decline allows for timely intervention, care planning, and possible reversible
condition treatment.
, 3
3. Which of the following is a common age-related physiological change in the renal
Page | 3
system?
A. Increased glomerular filtration rate (GFR)
B. Increased renal blood flow
✔ C. Decreased GFR
D. Increased creatinine clearance
Rationale:
Aging is associated with a gradual decline in renal function, including a decrease in
glomerular filtration rate (GFR) and renal blood flow. This occurs due to nephron loss and
vascular changes within the kidneys. A lower GFR affects the pharmacokinetics of many
medications, increasing the risk of drug accumulation and toxicity in older adults. Creatinine
clearance also decreases, even though serum creatinine may appear normal due to reduced
muscle mass. Therefore, drug dosing and hydration management require careful attention in
elderly patients.
4. Which of the following is considered a geriatric syndrome?
A. Hypertension
✔ B. Delirium
C. Hypothyroidism
D. Chronic bronchitis
Rationale:
Delirium is classified as a geriatric syndrome—a multifactorial condition common in older
, 4
adults that does not fit into discrete disease categories. Geriatric syndromes, such as delirium,
falls, incontinence, and frailty, often arise from multiple underlying causes and contribute
significantly to morbidity and mortality. Unlike single-organ diseases such as hypertension or
Page | 4
bronchitis, geriatric syndromes require a broad, interdisciplinary approach to diagnosis,
prevention, and treatment. Delirium, in particular, is an acute cognitive disturbance often
triggered by illness, medications, or environmental changes.
5. Which of the following medications is most commonly associated with causing
delirium in older adults?
✔ A. Diphenhydramine
B. Acetaminophen
C. Lisinopril
D. Omeprazole
Rationale:
Diphenhydramine, a first-generation antihistamine, has strong anticholinergic properties and
is a well-known cause of delirium in older adults. The elderly are particularly sensitive to
anticholinergic burden, which impairs cognition and contributes to confusion, falls, and
urinary retention. Acetaminophen, lisinopril, and omeprazole are generally safer in terms of
cognitive side effects. Diphenhydramine is on the Beers Criteria list of potentially
inappropriate medications for older adults, and safer alternatives should be considered
whenever possible.
