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NCLEX gerontology practice questions

20 free NCLEX-style gerontology questions: normal aging changes versus the findings you must never call normal, like new confusion or a sudden fall, each with the answer and rationale.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

An 82-year-old client with severe osteoarthritis of both knees has episodes of urinary incontinence because she cannot reach the bathroom in time. Her urinalysis is normal, and a bladder scan after voiding shows 30 mL. Which intervention should the nurse include in the plan of care?

  1. Limit fluid intake to 1,000 mL spread over each day to reduce urine volume
  2. Insert an indwelling urinary catheter and secure it to keep the client dry
  3. Put a commode by the bed and offer toileting every 2 hours while awake
  4. Teach pelvic floor muscle exercises daily to strengthen the urethral sphincter
Show the answer and rationale

Answer: C

A normal urinalysis and a postvoid residual of 30 mL show the bladder empties well, so incontinence from being unable to reach the bathroom in time is functional incontinence, and a bedside commode with toileting offered every 2 hours while awake removes the barrier causing the episodes. Teaching pelvic floor muscle exercises daily is the runner-up because strengthening the urethral sphincter helps incontinence, but that treats stress incontinence and does not help the client reach a toilet faster. Limiting fluid intake to 1,000 mL a day concentrates urine and risks dehydration, and an indwelling catheter placed to keep the client dry adds infection risk without addressing mobility.

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Question 2 of 20

An 84-year-old client moved into a long-term care facility yesterday after a fall at home. She is tearful, says she wants to go home, and slept poorly last night. Which action by the nurse is most appropriate?

  1. Encourage her to join this afternoon's group activity to meet others
  2. Help her set out familiar belongings, and learn her routines
  3. Give her a printed copy of the facility's daily meal and activity schedule
  4. Ask her family to limit visits this week so she has time to settle in
Show the answer and rationale

Answer: B

Relocation stress is common after a move to a care facility, and familiar belongings, the client's usual routines, regular family contact, and a say in decisions help her feel at home and in control. Encouraging her to join a group activity is a reasonable later step, but on her first full day it asks a tearful client to socialize before she feels secure. A printed schedule orients her to the facility's routine rather than her own, and limiting family visits removes her main support during the hardest days.

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Question 3 of 20

A 76-year-old client reports getting up three or four times each night to urinate and feeling tired during the day. A urinalysis is normal. Which instruction should the nurse give?

  1. Have a cup of warm milk at bedtime to help you sleep soundly
  2. Drink fluids earlier in the day and cut back in the evening
  3. Wear absorbent briefs at night so you don't have to get up
  4. Cut back on how much you drink over the whole day
Show the answer and rationale

Answer: B

Shifting fluids to earlier in the day and limiting them in the 2 to 4 hours before bed, along with avoiding evening caffeine and alcohol and voiding just before bed, reduces nighttime urination without risking dehydration. Cutting back over the whole day sounds logical, but it concentrates the urine, which irritates the bladder, and leads to dehydration and constipation. Warm milk at bedtime adds fluid just when it should be limited, and wearing briefs to avoid getting up encourages incontinence and skin breakdown without treating the cause.

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Question 4 of 20

A 68-year-old postmenopausal client tells the nurse that she has begun a sexual relationship with a new partner. Which information should the nurse include in the teaching?

  1. A spermicide with nonoxynol-9 adds protection against infection
  2. Petroleum jelly is a good lubricant for dryness when using condoms
  3. Testing for sexually transmitted infections stops after age 65
  4. Condoms with a new partner lower the risk of infection
Show the answer and rationale

Answer: D

Older adults remain at risk for sexually transmitted infections, and thin, dry postmenopausal vaginal tissue tears more easily, so condoms are recommended with any new partner. Nonoxynol-9 sounds protective, but spermicides do not prevent these infections and can irritate the vaginal lining, which may raise HIV risk. Testing is based on risk, not on age. A water-based lubricant eases dryness and is safe with latex condoms, while oil-based products such as petroleum jelly weaken latex and can cause breakage.

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Question 5 of 20

An older adult with moderate dementia becomes agitated and strikes out each time the nursing assistant starts a shower. Which approach should the nurse suggest?

  1. Stop the shower and try again once the client is calm
  2. Ask the provider for an antianxiety drug to give before showers
  3. Reorient the client to why a shower is needed before starting
  4. Switch to a warm towel bath, keeping the client covered
Show the answer and rationale

Answer: D

Agitation during bathing usually comes from cold, fear and feeling exposed. A warm towel or sponge bath that keeps the client covered, at the time of day the client is used to, gets the client clean with far less distress. Trying again later suits a single outburst, but this client strikes out every time, so the bath itself must change, and missed hygiene risks skin breakdown and infection. A drug given only to get the client through a shower, rather than to treat a medical symptom, acts as a chemical restraint, which is not permitted; psychotropic drugs are considered only after several nonpharmacological approaches have been tried and failed. Reasoning and long explanations overwhelm a client with moderate dementia.

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Question 6 of 20

An 81-year-old client whose spouse died 5 months ago tells the clinic nurse, 'I don't bother cooking anymore, and I stopped going to the senior center because I can't drive after dark.' The client has lost 9 lb (4 kg) since the last visit. Which action by the nurse is most appropriate?

  1. Suggest daytime senior center visits and a volunteer driver program
  2. Refer the client to a grief support group and a bereavement counselor
  3. Screen for depression and link the client to meal and ride programs
  4. Recommend a high-calorie shake and recheck the weight in a month
Show the answer and rationale

Answer: C

Weight loss, skipped meals, and withdrawal after a spouse's death, together with loss of nighttime driving, point to isolation and possible depression, which is not a normal part of aging; screening for depression plus practical meal and transportation links addresses both assessment and daily needs. The runner-up is referral to a grief support group and a bereavement counselor, because grief help is appropriate but it skips depression screening and does nothing for missed meals or rides. A high-calorie shake with a weight recheck in a month treats only nutrition and delays assessment. Daytime senior center visits with a volunteer driver program help social contact and transport, yet still leave depression and meal intake unassessed.

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Question 7 of 20

A nurse observes assistive personnel (AP) giving denture care to a resident of a long-term care facility. Which action by the AP requires the nurse to intervene?

  1. Rinses the dentures under hot running water to sanitize them
  2. Soaks the dentures overnight in a labeled cup of cool water
  3. Brushes the gums and tongue of a resident who has no natural teeth
  4. Lines the sink with a towel and some water before brushing the dentures
Show the answer and rationale

Answer: A

Hot water can warp the denture base so it no longer fits, which causes sore spots and poor chewing, so dentures are cleaned with a denture brush in cool or lukewarm water. Brushing the gums and tongue can look unnecessary when the resident has no natural teeth, but it removes plaque and food and stimulates the gums. Padding the sink with a towel and water prevents breakage if the dentures slip, and soaking them out of the mouth overnight in a labeled cup of water or soaking solution rests the gums and keeps the dentures from drying out or being lost.

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Question 8 of 20

A 67-year-old client who has been inactive since retiring asks the nurse how much exercise is recommended. Which plan meets current physical activity guidelines for older adults?

  1. Brisk walking 30 minutes 3 days a week, plus strength training on 2 days each week
  2. Vigorous cycling 25 minutes 3 days a week, plus stretching and balance work daily
  3. Brisk walking 20 minutes 5 days a week, plus strength and balance work 1 day a week
  4. Brisk walking 30 minutes 5 days a week, plus strength and balance work 2 days a week
Show the answer and rationale

Answer: D

The Physical Activity Guidelines for Americans call for at least 150 minutes a week of moderate aerobic activity such as brisk walking, plus muscle-strengthening activity on 2 or more days, and older adults add balance training to lower fall risk; only the 30 minutes on 5 days plus strength and balance work on 2 days meets all three parts. The runner-up is brisk walking 30 minutes on 3 days with strength training on 2 days: the strengthening frequency is right, but 90 minutes of aerobic activity falls short of 150. Walking 20 minutes on 5 days totals only 100 minutes and provides strengthening on just 1 day, and vigorous cycling 25 minutes on 3 days meets the aerobic target through the vigorous-intensity equivalent but substitutes stretching for the required muscle strengthening.

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Question 9 of 20

A client who started continuous positive airway pressure (CPAP) for obstructive sleep apnea 2 weeks ago says, 'My nose and mouth get so dry that I take the mask off halfway through the night.' Which response by the nurse is best?

  1. 'Turn the pressure down on the machine until the dryness stops.'
  2. 'Some use is better than none, so wear it as long as you can.'
  3. 'A saline nasal spray at bedtime should keep your nose from drying.'
  4. 'A heated humidifier can ease that, so let's ask your provider.'
Show the answer and rationale

Answer: D

Dryness and nasal congestion are among the most common reasons clients abandon CPAP, and a heated humidifier, a better-fitting mask, or a chin strap for mouth leaks usually fixes them, so the nurse helps solve the problem rather than accept giving up the treatment. A saline spray may moisten the nose, but it does nothing for the dry mouth caused by air leaking out of the mouth, so it is less complete. CPAP works only while it is worn, and the airway collapses again whenever the mask comes off, so partial use is not the goal; it is used for all sleep, including naps. The pressure is prescribed from a sleep study, and lowering it on one's own lets the apneas return.

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Question 10 of 20

At a wellness visit, a 79-year-old client who lives alone takes 16 seconds to complete the Timed Up and Go test: rising from a chair, walking 10 ft (3 m), turning, walking back and sitting down. Which action should the nurse take next?

  1. Check orthostatic vital signs and advise indoor walking with a companion until reassessed
  2. Refer the client for a home safety evaluation and fitting for a four-wheeled walker
  3. Review the client's medications and refer for strength and balance exercise
  4. Document the time and schedule a repeat Timed Up and Go test at the next routine visit
Show the answer and rationale

Answer: C

A Timed Up and Go time of 12 seconds or longer signals increased fall risk, so the nurse reviews contributors such as medications that cause dizziness or sedation and refers the client for exercise or physical therapy to build strength, gait and balance. The runner-up is checking orthostatic vital signs and advising supervised indoor walking: it checks one contributor, but it neither reviews the medication list nor builds strength and balance. Documenting the time and repeating the test at the next visit delays intervention, and a home safety evaluation with a walker addresses the environment and mobility support without treating the underlying weakness and medication risks.

๐Ÿ“š Learn it: Normal Aging Versus the Thing You Must Not Call Normal

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Question 11 of 20

A nurse is completing a sleep history for a 72-year-old client. Which finding should the nurse report to the provider for further evaluation?

  1. Wakes two or three times each night, returns to sleep within 10 minutes, and feels rested
  2. Snores loudly, with pauses in breathing and daytime sleepiness
  3. Has trouble falling asleep for about an hour on nights after coffee with dinner at 6 p.m.
  4. Wakes at 5 a.m. most days, feels sleepy by 8 p.m., and naps briefly after lunch
Show the answer and rationale

Answer: B

Loud snoring with pauses in breathing and daytime sleepiness suggests obstructive sleep apnea, which raises the risk of hypertension, arrhythmias, stroke, and falls and calls for provider evaluation and a sleep study. Having trouble falling asleep for about an hour after coffee with dinner is the runner-up because it genuinely disrupts sleep, but caffeine timing is handled with teaching rather than referral. Waking at 5 a.m., feeling sleepy by early evening, and napping briefly reflect the earlier sleep timing common in older adults, and waking two or three times nightly with a quick return to sleep and feeling rested is also expected with aging.

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Question 12 of 20

A 79-year-old client in an assisted living facility has begun accusing other residents of whispering about her and refuses to go to the dining room. Her daughter says she stopped wearing her hearing aids a month ago because they were uncomfortable. Which action should the nurse take first?

  1. Face her and speak slowly and clearly whenever talking with her
  2. Arrange to have her hearing and hearing aids checked and refitted
  3. Ask the provider if an antipsychotic could ease her paranoia
  4. Encourage her to put her hearing aids back in before meals and activities
Show the answer and rationale

Answer: B

Hearing loss can lead older adults to misinterpret conversations they cannot hear clearly, and suspiciousness that began after she stopped wearing her hearing aids points to a sensory cause to correct first; a check and refitting fix the hearing loss and the discomfort that made her stop. Urging her to put the aids back in sounds right but ignores why she stopped, so she is unlikely to keep them in. Facing her and speaking clearly helps with staff but not with what she overhears, and an antipsychotic would treat the symptom without its likely cause and carries serious risks for older adults.

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Question 13 of 20

A nurse is performing a physical assessment on an 80-year-old client at an annual wellness visit. Which finding should the nurse document as an expected age-related change?

  1. Gray-white ring around the outer edge of each cornea
  2. Blood pressure of 168/72 mm Hg on two separate readings
  3. Loss of the left half of the visual field in both eyes
  4. Fasting blood glucose of 134 mg/dL on two occasions
Show the answer and rationale

Answer: A

Arcus senilis, a gray-white ring of lipid deposits at the edge of the cornea, is a common, benign finding in older adults and does not affect vision. Isolated systolic hypertension becomes more common with age but is not normal; it raises the risk of stroke and heart disease and needs treatment. Loss of the same half of the visual field in both eyes suggests a stroke, and two fasting glucose levels of 126 mg/dL or higher meet the criteria for diabetes.

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Question 14 of 20

A nurse in a long-term care facility suspects that an 86-year-old resident is developing a fluid volume deficit. Which finding is the most reliable indicator of the resident's fluid status?

  1. Tenting of the skin on the back of the hand
  2. A report of not feeling thirsty today
  3. Dry, cracked lips noted during mouth care
  4. A weight 1 kg (2.2 lb) lower than yesterday
Show the answer and rationale

Answer: D

A change in weight is the most accurate measure of fluid balance, since 1 kg (2.2 lb) gained or lost in a day equals about 1 L of fluid. Skin turgor is unreliable in older adults because aging skin loses elasticity and may tent even when the client is well hydrated. Thirst sensation declines with age, so a resident who does not feel thirsty may still be dehydrated, and dry lips can come from mouth breathing or oxygen therapy.

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Question 15 of 20

A client with advanced macular degeneration is served a meal tray in the hospital. Which action by the nurse best promotes the client's independence at mealtime?

  1. Ask dietary services to send only finger foods on each tray
  2. Remove the lids, then leave so the client can eat undisturbed
  3. Feed the client so that food is not spilled on the bed
  4. Describe where each food is on the plate using clock positions
Show the answer and rationale

Answer: D

Describing food locations by clock position, such as chicken at 6 o'clock and rice at 9 o'clock, along with opening containers and pointing out hot liquids, lets a client with low vision eat independently. Feeding the client takes away a skill the client still has, and limiting the tray to finger foods restricts choice and nutrition without solving the real problem. Leaving after removing the lids gives the client no way to find the food or avoid a hot spill.

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Question 16 of 20

During an annual wellness visit, a 63-year-old client whose last menstrual period was 11 years ago, and who does not take hormone therapy, mentions light vaginal spotting several times in the past month. She says, 'I figured my body was just changing again.' Which action by the nurse is most appropriate?

  1. Report the bleeding so the provider can evaluate the uterine lining
  2. Reassure her that light spotting is common in the years after menopause
  3. Suggest a vaginal moisturizer, since dryness is the usual cause of spotting
  4. Ask her to keep a bleeding diary and review it at next year's visit
Show the answer and rationale

Answer: A

Any vaginal bleeding after menopause (12 months without a period) is abnormal and is evaluated promptly, usually with a transvaginal ultrasound or an endometrial biopsy, because it is the presenting sign in most cases of endometrial cancer. Vaginal atrophy can cause spotting, but that diagnosis is made only after cancer has been ruled out. Reassurance or a year of watching delays the diagnosis of a cancer that is usually curable when found early.

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Question 17 of 20

A 79-year-old client reports that sounds in the right ear have seemed muffled for 2 weeks. During the Weber test the client hears the tuning fork louder in the right ear, and the Rinne test shows that bone conduction lasts longer than air conduction in the right ear. How should the nurse interpret these findings?

  1. An expected result for age, since presbycusis alters both tuning fork tests
  2. Sensorineural hearing loss in the right ear from age-related presbycusis
  3. Sensorineural hearing loss in the left ear, with normal hearing on the right
  4. Conductive hearing loss in the right ear, such as from impacted cerumen
Show the answer and rationale

Answer: D

When sound is blocked from reaching the inner ear, the Weber tone lateralizes to the affected ear and the Rinne test shows bone conduction equal to or longer than air conduction on that side, the pattern of a conductive loss; impacted cerumen is a common, easily treated cause in older adults, so an otoscopic exam comes next. Presbycusis is a sensorineural loss of high-frequency hearing in which air conduction still lasts longer than bone conduction. A sensorineural loss in the left ear would send the Weber tone to the right, but the right-sided Rinne test would then be normal.

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Question 18 of 20

A nurse is inspecting the skin of a 71-year-old client during a physical examination. Which finding should the nurse report to the provider for further evaluation?

  1. Several small, bright red, dome-shaped papules scattered over the trunk
  2. A mole on the calf with an irregular border that has grown since spring
  3. Flat, dark purple patches on the forearms that fade over a few weeks
  4. Raised, waxy brown plaques that look 'stuck on' to the skin of the back
Show the answer and rationale

Answer: B

A pigmented lesion that is changing in size, shape or color, or that has an irregular border, fits the ABCDE warning signs of melanoma (asymmetry, border, color, diameter over 6 mm, evolving), and change over time is the most important sign. Seborrheic keratoses, which look waxy and stuck on, and cherry angiomas, small red papules, are common benign growths in older adults. Purple patches on the forearms are actinic (senile) purpura from fragile capillaries; bruising in unusual places or patterns, however, is assessed for falls, medication effects or abuse.

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Question 19 of 20

A nurse is planning care to reduce the risk of delirium for an 82-year-old client on the first day after hip surgery. Which intervention should the nurse include?

  1. Keep the room lights on at night so the client can see the room
  2. Keep the client in bed until the surgeon clears the client for discharge
  3. Give a prescribed sedative each evening to ensure a full night of sleep
  4. Make sure the client wears eyeglasses and hearing aids while awake
Show the answer and rationale

Answer: D

Vision and hearing loss are major risk factors for delirium, so keeping eyeglasses and hearing aids in place helps the client stay oriented and interpret the surroundings correctly, along with early mobility, hydration, and a normal sleep-wake cycle. Lights left on at night disrupt sleep, and staying in bed until discharge gives up the benefit of early mobilization. Sedatives such as benzodiazepines commonly cause delirium in older adults, so nondrug sleep measures are preferred.

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Question 20 of 20

A nurse is teaching home safety to a 78-year-old client with diabetic peripheral neuropathy who lives alone. Which client statement indicates correct understanding?

  1. 'I'll keep a small rug beside the tub so I don't slip on the tile.'
  2. 'I'll test how hot the bath water is with my toes first.'
  3. 'I'll use a heating pad on my feet at night to keep them warm.'
  4. 'I'll check the bath water with a thermometer before I get in.'
Show the answer and rationale

Answer: D

Neuropathy dulls the ability to feel heat, so bath water is checked with a thermometer, and the water heater should be set no higher than 120 ยฐF (49 ยฐC) to prevent scalds. Testing with the toes relies on the very sensation that is lost, a heating pad on numb feet can cause a deep burn, and a loose rug is a tripping hazard; a nonslip mat in the tub and grab bars are the safer choices.

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