NCLEX Geriatric Specialty Care questions
The PrepScore bank has 42 Geriatric Specialty Care questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Generate solutions and Take action, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Delirium vs dementia, polypharmacy + Beers list, frailty + sarcopenia, failure to thrive, atypical UTI, capacity vs competence, elder abuse, end-of-life planning.
Three worked questions
Q1. A 78-year-old male is admitted on multiple medications. The pharmacy nurse performs a medication review using the AGS Beers Criteria. Which medications are on the BEERS CRITERIA as POTENTIALLY INAPPROPRIATE for older adults? Select all that apply.
- A. Diphenhydramine (anticholinergic — delirium, falls, urinary retention, constipation)
- B. Long-acting benzodiazepines (diazepam, clonazepam — falls, delirium, sedation)
- C. Acetaminophen at appropriate dose (preferred analgesic in older adults — NOT Beers)
- D. First-generation antipsychotics in dementia (haloperidol — FDA black-box warning increased mortality in elderly with dementia)
- E. Lisinopril at appropriate dose (preferred antihypertensive — NOT Beers)
- F. Meperidine (CNS toxic metabolite normeperidine + seizure risk + delirium)
Show answer and rationale
Answer: Diphenhydramine (anticholinergic — delirium, falls, urinary retention, constipation)Long-acting benzodiazepines (diazepam, clonazepam — falls, delirium, sedation)First-generation antipsychotics in dementia (haloperidol — FDA black-box warning increased mortality in elderly with dementia)Meperidine (CNS toxic metabolite normeperidine + seizure risk + delirium)
Beers Criteria PIM: diphenhydramine + long-acting benzos + first-gen antipsychotics in dementia + meperidine. Acetaminophen and lisinopril at appropriate doses are NOT on Beers (preferred drugs).
Q2. A 78-year-old female is brought to the ED by her adult son. The ED nurse performs comprehensive assessment and notes concerning findings. Which findings SUGGEST ELDER ABUSE? Select all that apply.
- A. Unexplained bruises in various stages of healing (on torso, face, or protected areas)
- B. Caregiver providing conflicting stories about the mechanism of injury
- C. Patient appears isolated + fearful around caregiver + caregiver answers questions for patient
- D. Untreated medical problems despite financial means and access to care
- E. Stable home environment + supportive family + patient relaxed around caregiver (NOT suggestive of abuse)
- F. Routine doctor visits + medication adherence + appropriate hygiene (NOT suggestive of abuse)
Show answer and rationale
Answer: Unexplained bruises in various stages of healing (on torso, face, or protected areas)Caregiver providing conflicting stories about the mechanism of injuryPatient appears isolated + fearful around caregiver + caregiver answers questions for patientUntreated medical problems despite financial means and access to care
Elder abuse signs: unexplained bruises in various stages + caregiver conflicting story + isolation + fear around caregiver + untreated medical problems despite means. Stable supportive home + routine adherence are NOT suggestive of abuse.
Q3. A 72-year-old female at her annual geriatric visit asks the nurse about strategies to maintain cognitive function. The nurse provides evidence-based teaching. Which interventions SUPPORT COGNITIVE FUNCTION in older adults? Select all that apply.
- A. Cognitive activity (reading, puzzles, learning new skills, language) + social engagement (clubs, volunteering, faith community)
- B. Adequate sleep (7-9 hours per night with sleep hygiene)
- C. Manage chronic conditions (HTN, diabetes, hyperlipidemia, depression, hearing/vision)
- D. Physical activity (aerobic + resistance + balance — ≥ 150 min/week moderate)
- E. Isolation in private room without social interaction (worsens cognition — NOT recommended)
- F. Heavy sedation with anticholinergics or benzodiazepines (worsens cognition — Beers Criteria PIM)
Show answer and rationale
Answer: Cognitive activity (reading, puzzles, learning new skills, language) + social engagement (clubs, volunteering, faith community)Adequate sleep (7-9 hours per night with sleep hygiene)Manage chronic conditions (HTN, diabetes, hyperlipidemia, depression, hearing/vision)Physical activity (aerobic + resistance + balance — ≥ 150 min/week moderate)
Cognitive function support: cognitive activity + social engagement + adequate sleep + manage chronic conditions + physical activity. Isolation worsens cognition; heavy sedation with anticholinergics/benzos is Beers PIM.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Delirium is acute (hours-days), fluctuating, with inattention + altered consciousness. Dementia is gradual (months-years), progressive, with preserved consciousness early. Delirium has reversible causes: infection, hypoxia, electrolytes, dehydration, pain, retention, constipation, medications (especially anticholinergics, benzos, opioids). NON-PHARM is first-line. Benzodiazepines WORSEN delirium except in alcohol/benzo withdrawal.
Beers Criteria identifies meds to avoid or use with caution in elderly. High-risk classes: benzodiazepines, anticholinergics (diphenhydramine, oxybutynin), NSAIDs (renal/GI), Z-drugs (zolpidem), tricyclics. Deprescribing process: identify, prioritize, gradual taper, monitor. Benzodiazepines + opioids + some BP meds need slow tapers to avoid withdrawal. Replace function (sleep, pain) with non-pharm.
UTI in elderly often presents as confusion, falls, decreased appetite, change in baseline function — NOT classic dysuria/frequency. Always consider UTI for any acute change. Treat symptomatic UTI; do NOT treat asymptomatic bacteriuria in elderly (IDSA guidelines — causes resistance + side effects without benefit). Mental status returns to baseline after treatment.
Fried Frailty Phenotype: unintentional weight loss + exhaustion + weakness (grip) + slow gait + low activity (3+ = frail, 1-2 = pre-frail). Causes (often reversible): depression, malignancy, GI, endocrine, malabsorption, medication. Treatment: resistance training + protein-rich nutrition (1.0-1.2 g/kg) + vit D + treat underlying causes. Frailty IS reversible.
Capacity is assessed at bedside, decision-specific, can vary day-to-day. 4 elements: UNDERSTAND, APPRECIATE, REASON, COMMUNICATE. Dementia diagnosis does NOT automatically remove capacity. Competence is a court determination — different concept. Cannot override a capable patient's autonomy, even by family. Engage ethics + palliative + chaplain for difficult conversations.
Types: physical, sexual, emotional, financial, NEGLECT (most common), abandonment. Red flags: pressure injuries + dehydration + malnutrition + poor hygiene + injuries in stages + delayed care + caregiver behavior. RNs are mandated reporters in all states — report to Adult Protective Services on REASONABLE SUSPICION, not proof. Do NOT confront caregiver. Mandatory reporting overrides patient preference when criteria met.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Geriatric Specialty Care questions does the bank have?
42 multiple-choice items, plus 10 unfolding cases in the Geriatric Specialty Care pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Generate solutions and Take action, though every step appears.
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