Geriatrics NCLEX Review 2/17/25

Which of the following statements are true about IV placement in older adults?

• Older adults have thicker veins, making it more difficult to place an IV

• Older adults are at an increased risk of hypervolemia due to reduced cardiac and renal function

• The IV catheter should be inserted at a 35-45 degree angle because older adults have deeper veins

• Using an infusion pump is considered a best practice

• The nurse should increase tourniquet pressure to make it easier to access veins

Answer explanation

Infusion pump use is a best practice for clients of all ages. Older adults have fragile veins with an increased risk of infiltration. Older adults have less subcutaneous tissue, so the IV should be inserted at a steeper angle closer to 10 degrees. Older adults have fragile skin and are susceptible to bruising and skin tears, which may be caused by an excessively tight tourniquet. 

The nurse is preparing to discharge an 80-year-old client who has a new prescription for warfarin (Coumadin) for deep vein thrombosis. Which of the following instructions should be included in the nurse’s discharge teaching?

• Follow a healthy diet by increasing green, leafy vegetables

• Take herbal remedies to manage cold symptoms

• Avoid alcohol due to enhanced anticoagulant effect

• Take Coumadin only on an empty stomach

Answer explanation

A is incorrect because eating more leafy greens will increase the patient's levels of vitamin K, counteracting the effects of warfarin.

B is incorrect because herbal remedies may be incompatible with the patient's medications.

C is correct because alcohol reduces the coagulability of blood, which can put the patient at risk of hemorrhage when also taking anticoagulant medications like warfarin.

D is incorrect because warfarin should not be taken on an empty stomach.

The nurse is caring for an older adult client with a hip replacement due to fracture of acetabulum and greater trochanter. At what mark on the drawing is the acetabulum located?

• A

• B

• C

• D

• E

Answer explanation

A: Acetabulum

B: Ischium

C: Obturator foramen

D: Illium

E: Sacrum

A nurse is working in a rural care facility for clients of all ages. The nurse understands that the age group at highest risk of death from a fall is which of the following?

• Toddlers aged 12 to 18 months

• The elderly

• Teenaged males

• School-aged children of both genders

• Newborns

Answer explanation

Older adults suffer the highest number of fatal falls and the risk increases with age. This is due to cognitive, physical, and sensory changes associated with advancing age.

The nurse is providing information to client entering perimenopause. Which of the following is true about this periodic change in the client? (Select all that apply)

• Vaginal rugae increase in number

• Vaginal pH increases

• Vaginal lubrication increases

• Vasomotor instability occurs

• Vulvar tissue atrophies

Answer explanation

The number of vaginal rugae decreases with menopause.

A drop in estrogen causes vaginal pH to rise.

A drop in estrogen leads to less vaginal lubrication.

Vasomotor instability (hot flashes) occurs due to changes in thermoregulation.

A drop in estrogen causes vulvar tissue to atrophy.

A nurse wants to avoid overstimulating her 88-year old client who has limited mobility, yet still provide enough engagement ro make his activities enjoyable. Which action of the nurse is most appropriate?

• Provide books and materials that have large print

• Keep the client in an isolated environment to reduce distractions

• Open the window in the client’s room

• Allow the client to sit in a chair next to the nurse’s station

Answer explanation

[A] (correct) - This makes it easier for the client to read to pass the time without having to strain to see

[B] - This may not be stimulating enough and may contribute to loneliness

[C] - This may be distracting and noisy 

[D] - Although this may provide more interaction, this may be too stimulating and distracting for the client, especially if he does not want to be there

The nurse is assessing an elderly client for the risk of falls. Which of the following should the nurse collect?

• The facility restraint policy

• Information on gait, balance, and visual impairment

• Psychosocial history

• The facility environmental safety plan

Answer explanation

[A] - The facility restraint policy is not related to a client’s fall risk 

[B] (CORRECT)- This is part of a fall assessment 

[C] - Psychosocial history is important but not typically related to falls

[D] - The facility safety plan is not information that would be collected from the client 

The nurse is administering silver sulfadiazine to an older adult client. Which of the following is true about this drug? (Select all that apply)

• It causes black stains of the skin

• It causes leukopenia

• It interferes with liver function

• It forms sulfa crystals in urine

• Sulfamylon is the trade name

Answer explanation

[A] - It does not cause black stains

[B](CORRECT) - Leukopenia is reported to occur frequently upon usage of this drug

[C] - It does not interfere with liver function

[D](CORRECT) - Silver sulfadiazine contains propylene glycol. When absorbed systemically, this can cause elevated serum osmolality and high specific gravity of urine, as well as sulfa crystal formation. It is important to keep the client well hydrated. 

[E] - Sulfamylon is the brand name of mafenide acetate, not silver sulfadiazine

1. A nurse is performing a physical assessment on an 88-year old client who is being admitted for persistent vomiting and dehydration. Which of the following physical assessments would the nurse most likely see in this client as a result of age-related changes?

• Skin that is thicker and more wrinkled

• Increased number and size of sweat glands

• Decreased blood vessel fragility

• Increased constipation due to decreased gastric motility

Answer explanation

[A] - Skin becomes thinner and more wrinkled with age

[B] - Older adults see a decrease in the amount and size of sweat glands, leading to reduced sweat production 

[C] - Blood vessels become more fragile with advancing age

[D] (CORRECT) - Gastric motility decreases with age, leading to more frequent constipation 

1. A nurse is visiting a home care client at home to assess safety. The nurse notices that there are no fire alarms in the client’s home. The client responds that he has never had any fire alarms and doesn’t see the need for them. Which of the following is the appropriate response by the nurse?

• Without telling the client, call the client’s family and request that they install fire alarms in the home immediately

• Educate the client regarding the importance of having working fire alarms and encourage him to think about having a fire alarm installed on each floor

• Advise the client that he will be sent to a nursing home if a report is filed that states he does not live in a safe environment

• Call the client’s primary care provider and report the absence of working fire alarms in the house

Answer explanation

[A] - The client has a right to privacy and calling his family could be construed as a breach of confidentiality

[B] (CORRECT)- The nurse should attempt to provide the client with enough information to make an informed decision 

[C] - Threatening the client will harm the nurse-client relationship and reduce the client’s trust

[D] - The primary care provider is not present and the nurse should manage this situation independently