Geriatric Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Ageing Changes, Falls, Delirium and Dementia, Polypharmacy, Pressure Injuries, Incontinence, Nutrition, Dysphagia, Elder Abuse and End-of-Life Care

Care of the older adult is tested across the medical-surgical, mental health and fundamentals domains of the registered nurse paper, typically 8 to 12 questions, and demand is rising fast: the Gulf's own population is ageing, home-care agencies in Dubai, Abu Dhabi and Riyadh recruit nurses specifically for elderly care, and long-term care facilities are expanding. The exam tests whether you can tell normal ageing from disease, recognise atypical presentations, and keep older patients safe from the preventable harms of hospital care. This set covers what recurs.

Ageing and assessment

Question 1

Which finding in an 80-year-old is a normal age-related change rather than a sign of disease?

1. Urinary incontinence
2. Reduced skin elasticity and thinning, presbyopia and presbycusis (high-frequency hearing loss), decreased thirst sensation, reduced renal clearance, a modest decline in processing speed, and reduced bladder capacity with nocturia
3. Confusion
4. Falls

Answer: B. Incontinence, confusion, falls, depression and significant memory loss are never "just old age"; each is assessed for a treatable cause.

Question 2

An 84-year-old woman is brought in by her daughter because she has become quiet, stopped eating and is "not herself" over two days. She has no fever and no complaint of pain. The nurse should recognise:

1. A normal fluctuation in mood
2. An atypical presentation of acute illness common in older adults, in which infection (pneumonia, urinary infection), myocardial infarction, dehydration or a medication effect may present as confusion, reduced intake, falls or functional decline without fever or classic symptoms; a full assessment including vital signs, glucose, hydration, urinalysis, bloods and ECG is needed
3. Dementia, which needs no urgent action
4. Attention-seeking behaviour

Answer: B. Baseline temperature is lower in old age, so a rise of 1.1 °C above baseline or a temperature above 37.8 °C is significant.

Question 3

Comprehensive geriatric assessment includes:

1. A medical history only
2. Medical, functional (activities of daily living with tools such as Barthel or Katz, instrumental ADLs), cognitive (for example MoCA or Mini-Cog), mood (Geriatric Depression Scale), nutritional (Mini Nutritional Assessment), social and environmental assessment, medication review, and falls and continence assessment, by a multidisciplinary team, leading to a coordinated care plan
3. Laboratory tests only
4. A brief screen in the emergency department

Answer: B. CGA reduces mortality and institutionalisation in frail older people admitted to hospital.

Falls and mobility

Question 4

A 78-year-old admitted with pneumonia takes a sedative at night, a diuretic, an antihypertensive and an anticholinergic for bladder symptoms. She has had two falls at home this year. The most effective falls-prevention approach is:

1. Bed rails up and a sedative to keep her in bed
2. A multifactorial falls assessment and intervention: medication review to reduce sedatives, anticholinergics and diuretic timing, orthostatic blood pressure check, vision and footwear assessment, toileting schedule, bed low with call bell in reach, mobility aid within reach, adequate lighting, hourly rounding, and strength and balance exercise referral
3. Restricting the patient to a chair with a lap belt
4. Hip protectors alone

Answer: B. Restraints and full bed rails increase injury severity; a fall with head injury in a patient on anticoagulants requires urgent CT.

Question 5

An older patient reports dizziness when standing. Lying blood pressure is 140/80, standing after three minutes is 112/70 with a heart rate rise of 8. The nurse interprets:

1. Normal variation
2. Orthostatic hypotension (a systolic fall of 20 mmHg or more, or diastolic of 10 or more, within three minutes of standing), a major falls risk; review antihypertensives, diuretics and alpha blockers, ensure hydration, teach to rise slowly and sit on the edge of the bed, consider compression stockings, and report to the prescriber
3. Anxiety
4. Vertigo requiring vestibular rehabilitation

Answer: B. Postprandial hypotension and dehydration in hot climates compound the problem in Gulf patients.

Cognition and mood

Question 6

Which features distinguish delirium from dementia?

1. Delirium develops over years with clear consciousness
2. Delirium has acute onset (hours to days), a fluctuating course, impaired attention and altered level of consciousness, often with perceptual disturbance, and is usually reversible when the cause is treated; dementia is insidious, progressive and chronic with intact attention and alertness until late stages; the two commonly coexist, and the CAM is the screening tool for delirium
3. Dementia always has hallucinations
4. Delirium cannot occur in a patient with dementia

Answer: B. Hypoactive delirium (quiet, withdrawn) is missed more often than hyperactive delirium and has a worse prognosis.

Question 7

Which nursing interventions prevent delirium in a hospitalised older adult?

1. Night-time sedation with benzodiazepines
2. Orientation (clock, calendar, introductions), glasses and hearing aids in place, early mobilisation, hydration and nutrition, sleep promotion with reduced night noise and light, avoiding unnecessary catheters and restraints, pain control, medication review (especially anticholinergics, benzodiazepines and opioids), bowel and bladder care, and family presence
3. Strict bed rest
4. Minimising family visits to reduce stimulation

Answer: B. Multicomponent non-pharmacological programmes (such as HELP) reduce delirium incidence by about a third; antipsychotics do not prevent it.

Question 8

An 80-year-old man with moderate Alzheimer's disease refuses to shower and becomes agitated when the nurse insists. The best approach is:

1. Insist firmly and call for help to complete the shower
2. Step back and try later, use a calm tone and simple one-step instructions, offer choices (shower or wash at the sink, now or after breakfast), keep the routine familiar, ensure warmth and privacy, involve a family member or preferred carer, assess for pain, fear or unmet needs, and use distraction; sedation is not a first response
3. Give an antipsychotic
4. Skip hygiene care permanently

Answer: B. Behavioural symptoms usually communicate an unmet need; antipsychotics in dementia increase stroke and death and are reserved for severe distress or danger.

Question 9

An older widow has lost interest in activities, sleeps poorly, has lost weight and says she is a burden. Her MoCA is 25 out of 30 and she answers "I don't know" to many questions. The nurse should consider:

1. Dementia only
2. Depression, which is common and under-diagnosed in older adults, often presents with somatic complaints and apparent cognitive impairment ("pseudodementia"), and carries a high suicide risk in older men especially; screen with the Geriatric Depression Scale, ask directly about suicidal thoughts and refer
3. Normal grief that needs no assessment
4. Hypothyroidism only

Answer: B. Thyroid function, B12 and medication effects are also checked; depression is treatable at any age.

Medications

Question 10

Which medication list raises the most concern under the Beers criteria for an 82-year-old?

1. Paracetamol, a statin and vitamin D
2. Diazepam for sleep, diphenhydramine for allergy, oxybutynin for bladder symptoms, long-term NSAIDs and a sliding-scale insulin regimen, each of which is potentially inappropriate in older adults because of falls, delirium, anticholinergic burden, bleeding and renal risk, or hypoglycaemia
3. Low-dose aspirin after a stroke
4. Levothyroxine

Answer: B. Start low and go slow; renal function (not just creatinine, which can be falsely reassuring with low muscle mass) guides dosing of renally cleared drugs such as digoxin, gabapentin and DOACs.

Question 11

An older patient takes 12 regular medications from three prescribers and has had two recent falls and a hospital admission for confusion. The nurse's most useful action is:

1. Teach the patient to take all medications at once
2. Compile a complete medication reconciliation including over-the-counter and herbal products, identify duplications, interactions and drugs without a current indication, and request a structured medication review (deprescribing) by the physician and pharmacist, with a single up-to-date list, a dosette box or blister pack and carer involvement
3. Stop all medications
4. Add a sedative for the confusion

Answer: B. A prescribing cascade (a drug given to treat the side effect of another drug) is a tested concept; medication reconciliation at every transition of care is an International Patient Safety Goal.

Skin, continence and nutrition

Question 12

An immobile 88-year-old has a Braden score of 11. The pressure injury prevention plan includes:

1. Massage over the sacrum and heels
2. Repositioning at least every two hours in bed and hourly in a chair (with a 30-degree tilt), a high-specification pressure-redistributing mattress and cushion, heel offloading, keeping skin clean and dry with barrier products for incontinence, nutrition and hydration optimisation, and daily skin inspection focusing on bony prominences and under devices
3. Donut cushions
4. Head of bed at 90 degrees at all times

Answer: B. A Braden score of 12 or less is very high risk; donut cushions and massage over bony prominences are harmful.

Question 13

A 76-year-old woman leaks urine when she coughs or laughs. Another resident leaks after a sudden strong urge she cannot defer. The types and first-line management are:

1. Both have overflow incontinence; catheterise both
2. Stress incontinence (pelvic floor muscle training, weight management, treating cough) and urge incontinence or overactive bladder (bladder training, timed voiding, reducing caffeine and evening fluids, then medication if needed, avoiding oxybutynin in frail older adults because of cognitive effects)
3. Functional incontinence; indwelling catheter
4. Normal ageing; pads only

Answer: B. Indwelling catheters are not a treatment for incontinence; functional incontinence (inability to reach the toilet in time) is managed with access, clothing and scheduled toileting.

Question 14

An older patient reports no bowel movement for five days, abdominal discomfort and small amounts of liquid stool leaking. The nurse should suspect and manage:

1. Diarrhoea; give loperamide
2. Faecal impaction with overflow; assess the abdomen and rectum as per policy, treat impaction with enemas or suppositories and manual disimpaction if required, then establish a bowel regimen with adequate fluids, fibre, mobility, timed toileting after meals and a regular laxative for patients on opioids
3. Normal bowel pattern
4. Gastroenteritis; isolate

Answer: B. Loperamide would worsen impaction; opioids, anticholinergics, iron and calcium are common causes.

Question 15

A frail 85-year-old has lost 6% of body weight in three months, has poor dentition, eats alone and takes multiple medications. Nursing actions include:

1. A low-calorie diet to prevent obesity
2. Screen with the Mini Nutritional Assessment, assess for causes (dysphagia, dentition, depression, medications affecting taste or appetite, financial or social barriers, disease), refer to the dietitian, offer small frequent energy- and protein-dense meals and snacks, assistance and company at meals, oral nutritional supplements between meals, and monitor weight weekly
3. Nasogastric feeding immediately
4. Restrict fluids to reduce incontinence

Answer: B. Unintentional weight loss of more than 5% in a month or 10% in six months is significant; dehydration is common because thirst is blunted, and fluids are scheduled rather than left to thirst.

Question 16

A patient recovering from a stroke coughs during drinks, has a wet voice after swallowing and has had two chest infections. The nurse should:

1. Encourage thin fluids through a straw
2. Recognise signs of dysphagia and aspiration risk, keep nil by mouth until a bedside swallow screen and speech and language therapy assessment, then follow the recommended texture-modified diet and thickened fluids (IDDSI levels), sit the patient fully upright for meals and 30 minutes after, give small amounts slowly, check for pocketing, provide oral care after meals and supervise eating
3. Puree all food permanently without assessment
4. Give medications crushed in thin water

Answer: B. Silent aspiration (without coughing) is common after stroke; oral hygiene reduces aspiration pneumonia more than almost any other single measure.

Safety, abuse and end of life

Question 17

An older woman admitted from home has unexplained bruises on both upper arms, is unkempt and underweight, flinches when her son approaches and has unfilled prescriptions. The nurse should:

1. Accept the son's explanation that she falls often
2. Recognise indicators of possible elder abuse and neglect (physical, psychological, financial, neglect), interview the patient privately and sensitively, document findings objectively with body maps and photographs with consent, ensure her safety, and report through the hospital's safeguarding or social work pathway in line with local law
3. Confront the son
4. Discharge home quickly

Answer: B. Gulf states have introduced senior citizen protection laws (for example the UAE's Federal Law on the Rights of Senior Emiratis); health professionals are expected to report suspected abuse.

Question 18

A confused 79-year-old repeatedly tries to climb out of bed and pull out his intravenous line. The staff suggest wrist restraints. The nurse's correct approach is:

1. Apply restraints immediately for safety
2. Try alternatives first (address the cause of agitation such as pain, urinary retention or hypoxia, re-site or conceal the line, low bed, family presence, distraction, one-to-one observation); if restraint is unavoidable it requires a physician order, the least restrictive type for the shortest time, consent from the patient or legal representative where possible, checks of circulation, skin and comfort at least every two hours with release and repositioning, and full documentation per hospital and authority policy
3. Sedate heavily so the patient sleeps
4. Tie the patient's hands with bandages

Answer: B. Restraints increase delirium, pressure injuries, strangulation and death; Gulf authorities audit restraint use as a quality indicator.

Question 19

A 90-year-old with advanced dementia, recurrent aspiration pneumonia and weight loss is admitted again. The family asks about a feeding tube. The evidence-based information the nurse supports the team to share is:

1. Tube feeding prevents aspiration and prolongs life in advanced dementia
2. Tube feeding in advanced dementia does not prevent aspiration, improve nutrition markers meaningfully, heal pressure injuries or prolong survival, and carries risks of agitation, restraint and complications; careful hand feeding, comfort-focused care and a goals-of-care discussion with palliative care involvement are recommended, respecting cultural and religious values about nutrition
3. Tube feeding is mandatory
4. The decision is the nurse's alone

Answer: B. Islamic bioethics generally permits withholding burdensome interventions when they do not benefit the patient, while artificial nutrition decisions are made with scholars and families where needed.

Question 20

Which statement about pain in older adults is correct?

1. Older people feel less pain, so less analgesia is needed
2. Pain is under-reported and under-treated in older adults, especially those with dementia; use self-report where possible and behavioural tools such as PAINAD or Abbey in cognitive impairment, give paracetamol regularly as first line, avoid long-term NSAIDs, use opioids cautiously with lower starting doses and a laxative, and reassess regularly
3. Pain assessment is impossible in dementia
4. Pethidine is the preferred opioid in the elderly

Answer: B. Untreated pain presents as agitation, withdrawal or reduced function in people with dementia; pethidine is avoided in older adults because of its neurotoxic metabolite.

How to practise

• Separate normal ageing from disease, and expect atypical presentations.
• Learn the geriatric syndromes: falls, delirium, incontinence, pressure injury, malnutrition, polypharmacy, and their multifactorial prevention.
• Know the safety and ethics rules: restraint, elder abuse reporting, capacity and goals-of-care decisions.

Gerontology chapters with explanations are in the Registered Nurse bank; related sets are the mental health questions, fundamentals questions and medical-surgical questions. Nurses considering elderly home care in the Gulf should read home care nurse jobs in Dubai.

Frequently asked questions

How many geriatric questions are in the Prometric nursing exam?

About 8 to 12 of 150, spread across the medical-surgical, mental health and fundamentals domains.

Which geriatric topics come up most?

Delirium versus dementia, falls prevention, polypharmacy and the Beers criteria, pressure injury prevention, incontinence types, dysphagia and restraint rules.

Is elderly care a growing job market in the Gulf?

Yes. Home-care agencies and long-term care facilities in the UAE and Saudi Arabia recruit nurses specifically for elderly care, and hospital geriatric services are expanding.

Are end-of-life questions included?

Yes, at the level of comfort care, feeding decisions in advanced dementia, pain assessment and family communication within cultural and legal frameworks.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.