Aging process NCLEX-RN Practice Questions

Aging process NCLEX-RN Practice Questions

The aging process influences every body system and shapes how nurses promote health, prevent complications, and tailor care for older adults. This topic-wise NCLEX-RN question set focuses on normal versus pathological age-related changes, high-yield screening and vaccination schedules, polypharmacy risks, fall prevention, mental health, and functional safety. You will practice distinguishing delirium, dementia, and depression, applying Beers Criteria, and prioritizing interventions that reduce harm. Designed for rigorous exam preparation, these questions blend clinical reasoning, evidence-based guidelines, and realistic scenarios encountered in gerontological nursing. Use them to sharpen assessment skills, anticipate atypical presentations, and reinforce prevention strategies that support healthy aging, independence, and quality of life for older adults in all care settings.

Q1. Which physiological change is considered a normal part of cardiovascular aging?

• Progressive increase in resting heart rate due to sinoatrial node hyperactivity
• Increased systolic blood pressure related to arterial stiffness
• Marked decrease in stroke volume at rest
• Widened pulse pressure caused by severe aortic regurgitation

Correct Answer: Increased systolic blood pressure related to arterial stiffness

Q2. A 72-year-old community-dwelling adult with no prior pneumococcal vaccination asks about immunizations. Which plan is most appropriate?

• Administer live zoster vaccine today and repeat annually
• Administer recombinant zoster vaccine (2-dose series), annual influenza, and a single dose PCV20 today
• Administer PCV13 today and no further pneumococcal vaccines
• Skip influenza vaccine due to lower efficacy in older adults

Correct Answer: Administer recombinant zoster vaccine (2-dose series), annual influenza, and a single dose PCV20 today

Q3. Which age-related pharmacokinetic change most increases the risk of drug accumulation and toxicity in older adults?

• Increased hepatic blood flow enhancing first-pass metabolism
• Decreased glomerular filtration rate reducing renal drug clearance
• Increased total body water expanding hydrophilic drug distribution
• Increased serum albumin raising protein binding

Correct Answer: Decreased glomerular filtration rate reducing renal drug clearance

Q4. The nurse plans fall-prevention for a recently hospitalized 80-year-old. Which intervention is the best initial approach?

• Use bilateral wrist restraints at night to prevent wandering
• Conduct a multifactorial fall risk assessment including medications, orthostatic vital signs, vision, feet/footwear, and home hazards
• Apply bed alarms only
• Restrict fluids after 6 PM to reduce nocturia

Correct Answer: Conduct a multifactorial fall risk assessment including medications, orthostatic vital signs, vision, feet/footwear, and home hazards

Q5. An 82-year-old becomes suddenly confused, inattentive, and fluctuates between agitation and somnolence after surgery. Which condition is most likely?

• Dementia
• Delirium
• Major depressive disorder
• Normal aging

Correct Answer: Delirium

Q6. Which skin finding is a common, nonpathologic change in older adults?

• Thickening of the dermis with increased sebaceous activity
• Thinning of the epidermis and decreased subcutaneous fat leading to skin fragility
• Rapid wound healing due to enhanced angiogenesis
• Persistent stage 2 pressure injury

Correct Answer: Thinning of the epidermis and decreased subcutaneous fat leading to skin fragility

Q7. Which statement about sleep in older adults is accurate?

• Older adults have increased slow-wave sleep and minimal awakenings
• Total nightly sleep time increases dramatically with age
• There is decreased slow-wave sleep and increased nighttime awakenings
• Benzodiazepines are first-line to correct sleep architecture

Correct Answer: There is decreased slow-wave sleep and increased nighttime awakenings

Q8. A 78-year-old with mild sarcopenia asks about diet. Which recommendation is evidence-based for healthy aging (no CKD)?

• Limit protein to 0.6 g/kg/day to reduce kidney strain
• Aim for 1.0–1.2 g/kg/day of protein, adequate calories, and vitamin D/calcium intake
• Avoid vitamin D after age 70
• Use stimulant laxatives daily to maintain regularity

Correct Answer: Aim for 1.0–1.2 g/kg/day of protein, adequate calories, and vitamin D/calcium intake

Q9. An older adult reports sudden strong urges to void with large-volume leakage before reaching the toilet. What type of incontinence is most likely?

• Stress incontinence
• Overflow incontinence
• Urge incontinence
• Functional incontinence

Correct Answer: Urge incontinence

Q10. Which measurement criteria confirm orthostatic hypotension in an older adult?

• Increase in systolic BP ≥20 mm Hg after standing 3 minutes
• Decrease in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg within 1–3 minutes of standing
• Pulse increase by 5 beats/min upon standing
• Any change in BP with standing

Correct Answer: Decrease in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg within 1–3 minutes of standing

Q11. Best communication strategy for presbycusis includes:

• Speak loudly in a high pitch from behind the patient
• Speak slowly in a lower pitch at normal volume, facing the patient and reducing background noise
• Repeat the entire sentence without pausing
• Cover your mouth to prevent lip-reading

Correct Answer: Speak slowly in a lower pitch at normal volume, facing the patient and reducing background noise

Q12. Which visual change is typical with aging and affects near tasks?

• Presbyopia requiring increased reading distance or corrective lenses
• Acute central vision loss due to retinal detachment
• Sudden unilateral vision loss due to optic neuritis
• Permanent loss of peripheral vision due to acute glaucoma

Correct Answer: Presbyopia requiring increased reading distance or corrective lenses

Q13. A 79-year-old with moderate Alzheimer’s disease grimaces and guards the hip after a fall but cannot rate pain. Best assessment approach?

• Assume no pain if the patient cannot self-report
• Use a behavioral pain scale such as PAINAD to guide analgesia
• Give a placebo to test pain validity
• Delay analgesics until radiology confirms fracture

Correct Answer: Use a behavioral pain scale such as PAINAD to guide analgesia

Q14. Which medication on a new admission’s list should the nurse question first based on Beers Criteria?

• Diphenhydramine 50 mg at bedtime for sleep
• Acetaminophen 500 mg as needed for pain
• Vitamin D3 1000 IU daily
• Omeprazole 20 mg daily for 6 weeks post-GI bleed

Correct Answer: Diphenhydramine 50 mg at bedtime for sleep

Q15. An 86-year-old with mild cognitive impairment expresses wishes consistent with a documented living will. What is the priority nursing action?

• Ignore the living will if family disagrees
• First assess decision-making capacity and then honor the patient’s directives if capacity is intact
• Automatically assign the healthcare proxy to make all decisions
• Delay decisions until a capacity hearing is held

Correct Answer: First assess decision-making capacity and then honor the patient’s directives if capacity is intact

Q16. Which nursing intervention best prevents pressure injuries in frail older adults with limited mobility?

• Reposition at least every 2 hours, offload heels, manage moisture, and optimize protein/calorie intake
• Massage reddened bony prominences
• Use donut cushions under the sacrum
• Restrict fluids to reduce edema

Correct Answer: Reposition at least every 2 hours, offload heels, manage moisture, and optimize protein/calorie intake

Q17. Which statement about thermoregulation in older adults is true?

• Older adults mount higher fevers during infection
• Lower baseline temperatures and blunted febrile responses can mask infection
• Shivering increases heat production more than in younger adults
• Hypothermia is rare in older adults

Correct Answer: Lower baseline temperatures and blunted febrile responses can mask infection

Q18. An older adult endorses anhedonia, sleep changes, and low energy for 6 weeks. What is the best next step?

• Reassure that depression is normal aging
• Screen using the Geriatric Depression Scale and evaluate suicide risk
• Start a benzodiazepine at bedtime
• Advise isolation until mood improves

Correct Answer: Screen using the Geriatric Depression Scale and evaluate suicide risk

Q19. During assessment, the caregiver refuses to leave the room. The older adult has bruises in different healing stages and appears fearful. What should the nurse do first?

• Document and continue routine care
• Interview the patient privately and follow mandatory reporting laws for suspected elder abuse
• Ask the caregiver to explain the bruises and accept the answer
• Schedule a routine follow-up

Correct Answer: Interview the patient privately and follow mandatory reporting laws for suspected elder abuse

Q20. An 84-year-old with dementia has severe agitation. Which statement about antipsychotic use is correct?

• Antipsychotics are first-line and reduce mortality
• They carry a black box warning for increased mortality and should be used only for severe distress or danger after nonpharmacologic measures fail
• They prevent progression of dementia
• They are harmless if used at bedtime only

Correct Answer: They carry a black box warning for increased mortality and should be used only for severe distress or danger after nonpharmacologic measures fail

Q21. Which finding requires priority evaluation of an older adult’s driving safety?

• Uses cruise control on highways
• Reports occasional night glare managed with glasses
• Gets lost on familiar routes and has recent near-misses
• Prefers not to drive in rain

Correct Answer: Gets lost on familiar routes and has recent near-misses

Q22. Which exercise prescription best supports healthy aging in a 70-year-old without contraindications?

• 150 minutes/week moderate aerobic activity plus strength training 2+ days/week and balance work
• Vigorous-only activity 7 days/week
• Strength training only, avoid balance exercises
• No exercise to protect joints

Correct Answer: 150 minutes/week moderate aerobic activity plus strength training 2+ days/week and balance work

Q23. Which statement about immunosenescence is accurate?

• Older adults should avoid vaccines due to poor responses
• Immune responses are blunted, but high-dose or adjuvanted vaccines and timely schedules still reduce morbidity
• Live vaccines are more effective and always preferred in older adults
• Vaccines eliminate the need for hand hygiene

Correct Answer: Immune responses are blunted, but high-dose or adjuvanted vaccines and timely schedules still reduce morbidity

Q24. Which finding best indicates dehydration risk in an older adult?

• Persistent strong thirst sensation
• Decreased thirst perception with dry mucous membranes and orthostatic changes
• Low specific gravity of urine with high fluid intake
• Edema of lower extremities

Correct Answer: Decreased thirst perception with dry mucous membranes and orthostatic changes

Q25. An 81-year-old with constipation and multiple meds (calcium, verapamil, oxycodone) asks for help. Best initial intervention?

• Start daily stimulant laxatives long-term without other changes
• Increase dietary fiber and fluids as tolerated, encourage mobility, review constipating meds, and consider osmotic laxative
• Stop all medications immediately
• Use mineral oil regularly

Correct Answer: Increase dietary fiber and fluids as tolerated, encourage mobility, review constipating meds, and consider osmotic laxative

Q26. Which screening is recommended for a healthy 67-year-old woman with no major risk factors?

• Dual-energy X-ray absorptiometry (DEXA) scan for osteoporosis
• Stop all cancer screening after 65
• Pap smear annually indefinitely
• AAA ultrasound screening mandatory for all women

Correct Answer: Dual-energy X-ray absorptiometry (DEXA) scan for osteoporosis

Q27. Which presentation of pneumonia is most typical in a frail 88-year-old?

• High fever and pleuritic chest pain
• Confusion, anorexia, functional decline, and tachypnea without high fever
• Hemoptysis and wheezing only
• Sudden cyanosis as the sole symptom

Correct Answer: Confusion, anorexia, functional decline, and tachypnea without high fever

Q28. An older adult with chronic insomnia requests “something strong” for sleep. Best response?

• Recommend diphenhydramine nightly
• Start a benzodiazepine as first-line
• Initiate sleep hygiene measures and refer for CBT-I; avoid sedative-hypnotics unless indicated short term
• Suggest alcohol to induce sleep

Correct Answer: Initiate sleep hygiene measures and refer for CBT-I; avoid sedative-hypnotics unless indicated short term

Q29. A 74-year-old postmenopausal woman reports dyspareunia due to vaginal dryness. Appropriate teaching includes:

• Sexual activity is unsafe after menopause
• Use water-based lubricants or consider low-dose vaginal estrogen if not contraindicated
• Avoid all lubricants to prevent infection
• Abstain permanently to prevent pain

Correct Answer: Use water-based lubricants or consider low-dose vaginal estrogen if not contraindicated

Q30. Which musculoskeletal and postural change is commonly associated with aging and affects respiratory function?

• Lordosis causing increased lung expansion
• Kyphosis from vertebral compression reducing chest wall expansion
• Increased intervertebral disc height with aging
• Marked scoliosis in all older adults

Correct Answer: Kyphosis from vertebral compression reducing chest wall expansion

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