An older patient's skin breaks down where an oxygen mask strap presses behind the ear. How is this classified?

Medical device-related pressure injury

Moisture-associated skin damage

A patient in the last weeks of life with heart failure is breathless at rest despite treatment. Which nursing measure can relieve the breathlessness?

Direct a hand-held fan toward the face

Lay the patient flat to rest the heart

Limit visitors to reduce the oxygen demand

Keep the room warm and the window closed

A frail 88-year-old gets a skin tear on the forearm while being helped out of a chair, and the skin flap is still attached. After controlling the bleeding and cleaning the wound, the nurse should:

Ease the flap back over the wound and apply a non-adherent silicone dressing

Trim the flap away and leave the wound open to the air

Pull the edges together tightly with adhesive skin-closure strips

Apply a hydrocolloid dressing and change it every day

A 78-year-old man was started on oxybutynin yesterday. Today he is agitated, pulling at his gown and pressing on his lower abdomen. He has not passed urine for 9 hours. What should the nurse do first?

Do a bladder scan for retention

Encourage him to drink 500 mL now

Apply mittens to protect his lines

A 76-year-old man taking apixaban for atrial fibrillation slipped in the bathroom 20 minutes ago and struck his head on the sink. He is alert, GCS 15, with a small bruise on the forehead, and says he feels fine. What is the priority action?

Start neurological observations and report for urgent head CT

Give the next apixaban dose on time to prevent a stroke

Document the fall and review the plan at the next shift

Apply a cold pack and recheck him at the next routine round

Care of the older adult and chronic illness

40 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Care of the older adult and chronic illness, part of Adult Health Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
An older patient's skin breaks down where an oxygen mask strap presses behind the ear. How is this classified?
1. AMoisture-associated skin damage
2. BMedical device-related pressure injury
3. CSkin tear from friction
4. DArterial ulcer of the skin
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Answer: B · Medical device-related pressure injury
A medical device-related pressure injury results from a device applied for diagnosis or treatment, and it takes the shape of the device. It is then staged with the usual system if it is on skin. Common sites are behind the ears from masks and tubing, the nose from nasogastric tubes, and the legs from compression devices. Padding under straps and checking the skin under devices each shift prevent it.
- A: Moisture damage comes from urine, stool, sweat or exudate, not device pressure.
- C: A skin tear is a traumatic wound from shear, not sustained pressure.
- D: Arterial ulcers come from poor perfusion, usually on the toes or feet.
Question 2 · Medium
A patient in the last weeks of life with heart failure is breathless at rest despite treatment. Which nursing measure can relieve the breathlessness?
1. ADirect a hand-held fan toward the face
2. BLay the patient flat to rest the heart
3. CLimit visitors to reduce the oxygen demand
4. DKeep the room warm and the window closed
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Answer: A · Direct a hand-held fan toward the face
Cool air moving across the face stimulates trigeminal nerve receptors and reduces the sensation of breathlessness. Sitting upright, a calm presence, a cool room and pacing activity also help. Low-dose opioids are the main drug treatment for breathlessness at the end of life, and oxygen helps mainly when the patient is hypoxaemic. Lying flat worsens breathlessness in heart failure.
- B: Lying flat increases venous return and orthopnoea.
- C: Family presence comforts and does not meaningfully raise oxygen demand.
- D: A warm, closed room usually makes breathlessness feel worse.
Question 3 · Easy
A frail 88-year-old gets a skin tear on the forearm while being helped out of a chair, and the skin flap is still attached. After controlling the bleeding and cleaning the wound, the nurse should:
1. ATrim the flap away and leave the wound open to the air
2. BPull the edges together tightly with adhesive skin-closure strips
3. CEase the flap back over the wound and apply a non-adherent silicone dressing
4. DApply a hydrocolloid dressing and change it every day
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Answer: C · Ease the flap back over the wound and apply a non-adherent silicone dressing
The attached flap is living skin that acts as the best dressing, so it is gently eased back over the wound bed with a moist swab. A non-adherent silicone or foam dressing follows, with an arrow drawn on it to show the direction of removal so the flap is not lifted later. Strongly adhesive products tear thin older skin when they come off. Prevention includes padded rails, long sleeves and moving the patient with a sheet instead of pulling on the arms.
- A: Removing the flap turns a partial wound into a larger open one and slows healing.
- B: Adhesive strips pull on fragile skin, and tight closure can cut off the flap's blood supply.
- D: Hydrocolloids stick firmly and can strip fragile skin, and daily changes add more damage.
Question 4 · Hard
A 78-year-old man was started on oxybutynin yesterday. Today he is agitated, pulling at his gown and pressing on his lower abdomen. He has not passed urine for 9 hours. What should the nurse do first?
1. AEncourage him to drink 500 mL now
2. BApply mittens to protect his lines
3. CDo a bladder scan for retention
4. DGive the as-needed haloperidol
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Answer: C · Do a bladder scan for retention
Oxybutynin is an anticholinergic, a class that can cause both urinary retention and delirium in older adults. Agitation with suprapubic discomfort and no urine for hours points to retention, which is itself a common trigger of delirium. A bladder scan confirms it, and catheterisation as ordered relieves it, often settling the agitation. The anticholinergic should be reported for review.
- A: Extra fluid will increase bladder distension if the outflow is blocked.
- B: Mittens restrain him without treating the reason for his distress.
- D: Sedation hides the cause and haloperidol adds its own risks.
Question 5 · Hard
A 76-year-old man taking apixaban for atrial fibrillation slipped in the bathroom 20 minutes ago and struck his head on the sink. He is alert, GCS 15, with a small bruise on the forehead, and says he feels fine. What is the priority action?
1. AGive the next apixaban dose on time to prevent a stroke
2. BStart neurological observations and report for urgent head CT
3. CDocument the fall and review the plan at the next shift
4. DApply a cold pack and recheck him at the next routine round
Show answerHide answer
Answer: B · Start neurological observations and report for urgent head CT
An anticoagulated older adult who hits his head can develop an intracranial bleed even with a normal first GCS, and the decline may be delayed. Head injury guidelines advise urgent CT for anyone on an anticoagulant after a head injury, with frequent neurological observations meanwhile. The provider decides whether to hold the next apixaban dose. A cold pack and routine rechecks would miss early deterioration.
- A: Giving apixaban before a bleed is excluded could enlarge a haemorrhage.
- C: Documentation is needed, but delaying assessment risks missing a bleed.
- D: Routine rechecks are too infrequent for a possible bleed on an anticoagulant.
Question 6 · Hard
An 84-year-old woman taking digoxin 0.25 mg daily and furosemide reports nausea, poor appetite and seeing yellow halos around lights. Pulse 52 beats/min and irregular, potassium 3.1 mmol/L (3.5-5.0), creatinine raised from her baseline. What should the nurse do first?
1. AGive an antiemetic and continue the routine doses
2. BGive the digoxin with food to ease the nausea
3. CEncourage fluids and recheck the pulse tomorrow
4. DHold the digoxin and report a likely toxicity
Answer and explanation in LearnFree account
Question 7 · Easy
A dying patient has noisy, rattling breathing from secretions in the throat. What is the nurse's first measure?
1. AEncourage the patient to drink
2. BTurn the patient onto the side
3. CIncrease the IV fluid rate
4. DStart deep oral suctioning hourly
Answer and explanation in LearnFree account
Question 8 · Easy
In care of older adults, polypharmacy is most commonly defined as the regular use of at least:
1. ATwo medicines
2. BFive medicines
3. CTen medicines
4. DThree medicines
Answer and explanation in LearnFree account
Question 9 · Easy
The family of a dying Muslim patient asks to turn the bed. The nurse understands that they usually want the patient to face:
1. AToward the family at the bedside
2. BToward the window and daylight
3. CToward Mecca (the Qibla)
4. DToward the door of the room
Answer and explanation in LearnFree account
Question 10 · Medium
On a sacral pressure injury the nurse can see tendon at the base of the wound, with no slough or eschar covering it. This is recorded as a:
1. ADeep tissue pressure injury
2. BStage 3 pressure injury
3. CStage 4 pressure injury
4. DUnstageable pressure injury
Answer and explanation in LearnFree account
Question 11 · Medium
A 72-year-old man with moderate dementia refuses a bath each morning and becomes upset when the nurse insists. The best approach is to:
1. AOffer the bath later at his usual time, in simple steps
2. BAsk two staff to bathe him quickly before he objects
3. CExplain the health benefits of bathing in detail
4. DTell him he cannot have breakfast until he bathes
Answer and explanation in LearnFree account
Question 12 · Medium
Two days after a hip fracture repair, an 82-year-old woman is drowsy, quiet and eats little. She cannot keep her attention on questions and was alert and oriented on admission. These findings most suggest:
1. AHypoactive delirium
2. BProgression of dementia
3. CNormal post-operative tiredness
4. DExpected effect of ageing
Answer and explanation in LearnFree account
Question 13 · Medium
A 75-year-old man develops ankle swelling after starting amlodipine, and furosemide is then prescribed for the swelling. This sequence is called a:
1. ADrug-drug interaction
2. BPrescribing cascade
3. CParadoxical drug reaction
4. DTherapeutic duplication
Answer and explanation in LearnFree account
Question 14 · Medium
Which nursing measure helps most to prevent delirium in an 86-year-old admitted with pneumonia?
1. AMove her to a different bed each shift for observation
2. BKeep her on bed rest until her chest is clear
3. CMake sure she wears her own glasses and hearing aids
4. DKeep the room lit and the TV on through the night
Answer and explanation in LearnFree account
Question 15 · Hard
An 80-year-old man on day 3 after a bowel resection becomes confused and restless. He started hydrochlorothiazide last week. Temp 37.0 °C, SpO2 96% on air, glucose 6.2 mmol/L (112 mg/dL), sodium 122 mmol/L (135-145), potassium 3.8 mmol/L. The most likely cause of his delirium is:
1. AHypoxaemia
2. BInfection
3. CHyponatraemia
4. DHypoglycaemia
Answer and explanation in LearnFree account
Question 16 · Hard
A 68-kg man has a stage 3 pressure injury and eats poorly. The dietitian sets protein at 1.25-1.5 g/kg/day, as advised in international pressure-injury guidelines. What is his daily protein target?
1. A85-102 g
2. B54-68 g
3. C102-120 g
4. D68-85 g
Answer and explanation in LearnFree account
Question 17 · Easy
In rehabilitation, the Barthel Index is used to measure a patient's:
1. ASeverity of pain on movement
2. BIndependence in activities of daily living
3. CLevel of consciousness after a recent head injury
4. DRisk of developing a pressure injury
Answer and explanation in LearnFree account
Question 18 · Medium
An 82-year-old woman has fallen twice this month. Her regular medicines include lorazepam at night, omeprazole, paracetamol and vitamin D. Which medicine most likely contributes to her falls?
1. AVitamin D
2. BParacetamol
3. CLorazepam
4. DOmeprazole
Answer and explanation in LearnFree account
Question 19 · Easy
Which tool is used at the bedside to screen an older patient for delirium?
1. AConfusion Assessment Method
2. BGeriatric Depression Scale
3. CMini-Mental State Examination
4. DMorse Fall Scale
Answer and explanation in LearnFree account
Question 20 · Medium
A 90-year-old woman with poor mobility has an intact area of deep maroon skin over the right heel that does not blanch. The nurse should record this as a:
1. ADeep tissue pressure injury
2. BStage 1 pressure injury
3. CUnstageable pressure injury
4. DStage 2 pressure injury
Answer and explanation in LearnFree account
Question 21 · Medium
An 83-year-old woman with mild dementia keeps trying to get out of bed alone at night to go to the toilet. Which measure best reduces her risk of falling?
1. AA sedative given at bedtime
2. BA vest restraint applied at night
3. CKeeping her room dark and quiet
4. DScheduled toileting and rounding with a low bed
Answer and explanation in LearnFree account
Question 22 · Medium
A patient with Alzheimer disease takes donepezil. Which finding should the nurse report before the next dose?
1. AMild forgetfulness of recent daily events
2. BPulse of 46 beats/min with dizziness
3. CBlood pressure of 128/78 mmHg
4. DSleeping well for 7 hours at night
Answer and explanation in LearnFree account
Question 23 · Medium
The daughter of an 84-year-old man with dementia asks why the team prefers not to give antipsychotics for his evening agitation. The nurse explains that in older people with dementia these drugs:
1. AAlways cause severe liver damage
2. BCan only be given by injection
3. CIncrease the risk of stroke and death
4. DBecome ineffective after the first week
Answer and explanation in LearnFree account
Question 24 · Medium
A patient with right-sided weakness after a stroke is being helped from bed to chair. To protect the weak shoulder, the nurse should:
1. AHave the patient pull up on the nurse's neck
2. BLet the weak arm hang freely to stretch the muscles
3. CSupport the weak arm and never pull on it
4. DLift the patient by placing hands under the armpits
Answer and explanation in LearnFree account
Question 25 · Medium
A patient with advanced lung cancer receives regular morphine for pain. Which order should the nurse expect to start at the same time?
1. ANaloxone given every 4 hours as a routine
2. BA bulk-forming fibre laxative taken alone
3. CAn antiemetic given only if vomiting occurs
4. DA regular stimulant laxative with a stool softener
Answer and explanation in LearnFree account

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Care of the older adult and chronic illness

An older patient's skin breaks down where an oxygen mask strap presses behind the ear. How is this classified?

A patient in the last weeks of life with heart failure is breathless at rest despite treatment. Which nursing measure can relieve the breathlessness?

A frail 88-year-old gets a skin tear on the forearm while being helped out of a chair, and the skin flap is still attached. After controlling the bleeding and cleaning the wound, the nurse should:

A 78-year-old man was started on oxybutynin yesterday. Today he is agitated, pulling at his gown and pressing on his lower abdomen. He has not passed urine for 9 hours. What should the nurse do first?

A 76-year-old man taking apixaban for atrial fibrillation slipped in the bathroom 20 minutes ago and struck his head on the sink. He is alert, GCS 15, with a small bruise on the forehead, and says he feels fine. What is the priority action?

An 84-year-old woman taking digoxin 0.25 mg daily and furosemide reports nausea, poor appetite and seeing yellow halos around lights. Pulse 52 beats/min and irregular, potassium 3.1 mmol/L (3.5-5.0), creatinine raised from her baseline. What should the nurse do first?

A dying patient has noisy, rattling breathing from secretions in the throat. What is the nurse's first measure?

In care of older adults, polypharmacy is most commonly defined as the regular use of at least:

The family of a dying Muslim patient asks to turn the bed. The nurse understands that they usually want the patient to face:

On a sacral pressure injury the nurse can see tendon at the base of the wound, with no slough or eschar covering it. This is recorded as a:

A 72-year-old man with moderate dementia refuses a bath each morning and becomes upset when the nurse insists. The best approach is to:

Two days after a hip fracture repair, an 82-year-old woman is drowsy, quiet and eats little. She cannot keep her attention on questions and was alert and oriented on admission. These findings most suggest:

A 75-year-old man develops ankle swelling after starting amlodipine, and furosemide is then prescribed for the swelling. This sequence is called a:

Which nursing measure helps most to prevent delirium in an 86-year-old admitted with pneumonia?

An 80-year-old man on day 3 after a bowel resection becomes confused and restless. He started hydrochlorothiazide last week. Temp 37.0 °C, SpO2 96% on air, glucose 6.2 mmol/L (112 mg/dL), sodium 122 mmol/L (135-145), potassium 3.8 mmol/L. The most likely cause of his delirium is:

A 68-kg man has a stage 3 pressure injury and eats poorly. The dietitian sets protein at 1.25-1.5 g/kg/day, as advised in international pressure-injury guidelines. What is his daily protein target?

In rehabilitation, the Barthel Index is used to measure a patient's:

An 82-year-old woman has fallen twice this month. Her regular medicines include lorazepam at night, omeprazole, paracetamol and vitamin D. Which medicine most likely contributes to her falls?

Which tool is used at the bedside to screen an older patient for delirium?

A 90-year-old woman with poor mobility has an intact area of deep maroon skin over the right heel that does not blanch. The nurse should record this as a:

An 83-year-old woman with mild dementia keeps trying to get out of bed alone at night to go to the toilet. Which measure best reduces her risk of falling?

A patient with Alzheimer disease takes donepezil. Which finding should the nurse report before the next dose?

The daughter of an 84-year-old man with dementia asks why the team prefers not to give antipsychotics for his evening agitation. The nurse explains that in older people with dementia these drugs:

A patient with right-sided weakness after a stroke is being helped from bed to chair. To protect the weak shoulder, the nurse should:

A patient with advanced lung cancer receives regular morphine for pain. Which order should the nurse expect to start at the same time?