NCLEX-RN Study Guide

NCLEX Geriatric Questions: Falls and Polypharmacy

November 2, 2026 · 5 min read

Short answer. Geriatric NCLEX questions expect you to separate normal ageing from pathology and to treat sudden change as illness. A new confusion in an older adult is delirium until proven otherwise, even when the family says it is just their memory.

What the 2026 NCLEX tests in this area

Health Promotion and Maintenance: normal ageing, screening, safety
Safety and Infection Control: falls, restraint avoidance, abuse recognition

Key facts to know

Delirium versus dementia	Delirium is acute and fluctuating. Dementia is slow, progressive and stable across hours
Most common delirium cause	Infection, especially urinary tract infection, plus medication effects and dehydration
Fall risk factors	Sedatives, hypotension, vision loss, gait instability, and a prior fall
Normal ageing change	Slower reaction time and reduced renal clearance of drugs
Polypharmacy definition	Multiple medications, commonly five or more, with rising interaction risk
Signs of elder abuse	Unexplained injuries, dehydration, fear of a caregiver, and inconsistent explanations

Practice question from this chapter

An older client with dementia becomes agitated at night and repeatedly tries to get out of bed. The oxygen saturation is 95%, the temperature is 37.1 degreesC, and urine output is normal. Which action should the nurse implement first?

Apply a physical restraint to prevent falls
Administer a sedative to help the client sleep
Assess for pain, hunger, toileting needs, and changes in the environment
Raise all four side rails and leave the room

Show answer and rationale

Correct answer: C. Assess for pain, hunger, toileting needs, and changes in the environment

The correct action is to assess for pain, hunger, toileting needs, and changes in the environment because new agitation in an older adult is often caused by an unmet physical need or a change in surroundings, and identifying the cause is the first step. Restraints and sedatives can worsen delirium, and side rails are a form of restraint that increases fall risk.

Second practice question

An older client with pneumonia has a temperature of 38.2 degreesC, respiratory rate 24 breaths/min, oxygen saturation 90% on room air, and new confusion. Which action should the nurse implement first?

Encourage the client to drink more fluids
Administer oxygen and notify the provider of the confusion
Administer an antipyretic and reassess
Document the confusion as dementia

Show answer and rationale

Correct answer: B. Administer oxygen and notify the provider of the confusion

The correct action is to administer oxygen and notify the provider of the confusion because new confusion in an older client with pneumonia and oxygen saturation of 90% indicates cerebral hypoxia and possible sepsis, which require immediate correction of oxygenation and evaluation. Fluids and antipyretics do not address the hypoxia, and new confusion is not baseline dementia.

Acute change means illness

An older adult who becomes confused over hours has delirium, and the cause is usually something reversible: infection, dehydration, pain, constipation, a new medication or sensory deprivation. Your priority is to find and treat the cause, not to sedate the behaviour. Restraints and sedatives increase the risk of falls and worsen delirium.

Environment is treatment. Glasses, hearing aids, orientation cues, daylight, hydration and uninterrupted sleep resolve a surprising proportion of episodes.

Medication review as nursing work

Older adults clear drugs more slowly and take more of them. Anticholinergics, sedatives and antihypertensives are the usual culprits for confusion and falls. When an item describes a new symptom after a new prescription, suspect the drug before you suspect a new disease.

Normal ageing versus illness

Learn the normal changes so you do not over react or under react. Thinning skin, reduced renal clearance, slower reaction time and reduced thirst are normal. New confusion, falls, incontinence or weight loss are not normal at any age, and they are the presentation of common illnesses in an older adult.

This is why an older adult with pneumonia may present with confusion rather than fever or cough. The exam uses that pattern to check whether you look for the infection or just settle the behaviour.

Reviews that prevent harm

Medication review is the highest yield intervention in older adult care. Anticholinergics, sedatives, antihypertensives and non steroidal anti inflammatory drugs are the usual culprits for confusion, falls and renal injury. A new symptom after a new prescription is a drug effect until proven otherwise.

Screening and safety follow: falls risk, vision and hearing, continence, nutrition, and a home environment check. Also screen for abuse, because the clues are specific: injury with an unclear mechanism, dehydration, and a caregiver who dominates the conversation.

Frequently asked questions

How do I tell delirium from dementia?

Onset and course. Delirium starts over hours, fluctuates through the day and is reversible. Dementia is gradual and progressive.

What is the first action for new confusion in an older adult?

Assess for a cause, starting with infection, dehydration, pain, constipation and medications. Do not sedate first.

Are restraints appropriate for a confused client?

No. Restraints increase injury risk. Use supervision, environmental changes and family presence instead.

Which falls prevention measures actually work?

Hourly rounding, call light in reach, non skid footwear, bed low and locked, adequate lighting, and reviewing sedating medication.

Why do older adults clear medications more slowly?

Reduced renal filtration and hepatic metabolism with less body water and more fat, which increases the half life of many drugs and raises the risk of accumulation.

What is the first intervention for a fall risk client?

Assess and modify. Review sedating medication, keep the bed low with brakes locked, put the call light within reach, use non skid footwear, and increase rounding rather than starting with a restraint.

Practise this chapter with rationales

NCLEXDeck gives you practice questions for every body system, with a rationale for the correct answer and for each distractor. Start on the free tier, no card required.

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