NUR 257 Chronic Exam 4 Complete Study Guide
(2026–2027) | 100+ NCLEX-Style Practice Questions
with Answers and Rationales | pdf
Antipsychotics, Elderly Care, Thermoregulation, Medication Safety, SAFE DRIVE
Assessment, Antidepressant Switching, and High-Yield Nursing Exam Prep
1.
A nurse is caring for an older adult who suddenly becomes lethargic, confused, and refuses
to take oral medications. What is the priority nursing action?
Ans:
Assess vital signs and blood glucose immediately to rule out acute metabolic or medical
causes.
Explanation: Sudden mental status change requires immediate physiologic assessment.
2.
A patient on long-term antipsychotic therapy develops high fever, muscle rigidity, and
altered mental status. What condition should the nurse suspect first?
Ans:
Neuroleptic malignant syndrome (NMS).
Explanation: Life-threatening reaction requiring emergency intervention.
3.
Which finding in an older adult most strongly suggests unsafe medication self-management
at home?
Ans:
Multiple medications stored without labeling or schedule organization.
Explanation: Increases risk for dosing errors.
,4.
A nurse is teaching an older adult about fall prevention while taking antipsychotic
medications. Which instruction is most appropriate?
Ans:
Rise slowly from sitting or lying positions to prevent dizziness and falls.
Explanation: Prevents orthostatic hypotension-related injury.
5.
A client switching from a tricyclic antidepressant to an SSRI reports confusion and agitation.
What is the nurse’s best action?
Ans:
Monitor closely and notify the provider of possible adverse drug interaction.
Explanation: Transition phase requires monitoring for serotonin imbalance.
6.
An older adult client insists on managing medications independently but has missed several
doses recently. What is the nurse’s best response?
Ans:
Assess cognitive ability and introduce supportive medication management tools.
Explanation: Supports autonomy while ensuring safety.
7.
Which symptom in a patient taking antipsychotics requires immediate emergency
intervention?
Ans:
Sudden weakness on one side of the body with slurred speech.
Explanation: Possible stroke.
, 8.
A nurse is assessing thermoregulation in an elderly client. Which finding is expected?
Ans:
Reduced ability to detect temperature changes accurately.
Explanation: Normal age-related physiological decline.
9.
What is the most important teaching point for a patient on long-term antipsychotic therapy?
Ans:
Do not stop medication abruptly without consulting the provider.
Explanation: Prevents relapse of symptoms.
10.
A home health nurse finds an older adult wearing heavy clothing in a warm home. What is
the priority nursing concern?
Ans:
Impaired thermoregulation leading to potential heat-related illness.
Explanation: Aging reduces temperature perception.
11.
Which assessment finding indicates a high risk for medication nonadherence in older
adults?
Ans:
Difficulty recalling medication names and dosing schedules.
Explanation: Memory impairment affects adherence.
12.
A client reports dizziness when standing after starting a new antipsychotic. What is the best
nursing instruction?
(2026–2027) | 100+ NCLEX-Style Practice Questions
with Answers and Rationales | pdf
Antipsychotics, Elderly Care, Thermoregulation, Medication Safety, SAFE DRIVE
Assessment, Antidepressant Switching, and High-Yield Nursing Exam Prep
1.
A nurse is caring for an older adult who suddenly becomes lethargic, confused, and refuses
to take oral medications. What is the priority nursing action?
Ans:
Assess vital signs and blood glucose immediately to rule out acute metabolic or medical
causes.
Explanation: Sudden mental status change requires immediate physiologic assessment.
2.
A patient on long-term antipsychotic therapy develops high fever, muscle rigidity, and
altered mental status. What condition should the nurse suspect first?
Ans:
Neuroleptic malignant syndrome (NMS).
Explanation: Life-threatening reaction requiring emergency intervention.
3.
Which finding in an older adult most strongly suggests unsafe medication self-management
at home?
Ans:
Multiple medications stored without labeling or schedule organization.
Explanation: Increases risk for dosing errors.
,4.
A nurse is teaching an older adult about fall prevention while taking antipsychotic
medications. Which instruction is most appropriate?
Ans:
Rise slowly from sitting or lying positions to prevent dizziness and falls.
Explanation: Prevents orthostatic hypotension-related injury.
5.
A client switching from a tricyclic antidepressant to an SSRI reports confusion and agitation.
What is the nurse’s best action?
Ans:
Monitor closely and notify the provider of possible adverse drug interaction.
Explanation: Transition phase requires monitoring for serotonin imbalance.
6.
An older adult client insists on managing medications independently but has missed several
doses recently. What is the nurse’s best response?
Ans:
Assess cognitive ability and introduce supportive medication management tools.
Explanation: Supports autonomy while ensuring safety.
7.
Which symptom in a patient taking antipsychotics requires immediate emergency
intervention?
Ans:
Sudden weakness on one side of the body with slurred speech.
Explanation: Possible stroke.
, 8.
A nurse is assessing thermoregulation in an elderly client. Which finding is expected?
Ans:
Reduced ability to detect temperature changes accurately.
Explanation: Normal age-related physiological decline.
9.
What is the most important teaching point for a patient on long-term antipsychotic therapy?
Ans:
Do not stop medication abruptly without consulting the provider.
Explanation: Prevents relapse of symptoms.
10.
A home health nurse finds an older adult wearing heavy clothing in a warm home. What is
the priority nursing concern?
Ans:
Impaired thermoregulation leading to potential heat-related illness.
Explanation: Aging reduces temperature perception.
11.
Which assessment finding indicates a high risk for medication nonadherence in older
adults?
Ans:
Difficulty recalling medication names and dosing schedules.
Explanation: Memory impairment affects adherence.
12.
A client reports dizziness when standing after starting a new antipsychotic. What is the best
nursing instruction?
