NUR 258 Exam 4 V2 | NUR 258 Concepts
of Aging & Chronic Illness | Actual Q&A
with Rationale (NUR258 Exam 4) | Galen
1. An 82-year-old client is admitted with an acute change in mental status. Which assessment
finding most clearly differentiates delirium from dementia?
A. The symptoms developed suddenly over the past 24 hours.
B. The client has difficulty finding the right words during the interview.
C. The client is unable to remember events from ten years ago.
D. The client’s mood appears flat and indifferent.
Correct Answer: A
Explanation: This exam is designed to evaluate clinical judgment in the management of
complex geriatric and chronic conditions. It integrates NCLEX-style questioning to assess
the student’s ability to prioritize care, recognize atypical presentations in older adults, and
apply evidence-based interventions. The rationale sections emphasize the ‘why’ behind
nursing actions to support deep learning and exam readiness. Delirium is characterized by
an acute, rapid onset, whereas dementia is a slow, progressive decline.
2. A nurse is caring for a client with end-stage Chronic Obstructive Pulmonary Disease (COPD).
Which intervention is a priority for managing dyspnea in a palliative care setting?
A. Administering high-flow oxygen at 6 L/min via nasal cannula.
,B. Encouraging vigorous chest physiotherapy sessions.
C. Administering low-dose oral morphine as prescribed.
D. Maintaining the client in a supine position to conserve energy.
Correct Answer: C
Explanation: Low-dose opioids like morphine are the gold standard in palliative care to
reduce the sensation of air hunger and work of breathing in end-stage COPD. High-flow
oxygen can suppress the respiratory drive in chronic CO2 retainers.
3. Which clinical manifestation is considered an atypical sign of infection in a 90-year-old
client?
A. New-onset confusion and lethargy.
B. Increased white blood cell count.
C. Fever of 102.4°F (39.1°C).
D. Localized redness and swelling.
Correct Answer: A
Explanation: Older adults often lack a robust febrile response and instead present with
‘atypical’ symptoms like acute confusion (delirium), falls, or decreased functional status
when an infection (like a UTI) is present.
, 4. A client with Heart Failure (HF) is being discharged. Which statement by the client indicates
a need for further teaching regarding weight monitoring?
A. I will weigh myself every morning after I use the bathroom.
B. I only need to weigh myself if I feel my shoes getting tight.
C. I should wear similar clothes every time I weigh myself.
D. I will call my doctor if I gain more than 3 pounds in 2 days.
Correct Answer: B
Explanation: Daily weights are essential for HF management to detect fluid retention
early, often before physical symptoms like edema (tight shoes) are noticeable. Waiting for
symptoms is unsafe.
5. The nurse is reviewing the medication list of an older adult with polypharmacy. Which
medication class is most likely to increase the risk of falls due to orthostatic hypotension?
A. Proton pump inhibitors.
B. Alpha-blockers used for BPH.
C. Stool softeners.
D. Antibiotics.
Correct Answer: B
Explanation: Alpha-blockers (like Tamsulosin) cause vasodilation and significantly
increase the risk of orthostatic hypotension and subsequent falls in the elderly.
of Aging & Chronic Illness | Actual Q&A
with Rationale (NUR258 Exam 4) | Galen
1. An 82-year-old client is admitted with an acute change in mental status. Which assessment
finding most clearly differentiates delirium from dementia?
A. The symptoms developed suddenly over the past 24 hours.
B. The client has difficulty finding the right words during the interview.
C. The client is unable to remember events from ten years ago.
D. The client’s mood appears flat and indifferent.
Correct Answer: A
Explanation: This exam is designed to evaluate clinical judgment in the management of
complex geriatric and chronic conditions. It integrates NCLEX-style questioning to assess
the student’s ability to prioritize care, recognize atypical presentations in older adults, and
apply evidence-based interventions. The rationale sections emphasize the ‘why’ behind
nursing actions to support deep learning and exam readiness. Delirium is characterized by
an acute, rapid onset, whereas dementia is a slow, progressive decline.
2. A nurse is caring for a client with end-stage Chronic Obstructive Pulmonary Disease (COPD).
Which intervention is a priority for managing dyspnea in a palliative care setting?
A. Administering high-flow oxygen at 6 L/min via nasal cannula.
,B. Encouraging vigorous chest physiotherapy sessions.
C. Administering low-dose oral morphine as prescribed.
D. Maintaining the client in a supine position to conserve energy.
Correct Answer: C
Explanation: Low-dose opioids like morphine are the gold standard in palliative care to
reduce the sensation of air hunger and work of breathing in end-stage COPD. High-flow
oxygen can suppress the respiratory drive in chronic CO2 retainers.
3. Which clinical manifestation is considered an atypical sign of infection in a 90-year-old
client?
A. New-onset confusion and lethargy.
B. Increased white blood cell count.
C. Fever of 102.4°F (39.1°C).
D. Localized redness and swelling.
Correct Answer: A
Explanation: Older adults often lack a robust febrile response and instead present with
‘atypical’ symptoms like acute confusion (delirium), falls, or decreased functional status
when an infection (like a UTI) is present.
, 4. A client with Heart Failure (HF) is being discharged. Which statement by the client indicates
a need for further teaching regarding weight monitoring?
A. I will weigh myself every morning after I use the bathroom.
B. I only need to weigh myself if I feel my shoes getting tight.
C. I should wear similar clothes every time I weigh myself.
D. I will call my doctor if I gain more than 3 pounds in 2 days.
Correct Answer: B
Explanation: Daily weights are essential for HF management to detect fluid retention
early, often before physical symptoms like edema (tight shoes) are noticeable. Waiting for
symptoms is unsafe.
5. The nurse is reviewing the medication list of an older adult with polypharmacy. Which
medication class is most likely to increase the risk of falls due to orthostatic hypotension?
A. Proton pump inhibitors.
B. Alpha-blockers used for BPH.
C. Stool softeners.
D. Antibiotics.
Correct Answer: B
Explanation: Alpha-blockers (like Tamsulosin) cause vasodilation and significantly
increase the risk of orthostatic hypotension and subsequent falls in the elderly.
