NUR 257 Concepts of Aging and Chronic Illness
Exam 4 – Galen College of Nursing –
2026/2027
1. For a client with unilateral hearing loss, which communication technique is
correct?
• A. Maintain eye contact and avoid covering your mouth
• B. Speak softly to avoid startling the client
• C. Stand behind the patient to project voice clearly
• D. Turn the lights down for comfort
Answer: A. Facing the client and keeping your mouth visible supports lip-reading
and visual cues. Good lighting and clear articulation are key strategies with older
adults who have hearing deficits. Speaking softly (B) would not help; standing
behind (C) prevents lip-reading; turning lights down (D) reduces visual cues .
2. An older adult with Alzheimer's disease has disruptive sleep patterns. What is
the best intervention?
• A. Increase caffeine during the day to promote alertness
• B. Increase daytime light exposure and limit naps
• C. Allow unlimited daytime rest to prevent fatigue
• D. Restrict all physical activity to conserve energy
Answer: B. Bright-light exposure and structured daytime activity help regulate
circadian rhythm. Long or frequent naps worsen nighttime wakefulness, a
common issue in dementia. Caffeine (A) is not recommended; unlimited rest (C)
worsens the problem; restricting all activity (D) is not therapeutic .
3. Which statement correctly describes REM sleep behavior disorder?
, • A. It affects mostly young adults
• B. It stops with exercise
• C. It is not dangerous
• D. It is more common in males over 60
Answer: D. REM sleep behavior disorder, characterized by acting out dreams, is
more frequent in older men and may precede neurodegenerative disease. It is not
limited to young adults (A), does not stop with exercise (B), and can be dangerous
due to injury risk (C) .
4. A hospitalized older adult is prescribed zolpidem (Ambien). What is the
nurse's priority?
• A. Implement fall precautions
• B. Offer warm milk at bedtime
• C. Dim the lights for comfort
• D. Provide a soft pillow
Answer: A. Sedative-hypnotics increase confusion, dizziness, and fall risk in older
adults. Safety measures like bed alarms, low bed position, and assistance with
ambulation are essential. Warm milk (B), dim lights (C), and pillows (D) do not
address the priority safety concern .
5. Which findings support suspected sleep apnea in an older adult?
• A. Early morning awakening
• B. Daytime sleepiness and choking on awakening
• C. Low blood pressure readings
• D. Sleeping without pillows
Answer: B. Obstructive sleep apnea typically presents with loud snoring,
witnessed apneas, gasping, and excessive daytime sleepiness. In older adults,
,untreated sleep apnea worsens cardiovascular disease and cognition. Early rising
(A) is less specific; hypotension (C) is not typical; sleeping without pillows (D) is
not a finding .
6. Which statement about sleep in older adults is correct?
• A. They sleep longer each night
• B. REM sleep increases with age
• C. Time in bed increases, but time asleep decreases
• D. They need fewer hours of sleep
Answer: C. Older adults often spend more time in bed but experience decreased
total sleep time, more frequent awakenings, and less deep sleep. Sleep duration
does not necessarily increase (A); REM sleep typically decreases (B); the need for
sleep does not change significantly (D) .
7. A client reports weeks of insomnia. What is the best intervention?
• A. Minimize bedroom lighting and use earplugs
• B. Increase afternoon naps to compensate
• C. Watch TV in bed until falling asleep
• D. Keep the bedroom brightly lit
Answer: A. Reducing environmental stimuli (light, noise) promotes sleep onset.
Naps (B) can worsen nighttime sleep; TV in bed (C) stimulates the brain; bright
light (D) inhibits melatonin production .
8. Which action is appropriate when providing post-operative teaching for an
older adult after laser cataract surgery?
• A. "You can lift heavy objects immediately."
• B. "You can bend over freely after 24 hours."
, • C. "You should avoid tying your shoes for several weeks."
• D. "You should use eye makeup today."
Answer: C. Bending at the waist and lifting increase intraocular pressure and risk
complications. Avoiding activities like shoe-tying that require bending is
appropriate post-op teaching. Lifting (A), bending (B), and eye makeup (D) are all
contraindicated .
9. Which finding is expected in primary open-angle glaucoma?
• A. Sudden severe eye pain
• B. Progressive loss of peripheral vision
• C. Cloudy cornea visible to the naked eye
• D. Decreased intraocular pressure
Answer: B. Open-angle glaucoma develops insidiously, causing tunnel vision from
peripheral field loss. Screening is critical in older adults because symptoms are
subtle until late. Sudden severe pain (A) suggests angle-closure glaucoma; cloudy
cornea (C) suggests cataracts; pressure is increased, not decreased (D) .
10. Which patient action supports suspicion of hearing loss?
• A. Turning one ear toward the nurse and complaining of mumbling
• B. Frequent smiling during conversation
• C. Reading lips occasionally
• D. Wearing sunglasses indoors
Answer: A. Favoring one ear and complaining that others "mumble" are classic
behavioral signs of hearing loss. Early recognition allows timely referral and helps
preserve social engagement. Lip-reading (C) can be a coping strategy but is not a
specific sign .
Exam 4 – Galen College of Nursing –
2026/2027
1. For a client with unilateral hearing loss, which communication technique is
correct?
• A. Maintain eye contact and avoid covering your mouth
• B. Speak softly to avoid startling the client
• C. Stand behind the patient to project voice clearly
• D. Turn the lights down for comfort
Answer: A. Facing the client and keeping your mouth visible supports lip-reading
and visual cues. Good lighting and clear articulation are key strategies with older
adults who have hearing deficits. Speaking softly (B) would not help; standing
behind (C) prevents lip-reading; turning lights down (D) reduces visual cues .
2. An older adult with Alzheimer's disease has disruptive sleep patterns. What is
the best intervention?
• A. Increase caffeine during the day to promote alertness
• B. Increase daytime light exposure and limit naps
• C. Allow unlimited daytime rest to prevent fatigue
• D. Restrict all physical activity to conserve energy
Answer: B. Bright-light exposure and structured daytime activity help regulate
circadian rhythm. Long or frequent naps worsen nighttime wakefulness, a
common issue in dementia. Caffeine (A) is not recommended; unlimited rest (C)
worsens the problem; restricting all activity (D) is not therapeutic .
3. Which statement correctly describes REM sleep behavior disorder?
, • A. It affects mostly young adults
• B. It stops with exercise
• C. It is not dangerous
• D. It is more common in males over 60
Answer: D. REM sleep behavior disorder, characterized by acting out dreams, is
more frequent in older men and may precede neurodegenerative disease. It is not
limited to young adults (A), does not stop with exercise (B), and can be dangerous
due to injury risk (C) .
4. A hospitalized older adult is prescribed zolpidem (Ambien). What is the
nurse's priority?
• A. Implement fall precautions
• B. Offer warm milk at bedtime
• C. Dim the lights for comfort
• D. Provide a soft pillow
Answer: A. Sedative-hypnotics increase confusion, dizziness, and fall risk in older
adults. Safety measures like bed alarms, low bed position, and assistance with
ambulation are essential. Warm milk (B), dim lights (C), and pillows (D) do not
address the priority safety concern .
5. Which findings support suspected sleep apnea in an older adult?
• A. Early morning awakening
• B. Daytime sleepiness and choking on awakening
• C. Low blood pressure readings
• D. Sleeping without pillows
Answer: B. Obstructive sleep apnea typically presents with loud snoring,
witnessed apneas, gasping, and excessive daytime sleepiness. In older adults,
,untreated sleep apnea worsens cardiovascular disease and cognition. Early rising
(A) is less specific; hypotension (C) is not typical; sleeping without pillows (D) is
not a finding .
6. Which statement about sleep in older adults is correct?
• A. They sleep longer each night
• B. REM sleep increases with age
• C. Time in bed increases, but time asleep decreases
• D. They need fewer hours of sleep
Answer: C. Older adults often spend more time in bed but experience decreased
total sleep time, more frequent awakenings, and less deep sleep. Sleep duration
does not necessarily increase (A); REM sleep typically decreases (B); the need for
sleep does not change significantly (D) .
7. A client reports weeks of insomnia. What is the best intervention?
• A. Minimize bedroom lighting and use earplugs
• B. Increase afternoon naps to compensate
• C. Watch TV in bed until falling asleep
• D. Keep the bedroom brightly lit
Answer: A. Reducing environmental stimuli (light, noise) promotes sleep onset.
Naps (B) can worsen nighttime sleep; TV in bed (C) stimulates the brain; bright
light (D) inhibits melatonin production .
8. Which action is appropriate when providing post-operative teaching for an
older adult after laser cataract surgery?
• A. "You can lift heavy objects immediately."
• B. "You can bend over freely after 24 hours."
, • C. "You should avoid tying your shoes for several weeks."
• D. "You should use eye makeup today."
Answer: C. Bending at the waist and lifting increase intraocular pressure and risk
complications. Avoiding activities like shoe-tying that require bending is
appropriate post-op teaching. Lifting (A), bending (B), and eye makeup (D) are all
contraindicated .
9. Which finding is expected in primary open-angle glaucoma?
• A. Sudden severe eye pain
• B. Progressive loss of peripheral vision
• C. Cloudy cornea visible to the naked eye
• D. Decreased intraocular pressure
Answer: B. Open-angle glaucoma develops insidiously, causing tunnel vision from
peripheral field loss. Screening is critical in older adults because symptoms are
subtle until late. Sudden severe pain (A) suggests angle-closure glaucoma; cloudy
cornea (C) suggests cataracts; pressure is increased, not decreased (D) .
10. Which patient action supports suspicion of hearing loss?
• A. Turning one ear toward the nurse and complaining of mumbling
• B. Frequent smiling during conversation
• C. Reading lips occasionally
• D. Wearing sunglasses indoors
Answer: A. Favoring one ear and complaining that others "mumble" are classic
behavioral signs of hearing loss. Early recognition allows timely referral and helps
preserve social engagement. Lip-reading (C) can be a coping strategy but is not a
specific sign .
