NUR 257 EXAM 4: CONCEPTS OF AGING
& CHRONIC ILLNESS REVIEW
1. An 82-year-old patient is admitted with acute delirium. Which physiological change
associated with aging most significantly increases the risk for adverse drug reactions leading
to cognitive impairment?
A. Increased total body water
B. Increased serum albumin levels
C. Decreased glomerular filtration rate (GFR)
D. Decreased gastric pH
Answer: C
Conceptual Explanation: Aging causes a natural decline in renal function, specifically GFR,
which delays drug clearance and increases the risk of toxicity and delirium. Total body
water decreases, albumin decreases, and gastric pH usually increases.
,2. A patient with end-stage heart failure is transitioning to palliative care. Which statement
by the nurse best describes the primary goal of this service?
A. The goal is to provide symptom relief and improve quality of life regardless of the
prognosis.
B. The focus is on curative treatments while managing side effects.
C. Palliative care is intended for patients with a life expectancy of less than 6 months.
D. It is a service that replaces all primary medical care for the patient.
Answer: A
Conceptual Explanation: Palliative care focuses on symptom management and quality of
life at any stage of a serious illness, unlike hospice, which is specifically for terminal illness
with a limited prognosis.
3. When assessing an older adult for depression, which symptom is often more prominent
than a ‘sad mood’ in this population?
A. Overt crying spells
B. Somatic complaints and irritability
C. Increased appetite and weight gain
D. Hyper-verbal speech patterns
Answer: B
, Conceptual Explanation: Older adults frequently present with ‘masked’ depression,
manifesting as physical (somatic) aches, pains, or irritability rather than the classic
dysphoria seen in younger adults.
4. According to the Beers Criteria, which medication class should be avoided in older adults
due to the high risk of orthostatic hypotension and anticholinergic effects?
A. Biguanides
B. ACE inhibitors
C. Tricyclic antidepressants
D. Selective serotonin reuptake inhibitors
Answer: C
Conceptual Explanation: Tricyclic antidepressants (TCAs) like amitriptyline are highly
anticholinergic and cause significant orthostatic hypotension, increasing fall risk in the
elderly.
5. A nurse is educating an older adult with Type 2 Diabetes. Why is the risk of hypoglycemia
more dangerous in this age group?
A. They have a higher insulin sensitivity.
B. They metabolize glucose faster.
C. They have a decreased autonomic response to low blood glucose.
D. They usually have excessive glycogen stores in the liver.
& CHRONIC ILLNESS REVIEW
1. An 82-year-old patient is admitted with acute delirium. Which physiological change
associated with aging most significantly increases the risk for adverse drug reactions leading
to cognitive impairment?
A. Increased total body water
B. Increased serum albumin levels
C. Decreased glomerular filtration rate (GFR)
D. Decreased gastric pH
Answer: C
Conceptual Explanation: Aging causes a natural decline in renal function, specifically GFR,
which delays drug clearance and increases the risk of toxicity and delirium. Total body
water decreases, albumin decreases, and gastric pH usually increases.
,2. A patient with end-stage heart failure is transitioning to palliative care. Which statement
by the nurse best describes the primary goal of this service?
A. The goal is to provide symptom relief and improve quality of life regardless of the
prognosis.
B. The focus is on curative treatments while managing side effects.
C. Palliative care is intended for patients with a life expectancy of less than 6 months.
D. It is a service that replaces all primary medical care for the patient.
Answer: A
Conceptual Explanation: Palliative care focuses on symptom management and quality of
life at any stage of a serious illness, unlike hospice, which is specifically for terminal illness
with a limited prognosis.
3. When assessing an older adult for depression, which symptom is often more prominent
than a ‘sad mood’ in this population?
A. Overt crying spells
B. Somatic complaints and irritability
C. Increased appetite and weight gain
D. Hyper-verbal speech patterns
Answer: B
, Conceptual Explanation: Older adults frequently present with ‘masked’ depression,
manifesting as physical (somatic) aches, pains, or irritability rather than the classic
dysphoria seen in younger adults.
4. According to the Beers Criteria, which medication class should be avoided in older adults
due to the high risk of orthostatic hypotension and anticholinergic effects?
A. Biguanides
B. ACE inhibitors
C. Tricyclic antidepressants
D. Selective serotonin reuptake inhibitors
Answer: C
Conceptual Explanation: Tricyclic antidepressants (TCAs) like amitriptyline are highly
anticholinergic and cause significant orthostatic hypotension, increasing fall risk in the
elderly.
5. A nurse is educating an older adult with Type 2 Diabetes. Why is the risk of hypoglycemia
more dangerous in this age group?
A. They have a higher insulin sensitivity.
B. They metabolize glucose faster.
C. They have a decreased autonomic response to low blood glucose.
D. They usually have excessive glycogen stores in the liver.
