NUR 257: Concepts of Aging & Chronic Illness
Comprehensive Exam Review 2026/2027
Question 1.
An 82-year-old patient is admitted with dehydration. The nurse notes the patient's
skin appears thin, dry, and has decreased turgor. Which age-related change primarily
contributes to this finding?
A. Decreased sebaceous gland activity and thinning of the dermis
B. Increased collagen production and hyperplasia of sweat glands
C. Hypertrophy of subcutaneous fat and increased elastin fibers
D. Enhanced vascularization of the skin and increased hydration
Correct Answer: A
Rationale: Aging skin undergoes atrophy of the dermis and epidermis, decreased
sebaceous and sweat gland activity, and reduced collagen and elastin. These changes lead to
thin, dry, fragile skin with poor turgor, increasing the risk for skin tears and delayed wound
healing in older adults.
Question 2.
A nurse is assessing an older adult with chronic heart failure. The patient reports
increasing shortness of breath when lying flat. Which term describes this condition,
and what is the priority nursing intervention?
A. Orthopnea; elevate the head of the bed and administer prescribed diuretics
B. Dyspnea; apply supplemental oxygen and encourage deep breathing
C. Paroxysmal nocturnal dyspnea; position supine and monitor SpO2
D. Cheyne-Stokes respiration; administer sedatives and dim lights
Correct Answer: A
Rationale: Orthopnea is dyspnea that occurs when lying flat due to fluid redistribution
increasing pulmonary venous pressure. Elevating the head of the bed reduces venous return
to the heart and decreases pulmonary congestion. Diuretics help reduce fluid overload. This
is a classic sign of decompensated heart failure in older adults.
Question 3.
,An older adult with type 2 diabetes mellitus is prescribed metformin. The nurse
recognizes that which age-related physiological change increases the risk of lactic
acidosis with this medication?
A. Decreased glomerular filtration rate and reduced hepatic blood flow
B. Increased gastric acid secretion and accelerated intestinal motility
C. Enhanced pancreatic beta-cell function and increased insulin sensitivity
D. Hyperplasia of renal tubules and increased creatinine clearance
Correct Answer: A
Rationale: Aging is associated with decreased glomerular filtration rate (GFR), reduced
hepatic blood flow, and diminished hepatic enzyme activity. These changes impair drug
metabolism and excretion, increasing the risk of metformin accumulation and lactic
acidosis. Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m².
Question 4.
A 78-year-old patient with Alzheimer's disease becomes agitated and attempts to
wander from the unit. Which nursing intervention is most appropriate according to
non-pharmacological management principles?
A. Apply physical restraints to prevent falls and wandering
B. Redirect the patient to a meaningful activity in a calm environment
C. Administer PRN haloperidol immediately to control behavior
D. Isolate the patient in a quiet room until calm
Correct Answer: B
Rationale: Non-pharmacological interventions are first-line for managing behavioral and
psychological symptoms of dementia (BPSD). Redirection to meaningful activities addresses
unmet needs, reduces agitation, and preserves dignity. Physical restraints and isolation
increase agitation and injury risk. Antipsychotics should be reserved for severe cases due to
increased mortality and stroke risk in elderly patients with dementia.
Question 5.
A nurse is reviewing medications for an 85-year-old patient taking 12 different
prescriptions. Which principle should guide the nurse's assessment to minimize
adverse drug events?
A. The 'start low, go slow' approach and regular medication reconciliation
B. Maintaining all prescriptions indefinitely to avoid withdrawal effects
, C. Doubling doses for elderly patients due to decreased drug sensitivity
D. Avoiding generic substitutions to ensure brand-name consistency
Correct Answer: A
Rationale: Polypharmacy is a major concern in older adults due to altered
pharmacokinetics and pharmacodynamics. The 'start low, go slow' principle minimizes
adverse effects. Regular medication reconciliation identifies potentially inappropriate
medications (PIMs), drug interactions, and deprescribing opportunities. The Beers Criteria
and START/STOPP tools help guide safe prescribing in older adults.
Question 6.
An older adult with chronic obstructive pulmonary disease (COPD) is receiving home
oxygen therapy at 2 L/min via nasal cannula. The nurse teaches the patient and
family about fire safety. Which statement by the patient indicates understanding?
A. 'I can smoke if I stay at least 3 feet from the oxygen tubing.'
B. 'I should keep a fire extinguisher nearby and avoid open flames.'
C. 'Petroleum-based lotions are safe to use around the nasal cannula.'
D. 'I can increase the flow to 6 L/min when I feel very short of breath.'
Correct Answer: B
Rationale: Oxygen supports combustion. Patients must avoid smoking, open flames, and
petroleum-based products near oxygen equipment. Flow rates should not be adjusted
without provider orders. COPD patients are particularly sensitive to high oxygen
concentrations, which can suppress the hypoxic drive and cause CO2 retention.
Question 7.
A nurse is caring for an older adult post-hip fracture repair. Which intervention is
most effective in preventing deep vein thrombosis (DVT)?
A. Encourage early ambulation and administer prescribed anticoagulants
B. Apply tight elastic bandages from toes to groin continuously
C. Keep the patient on strict bed rest for 7 days post-surgery
D. Massage the affected leg to promote venous return
Correct Answer: A
Rationale: Older adults are at high risk for DVT due to venous stasis, endothelial damage,
and hypercoagulability (Virchow's triad). Early ambulation promotes venous return.
Pharmacological prophylaxis (e.g., low molecular weight heparin, direct oral
Comprehensive Exam Review 2026/2027
Question 1.
An 82-year-old patient is admitted with dehydration. The nurse notes the patient's
skin appears thin, dry, and has decreased turgor. Which age-related change primarily
contributes to this finding?
A. Decreased sebaceous gland activity and thinning of the dermis
B. Increased collagen production and hyperplasia of sweat glands
C. Hypertrophy of subcutaneous fat and increased elastin fibers
D. Enhanced vascularization of the skin and increased hydration
Correct Answer: A
Rationale: Aging skin undergoes atrophy of the dermis and epidermis, decreased
sebaceous and sweat gland activity, and reduced collagen and elastin. These changes lead to
thin, dry, fragile skin with poor turgor, increasing the risk for skin tears and delayed wound
healing in older adults.
Question 2.
A nurse is assessing an older adult with chronic heart failure. The patient reports
increasing shortness of breath when lying flat. Which term describes this condition,
and what is the priority nursing intervention?
A. Orthopnea; elevate the head of the bed and administer prescribed diuretics
B. Dyspnea; apply supplemental oxygen and encourage deep breathing
C. Paroxysmal nocturnal dyspnea; position supine and monitor SpO2
D. Cheyne-Stokes respiration; administer sedatives and dim lights
Correct Answer: A
Rationale: Orthopnea is dyspnea that occurs when lying flat due to fluid redistribution
increasing pulmonary venous pressure. Elevating the head of the bed reduces venous return
to the heart and decreases pulmonary congestion. Diuretics help reduce fluid overload. This
is a classic sign of decompensated heart failure in older adults.
Question 3.
,An older adult with type 2 diabetes mellitus is prescribed metformin. The nurse
recognizes that which age-related physiological change increases the risk of lactic
acidosis with this medication?
A. Decreased glomerular filtration rate and reduced hepatic blood flow
B. Increased gastric acid secretion and accelerated intestinal motility
C. Enhanced pancreatic beta-cell function and increased insulin sensitivity
D. Hyperplasia of renal tubules and increased creatinine clearance
Correct Answer: A
Rationale: Aging is associated with decreased glomerular filtration rate (GFR), reduced
hepatic blood flow, and diminished hepatic enzyme activity. These changes impair drug
metabolism and excretion, increasing the risk of metformin accumulation and lactic
acidosis. Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m².
Question 4.
A 78-year-old patient with Alzheimer's disease becomes agitated and attempts to
wander from the unit. Which nursing intervention is most appropriate according to
non-pharmacological management principles?
A. Apply physical restraints to prevent falls and wandering
B. Redirect the patient to a meaningful activity in a calm environment
C. Administer PRN haloperidol immediately to control behavior
D. Isolate the patient in a quiet room until calm
Correct Answer: B
Rationale: Non-pharmacological interventions are first-line for managing behavioral and
psychological symptoms of dementia (BPSD). Redirection to meaningful activities addresses
unmet needs, reduces agitation, and preserves dignity. Physical restraints and isolation
increase agitation and injury risk. Antipsychotics should be reserved for severe cases due to
increased mortality and stroke risk in elderly patients with dementia.
Question 5.
A nurse is reviewing medications for an 85-year-old patient taking 12 different
prescriptions. Which principle should guide the nurse's assessment to minimize
adverse drug events?
A. The 'start low, go slow' approach and regular medication reconciliation
B. Maintaining all prescriptions indefinitely to avoid withdrawal effects
, C. Doubling doses for elderly patients due to decreased drug sensitivity
D. Avoiding generic substitutions to ensure brand-name consistency
Correct Answer: A
Rationale: Polypharmacy is a major concern in older adults due to altered
pharmacokinetics and pharmacodynamics. The 'start low, go slow' principle minimizes
adverse effects. Regular medication reconciliation identifies potentially inappropriate
medications (PIMs), drug interactions, and deprescribing opportunities. The Beers Criteria
and START/STOPP tools help guide safe prescribing in older adults.
Question 6.
An older adult with chronic obstructive pulmonary disease (COPD) is receiving home
oxygen therapy at 2 L/min via nasal cannula. The nurse teaches the patient and
family about fire safety. Which statement by the patient indicates understanding?
A. 'I can smoke if I stay at least 3 feet from the oxygen tubing.'
B. 'I should keep a fire extinguisher nearby and avoid open flames.'
C. 'Petroleum-based lotions are safe to use around the nasal cannula.'
D. 'I can increase the flow to 6 L/min when I feel very short of breath.'
Correct Answer: B
Rationale: Oxygen supports combustion. Patients must avoid smoking, open flames, and
petroleum-based products near oxygen equipment. Flow rates should not be adjusted
without provider orders. COPD patients are particularly sensitive to high oxygen
concentrations, which can suppress the hypoxic drive and cause CO2 retention.
Question 7.
A nurse is caring for an older adult post-hip fracture repair. Which intervention is
most effective in preventing deep vein thrombosis (DVT)?
A. Encourage early ambulation and administer prescribed anticoagulants
B. Apply tight elastic bandages from toes to groin continuously
C. Keep the patient on strict bed rest for 7 days post-surgery
D. Massage the affected leg to promote venous return
Correct Answer: A
Rationale: Older adults are at high risk for DVT due to venous stasis, endothelial damage,
and hypercoagulability (Virchow's triad). Early ambulation promotes venous return.
Pharmacological prophylaxis (e.g., low molecular weight heparin, direct oral
