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NUR 257 Exam 2 – Concepts of Aging & Chronic Illness
QUESTIONS AND VERIFIED ANSWERS WITH RATIONALES
JUST RELEASED
NUR 257 Exam 2 – Concepts of Aging & Chronic Illness
Exam Coverage Areas (Most Tested Topics)
1. Physiological Changes of Aging - Cardiovascular, respiratory, renal, neurological, gastrointestinal,
musculoskeletal, integumentary, and sensory system alterations
2. Chronic Illness Management - Diabetes mellitus, hypertension, heart failure, COPD, osteoarthritis,
rheumatoid arthritis, dementia, and Parkinson's disease
3. Polypharmacy & Medication Management - Pharmacokinetics/pharmacodynamics changes, Beers
Criteria, adverse drug reactions, drug interactions, and medication adherence
4. Functional Assessment & ADLs/IADLs - Katz Index, Lawton IADL scale, fall risk assessment, mobility
evaluation, and assistive device utilization
5. Cognitive & Mental Health Disorders - Delirium, dementia, depression, anxiety, sundowning
syndrome, and psychosocial adaptations to aging
6. Nutrition & Hydration - Age-related changes affecting nutrition, dysphagia management,
enteral/parenteral nutrition, and malnutrition screening tools
7. Pain Management in Older Adults - Atypical presentations, pharmacological considerations, non-
pharmacological interventions, and comprehensive pain assessment
8. End-of-Life & Palliative Care - Advance directives, hospice eligibility, symptom management,
grief/bereavement support, and ethical considerations
9. Geriatric Syndromes - Falls, pressure injuries, urinary incontinence, sleep disorders, sensory
impairments, and elder abuse/neglect
10. Health Promotion & Disease Prevention - Immunizations, screening recommendations, lifestyle
modifications, patient education, and community resources
1. An 82-year-old patient with a history of hypertension and type 2 diabetes presents to the clinic with
complaints of dizziness upon standing, and upon assessment you note a 25 mmHg drop in systolic blood
pressure when moving from supine to standing position; which of the following physiological changes
associated with aging most directly contributes to this clinical finding?
A) Decreased baroreceptor sensitivity
B) Reduced cardiac contractility
C) Increased peripheral vascular resistance
D) Diminished renal blood flow
Answer: A - Baroreceptor sensitivity decreases with age, leading to impaired compensatory mechanisms
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when position changes occur, resulting in orthostatic hypotension. The baroreceptors become less
responsive to changes in blood pressure, and the cardiovascular system cannot rapidly adjust to maintain
cerebral perfusion during positional changes.
2. An 87-year-old male patient diagnosed with Alzheimer's disease has been prescribed donepezil, and his
daughter expresses concern because she read that this medication can cause bradycardia; which nursing
intervention is most appropriate to address this potential adverse effect in this elderly patient?
A) Monitor heart rate and rhythm before each dose administration
B) Administer the medication with food to minimize GI side effects
C) Increase the dosage gradually to reduce cardiac complications
D) Discontinue the medication if any cardiac symptoms develop
Answer: A - Donepezil, a cholinesterase inhibitor, can cause bradycardia and syncope in elderly patients;
therefore, monitoring heart rate and rhythm is essential before administration. The medication should be
held if the heart rate drops below 60 beats per minute, and the healthcare provider should be notified for
further evaluation and potential dose adjustment.
3. A 78-year-old patient with chronic obstructive pulmonary disease is being discharged home with
supplemental oxygen at 2 liters per minute via nasal cannula, and the patient's spouse asks about home
safety precautions; which of the following instructions should the nurse prioritize to prevent
complications associated with home oxygen therapy?
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A) Post "No Smoking" signs throughout the home and remove all flammable materials
B) Apply petroleum-based ointments to nares to prevent drying of nasal mucosa
C) Increase oxygen flow rate to 4 liters during exercise to prevent breathlessness
D) Store oxygen cylinders in a closed closet to keep them out of sight
Answer: A - Oxygen supports combustion, so smoking and flammable materials must be avoided in the
home environment where oxygen is in use. Petroleum-based products should be avoided as they can ignite;
instead, water-based lubricants should be recommended for nasal dryness, and oxygen should be stored
upright in a well-ventilated area, not in closed spaces.
4. A 70-year-old female patient who recently moved to an assisted living facility reports that she has been
experiencing frequent episodes of urinary incontinence that occur when she coughs, sneezes, or laughs;
based on her symptoms and age-related changes in the genitourinary system, which type of incontinence
is this patient most likely experiencing?
A) Stress incontinence
B) Urge incontinence
C) Overflow incontinence
D) Functional incontinence
Answer: A - Stress incontinence occurs when increased intra-abdominal pressure from coughing, sneezing,
laughing, or lifting exceeds urethral sphincter resistance, and it is common in older women due to weakened
pelvic floor muscles and decreased urethral tone. Age-related loss of estrogen contributes to urethral
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mucosal atrophy, further reducing sphincter effectiveness in maintaining continence during physical
exertion.
5. An 84-year-old patient is admitted to the medical-surgical unit with a diagnosis of dehydration, and
upon assessment you note that the patient has poor skin turgor, dry mucous membranes, and a serum
sodium level of 155 mEq/L; which age-related physiological change most significantly predisposes this
patient to developing hypernatremic dehydration?
A) Diminished thirst perception and reduced total body water percentage
B) Increased aldosterone secretion leading to sodium retention
C) Enhanced renal concentrating ability causing excessive water loss
D) Elevated antidiuretic hormone levels that impair water excretion
Answer: A - Older adults have decreased thirst perception due to changes in the osmoreceptor response in
the hypothalamus, and total body water decreases with age, making them more susceptible to dehydration.
The reduced ability to concentrate urine and diminished renal function further compromise fluid balance, so
these patients may not feel thirsty even when significantly dehydrated, requiring careful monitoring of
intake and output.
6. A 72-year-old male patient who is 2 days post-operative following hip replacement surgery suddenly
becomes confused, disoriented to time and place, and is attempting to get out of bed while pulling at his
intravenous line; which assessment finding would most strongly differentiate this patient's acute
NUR 257 Exam 2 – Concepts of Aging & Chronic Illness
QUESTIONS AND VERIFIED ANSWERS WITH RATIONALES
JUST RELEASED
NUR 257 Exam 2 – Concepts of Aging & Chronic Illness
Exam Coverage Areas (Most Tested Topics)
1. Physiological Changes of Aging - Cardiovascular, respiratory, renal, neurological, gastrointestinal,
musculoskeletal, integumentary, and sensory system alterations
2. Chronic Illness Management - Diabetes mellitus, hypertension, heart failure, COPD, osteoarthritis,
rheumatoid arthritis, dementia, and Parkinson's disease
3. Polypharmacy & Medication Management - Pharmacokinetics/pharmacodynamics changes, Beers
Criteria, adverse drug reactions, drug interactions, and medication adherence
4. Functional Assessment & ADLs/IADLs - Katz Index, Lawton IADL scale, fall risk assessment, mobility
evaluation, and assistive device utilization
5. Cognitive & Mental Health Disorders - Delirium, dementia, depression, anxiety, sundowning
syndrome, and psychosocial adaptations to aging
6. Nutrition & Hydration - Age-related changes affecting nutrition, dysphagia management,
enteral/parenteral nutrition, and malnutrition screening tools
7. Pain Management in Older Adults - Atypical presentations, pharmacological considerations, non-
pharmacological interventions, and comprehensive pain assessment
8. End-of-Life & Palliative Care - Advance directives, hospice eligibility, symptom management,
grief/bereavement support, and ethical considerations
9. Geriatric Syndromes - Falls, pressure injuries, urinary incontinence, sleep disorders, sensory
impairments, and elder abuse/neglect
10. Health Promotion & Disease Prevention - Immunizations, screening recommendations, lifestyle
modifications, patient education, and community resources
1. An 82-year-old patient with a history of hypertension and type 2 diabetes presents to the clinic with
complaints of dizziness upon standing, and upon assessment you note a 25 mmHg drop in systolic blood
pressure when moving from supine to standing position; which of the following physiological changes
associated with aging most directly contributes to this clinical finding?
A) Decreased baroreceptor sensitivity
B) Reduced cardiac contractility
C) Increased peripheral vascular resistance
D) Diminished renal blood flow
Answer: A - Baroreceptor sensitivity decreases with age, leading to impaired compensatory mechanisms
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when position changes occur, resulting in orthostatic hypotension. The baroreceptors become less
responsive to changes in blood pressure, and the cardiovascular system cannot rapidly adjust to maintain
cerebral perfusion during positional changes.
2. An 87-year-old male patient diagnosed with Alzheimer's disease has been prescribed donepezil, and his
daughter expresses concern because she read that this medication can cause bradycardia; which nursing
intervention is most appropriate to address this potential adverse effect in this elderly patient?
A) Monitor heart rate and rhythm before each dose administration
B) Administer the medication with food to minimize GI side effects
C) Increase the dosage gradually to reduce cardiac complications
D) Discontinue the medication if any cardiac symptoms develop
Answer: A - Donepezil, a cholinesterase inhibitor, can cause bradycardia and syncope in elderly patients;
therefore, monitoring heart rate and rhythm is essential before administration. The medication should be
held if the heart rate drops below 60 beats per minute, and the healthcare provider should be notified for
further evaluation and potential dose adjustment.
3. A 78-year-old patient with chronic obstructive pulmonary disease is being discharged home with
supplemental oxygen at 2 liters per minute via nasal cannula, and the patient's spouse asks about home
safety precautions; which of the following instructions should the nurse prioritize to prevent
complications associated with home oxygen therapy?
, Page 3 of 171
A) Post "No Smoking" signs throughout the home and remove all flammable materials
B) Apply petroleum-based ointments to nares to prevent drying of nasal mucosa
C) Increase oxygen flow rate to 4 liters during exercise to prevent breathlessness
D) Store oxygen cylinders in a closed closet to keep them out of sight
Answer: A - Oxygen supports combustion, so smoking and flammable materials must be avoided in the
home environment where oxygen is in use. Petroleum-based products should be avoided as they can ignite;
instead, water-based lubricants should be recommended for nasal dryness, and oxygen should be stored
upright in a well-ventilated area, not in closed spaces.
4. A 70-year-old female patient who recently moved to an assisted living facility reports that she has been
experiencing frequent episodes of urinary incontinence that occur when she coughs, sneezes, or laughs;
based on her symptoms and age-related changes in the genitourinary system, which type of incontinence
is this patient most likely experiencing?
A) Stress incontinence
B) Urge incontinence
C) Overflow incontinence
D) Functional incontinence
Answer: A - Stress incontinence occurs when increased intra-abdominal pressure from coughing, sneezing,
laughing, or lifting exceeds urethral sphincter resistance, and it is common in older women due to weakened
pelvic floor muscles and decreased urethral tone. Age-related loss of estrogen contributes to urethral
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mucosal atrophy, further reducing sphincter effectiveness in maintaining continence during physical
exertion.
5. An 84-year-old patient is admitted to the medical-surgical unit with a diagnosis of dehydration, and
upon assessment you note that the patient has poor skin turgor, dry mucous membranes, and a serum
sodium level of 155 mEq/L; which age-related physiological change most significantly predisposes this
patient to developing hypernatremic dehydration?
A) Diminished thirst perception and reduced total body water percentage
B) Increased aldosterone secretion leading to sodium retention
C) Enhanced renal concentrating ability causing excessive water loss
D) Elevated antidiuretic hormone levels that impair water excretion
Answer: A - Older adults have decreased thirst perception due to changes in the osmoreceptor response in
the hypothalamus, and total body water decreases with age, making them more susceptible to dehydration.
The reduced ability to concentrate urine and diminished renal function further compromise fluid balance, so
these patients may not feel thirsty even when significantly dehydrated, requiring careful monitoring of
intake and output.
6. A 72-year-old male patient who is 2 days post-operative following hip replacement surgery suddenly
becomes confused, disoriented to time and place, and is attempting to get out of bed while pulling at his
intravenous line; which assessment finding would most strongly differentiate this patient's acute
