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NUR 257 Exam 4 Concepts of Aging &
Chronic Illness | Galen Nursing – 200
Practice Questions with Answers &
Rationales
This comprehensive NUR 257 Exam 4 study guide features 200
multiple-choice questions covering all core Concepts of Aging
& Chronic Illness tested at Galen College of Nursing. Topics
include: aging theories (Free Radical & Wear and Tear), sleep
changes, Beers Criteria, safe medication practices, presbycusis,
open-angle glaucoma, osteoarthritis vs. rheumatoid arthritis,
gout management, COPD (oxygen targets 88-92%, pursed-lip
breathing), heart failure (fluid restrictions, daily weights),
Parkinson's disease (pill-rolling tremor, bradykinesia, carbidopa-
levodopa), Alzheimer's disease (sundowning, non-
pharmacologic interventions), delirium vs. dementia, pressure
ulcer prevention (Braden Scale), fall prevention (4 Ps hourly
rounding), and end-of-life care. Every question includes the
correct answer in bold italic plus a detailed rationale to
reinforce clinical reasoning and NCLEX-style critical thinking.
Perfect for exam prep, remediation, and clinical simulation
review. Instant digital download – study on the go and ace your
NUR 257 Exam 4! 📚✅
,2|Page
Question 1
A 78-year-old patient reports difficulty sleeping and states, "I just don't sleep as
deeply as I used to." The nurse understands that which age-related sleep change is
most responsible for this patient's perception?
A) Increased total sleep time during the night
B) Increased time spent in REM sleep
C) Decreased time spent in Stages 3 and 4 (deep sleep)
D) Increased production of melatonin
Answer: C) Decreased time spent in Stages 3 and 4 (deep sleep)
Rationale: As part of normal aging, older adults experience a significant
reduction in slow-wave sleep (Stages 3 and 4) and REM sleep. This decrease in
deep sleep leads to more fragmented sleep and the perception of lighter, less
restorative rest. Total sleep time typically decreases, not increases, and
melatonin production decreases rather than increases with age, disrupting
circadian rhythms rather than deepening sleep.
Question 2
An 82-year-old patient with osteoarthritis is being discharged. Which statement by
the patient indicates a correct understanding of pain management related to this
condition?
A) "I should exercise during periods of severe pain to work through the stiffness."
B) "My pain is usually worse in the morning and improves as I move throughout the
day."
C) "My pain typically worsens with activity and improves with rest."
D) "I should avoid all physical activity to prevent further joint damage."
Answer: C) "My pain typically worsens with activity and improves with rest."
Rationale: Osteoarthritis is characterized by mechanical pain that worsens with
weight-bearing activity and improves with rest. In contrast, rheumatoid
arthritis pain typically improves with activity and is worse with rest or in the
morning with prolonged stiffness. Exercise is encouraged during periods of low
,3|Page
pain to maintain joint function, but complete avoidance of activity leads to
deconditioning and worsened outcomes.
Question 3
The nurse is reviewing medications for a 76-year-old patient with multiple chronic
conditions. Which medication class should the nurse identify as potentially
inappropriate for this patient based on the Beers Criteria?
A) Acetaminophen
B) Metoprolol
C) Diphenhydramine
D) Aspirin for secondary prevention
Answer: C) Diphenhydramine
Rationale: Diphenhydramine is an anticholinergic medication included in the
Beers Criteria as potentially inappropriate for older adults due to its high risk of
causing confusion, sedation, falls, and anticholinergic side effects such as dry
mouth and urinary retention. Acetaminophen is generally safe for pain in older
adults. Metoprolol (cardioselective) is preferred in heart failure and COPD
patients. Aspirin for secondary prevention is appropriate, though primary
prevention is generally not recommended in older adults.
Question 4
A 70-year-old male patient is newly diagnosed with Parkinson's disease. Which
cardinal sign should the nurse expect to observe during the initial assessment?
A) Intention tremor that worsens with purposeful movement
B) Resting tremor described as "pill-rolling"
C) Hypertonia with spasticity
D) Choreiform movements of the extremities
Answer: B) Resting tremor described as "pill-rolling"
Rationale: Parkinson's disease is characterized by four cardinal signs: resting
tremor (often described as pill-rolling), bradykinesia (slowness of movement),
rigidity (cogwheel or lead-pipe), and postural instability. The tremor is present
, 4|Page
at rest and diminishes with purposeful movement, which is the opposite of an
intention tremor seen in cerebellar disorders. Spasticity is more common in
upper motor neuron lesions, and choreiform movements are seen in
Huntington's disease.
Question 5
The nurse is assessing an 80-year-old patient with presbycusis. Which
communication strategy should the nurse prioritize to improve understanding?
A) Speak loudly and directly into the patient's affected ear
B) Face the patient, speak clearly, and reduce background noise
C) Use written communication for all instructions
D) Speak in a higher-pitched voice to enhance clarity
Answer: B) Face the patient, speak clearly, and reduce background noise
Rationale: Presbycusis is age-related high-frequency hearing loss. The most
effective communication strategies include facing the patient so they can use
visual cues and lip-reading, speaking clearly and slowly, and minimizing
background noise. Shouting distorts sound further, and speaking in a higher
pitch is actually less effective because high-frequency sounds are the ones most
affected. Written communication is useful as a supplement but should not
replace verbal interaction unless necessary.
Question 6
A patient with COPD and heart failure is being started on a beta-blocker. Which type
of beta-blocker should the nurse anticipate being prescribed?
A) Propranolol
B) Atenolol
C) Metoprolol
D) Nadolol
Answer: C) Metoprolol
Rationale: In patients with both COPD and heart failure, a cardioselective beta-
1 blocker such as metoprolol or bisoprolol is preferred. These agents primarily
NUR 257 Exam 4 Concepts of Aging &
Chronic Illness | Galen Nursing – 200
Practice Questions with Answers &
Rationales
This comprehensive NUR 257 Exam 4 study guide features 200
multiple-choice questions covering all core Concepts of Aging
& Chronic Illness tested at Galen College of Nursing. Topics
include: aging theories (Free Radical & Wear and Tear), sleep
changes, Beers Criteria, safe medication practices, presbycusis,
open-angle glaucoma, osteoarthritis vs. rheumatoid arthritis,
gout management, COPD (oxygen targets 88-92%, pursed-lip
breathing), heart failure (fluid restrictions, daily weights),
Parkinson's disease (pill-rolling tremor, bradykinesia, carbidopa-
levodopa), Alzheimer's disease (sundowning, non-
pharmacologic interventions), delirium vs. dementia, pressure
ulcer prevention (Braden Scale), fall prevention (4 Ps hourly
rounding), and end-of-life care. Every question includes the
correct answer in bold italic plus a detailed rationale to
reinforce clinical reasoning and NCLEX-style critical thinking.
Perfect for exam prep, remediation, and clinical simulation
review. Instant digital download – study on the go and ace your
NUR 257 Exam 4! 📚✅
,2|Page
Question 1
A 78-year-old patient reports difficulty sleeping and states, "I just don't sleep as
deeply as I used to." The nurse understands that which age-related sleep change is
most responsible for this patient's perception?
A) Increased total sleep time during the night
B) Increased time spent in REM sleep
C) Decreased time spent in Stages 3 and 4 (deep sleep)
D) Increased production of melatonin
Answer: C) Decreased time spent in Stages 3 and 4 (deep sleep)
Rationale: As part of normal aging, older adults experience a significant
reduction in slow-wave sleep (Stages 3 and 4) and REM sleep. This decrease in
deep sleep leads to more fragmented sleep and the perception of lighter, less
restorative rest. Total sleep time typically decreases, not increases, and
melatonin production decreases rather than increases with age, disrupting
circadian rhythms rather than deepening sleep.
Question 2
An 82-year-old patient with osteoarthritis is being discharged. Which statement by
the patient indicates a correct understanding of pain management related to this
condition?
A) "I should exercise during periods of severe pain to work through the stiffness."
B) "My pain is usually worse in the morning and improves as I move throughout the
day."
C) "My pain typically worsens with activity and improves with rest."
D) "I should avoid all physical activity to prevent further joint damage."
Answer: C) "My pain typically worsens with activity and improves with rest."
Rationale: Osteoarthritis is characterized by mechanical pain that worsens with
weight-bearing activity and improves with rest. In contrast, rheumatoid
arthritis pain typically improves with activity and is worse with rest or in the
morning with prolonged stiffness. Exercise is encouraged during periods of low
,3|Page
pain to maintain joint function, but complete avoidance of activity leads to
deconditioning and worsened outcomes.
Question 3
The nurse is reviewing medications for a 76-year-old patient with multiple chronic
conditions. Which medication class should the nurse identify as potentially
inappropriate for this patient based on the Beers Criteria?
A) Acetaminophen
B) Metoprolol
C) Diphenhydramine
D) Aspirin for secondary prevention
Answer: C) Diphenhydramine
Rationale: Diphenhydramine is an anticholinergic medication included in the
Beers Criteria as potentially inappropriate for older adults due to its high risk of
causing confusion, sedation, falls, and anticholinergic side effects such as dry
mouth and urinary retention. Acetaminophen is generally safe for pain in older
adults. Metoprolol (cardioselective) is preferred in heart failure and COPD
patients. Aspirin for secondary prevention is appropriate, though primary
prevention is generally not recommended in older adults.
Question 4
A 70-year-old male patient is newly diagnosed with Parkinson's disease. Which
cardinal sign should the nurse expect to observe during the initial assessment?
A) Intention tremor that worsens with purposeful movement
B) Resting tremor described as "pill-rolling"
C) Hypertonia with spasticity
D) Choreiform movements of the extremities
Answer: B) Resting tremor described as "pill-rolling"
Rationale: Parkinson's disease is characterized by four cardinal signs: resting
tremor (often described as pill-rolling), bradykinesia (slowness of movement),
rigidity (cogwheel or lead-pipe), and postural instability. The tremor is present
, 4|Page
at rest and diminishes with purposeful movement, which is the opposite of an
intention tremor seen in cerebellar disorders. Spasticity is more common in
upper motor neuron lesions, and choreiform movements are seen in
Huntington's disease.
Question 5
The nurse is assessing an 80-year-old patient with presbycusis. Which
communication strategy should the nurse prioritize to improve understanding?
A) Speak loudly and directly into the patient's affected ear
B) Face the patient, speak clearly, and reduce background noise
C) Use written communication for all instructions
D) Speak in a higher-pitched voice to enhance clarity
Answer: B) Face the patient, speak clearly, and reduce background noise
Rationale: Presbycusis is age-related high-frequency hearing loss. The most
effective communication strategies include facing the patient so they can use
visual cues and lip-reading, speaking clearly and slowly, and minimizing
background noise. Shouting distorts sound further, and speaking in a higher
pitch is actually less effective because high-frequency sounds are the ones most
affected. Written communication is useful as a supplement but should not
replace verbal interaction unless necessary.
Question 6
A patient with COPD and heart failure is being started on a beta-blocker. Which type
of beta-blocker should the nurse anticipate being prescribed?
A) Propranolol
B) Atenolol
C) Metoprolol
D) Nadolol
Answer: C) Metoprolol
Rationale: In patients with both COPD and heart failure, a cardioselective beta-
1 blocker such as metoprolol or bisoprolol is preferred. These agents primarily
