GALEN NUR 168 | EXAM 4 / FINAL STUDY GUIDE | 2026/2027
GALEN COLLEGE OF NURSING
NUR 168
Exam 4 / Final Study Guide
Aging • Chronic Disease • Cognitive Disorders • Rehabilitation • End-of-Life • Grief • Clinical
Judgment
Course NUR 168 - Integrated Concepts of Registered Nursing
Practice
Assessment Exam 4 / Final
Alignment 2026 course catalog + public detailed NUR 168 exam
blueprint
Edition September -2027 study edition
Includes 75 original practice questions with answer rationales
Independent educational study resource - not an official Galen exam or answer key.
Page 1
, GALEN NUR 168 | EXAM 4 / FINAL STUDY GUIDE | 2026/2027
1. Alignment and Exam Blueprint
Galen's 2026 course catalog describes NUR 168 as an integrated transition-to-RN course that includes care of patients
experiencing chronic disruptions in health. A publicly available detailed NUR 168 syllabus (2024/2025 version) provides an
Exam 4 blueprint with 50 questions. Because Galen can revise Canvas content and exam construction, use this guide to
master the stated concepts rather than as a prediction of exact exam wording.
Exam 4 weighting to prioritize
Unit 10: approximately 37-42 of 50 items (about three quarters of the exam). Unit 11: approximately 8-13 of 50 items.
This guide therefore gives substantially more space and practice to aging, chronic disease, and cognitive disorders than
to the Unit 11 topics.
Blueprint Area Topics Approx. Items
Unit 10 Age-related changes and management; 37-42
chronic disease concepts; cognitive
disorders
Unit 11 Rehabilitation concepts; assistive devices; 8-13
advance directives/end-of-life decisions;
loss/grief; critical thinking
Total Integrated clinical judgment across the 50
above topics
How to use this guide
Read the high-yield tables first, then explain each priority aloud without looking.
For older-adult questions, separate expected age-related change from pathology.
For chronic illness, think function, symptom control, adherence, family impact, and prevention of decompensation.
For cognitive disorders, identify onset/time course before choosing a nursing response.
For mobility and end-of-life questions, prioritize safety, autonomy, comfort, and the patient's expressed goals.
Complete the 75-question practice set without notes, then review every rationale - including questions answered correctly.
2. High-Yield Clinical Judgment Frameworks
Priority sequence for NUR 168 final questions
Step Question to ask Typical nursing action
1. Immediate threat Is airway, breathing, circulation, severe Assess/intervene for the life threat first.
bleeding, acute neuro change, or unstable
vital signs present?
2. Acute vs. chronic Is this a sudden change from baseline or Sudden changes usually outrank stable
an expected chronic problem? chronic findings.
3. Safety Is the patient at risk for falls, aspiration, Reduce immediate hazards and supervise
injury, wandering, medication harm, or skin as needed.
breakdown?
4. Function What can the patient safely do Promote the highest safe level of
independently? independence.
5. Goals and autonomy What does the patient want and what is Honor informed preferences and valid
legally documented? directives.
6. Teach and evaluate What must the patient/caregiver know Use teach-back and verify safe self-
before discharge? management.
Exam trap
Do not automatically choose the most dramatic diagnosis. The best nursing answer is usually the option that addresses
the most immediate, modifiable risk while preserving autonomy and function.
Page 2
, GALEN NUR 168 | EXAM 4 / FINAL STUDY GUIDE | 2026/2027
3. Aging: Normal Changes vs. Concerning Findings
Aging changes physiologic reserve, drug handling, sensory input, balance, and the presentation of illness. Older adults may
show atypical symptoms: infection may first appear as functional decline or confusion, and acute illness may present without
a high fever.
System Expected tendencies Concerning / not normal
Cardiovascular Stiffer arteries; reduced maximal heart-rate New chest pain, syncope, new edema,
response; slower baroreceptor response acute dyspnea, marked orthostatic
symptoms
Respiratory Reduced chest-wall compliance; weaker New hypoxemia, increased work of
cough; lower respiratory reserve breathing, change in sputum, acute
confusion
Renal Lower renal reserve and slower drug Rapid urine-output decline, dehydration,
elimination in many patients sudden electrolyte change
GI Slower motility; altered taste and appetite GI bleeding, persistent vomiting, severe
weight loss, dysphagia
Neurologic Slower reaction time; sleep pattern Acute confusion, focal weakness, new
changes speech change, sudden severe headache
Vision/hearing Reduced near vision, contrast sensitivity, Sudden vision loss, acute unilateral hearing
high-frequency hearing loss
Musculoskeletal Lower muscle mass and bone density Acute inability to bear weight, new
deformity after fall, severe focal pain
Skin Thinner, drier skin; less subcutaneous Nonblanching erythema, open areas,
tissue rapidly worsening wound, infection signs
Immune/temperature Less robust febrile response Functional decline, confusion, tachypnea,
or hypotension suggesting infection
Functional assessment
ADLs: bathing, dressing, toileting, transferring, continence, feeding.
IADLs: medications, finances, shopping, transportation, cooking, communication, housekeeping.
Compare current function with the patient's baseline; a new loss of function is clinically significant.
Assess gait, balance, home hazards, vision, footwear, cognition, orthostatic symptoms, and medications when fall risk
increases.
4. Medication Safety in Older Adults
Older adults often have multiple conditions and medications. Age-related changes in renal function, hepatic metabolism,
body composition, and receptor sensitivity can increase adverse effects. The nurse should not assume that every symptom
is a new disease; medication effects and interactions must be considered.
Risk Why it matters Nursing focus
Polypharmacy More opportunities for interactions, Reconcile all prescription, OTC, and herbal
duplication, and nonadherence products.
Renal clearance Some drugs/metabolites accumulate when Monitor renal function and signs of toxicity;
renal function declines verify dose appropriateness.
Orthostatic effects Antihypertensives, diuretics, sedatives and Check orthostatic symptoms, hydration,
other drugs can contribute to falls and fall precautions.
Anticholinergic burden Can worsen dry mouth, constipation, Watch for new cognitive or functional
urinary retention, blurred vision, and decline.
confusion
Sedation Increases falls, aspiration risk, and delirium Use the lowest-risk approach and reassess
Page 3
GALEN COLLEGE OF NURSING
NUR 168
Exam 4 / Final Study Guide
Aging • Chronic Disease • Cognitive Disorders • Rehabilitation • End-of-Life • Grief • Clinical
Judgment
Course NUR 168 - Integrated Concepts of Registered Nursing
Practice
Assessment Exam 4 / Final
Alignment 2026 course catalog + public detailed NUR 168 exam
blueprint
Edition September -2027 study edition
Includes 75 original practice questions with answer rationales
Independent educational study resource - not an official Galen exam or answer key.
Page 1
, GALEN NUR 168 | EXAM 4 / FINAL STUDY GUIDE | 2026/2027
1. Alignment and Exam Blueprint
Galen's 2026 course catalog describes NUR 168 as an integrated transition-to-RN course that includes care of patients
experiencing chronic disruptions in health. A publicly available detailed NUR 168 syllabus (2024/2025 version) provides an
Exam 4 blueprint with 50 questions. Because Galen can revise Canvas content and exam construction, use this guide to
master the stated concepts rather than as a prediction of exact exam wording.
Exam 4 weighting to prioritize
Unit 10: approximately 37-42 of 50 items (about three quarters of the exam). Unit 11: approximately 8-13 of 50 items.
This guide therefore gives substantially more space and practice to aging, chronic disease, and cognitive disorders than
to the Unit 11 topics.
Blueprint Area Topics Approx. Items
Unit 10 Age-related changes and management; 37-42
chronic disease concepts; cognitive
disorders
Unit 11 Rehabilitation concepts; assistive devices; 8-13
advance directives/end-of-life decisions;
loss/grief; critical thinking
Total Integrated clinical judgment across the 50
above topics
How to use this guide
Read the high-yield tables first, then explain each priority aloud without looking.
For older-adult questions, separate expected age-related change from pathology.
For chronic illness, think function, symptom control, adherence, family impact, and prevention of decompensation.
For cognitive disorders, identify onset/time course before choosing a nursing response.
For mobility and end-of-life questions, prioritize safety, autonomy, comfort, and the patient's expressed goals.
Complete the 75-question practice set without notes, then review every rationale - including questions answered correctly.
2. High-Yield Clinical Judgment Frameworks
Priority sequence for NUR 168 final questions
Step Question to ask Typical nursing action
1. Immediate threat Is airway, breathing, circulation, severe Assess/intervene for the life threat first.
bleeding, acute neuro change, or unstable
vital signs present?
2. Acute vs. chronic Is this a sudden change from baseline or Sudden changes usually outrank stable
an expected chronic problem? chronic findings.
3. Safety Is the patient at risk for falls, aspiration, Reduce immediate hazards and supervise
injury, wandering, medication harm, or skin as needed.
breakdown?
4. Function What can the patient safely do Promote the highest safe level of
independently? independence.
5. Goals and autonomy What does the patient want and what is Honor informed preferences and valid
legally documented? directives.
6. Teach and evaluate What must the patient/caregiver know Use teach-back and verify safe self-
before discharge? management.
Exam trap
Do not automatically choose the most dramatic diagnosis. The best nursing answer is usually the option that addresses
the most immediate, modifiable risk while preserving autonomy and function.
Page 2
, GALEN NUR 168 | EXAM 4 / FINAL STUDY GUIDE | 2026/2027
3. Aging: Normal Changes vs. Concerning Findings
Aging changes physiologic reserve, drug handling, sensory input, balance, and the presentation of illness. Older adults may
show atypical symptoms: infection may first appear as functional decline or confusion, and acute illness may present without
a high fever.
System Expected tendencies Concerning / not normal
Cardiovascular Stiffer arteries; reduced maximal heart-rate New chest pain, syncope, new edema,
response; slower baroreceptor response acute dyspnea, marked orthostatic
symptoms
Respiratory Reduced chest-wall compliance; weaker New hypoxemia, increased work of
cough; lower respiratory reserve breathing, change in sputum, acute
confusion
Renal Lower renal reserve and slower drug Rapid urine-output decline, dehydration,
elimination in many patients sudden electrolyte change
GI Slower motility; altered taste and appetite GI bleeding, persistent vomiting, severe
weight loss, dysphagia
Neurologic Slower reaction time; sleep pattern Acute confusion, focal weakness, new
changes speech change, sudden severe headache
Vision/hearing Reduced near vision, contrast sensitivity, Sudden vision loss, acute unilateral hearing
high-frequency hearing loss
Musculoskeletal Lower muscle mass and bone density Acute inability to bear weight, new
deformity after fall, severe focal pain
Skin Thinner, drier skin; less subcutaneous Nonblanching erythema, open areas,
tissue rapidly worsening wound, infection signs
Immune/temperature Less robust febrile response Functional decline, confusion, tachypnea,
or hypotension suggesting infection
Functional assessment
ADLs: bathing, dressing, toileting, transferring, continence, feeding.
IADLs: medications, finances, shopping, transportation, cooking, communication, housekeeping.
Compare current function with the patient's baseline; a new loss of function is clinically significant.
Assess gait, balance, home hazards, vision, footwear, cognition, orthostatic symptoms, and medications when fall risk
increases.
4. Medication Safety in Older Adults
Older adults often have multiple conditions and medications. Age-related changes in renal function, hepatic metabolism,
body composition, and receptor sensitivity can increase adverse effects. The nurse should not assume that every symptom
is a new disease; medication effects and interactions must be considered.
Risk Why it matters Nursing focus
Polypharmacy More opportunities for interactions, Reconcile all prescription, OTC, and herbal
duplication, and nonadherence products.
Renal clearance Some drugs/metabolites accumulate when Monitor renal function and signs of toxicity;
renal function declines verify dose appropriateness.
Orthostatic effects Antihypertensives, diuretics, sedatives and Check orthostatic symptoms, hydration,
other drugs can contribute to falls and fall precautions.
Anticholinergic burden Can worsen dry mouth, constipation, Watch for new cognitive or functional
urinary retention, blurred vision, and decline.
confusion
Sedation Increases falls, aspiration risk, and delirium Use the lowest-risk approach and reassess
Page 3
