NU 176 Exam 3 | NU 176 Geriatric Nursing |
Questions & Answers with Rationales
2026/2027 Update
Question 1
An older adult client with a history of hypertension and osteoporosis is admitted
to the medical unit following a fall at home. The client reports severe pain in the
left hip and groin area, and the nurse notes that the left leg appears shortened
and externally rotated. What is the priority nursing intervention?
A. Assist the client to stand and perform a gait assessment.
B. Immobilize the left leg, align the extremity, and maintain bed rest.
C. Place the client in a high-Fowler's position and apply heat to the hip.
D. Perform passive range-of-motion exercises on both lower extremities.
Answer: B
Rationale: Shortening and external rotation of an affected extremity are classic
signs of a fractured hip. The priority nursing action is to immobilize and align the
extremity to prevent further soft tissue damage, nerve impairment, blood loss,
and displacement of the fracture before formal orthopedic evaluation and
intervention.
Question 2
A nurse is providing discharge teaching to an older adult client prescribed
transdermal fentanyl patches for severe chronic osteoarthritis pain. Which
statement by the client demonstrates a correct understanding of transdermal
patch safety?
A. "I will apply a heating pad over the patch if my pain worsens."
B. "I will fold the used patch in half with the sticky sides together before disposing
of it safely."
,C. "I can cut the patch in half if I need a smaller dose."
D. "I should leave the old patch on for two days after applying a new one."
Answer: B
Rationale: Used fentanyl patches still contain substantial amounts of active drug.
Folding the patch so the adhesive side sticks to itself prevents accidental skin
absorption by others or pets. Applying direct heat over a transdermal patch
accelerates drug absorption and can cause fatal overdose, and patches should
never be cut unless explicitly designed for cutting.
Question 3
An 82-year-old client with chronic heart failure is prescribed a daily oral dose of
spironolactone. Which serum laboratory finding should the nurse prioritize
reporting to the healthcare provider?
A. Serum sodium level of 138 mEq/L.
B. Serum potassium level of 5.8 mEq/L.
C. Serum calcium level of 9.1 mg/dL.
D. Serum magnesium level of 2.1 mEq/L.
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that inhibits aldosterone
action in the distal renal tubules. A serum potassium level of 5.8 mEq/L indicates
hyperkalemia (normal range 3.5–5.0 mEq/L), which increases the risk of life-
threatening cardiac dysrhythmias and conduction blocks, especially in older adults
with reduced baseline renal function.
Question 4
A nurse is assessing an older adult client who reports gradual, painless loss of
vision in both eyes over the past two years. The client states that colors appear
dulled and night driving has become difficult due to severe headlight glare. Eye
examination reveals opacification of the crystalline lenses. Which condition is
present?
A. Chronic open-angle glaucoma.
,B. Macular degeneration.
C. Cataracts.
D. Retinal detachment.
Answer: C
Rationale: Cataracts involve progressive, painless opacification or clouding of the
eye's natural crystalline lens. Classic manifestations include blurred visual acuity,
sensitivity to glare (especially at night), altered color perception, and double
vision in a single eye. Glaucoma affects peripheral fields, while macular
degeneration impacts central vision.
Question 5
Which physiological change associated with normal biological aging contributes to
an elevated risk of hypothermia in older adults exposed to cool environments?
A. Increased subcutaneous tissue volume.
B. Diminished shivering response and blunted peripheral vasoconstriction.
C. Elevated basal metabolic rate.
D. Hyperactive hypothalamic thermal regulation.
Answer: B
Rationale: Aging impairs the body's thermoregulatory mechanisms. Loss of
subcutaneous insulating fat, decreased basal metabolic rate, blunted perception
of cold, and delayed or reduced peripheral vasoconstriction and shivering
responses make older adults highly susceptible to rapid core body temperature
drops and hypothermia.
Question 6
An older client taking oral levothyroxine for hypothyroidism presents with a heart
rate of 112 beats per minute, fine tremors, heat intolerance, and new-onset
insomnia. Which clinical situation should the nurse suspect?
A. Inadequate levothyroxine dosage requiring an increase.
B. Excessive levothyroxine dosage causing hyperthyroidism.
, C. Expected progression of primary hypothyroidism.
D. Acute onset of age-related autonomic dysfunction.
Answer: B
Rationale: Tachycardia, tremors, heat intolerance, weight loss, and insomnia
reflect excess circulating thyroid hormone (hyperthyroidism). This indicates that
the current levothyroxine dosage is too high and requires provider notification for
potential dosage reduction.
Question 7
Which assessment finding in an 84-year-old client evaluates a Basic Activity of
Daily Living (ADL)?
A. The client is able to balance a monthly checking account.
B. The client requires physical assistance to transfer from a bed to a wheelchair.
C. The client can prepare a multi-course dinner independently.
D. The client uses public transit to shop for groceries.
Answer: B
Rationale: Basic ADLs evaluate fundamental self-care tasks necessary for daily
physical survival: bathing, dressing, grooming, eating, toileting, and transferring.
Financial management, meal preparation, and shopping fall under Instrumental
Activities of Daily Living (IADLs).
Question 8
An older adult client with type 2 diabetes mellitus presents to the clinic with an
HbA1c value of 11.2% and a fasting blood glucose of 290 mg/dL. The client reports
persistent thirst, frequent urination, and weight loss. Which acute complication
should the nurse monitor for if severe dehydration and hyperosmolality worsen?
A. Diabetic Ketoacidosis (DKA).
B. Hyperglycemic Hyperosmolar State (HHS).
C. Acute Hypoglycemic Shock.
Questions & Answers with Rationales
2026/2027 Update
Question 1
An older adult client with a history of hypertension and osteoporosis is admitted
to the medical unit following a fall at home. The client reports severe pain in the
left hip and groin area, and the nurse notes that the left leg appears shortened
and externally rotated. What is the priority nursing intervention?
A. Assist the client to stand and perform a gait assessment.
B. Immobilize the left leg, align the extremity, and maintain bed rest.
C. Place the client in a high-Fowler's position and apply heat to the hip.
D. Perform passive range-of-motion exercises on both lower extremities.
Answer: B
Rationale: Shortening and external rotation of an affected extremity are classic
signs of a fractured hip. The priority nursing action is to immobilize and align the
extremity to prevent further soft tissue damage, nerve impairment, blood loss,
and displacement of the fracture before formal orthopedic evaluation and
intervention.
Question 2
A nurse is providing discharge teaching to an older adult client prescribed
transdermal fentanyl patches for severe chronic osteoarthritis pain. Which
statement by the client demonstrates a correct understanding of transdermal
patch safety?
A. "I will apply a heating pad over the patch if my pain worsens."
B. "I will fold the used patch in half with the sticky sides together before disposing
of it safely."
,C. "I can cut the patch in half if I need a smaller dose."
D. "I should leave the old patch on for two days after applying a new one."
Answer: B
Rationale: Used fentanyl patches still contain substantial amounts of active drug.
Folding the patch so the adhesive side sticks to itself prevents accidental skin
absorption by others or pets. Applying direct heat over a transdermal patch
accelerates drug absorption and can cause fatal overdose, and patches should
never be cut unless explicitly designed for cutting.
Question 3
An 82-year-old client with chronic heart failure is prescribed a daily oral dose of
spironolactone. Which serum laboratory finding should the nurse prioritize
reporting to the healthcare provider?
A. Serum sodium level of 138 mEq/L.
B. Serum potassium level of 5.8 mEq/L.
C. Serum calcium level of 9.1 mg/dL.
D. Serum magnesium level of 2.1 mEq/L.
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that inhibits aldosterone
action in the distal renal tubules. A serum potassium level of 5.8 mEq/L indicates
hyperkalemia (normal range 3.5–5.0 mEq/L), which increases the risk of life-
threatening cardiac dysrhythmias and conduction blocks, especially in older adults
with reduced baseline renal function.
Question 4
A nurse is assessing an older adult client who reports gradual, painless loss of
vision in both eyes over the past two years. The client states that colors appear
dulled and night driving has become difficult due to severe headlight glare. Eye
examination reveals opacification of the crystalline lenses. Which condition is
present?
A. Chronic open-angle glaucoma.
,B. Macular degeneration.
C. Cataracts.
D. Retinal detachment.
Answer: C
Rationale: Cataracts involve progressive, painless opacification or clouding of the
eye's natural crystalline lens. Classic manifestations include blurred visual acuity,
sensitivity to glare (especially at night), altered color perception, and double
vision in a single eye. Glaucoma affects peripheral fields, while macular
degeneration impacts central vision.
Question 5
Which physiological change associated with normal biological aging contributes to
an elevated risk of hypothermia in older adults exposed to cool environments?
A. Increased subcutaneous tissue volume.
B. Diminished shivering response and blunted peripheral vasoconstriction.
C. Elevated basal metabolic rate.
D. Hyperactive hypothalamic thermal regulation.
Answer: B
Rationale: Aging impairs the body's thermoregulatory mechanisms. Loss of
subcutaneous insulating fat, decreased basal metabolic rate, blunted perception
of cold, and delayed or reduced peripheral vasoconstriction and shivering
responses make older adults highly susceptible to rapid core body temperature
drops and hypothermia.
Question 6
An older client taking oral levothyroxine for hypothyroidism presents with a heart
rate of 112 beats per minute, fine tremors, heat intolerance, and new-onset
insomnia. Which clinical situation should the nurse suspect?
A. Inadequate levothyroxine dosage requiring an increase.
B. Excessive levothyroxine dosage causing hyperthyroidism.
, C. Expected progression of primary hypothyroidism.
D. Acute onset of age-related autonomic dysfunction.
Answer: B
Rationale: Tachycardia, tremors, heat intolerance, weight loss, and insomnia
reflect excess circulating thyroid hormone (hyperthyroidism). This indicates that
the current levothyroxine dosage is too high and requires provider notification for
potential dosage reduction.
Question 7
Which assessment finding in an 84-year-old client evaluates a Basic Activity of
Daily Living (ADL)?
A. The client is able to balance a monthly checking account.
B. The client requires physical assistance to transfer from a bed to a wheelchair.
C. The client can prepare a multi-course dinner independently.
D. The client uses public transit to shop for groceries.
Answer: B
Rationale: Basic ADLs evaluate fundamental self-care tasks necessary for daily
physical survival: bathing, dressing, grooming, eating, toileting, and transferring.
Financial management, meal preparation, and shopping fall under Instrumental
Activities of Daily Living (IADLs).
Question 8
An older adult client with type 2 diabetes mellitus presents to the clinic with an
HbA1c value of 11.2% and a fasting blood glucose of 290 mg/dL. The client reports
persistent thirst, frequent urination, and weight loss. Which acute complication
should the nurse monitor for if severe dehydration and hyperosmolality worsen?
A. Diabetic Ketoacidosis (DKA).
B. Hyperglycemic Hyperosmolar State (HHS).
C. Acute Hypoglycemic Shock.
