NUR 257: CONCEPTS OF AGING AND CHRONIC ILLNESS
EXAM 3— 2026
Q1. An older adult client with dementia is observed wandering continuously in a
random, lapping pattern in the unit hallway. Which action by the nurse represents the
most appropriate initial management of this locomotion behavior?
A) Administer a PRN dose of Lorazepam to sedate the client.
B) Place the client in physical isolation in a darkened room.
C) Apply wrist restraints immediately to prevent elopement.
D) Sit and talk with the client and gently redirect them.
□ Correct Answer: Option D (Sit and talk with the client and gently redirect them.)
□ Rationale: Dementia-related wandering manifested in lapping or pacing patterns should be
managed by sitting and talking with the client as well as redirecting them. Restraints, sedation, or
isolation exacerbate confusion.
Q2. An older adult patient is admitted with acute confusion, disorientation, and
fluctuating alertness that worsens at night. Which condition is documented as the #1
underlying cause of delirium in older adults?
A) Urinary Tract Infection (UTI)
B) Left ventricular hypertrophy
C) Severe hyperglycemia with ketoacidosis
D) Acute ischemic stroke
□ Correct Answer: Option A (Urinary Tract Infection (UTI))
□ Rationale: A Urinary Tract Infection (UTI) is identified as the #1 cause of delirium in older adults.
Delirium has an underlying cause that must be identified and treated first.
,Q3. A nurse assesses a client who exhibits hypoactive delirium. Which clinical
presentation is characteristic of this subtype?
A) Reduced activity, lack of facial expression, disturbed affect, and a sluggish or withdrawn
demeanor.
B) Excessive alertness, agitation, and attempting to pull out IV catheters.
C) Loud, rapid speech with active visual and auditory hallucinations.
D) Unpredictable violent outbursts alternating with hypersexuality.
□ Correct Answer: Option A (Reduced activity, lack of facial expression, disturbed affect,
and a sluggish or withdrawn demeanor.)
□ Rationale: Hypoactive delirium is characterized by reduced activity, lack of facial expression
(disturbed affect), lethargy, sluggishness, and a quiet or pleasantly confused state.
Q4. Which subtype of delirium in older adults is recognized in course notes as being
most frequently missed or underdiagnosed by clinicians?
A) Mixed subtype delirium
B) Vascular delirium
C) Hyperactive delirium
D) Hypoactive delirium
□ Correct Answer: Option C (Hyperactive delirium)
□ Rationale: Hyperactive delirium—characterized by agitation, wandering, yelling, and pulling at
tubes—is noted as being most often missed in older adults.
Q5. A nurse is caring for an older adult whose acute confusion worsens significantly in
the late afternoon and evening hours. Which intervention is most helpful in reducing
this client's confusion?
A) Instruct the client to remain completely motionless in bed.
B) Restrict fluid intake to less than 500 mL per day.
C) Administer a prescribed oral dose of Levodopa on a full stomach.
D) Utilize familiar voices, sit and talk with the client, and maintain a quiet, structured environment.
□ Correct Answer: Option D (Utilize familiar voices, sit and talk with the client, and
maintain a quiet, structured environment.)
□ Rationale: Sundowning (delirium worsening at night) is managed by creating a reassuring
environment, using familiar voices to reduce confusion, sitting and talking, and avoiding
overstimulation.
, Q6. A nurse reviews the medication list of an older adult presenting with acute onset
of delirium. Which medication class should the nurse identify as a major contributor
that can worsen delirium?
A) Anticoagulants
B) Incentive spirometers
C) Benzodiazepines
D) Beta-agonists
□ Correct Answer: Option C (Benzodiazepines)
□ Rationale: Course review notes explicitly highlight that 'benzos can worsen delirium.'
Psychotropics and polypharmacy are major causes.
Q7. Using the DELIRIUM mnemonic for identifying causes of acute neurocognitive
changes, what does the letter 'I' represent?
A) Incontinence and Indapamide
B) Insulin excess and Indigestion
C) Infection and Injury/pain/stress
D) Impaired gas exchange and Ischemia
□ Correct Answer: Option C (Infection and Injury/pain/stress)
□ Rationale: In the DELIRIUM mnemonic, 'I' stands for Infection as well as Injury, pain, and stress.
Q8. An agitated client with delirium is repeatedly pulling at an endotracheal tube.
What is the nurse's priority action regarding invasive lines?
A) Remove invasive lines as soon as safe and feasible, and maintain continuous surveillance.
B) Lock the client in a room alone to reduce noise.
C) Administer a rapid bolus of high-dose sedatives without assessment.
D) Apply physical restraints immediately without attempting redirection.
□ Correct Answer: Option A (Remove invasive lines as soon as safe and feasible, and
maintain continuous surveillance.)
□ Rationale: Interventions for delirium prioritize removing invasive lines for safety, ongoing
surveillance, and reorientation. Pharmacological intervention is a last resort unless the client is
harming self or others.
Q9. A 25-year-old client is diagnosed with Type 1 Diabetes Mellitus. Which clinical
features and emergency risks are associated with this condition?
A) Insulin resistance, onset at any age, and high risk for HHS.
B) Total absence of insulin production, onset at age 30 or younger, and high risk for DKA (blood
sugar > 400 mg/dL).
C) Overproduction of insulin by alpha cells and elevated serum potassium above 5.5 mEq/L.
D) Thickened bronchial basement membranes and high risk for emphysema.
□ Correct Answer: Option B (Total absence of insulin production, onset at age 30 or
younger, and high risk for DKA (blood sugar > 400 mg/dL).)
□ Rationale: Type 1 Diabetes involves the body being unable to produce insulin, onset at 30 years
or younger, glucosuria, fatigue, weight loss, and high risk for DKA (blood sugar > 400 mg/dL).
EXAM 3— 2026
Q1. An older adult client with dementia is observed wandering continuously in a
random, lapping pattern in the unit hallway. Which action by the nurse represents the
most appropriate initial management of this locomotion behavior?
A) Administer a PRN dose of Lorazepam to sedate the client.
B) Place the client in physical isolation in a darkened room.
C) Apply wrist restraints immediately to prevent elopement.
D) Sit and talk with the client and gently redirect them.
□ Correct Answer: Option D (Sit and talk with the client and gently redirect them.)
□ Rationale: Dementia-related wandering manifested in lapping or pacing patterns should be
managed by sitting and talking with the client as well as redirecting them. Restraints, sedation, or
isolation exacerbate confusion.
Q2. An older adult patient is admitted with acute confusion, disorientation, and
fluctuating alertness that worsens at night. Which condition is documented as the #1
underlying cause of delirium in older adults?
A) Urinary Tract Infection (UTI)
B) Left ventricular hypertrophy
C) Severe hyperglycemia with ketoacidosis
D) Acute ischemic stroke
□ Correct Answer: Option A (Urinary Tract Infection (UTI))
□ Rationale: A Urinary Tract Infection (UTI) is identified as the #1 cause of delirium in older adults.
Delirium has an underlying cause that must be identified and treated first.
,Q3. A nurse assesses a client who exhibits hypoactive delirium. Which clinical
presentation is characteristic of this subtype?
A) Reduced activity, lack of facial expression, disturbed affect, and a sluggish or withdrawn
demeanor.
B) Excessive alertness, agitation, and attempting to pull out IV catheters.
C) Loud, rapid speech with active visual and auditory hallucinations.
D) Unpredictable violent outbursts alternating with hypersexuality.
□ Correct Answer: Option A (Reduced activity, lack of facial expression, disturbed affect,
and a sluggish or withdrawn demeanor.)
□ Rationale: Hypoactive delirium is characterized by reduced activity, lack of facial expression
(disturbed affect), lethargy, sluggishness, and a quiet or pleasantly confused state.
Q4. Which subtype of delirium in older adults is recognized in course notes as being
most frequently missed or underdiagnosed by clinicians?
A) Mixed subtype delirium
B) Vascular delirium
C) Hyperactive delirium
D) Hypoactive delirium
□ Correct Answer: Option C (Hyperactive delirium)
□ Rationale: Hyperactive delirium—characterized by agitation, wandering, yelling, and pulling at
tubes—is noted as being most often missed in older adults.
Q5. A nurse is caring for an older adult whose acute confusion worsens significantly in
the late afternoon and evening hours. Which intervention is most helpful in reducing
this client's confusion?
A) Instruct the client to remain completely motionless in bed.
B) Restrict fluid intake to less than 500 mL per day.
C) Administer a prescribed oral dose of Levodopa on a full stomach.
D) Utilize familiar voices, sit and talk with the client, and maintain a quiet, structured environment.
□ Correct Answer: Option D (Utilize familiar voices, sit and talk with the client, and
maintain a quiet, structured environment.)
□ Rationale: Sundowning (delirium worsening at night) is managed by creating a reassuring
environment, using familiar voices to reduce confusion, sitting and talking, and avoiding
overstimulation.
, Q6. A nurse reviews the medication list of an older adult presenting with acute onset
of delirium. Which medication class should the nurse identify as a major contributor
that can worsen delirium?
A) Anticoagulants
B) Incentive spirometers
C) Benzodiazepines
D) Beta-agonists
□ Correct Answer: Option C (Benzodiazepines)
□ Rationale: Course review notes explicitly highlight that 'benzos can worsen delirium.'
Psychotropics and polypharmacy are major causes.
Q7. Using the DELIRIUM mnemonic for identifying causes of acute neurocognitive
changes, what does the letter 'I' represent?
A) Incontinence and Indapamide
B) Insulin excess and Indigestion
C) Infection and Injury/pain/stress
D) Impaired gas exchange and Ischemia
□ Correct Answer: Option C (Infection and Injury/pain/stress)
□ Rationale: In the DELIRIUM mnemonic, 'I' stands for Infection as well as Injury, pain, and stress.
Q8. An agitated client with delirium is repeatedly pulling at an endotracheal tube.
What is the nurse's priority action regarding invasive lines?
A) Remove invasive lines as soon as safe and feasible, and maintain continuous surveillance.
B) Lock the client in a room alone to reduce noise.
C) Administer a rapid bolus of high-dose sedatives without assessment.
D) Apply physical restraints immediately without attempting redirection.
□ Correct Answer: Option A (Remove invasive lines as soon as safe and feasible, and
maintain continuous surveillance.)
□ Rationale: Interventions for delirium prioritize removing invasive lines for safety, ongoing
surveillance, and reorientation. Pharmacological intervention is a last resort unless the client is
harming self or others.
Q9. A 25-year-old client is diagnosed with Type 1 Diabetes Mellitus. Which clinical
features and emergency risks are associated with this condition?
A) Insulin resistance, onset at any age, and high risk for HHS.
B) Total absence of insulin production, onset at age 30 or younger, and high risk for DKA (blood
sugar > 400 mg/dL).
C) Overproduction of insulin by alpha cells and elevated serum potassium above 5.5 mEq/L.
D) Thickened bronchial basement membranes and high risk for emphysema.
□ Correct Answer: Option B (Total absence of insulin production, onset at age 30 or
younger, and high risk for DKA (blood sugar > 400 mg/dL).)
□ Rationale: Type 1 Diabetes involves the body being unable to produce insulin, onset at 30 years
or younger, glucosuria, fatigue, weight loss, and high risk for DKA (blood sugar > 400 mg/dL).
