NU 176 Exam 4 | NU 176 Geriatric Nursing |
Questions & Answers with Rationales
2026/2027 Update
Question 1
An older adult client with a history of heart failure and hypertension is brought to
the emergency department by their adult child. The nurse notes diffuse
ecchymoses on the client's inner thighs, back, and upper arms in various stages of
resolution. When asked about the injuries, the client looks down, hesitates, and
looks toward their child before responding. What is the nurse's priority action?
A. Immediately contact local law enforcement to file a report.
B. Ask the adult child to step out of the room so the client can be interviewed
alone.
C. Document the location and appearance of all bruises in the electronic health
record.
D. Consult social services to arrange an immediate safety assessment.
Answer: B
Rationale: When physical indicators or patient behaviors suggest potential elder
abuse, the nurse's immediate priority during assessment is to interview the client
privately without family members or caregivers present. This creates a safe space
where the client can speak freely without fear of intimidation or retaliation.
Documentation and official reporting follow following a complete private
evaluation.
Question 2
An 84-year-old client diagnosed with severe osteoarthritis of both knees asks the
nurse about safe ways to stay physically active without causing further joint pain.
Which physical activity recommendation is most appropriate?
A. Jogging on an outdoor dirt trail three times a week.
,B. Water aerobics and swimming in a warm pool.
C. High-impact aerobic step classes.
D. Complete bed rest combined with passive joint movement.
Answer: B
Rationale: Swimming and water aerobics are ideal low-impact exercises for older
adults with severe osteoarthritis because water buoyancy reduces weight-bearing
mechanical stress on joint cartilage while maintaining cardiovascular endurance
and muscle strength. High-impact or running activities exacerbate joint
destruction.
Question 3
An older adult client diagnosed with heart failure is taking oral furosemide 40 mg
daily. Which lab result requires immediate notification of the healthcare
provider?
A. Serum sodium level of 137 mEq/L.
B. Serum potassium level of 2.8 mEq/L.
C. Serum creatinine level of 1.0 mg/dL.
D. Blood urea nitrogen (BUN) level of 17 mg/dL.
Answer: B
Rationale: Furosemide is a loop diuretic that promotes potassium and water
excretion in the loop of Henle. A serum potassium level of 2.8 mEq/L indicates
severe hypokalemia (normal range 3.5–5.0 mEq/L), placing the client at high risk
for fatal cardiac dysrhythmias and severe muscle weakness.
Question 4
An 86-year-old client is admitted to the acute care unit with sudden onset of
acute confusion, disorientation, and functional decline over 24 hours. Which
health condition is the leading underlying cause of acute delirium in older adults?
A. Expected age-related neurological decline.
B. Urinary tract infection.
,C. Major depressive disorder.
D. Early-stage Alzheimer's disease.
Answer: B
Rationale: Systemic infections, particularly urinary tract infections (UTIs) and
pneumonia, frequently manifest as sudden delirium or acute mental status
changes in older adults due to age-related changes in the immune and central
nervous systems. Normal biological aging and chronic dementia do not cause
sudden cognitive changes over hours or days.
Question 5
Which age-related physiological alteration alters drug distribution and increases
the risk of toxicity from fat-soluble (lipophilic) medications in older adults?
A. Increased percentage of total body water.
B. Increased proportion of body fat relative to lean muscle mass.
C. Elevated hepatic blood flow.
D. Increased total serum protein levels.
Answer: B
Rationale: Biological aging is accompanied by an increase in body fat percentage
combined with a decrease in total body water and lean muscle mass. Lipophilic
(fat-soluble) drugs dissolve and accumulate in expanded adipose tissue, resulting
in a prolonged elimination half-life and heightened toxicity risk.
Question 6
An older adult client asks the nurse why they feel cold all the time, even when the
ambient room temperature is comfortable for family members. What explanation
by the nurse is correct?
A. Thinning of the epidermal layer and loss of insulating subcutaneous fat.
B. Hypersecretion of thyroid hormone.
C. Constant, uncoordinated shivering responses.
, D. Increased peripheral cutaneous vasodilation.
Answer: A
Rationale: Age-related cutaneous changes include a loss of insulating
subcutaneous adipose tissue, epidermal thinning, and reduced dermal
microcirculation. This diminishes the body's natural thermal insulation, causing
older adults to feel cold easily in standard environmental temperatures.
Question 7
A nurse is reviewing medication administration safety in an 81-year-old client.
Which age-related renal change contributes significantly to impaired drug
excretion and toxicity?
A. Increased glomerular filtration rate.
B. Reduction in functional nephrons and decreased renal blood flow.
C. Elevated tubular secretion capacity.
D. Hypertrophy of renal tissue mass.
Answer: B
Rationale: Biological aging is marked by a decline in total functional nephrons, loss
of renal cortical mass, and reduced renal vascular perfusion, which together cause
a progressive drop in glomerular filtration rate (GFR). This reduces renal clearance
of water-soluble drugs, increasing the risk of drug accumulation and adverse drug
reactions.
Question 8
An older adult client reports persistent dry mouth (xerostomia) after starting a
new cardiac medication. Which recommendation should the nurse offer to relieve
this symptom?
A. Consuming sugar-sweetened carbonated beverages throughout the day.
B. Practicing frequent oral care and sipping water or sucking on sugarless hard
candies.
C. Avoiding brushing teeth to protect fragile mucous membranes.
Questions & Answers with Rationales
2026/2027 Update
Question 1
An older adult client with a history of heart failure and hypertension is brought to
the emergency department by their adult child. The nurse notes diffuse
ecchymoses on the client's inner thighs, back, and upper arms in various stages of
resolution. When asked about the injuries, the client looks down, hesitates, and
looks toward their child before responding. What is the nurse's priority action?
A. Immediately contact local law enforcement to file a report.
B. Ask the adult child to step out of the room so the client can be interviewed
alone.
C. Document the location and appearance of all bruises in the electronic health
record.
D. Consult social services to arrange an immediate safety assessment.
Answer: B
Rationale: When physical indicators or patient behaviors suggest potential elder
abuse, the nurse's immediate priority during assessment is to interview the client
privately without family members or caregivers present. This creates a safe space
where the client can speak freely without fear of intimidation or retaliation.
Documentation and official reporting follow following a complete private
evaluation.
Question 2
An 84-year-old client diagnosed with severe osteoarthritis of both knees asks the
nurse about safe ways to stay physically active without causing further joint pain.
Which physical activity recommendation is most appropriate?
A. Jogging on an outdoor dirt trail three times a week.
,B. Water aerobics and swimming in a warm pool.
C. High-impact aerobic step classes.
D. Complete bed rest combined with passive joint movement.
Answer: B
Rationale: Swimming and water aerobics are ideal low-impact exercises for older
adults with severe osteoarthritis because water buoyancy reduces weight-bearing
mechanical stress on joint cartilage while maintaining cardiovascular endurance
and muscle strength. High-impact or running activities exacerbate joint
destruction.
Question 3
An older adult client diagnosed with heart failure is taking oral furosemide 40 mg
daily. Which lab result requires immediate notification of the healthcare
provider?
A. Serum sodium level of 137 mEq/L.
B. Serum potassium level of 2.8 mEq/L.
C. Serum creatinine level of 1.0 mg/dL.
D. Blood urea nitrogen (BUN) level of 17 mg/dL.
Answer: B
Rationale: Furosemide is a loop diuretic that promotes potassium and water
excretion in the loop of Henle. A serum potassium level of 2.8 mEq/L indicates
severe hypokalemia (normal range 3.5–5.0 mEq/L), placing the client at high risk
for fatal cardiac dysrhythmias and severe muscle weakness.
Question 4
An 86-year-old client is admitted to the acute care unit with sudden onset of
acute confusion, disorientation, and functional decline over 24 hours. Which
health condition is the leading underlying cause of acute delirium in older adults?
A. Expected age-related neurological decline.
B. Urinary tract infection.
,C. Major depressive disorder.
D. Early-stage Alzheimer's disease.
Answer: B
Rationale: Systemic infections, particularly urinary tract infections (UTIs) and
pneumonia, frequently manifest as sudden delirium or acute mental status
changes in older adults due to age-related changes in the immune and central
nervous systems. Normal biological aging and chronic dementia do not cause
sudden cognitive changes over hours or days.
Question 5
Which age-related physiological alteration alters drug distribution and increases
the risk of toxicity from fat-soluble (lipophilic) medications in older adults?
A. Increased percentage of total body water.
B. Increased proportion of body fat relative to lean muscle mass.
C. Elevated hepatic blood flow.
D. Increased total serum protein levels.
Answer: B
Rationale: Biological aging is accompanied by an increase in body fat percentage
combined with a decrease in total body water and lean muscle mass. Lipophilic
(fat-soluble) drugs dissolve and accumulate in expanded adipose tissue, resulting
in a prolonged elimination half-life and heightened toxicity risk.
Question 6
An older adult client asks the nurse why they feel cold all the time, even when the
ambient room temperature is comfortable for family members. What explanation
by the nurse is correct?
A. Thinning of the epidermal layer and loss of insulating subcutaneous fat.
B. Hypersecretion of thyroid hormone.
C. Constant, uncoordinated shivering responses.
, D. Increased peripheral cutaneous vasodilation.
Answer: A
Rationale: Age-related cutaneous changes include a loss of insulating
subcutaneous adipose tissue, epidermal thinning, and reduced dermal
microcirculation. This diminishes the body's natural thermal insulation, causing
older adults to feel cold easily in standard environmental temperatures.
Question 7
A nurse is reviewing medication administration safety in an 81-year-old client.
Which age-related renal change contributes significantly to impaired drug
excretion and toxicity?
A. Increased glomerular filtration rate.
B. Reduction in functional nephrons and decreased renal blood flow.
C. Elevated tubular secretion capacity.
D. Hypertrophy of renal tissue mass.
Answer: B
Rationale: Biological aging is marked by a decline in total functional nephrons, loss
of renal cortical mass, and reduced renal vascular perfusion, which together cause
a progressive drop in glomerular filtration rate (GFR). This reduces renal clearance
of water-soluble drugs, increasing the risk of drug accumulation and adverse drug
reactions.
Question 8
An older adult client reports persistent dry mouth (xerostomia) after starting a
new cardiac medication. Which recommendation should the nurse offer to relieve
this symptom?
A. Consuming sugar-sweetened carbonated beverages throughout the day.
B. Practicing frequent oral care and sipping water or sucking on sugarless hard
candies.
C. Avoiding brushing teeth to protect fragile mucous membranes.
