NU 176 Exam 2 | NU 176 Geriatric Nursing |
Questions & Answers with Rationales
2026/2027 Update
Question 1
An older adult client with Parkinson's disease is experiencing severe dysphagia
and frequent coughing while eating. Which action should the nurse take first
when preparing to assist the client with mealtime?
A. Elevate the head of the bed to 90 degrees and instruct the client to flex their
chin slightly downward when swallowing.
B. Place the client in a semi-Fowler's position and encourage them to drink thin
liquids using a straw.
C. Offer the client large bites of solid food to stimulate the swallowing reflex.
D. Instruct the client to tilt their head backward while swallowing to assist gravity.
Answer: A
Rationale: Elevating the head of the bed fully to 90 degrees (high-Fowler's
position) and utilizing the chin-tuck maneuver protects the airway by closing the
glottis and widening the esophagus. Straws, thin liquids, and head tilting
backward significantly increase the risk of aspiration into the lungs.
Question 2
A nurse is reviewing the laboratory results of an 82-year-old client receiving
digoxin for atrial fibrillation. Which laboratory value requires immediate clinical
intervention by the nurse?
A. Serum potassium level of 2.9 mEq/L.
B. Serum sodium level of 137 mEq/L.
C. Serum calcium level of 9.2 mg/dL.
D. Serum magnesium level of 2.0 mEq/L.
,Answer: A
Rationale: Hypokalemia (serum potassium < 3.5 mEq/L) greatly sensitizes the
myocardium to digoxin, increasing the risk of severe digoxin toxicity and fatal
cardiac dysrhythmias even when digoxin serum levels are within normal limits.
The other electrolyte levels are within normal physiological parameters.
Question 3
Which gastrointestinal age-related change contributes directly to reduced calcium
and vitamin B12 absorption in older adults?
A. Atrophic gastritis leading to reduced gastric acid secretion and intrinsic factor
loss.
B. Hypersecretion of pepsin and hydrochloric acid.
C. Increased intestinal surface area of villi.
D. Rapid accelerated gastric emptying time.
Answer: A
Rationale: Atrophic gastritis is common in older adults and results in
hypochlorhydria or achlorhydria (reduced gastric acid). Gastric acid is essential for
cleaving vitamin B12 from protein foods and solubilizing calcium. Intrinsic factor
loss prevents B12 absorption in the ileum.
Question 4
An older client reports sudden, painless visual blurring in one eye, described as a
"dark shade or shadow pulled over the eye." Which ophthalmic condition is
indicated?
A. Age-related macular degeneration.
B. Open-angle glaucoma.
C. Retinal detachment.
D. Nuclear cataract formation.
Answer: C
,Rationale: Retinal detachment classically presents with sudden, painless visual
field loss often described as a dark curtain, shade, or shadow falling over the line
of sight, frequently accompanied by flashes of light or sudden floaters. It
represents a medical emergency requiring immediate repair.
Question 5
A home health nurse assesses an older adult client taking lisinopril for
hypertension. Which safety instruction is vital to prevent falls related to
orthostatic hypotension?
A. Rise rapidly from a sitting or lying position to stimulate circulation.
B. Sit on the side of the bed for a few moments before slowly standing up.
C. Limit fluid intake to under 1,000 mL per day.
D. Take the medication with a double dose of caffeinated coffee.
Answer: B
Rationale: Antihypertensive medications combined with blunted baroreceptor
reflexes in older adults increase the risk of orthostatic hypotension. Dangling legs
over the bed frame before standing allows time for vascular adaptation,
preventing cerebral ischemia, dizziness, and falls.
Question 6
Which clinical manifestation in an older adult with pneumonia is considered an
atypical presentation compared to a younger adult?
A. High fever accompanied by shaking chills.
B. Acute onset of confusion, lethargy, and functional decline.
C. Leukocytosis with a significant left shift.
D. Severe pleuritic chest pain upon deep inspiration.
Answer: B
Rationale: Older adults often fail to mount a typical febrile or leukocytic response
to infection due to immunosenescence. Instead, systemic infections such as
, pneumonia or urinary tract infections often present atypically as acute confusion
(delirium), lethargy, anorexia, or functional decline.
Question 7
An older client taking warfarin for a history of deep vein thrombosis asks if they
can take ginkgo biloba supplements to support memory. What is the nurse's best
response?
A. "Ginkgo biloba is safe and has no interactions with warfarin."
B. "Avoid ginkgo biloba because combining it with warfarin significantly increases
your risk of severe bleeding."
C. "Ginkgo biloba neutralizes warfarin and causes blood clots."
D. "Take ginkgo biloba only on an empty stomach with fruit juice."
Answer: B
Rationale: Ginkgo biloba possesses antiplatelet properties. When taken
concurrently with oral anticoagulants such as warfarin, it exerts a synergistic anti-
hemostatic effect, markedly elevating the risk of severe internal hemorrhage.
Question 8
Which physiological factor explains why older adults have a higher risk of toxicity
when given highly fat-soluble (lipophilic) drugs like diazepam?
A. Decreased overall body fat percentage.
B. Increased proportion of adipose tissue and decreased total body water.
C. Elevated total serum albumin production.
D. Increased glomerular filtration rate.
Answer: B
Rationale: Aging alters body composition by increasing adipose tissue (body fat)
and decreasing total body water and lean body mass. Lipophilic drugs distribute
extensively into increased fat stores, leading to a prolonged elimination half-life
and elevated toxicity risk.
Questions & Answers with Rationales
2026/2027 Update
Question 1
An older adult client with Parkinson's disease is experiencing severe dysphagia
and frequent coughing while eating. Which action should the nurse take first
when preparing to assist the client with mealtime?
A. Elevate the head of the bed to 90 degrees and instruct the client to flex their
chin slightly downward when swallowing.
B. Place the client in a semi-Fowler's position and encourage them to drink thin
liquids using a straw.
C. Offer the client large bites of solid food to stimulate the swallowing reflex.
D. Instruct the client to tilt their head backward while swallowing to assist gravity.
Answer: A
Rationale: Elevating the head of the bed fully to 90 degrees (high-Fowler's
position) and utilizing the chin-tuck maneuver protects the airway by closing the
glottis and widening the esophagus. Straws, thin liquids, and head tilting
backward significantly increase the risk of aspiration into the lungs.
Question 2
A nurse is reviewing the laboratory results of an 82-year-old client receiving
digoxin for atrial fibrillation. Which laboratory value requires immediate clinical
intervention by the nurse?
A. Serum potassium level of 2.9 mEq/L.
B. Serum sodium level of 137 mEq/L.
C. Serum calcium level of 9.2 mg/dL.
D. Serum magnesium level of 2.0 mEq/L.
,Answer: A
Rationale: Hypokalemia (serum potassium < 3.5 mEq/L) greatly sensitizes the
myocardium to digoxin, increasing the risk of severe digoxin toxicity and fatal
cardiac dysrhythmias even when digoxin serum levels are within normal limits.
The other electrolyte levels are within normal physiological parameters.
Question 3
Which gastrointestinal age-related change contributes directly to reduced calcium
and vitamin B12 absorption in older adults?
A. Atrophic gastritis leading to reduced gastric acid secretion and intrinsic factor
loss.
B. Hypersecretion of pepsin and hydrochloric acid.
C. Increased intestinal surface area of villi.
D. Rapid accelerated gastric emptying time.
Answer: A
Rationale: Atrophic gastritis is common in older adults and results in
hypochlorhydria or achlorhydria (reduced gastric acid). Gastric acid is essential for
cleaving vitamin B12 from protein foods and solubilizing calcium. Intrinsic factor
loss prevents B12 absorption in the ileum.
Question 4
An older client reports sudden, painless visual blurring in one eye, described as a
"dark shade or shadow pulled over the eye." Which ophthalmic condition is
indicated?
A. Age-related macular degeneration.
B. Open-angle glaucoma.
C. Retinal detachment.
D. Nuclear cataract formation.
Answer: C
,Rationale: Retinal detachment classically presents with sudden, painless visual
field loss often described as a dark curtain, shade, or shadow falling over the line
of sight, frequently accompanied by flashes of light or sudden floaters. It
represents a medical emergency requiring immediate repair.
Question 5
A home health nurse assesses an older adult client taking lisinopril for
hypertension. Which safety instruction is vital to prevent falls related to
orthostatic hypotension?
A. Rise rapidly from a sitting or lying position to stimulate circulation.
B. Sit on the side of the bed for a few moments before slowly standing up.
C. Limit fluid intake to under 1,000 mL per day.
D. Take the medication with a double dose of caffeinated coffee.
Answer: B
Rationale: Antihypertensive medications combined with blunted baroreceptor
reflexes in older adults increase the risk of orthostatic hypotension. Dangling legs
over the bed frame before standing allows time for vascular adaptation,
preventing cerebral ischemia, dizziness, and falls.
Question 6
Which clinical manifestation in an older adult with pneumonia is considered an
atypical presentation compared to a younger adult?
A. High fever accompanied by shaking chills.
B. Acute onset of confusion, lethargy, and functional decline.
C. Leukocytosis with a significant left shift.
D. Severe pleuritic chest pain upon deep inspiration.
Answer: B
Rationale: Older adults often fail to mount a typical febrile or leukocytic response
to infection due to immunosenescence. Instead, systemic infections such as
, pneumonia or urinary tract infections often present atypically as acute confusion
(delirium), lethargy, anorexia, or functional decline.
Question 7
An older client taking warfarin for a history of deep vein thrombosis asks if they
can take ginkgo biloba supplements to support memory. What is the nurse's best
response?
A. "Ginkgo biloba is safe and has no interactions with warfarin."
B. "Avoid ginkgo biloba because combining it with warfarin significantly increases
your risk of severe bleeding."
C. "Ginkgo biloba neutralizes warfarin and causes blood clots."
D. "Take ginkgo biloba only on an empty stomach with fruit juice."
Answer: B
Rationale: Ginkgo biloba possesses antiplatelet properties. When taken
concurrently with oral anticoagulants such as warfarin, it exerts a synergistic anti-
hemostatic effect, markedly elevating the risk of severe internal hemorrhage.
Question 8
Which physiological factor explains why older adults have a higher risk of toxicity
when given highly fat-soluble (lipophilic) drugs like diazepam?
A. Decreased overall body fat percentage.
B. Increased proportion of adipose tissue and decreased total body water.
C. Elevated total serum albumin production.
D. Increased glomerular filtration rate.
Answer: B
Rationale: Aging alters body composition by increasing adipose tissue (body fat)
and decreasing total body water and lean body mass. Lipophilic drugs distribute
extensively into increased fat stores, leading to a prolonged elimination half-life
and elevated toxicity risk.
