NU 176 Exam 1 | NU 176 Geriatric Nursing |
Questions & Answers with Rationales
2026/2027 Update
Question 1
An older adult client is admitted to the long-term care facility. During the
admission assessment, the nurse notes that the client has multiple bruises at
varying stages of healing on their upper arms and back. The client appears
anxious and looks at their adult child before answering questions. What is the
nurse's priority action?
A. Document the findings in the client's medical record and continue the
assessment.
B. Ask the adult child to leave the room so the nurse can interview the client
privately.
C. Immediately call local law enforcement to report suspected elder abuse.
D. Contact the social worker to arrange a home safety evaluation.
Answer: B
Rationale: When suspected elder abuse or negligence is indicated by physical
signs and behavior, the nurse's immediate priority during assessment is to
interview the client privately without the caregiver or family member present.
This allows the client to speak freely without fear of intimidation or retaliation.
Documentation and reporting to proper authorities follow established procedures
after a thorough private assessment is conducted.
Question 2
A nurse is planning care for an 82-year-old client with severe osteoarthritis of the
knees. Which intervention is most appropriate for promoting physical mobility
while minimizing joint stress?
A. Encased weight-bearing exercises such as running on a treadmill.
,B. High-impact aerobic dance classes three times a week.
C. Low-impact aquatic exercises in a warm pool.
D. Complete bed rest with passive range-of-motion exercises.
Answer: C
Rationale: Aquatic therapy and swimming are ideal for older adults with severe
osteoarthritis because the buoyancy of warm water decreases weight-bearing
stress on joints while maintaining cardiovascular fitness and muscle strength.
High-impact or running activities exacerbate joint pain and degeneration. Bed rest
leads to rapid muscle atrophy and joint stiffness.
Question 3
An older adult client diagnosed with heart failure is prescribed furosemide 40 mg
orally daily. Which lab value requires immediate notification of the healthcare
provider?
A. Serum sodium level of 138 mEq/L.
B. Serum potassium level of 2.8 mEq/L.
C. Blood urea nitrogen (BUN) level of 18 mg/dL.
D. Serum creatinine level of 1.0 mg/dL.
Answer: B
Rationale: Furosemide is a loop diuretic that causes excretion of potassium and
water. A serum potassium level of 2.8 mEq/L indicates severe hypokalemia,
placing the client at high risk for cardiac dysrhythmias and muscle weakness.
Normal potassium levels range between 3.5 and 5.0 mEq/L. The other laboratory
values fall within normal physiological limits.
Question 4
The nurse is evaluating an 88-year-old client who was admitted with confusion
and acute decline in functional status. Which condition is the most common cause
of sudden delirium in older adults?
A. Normal age-related neurological decline.
,B. Major depressive disorder.
C. Urinary tract infection.
D. Early-stage Alzheimer's disease.
Answer: C
Rationale: Systemic infections, particularly urinary tract infections (UTIs) and
pneumonia, frequently present as sudden delirium or confusion in older adults
due to age-related changes in the immune and central nervous systems. Normal
aging and chronic dementia do not cause sudden acute changes in mental status
over hours or days.
Question 5
Which physiological change associated with normal aging alters drug distribution
and increases the risk of toxicity from fat-soluble medications in older adults?
A. Increased total body water percentage.
B. Increased proportion of body fat.
C. Increased hepatic blood flow.
D. Increased serum albumin concentration.
Answer: B
Rationale: Age-related body composition changes include a decrease in total body
water and lean muscle mass paired with an increase in body fat percentage.
Lipophilic (fat-soluble) drugs dissolve and accumulate in adipose tissue, prolonged
duration of action and increasing toxicity risk. Serum albumin levels and hepatic
blood flow generally decrease with age.
Question 6
An older adult client asks the nurse why they feel cold all the time, even when the
room temperature is comfortable for others. Which explanation by the nurse is
correct?
A. Loss of subcutaneous tissue and thinning of the epidermal layer.
B. Excess secretion of thyroid hormones.
, C. Involuntary shiver responses occurring constantly.
D. Increased peripheral vascular vasodilation.
Answer: A
Rationale: As skin ages, there is a loss of subcutaneous fat along with epidermal
thinning and decreased vascularity in the dermal layer. This reduces the body's
natural insulation against environmental temperature changes, causing older
adults to feel colder easily.
Question 7
A nurse is administering medications to an 80-year-old client. Which age-related
renal change contributes most significantly to drug accumulation and toxicity?
A. Increased glomerular filtration rate.
B. Decreased number of functional nephrons and lower renal blood flow.
C. Increased tubular secretion capability.
D. Hypertrophic kidney mass.
Answer: B
Rationale: Aging is accompanied by a decline in total functional nephrons,
reduced renal mass, and reduced renal blood flow, which collectively decrease
the glomerular filtration rate (GFR). This reduces renal clearance of drugs
excreted by the kidneys, increasing the risk of drug accumulation and adverse
drug reactions.
Question 8
An older client reports persistent dry mouth (xerostomia) since starting a new
cardiac medication. Which action should the nurse recommend to alleviate this
discomfort?
A. Drink excessive amounts of sugar-sweetened beverages.
B. Practice frequent oral hygiene and sip water or suck on sugarless hard candies.
C. Avoid brushing teeth to protect dry gums.
Questions & Answers with Rationales
2026/2027 Update
Question 1
An older adult client is admitted to the long-term care facility. During the
admission assessment, the nurse notes that the client has multiple bruises at
varying stages of healing on their upper arms and back. The client appears
anxious and looks at their adult child before answering questions. What is the
nurse's priority action?
A. Document the findings in the client's medical record and continue the
assessment.
B. Ask the adult child to leave the room so the nurse can interview the client
privately.
C. Immediately call local law enforcement to report suspected elder abuse.
D. Contact the social worker to arrange a home safety evaluation.
Answer: B
Rationale: When suspected elder abuse or negligence is indicated by physical
signs and behavior, the nurse's immediate priority during assessment is to
interview the client privately without the caregiver or family member present.
This allows the client to speak freely without fear of intimidation or retaliation.
Documentation and reporting to proper authorities follow established procedures
after a thorough private assessment is conducted.
Question 2
A nurse is planning care for an 82-year-old client with severe osteoarthritis of the
knees. Which intervention is most appropriate for promoting physical mobility
while minimizing joint stress?
A. Encased weight-bearing exercises such as running on a treadmill.
,B. High-impact aerobic dance classes three times a week.
C. Low-impact aquatic exercises in a warm pool.
D. Complete bed rest with passive range-of-motion exercises.
Answer: C
Rationale: Aquatic therapy and swimming are ideal for older adults with severe
osteoarthritis because the buoyancy of warm water decreases weight-bearing
stress on joints while maintaining cardiovascular fitness and muscle strength.
High-impact or running activities exacerbate joint pain and degeneration. Bed rest
leads to rapid muscle atrophy and joint stiffness.
Question 3
An older adult client diagnosed with heart failure is prescribed furosemide 40 mg
orally daily. Which lab value requires immediate notification of the healthcare
provider?
A. Serum sodium level of 138 mEq/L.
B. Serum potassium level of 2.8 mEq/L.
C. Blood urea nitrogen (BUN) level of 18 mg/dL.
D. Serum creatinine level of 1.0 mg/dL.
Answer: B
Rationale: Furosemide is a loop diuretic that causes excretion of potassium and
water. A serum potassium level of 2.8 mEq/L indicates severe hypokalemia,
placing the client at high risk for cardiac dysrhythmias and muscle weakness.
Normal potassium levels range between 3.5 and 5.0 mEq/L. The other laboratory
values fall within normal physiological limits.
Question 4
The nurse is evaluating an 88-year-old client who was admitted with confusion
and acute decline in functional status. Which condition is the most common cause
of sudden delirium in older adults?
A. Normal age-related neurological decline.
,B. Major depressive disorder.
C. Urinary tract infection.
D. Early-stage Alzheimer's disease.
Answer: C
Rationale: Systemic infections, particularly urinary tract infections (UTIs) and
pneumonia, frequently present as sudden delirium or confusion in older adults
due to age-related changes in the immune and central nervous systems. Normal
aging and chronic dementia do not cause sudden acute changes in mental status
over hours or days.
Question 5
Which physiological change associated with normal aging alters drug distribution
and increases the risk of toxicity from fat-soluble medications in older adults?
A. Increased total body water percentage.
B. Increased proportion of body fat.
C. Increased hepatic blood flow.
D. Increased serum albumin concentration.
Answer: B
Rationale: Age-related body composition changes include a decrease in total body
water and lean muscle mass paired with an increase in body fat percentage.
Lipophilic (fat-soluble) drugs dissolve and accumulate in adipose tissue, prolonged
duration of action and increasing toxicity risk. Serum albumin levels and hepatic
blood flow generally decrease with age.
Question 6
An older adult client asks the nurse why they feel cold all the time, even when the
room temperature is comfortable for others. Which explanation by the nurse is
correct?
A. Loss of subcutaneous tissue and thinning of the epidermal layer.
B. Excess secretion of thyroid hormones.
, C. Involuntary shiver responses occurring constantly.
D. Increased peripheral vascular vasodilation.
Answer: A
Rationale: As skin ages, there is a loss of subcutaneous fat along with epidermal
thinning and decreased vascularity in the dermal layer. This reduces the body's
natural insulation against environmental temperature changes, causing older
adults to feel colder easily.
Question 7
A nurse is administering medications to an 80-year-old client. Which age-related
renal change contributes most significantly to drug accumulation and toxicity?
A. Increased glomerular filtration rate.
B. Decreased number of functional nephrons and lower renal blood flow.
C. Increased tubular secretion capability.
D. Hypertrophic kidney mass.
Answer: B
Rationale: Aging is accompanied by a decline in total functional nephrons,
reduced renal mass, and reduced renal blood flow, which collectively decrease
the glomerular filtration rate (GFR). This reduces renal clearance of drugs
excreted by the kidneys, increasing the risk of drug accumulation and adverse
drug reactions.
Question 8
An older client reports persistent dry mouth (xerostomia) since starting a new
cardiac medication. Which action should the nurse recommend to alleviate this
discomfort?
A. Drink excessive amounts of sugar-sweetened beverages.
B. Practice frequent oral hygiene and sip water or suck on sugarless hard candies.
C. Avoid brushing teeth to protect dry gums.
