NUR 257 Concepts of Aging Chronic Illness
ACTUAL EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1: A 78-year-old female patient with a history of diabetes and hypertension presents
with confusion, urinary frequency, and increased thirst. Her family reports these symptoms
developed gradually over the past 2 weeks. Her MMSE score is 22/30, down from 27/30 six
months ago. Which assessment finding would best differentiate delirium from dementia in
this patient?
A. Gradual onset of symptoms over weeks
B. Fluctuating level of consciousness throughout the day
C. History of diabetes mellitus
D. Decreased MMSE score from baseline
Correct Answer: B
Rationale: Delirium is characterized by acute onset, fluctuating consciousness, and
inattention, while dementia has a more insidious onset with stable level of consciousness.
The fluctuating level of consciousness is a hallmark differentiating feature.
Question 2: A 82-year-old male resident in a long-term care facility with advanced Alzheimer's
disease becomes agitated and aggressive during evening care. He has a history of falls and
is currently taking donepezil and memantine. Which non-pharmacological intervention should
be implemented first according to the DICE approach?
A. Administer PRN haloperidol
B. Investigate potential triggers for the behavior
C. Increase donepezil dosage
D. Apply physical restraints
Correct Answer: B
Rationale: The DICE approach (Describe, Investigate, Create, Evaluate) prioritizes
investigating potential triggers for behavioral and psychological symptoms of dementia
(BPSD) before implementing interventions.
Question 3: A 75-year-old woman with heart failure presents with a 5-pound weight gain in 3
days, bilateral ankle edema, and reports sleeping on 3 pillows instead of her usual 1 pillow.
Her current medications include lisinopril 10mg daily, furosemide 20mg daily, and metoprolol
50mg BID. Which medication adjustment is most appropriate?
A. Increase lisinopril to 20mg daily
,B. Increase furosemide to 40mg daily
C. Decrease metoprolol to 25mg BID
D. Add digoxin 0.125mg daily
Correct Answer: B
Rationale: The patient is exhibiting signs of fluid overload (weight gain, edema, orthopnea).
Increasing the diuretic (furosemide) is the most appropriate initial response to manage fluid
retention in heart failure exacerbation.
Question 4: An 80-year-old male with COPD has an FEV1/FVC ratio of 55% and FEV1 of 45%
predicted. He reports dyspnea with minimal activity and uses his rescue inhaler 4-5 times
daily. According to GOLD guidelines, what is his COPD classification and recommended
first-line treatment?
A. GOLD 2 - LAMA monotherapy
B. GOLD 3 - LABA + LAMA combination
C. GOLD 4 - Triple therapy with LABA/LAMA/ICS
D. GOLD 3 - LABA monotherapy
Correct Answer: B
Rationale: With FEV1 45% predicted and significant dyspnea, this represents GOLD 3 (severe)
COPD. The recommended first-line treatment is LABA + LAMA combination therapy for
symptom management.
Question 5: A 77-year-old woman with type 2 diabetes has an HbA1c of 8.2%, BMI of 24, and
eGFR of 45 mL/min/1.73m². She currently takes metformin 1000mg BID and glipizide 5mg
daily. Which medication adjustment is most appropriate according to the Beers Criteria?
A. Continue current regimen
B. Reduce metformin to 500mg BID
C. Stop metformin and start insulin
D. Increase glipizide to 10mg daily
Correct Answer: B
Rationale: With eGFR 45 mL/min/1.73m², metformin should be reduced due to increased risk
of lactic acidosis. The Beers Criteria recommend dose reduction with eGFR 30-45 and
discontinuation when eGFR <30.
Question 6: A 79-year-old male patient is taking 12 different medications including warfarin,
atorvastatin, and omeprazole. His family reports increased confusion and falls over the past
month. Which assessment tool would best identify potentially inappropriate medications
contributing to his symptoms?
A. Barthel Index
, B. STOPP/START criteria
C. Geriatric Depression Scale
D. Katz Index of ADLs
Correct Answer: B
Rationale: The STOPP/START criteria specifically identify potentially inappropriate
medications in older adults, including drug-drug interactions and medications that may
contribute to falls and cognitive impairment.
Question 7: An 85-year-old female with advanced dementia and recurrent aspiration
pneumonia has a feeding tube placed. Her family requests that all care decisions be made by
the healthcare team as they "don't want to make difficult choices." Which ethical principle is
being compromised?
A. Beneficence
B. Autonomy
C. Non-maleficence
D. Justice
Correct Answer: B
Rationale: Patient autonomy and surrogate decision-making require that families/residents
make informed decisions based on patient values and preferences, not abdicate
decision-making to healthcare providers.
Question 8: A 76-year-old man with Parkinson's disease reports "freezing" episodes and
increased falls. His current medications include carbidopa/levodopa 25/100mg TID and
amantadine 100mg BID. On examination, he has dyskinesias and wearing-off phenomena.
Which medication adjustment is most appropriate?
A. Increase carbidopa/levodopa to QID
B. Add a COMT inhibitor
C. Decrease carbidopa/levodopa frequency
D. Stop amantadine
Correct Answer: B
Rationale: The patient exhibits motor complications from levodopa therapy. Adding a COMT
inhibitor (entacapone) can extend levodopa duration and reduce wearing-off phenomena
without increasing dyskinesias.
Question 9: An 82-year-old woman with osteoporosis and recent vertebral fracture has a
T-score of -3.2 at the lumbar spine. Her FRAX score shows 10-year fracture risk of 25%. Which
medication is most appropriate as first-line treatment?
A. Calcium and vitamin D only
ACTUAL EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1: A 78-year-old female patient with a history of diabetes and hypertension presents
with confusion, urinary frequency, and increased thirst. Her family reports these symptoms
developed gradually over the past 2 weeks. Her MMSE score is 22/30, down from 27/30 six
months ago. Which assessment finding would best differentiate delirium from dementia in
this patient?
A. Gradual onset of symptoms over weeks
B. Fluctuating level of consciousness throughout the day
C. History of diabetes mellitus
D. Decreased MMSE score from baseline
Correct Answer: B
Rationale: Delirium is characterized by acute onset, fluctuating consciousness, and
inattention, while dementia has a more insidious onset with stable level of consciousness.
The fluctuating level of consciousness is a hallmark differentiating feature.
Question 2: A 82-year-old male resident in a long-term care facility with advanced Alzheimer's
disease becomes agitated and aggressive during evening care. He has a history of falls and
is currently taking donepezil and memantine. Which non-pharmacological intervention should
be implemented first according to the DICE approach?
A. Administer PRN haloperidol
B. Investigate potential triggers for the behavior
C. Increase donepezil dosage
D. Apply physical restraints
Correct Answer: B
Rationale: The DICE approach (Describe, Investigate, Create, Evaluate) prioritizes
investigating potential triggers for behavioral and psychological symptoms of dementia
(BPSD) before implementing interventions.
Question 3: A 75-year-old woman with heart failure presents with a 5-pound weight gain in 3
days, bilateral ankle edema, and reports sleeping on 3 pillows instead of her usual 1 pillow.
Her current medications include lisinopril 10mg daily, furosemide 20mg daily, and metoprolol
50mg BID. Which medication adjustment is most appropriate?
A. Increase lisinopril to 20mg daily
,B. Increase furosemide to 40mg daily
C. Decrease metoprolol to 25mg BID
D. Add digoxin 0.125mg daily
Correct Answer: B
Rationale: The patient is exhibiting signs of fluid overload (weight gain, edema, orthopnea).
Increasing the diuretic (furosemide) is the most appropriate initial response to manage fluid
retention in heart failure exacerbation.
Question 4: An 80-year-old male with COPD has an FEV1/FVC ratio of 55% and FEV1 of 45%
predicted. He reports dyspnea with minimal activity and uses his rescue inhaler 4-5 times
daily. According to GOLD guidelines, what is his COPD classification and recommended
first-line treatment?
A. GOLD 2 - LAMA monotherapy
B. GOLD 3 - LABA + LAMA combination
C. GOLD 4 - Triple therapy with LABA/LAMA/ICS
D. GOLD 3 - LABA monotherapy
Correct Answer: B
Rationale: With FEV1 45% predicted and significant dyspnea, this represents GOLD 3 (severe)
COPD. The recommended first-line treatment is LABA + LAMA combination therapy for
symptom management.
Question 5: A 77-year-old woman with type 2 diabetes has an HbA1c of 8.2%, BMI of 24, and
eGFR of 45 mL/min/1.73m². She currently takes metformin 1000mg BID and glipizide 5mg
daily. Which medication adjustment is most appropriate according to the Beers Criteria?
A. Continue current regimen
B. Reduce metformin to 500mg BID
C. Stop metformin and start insulin
D. Increase glipizide to 10mg daily
Correct Answer: B
Rationale: With eGFR 45 mL/min/1.73m², metformin should be reduced due to increased risk
of lactic acidosis. The Beers Criteria recommend dose reduction with eGFR 30-45 and
discontinuation when eGFR <30.
Question 6: A 79-year-old male patient is taking 12 different medications including warfarin,
atorvastatin, and omeprazole. His family reports increased confusion and falls over the past
month. Which assessment tool would best identify potentially inappropriate medications
contributing to his symptoms?
A. Barthel Index
, B. STOPP/START criteria
C. Geriatric Depression Scale
D. Katz Index of ADLs
Correct Answer: B
Rationale: The STOPP/START criteria specifically identify potentially inappropriate
medications in older adults, including drug-drug interactions and medications that may
contribute to falls and cognitive impairment.
Question 7: An 85-year-old female with advanced dementia and recurrent aspiration
pneumonia has a feeding tube placed. Her family requests that all care decisions be made by
the healthcare team as they "don't want to make difficult choices." Which ethical principle is
being compromised?
A. Beneficence
B. Autonomy
C. Non-maleficence
D. Justice
Correct Answer: B
Rationale: Patient autonomy and surrogate decision-making require that families/residents
make informed decisions based on patient values and preferences, not abdicate
decision-making to healthcare providers.
Question 8: A 76-year-old man with Parkinson's disease reports "freezing" episodes and
increased falls. His current medications include carbidopa/levodopa 25/100mg TID and
amantadine 100mg BID. On examination, he has dyskinesias and wearing-off phenomena.
Which medication adjustment is most appropriate?
A. Increase carbidopa/levodopa to QID
B. Add a COMT inhibitor
C. Decrease carbidopa/levodopa frequency
D. Stop amantadine
Correct Answer: B
Rationale: The patient exhibits motor complications from levodopa therapy. Adding a COMT
inhibitor (entacapone) can extend levodopa duration and reduce wearing-off phenomena
without increasing dyskinesias.
Question 9: An 82-year-old woman with osteoporosis and recent vertebral fracture has a
T-score of -3.2 at the lumbar spine. Her FRAX score shows 10-year fracture risk of 25%. Which
medication is most appropriate as first-line treatment?
A. Calcium and vitamin D only
