NUR 257 Final Exam Study Guide
Comprehensive 100 Questions & Answers
2026/2027 Edition
SECTION 1: GERIATRIC SYNDROMES & ELDERLY CARE
(Questions 1-15)
1. A nurse is assessing an older adult client using the SPICES tool.
What does the "C" in SPICES represent?
A) Cognition
B) Confusion
C) Circulation
D) Coordination
Answer B:
Rationale: SPICES is an assessment tool for geriatric syndromes: S -
Sleep disorders, P - Problems with eating or feeding, I - Incontinence,
C - Confusion, E - Evidence of falls, S - Skin breakdown. This tool
provides a quick overall assessment focusing on common issues
affecting older adults. ---
,2. An 80-year-old patient with mild cognitive impairment is at risk
for dehydration. Which intervention should the nurse prioritize?
A) Restrict fluids after 6 PM to prevent nocturia
B) Offer small amounts of fluid frequently throughout the day
C) Encourage the patient to drink large amounts of water at meals
D) Limit fluid intake to 1,000 mL per day
Answer B:
Rationale: Older adults with cognitive impairment are at increased
risk for dehydration due to decreased thirst sensation and difficulty
remembering to drink. Offering small amounts of fluid frequently
throughout the day promotes adequate hydration without
overwhelming the patient. Restricting fluids increases the risk of
dehydration, UTIs, and acute kidney injury. ---
3. A nurse is evaluating an older adult patient with new-onset
urinary incontinence. Which action is most appropriate?
A) Place an indwelling catheter to manage the incontinence
B) Obtain a urinalysis and urine culture
C) Schedule a urology consultation immediately
D) Start the patient on anticholinergic medications
Answer B:
Rationale: New-onset urinary incontinence in older adults is not a
normal part of aging and requires evaluation for reversible causes.
Urinary tract infection is a common cause of acute incontinence in
older adults. A urinalysis and culture should be obtained before
initiating invasive or pharmacological interventions. ---
,4. A home health nurse visits an older adult patient living alone.
The patient reports falling twice in the past month. Which
assessment should the nurse prioritize?
A) Assessing the patient's nutritional status
B) Evaluating the patient's home environment for fall hazards
C) Reviewing the patient's medication list
D) All of the above
Answer D:
Rationale: Fall risk assessment in older adults should be
multifactorial, including evaluation of environmental hazards,
medication review (especially sedatives, antihypertensives, and
hypoglycemics), and nutritional status. All of these factors contribute
to fall risk and should be addressed to prevent future falls. ---
5. A nurse is teaching a family caregiver about providing care for
a patient with Alzheimer's disease. Which instruction is most
appropriate?
A) "Argue with the patient to help them remember reality"
B) "Maintain a structured daily routine"
C) "Allow the patient to wander freely for exercise"
D) "Correct the patient when they make mistakes"
Answer B:
Rationale: Maintaining a structured daily routine reduces confusion
and anxiety in patients with Alzheimer's disease. Arguing with or
correcting the patient can increase agitation and distress. Safe
wandering should be supervised to prevent injury. ---
, 6. A 75-year-old patient is prescribed a medication that the nurse
suspects is inappropriate for older adults. Which medication class
should the nurse question?
A) Antihypertensives
B) Antibiotics
C) Benzodiazepines
D) Statins
Answer C:
Rationale: Benzodiazepines are listed on the Beers Criteria as
potentially inappropriate for older adults due to increased risk of falls,
cognitive impairment, and dependence. If used, they should be at the
lowest effective dose for the shortest duration. Alternatives like SSRIs
or non-pharmacological interventions should be considered for anxiety
or insomnia. ---
7. An older adult patient is diagnosed with osteoporosis. Which
intervention should the nurse include in the care plan?
A) Encourage high-calcium diet and vitamin D supplementation
B) Restrict physical activity to prevent fractures
C) Administer calcium supplements once weekly
D) Limit fluid intake to prevent falls
Answer A:
Rationale: Osteoporosis management includes adequate calcium and
vitamin D intake, weight-bearing exercise, fall prevention strategies,
and pharmacological therapy as prescribed. Restricting activity
increases bone loss and fall risk. ---
Comprehensive 100 Questions & Answers
2026/2027 Edition
SECTION 1: GERIATRIC SYNDROMES & ELDERLY CARE
(Questions 1-15)
1. A nurse is assessing an older adult client using the SPICES tool.
What does the "C" in SPICES represent?
A) Cognition
B) Confusion
C) Circulation
D) Coordination
Answer B:
Rationale: SPICES is an assessment tool for geriatric syndromes: S -
Sleep disorders, P - Problems with eating or feeding, I - Incontinence,
C - Confusion, E - Evidence of falls, S - Skin breakdown. This tool
provides a quick overall assessment focusing on common issues
affecting older adults. ---
,2. An 80-year-old patient with mild cognitive impairment is at risk
for dehydration. Which intervention should the nurse prioritize?
A) Restrict fluids after 6 PM to prevent nocturia
B) Offer small amounts of fluid frequently throughout the day
C) Encourage the patient to drink large amounts of water at meals
D) Limit fluid intake to 1,000 mL per day
Answer B:
Rationale: Older adults with cognitive impairment are at increased
risk for dehydration due to decreased thirst sensation and difficulty
remembering to drink. Offering small amounts of fluid frequently
throughout the day promotes adequate hydration without
overwhelming the patient. Restricting fluids increases the risk of
dehydration, UTIs, and acute kidney injury. ---
3. A nurse is evaluating an older adult patient with new-onset
urinary incontinence. Which action is most appropriate?
A) Place an indwelling catheter to manage the incontinence
B) Obtain a urinalysis and urine culture
C) Schedule a urology consultation immediately
D) Start the patient on anticholinergic medications
Answer B:
Rationale: New-onset urinary incontinence in older adults is not a
normal part of aging and requires evaluation for reversible causes.
Urinary tract infection is a common cause of acute incontinence in
older adults. A urinalysis and culture should be obtained before
initiating invasive or pharmacological interventions. ---
,4. A home health nurse visits an older adult patient living alone.
The patient reports falling twice in the past month. Which
assessment should the nurse prioritize?
A) Assessing the patient's nutritional status
B) Evaluating the patient's home environment for fall hazards
C) Reviewing the patient's medication list
D) All of the above
Answer D:
Rationale: Fall risk assessment in older adults should be
multifactorial, including evaluation of environmental hazards,
medication review (especially sedatives, antihypertensives, and
hypoglycemics), and nutritional status. All of these factors contribute
to fall risk and should be addressed to prevent future falls. ---
5. A nurse is teaching a family caregiver about providing care for
a patient with Alzheimer's disease. Which instruction is most
appropriate?
A) "Argue with the patient to help them remember reality"
B) "Maintain a structured daily routine"
C) "Allow the patient to wander freely for exercise"
D) "Correct the patient when they make mistakes"
Answer B:
Rationale: Maintaining a structured daily routine reduces confusion
and anxiety in patients with Alzheimer's disease. Arguing with or
correcting the patient can increase agitation and distress. Safe
wandering should be supervised to prevent injury. ---
, 6. A 75-year-old patient is prescribed a medication that the nurse
suspects is inappropriate for older adults. Which medication class
should the nurse question?
A) Antihypertensives
B) Antibiotics
C) Benzodiazepines
D) Statins
Answer C:
Rationale: Benzodiazepines are listed on the Beers Criteria as
potentially inappropriate for older adults due to increased risk of falls,
cognitive impairment, and dependence. If used, they should be at the
lowest effective dose for the shortest duration. Alternatives like SSRIs
or non-pharmacological interventions should be considered for anxiety
or insomnia. ---
7. An older adult patient is diagnosed with osteoporosis. Which
intervention should the nurse include in the care plan?
A) Encourage high-calcium diet and vitamin D supplementation
B) Restrict physical activity to prevent fractures
C) Administer calcium supplements once weekly
D) Limit fluid intake to prevent falls
Answer A:
Rationale: Osteoporosis management includes adequate calcium and
vitamin D intake, weight-bearing exercise, fall prevention strategies,
and pharmacological therapy as prescribed. Restricting activity
increases bone loss and fall risk. ---
