NUR257 Aging and Chronic Illness in Nursing Exam
3 - Galen College of Nursing 2026/2027 |
Gerontology & Chronic Care Review
60 Items | Geriatric Complexity & Chronic Care Focus
Section 1: Geriatric Assessment & Atypical Presentation (Questions 1-20)
1. An 85-year-old woman, Mrs. L, lives alone. Her daughter reports she has become
"confused" over 3 days. PMH: HTN, OA. Meds: Lisinopril, Acetaminophen PRN. Baseline:
independent in IADLs, uses a cane. Vitals: T 99.8°F (oral), HR 98, RR 22, BP 142/88.
Exam: Mildly lethargic, disoriented to time. Lungs: clear. No focal neuro deficits.
Urinalysis: +Leukocyte esterase, +Nitrites.
The nurse's initial analysis of this acute confusion should focus on:
A. Ruling out a new cerebrovascular accident (CVA).
B. Treating as delirium secondary to a likely UTI until proven otherwise. (Correct Answer)
C. Starting a dementia evaluation (Mini-Cog, MMSE).
D. Assuming it is sundowning and recommending increased daytime activity.
Answer: B
Rationale: Acute onset confusion in an older adult is delirium until proven otherwise,
and UTI is a common, reversible cause. This follows the geriatric imperative to search
for underlying medical causes of mental status changes. Initiating a dementia workup
(C) is inappropriate for an acute change. While a CVA (A) should be considered, the
absence of focal findings and presence of UTI signs make infection the more probable
cause. Labeling it as sundowning (D) is dismissive and delays treatment.
,2. During a home visit, you note an 80-year-old man with Parkinson's disease has lost 8
pounds in 3 months without trying. He reports food "just doesn't taste good." Which
assessment is MOST critical to perform next?
A. A full nutritional panel (albumin, pre-albumin).
B. A medication review focusing on anticholinergic effects and timing of levodopa.
(Correct Answer)
C. A depression screen using the Geriatric Depression Scale (GDS).
D. A calorie count for 3 days.
Answer: B
Rationale: In Parkinson's, weight loss and taste changes are often linked to medication
side effects or off-periods. Levodopa can cause nausea, and anticholinergic drugs
(common for tremor) cause dry mouth and altered taste. This applies the principle of
assessing medication effects before pursuing complex diagnostics. While nutrition labs
(A), depression (C), and calorie counts (D) are relevant, the medication review is the
highest-yield, immediate, and modifiable intervention.
3. An 82-year-old man is brought to the ED after a fall at home. He is alert but states, "I
just felt dizzy." Vitals: HR 42, BP 160/90, RR 20, T 98.6°F, O2 sat 95% RA. Medications:
Metoprolol 50 mg BID, warfarin 5 mg daily, omeprazole 20 mg daily. EKG: Sinus
bradycardia, no ST changes. Which medication is MOST likely contributing to his fall
risk?
A. Omeprazole (increases bleeding risk)
B. Metoprolol (causes bradycardia and dizziness) (Correct Answer)
C. Warfarin (increases bleeding risk)
D. No medication issue; this is normal aging.
Answer: B
Rationale: Symptomatic bradycardia (HR 42) with dizziness is a direct effect of
metoprolol, a high-risk medication in older adults per Beers Criteria 2026 due to CNS
side effects and cardiac conduction suppression. While warfarin (C) increases bleeding
, risk, it does not cause dizziness. Omeprazole (A) is low-risk for falls. Attributing falls to
"normal aging" (D) is ageist and dismissive of reversible causes.
4. A nurse is performing a SPICES assessment on a newly admitted 78-year-old. Which
finding would be prioritized as the most urgent?
A. Sleep disturbance (up 4× per night)
B. Incontinence (occasional dribbling)
C. Confusion (oriented ×2, sundowning)
D. Evidence of falls (bruises on hips, fear of falling) (Correct Answer)
Answer: D
Rationale: Falls and fear of falling represent immediate safety risk and potential for
serious injury, making them the highest priority in SPICES (Sleep, Problems with feeding,
Incontinence, Confusion, Evidence of falls, Skin breakdown). While confusion (C) is
urgent, the physical evidence of trauma from falls takes precedence for immediate
safety interventions.
5. An 88-year-old woman with mild dementia (MMSE 22/30) is admitted with "failure to
thrive." She has lost 10 lbs in 6 months. Which component of the Comprehensive
Geriatric Assessment (CGA) should be initiated first?
A. Nutritional screening using the Mini Nutritional Assessment (MNA) (Correct Answer)
B. Cognitive testing with Montreal Cognitive Assessment (MoCA)
C. Depression screening with Geriatric Depression Scale (GDS)
D. Advanced care planning discussion
Answer: A
Rationale: Weight loss is a concrete, measurable decline that can be quickly assessed
and intervened upon. The MNA is a validated, rapid tool for older adults. While cognition
3 - Galen College of Nursing 2026/2027 |
Gerontology & Chronic Care Review
60 Items | Geriatric Complexity & Chronic Care Focus
Section 1: Geriatric Assessment & Atypical Presentation (Questions 1-20)
1. An 85-year-old woman, Mrs. L, lives alone. Her daughter reports she has become
"confused" over 3 days. PMH: HTN, OA. Meds: Lisinopril, Acetaminophen PRN. Baseline:
independent in IADLs, uses a cane. Vitals: T 99.8°F (oral), HR 98, RR 22, BP 142/88.
Exam: Mildly lethargic, disoriented to time. Lungs: clear. No focal neuro deficits.
Urinalysis: +Leukocyte esterase, +Nitrites.
The nurse's initial analysis of this acute confusion should focus on:
A. Ruling out a new cerebrovascular accident (CVA).
B. Treating as delirium secondary to a likely UTI until proven otherwise. (Correct Answer)
C. Starting a dementia evaluation (Mini-Cog, MMSE).
D. Assuming it is sundowning and recommending increased daytime activity.
Answer: B
Rationale: Acute onset confusion in an older adult is delirium until proven otherwise,
and UTI is a common, reversible cause. This follows the geriatric imperative to search
for underlying medical causes of mental status changes. Initiating a dementia workup
(C) is inappropriate for an acute change. While a CVA (A) should be considered, the
absence of focal findings and presence of UTI signs make infection the more probable
cause. Labeling it as sundowning (D) is dismissive and delays treatment.
,2. During a home visit, you note an 80-year-old man with Parkinson's disease has lost 8
pounds in 3 months without trying. He reports food "just doesn't taste good." Which
assessment is MOST critical to perform next?
A. A full nutritional panel (albumin, pre-albumin).
B. A medication review focusing on anticholinergic effects and timing of levodopa.
(Correct Answer)
C. A depression screen using the Geriatric Depression Scale (GDS).
D. A calorie count for 3 days.
Answer: B
Rationale: In Parkinson's, weight loss and taste changes are often linked to medication
side effects or off-periods. Levodopa can cause nausea, and anticholinergic drugs
(common for tremor) cause dry mouth and altered taste. This applies the principle of
assessing medication effects before pursuing complex diagnostics. While nutrition labs
(A), depression (C), and calorie counts (D) are relevant, the medication review is the
highest-yield, immediate, and modifiable intervention.
3. An 82-year-old man is brought to the ED after a fall at home. He is alert but states, "I
just felt dizzy." Vitals: HR 42, BP 160/90, RR 20, T 98.6°F, O2 sat 95% RA. Medications:
Metoprolol 50 mg BID, warfarin 5 mg daily, omeprazole 20 mg daily. EKG: Sinus
bradycardia, no ST changes. Which medication is MOST likely contributing to his fall
risk?
A. Omeprazole (increases bleeding risk)
B. Metoprolol (causes bradycardia and dizziness) (Correct Answer)
C. Warfarin (increases bleeding risk)
D. No medication issue; this is normal aging.
Answer: B
Rationale: Symptomatic bradycardia (HR 42) with dizziness is a direct effect of
metoprolol, a high-risk medication in older adults per Beers Criteria 2026 due to CNS
side effects and cardiac conduction suppression. While warfarin (C) increases bleeding
, risk, it does not cause dizziness. Omeprazole (A) is low-risk for falls. Attributing falls to
"normal aging" (D) is ageist and dismissive of reversible causes.
4. A nurse is performing a SPICES assessment on a newly admitted 78-year-old. Which
finding would be prioritized as the most urgent?
A. Sleep disturbance (up 4× per night)
B. Incontinence (occasional dribbling)
C. Confusion (oriented ×2, sundowning)
D. Evidence of falls (bruises on hips, fear of falling) (Correct Answer)
Answer: D
Rationale: Falls and fear of falling represent immediate safety risk and potential for
serious injury, making them the highest priority in SPICES (Sleep, Problems with feeding,
Incontinence, Confusion, Evidence of falls, Skin breakdown). While confusion (C) is
urgent, the physical evidence of trauma from falls takes precedence for immediate
safety interventions.
5. An 88-year-old woman with mild dementia (MMSE 22/30) is admitted with "failure to
thrive." She has lost 10 lbs in 6 months. Which component of the Comprehensive
Geriatric Assessment (CGA) should be initiated first?
A. Nutritional screening using the Mini Nutritional Assessment (MNA) (Correct Answer)
B. Cognitive testing with Montreal Cognitive Assessment (MoCA)
C. Depression screening with Geriatric Depression Scale (GDS)
D. Advanced care planning discussion
Answer: A
Rationale: Weight loss is a concrete, measurable decline that can be quickly assessed
and intervened upon. The MNA is a validated, rapid tool for older adults. While cognition
