NU 176: GERIATRIC NURSING EXAM 2 VERIFIED EXAM SOLUTIONS
- COMPREHENSIVE QUESTIONS AND ANSWERS - CURRENT
VERSION (2026/2027)
Q1. What is the most common cardiovascular disease in older adults?
ANSWER Hypertension (high blood pressure), affecting more than 70% of
adults over age 65.
Q2. What is the normal age-related change in the heart that reduces
cardiac output? ANSWER Decreased heart rate response to stress
(chronotropic incompetence) and reduced ventricular compliance lead to
decreased cardiac output with age.
Q3. How does blood pressure normally change with aging? ANSWER
Systolic blood pressure tends to increase due to arterial stiffness; diastolic
pressure may decrease after age 60, leading to widened pulse pressure.
Q4. What is isolated systolic hypertension (ISH)? ANSWER A condition
where systolic BP is ≥140 mmHg but diastolic BP is <90 mmHg; common in
older adults due to arterial stiffness.
Q5. What are the first-line lifestyle modifications for hypertension in the
elderly? ANSWER DASH diet, sodium restriction (<2g/day), weight loss,
regular aerobic exercise, limiting alcohol, and smoking cessation.
Q6. What class of antihypertensive is preferred for elderly patients with
heart failure with reduced ejection fraction? ANSWER ACE inhibitors
(e.g., lisinopril) or ARBs (e.g., losartan), plus beta-blockers and diuretics.
Q7. Why are older adults at higher risk for orthostatic hypotension?
ANSWER Due to decreased baroreceptor sensitivity, reduced vascular
compliance, and medications (diuretics, antihypertensives, alpha-blockers).
Q8. How is orthostatic hypotension defined? ANSWER A drop in systolic
BP ≥20 mmHg or diastolic BP ≥10 mmHg within 3 minutes of standing from
sitting or lying.
Q9. What nursing intervention helps prevent falls due to orthostatic
hypotension? ANSWER Teach patient to rise slowly from lying to sitting to
standing; dangle legs at bedside; avoid prolonged standing; stay hydrated.
,Q10. What ECG change is a common age-related finding in older adults?
ANSWER Slight prolongation of the PR interval and increased prevalence of
bundle branch blocks; however, ST changes should always be investigated.
Q11. What is atrial fibrillation (A-fib) and why is it common in the elderly?
ANSWER An irregular, chaotic atrial rhythm caused by disorganized electrical
impulses; more common with age due to atrial fibrosis, hypertension, and
valvular disease.
Q12. What is the major complication of untreated atrial fibrillation?
ANSWER Stroke due to thrombus formation in the left atrial appendage.
Q13. What anticoagulant is commonly used in elderly A-fib patients to
prevent stroke? ANSWER Warfarin or direct oral anticoagulants (DOACs)
such as apixaban (Eliquis) or rivaroxaban (Xarelto).
Q14. What score is used to assess stroke risk in A-fib patients? ANSWER
The CHA2DS2-VASc score (Congestive HF, Hypertension, Age 75+, Diabetes,
Stroke history, Vascular disease, Age 65-74, Sex).
Q15. What are classic signs of heart failure in elderly patients? ANSWER
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, crackles
in lungs, S3 gallop, weight gain, and fatigue.
Q16. Why may elderly patients with MI present atypically? ANSWER
They may present with fatigue, confusion, nausea, dyspnea, or syncope instead
of classic crushing chest pain, due to altered pain perception and comorbidities.
Q17. What lab marker confirms myocardial infarction? ANSWER
Troponin I or Troponin T; elevated levels indicate myocardial cell injury.
Q18. What is the nursing priority for a patient with suspected acute MI?
ANSWER Administer supplemental oxygen if SpO2 <90%, obtain 12-lead
ECG, establish IV access, give aspirin 325 mg, notify physician immediately.
Q19. What is peripheral artery disease (PAD) and how does it present?
ANSWER Atherosclerotic narrowing of peripheral arteries; presents with
intermittent claudication, cold extremities, decreased or absent pulses, and non-
healing wounds.
Q20. What is the ABI (Ankle-Brachial Index) and what value indicates
PAD? ANSWER Ratio of ankle systolic BP to arm systolic BP; an ABI <0.9
indicates PAD.
, Q21. What lifestyle change is most important for patients with PAD?
ANSWER Smoking cessation is the single most important modifiable risk
factor.
Q22. What is venous thromboembolism (VTE) and why are elderly at
increased risk? ANSWER DVT or pulmonary embolism; elderly are at risk
due to immobility, dehydration, venous insufficiency, and hypercoagulable
states.
Q23. What is Virchow's Triad? ANSWER Three factors contributing to
thrombosis: venous stasis, endothelial injury, and hypercoagulability.
Q24. What are the classic signs of deep vein thrombosis (DVT)? ANSWER
Unilateral leg swelling, warmth, redness, and pain (Homan's sign is not
reliable).
Q25. What diagnostic test confirms DVT? ANSWER Venous duplex
ultrasound.
Q26. What medication is used in the acute treatment of DVT? ANSWER
Heparin (IV unfractionated or subcutaneous LMWH such as enoxaparin),
followed by long-term anticoagulation with warfarin or a DOAC.
Q27. What patient education is important for patients on warfarin?
ANSWER Consistent vitamin K intake, frequent INR monitoring (goal 2-3),
avoid NSAIDs, watch for signs of bleeding, and inform all providers of
anticoagulation.
Q28. What signs of heart failure exacerbation warrant immediate
reporting? ANSWER Weight gain >2 lbs in 1 day or >5 lbs in a week,
worsening dyspnea, increased edema, or decreased activity tolerance.
Q29. What is the significance of BNP (Brain Natriuretic Peptide)?
ANSWER Elevated BNP indicates ventricular wall stress and is used to
diagnose and monitor heart failure severity.
Q30. What is cardiac rehabilitation and why is it beneficial for older
adults? ANSWER A supervised program of exercise, education, and cardiac
risk reduction; improves functional capacity, quality of life, and reduces
hospitalizations.
Q31. What are age-related changes to the heart valves? ANSWER
Calcification of valve leaflets and annuli; aortic stenosis is the most common
valvular disease in the elderly due to calcific degeneration.
- COMPREHENSIVE QUESTIONS AND ANSWERS - CURRENT
VERSION (2026/2027)
Q1. What is the most common cardiovascular disease in older adults?
ANSWER Hypertension (high blood pressure), affecting more than 70% of
adults over age 65.
Q2. What is the normal age-related change in the heart that reduces
cardiac output? ANSWER Decreased heart rate response to stress
(chronotropic incompetence) and reduced ventricular compliance lead to
decreased cardiac output with age.
Q3. How does blood pressure normally change with aging? ANSWER
Systolic blood pressure tends to increase due to arterial stiffness; diastolic
pressure may decrease after age 60, leading to widened pulse pressure.
Q4. What is isolated systolic hypertension (ISH)? ANSWER A condition
where systolic BP is ≥140 mmHg but diastolic BP is <90 mmHg; common in
older adults due to arterial stiffness.
Q5. What are the first-line lifestyle modifications for hypertension in the
elderly? ANSWER DASH diet, sodium restriction (<2g/day), weight loss,
regular aerobic exercise, limiting alcohol, and smoking cessation.
Q6. What class of antihypertensive is preferred for elderly patients with
heart failure with reduced ejection fraction? ANSWER ACE inhibitors
(e.g., lisinopril) or ARBs (e.g., losartan), plus beta-blockers and diuretics.
Q7. Why are older adults at higher risk for orthostatic hypotension?
ANSWER Due to decreased baroreceptor sensitivity, reduced vascular
compliance, and medications (diuretics, antihypertensives, alpha-blockers).
Q8. How is orthostatic hypotension defined? ANSWER A drop in systolic
BP ≥20 mmHg or diastolic BP ≥10 mmHg within 3 minutes of standing from
sitting or lying.
Q9. What nursing intervention helps prevent falls due to orthostatic
hypotension? ANSWER Teach patient to rise slowly from lying to sitting to
standing; dangle legs at bedside; avoid prolonged standing; stay hydrated.
,Q10. What ECG change is a common age-related finding in older adults?
ANSWER Slight prolongation of the PR interval and increased prevalence of
bundle branch blocks; however, ST changes should always be investigated.
Q11. What is atrial fibrillation (A-fib) and why is it common in the elderly?
ANSWER An irregular, chaotic atrial rhythm caused by disorganized electrical
impulses; more common with age due to atrial fibrosis, hypertension, and
valvular disease.
Q12. What is the major complication of untreated atrial fibrillation?
ANSWER Stroke due to thrombus formation in the left atrial appendage.
Q13. What anticoagulant is commonly used in elderly A-fib patients to
prevent stroke? ANSWER Warfarin or direct oral anticoagulants (DOACs)
such as apixaban (Eliquis) or rivaroxaban (Xarelto).
Q14. What score is used to assess stroke risk in A-fib patients? ANSWER
The CHA2DS2-VASc score (Congestive HF, Hypertension, Age 75+, Diabetes,
Stroke history, Vascular disease, Age 65-74, Sex).
Q15. What are classic signs of heart failure in elderly patients? ANSWER
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, crackles
in lungs, S3 gallop, weight gain, and fatigue.
Q16. Why may elderly patients with MI present atypically? ANSWER
They may present with fatigue, confusion, nausea, dyspnea, or syncope instead
of classic crushing chest pain, due to altered pain perception and comorbidities.
Q17. What lab marker confirms myocardial infarction? ANSWER
Troponin I or Troponin T; elevated levels indicate myocardial cell injury.
Q18. What is the nursing priority for a patient with suspected acute MI?
ANSWER Administer supplemental oxygen if SpO2 <90%, obtain 12-lead
ECG, establish IV access, give aspirin 325 mg, notify physician immediately.
Q19. What is peripheral artery disease (PAD) and how does it present?
ANSWER Atherosclerotic narrowing of peripheral arteries; presents with
intermittent claudication, cold extremities, decreased or absent pulses, and non-
healing wounds.
Q20. What is the ABI (Ankle-Brachial Index) and what value indicates
PAD? ANSWER Ratio of ankle systolic BP to arm systolic BP; an ABI <0.9
indicates PAD.
, Q21. What lifestyle change is most important for patients with PAD?
ANSWER Smoking cessation is the single most important modifiable risk
factor.
Q22. What is venous thromboembolism (VTE) and why are elderly at
increased risk? ANSWER DVT or pulmonary embolism; elderly are at risk
due to immobility, dehydration, venous insufficiency, and hypercoagulable
states.
Q23. What is Virchow's Triad? ANSWER Three factors contributing to
thrombosis: venous stasis, endothelial injury, and hypercoagulability.
Q24. What are the classic signs of deep vein thrombosis (DVT)? ANSWER
Unilateral leg swelling, warmth, redness, and pain (Homan's sign is not
reliable).
Q25. What diagnostic test confirms DVT? ANSWER Venous duplex
ultrasound.
Q26. What medication is used in the acute treatment of DVT? ANSWER
Heparin (IV unfractionated or subcutaneous LMWH such as enoxaparin),
followed by long-term anticoagulation with warfarin or a DOAC.
Q27. What patient education is important for patients on warfarin?
ANSWER Consistent vitamin K intake, frequent INR monitoring (goal 2-3),
avoid NSAIDs, watch for signs of bleeding, and inform all providers of
anticoagulation.
Q28. What signs of heart failure exacerbation warrant immediate
reporting? ANSWER Weight gain >2 lbs in 1 day or >5 lbs in a week,
worsening dyspnea, increased edema, or decreased activity tolerance.
Q29. What is the significance of BNP (Brain Natriuretic Peptide)?
ANSWER Elevated BNP indicates ventricular wall stress and is used to
diagnose and monitor heart failure severity.
Q30. What is cardiac rehabilitation and why is it beneficial for older
adults? ANSWER A supervised program of exercise, education, and cardiac
risk reduction; improves functional capacity, quality of life, and reduces
hospitalizations.
Q31. What are age-related changes to the heart valves? ANSWER
Calcification of valve leaflets and annuli; aortic stenosis is the most common
valvular disease in the elderly due to calcific degeneration.
