NUR 257 Exam 4: Concepts of
Aging & Chronic Illness
(Latest 2025/2026) – Verified
Questions, Answers &
Rationales – Galen College of
Nursing
Master your NUR 257 Chronic Exam 4 with this comprehensive study guide
updated for the 2025/2026 academic year. This document features NCLEX-
style questions with detailed rationales covering core concepts: geriatric
syndromes, musculoskeletal disorders (Osteoporosis, OA, RA), sensory
impairments, sleep hygiene, and chronic pain management. Perfect for
students at Galen College of Nursing and others seeking a guaranteed pass.
Instant PDF download included!
, 1. A nurse is conducting a sleep assessment on an older adult. Which of the following is a
normal age-related change in sleep architecture?
a) Increase in Stage 3 and Stage 4 sleep.
b) Decrease in the time spent in REM sleep.
c) Increase in the total amount of sleep needed.
d) Decrease in sleep latency (time to fall asleep).
b) Decrease in the time spent in REM sleep.
Rationale: As individuals age, they spend less time in REM (Rapid Eye Movement) and deep
sleep (Stages 3 and 4), while spending more time in Stage 1 and light sleep.
2. A patient with osteoarthritis (OA) asks how to slow the progression of the disease.
Which recommendation should the nurse provide?
a) Avoid all physical activity to preserve the joint.
b) Engage in high-impact aerobics to strengthen muscles.
c) Maintain a healthy weight and perform low-impact exercises like swimming.
d) Use heat packs continuously throughout the day.
c) Maintain a healthy weight and perform low-impact exercises like swimming.
Rationale: Low-impact activities like swimming or walking reduce joint stress while
maintaining mobility. Weight management is crucial to reduce the load on weight-
bearing joints.
3. An older adult is diagnosed with open-angle glaucoma. What clinical manifestation
should the nurse expect to find?
a) Sudden, severe eye pain and nausea.
b) Floating spots or "cobwebs" in the vision.
c) Gradual loss of peripheral vision (tunnel vision).
d) Total loss of central vision.
c) Gradual loss of peripheral vision (tunnel vision).
Rationale: Open-angle glaucoma typically presents with a painless, gradual loss of
peripheral vision due to increased intraocular pressure.
4. A nurse is teaching a client about gout management. Which statement by the client
indicates a need for further teaching?
a) "I will take allopurinol daily to prevent future attacks."
b) "I should avoid eating organ meats like liver and kidneys."
c) "I can drink a few glasses of beer every night to help me relax."
, d) "I will use colchicine if I have a sudden, painful flare-up."
c) "I can drink a few glasses of beer every night to help me relax."
Rationale: Alcohol, especially beer, can trigger gout attacks by increasing uric acid levels.
Allopurinol is for chronic prevention, and colchicine is for acute attacks.
5. Which of the following non-pharmacological interventions is most appropriate for a
client with chronic back pain who wants to avoid more medication?
a) Absolute bed rest until the pain resolves.
b) Guided imagery and relaxation techniques.
c) Restricting fluid intake to reduce swelling.
d) Vigorous massage directly over the painful area.
b) Guided imagery and relaxation techniques.
Rationale: Cognitive-behavioral techniques like guided imagery reduce pain perception
and are effective non-pharmacological adjuncts for chronic pain management.
6. A nurse observes a patient who snores loudly and reports morning headaches. What is
the priority assessment for this client?
a) Assess for signs of obstructive sleep apnea (OSA).
b) Determine if the patient has a history of restless leg syndrome.
c) Evaluate the patient's intake of caffeine before bed.
d) Check for symptoms of macular degeneration.
a) Assess for signs of obstructive sleep apnea (OSA).
Rationale: Snoring combined with morning headaches and daytime irritability are classic
indicators of sleep apnea in older adults.
7. A patient is recovering from cataract surgery. Which discharge instruction is the most
important for the nurse to include?
a) Expect severe eye pain for the first 48 hours.
b) Notify the provider immediately if you experience sharp, sudden pain.
c) Sleep on the operative side to reduce pressure.
d) Avoid using any eye shields during the night.
b) Notify the provider immediately if you experience sharp, sudden pain.
Rationale: Severe or sudden pain after cataract surgery can indicate complications like
increased intraocular pressure or hemorrhage and requires immediate medical attention.
8. When assessing an older adult with advanced dementia for pain, which tool is most
appropriate?
a) Numeric Pain Rating Scale (0-10).
b) Visual Analog Scale (VAS).
c) PAINAD (Pain Assessment in Advanced Dementia) scale.
, d) Wong-Baker FACES scale.
c) PAINAD (Pain Assessment in Advanced Dementia) scale.
Rationale: The PAINAD scale is designed specifically for non-verbal patients with
cognitive impairment, focusing on behaviors like breathing, vocalization, and body
language.
9. A nurse is educating a client on osteoporosis prevention. Which lifestyle modification
should be emphasized?
a) Increasing caffeine intake to improve energy.
b) Using a firm mattress for sleeping.
c) Performing daily weight-bearing exercises like walking.
d) Avoiding all dairy products to reduce inflammation.
c) Performing daily weight-bearing exercises like walking.
Rationale: Weight-bearing exercise stimulates osteoblast activity, which helps maintain
and build bone density in patients with osteoporosis.
10. An older adult patient has "linear, serpiginous burrows" between their fingers and
reports intense itching at night. What does the nurse suspect?
a) Candidiasis.
b) Scabies.
c) Xerosis.
d) Pressure injury.
b) Scabies.
Rationale: The characteristic "linear, serpiginous (curved) burrows" and nocturnal itching
are classic signs of a scabies infestation in older adults. [Search Context]
11. A nurse identifies a patient is at high risk for falls. Which extrinsic (environmental) factor
should be addressed first?
a) The patient's unsteady gait.
b) Poor lighting and loose scatter rugs in the hallway.
c) The patient's history of orthostatic hypotension.
d) Cognitive impairment from dementia.
b) Poor lighting and loose scatter rugs in the hallway.
Rationale: Extrinsic factors refer to the external environment. Gait, hypotension, and
cognitive status are intrinsic factors belonging to the patient.
12. A patient with Rheumatoid Arthritis (RA) is prescribed daily Prednisone. What should be
included in their education?
a) Stop the medication immediately if you feel better.
b) Take a bone density scan every two years.
Aging & Chronic Illness
(Latest 2025/2026) – Verified
Questions, Answers &
Rationales – Galen College of
Nursing
Master your NUR 257 Chronic Exam 4 with this comprehensive study guide
updated for the 2025/2026 academic year. This document features NCLEX-
style questions with detailed rationales covering core concepts: geriatric
syndromes, musculoskeletal disorders (Osteoporosis, OA, RA), sensory
impairments, sleep hygiene, and chronic pain management. Perfect for
students at Galen College of Nursing and others seeking a guaranteed pass.
Instant PDF download included!
, 1. A nurse is conducting a sleep assessment on an older adult. Which of the following is a
normal age-related change in sleep architecture?
a) Increase in Stage 3 and Stage 4 sleep.
b) Decrease in the time spent in REM sleep.
c) Increase in the total amount of sleep needed.
d) Decrease in sleep latency (time to fall asleep).
b) Decrease in the time spent in REM sleep.
Rationale: As individuals age, they spend less time in REM (Rapid Eye Movement) and deep
sleep (Stages 3 and 4), while spending more time in Stage 1 and light sleep.
2. A patient with osteoarthritis (OA) asks how to slow the progression of the disease.
Which recommendation should the nurse provide?
a) Avoid all physical activity to preserve the joint.
b) Engage in high-impact aerobics to strengthen muscles.
c) Maintain a healthy weight and perform low-impact exercises like swimming.
d) Use heat packs continuously throughout the day.
c) Maintain a healthy weight and perform low-impact exercises like swimming.
Rationale: Low-impact activities like swimming or walking reduce joint stress while
maintaining mobility. Weight management is crucial to reduce the load on weight-
bearing joints.
3. An older adult is diagnosed with open-angle glaucoma. What clinical manifestation
should the nurse expect to find?
a) Sudden, severe eye pain and nausea.
b) Floating spots or "cobwebs" in the vision.
c) Gradual loss of peripheral vision (tunnel vision).
d) Total loss of central vision.
c) Gradual loss of peripheral vision (tunnel vision).
Rationale: Open-angle glaucoma typically presents with a painless, gradual loss of
peripheral vision due to increased intraocular pressure.
4. A nurse is teaching a client about gout management. Which statement by the client
indicates a need for further teaching?
a) "I will take allopurinol daily to prevent future attacks."
b) "I should avoid eating organ meats like liver and kidneys."
c) "I can drink a few glasses of beer every night to help me relax."
, d) "I will use colchicine if I have a sudden, painful flare-up."
c) "I can drink a few glasses of beer every night to help me relax."
Rationale: Alcohol, especially beer, can trigger gout attacks by increasing uric acid levels.
Allopurinol is for chronic prevention, and colchicine is for acute attacks.
5. Which of the following non-pharmacological interventions is most appropriate for a
client with chronic back pain who wants to avoid more medication?
a) Absolute bed rest until the pain resolves.
b) Guided imagery and relaxation techniques.
c) Restricting fluid intake to reduce swelling.
d) Vigorous massage directly over the painful area.
b) Guided imagery and relaxation techniques.
Rationale: Cognitive-behavioral techniques like guided imagery reduce pain perception
and are effective non-pharmacological adjuncts for chronic pain management.
6. A nurse observes a patient who snores loudly and reports morning headaches. What is
the priority assessment for this client?
a) Assess for signs of obstructive sleep apnea (OSA).
b) Determine if the patient has a history of restless leg syndrome.
c) Evaluate the patient's intake of caffeine before bed.
d) Check for symptoms of macular degeneration.
a) Assess for signs of obstructive sleep apnea (OSA).
Rationale: Snoring combined with morning headaches and daytime irritability are classic
indicators of sleep apnea in older adults.
7. A patient is recovering from cataract surgery. Which discharge instruction is the most
important for the nurse to include?
a) Expect severe eye pain for the first 48 hours.
b) Notify the provider immediately if you experience sharp, sudden pain.
c) Sleep on the operative side to reduce pressure.
d) Avoid using any eye shields during the night.
b) Notify the provider immediately if you experience sharp, sudden pain.
Rationale: Severe or sudden pain after cataract surgery can indicate complications like
increased intraocular pressure or hemorrhage and requires immediate medical attention.
8. When assessing an older adult with advanced dementia for pain, which tool is most
appropriate?
a) Numeric Pain Rating Scale (0-10).
b) Visual Analog Scale (VAS).
c) PAINAD (Pain Assessment in Advanced Dementia) scale.
, d) Wong-Baker FACES scale.
c) PAINAD (Pain Assessment in Advanced Dementia) scale.
Rationale: The PAINAD scale is designed specifically for non-verbal patients with
cognitive impairment, focusing on behaviors like breathing, vocalization, and body
language.
9. A nurse is educating a client on osteoporosis prevention. Which lifestyle modification
should be emphasized?
a) Increasing caffeine intake to improve energy.
b) Using a firm mattress for sleeping.
c) Performing daily weight-bearing exercises like walking.
d) Avoiding all dairy products to reduce inflammation.
c) Performing daily weight-bearing exercises like walking.
Rationale: Weight-bearing exercise stimulates osteoblast activity, which helps maintain
and build bone density in patients with osteoporosis.
10. An older adult patient has "linear, serpiginous burrows" between their fingers and
reports intense itching at night. What does the nurse suspect?
a) Candidiasis.
b) Scabies.
c) Xerosis.
d) Pressure injury.
b) Scabies.
Rationale: The characteristic "linear, serpiginous (curved) burrows" and nocturnal itching
are classic signs of a scabies infestation in older adults. [Search Context]
11. A nurse identifies a patient is at high risk for falls. Which extrinsic (environmental) factor
should be addressed first?
a) The patient's unsteady gait.
b) Poor lighting and loose scatter rugs in the hallway.
c) The patient's history of orthostatic hypotension.
d) Cognitive impairment from dementia.
b) Poor lighting and loose scatter rugs in the hallway.
Rationale: Extrinsic factors refer to the external environment. Gait, hypotension, and
cognitive status are intrinsic factors belonging to the patient.
12. A patient with Rheumatoid Arthritis (RA) is prescribed daily Prednisone. What should be
included in their education?
a) Stop the medication immediately if you feel better.
b) Take a bone density scan every two years.
