NUR 257 CHRONIC EXAM 2 WITH CORRECT ANSWERS PLUS
RATIONALES 2026/2027 VERSION
1. An older adult reports dizziness when standing after taking antihypertensive
medication. What is the nurse's priority assessment?
• A) Hearing acuity
• B) Orthostatic blood pressure
• C) Visual acuity
• D) Pain level
Answer: B
Rationale: Antihypertensives can cause orthostatic hypotension, significantly increasing
fall risk in older adults. Checking orthostatic blood pressure (lying, sitting, standing) helps
identify this issue and guide interventions .
2. Which finding suggests dysphagia in an older adult?
• A) Increased appetite
• B) Dry skin
• C) Coughing during meals
• D) Increased urination
Answer: C
Rationale: Coughing or throat clearing during meals may indicate swallowing difficulty
and aspiration risk, which can lead to pneumonia and malnutrition in older adults .
3. A nurse is assessing an older adult client for delirium. Which characteristic
distinguishes delirium from dementia?
• A) Gradual onset over years
• B) Acute onset with fluctuating levels of consciousness
• C) Irreversible cognitive decline
• D) Intact attention span
,Answer: B
Rationale: Delirium is characterized by an acute, rapid onset and fluctuating levels of
consciousness, whereas dementia is gradual and progressive .
4. Which chronic condition is characterized by irreversible obstruction of airflow
and is often associated with long-term smoking?
• A) Chronic Obstructive Pulmonary Disease (COPD)
• B) Congestive Heart Failure
• C) Diabetes Mellitus Type 2
• D) Rheumatoid Arthritis
Answer: A
Rationale: COPD is a chronic inflammatory lung disease causing obstructed airflow,
primarily caused by long-term exposure to cigarette smoke .
5. When educating an older adult about hypertension management, which lifestyle
modification has the most significant impact on blood pressure reduction?
• A) Reducing caffeine intake
• B) Increasing protein intake
• C) Taking daily vitamin C supplements
• D) Weight reduction and DASH diet
Answer: D
Rationale: Weight loss and the Dietary Approaches to Stop Hypertension (DASH) diet are
proven to significantly lower blood pressure in hypertensive patients .
6. An older adult patient is diagnosed with Right-sided Heart Failure. Which
clinical manifestation should the nurse expect to observe?
• A) Pulmonary edema
, • B) Peripheral edema and jugular venous distention
• C) Crackles in the lungs
• D) Dyspnea on exertion
Answer: B
Rationale: Right-sided heart failure causes blood to back up into the systemic circulation,
leading to peripheral edema, ascites, and jugular venous distention .
7. What is the primary goal of Palliative Care for a patient with a chronic, life-
limiting illness?
• A) Curing the underlying disease
• B) Improving quality of life through symptom management
• C) Speeding up the dying process
• D) Limiting all medical interventions
Answer: B
Rationale: Palliative care focuses on providing relief from symptoms and stress of a serious
illness to improve quality of life for both the patient and the family .
8. Which of the following is a common geriatric syndrome characterized by a loss
of muscle mass and strength?
• A) Sarcopenia
• B) Osteoporosis
• C) Presbyopia
• D) Kyphosis
Answer: A
Rationale: Sarcopenia is the age-related loss of skeletal muscle mass and strength, which
contributes to frailty and falls .
, 9. A nurse is teaching a client diagnosed with aortic stenosis about strategies to
relieve angina without taking medications. What should the nurse teach the client?
• A) Eat a small meal before taking nitroglycerin
• B) Drink a glass of milk before taking nitroglycerin
• C) Rest and relax before taking nitroglycerin
• D) Engage in 15 minutes of light exercise before taking nitroglycerin
Answer: C
Rationale: Resting and relaxing before taking nitroglycerin can help relieve angina
symptoms. Rest reduces myocardial oxygen demand .
10. A client with aortic stenosis is reluctant to have valve replacement surgery.
What less invasive treatment option is likely to relieve some symptoms?
• A) Balloon percutaneous valvuloplasty
• B) Placement of an autograft valve
• C) Antibiotic therapy
• D) Placement of a xenograft valve
Answer: A
Rationale: Balloon percutaneous valvuloplasty is a less invasive procedure that can relieve
symptoms of aortic stenosis. It does not replace the valve but stretches the narrowed valve
opening .
11. A client had a prosthetic valve replacement and is taking warfarin to reduce
thrombosis risk. What INR level would alert the nurse to notify the healthcare
provider?
• A) 2.6
• B) 3.4
• C) 3.0
• D) 3.8
RATIONALES 2026/2027 VERSION
1. An older adult reports dizziness when standing after taking antihypertensive
medication. What is the nurse's priority assessment?
• A) Hearing acuity
• B) Orthostatic blood pressure
• C) Visual acuity
• D) Pain level
Answer: B
Rationale: Antihypertensives can cause orthostatic hypotension, significantly increasing
fall risk in older adults. Checking orthostatic blood pressure (lying, sitting, standing) helps
identify this issue and guide interventions .
2. Which finding suggests dysphagia in an older adult?
• A) Increased appetite
• B) Dry skin
• C) Coughing during meals
• D) Increased urination
Answer: C
Rationale: Coughing or throat clearing during meals may indicate swallowing difficulty
and aspiration risk, which can lead to pneumonia and malnutrition in older adults .
3. A nurse is assessing an older adult client for delirium. Which characteristic
distinguishes delirium from dementia?
• A) Gradual onset over years
• B) Acute onset with fluctuating levels of consciousness
• C) Irreversible cognitive decline
• D) Intact attention span
,Answer: B
Rationale: Delirium is characterized by an acute, rapid onset and fluctuating levels of
consciousness, whereas dementia is gradual and progressive .
4. Which chronic condition is characterized by irreversible obstruction of airflow
and is often associated with long-term smoking?
• A) Chronic Obstructive Pulmonary Disease (COPD)
• B) Congestive Heart Failure
• C) Diabetes Mellitus Type 2
• D) Rheumatoid Arthritis
Answer: A
Rationale: COPD is a chronic inflammatory lung disease causing obstructed airflow,
primarily caused by long-term exposure to cigarette smoke .
5. When educating an older adult about hypertension management, which lifestyle
modification has the most significant impact on blood pressure reduction?
• A) Reducing caffeine intake
• B) Increasing protein intake
• C) Taking daily vitamin C supplements
• D) Weight reduction and DASH diet
Answer: D
Rationale: Weight loss and the Dietary Approaches to Stop Hypertension (DASH) diet are
proven to significantly lower blood pressure in hypertensive patients .
6. An older adult patient is diagnosed with Right-sided Heart Failure. Which
clinical manifestation should the nurse expect to observe?
• A) Pulmonary edema
, • B) Peripheral edema and jugular venous distention
• C) Crackles in the lungs
• D) Dyspnea on exertion
Answer: B
Rationale: Right-sided heart failure causes blood to back up into the systemic circulation,
leading to peripheral edema, ascites, and jugular venous distention .
7. What is the primary goal of Palliative Care for a patient with a chronic, life-
limiting illness?
• A) Curing the underlying disease
• B) Improving quality of life through symptom management
• C) Speeding up the dying process
• D) Limiting all medical interventions
Answer: B
Rationale: Palliative care focuses on providing relief from symptoms and stress of a serious
illness to improve quality of life for both the patient and the family .
8. Which of the following is a common geriatric syndrome characterized by a loss
of muscle mass and strength?
• A) Sarcopenia
• B) Osteoporosis
• C) Presbyopia
• D) Kyphosis
Answer: A
Rationale: Sarcopenia is the age-related loss of skeletal muscle mass and strength, which
contributes to frailty and falls .
, 9. A nurse is teaching a client diagnosed with aortic stenosis about strategies to
relieve angina without taking medications. What should the nurse teach the client?
• A) Eat a small meal before taking nitroglycerin
• B) Drink a glass of milk before taking nitroglycerin
• C) Rest and relax before taking nitroglycerin
• D) Engage in 15 minutes of light exercise before taking nitroglycerin
Answer: C
Rationale: Resting and relaxing before taking nitroglycerin can help relieve angina
symptoms. Rest reduces myocardial oxygen demand .
10. A client with aortic stenosis is reluctant to have valve replacement surgery.
What less invasive treatment option is likely to relieve some symptoms?
• A) Balloon percutaneous valvuloplasty
• B) Placement of an autograft valve
• C) Antibiotic therapy
• D) Placement of a xenograft valve
Answer: A
Rationale: Balloon percutaneous valvuloplasty is a less invasive procedure that can relieve
symptoms of aortic stenosis. It does not replace the valve but stretches the narrowed valve
opening .
11. A client had a prosthetic valve replacement and is taking warfarin to reduce
thrombosis risk. What INR level would alert the nurse to notify the healthcare
provider?
• A) 2.6
• B) 3.4
• C) 3.0
• D) 3.8
