NUR 257 Concepts Of Aging & Chronic Illness Exam 3
| 70 Verified Questions And Answers With Rationales |
2026/2027 Updates
Question 1.
An 81-year-old patient with a history of hypertension and diabetes is admitted with
acute confusion. Family reports the patient was fine yesterday but today is agitated,
disoriented, and picking at the bedsheets. Vital signs show temperature 101.8°F, HR
102, BP 148/88, RR 22, SpO2 92% on room air. The nurse suspects:
• A. Delirium due to infection, likely urinary tract infection or pneumonia,
requiring immediate assessment and treatment of the underlying cause
• B. Normal progression of Alzheimer's disease that does not require intervention
• C. Depression manifesting as psychomotor agitation
• D. Medication side effect that will resolve with time
Correct Answer: A
Rationale: This presentation is classic for delirium: acute onset (hours to days), fluctuating
course, inattention, disorganized thinking, and altered level of consciousness. The fever and
low oxygen saturation suggest infection (UTI, pneumonia, or sepsis) as the likely cause.
Delirium is a medical emergency requiring prompt identification and treatment of the
underlying cause. The CAM (Confusion Assessment Method) is the standard screening tool.
Non-pharmacological interventions (reorientation, sleep hygiene, sensory aids, family
involvement) are first-line. Antipsychotics are reserved for severe agitation threatening
safety.
Question 2.
A nurse is caring for an older adult with a new diagnosis of Lewy body dementia
(LBD). Which symptom is most characteristic of this type of dementia and
distinguishes it from Alzheimer's disease?
• A. Visual hallucinations, fluctuating cognition, Parkinsonism, and severe
neuroleptic sensitivity
• B. Gradual memory loss with preserved visuospatial function
• C. Early onset before age 50 with rapid progression
• D. Absence of any motor symptoms throughout the disease course
Correct Answer: A
,Rationale: Lewy body dementia is the second most common neurodegenerative dementia
after Alzheimer's. Core clinical features include fluctuating cognition with pronounced
variations in attention and alertness, recurrent visual hallucinations (typically well-
formed), REM sleep behavior disorder, and spontaneous Parkinsonism. A critical
distinguishing feature is severe sensitivity to antipsychotics (neuroleptics), which can cause
worsening Parkinsonism, sedation, and even death. Cholinesterase inhibitors (donepezil,
rivastigmine) are preferred for cognitive symptoms. Levodopa may be used cautiously for
motor symptoms.
Question 3.
An older adult with chronic heart failure is prescribed sacubitril/valsartan
(Entresto). The nurse understands that this medication works by:
• A. Combining neprilysin inhibition (increasing natriuretic peptides) with
angiotensin receptor blockade to reduce mortality and hospitalization
• B. Blocking beta-adrenergic receptors to reduce cardiac workload
• C. Inhibiting the sodium-potassium ATPase pump to increase contractility
• D. Dilating arteries through direct calcium channel blockade
Correct Answer: A
Rationale: Sacubitril/valsartan (Entresto) is an angiotensin receptor-neprilysin inhibitor
(ARNI) approved for heart failure with reduced ejection fraction (HFrEF). Sacubitril inhibits
neprilysin, an enzyme that degrades beneficial natriuretic peptides (which promote
vasodilation, diuresis, and antifibrosis). Valsartan blocks angiotensin II receptors. The
PARADIGM-HF trial demonstrated superior outcomes compared to enalapril. It is
contraindicated with ACE inhibitors (36-hour washout required) and in pregnancy. The
most common adverse effects are hypotension, hyperkalemia, and cough.
Question 4.
A nurse is assessing an older adult with sarcopenia. Which intervention is most
effective for preventing and treating sarcopenia?
• A. Progressive resistance training combined with adequate protein intake (1.0-
1.2 g/kg/day) and vitamin D supplementation
• B. Complete bed rest to prevent muscle injury
• C. High-dose corticosteroids to reduce inflammation
• D. Sodium restriction and fluid limitation
Correct Answer: A
,Rationale: Sarcopenia is the age-related loss of muscle mass, strength, and function. It
increases risk of falls, fractures, disability, and mortality. Evidence-based management
includes progressive resistance training (the most effective intervention), adequate protein
intake (1.0-1.2 g/kg/day, higher if acutely ill), and vitamin D supplementation (800-1000
IU/day) if deficient. The SARC-F questionnaire screens for sarcopenia. Physical inactivity,
malnutrition, chronic inflammation, and hormonal changes contribute to its development.
Complete bed rest accelerates muscle atrophy.
Question 5.
An older adult with type 2 diabetes and chronic kidney disease is prescribed
dapagliflozin. The nurse should educate the patient that SGLT2 inhibitors provide
which benefit beyond glucose lowering?
• A. Cardiovascular and renal protection, reducing risk of heart failure
hospitalization and slowing CKD progression
• B. Weight gain and improved wound healing
• C. Reversal of diabetic retinopathy
• D. Prevention of all types of infection
Correct Answer: A
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin) provide significant
cardiovascular and renal benefits independent of glucose lowering. The DAPA-HF,
EMPEROR-Reduced, and EMPEROR-Preserved trials demonstrated reduced heart failure
hospitalizations. The DAPA-CKD and EMPA-KIDNEY trials showed slowed CKD progression
and reduced mortality in patients with and without diabetes. Adverse effects include genital
mycotic infections, urinary tract infections, euglycemic DKA, and volume depletion. They
are now recommended for patients with HFrEF and CKD regardless of diabetes status.
Question 6.
A nurse is caring for an older adult with a hip fracture who is post-operative day 3.
The patient becomes increasingly confused, restless, and tries to climb out of bed.
The patient has a Foley catheter and IV line. Which nursing intervention is the
priority?
• A. Assess for delirium triggers (pain, infection, hypoxia, medications,
dehydration) and implement non-pharmacological reorientation strategies
• B. Apply physical restraints to all four extremities to prevent injury
• C. Administer haloperidol immediately to sedate the patient
• D. Discharge the patient home with family supervision
, Correct Answer: A
Rationale: Postoperative delirium is common in older adults after hip fracture surgery,
with incidence up to 50%. The priority is identifying and addressing underlying causes:
uncontrolled pain, infection, hypoxia, dehydration, electrolyte imbalance, constipation,
urinary retention, or medication effects (opioids, anticholinergics, benzodiazepines). Non-
pharmacological interventions include reorientation, ensuring glasses/hearing aids are
worn, promoting sleep hygiene, early mobilization, and family involvement. Physical
restraints increase agitation and injury risk. Antipsychotics are reserved for severe
agitation threatening safety.
Question 7.
An older adult with atrial fibrillation is prescribed apixaban (Eliquis). The nurse
should educate the patient that apixaban differs from warfarin in which important
way?
• A. Apixaban does not require routine INR monitoring, has fewer food and drug
interactions, and has a lower risk of intracranial hemorrhage
• B. Apixaban requires weekly INR monitoring and has a slow onset requiring bridging
with heparin
• C. Apixaban is a vitamin K antagonist that requires dietary vitamin K restriction
• D. Apixaban is only effective when taken with food and must be avoided on an empty
stomach
Correct Answer: A
Rationale: Apixaban is a direct factor Xa inhibitor (DOAC) with rapid onset, predictable
pharmacokinetics, no requirement for routine coagulation monitoring, and few food/drug
interactions compared to warfarin. The ARISTOTLE and AVERROES trials demonstrated
that apixaban is superior to warfarin in preventing stroke/systemic embolism with
significantly less major bleeding and intracranial hemorrhage. It is administered twice daily
with or without food. Andexanet alfa is the specific reversal agent. Dose adjustments are
needed for age >80, weight <60 kg, and creatinine >1.5 mg/dL (two of three criteria = 2.5
mg BID).
Question 8.
A nurse is assessing an older adult with frailty using the FRAIL scale. Which
components are assessed in this screening tool?
• A. Fatigue, Resistance (ability to climb stairs), Ambulation (ability to walk one
block), Illnesses (≥5 comorbidities), and Loss of weight (>5%)
| 70 Verified Questions And Answers With Rationales |
2026/2027 Updates
Question 1.
An 81-year-old patient with a history of hypertension and diabetes is admitted with
acute confusion. Family reports the patient was fine yesterday but today is agitated,
disoriented, and picking at the bedsheets. Vital signs show temperature 101.8°F, HR
102, BP 148/88, RR 22, SpO2 92% on room air. The nurse suspects:
• A. Delirium due to infection, likely urinary tract infection or pneumonia,
requiring immediate assessment and treatment of the underlying cause
• B. Normal progression of Alzheimer's disease that does not require intervention
• C. Depression manifesting as psychomotor agitation
• D. Medication side effect that will resolve with time
Correct Answer: A
Rationale: This presentation is classic for delirium: acute onset (hours to days), fluctuating
course, inattention, disorganized thinking, and altered level of consciousness. The fever and
low oxygen saturation suggest infection (UTI, pneumonia, or sepsis) as the likely cause.
Delirium is a medical emergency requiring prompt identification and treatment of the
underlying cause. The CAM (Confusion Assessment Method) is the standard screening tool.
Non-pharmacological interventions (reorientation, sleep hygiene, sensory aids, family
involvement) are first-line. Antipsychotics are reserved for severe agitation threatening
safety.
Question 2.
A nurse is caring for an older adult with a new diagnosis of Lewy body dementia
(LBD). Which symptom is most characteristic of this type of dementia and
distinguishes it from Alzheimer's disease?
• A. Visual hallucinations, fluctuating cognition, Parkinsonism, and severe
neuroleptic sensitivity
• B. Gradual memory loss with preserved visuospatial function
• C. Early onset before age 50 with rapid progression
• D. Absence of any motor symptoms throughout the disease course
Correct Answer: A
,Rationale: Lewy body dementia is the second most common neurodegenerative dementia
after Alzheimer's. Core clinical features include fluctuating cognition with pronounced
variations in attention and alertness, recurrent visual hallucinations (typically well-
formed), REM sleep behavior disorder, and spontaneous Parkinsonism. A critical
distinguishing feature is severe sensitivity to antipsychotics (neuroleptics), which can cause
worsening Parkinsonism, sedation, and even death. Cholinesterase inhibitors (donepezil,
rivastigmine) are preferred for cognitive symptoms. Levodopa may be used cautiously for
motor symptoms.
Question 3.
An older adult with chronic heart failure is prescribed sacubitril/valsartan
(Entresto). The nurse understands that this medication works by:
• A. Combining neprilysin inhibition (increasing natriuretic peptides) with
angiotensin receptor blockade to reduce mortality and hospitalization
• B. Blocking beta-adrenergic receptors to reduce cardiac workload
• C. Inhibiting the sodium-potassium ATPase pump to increase contractility
• D. Dilating arteries through direct calcium channel blockade
Correct Answer: A
Rationale: Sacubitril/valsartan (Entresto) is an angiotensin receptor-neprilysin inhibitor
(ARNI) approved for heart failure with reduced ejection fraction (HFrEF). Sacubitril inhibits
neprilysin, an enzyme that degrades beneficial natriuretic peptides (which promote
vasodilation, diuresis, and antifibrosis). Valsartan blocks angiotensin II receptors. The
PARADIGM-HF trial demonstrated superior outcomes compared to enalapril. It is
contraindicated with ACE inhibitors (36-hour washout required) and in pregnancy. The
most common adverse effects are hypotension, hyperkalemia, and cough.
Question 4.
A nurse is assessing an older adult with sarcopenia. Which intervention is most
effective for preventing and treating sarcopenia?
• A. Progressive resistance training combined with adequate protein intake (1.0-
1.2 g/kg/day) and vitamin D supplementation
• B. Complete bed rest to prevent muscle injury
• C. High-dose corticosteroids to reduce inflammation
• D. Sodium restriction and fluid limitation
Correct Answer: A
,Rationale: Sarcopenia is the age-related loss of muscle mass, strength, and function. It
increases risk of falls, fractures, disability, and mortality. Evidence-based management
includes progressive resistance training (the most effective intervention), adequate protein
intake (1.0-1.2 g/kg/day, higher if acutely ill), and vitamin D supplementation (800-1000
IU/day) if deficient. The SARC-F questionnaire screens for sarcopenia. Physical inactivity,
malnutrition, chronic inflammation, and hormonal changes contribute to its development.
Complete bed rest accelerates muscle atrophy.
Question 5.
An older adult with type 2 diabetes and chronic kidney disease is prescribed
dapagliflozin. The nurse should educate the patient that SGLT2 inhibitors provide
which benefit beyond glucose lowering?
• A. Cardiovascular and renal protection, reducing risk of heart failure
hospitalization and slowing CKD progression
• B. Weight gain and improved wound healing
• C. Reversal of diabetic retinopathy
• D. Prevention of all types of infection
Correct Answer: A
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin) provide significant
cardiovascular and renal benefits independent of glucose lowering. The DAPA-HF,
EMPEROR-Reduced, and EMPEROR-Preserved trials demonstrated reduced heart failure
hospitalizations. The DAPA-CKD and EMPA-KIDNEY trials showed slowed CKD progression
and reduced mortality in patients with and without diabetes. Adverse effects include genital
mycotic infections, urinary tract infections, euglycemic DKA, and volume depletion. They
are now recommended for patients with HFrEF and CKD regardless of diabetes status.
Question 6.
A nurse is caring for an older adult with a hip fracture who is post-operative day 3.
The patient becomes increasingly confused, restless, and tries to climb out of bed.
The patient has a Foley catheter and IV line. Which nursing intervention is the
priority?
• A. Assess for delirium triggers (pain, infection, hypoxia, medications,
dehydration) and implement non-pharmacological reorientation strategies
• B. Apply physical restraints to all four extremities to prevent injury
• C. Administer haloperidol immediately to sedate the patient
• D. Discharge the patient home with family supervision
, Correct Answer: A
Rationale: Postoperative delirium is common in older adults after hip fracture surgery,
with incidence up to 50%. The priority is identifying and addressing underlying causes:
uncontrolled pain, infection, hypoxia, dehydration, electrolyte imbalance, constipation,
urinary retention, or medication effects (opioids, anticholinergics, benzodiazepines). Non-
pharmacological interventions include reorientation, ensuring glasses/hearing aids are
worn, promoting sleep hygiene, early mobilization, and family involvement. Physical
restraints increase agitation and injury risk. Antipsychotics are reserved for severe
agitation threatening safety.
Question 7.
An older adult with atrial fibrillation is prescribed apixaban (Eliquis). The nurse
should educate the patient that apixaban differs from warfarin in which important
way?
• A. Apixaban does not require routine INR monitoring, has fewer food and drug
interactions, and has a lower risk of intracranial hemorrhage
• B. Apixaban requires weekly INR monitoring and has a slow onset requiring bridging
with heparin
• C. Apixaban is a vitamin K antagonist that requires dietary vitamin K restriction
• D. Apixaban is only effective when taken with food and must be avoided on an empty
stomach
Correct Answer: A
Rationale: Apixaban is a direct factor Xa inhibitor (DOAC) with rapid onset, predictable
pharmacokinetics, no requirement for routine coagulation monitoring, and few food/drug
interactions compared to warfarin. The ARISTOTLE and AVERROES trials demonstrated
that apixaban is superior to warfarin in preventing stroke/systemic embolism with
significantly less major bleeding and intracranial hemorrhage. It is administered twice daily
with or without food. Andexanet alfa is the specific reversal agent. Dose adjustments are
needed for age >80, weight <60 kg, and creatinine >1.5 mg/dL (two of three criteria = 2.5
mg BID).
Question 8.
A nurse is assessing an older adult with frailty using the FRAIL scale. Which
components are assessed in this screening tool?
• A. Fatigue, Resistance (ability to climb stairs), Ambulation (ability to walk one
block), Illnesses (≥5 comorbidities), and Loss of weight (>5%)
