NUR 257 Chronic Health Concepts Final Exam – Concepts of
Aging and Chronic Illness in Nursing – Galen College of Nursing
– 2026/2027 Academic Year – 50 Questions and Answers
Covering Four Core Domains
Question 1
A 78-year-old patient presents with acute confusion, urinary frequency, and a low-
grade fever. The patient's family reports that the patient was functioning
independently last week. What is the most likely explanation for this clinical
presentation?
A) The patient is exhibiting normal age-related cognitive decline
B) The patient is experiencing an atypical presentation of a urinary tract infection
C) The patient has early-stage Alzheimer's disease
D) The patient is exhibiting signs of medication side effects
Correct Answer: B
Rationale: In older adults, localized infections such as urinary tract infections or
pneumonia commonly present atypically as acute delirium, confusion, or behavioral
changes rather than with classic symptoms like fever and leukocytosis. This atypical
presentation is due to immunosenescence (altered immune response) and
diminished thermoregulatory mechanisms in the aging adult .
Question 2
An 82-year-old patient has experienced an unintentional weight loss of 12 pounds
over the past 6 months, reports exhaustion, exhibits a slow gait speed, and has weak
grip strength. The nurse recognizes these findings as indicative of which syndrome?
A) Sarcopenia
B) Malnutrition
C) Frailty syndrome
D) Depression
Correct Answer: C
Rationale: The patient's presentation meets multiple criteria from the Fried
Phenotype for frailty syndrome, which includes unintentional weight loss, exhaustion,
slow gait speed, and weak grip strength. Frailty is a geriatric syndrome characterized
by decreased reserve and increased vulnerability to adverse outcomes .
Question 3
Which biological theory of aging suggests that cumulative damage from normal
metabolic processes leads to cellular decline over time?
A) Telomere shortening theory
B) Free radical theory
C) Wear-and-tear theory
D) Immunosenescence theory
,Correct Answer: C
Rationale: The wear-and-tear theory proposes that the body accumulates damage
over time from normal metabolic processes and environmental exposures, leading to
gradual decline. The free radical theory specifically involves oxidative stress, telomere
shortening involves cellular senescence, and immunosenescence involves age-related
immune system decline .
Question 4
A 75-year-old patient is being evaluated for a new onset of confusion. The nurse
understands that age-related changes in which system make the older adult more
vulnerable to systemic inflammation affecting cognitive function?
A) Cardiovascular system
B) Blood-brain barrier
C) Renal system
D) Gastrointestinal system
Correct Answer: B
Rationale: Changes in the blood-brain barrier make the aging central nervous
system highly vulnerable to circulating systemic inflammatory cytokines. This
vulnerability explains why infections or inflammatory conditions in older adults can
rapidly manifest as cognitive changes or delirium .
Question 5
Which physiological change associated with normal aging contributes to the
increased risk of falls in older adults?
A) Increased bone density
B) Sarcopenia and reduced muscle strength
C) Enhanced proprioception
D) Increased cardiac output
Correct Answer: B
Rationale: Sarcopenia, the age-related loss of muscle mass and strength, is a primary
contributor to fall risk in older adults. This physiological change, combined with
decreased bone density and altered gait, increases fall susceptibility and injury
severity .
Question 6
A 70-year-old patient has been diagnosed with rheumatoid arthritis. The nurse
understands that this condition is characterized by which pathophysiological
process?
A) Degeneration of cartilage from mechanical wear
B) Autoimmune response resulting in pannus formation and joint destruction
C) Deposition of urate crystals in joint spaces
D) Infection of the synovial membrane
, Correct Answer: B
Rationale: Rheumatoid arthritis is an autoimmune disorder where the body
recognizes its own tissue as foreign, leading to chronic inflammation. This
inflammatory process results in pannus (abnormal tissue growth in joints) formation,
which causes joint destruction, pain, and deformity .
Question 7
The nurse is assessing a 65-year-old patient with osteoarthritis. Which finding is most
consistent with this diagnosis?
A) Morning stiffness lasting more than 60 minutes
B) Joint swelling with warmth and erythema
C) Joint pain that worsens with activity and improves with rest
D) Symmetrical joint involvement
Correct Answer: C
Rationale: Osteoarthritis is characterized by degenerative joint changes from
mechanical wear. Pain typically worsens with activity and improves with rest. Morning
stiffness in osteoarthritis is usually brief (less than 30 minutes), unlike rheumatoid
arthritis where stiffness lasts more than 60 minutes. Joint warmth and symmetrical
involvement are more characteristic of inflammatory conditions .
Question 8
A 72-year-old patient with type 2 diabetes mellitus is being managed with oral
hypoglycemics. Which physiological change associated with aging increases this
patient's risk for hypoglycemia?
A) Increased insulin sensitivity
B) Decreased renal function affecting drug clearance
C) Enhanced hepatic glucose production
D) Increased gastric emptying
Correct Answer: B
Rationale: Age-related decline in renal function affects the clearance of many
medications, including oral hypoglycemics. This decreased drug clearance can lead to
medication accumulation and increased risk of hypoglycemia in older adults with
diabetes. This principle is also central to the concept of polypharmacy management
in geriatric care .
Question 9
According to the Beers Criteria, which of the following medications should be
avoided or used with caution in older adults due to increased risk of adverse effects?
A) Acetaminophen
B) Aspirin for primary prevention of cardiovascular disease
C) Lisinopril
D) Metformin
Aging and Chronic Illness in Nursing – Galen College of Nursing
– 2026/2027 Academic Year – 50 Questions and Answers
Covering Four Core Domains
Question 1
A 78-year-old patient presents with acute confusion, urinary frequency, and a low-
grade fever. The patient's family reports that the patient was functioning
independently last week. What is the most likely explanation for this clinical
presentation?
A) The patient is exhibiting normal age-related cognitive decline
B) The patient is experiencing an atypical presentation of a urinary tract infection
C) The patient has early-stage Alzheimer's disease
D) The patient is exhibiting signs of medication side effects
Correct Answer: B
Rationale: In older adults, localized infections such as urinary tract infections or
pneumonia commonly present atypically as acute delirium, confusion, or behavioral
changes rather than with classic symptoms like fever and leukocytosis. This atypical
presentation is due to immunosenescence (altered immune response) and
diminished thermoregulatory mechanisms in the aging adult .
Question 2
An 82-year-old patient has experienced an unintentional weight loss of 12 pounds
over the past 6 months, reports exhaustion, exhibits a slow gait speed, and has weak
grip strength. The nurse recognizes these findings as indicative of which syndrome?
A) Sarcopenia
B) Malnutrition
C) Frailty syndrome
D) Depression
Correct Answer: C
Rationale: The patient's presentation meets multiple criteria from the Fried
Phenotype for frailty syndrome, which includes unintentional weight loss, exhaustion,
slow gait speed, and weak grip strength. Frailty is a geriatric syndrome characterized
by decreased reserve and increased vulnerability to adverse outcomes .
Question 3
Which biological theory of aging suggests that cumulative damage from normal
metabolic processes leads to cellular decline over time?
A) Telomere shortening theory
B) Free radical theory
C) Wear-and-tear theory
D) Immunosenescence theory
,Correct Answer: C
Rationale: The wear-and-tear theory proposes that the body accumulates damage
over time from normal metabolic processes and environmental exposures, leading to
gradual decline. The free radical theory specifically involves oxidative stress, telomere
shortening involves cellular senescence, and immunosenescence involves age-related
immune system decline .
Question 4
A 75-year-old patient is being evaluated for a new onset of confusion. The nurse
understands that age-related changes in which system make the older adult more
vulnerable to systemic inflammation affecting cognitive function?
A) Cardiovascular system
B) Blood-brain barrier
C) Renal system
D) Gastrointestinal system
Correct Answer: B
Rationale: Changes in the blood-brain barrier make the aging central nervous
system highly vulnerable to circulating systemic inflammatory cytokines. This
vulnerability explains why infections or inflammatory conditions in older adults can
rapidly manifest as cognitive changes or delirium .
Question 5
Which physiological change associated with normal aging contributes to the
increased risk of falls in older adults?
A) Increased bone density
B) Sarcopenia and reduced muscle strength
C) Enhanced proprioception
D) Increased cardiac output
Correct Answer: B
Rationale: Sarcopenia, the age-related loss of muscle mass and strength, is a primary
contributor to fall risk in older adults. This physiological change, combined with
decreased bone density and altered gait, increases fall susceptibility and injury
severity .
Question 6
A 70-year-old patient has been diagnosed with rheumatoid arthritis. The nurse
understands that this condition is characterized by which pathophysiological
process?
A) Degeneration of cartilage from mechanical wear
B) Autoimmune response resulting in pannus formation and joint destruction
C) Deposition of urate crystals in joint spaces
D) Infection of the synovial membrane
, Correct Answer: B
Rationale: Rheumatoid arthritis is an autoimmune disorder where the body
recognizes its own tissue as foreign, leading to chronic inflammation. This
inflammatory process results in pannus (abnormal tissue growth in joints) formation,
which causes joint destruction, pain, and deformity .
Question 7
The nurse is assessing a 65-year-old patient with osteoarthritis. Which finding is most
consistent with this diagnosis?
A) Morning stiffness lasting more than 60 minutes
B) Joint swelling with warmth and erythema
C) Joint pain that worsens with activity and improves with rest
D) Symmetrical joint involvement
Correct Answer: C
Rationale: Osteoarthritis is characterized by degenerative joint changes from
mechanical wear. Pain typically worsens with activity and improves with rest. Morning
stiffness in osteoarthritis is usually brief (less than 30 minutes), unlike rheumatoid
arthritis where stiffness lasts more than 60 minutes. Joint warmth and symmetrical
involvement are more characteristic of inflammatory conditions .
Question 8
A 72-year-old patient with type 2 diabetes mellitus is being managed with oral
hypoglycemics. Which physiological change associated with aging increases this
patient's risk for hypoglycemia?
A) Increased insulin sensitivity
B) Decreased renal function affecting drug clearance
C) Enhanced hepatic glucose production
D) Increased gastric emptying
Correct Answer: B
Rationale: Age-related decline in renal function affects the clearance of many
medications, including oral hypoglycemics. This decreased drug clearance can lead to
medication accumulation and increased risk of hypoglycemia in older adults with
diabetes. This principle is also central to the concept of polypharmacy management
in geriatric care .
Question 9
According to the Beers Criteria, which of the following medications should be
avoided or used with caution in older adults due to increased risk of adverse effects?
A) Acetaminophen
B) Aspirin for primary prevention of cardiovascular disease
C) Lisinopril
D) Metformin
