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NUR 257 Exam 2 – Concepts of Aging & Chronic
Illness QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES
NUR 257 Exam 2 – Concepts of Aging & Chronic Illness
Exam Coverage Areas (Most Tested Topics)
1. Physiological Changes of Aging (Cardiovascular, Respiratory, Renal, Gastrointestinal,
Neurological, Musculoskeletal, Integumentary, Sensory)
2. Polypharmacy and Medication Management in Older Adults (Beers Criteria, pharmacokinetics,
pharmacodynamics)
3. Pain Assessment and Management in Older Adults (atypical presentation, non-pharmacological
interventions)
4. Delirium, Dementia, and Depression (differentiation, assessment tools, interventions)
5. Falls Prevention and Mobility Issues (risk factors, assessment, environmental modifications)
6. Urinary Incontinence and Constipation (types, assessment, management strategies)
7. Nutritional Considerations and Hydration in Aging Adults (malnutrition, dysphagia, feeding
assistance)
8. Elder Abuse and Neglect (types, risk factors, reporting requirements, assessment)
9. End-of-Life and Palliative Care (advance directives, symptom management, grief, cultural
considerations)
10. Health Promotion and Patient Education (immunizations, screenings, functional assessment,
community resources)
Question 1: An 82-year-old patient with a history of hypertension and type 2 diabetes mellitus reports
feeling dizzy and lightheaded whenever they stand up from a seated position, which has resulted in two
near-fall episodes over the past week; what is the most appropriate initial nursing intervention to
address this patient's symptoms?
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A) Instruct the patient to increase their dietary sodium intake to raise blood pressure
B) Teach the patient to rise slowly from seated or lying positions and dangle feet before standing
C) Discontinue all antihypertensive medications immediately to prevent further episodes
D) Restrict all oral fluid intake to 1 liter per day to reduce cardiovascular workload
Answer: B
Rationale: Orthostatic hypotension is common in older adults due to decreased baroreceptor sensitivity
and autonomic nervous system changes; teaching the patient to change positions slowly allows
compensatory mechanisms to activate, while dangling feet before standing helps prevent rapid blood
pressure drops that lead to falls, unlike increasing sodium which could worsen hypertension or
discontinuing medications abruptly which could cause rebound hypertension or cardiovascular events.
Question 2: An 88-year-old patient who recently lost their spouse of 60 years is brought to the clinic by
their adult child who reports that the patient has become increasingly confused, disoriented to time and
place, and has been having difficulty managing their finances and medications over the past two weeks,
which finding would be most indicative of depression rather than dementia or delirium?
A) The patient's symptoms developed gradually over a period of several months to years
B) The patient exhibits significant short-term memory impairment with inability to learn new
information
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C) The patient demonstrates sudden onset of symptoms with fluctuating levels of consciousness
throughout the day
D) The patient expresses persistent feelings of worthlessness and expresses a desire to "join their
spouse"
Answer: D
Rationale: Depression in older adults often presents with prominent feelings of worthlessness,
hopelessness, and suicidal ideation, particularly following significant life events such as bereavement;
gradual symptom development is more characteristic of dementia, while sudden onset with fluctuating
consciousness is classic for delirium, and short-term memory impairment is a hallmark of dementia
rather than depression.
Question 3: A 79-year-old patient who lives alone and manages their own medications presents to the
emergency department with confusion, lethargy, and an unsteady gait; their medication list includes
digoxin, furosemide, lisinopril, aspirin, and lorazepam as needed for anxiety, and their serum digoxin
level is 3.2 ng/mL, what is the most appropriate nursing action based on this finding?
A) Administer an additional dose of digoxin to achieve therapeutic levels as ordered
B) Hold the next dose of digoxin and notify the healthcare provider immediately
C) Encourage the patient to take their digoxin with a full glass of orange juice to enhance absorption
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D) Increase the patient's dietary potassium intake to counteract the effects of elevated digoxin
Answer: B
Rationale: The therapeutic range for digoxin is 0.8-2.0 ng/mL, and a level of 3.2 ng/mL indicates digitalis
toxicity, which presents with confusion, lethargy, gait disturbances, and potentially cardiac arrhythmias;
holding the medication and notifying the provider is essential to prevent serious complications, while
administering additional digoxin would exacerbate toxicity, orange juice could affect absorption
unpredictably, and increasing potassium without provider oversight could cause hyperkalemia.
Question 4: A 76-year-old female patient with osteoarthritis reports having difficulty performing her
activities of daily living, particularly bathing and dressing, due to severe pain and stiffness in her hands
and knees that is worse in the morning and improves with movement throughout the day; which of the
following non-pharmacological interventions should the nurse recommend as the most effective initial
approach for managing this patient's symptoms?
A) Complete bed rest for at least 48 hours to allow joint inflammation to subside
B) Application of heat before activity and cold therapy after exercise to manage pain and stiffness
C) High-impact aerobic exercise three times weekly to strengthen muscles around affected joints
D) Restriction of all physical activity to prevent further joint damage and deterioration
Answer: B
NUR 257 Exam 2 – Concepts of Aging & Chronic
Illness QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES
NUR 257 Exam 2 – Concepts of Aging & Chronic Illness
Exam Coverage Areas (Most Tested Topics)
1. Physiological Changes of Aging (Cardiovascular, Respiratory, Renal, Gastrointestinal,
Neurological, Musculoskeletal, Integumentary, Sensory)
2. Polypharmacy and Medication Management in Older Adults (Beers Criteria, pharmacokinetics,
pharmacodynamics)
3. Pain Assessment and Management in Older Adults (atypical presentation, non-pharmacological
interventions)
4. Delirium, Dementia, and Depression (differentiation, assessment tools, interventions)
5. Falls Prevention and Mobility Issues (risk factors, assessment, environmental modifications)
6. Urinary Incontinence and Constipation (types, assessment, management strategies)
7. Nutritional Considerations and Hydration in Aging Adults (malnutrition, dysphagia, feeding
assistance)
8. Elder Abuse and Neglect (types, risk factors, reporting requirements, assessment)
9. End-of-Life and Palliative Care (advance directives, symptom management, grief, cultural
considerations)
10. Health Promotion and Patient Education (immunizations, screenings, functional assessment,
community resources)
Question 1: An 82-year-old patient with a history of hypertension and type 2 diabetes mellitus reports
feeling dizzy and lightheaded whenever they stand up from a seated position, which has resulted in two
near-fall episodes over the past week; what is the most appropriate initial nursing intervention to
address this patient's symptoms?
, Page 2 of 195
A) Instruct the patient to increase their dietary sodium intake to raise blood pressure
B) Teach the patient to rise slowly from seated or lying positions and dangle feet before standing
C) Discontinue all antihypertensive medications immediately to prevent further episodes
D) Restrict all oral fluid intake to 1 liter per day to reduce cardiovascular workload
Answer: B
Rationale: Orthostatic hypotension is common in older adults due to decreased baroreceptor sensitivity
and autonomic nervous system changes; teaching the patient to change positions slowly allows
compensatory mechanisms to activate, while dangling feet before standing helps prevent rapid blood
pressure drops that lead to falls, unlike increasing sodium which could worsen hypertension or
discontinuing medications abruptly which could cause rebound hypertension or cardiovascular events.
Question 2: An 88-year-old patient who recently lost their spouse of 60 years is brought to the clinic by
their adult child who reports that the patient has become increasingly confused, disoriented to time and
place, and has been having difficulty managing their finances and medications over the past two weeks,
which finding would be most indicative of depression rather than dementia or delirium?
A) The patient's symptoms developed gradually over a period of several months to years
B) The patient exhibits significant short-term memory impairment with inability to learn new
information
, Page 3 of 195
C) The patient demonstrates sudden onset of symptoms with fluctuating levels of consciousness
throughout the day
D) The patient expresses persistent feelings of worthlessness and expresses a desire to "join their
spouse"
Answer: D
Rationale: Depression in older adults often presents with prominent feelings of worthlessness,
hopelessness, and suicidal ideation, particularly following significant life events such as bereavement;
gradual symptom development is more characteristic of dementia, while sudden onset with fluctuating
consciousness is classic for delirium, and short-term memory impairment is a hallmark of dementia
rather than depression.
Question 3: A 79-year-old patient who lives alone and manages their own medications presents to the
emergency department with confusion, lethargy, and an unsteady gait; their medication list includes
digoxin, furosemide, lisinopril, aspirin, and lorazepam as needed for anxiety, and their serum digoxin
level is 3.2 ng/mL, what is the most appropriate nursing action based on this finding?
A) Administer an additional dose of digoxin to achieve therapeutic levels as ordered
B) Hold the next dose of digoxin and notify the healthcare provider immediately
C) Encourage the patient to take their digoxin with a full glass of orange juice to enhance absorption
, Page 4 of 195
D) Increase the patient's dietary potassium intake to counteract the effects of elevated digoxin
Answer: B
Rationale: The therapeutic range for digoxin is 0.8-2.0 ng/mL, and a level of 3.2 ng/mL indicates digitalis
toxicity, which presents with confusion, lethargy, gait disturbances, and potentially cardiac arrhythmias;
holding the medication and notifying the provider is essential to prevent serious complications, while
administering additional digoxin would exacerbate toxicity, orange juice could affect absorption
unpredictably, and increasing potassium without provider oversight could cause hyperkalemia.
Question 4: A 76-year-old female patient with osteoarthritis reports having difficulty performing her
activities of daily living, particularly bathing and dressing, due to severe pain and stiffness in her hands
and knees that is worse in the morning and improves with movement throughout the day; which of the
following non-pharmacological interventions should the nurse recommend as the most effective initial
approach for managing this patient's symptoms?
A) Complete bed rest for at least 48 hours to allow joint inflammation to subside
B) Application of heat before activity and cold therapy after exercise to manage pain and stiffness
C) High-impact aerobic exercise three times weekly to strengthen muscles around affected joints
D) Restriction of all physical activity to prevent further joint damage and deterioration
Answer: B
