Page 1 of 171
NUR 257 Exam 1 Concepts of Aging and Chronic
Illness QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES
NUR 257 Exam 1: Concepts of Aging and Chronic Illness
Exam Coverage Areas (Mostly Tested)
1. Theories of Aging - Biological (Free Radical, Wear-and-Tear, Hayflick Limit, Immunologic),
Psychosocial (Erikson's Ego Integrity vs. Despair, Disengagement, Activity, Continuity, Role
theories)
2. Age-Related Physiological Changes - Cardiovascular (baroreceptor sensitivity, arterial
compliance), Respiratory (vital capacity, residual volume), Renal (GFR decline, nephron loss),
Musculoskeletal (bone density, muscle mass), Sensory (presbyopia, presbycusis), Integumentary
(skin changes)
3. Geriatric Syndromes and Assessment Tools - SPICES (Sleep disorders, Problems with eating,
Incontinence, Confusion, Evidence of falls, Skin breakdown), FANCAPES, Fulmer SPICES, RAI,
Functional assessment (ADLs/IADLs)
4. Pharmacokinetics and Pharmacodynamics in Older Adults - Beers Criteria, polypharmacy,
medication safety, water-soluble vs. lipophilic drug changes, renal dosing adjustments
5. Chronic Illness Trajectory and Management - Diabetes, COPD, Heart disease, Osteoarthritis,
Osteoporosis, HIV/AIDS in older adults, self-management principles
6. Cognitive and Mental Health Assessment - Dementia staging (Global Deterioration Scale), Mini-
Cog, Mini-Mental State Exam, depression, grief and bereavement, delirium recognition
7. Elder Abuse, Neglect, and Ethical/Legal Issues - Mandatory reporting, types of abuse, most
common abusers, Living Will, Durable Power of Attorney for Healthcare, HIPAA
8. End-of-Life and Palliative Care - Hospice principles, symptom management (pain, dyspnea),
comfort measures, grief reactions in partners, complementary therapies, dignity
9. Nutrition, Hydration, and Elimination - Malnutrition risk factors, dysphagia signs, dehydration
assessment, urinary incontinence, constipation, diverticular disease prevention
10. Health Promotion, Safety, and Functional Assessment - Fall prevention, ADLs/IADLs
differentiation, wellness promotion, frailty indicators, caregiver stress and support
, Page 2 of 171
1. A nurse is performing a comprehensive assessment on an 82-year-old patient and notes the patient
has difficulty hearing high-pitched sounds, particularly women's and children's voices. Which age-
related sensory change best explains this finding?
A) Otosclerosis causing conductive hearing loss
B) Presbycusis with high-frequency hearing loss
C) Impacted cerumen blocking the external auditory canal
D) Ménière's disease affecting the inner ear
Answer: B) Presbycusis with high-frequency hearing loss
Rationale: Presbycusis is the age-related sensorineural hearing loss that primarily affects the ability to
hear high-frequency sounds. This explains why older adults have particular difficulty understanding
women's and children's voices. Cerumen impaction would cause generalized hearing loss, while
otosclerosis and Ménière's disease are less common and have different presentations .
2. An 80-year-old patient has been taking amitriptyline for depression for several years. The nurse
reviews this medication in the context of the patient's age and should be most concerned about which
adverse effect based on the Beers Criteria?
, Page 3 of 171
A) Increased risk of gastrointestinal bleeding
B) Significant anticholinergic effects leading to confusion and falls
C) Development of tardive dyskinesia
D) Severe hepatotoxicity
Answer: B) Significant anticholinergic effects leading to confusion and falls
Rationale: Amitriptyline is a tricyclic antidepressant with potent anticholinergic properties and is listed
on the Beers Criteria as potentially inappropriate for older adults. It significantly increases the risk of
sedation, confusion, orthostatic hypotension, and falls in this population, making it a medication that
requires immediate intervention and potentially deprescribing .
3. A nurse is educating a family about the chronic illness trajectory of their elderly father who has
been diagnosed with COPD and heart failure. Which statement by the family indicates a correct
understanding of chronic illness management?
A) "His condition will steadily decline without any periods of improvement."
B) "Chronic illnesses often have periods of stability and exacerbation that require ongoing
management."
, Page 4 of 171
C) "Most health problems in older adults are acute and resolve completely with treatment."
D) "His chronic conditions do not interact with each other and can be managed separately."
Answer: B) "Chronic illnesses often have periods of stability and exacerbation that require ongoing
management."
Rationale: Chronic illnesses typically follow a trajectory with periods of stability interspersed with
exacerbations or acute episodes. Self-management is a key component of chronic illness care, and
chronic diseases frequently coexist in older adults. Understanding this trajectory is central to geriatric
nursing care .
4. An older adult patient presents to the emergency department with acute confusion, urinary
frequency, and a low-grade fever. The family reports the patient has been "acting strange" for the
past two days. What is the most likely cause of these symptoms in this patient?
A) Onset of Alzheimer's disease
B) Urinary tract infection presenting with atypical symptoms
C) Medication side effect from a new antihypertensive
D) Electrolyte imbalance from poor oral intake
Answer: B) Urinary tract infection presenting with atypical symptoms
NUR 257 Exam 1 Concepts of Aging and Chronic
Illness QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES
NUR 257 Exam 1: Concepts of Aging and Chronic Illness
Exam Coverage Areas (Mostly Tested)
1. Theories of Aging - Biological (Free Radical, Wear-and-Tear, Hayflick Limit, Immunologic),
Psychosocial (Erikson's Ego Integrity vs. Despair, Disengagement, Activity, Continuity, Role
theories)
2. Age-Related Physiological Changes - Cardiovascular (baroreceptor sensitivity, arterial
compliance), Respiratory (vital capacity, residual volume), Renal (GFR decline, nephron loss),
Musculoskeletal (bone density, muscle mass), Sensory (presbyopia, presbycusis), Integumentary
(skin changes)
3. Geriatric Syndromes and Assessment Tools - SPICES (Sleep disorders, Problems with eating,
Incontinence, Confusion, Evidence of falls, Skin breakdown), FANCAPES, Fulmer SPICES, RAI,
Functional assessment (ADLs/IADLs)
4. Pharmacokinetics and Pharmacodynamics in Older Adults - Beers Criteria, polypharmacy,
medication safety, water-soluble vs. lipophilic drug changes, renal dosing adjustments
5. Chronic Illness Trajectory and Management - Diabetes, COPD, Heart disease, Osteoarthritis,
Osteoporosis, HIV/AIDS in older adults, self-management principles
6. Cognitive and Mental Health Assessment - Dementia staging (Global Deterioration Scale), Mini-
Cog, Mini-Mental State Exam, depression, grief and bereavement, delirium recognition
7. Elder Abuse, Neglect, and Ethical/Legal Issues - Mandatory reporting, types of abuse, most
common abusers, Living Will, Durable Power of Attorney for Healthcare, HIPAA
8. End-of-Life and Palliative Care - Hospice principles, symptom management (pain, dyspnea),
comfort measures, grief reactions in partners, complementary therapies, dignity
9. Nutrition, Hydration, and Elimination - Malnutrition risk factors, dysphagia signs, dehydration
assessment, urinary incontinence, constipation, diverticular disease prevention
10. Health Promotion, Safety, and Functional Assessment - Fall prevention, ADLs/IADLs
differentiation, wellness promotion, frailty indicators, caregiver stress and support
, Page 2 of 171
1. A nurse is performing a comprehensive assessment on an 82-year-old patient and notes the patient
has difficulty hearing high-pitched sounds, particularly women's and children's voices. Which age-
related sensory change best explains this finding?
A) Otosclerosis causing conductive hearing loss
B) Presbycusis with high-frequency hearing loss
C) Impacted cerumen blocking the external auditory canal
D) Ménière's disease affecting the inner ear
Answer: B) Presbycusis with high-frequency hearing loss
Rationale: Presbycusis is the age-related sensorineural hearing loss that primarily affects the ability to
hear high-frequency sounds. This explains why older adults have particular difficulty understanding
women's and children's voices. Cerumen impaction would cause generalized hearing loss, while
otosclerosis and Ménière's disease are less common and have different presentations .
2. An 80-year-old patient has been taking amitriptyline for depression for several years. The nurse
reviews this medication in the context of the patient's age and should be most concerned about which
adverse effect based on the Beers Criteria?
, Page 3 of 171
A) Increased risk of gastrointestinal bleeding
B) Significant anticholinergic effects leading to confusion and falls
C) Development of tardive dyskinesia
D) Severe hepatotoxicity
Answer: B) Significant anticholinergic effects leading to confusion and falls
Rationale: Amitriptyline is a tricyclic antidepressant with potent anticholinergic properties and is listed
on the Beers Criteria as potentially inappropriate for older adults. It significantly increases the risk of
sedation, confusion, orthostatic hypotension, and falls in this population, making it a medication that
requires immediate intervention and potentially deprescribing .
3. A nurse is educating a family about the chronic illness trajectory of their elderly father who has
been diagnosed with COPD and heart failure. Which statement by the family indicates a correct
understanding of chronic illness management?
A) "His condition will steadily decline without any periods of improvement."
B) "Chronic illnesses often have periods of stability and exacerbation that require ongoing
management."
, Page 4 of 171
C) "Most health problems in older adults are acute and resolve completely with treatment."
D) "His chronic conditions do not interact with each other and can be managed separately."
Answer: B) "Chronic illnesses often have periods of stability and exacerbation that require ongoing
management."
Rationale: Chronic illnesses typically follow a trajectory with periods of stability interspersed with
exacerbations or acute episodes. Self-management is a key component of chronic illness care, and
chronic diseases frequently coexist in older adults. Understanding this trajectory is central to geriatric
nursing care .
4. An older adult patient presents to the emergency department with acute confusion, urinary
frequency, and a low-grade fever. The family reports the patient has been "acting strange" for the
past two days. What is the most likely cause of these symptoms in this patient?
A) Onset of Alzheimer's disease
B) Urinary tract infection presenting with atypical symptoms
C) Medication side effect from a new antihypertensive
D) Electrolyte imbalance from poor oral intake
Answer: B) Urinary tract infection presenting with atypical symptoms
