GALEN COLLEGE OF NURSING — NUR 257 CONCEPTS OF AGING & CHRONIC ILLNESS FINAL
GALEN COLLEGE OF NURSING
NUR 257: Concepts of Aging and Chronic Illness
Exam Final Comprehensive Review — Fall 2026
Q1. A nurse is caring for an bed-bound older adult client at risk for pressure injuries. Which head-of-bed (HOB)
elevation angle should the nurse maintain to minimize shear and pressure forces?
A. 60 degrees
B. 90 degrees
C. 45 degrees
D. 30 degrees
✔ Correct Answer: Option D (30 degrees)
Rationale: Maintaining the head of the bed (HOB) at 30 degrees or less reduces shear and pressure forces on the sacrum
and coccyx. Elevation at 45 degrees (Semi-Fowler's) or higher is contraindicated because it significantly increases
tissue shear and pressure injury risk.
Q2. Which laboratory test is most sensitive for evaluating short-term changes in a client's energy impairment
and acute nutritional status related to pressure ulcer healing?
A. Pre-albumin
B. Total Lymphocyte Count
C. Complete Blood Count (CBC)
D. Albumin
✔ Correct Answer: Option A (Pre-albumin)
Rationale: Pre-albumin has a short half-life (2 days) and is the most sensitive indicator of short-term energy impairment
and immediate nutritional status. Albumin reflects nutritional status over the prior 3 weeks.
Q3. A nurse is reviewing laboratory results for an older client with a Stage 3 sacral pressure injury. The serum
albumin level is evaluated. The nurse recognizes that serum albumin reflects nutritional status over what
timeframe?
A. 3 weeks prior
B. 2 days prior
C. 1 week prior
D. 6 weeks prior
✔ Correct Answer: Option A (3 weeks prior)
Rationale: Serum albumin levels reflect the client's nutritional status and protein intake over the preceding 3 weeks due
to its longer half-life.
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,GALEN COLLEGE OF NURSING — NUR 257 CONCEPTS OF AGING & CHRONIC ILLNESS FINAL
Q4. The nurse assesses an older client's sacrum and observes intact skin with a localized area
of non-blanchable erythema. How should the nurse document this pressure injury?
A. Unstageable pressure injury
B. Deep tissue pressure injury
C. Stage 1 pressure injury
D. Stage 2 pressure injury
✔ Correct Answer: Option C (Stage 1 pressure injury)
Rationale: Stage 1 pressure injury is defined as intact skin with a localized area of non-blanchable erythema. It does not
include purple or maroon discoloration.
Q5. A nurse assesses an ulcer on an older client's heel and notes partial-thickness skin loss with exposed
dermis. The wound bed is viable, pink, and moist without slough or granulation tissue. Which stage is this?
A. Stage 3 pressure injury
B. Stage 4 pressure injury
C. Stage 1 pressure injury
D. Stage 2 pressure injury
✔ Correct Answer: Option D (Stage 2 pressure injury)
Rationale: Stage 2 pressure injury involves partial-thickness skin loss with exposed dermis. The wound bed is viable, pink
or red, moist, and may present as an intact or ruptured serum-filled blister, without slough or granulation.
Q6. Upon physical examination of a trochanteric pressure injury, the nurse observes full-thickness skin loss
where subcutaneous adipose tissue is visible, along with granulation tissue and epibole. Muscle and bone are
not exposed. What stage is this injury?
A. Stage 4 pressure injury
B. Stage 2 pressure injury
C. Stage 3 pressure injury
D. Deep tissue pressure injury
✔ Correct Answer: Option C (Stage 3 pressure injury)
Rationale: Stage 3 pressure injury involves full-thickness skin loss in which adipose tissue is visible in the ulcer bed.
Granulation tissue and epibole (rolled edges) are present, but fascia, muscle, tendon, ligament, cartilage, or bone are
not exposed.
Q7. A nurse examines an extensive pressure injury on an immobilized client's ischial tuberosity and directly
palpates exposed bone and muscle tissue. Which stage pressure injury should the nurse document?
A. Deep tissue pressure injury
B. Stage 3 pressure injury
C. Stage 4 pressure injury
D. Unstageable pressure injury
✔ Correct Answer: Option C (Stage 4 pressure injury)
Rationale: Stage 4 pressure injury is characterized by full-thickness skin and tissue loss with exposed or directly palpable
fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer.
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,GALEN COLLEGE OF NURSING — NUR 257 CONCEPTS OF AGING & CHRONIC ILLNESS FINAL
Q8. A nurse assesses a bed-bound client's heel and observes an area of persistent, non-blanchable deep red
discoloration with intact skin. Which classification accurately describes this finding?
A. Deep tissue pressure injury (DTPI)
B. Unstageable pressure injury
C. Stage 1 pressure injury
D. Stage 2 pressure injury
✔ Correct Answer: Option A (Deep tissue pressure injury (DTPI))
Rationale: Deep tissue pressure injury (DTPI) presents as intact or non-intact skin with localized persistent non-
blanchable deep red, maroon, or purple discoloration, or epidermal separation revealing a dark wound bed or blood-
filled blister.
Q9. An older client has a full-thickness sacral ulcer that is completely covered with dark, thick eschar and
yellow slough. How should the nurse stage this wound?
A. Stage 3 pressure injury
B. Unstageable pressure injury
C. Stage 4 pressure injury
D. Deep tissue pressure injury
✔ Correct Answer: Option B (Unstageable pressure injury)
Rationale: An unstageable pressure injury occurs when full-thickness skin and tissue loss is obscured by slough or
eschar, preventing the true depth and stage from being determined until debrided.
Q10. According to evidence-based clinical safety alerts, approximately what percentage of pressure injuries in
older adults occur on the heels?
A. 70% to 80%
B. 10% to 15%
C. 25% to 35%
D. 50% to 60%
✔ Correct Answer: Option C (25% to 35%)
Rationale: Approximately 25% to 35% of all pressure injuries occur on the heels, making heel suspension and
prophylactic foam dressings critical interventions for high-risk older adults.
Q11. Which intervention is essential for preventing heel pressure injuries in an immobilized older adult client
in bed?
A. Maintain the client in a high-Fowler position
B. Elevate heels off the bed using a pillow placed under the calves
C. Place a donut cushion directly under the heel
D. Massage the heel vigorously every 2 hours
✔ Correct Answer: Option B (Elevate heels off the bed using a pillow placed under the calves)
Rationale: Elevating heels off the mattress using a pillow under the calf or utilizing heel suspension boots eliminates
pressure on the heels and prevents tissue breakdown.
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, GALEN COLLEGE OF NURSING — NUR 257 CONCEPTS OF AGING & CHRONIC ILLNESS FINAL
Q12. A nurse is developing a plan of care for a bed-bound older adult. What is the standard repositioning
interval required to maintain skin integrity?
A. Reposition once per shift
B. Reposition every 4 hours
C. Reposition every 2 hours
D. Reposition every 6 hours
✔ Correct Answer: Option C (Reposition every 2 hours)
Rationale: Bed-bound and chair-bound clients must be repositioned at least every 2 hours to relieve pressure and
prevent tissue ischemia.
Q13. To prevent skin surfaces from touching and rubbing against each other during side-lying positioning,
which item should the nurse place between the client's knees and ankles?
A. Pillows or foam wedges
B. Incontinence pads
C. Plastic-lined drawsheets
D. Standard bed sheets folded tightly
✔ Correct Answer: Option A (Pillows or foam wedges)
Rationale: Using pillows or foam wedges between bony prominences and skin surfaces prevents contact friction,
moisture accumulation, and skin breakdown.
Q14. Which laboratory values should the nurse monitor to evaluate immune function and nutritional adequacy
in an older client with a severe pressure ulcer?
A. Sodium and potassium
B. Platelet count and prothrombin time
C. Blood urea nitrogen (BUN) and creatinine
D. Lymphocytes and pre-albumin
✔ Correct Answer: Option D (Lymphocytes and pre-albumin)
Rationale: Pre-albumin monitors short-term nutritional intake, while lymphocyte count reflects immune system function
and protein-calorie malnutrition affecting wound healing.
Q15. A nurse uses the DIPAMOPI mnemonic to plan pressure injury care. What does the 'D' in DIPAMOPI
represent?
A. Document
B. Drape
C. Disinfect
D. Debride
✔ Correct Answer: Option D (Debride)
Rationale: In the DIPAMOPI mnemonic for pressure injury treatment, 'D' stands for Debride (removing necrotic
tissue/eschar).
Page 4
GALEN COLLEGE OF NURSING
NUR 257: Concepts of Aging and Chronic Illness
Exam Final Comprehensive Review — Fall 2026
Q1. A nurse is caring for an bed-bound older adult client at risk for pressure injuries. Which head-of-bed (HOB)
elevation angle should the nurse maintain to minimize shear and pressure forces?
A. 60 degrees
B. 90 degrees
C. 45 degrees
D. 30 degrees
✔ Correct Answer: Option D (30 degrees)
Rationale: Maintaining the head of the bed (HOB) at 30 degrees or less reduces shear and pressure forces on the sacrum
and coccyx. Elevation at 45 degrees (Semi-Fowler's) or higher is contraindicated because it significantly increases
tissue shear and pressure injury risk.
Q2. Which laboratory test is most sensitive for evaluating short-term changes in a client's energy impairment
and acute nutritional status related to pressure ulcer healing?
A. Pre-albumin
B. Total Lymphocyte Count
C. Complete Blood Count (CBC)
D. Albumin
✔ Correct Answer: Option A (Pre-albumin)
Rationale: Pre-albumin has a short half-life (2 days) and is the most sensitive indicator of short-term energy impairment
and immediate nutritional status. Albumin reflects nutritional status over the prior 3 weeks.
Q3. A nurse is reviewing laboratory results for an older client with a Stage 3 sacral pressure injury. The serum
albumin level is evaluated. The nurse recognizes that serum albumin reflects nutritional status over what
timeframe?
A. 3 weeks prior
B. 2 days prior
C. 1 week prior
D. 6 weeks prior
✔ Correct Answer: Option A (3 weeks prior)
Rationale: Serum albumin levels reflect the client's nutritional status and protein intake over the preceding 3 weeks due
to its longer half-life.
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,GALEN COLLEGE OF NURSING — NUR 257 CONCEPTS OF AGING & CHRONIC ILLNESS FINAL
Q4. The nurse assesses an older client's sacrum and observes intact skin with a localized area
of non-blanchable erythema. How should the nurse document this pressure injury?
A. Unstageable pressure injury
B. Deep tissue pressure injury
C. Stage 1 pressure injury
D. Stage 2 pressure injury
✔ Correct Answer: Option C (Stage 1 pressure injury)
Rationale: Stage 1 pressure injury is defined as intact skin with a localized area of non-blanchable erythema. It does not
include purple or maroon discoloration.
Q5. A nurse assesses an ulcer on an older client's heel and notes partial-thickness skin loss with exposed
dermis. The wound bed is viable, pink, and moist without slough or granulation tissue. Which stage is this?
A. Stage 3 pressure injury
B. Stage 4 pressure injury
C. Stage 1 pressure injury
D. Stage 2 pressure injury
✔ Correct Answer: Option D (Stage 2 pressure injury)
Rationale: Stage 2 pressure injury involves partial-thickness skin loss with exposed dermis. The wound bed is viable, pink
or red, moist, and may present as an intact or ruptured serum-filled blister, without slough or granulation.
Q6. Upon physical examination of a trochanteric pressure injury, the nurse observes full-thickness skin loss
where subcutaneous adipose tissue is visible, along with granulation tissue and epibole. Muscle and bone are
not exposed. What stage is this injury?
A. Stage 4 pressure injury
B. Stage 2 pressure injury
C. Stage 3 pressure injury
D. Deep tissue pressure injury
✔ Correct Answer: Option C (Stage 3 pressure injury)
Rationale: Stage 3 pressure injury involves full-thickness skin loss in which adipose tissue is visible in the ulcer bed.
Granulation tissue and epibole (rolled edges) are present, but fascia, muscle, tendon, ligament, cartilage, or bone are
not exposed.
Q7. A nurse examines an extensive pressure injury on an immobilized client's ischial tuberosity and directly
palpates exposed bone and muscle tissue. Which stage pressure injury should the nurse document?
A. Deep tissue pressure injury
B. Stage 3 pressure injury
C. Stage 4 pressure injury
D. Unstageable pressure injury
✔ Correct Answer: Option C (Stage 4 pressure injury)
Rationale: Stage 4 pressure injury is characterized by full-thickness skin and tissue loss with exposed or directly palpable
fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer.
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,GALEN COLLEGE OF NURSING — NUR 257 CONCEPTS OF AGING & CHRONIC ILLNESS FINAL
Q8. A nurse assesses a bed-bound client's heel and observes an area of persistent, non-blanchable deep red
discoloration with intact skin. Which classification accurately describes this finding?
A. Deep tissue pressure injury (DTPI)
B. Unstageable pressure injury
C. Stage 1 pressure injury
D. Stage 2 pressure injury
✔ Correct Answer: Option A (Deep tissue pressure injury (DTPI))
Rationale: Deep tissue pressure injury (DTPI) presents as intact or non-intact skin with localized persistent non-
blanchable deep red, maroon, or purple discoloration, or epidermal separation revealing a dark wound bed or blood-
filled blister.
Q9. An older client has a full-thickness sacral ulcer that is completely covered with dark, thick eschar and
yellow slough. How should the nurse stage this wound?
A. Stage 3 pressure injury
B. Unstageable pressure injury
C. Stage 4 pressure injury
D. Deep tissue pressure injury
✔ Correct Answer: Option B (Unstageable pressure injury)
Rationale: An unstageable pressure injury occurs when full-thickness skin and tissue loss is obscured by slough or
eschar, preventing the true depth and stage from being determined until debrided.
Q10. According to evidence-based clinical safety alerts, approximately what percentage of pressure injuries in
older adults occur on the heels?
A. 70% to 80%
B. 10% to 15%
C. 25% to 35%
D. 50% to 60%
✔ Correct Answer: Option C (25% to 35%)
Rationale: Approximately 25% to 35% of all pressure injuries occur on the heels, making heel suspension and
prophylactic foam dressings critical interventions for high-risk older adults.
Q11. Which intervention is essential for preventing heel pressure injuries in an immobilized older adult client
in bed?
A. Maintain the client in a high-Fowler position
B. Elevate heels off the bed using a pillow placed under the calves
C. Place a donut cushion directly under the heel
D. Massage the heel vigorously every 2 hours
✔ Correct Answer: Option B (Elevate heels off the bed using a pillow placed under the calves)
Rationale: Elevating heels off the mattress using a pillow under the calf or utilizing heel suspension boots eliminates
pressure on the heels and prevents tissue breakdown.
Page 3
, GALEN COLLEGE OF NURSING — NUR 257 CONCEPTS OF AGING & CHRONIC ILLNESS FINAL
Q12. A nurse is developing a plan of care for a bed-bound older adult. What is the standard repositioning
interval required to maintain skin integrity?
A. Reposition once per shift
B. Reposition every 4 hours
C. Reposition every 2 hours
D. Reposition every 6 hours
✔ Correct Answer: Option C (Reposition every 2 hours)
Rationale: Bed-bound and chair-bound clients must be repositioned at least every 2 hours to relieve pressure and
prevent tissue ischemia.
Q13. To prevent skin surfaces from touching and rubbing against each other during side-lying positioning,
which item should the nurse place between the client's knees and ankles?
A. Pillows or foam wedges
B. Incontinence pads
C. Plastic-lined drawsheets
D. Standard bed sheets folded tightly
✔ Correct Answer: Option A (Pillows or foam wedges)
Rationale: Using pillows or foam wedges between bony prominences and skin surfaces prevents contact friction,
moisture accumulation, and skin breakdown.
Q14. Which laboratory values should the nurse monitor to evaluate immune function and nutritional adequacy
in an older client with a severe pressure ulcer?
A. Sodium and potassium
B. Platelet count and prothrombin time
C. Blood urea nitrogen (BUN) and creatinine
D. Lymphocytes and pre-albumin
✔ Correct Answer: Option D (Lymphocytes and pre-albumin)
Rationale: Pre-albumin monitors short-term nutritional intake, while lymphocyte count reflects immune system function
and protein-calorie malnutrition affecting wound healing.
Q15. A nurse uses the DIPAMOPI mnemonic to plan pressure injury care. What does the 'D' in DIPAMOPI
represent?
A. Document
B. Drape
C. Disinfect
D. Debride
✔ Correct Answer: Option D (Debride)
Rationale: In the DIPAMOPI mnemonic for pressure injury treatment, 'D' stands for Debride (removing necrotic
tissue/eschar).
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