GALEN COLLEGE OF NURSING
Concepts of Aging and Chronic Illness (NUR 257)
Exam Final Fall 2026
150 Multiple-Choice Questions with Correct Answers and Rationales
Student Name: ______________________________ Date: __________________
Score: __________ / 150 Grade: __________
Question 1. An older adult reports spending more time in bed but sleeping for fewer hours. Which age-related
sleep change best explains this finding?
A. A progressive increase in total sleep efficiency
B. Less time in deep N3 sleep with more time awake or in N1 sleep
C. Longer and more intense REM periods
D. Elimination of nighttime awakenings
✓ Correct Answer: B. Less time in deep N3 sleep with more time awake or in N1 sleep
Rationale: The uploaded review notes describe aging sleep as lighter and more fragmented, with less N3 sleep,
more wake/N1 time, reduced total sleep time, and lower sleep efficiency.
Question 2. The nurse compares normal sleep architecture in an older adult with that of a younger adult.
Which finding is expected with aging?
A. Stage 3 and 4 sleep increase substantially
B. REM sleep becomes shorter, less intense, and more evenly distributed
C. REM sleep becomes longer and more concentrated late in the night
D. Nighttime leg movements become less frequent
✓ Correct Answer: B. REM sleep becomes shorter, less intense, and more evenly distributed
Rationale: The materials state that REM sleep shortens and becomes less intense and more evenly distributed as
people age; deep sleep also decreases and leg movements increase.
Question 3. Which assessment finding should the nurse recognize as a common age-related sleep pattern
rather than evidence that the older adult is sleeping more effectively?
A. Fewer periods of nighttime wakefulness
B. Longer periods of uninterrupted deep sleep
C. More time spent in bed awake before falling asleep
D. Increased total sleep time
✓ Correct Answer: C. More time spent in bed awake before falling asleep
Rationale: Older adults may remain in bed longer while actually sleeping less, with more frequent awakenings and
reduced sleep efficiency.
Question 4. An older adult's partner reports loud snoring and episodes of gasping and choking during the
night. Which disorder should the nurse suspect?
A. Obstructive sleep apnea
B. REM sleep behavior disorder
C. Restless leg syndrome
D. Advanced sleep phase disorder
✓ Correct Answer: A. Obstructive sleep apnea
Rationale: The source materials identify loud periodic snoring, gasping, choking on awakening, fragmented sleep,
daytime sleepiness, and morning headaches as sleep apnea findings.
Question 5. Which morning complaint is most consistent with obstructive sleep apnea in an older adult?
A. Intense nocturnal itching of the finger webs
B. Progressive central vision loss
C. Painful unilateral vesicles
D. Morning headaches with daytime drowsiness
NUR 257 Exam 4 Final Examination - Fall 2026 | Page 1
,✓ Correct Answer: D. Morning headaches with daytime drowsiness
Rationale: Morning headaches and daytime fatigue or drowsiness are repeatedly listed among sleep apnea
manifestations.
Question 6. The nurse is screening an older adult for sleep apnea. Which report should receive the greatest
attention?
A. The client awakens gasping for air and is excessively sleepy during the day
B. The client acts out vivid dreams by punching and kicking
C. The client goes to bed at 6 PM and awakens at 3 AM
D. The client has an urge to move the legs that improves with movement
✓ Correct Answer: A. The client awakens gasping for air and is excessively sleepy during the day
Rationale: Awakening gasping for air with daytime sleepiness fits the uploaded description of obstructive sleep
apnea.
Question 7. Which client has the greatest cluster of risk factors for obstructive sleep apnea according to the
review materials?
A. An older woman with a healed skin tear and controlled pruritus
B. An older woman with dry skin and a history of cataracts
C. An older man with increased neck circumference, excess weight, hypertension, and smoking history
D. An older man with hearing loss and a benign seborrheic keratosis
✓ Correct Answer: C. An older man with increased neck circumference, excess weight, hypertension, and
smoking history
Rationale: The notes list increasing age, male sex, increased neck circumference, excessive weight, hypertension,
smoking, sedative or alcohol use, and upper-airway abnormalities as risks.
Question 8. Which history should the nurse identify as increasing the risk for obstructive sleep apnea?
A. Brisk walking several times per week
B. Daily use of sunscreen
C. Use of alcohol or sedatives before sleep
D. Using a night-light in the hallway
✓ Correct Answer: C. Use of alcohol or sedatives before sleep
Rationale: Alcohol, sedatives, and tranquilizers are listed as sleep apnea risk factors because they can worsen
upper-airway obstruction during sleep.
Question 9. The nurse is teaching a client about modifiable sleep apnea risks. Which client statement
indicates understanding?
A. I should work on excess weight and avoid smoking and alcohol near bedtime.
B. I should avoid all daytime activity.
C. I should increase sedative use to prevent awakening.
D. I should sleep with the bedroom brightly lit all night.
✓ Correct Answer: A. I should work on excess weight and avoid smoking and alcohol near bedtime.
Rationale: Weight reduction and avoiding smoking, alcohol, and sedating substances are consistent with the
uploaded sleep apnea teaching points.
Question 10. Which intervention is included in the uploaded materials for an older adult with obstructive sleep
apnea?
A. Apply topical antifungal cream
B. Begin a purine-rich diet
C. Use a pressure-redistributing mattress
D. Use CPAP and consider weight loss
✓ Correct Answer: D. Use CPAP and consider weight loss
Rationale: The review materials identify weight loss and CPAP as key sleep apnea treatments and also note
elevating the head of the bed.
NUR 257 Exam 4 Final Examination - Fall 2026 | Page 2
, Question 11. A client asks how CPAP helps obstructive sleep apnea. Which explanation best matches the
study materials?
A. It reduces uric acid production while the client sleeps
B. It increases deep N3 sleep by sedating the client
C. It prevents nocturnal leg movement by immobilizing the legs
D. Pressurized air acts as an airway splint that keeps upper-airway tissues open
✓ Correct Answer: D. Pressurized air acts as an airway splint that keeps upper-airway tissues open
Rationale: The CPAP teaching in the uploaded concepts describes pressurized air that gently opens the throat and
maintains airway patency during sleep.
Question 12. Which plan should the nurse reinforce for a client with sleep apnea who is using CPAP?
A. Use the device at bedtime as prescribed and avoid alcohol or sedatives that worsen obstruction
B. Stop CPAP once snoring decreases for one night
C. Replace CPAP with daytime naps
D. Take a hypnotic first so the client sleeps through apneic episodes
✓ Correct Answer: A. Use the device at bedtime as prescribed and avoid alcohol or sedatives that worsen
obstruction
Rationale: The materials emphasize CPAP use and avoiding substances such as alcohol and sedatives that can
aggravate sleep apnea.
Question 13. Which description best matches restless leg syndrome (Willis-Ekbom disease)?
A. Loss of voluntary muscle atonia with dream enactment
B. A painful unilateral vesicular rash
C. An uncontrollable urge to move the legs associated with unpleasant sensations
D. Loss of central vision with intact peripheral vision
✓ Correct Answer: C. An uncontrollable urge to move the legs associated with unpleasant sensations
Rationale: The review defines restless leg syndrome as an uncontrollable need to move the legs because of
unpleasant sensations.
Question 14. An older adult reports crawling and creeping sensations in the legs that improve temporarily
with movement. Which problem is most likely?
A. Restless leg syndrome
B. Obstructive sleep apnea
C. Purpura
D. Retinal detachment
✓ Correct Answer: A. Restless leg syndrome
Rationale: The study guide describes paresthesia-like creeping or crawling leg sensations with an urge to move as
characteristic of restless leg syndrome.
Question 15. Which finding helps distinguish restless leg syndrome from REM sleep behavior disorder?
A. Potential injury to the sleeping partner
B. Punching or kicking while acting out dreams
C. Loss of muscle atonia during REM sleep
D. An urge to move the legs because of uncomfortable sensations
✓ Correct Answer: D. An urge to move the legs because of uncomfortable sensations
Rationale: Restless leg syndrome centers on unpleasant leg sensations and movement, whereas REM behavior
disorder involves dream enactment and loss of REM atonia.
Question 16. Which client factor is identified in the uploaded materials as a risk for restless leg syndrome?
A. Sleep deprivation with a sedentary lifestyle
B. Avoidance of tobacco and alcohol
C. Regular lower-extremity stretching
D. Consistent daytime sunlight exposure
✓ Correct Answer: A. Sleep deprivation with a sedentary lifestyle
NUR 257 Exam 4 Final Examination - Fall 2026 | Page 3
Concepts of Aging and Chronic Illness (NUR 257)
Exam Final Fall 2026
150 Multiple-Choice Questions with Correct Answers and Rationales
Student Name: ______________________________ Date: __________________
Score: __________ / 150 Grade: __________
Question 1. An older adult reports spending more time in bed but sleeping for fewer hours. Which age-related
sleep change best explains this finding?
A. A progressive increase in total sleep efficiency
B. Less time in deep N3 sleep with more time awake or in N1 sleep
C. Longer and more intense REM periods
D. Elimination of nighttime awakenings
✓ Correct Answer: B. Less time in deep N3 sleep with more time awake or in N1 sleep
Rationale: The uploaded review notes describe aging sleep as lighter and more fragmented, with less N3 sleep,
more wake/N1 time, reduced total sleep time, and lower sleep efficiency.
Question 2. The nurse compares normal sleep architecture in an older adult with that of a younger adult.
Which finding is expected with aging?
A. Stage 3 and 4 sleep increase substantially
B. REM sleep becomes shorter, less intense, and more evenly distributed
C. REM sleep becomes longer and more concentrated late in the night
D. Nighttime leg movements become less frequent
✓ Correct Answer: B. REM sleep becomes shorter, less intense, and more evenly distributed
Rationale: The materials state that REM sleep shortens and becomes less intense and more evenly distributed as
people age; deep sleep also decreases and leg movements increase.
Question 3. Which assessment finding should the nurse recognize as a common age-related sleep pattern
rather than evidence that the older adult is sleeping more effectively?
A. Fewer periods of nighttime wakefulness
B. Longer periods of uninterrupted deep sleep
C. More time spent in bed awake before falling asleep
D. Increased total sleep time
✓ Correct Answer: C. More time spent in bed awake before falling asleep
Rationale: Older adults may remain in bed longer while actually sleeping less, with more frequent awakenings and
reduced sleep efficiency.
Question 4. An older adult's partner reports loud snoring and episodes of gasping and choking during the
night. Which disorder should the nurse suspect?
A. Obstructive sleep apnea
B. REM sleep behavior disorder
C. Restless leg syndrome
D. Advanced sleep phase disorder
✓ Correct Answer: A. Obstructive sleep apnea
Rationale: The source materials identify loud periodic snoring, gasping, choking on awakening, fragmented sleep,
daytime sleepiness, and morning headaches as sleep apnea findings.
Question 5. Which morning complaint is most consistent with obstructive sleep apnea in an older adult?
A. Intense nocturnal itching of the finger webs
B. Progressive central vision loss
C. Painful unilateral vesicles
D. Morning headaches with daytime drowsiness
NUR 257 Exam 4 Final Examination - Fall 2026 | Page 1
,✓ Correct Answer: D. Morning headaches with daytime drowsiness
Rationale: Morning headaches and daytime fatigue or drowsiness are repeatedly listed among sleep apnea
manifestations.
Question 6. The nurse is screening an older adult for sleep apnea. Which report should receive the greatest
attention?
A. The client awakens gasping for air and is excessively sleepy during the day
B. The client acts out vivid dreams by punching and kicking
C. The client goes to bed at 6 PM and awakens at 3 AM
D. The client has an urge to move the legs that improves with movement
✓ Correct Answer: A. The client awakens gasping for air and is excessively sleepy during the day
Rationale: Awakening gasping for air with daytime sleepiness fits the uploaded description of obstructive sleep
apnea.
Question 7. Which client has the greatest cluster of risk factors for obstructive sleep apnea according to the
review materials?
A. An older woman with a healed skin tear and controlled pruritus
B. An older woman with dry skin and a history of cataracts
C. An older man with increased neck circumference, excess weight, hypertension, and smoking history
D. An older man with hearing loss and a benign seborrheic keratosis
✓ Correct Answer: C. An older man with increased neck circumference, excess weight, hypertension, and
smoking history
Rationale: The notes list increasing age, male sex, increased neck circumference, excessive weight, hypertension,
smoking, sedative or alcohol use, and upper-airway abnormalities as risks.
Question 8. Which history should the nurse identify as increasing the risk for obstructive sleep apnea?
A. Brisk walking several times per week
B. Daily use of sunscreen
C. Use of alcohol or sedatives before sleep
D. Using a night-light in the hallway
✓ Correct Answer: C. Use of alcohol or sedatives before sleep
Rationale: Alcohol, sedatives, and tranquilizers are listed as sleep apnea risk factors because they can worsen
upper-airway obstruction during sleep.
Question 9. The nurse is teaching a client about modifiable sleep apnea risks. Which client statement
indicates understanding?
A. I should work on excess weight and avoid smoking and alcohol near bedtime.
B. I should avoid all daytime activity.
C. I should increase sedative use to prevent awakening.
D. I should sleep with the bedroom brightly lit all night.
✓ Correct Answer: A. I should work on excess weight and avoid smoking and alcohol near bedtime.
Rationale: Weight reduction and avoiding smoking, alcohol, and sedating substances are consistent with the
uploaded sleep apnea teaching points.
Question 10. Which intervention is included in the uploaded materials for an older adult with obstructive sleep
apnea?
A. Apply topical antifungal cream
B. Begin a purine-rich diet
C. Use a pressure-redistributing mattress
D. Use CPAP and consider weight loss
✓ Correct Answer: D. Use CPAP and consider weight loss
Rationale: The review materials identify weight loss and CPAP as key sleep apnea treatments and also note
elevating the head of the bed.
NUR 257 Exam 4 Final Examination - Fall 2026 | Page 2
, Question 11. A client asks how CPAP helps obstructive sleep apnea. Which explanation best matches the
study materials?
A. It reduces uric acid production while the client sleeps
B. It increases deep N3 sleep by sedating the client
C. It prevents nocturnal leg movement by immobilizing the legs
D. Pressurized air acts as an airway splint that keeps upper-airway tissues open
✓ Correct Answer: D. Pressurized air acts as an airway splint that keeps upper-airway tissues open
Rationale: The CPAP teaching in the uploaded concepts describes pressurized air that gently opens the throat and
maintains airway patency during sleep.
Question 12. Which plan should the nurse reinforce for a client with sleep apnea who is using CPAP?
A. Use the device at bedtime as prescribed and avoid alcohol or sedatives that worsen obstruction
B. Stop CPAP once snoring decreases for one night
C. Replace CPAP with daytime naps
D. Take a hypnotic first so the client sleeps through apneic episodes
✓ Correct Answer: A. Use the device at bedtime as prescribed and avoid alcohol or sedatives that worsen
obstruction
Rationale: The materials emphasize CPAP use and avoiding substances such as alcohol and sedatives that can
aggravate sleep apnea.
Question 13. Which description best matches restless leg syndrome (Willis-Ekbom disease)?
A. Loss of voluntary muscle atonia with dream enactment
B. A painful unilateral vesicular rash
C. An uncontrollable urge to move the legs associated with unpleasant sensations
D. Loss of central vision with intact peripheral vision
✓ Correct Answer: C. An uncontrollable urge to move the legs associated with unpleasant sensations
Rationale: The review defines restless leg syndrome as an uncontrollable need to move the legs because of
unpleasant sensations.
Question 14. An older adult reports crawling and creeping sensations in the legs that improve temporarily
with movement. Which problem is most likely?
A. Restless leg syndrome
B. Obstructive sleep apnea
C. Purpura
D. Retinal detachment
✓ Correct Answer: A. Restless leg syndrome
Rationale: The study guide describes paresthesia-like creeping or crawling leg sensations with an urge to move as
characteristic of restless leg syndrome.
Question 15. Which finding helps distinguish restless leg syndrome from REM sleep behavior disorder?
A. Potential injury to the sleeping partner
B. Punching or kicking while acting out dreams
C. Loss of muscle atonia during REM sleep
D. An urge to move the legs because of uncomfortable sensations
✓ Correct Answer: D. An urge to move the legs because of uncomfortable sensations
Rationale: Restless leg syndrome centers on unpleasant leg sensations and movement, whereas REM behavior
disorder involves dream enactment and loss of REM atonia.
Question 16. Which client factor is identified in the uploaded materials as a risk for restless leg syndrome?
A. Sleep deprivation with a sedentary lifestyle
B. Avoidance of tobacco and alcohol
C. Regular lower-extremity stretching
D. Consistent daytime sunlight exposure
✓ Correct Answer: A. Sleep deprivation with a sedentary lifestyle
NUR 257 Exam 4 Final Examination - Fall 2026 | Page 3
