NU 176 Final Exam | NU 176 Geriatric
Nursing | Questions & Answers with
Rationales 2026/2027 Update
Question 1
An older adult client is brought to the emergency department by their caregiver
following a fall at home. The nurse notes multiple bruises in various stages of
healing across the client's back, upper arms, and buttocks. When the nurse
attempts to interview the client, the caregiver answers all questions and refuses
to leave the bedside. What is the nurse's priority action?
A. Document the physical findings and discharge the client to the caregiver's care.
B. Request that the caregiver step out of the room so the client can be
interviewed privately.
C. Contact local law enforcement immediately to file a report of elder abuse.
D. Order an immediate psychiatric consultation for the caregiver.
Answer: B
Rationale: When potential elder abuse or neglect is suspected based on physical
assessment findings or behavioral observations, the nurse's immediate priority is
to interview the client alone in a private, safe environment. Private interviewing
allows the client to speak openly without fear of intimidation or retaliation from
the caregiver. Reporting to proper authorities follows a full private evaluation.
Question 2
An 82-year-old client with severe osteoarthritis of both hips and knees asks the
nurse how to maintain physical activity without increasing joint pain. Which
physical activity recommendation is most appropriate?
A. Running on a treadmill three days per week.
B. Participating in low-impact water aerobics and swimming in a warm pool.
,C. Engaging in high-impact step aerobics daily.
D. Remaining on complete bed rest with passive range-of-motion exercises.
Answer: B
Rationale: Water aerobics and swimming are optimal exercises for older adults
with severe osteoarthritis because the buoyancy of water significantly decreases
weight-bearing mechanical stress on joint cartilage while maintaining
cardiovascular endurance and muscle strength. High-impact exercises exacerbate
joint destruction, and bed rest leads to rapid muscle atrophy.
Question 3
An older adult client diagnosed with heart failure is prescribed furosemide 40 mg
orally once daily. Which laboratory value requires immediate notification of the
healthcare provider?
A. Serum sodium level of 138 mEq/L.
B. Serum potassium level of 2.8 mEq/L.
C. Blood urea nitrogen (BUN) level of 18 mg/dL.
D. Serum creatinine level of 1.0 mg/dL.
Answer: B
Rationale: Furosemide is a loop diuretic that promotes the excretion of water,
sodium, and potassium. A serum potassium level of 2.8 mEq/L indicates severe
hypokalemia (normal range 3.5–5.0 mEq/L), placing the client at high risk for fatal
cardiac dysrhythmias and severe muscle weakness.
Question 4
An 86-year-old client is admitted to the medical unit with an acute change in
mental status, displaying disorientation, restlessness, and fluctuating attention
over the past 24 hours. Which health condition is the most common cause of
sudden acute delirium in older adults?
A. Expected age-related cognitive decline.
B. Urinary tract infection.
,C. Major depressive disorder.
D. Early-stage Alzheimer's disease.
Answer: B
Rationale: Systemic infections, particularly urinary tract infections (UTIs) and
pneumonia, frequently present as sudden delirium or acute confusion in older
adults due to age-related changes in the immune and central nervous systems.
Normal aging and chronic dementia do not produce sudden cognitive fluctuations
over hours or days.
Question 5
Which age-related physiological change alters drug distribution and increases the
risk of toxicity from fat-soluble (lipophilic) medications in older adults?
A. Increased percentage of total body water.
B. Increased proportion of body fat relative to lean muscle mass.
C. Increased hepatic blood flow.
D. Elevated serum albumin concentration.
Answer: B
Rationale: Normal biological aging alters body composition by increasing the
proportion of adipose tissue (body fat) while decreasing total body water and lean
muscle mass. Lipophilic drugs distribute extensively into expanded fat stores,
leading to a prolonged elimination half-life and elevated risk of drug toxicity.
Question 6
An older adult client asks the nurse why they feel cold easily, even when the room
temperature is comfortable for others. Which explanation by the nurse is correct?
A. Thinning of the epidermal layer and loss of insulating subcutaneous fat.
B. Overproduction of thyroid hormones.
C. Constant uncoordinated muscle shivering.
D. Increased peripheral cutaneous vasodilation.
, Answer: A
Rationale: Age-related skin changes include epidermal thinning, loss of insulating
subcutaneous fat, and reduced dermal microcirculation. These structural
alterations diminish the body's natural thermal insulation, causing older adults to
feel cold easily in standard ambient temperatures.
Question 7
A nurse is administering medications to an 81-year-old client. Which age-related
renal change contributes most significantly to drug accumulation and potential
toxicity?
A. Increased glomerular filtration rate.
B. Decreased number of functional nephrons and reduced renal blood flow.
C. Elevated tubular secretion capability.
D. Hypertrophic kidney mass.
Answer: B
Rationale: Biological aging is accompanied by a progressive loss of functional
nephrons, reduced renal tissue mass, and decreased renal blood flow, which
collectively decrease the glomerular filtration rate (GFR). This reduces renal
clearance of water-soluble drugs, increasing the risk of drug accumulation and
toxicity.
Question 8
An older adult client reports persistent dry mouth (xerostomia) since starting a
new cardiac medication. Which intervention should the nurse recommend to
relieve this discomfort?
A. Drinking sugar-sweetened carbonated beverages throughout the day.
B. Practicing frequent oral care and sipping water or sucking on sugarless hard
candies.
C. Avoiding brushing teeth to protect fragile oral mucosa.
D. Increasing consumption of caffeinated teas.
Nursing | Questions & Answers with
Rationales 2026/2027 Update
Question 1
An older adult client is brought to the emergency department by their caregiver
following a fall at home. The nurse notes multiple bruises in various stages of
healing across the client's back, upper arms, and buttocks. When the nurse
attempts to interview the client, the caregiver answers all questions and refuses
to leave the bedside. What is the nurse's priority action?
A. Document the physical findings and discharge the client to the caregiver's care.
B. Request that the caregiver step out of the room so the client can be
interviewed privately.
C. Contact local law enforcement immediately to file a report of elder abuse.
D. Order an immediate psychiatric consultation for the caregiver.
Answer: B
Rationale: When potential elder abuse or neglect is suspected based on physical
assessment findings or behavioral observations, the nurse's immediate priority is
to interview the client alone in a private, safe environment. Private interviewing
allows the client to speak openly without fear of intimidation or retaliation from
the caregiver. Reporting to proper authorities follows a full private evaluation.
Question 2
An 82-year-old client with severe osteoarthritis of both hips and knees asks the
nurse how to maintain physical activity without increasing joint pain. Which
physical activity recommendation is most appropriate?
A. Running on a treadmill three days per week.
B. Participating in low-impact water aerobics and swimming in a warm pool.
,C. Engaging in high-impact step aerobics daily.
D. Remaining on complete bed rest with passive range-of-motion exercises.
Answer: B
Rationale: Water aerobics and swimming are optimal exercises for older adults
with severe osteoarthritis because the buoyancy of water significantly decreases
weight-bearing mechanical stress on joint cartilage while maintaining
cardiovascular endurance and muscle strength. High-impact exercises exacerbate
joint destruction, and bed rest leads to rapid muscle atrophy.
Question 3
An older adult client diagnosed with heart failure is prescribed furosemide 40 mg
orally once daily. Which laboratory value requires immediate notification of the
healthcare provider?
A. Serum sodium level of 138 mEq/L.
B. Serum potassium level of 2.8 mEq/L.
C. Blood urea nitrogen (BUN) level of 18 mg/dL.
D. Serum creatinine level of 1.0 mg/dL.
Answer: B
Rationale: Furosemide is a loop diuretic that promotes the excretion of water,
sodium, and potassium. A serum potassium level of 2.8 mEq/L indicates severe
hypokalemia (normal range 3.5–5.0 mEq/L), placing the client at high risk for fatal
cardiac dysrhythmias and severe muscle weakness.
Question 4
An 86-year-old client is admitted to the medical unit with an acute change in
mental status, displaying disorientation, restlessness, and fluctuating attention
over the past 24 hours. Which health condition is the most common cause of
sudden acute delirium in older adults?
A. Expected age-related cognitive decline.
B. Urinary tract infection.
,C. Major depressive disorder.
D. Early-stage Alzheimer's disease.
Answer: B
Rationale: Systemic infections, particularly urinary tract infections (UTIs) and
pneumonia, frequently present as sudden delirium or acute confusion in older
adults due to age-related changes in the immune and central nervous systems.
Normal aging and chronic dementia do not produce sudden cognitive fluctuations
over hours or days.
Question 5
Which age-related physiological change alters drug distribution and increases the
risk of toxicity from fat-soluble (lipophilic) medications in older adults?
A. Increased percentage of total body water.
B. Increased proportion of body fat relative to lean muscle mass.
C. Increased hepatic blood flow.
D. Elevated serum albumin concentration.
Answer: B
Rationale: Normal biological aging alters body composition by increasing the
proportion of adipose tissue (body fat) while decreasing total body water and lean
muscle mass. Lipophilic drugs distribute extensively into expanded fat stores,
leading to a prolonged elimination half-life and elevated risk of drug toxicity.
Question 6
An older adult client asks the nurse why they feel cold easily, even when the room
temperature is comfortable for others. Which explanation by the nurse is correct?
A. Thinning of the epidermal layer and loss of insulating subcutaneous fat.
B. Overproduction of thyroid hormones.
C. Constant uncoordinated muscle shivering.
D. Increased peripheral cutaneous vasodilation.
, Answer: A
Rationale: Age-related skin changes include epidermal thinning, loss of insulating
subcutaneous fat, and reduced dermal microcirculation. These structural
alterations diminish the body's natural thermal insulation, causing older adults to
feel cold easily in standard ambient temperatures.
Question 7
A nurse is administering medications to an 81-year-old client. Which age-related
renal change contributes most significantly to drug accumulation and potential
toxicity?
A. Increased glomerular filtration rate.
B. Decreased number of functional nephrons and reduced renal blood flow.
C. Elevated tubular secretion capability.
D. Hypertrophic kidney mass.
Answer: B
Rationale: Biological aging is accompanied by a progressive loss of functional
nephrons, reduced renal tissue mass, and decreased renal blood flow, which
collectively decrease the glomerular filtration rate (GFR). This reduces renal
clearance of water-soluble drugs, increasing the risk of drug accumulation and
toxicity.
Question 8
An older adult client reports persistent dry mouth (xerostomia) since starting a
new cardiac medication. Which intervention should the nurse recommend to
relieve this discomfort?
A. Drinking sugar-sweetened carbonated beverages throughout the day.
B. Practicing frequent oral care and sipping water or sucking on sugarless hard
candies.
C. Avoiding brushing teeth to protect fragile oral mucosa.
D. Increasing consumption of caffeinated teas.
