NUR 257 Exams 1–4 Tested Questions & Answers with
Rationales – Aging & Chronic Illness | (2026/2027) PDF |
Galen
1. A 72-year-old patient with chronic heart failure has a heart rate of 52 beats/min and reports dizziness
when standing. The nurse recognizes that age-related cardiovascular changes increase sensitivity to
which medication side effect?
a) Hyperglycemia
b) Bradycardia
c) Hypokalemia
d) Tachypnea
Answer: b) Bradycardia
Rationale: Age-related reduction in beta-adrenergic receptor responsiveness and decreased
baroreceptor function increase sensitivity to beta-blockers, potentially leading to symptomatic
bradycardia and orthostatic hypotension.
2. The nurse is assessing functional ability in an 80-year-old patient. Which finding is most indicative of
frailty?
a) Ability to climb one flight of stairs without stopping
b) Unintentional weight loss of 10 pounds in the past year
c) Normal gait speed
d) Regular participation in senior center activities
Answer: b) Unintentional weight loss of 10 pounds in the past year
Rationale: Frailty phenotype includes unintentional weight loss (≥10 lbs/year), exhaustion, low physical
activity, slow gait speed, and weakness. Weight loss is a key indicator of physiologic decline.
3. A 75-year-old patient newly diagnosed with hypertension has a serum creatinine of 1.4 mg/dL and
estimated GFR of 45 mL/min. Which antihypertensive medication requires the most cautious dosing?
a) Hydrochlorothiazide
b) Lisinopril
c) Amlodipine
,d) Metoprolol
Answer: b) Lisinopril
Rationale: ACE inhibitors are renally excreted. In older adults with eGFR <60 mL/min, starting doses
should be reduced and kidney function monitored closely due to risk of hyperkalemia and acute kidney
injury.
4. An older adult with a history of falls is started on a new medication. Which class of drugs most
significantly increases fall risk in this population?
a) Statins
b) Benzodiazepines
c) Proton pump inhibitors
d) Acetaminophen
Answer: b) Benzodiazepines
Rationale: Benzodiazepines are on the Beers Criteria list as potentially inappropriate in older adults due
to increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents.
5. A 68-year-old patient with type 2 diabetes has an A1C of 8.5% and is on metformin 1000 mg twice
daily. The patient has stable coronary artery disease. The nurse practitioner adds which second-line
agent based on recent cardiovascular outcome trials?
a) Glipizide
b) Pioglitazone
c) Empagliflozin
d) Sitagliptin
Answer: c) Empagliflozin
Rationale: SGLT2 inhibitors (empagliflozin, canagliflozin) have demonstrated reduction in major adverse
cardiovascular events and heart failure hospitalizations in patients with type 2 diabetes and established
ASCVD.
6. An 85-year-old patient with moderate dementia is prescribed donepezil. The family reports the
patient has recently become more agitated and is experiencing vivid nightmares. What is the most
appropriate nursing action?
a) Increase the donepezil dose
,b) Discontinue donepezil immediately
c) Administer donepezil in the morning instead of at bedtime
d) Add a benzodiazepine to manage agitation
Answer: c) Administer donepezil in the morning instead of at bedtime
Rationale: Donepezil commonly causes insomnia and vivid dreams when taken at bedtime. Switching to
morning administration often resolves these side effects without discontinuing the medication.
7. The nurse is teaching a group of older adults about safe medication use. Which statement indicates
correct understanding of polypharmacy risks?
a) "If a medication was prescribed by a specialist, my primary doctor doesn't need to know about it."
b) "Taking over-the-counter medications with prescription drugs is always safe."
c) "I should bring all my medications, including herbals, to every doctor visit."
d) "I can split my time-release pills in half to save money."
Answer: c) "I should bring all my medications, including herbals, to every doctor visit."
Rationale: Medication reconciliation including all prescriptions, OTC drugs, and supplements at every
visit is essential to prevent polypharmacy, drug interactions, and adverse effects.
8. Which immunizations are recommended annually for all adults age 65 years and older?
a) Influenza and Tdap
b) Influenza and pneumococcal
c) Influenza only
d) Influenza and herpes zoster
Answer: a) Influenza and Tdap
Rationale: Annual influenza vaccine is recommended for all adults ≥65 years. Tdap (tetanus, diphtheria,
pertussis) is recommended once for all adults and repeated as Td every 10 years. Pneumococcal and
zoster vaccines are also recommended but are not given annually.
9. A 70-year-old patient with osteoarthritis reports joint pain rated 6/10. The patient has a history of
hypertension and chronic kidney disease stage 3. Which analgesic is most appropriate?
a) Ibuprofen 400 mg three times daily
b) Acetaminophen 650 mg every 6 hours PRN
, c) Naproxen 250 mg twice daily
d) Celecoxib 200 mg daily
Answer: b) Acetaminophen 650 mg every 6 hours PRN
Rationale: Acetaminophen is first-line for osteoarthritis pain in older adults. NSAIDs (including celecoxib)
are relatively contraindicated in CKD stage 3 due to risk of acute kidney injury and further GFR decline.
10. In assessing an 82-year-old patient for depression, which screening tool is most appropriate for use
in the primary care setting?
a) Mini-Mental State Examination (MMSE)
b) Geriatric Depression Scale (GDS-15)
c) Hamilton Rating Scale for Depression
d) Beck Depression Inventory (BDI)
Answer: b) Geriatric Depression Scale (GDS-15)
Rationale: The 15-item Geriatric Depression Scale is specifically designed for older adults, uses yes/no
questions, and does not include somatic symptoms common in medical illness, making it ideal for
primary care.
11. A 78-year-old patient with heart failure with preserved ejection fraction (HFpEF) presents with
dyspnea on exertion and peripheral edema. The patient is on furosemide 40 mg daily. Which additional
medication has been shown to reduce hospitalizations in HFpEF?
a) Spironolactone
b) Digoxin
c) Metoprolol
d) Hydralazine
Answer: a) Spironolactone
Rationale: The TOPCAT trial demonstrated that spironolactone reduces heart failure hospitalizations in
patients with HFpEF, particularly those with elevated BNP.
12. An 80-year-old patient is brought to the clinic by family due to "confusion over the past 2 days." The
patient has a history of hypertension and diabetes and takes lisinopril, metformin, and atorvastatin. The
patient's vital signs are normal, and the physical exam is unremarkable. What is the most likely cause of
the acute confusion?
Rationales – Aging & Chronic Illness | (2026/2027) PDF |
Galen
1. A 72-year-old patient with chronic heart failure has a heart rate of 52 beats/min and reports dizziness
when standing. The nurse recognizes that age-related cardiovascular changes increase sensitivity to
which medication side effect?
a) Hyperglycemia
b) Bradycardia
c) Hypokalemia
d) Tachypnea
Answer: b) Bradycardia
Rationale: Age-related reduction in beta-adrenergic receptor responsiveness and decreased
baroreceptor function increase sensitivity to beta-blockers, potentially leading to symptomatic
bradycardia and orthostatic hypotension.
2. The nurse is assessing functional ability in an 80-year-old patient. Which finding is most indicative of
frailty?
a) Ability to climb one flight of stairs without stopping
b) Unintentional weight loss of 10 pounds in the past year
c) Normal gait speed
d) Regular participation in senior center activities
Answer: b) Unintentional weight loss of 10 pounds in the past year
Rationale: Frailty phenotype includes unintentional weight loss (≥10 lbs/year), exhaustion, low physical
activity, slow gait speed, and weakness. Weight loss is a key indicator of physiologic decline.
3. A 75-year-old patient newly diagnosed with hypertension has a serum creatinine of 1.4 mg/dL and
estimated GFR of 45 mL/min. Which antihypertensive medication requires the most cautious dosing?
a) Hydrochlorothiazide
b) Lisinopril
c) Amlodipine
,d) Metoprolol
Answer: b) Lisinopril
Rationale: ACE inhibitors are renally excreted. In older adults with eGFR <60 mL/min, starting doses
should be reduced and kidney function monitored closely due to risk of hyperkalemia and acute kidney
injury.
4. An older adult with a history of falls is started on a new medication. Which class of drugs most
significantly increases fall risk in this population?
a) Statins
b) Benzodiazepines
c) Proton pump inhibitors
d) Acetaminophen
Answer: b) Benzodiazepines
Rationale: Benzodiazepines are on the Beers Criteria list as potentially inappropriate in older adults due
to increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents.
5. A 68-year-old patient with type 2 diabetes has an A1C of 8.5% and is on metformin 1000 mg twice
daily. The patient has stable coronary artery disease. The nurse practitioner adds which second-line
agent based on recent cardiovascular outcome trials?
a) Glipizide
b) Pioglitazone
c) Empagliflozin
d) Sitagliptin
Answer: c) Empagliflozin
Rationale: SGLT2 inhibitors (empagliflozin, canagliflozin) have demonstrated reduction in major adverse
cardiovascular events and heart failure hospitalizations in patients with type 2 diabetes and established
ASCVD.
6. An 85-year-old patient with moderate dementia is prescribed donepezil. The family reports the
patient has recently become more agitated and is experiencing vivid nightmares. What is the most
appropriate nursing action?
a) Increase the donepezil dose
,b) Discontinue donepezil immediately
c) Administer donepezil in the morning instead of at bedtime
d) Add a benzodiazepine to manage agitation
Answer: c) Administer donepezil in the morning instead of at bedtime
Rationale: Donepezil commonly causes insomnia and vivid dreams when taken at bedtime. Switching to
morning administration often resolves these side effects without discontinuing the medication.
7. The nurse is teaching a group of older adults about safe medication use. Which statement indicates
correct understanding of polypharmacy risks?
a) "If a medication was prescribed by a specialist, my primary doctor doesn't need to know about it."
b) "Taking over-the-counter medications with prescription drugs is always safe."
c) "I should bring all my medications, including herbals, to every doctor visit."
d) "I can split my time-release pills in half to save money."
Answer: c) "I should bring all my medications, including herbals, to every doctor visit."
Rationale: Medication reconciliation including all prescriptions, OTC drugs, and supplements at every
visit is essential to prevent polypharmacy, drug interactions, and adverse effects.
8. Which immunizations are recommended annually for all adults age 65 years and older?
a) Influenza and Tdap
b) Influenza and pneumococcal
c) Influenza only
d) Influenza and herpes zoster
Answer: a) Influenza and Tdap
Rationale: Annual influenza vaccine is recommended for all adults ≥65 years. Tdap (tetanus, diphtheria,
pertussis) is recommended once for all adults and repeated as Td every 10 years. Pneumococcal and
zoster vaccines are also recommended but are not given annually.
9. A 70-year-old patient with osteoarthritis reports joint pain rated 6/10. The patient has a history of
hypertension and chronic kidney disease stage 3. Which analgesic is most appropriate?
a) Ibuprofen 400 mg three times daily
b) Acetaminophen 650 mg every 6 hours PRN
, c) Naproxen 250 mg twice daily
d) Celecoxib 200 mg daily
Answer: b) Acetaminophen 650 mg every 6 hours PRN
Rationale: Acetaminophen is first-line for osteoarthritis pain in older adults. NSAIDs (including celecoxib)
are relatively contraindicated in CKD stage 3 due to risk of acute kidney injury and further GFR decline.
10. In assessing an 82-year-old patient for depression, which screening tool is most appropriate for use
in the primary care setting?
a) Mini-Mental State Examination (MMSE)
b) Geriatric Depression Scale (GDS-15)
c) Hamilton Rating Scale for Depression
d) Beck Depression Inventory (BDI)
Answer: b) Geriatric Depression Scale (GDS-15)
Rationale: The 15-item Geriatric Depression Scale is specifically designed for older adults, uses yes/no
questions, and does not include somatic symptoms common in medical illness, making it ideal for
primary care.
11. A 78-year-old patient with heart failure with preserved ejection fraction (HFpEF) presents with
dyspnea on exertion and peripheral edema. The patient is on furosemide 40 mg daily. Which additional
medication has been shown to reduce hospitalizations in HFpEF?
a) Spironolactone
b) Digoxin
c) Metoprolol
d) Hydralazine
Answer: a) Spironolactone
Rationale: The TOPCAT trial demonstrated that spironolactone reduces heart failure hospitalizations in
patients with HFpEF, particularly those with elevated BNP.
12. An 80-year-old patient is brought to the clinic by family due to "confusion over the past 2 days." The
patient has a history of hypertension and diabetes and takes lisinopril, metformin, and atorvastatin. The
patient's vital signs are normal, and the physical exam is unremarkable. What is the most likely cause of
the acute confusion?
