NUR 257 Concepts of Aging & Chronic Illness Exam 4 |
Comprehensive 70 Questions with Rationales |
2026/2027 updates
Question 1.
An 86-year-old patient with advanced dementia is admitted with a fever of 102.4°F,
tachypnea (30/min), and altered mental status. The patient has a stage 4 sacral
pressure injury with purulent drainage. Which nursing action is the priority?
• A. Obtain blood cultures, start broad-spectrum antibiotics per sepsis protocol,
and obtain wound cultures after cleansing
• B. Apply topical antibiotic ointment to the wound and monitor temperature every 4
hours
• C. Reposition the patient every 4 hours and apply a hydrocolloid dressing
• D. Discharge the patient home with oral antibiotics and family education
Correct Answer: A
Rationale: This patient presents with sepsis likely originating from the infected stage 4
pressure injury (osteomyelitis suspected with exposed bone and purulent drainage). Sepsis
in older adults often presents with atypical symptoms: altered mental status, fever or
hypothermia, and tachypnea. The priority is obtaining blood cultures before antibiotics,
starting broad-spectrum antibiotics within 1 hour, aggressive fluid resuscitation, and
wound cultures after gentle cleansing. Stage 4 pressure injuries with exposed bone require
MRI to evaluate for osteomyelitis. Mortality from sepsis in older adults is significantly
higher than in younger patients.
Question 2.
A nurse is caring for an older adult with a new diagnosis of frontotemporal dementia
(FTD). Which clinical feature most distinguishes FTD from Alzheimer's disease?
• A. Early and prominent behavioral changes, disinhibition, apathy, and language
deficits with relative preservation of memory in early stages
• B. Early and severe memory loss with preserved language and behavior
• C. Visual hallucinations and Parkinsonism as the first symptoms
• D. Purely motor symptoms without any cognitive changes
Correct Answer: A
Rationale: Frontotemporal dementia (FTD) is a group of neurodegenerative disorders
characterized by progressive atrophy of the frontal and temporal lobes. Unlike Alzheimer's
,disease, where memory loss is the hallmark early symptom, FTD presents with early
behavioral changes (disinhibition, apathy, loss of empathy, compulsive behaviors) or
language deficits (primary progressive aphasia). Memory is relatively preserved in early
stages. Onset is typically earlier than Alzheimer's (45-65 years). There are no FDA-
approved treatments for FTD; management focuses on behavioral interventions, speech
therapy, and caregiver support.
Question 3.
An older adult with chronic heart failure is being evaluated for cardiac
resynchronization therapy (CRT). Which criterion must be met for CRT
consideration?
• A. Sinus rhythm, QRS duration ≥150 ms with left bundle branch block
morphology, LVEF ≤35%, and persistent symptoms despite optimal medical
therapy
• B. Atrial fibrillation with rapid ventricular response and normal QRS duration
• C. LVEF >50% with isolated diastolic dysfunction
• D. Acute myocardial infarction within 48 hours
Correct Answer: A
Rationale: Cardiac resynchronization therapy (CRT) with biventricular pacing is indicated
for patients with heart failure with reduced ejection fraction (HFrEF), sinus rhythm, wide
QRS complex (≥150 ms with LBBB morphology, or 120-149 ms with LBBB), LVEF ≤35%,
and NYHA Class II-IV symptoms despite optimal medical therapy (ARNI/ACE-I/ARB, beta-
blocker, MRA, SGLT2 inhibitor). CRT improves ventricular synchrony, reduces mitral
regurgitation, and improves symptoms, quality of life, and survival. CRT-D includes
defibrillator capability. Response is better in women and those with non-ischemic
cardiomyopathy.
Question 4.
A nurse is assessing an older adult with frailty syndrome. Which intervention has the
strongest evidence for reversing frailty?
• A. Multicomponent physical exercise program combining resistance training,
aerobic exercise, and balance training with nutritional supplementation
• B. Complete bed rest to conserve energy
• C. High-dose corticosteroid therapy to reduce inflammation
• D. Sedative-hypnotics to improve sleep quality
,Correct Answer: A
Rationale: Frailty is a reversible syndrome of decreased physiological reserve. The
strongest evidence for reversing frailty comes from multicomponent interventions:
progressive resistance training (the cornerstone), aerobic exercise, balance and flexibility
training, nutritional optimization (protein supplementation, vitamin D), and management of
comorbidities. The FRAIL scale and Fried Frailty Phenotype (unintentional weight loss,
exhaustion, weakness, slow walking speed, low physical activity) are screening tools.
Complete bed rest worsens frailty. Corticosteroids and sedatives increase frailty. The nurse
should refer patients to physical therapy and geriatric exercise programs.
Question 5.
An older adult with type 2 diabetes and heart failure is being considered for
metformin therapy. The nurse recognizes that metformin should be used cautiously
or contraindicated in which situation?
• A. eGFR <30 mL/min/1.73m² (contraindicated) or eGFR 30-45 (use with caution
and dose reduction)
• B. Mild hypertension controlled with lifestyle modifications
• C. History of osteoarthritis managed with acetaminophen
• D. Mild cognitive impairment with intact ADLs
Correct Answer: A
Rationale: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to
increased risk of lactic acidosis from accumulation. When eGFR is 30-45, it should be used
with caution and the maximum dose reduced to 1000 mg/day. Metformin should be
withheld before and for 48 hours after iodinated contrast studies if eGFR <60 or if there is
risk of acute kidney injury. Despite these cautions, metformin remains first-line therapy for
type 2 diabetes due to its safety, efficacy, cardiovascular benefits, and low hypoglycemia
risk. It is also being studied for anti-aging effects.
Question 6.
A nurse is caring for an older adult post-stroke with left hemiplegia and neglect
syndrome. Which nursing intervention is most appropriate for managing neglect?
• A. Place the patient's belongings on the affected (left) side, use visual scanning
techniques, and provide consistent verbal cues to attend to the affected side
• B. Place all belongings on the unaffected (right) side for patient convenience
• C. Restrain the unaffected arm to force use of the affected side
, • D. Ignore the neglect as it will resolve spontaneously within days
Correct Answer: A
Rationale: Unilateral neglect (hemispatial neglect) is common after right hemisphere
stroke, causing failure to attend to the contralateral (left) side of space. Interventions
include placing belongings on the affected side, visual scanning training (teaching the
patient to systematically scan from left to right), prism adaptation therapy, limb activation
therapy, and consistent verbal cues ('look to your left'). Neglect significantly increases fall
risk, impairs rehabilitation, and affects safety. It may persist for months and requires
ongoing occupational therapy intervention. Prism glasses and virtual reality training are
emerging therapies.
Question 7.
An older adult with atrial fibrillation and a CHA2DS2-VASc score of 5 is prescribed
edoxaban. The nurse understands that edoxaban should be avoided or dose-reduced
in which patient population?
• A. Patients with creatinine clearance >95 mL/min due to reduced efficacy, and
those with CrCl <15 mL/min or body weight ≤60 kg
• B. Patients with mild hypertension only
• C. Patients with well-controlled type 2 diabetes
• D. Patients with a history of osteoarthritis
Correct Answer: A
Rationale: Edoxaban is a direct factor Xa inhibitor with unique dosing considerations. The
ENGAGE AF-TIMI 48 trial showed reduced efficacy (higher ischemic stroke rates) in
patients with CrCl >95 mL/min, so it is not recommended for this population. It is
contraindicated with CrCl <15 mL/min. The dose should be reduced to 30 mg daily for CrCl
15-50 mL/min, body weight ≤60 kg, or concurrent use of certain P-gp inhibitors. It is
administered once daily with or without food. Andexanet alfa reverses edoxaban. Like other
DOACs, it does not require routine INR monitoring.
Question 8.
A nurse is assessing an older adult with a new diagnosis of sarcopenic obesity. Which
description best characterizes this condition?
• A. Coexistence of low muscle mass/strength and excess body fat, creating a
paradoxical phenotype with worse metabolic and functional outcomes than either
condition alone
Comprehensive 70 Questions with Rationales |
2026/2027 updates
Question 1.
An 86-year-old patient with advanced dementia is admitted with a fever of 102.4°F,
tachypnea (30/min), and altered mental status. The patient has a stage 4 sacral
pressure injury with purulent drainage. Which nursing action is the priority?
• A. Obtain blood cultures, start broad-spectrum antibiotics per sepsis protocol,
and obtain wound cultures after cleansing
• B. Apply topical antibiotic ointment to the wound and monitor temperature every 4
hours
• C. Reposition the patient every 4 hours and apply a hydrocolloid dressing
• D. Discharge the patient home with oral antibiotics and family education
Correct Answer: A
Rationale: This patient presents with sepsis likely originating from the infected stage 4
pressure injury (osteomyelitis suspected with exposed bone and purulent drainage). Sepsis
in older adults often presents with atypical symptoms: altered mental status, fever or
hypothermia, and tachypnea. The priority is obtaining blood cultures before antibiotics,
starting broad-spectrum antibiotics within 1 hour, aggressive fluid resuscitation, and
wound cultures after gentle cleansing. Stage 4 pressure injuries with exposed bone require
MRI to evaluate for osteomyelitis. Mortality from sepsis in older adults is significantly
higher than in younger patients.
Question 2.
A nurse is caring for an older adult with a new diagnosis of frontotemporal dementia
(FTD). Which clinical feature most distinguishes FTD from Alzheimer's disease?
• A. Early and prominent behavioral changes, disinhibition, apathy, and language
deficits with relative preservation of memory in early stages
• B. Early and severe memory loss with preserved language and behavior
• C. Visual hallucinations and Parkinsonism as the first symptoms
• D. Purely motor symptoms without any cognitive changes
Correct Answer: A
Rationale: Frontotemporal dementia (FTD) is a group of neurodegenerative disorders
characterized by progressive atrophy of the frontal and temporal lobes. Unlike Alzheimer's
,disease, where memory loss is the hallmark early symptom, FTD presents with early
behavioral changes (disinhibition, apathy, loss of empathy, compulsive behaviors) or
language deficits (primary progressive aphasia). Memory is relatively preserved in early
stages. Onset is typically earlier than Alzheimer's (45-65 years). There are no FDA-
approved treatments for FTD; management focuses on behavioral interventions, speech
therapy, and caregiver support.
Question 3.
An older adult with chronic heart failure is being evaluated for cardiac
resynchronization therapy (CRT). Which criterion must be met for CRT
consideration?
• A. Sinus rhythm, QRS duration ≥150 ms with left bundle branch block
morphology, LVEF ≤35%, and persistent symptoms despite optimal medical
therapy
• B. Atrial fibrillation with rapid ventricular response and normal QRS duration
• C. LVEF >50% with isolated diastolic dysfunction
• D. Acute myocardial infarction within 48 hours
Correct Answer: A
Rationale: Cardiac resynchronization therapy (CRT) with biventricular pacing is indicated
for patients with heart failure with reduced ejection fraction (HFrEF), sinus rhythm, wide
QRS complex (≥150 ms with LBBB morphology, or 120-149 ms with LBBB), LVEF ≤35%,
and NYHA Class II-IV symptoms despite optimal medical therapy (ARNI/ACE-I/ARB, beta-
blocker, MRA, SGLT2 inhibitor). CRT improves ventricular synchrony, reduces mitral
regurgitation, and improves symptoms, quality of life, and survival. CRT-D includes
defibrillator capability. Response is better in women and those with non-ischemic
cardiomyopathy.
Question 4.
A nurse is assessing an older adult with frailty syndrome. Which intervention has the
strongest evidence for reversing frailty?
• A. Multicomponent physical exercise program combining resistance training,
aerobic exercise, and balance training with nutritional supplementation
• B. Complete bed rest to conserve energy
• C. High-dose corticosteroid therapy to reduce inflammation
• D. Sedative-hypnotics to improve sleep quality
,Correct Answer: A
Rationale: Frailty is a reversible syndrome of decreased physiological reserve. The
strongest evidence for reversing frailty comes from multicomponent interventions:
progressive resistance training (the cornerstone), aerobic exercise, balance and flexibility
training, nutritional optimization (protein supplementation, vitamin D), and management of
comorbidities. The FRAIL scale and Fried Frailty Phenotype (unintentional weight loss,
exhaustion, weakness, slow walking speed, low physical activity) are screening tools.
Complete bed rest worsens frailty. Corticosteroids and sedatives increase frailty. The nurse
should refer patients to physical therapy and geriatric exercise programs.
Question 5.
An older adult with type 2 diabetes and heart failure is being considered for
metformin therapy. The nurse recognizes that metformin should be used cautiously
or contraindicated in which situation?
• A. eGFR <30 mL/min/1.73m² (contraindicated) or eGFR 30-45 (use with caution
and dose reduction)
• B. Mild hypertension controlled with lifestyle modifications
• C. History of osteoarthritis managed with acetaminophen
• D. Mild cognitive impairment with intact ADLs
Correct Answer: A
Rationale: Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to
increased risk of lactic acidosis from accumulation. When eGFR is 30-45, it should be used
with caution and the maximum dose reduced to 1000 mg/day. Metformin should be
withheld before and for 48 hours after iodinated contrast studies if eGFR <60 or if there is
risk of acute kidney injury. Despite these cautions, metformin remains first-line therapy for
type 2 diabetes due to its safety, efficacy, cardiovascular benefits, and low hypoglycemia
risk. It is also being studied for anti-aging effects.
Question 6.
A nurse is caring for an older adult post-stroke with left hemiplegia and neglect
syndrome. Which nursing intervention is most appropriate for managing neglect?
• A. Place the patient's belongings on the affected (left) side, use visual scanning
techniques, and provide consistent verbal cues to attend to the affected side
• B. Place all belongings on the unaffected (right) side for patient convenience
• C. Restrain the unaffected arm to force use of the affected side
, • D. Ignore the neglect as it will resolve spontaneously within days
Correct Answer: A
Rationale: Unilateral neglect (hemispatial neglect) is common after right hemisphere
stroke, causing failure to attend to the contralateral (left) side of space. Interventions
include placing belongings on the affected side, visual scanning training (teaching the
patient to systematically scan from left to right), prism adaptation therapy, limb activation
therapy, and consistent verbal cues ('look to your left'). Neglect significantly increases fall
risk, impairs rehabilitation, and affects safety. It may persist for months and requires
ongoing occupational therapy intervention. Prism glasses and virtual reality training are
emerging therapies.
Question 7.
An older adult with atrial fibrillation and a CHA2DS2-VASc score of 5 is prescribed
edoxaban. The nurse understands that edoxaban should be avoided or dose-reduced
in which patient population?
• A. Patients with creatinine clearance >95 mL/min due to reduced efficacy, and
those with CrCl <15 mL/min or body weight ≤60 kg
• B. Patients with mild hypertension only
• C. Patients with well-controlled type 2 diabetes
• D. Patients with a history of osteoarthritis
Correct Answer: A
Rationale: Edoxaban is a direct factor Xa inhibitor with unique dosing considerations. The
ENGAGE AF-TIMI 48 trial showed reduced efficacy (higher ischemic stroke rates) in
patients with CrCl >95 mL/min, so it is not recommended for this population. It is
contraindicated with CrCl <15 mL/min. The dose should be reduced to 30 mg daily for CrCl
15-50 mL/min, body weight ≤60 kg, or concurrent use of certain P-gp inhibitors. It is
administered once daily with or without food. Andexanet alfa reverses edoxaban. Like other
DOACs, it does not require routine INR monitoring.
Question 8.
A nurse is assessing an older adult with a new diagnosis of sarcopenic obesity. Which
description best characterizes this condition?
• A. Coexistence of low muscle mass/strength and excess body fat, creating a
paradoxical phenotype with worse metabolic and functional outcomes than either
condition alone
