NUR 257 Chronic Exam 2026/2027 | Galen College of Nursing NUR 257
Concepts of Aging & Chronic Illness Study Guide, Exams 1–4 & Final
Exam Prep, Chronic Illness, Gerontology, Aging, Pain Management,
Diabetes, Cardiovascular, Respiratory, Neurological Disorders & Nursing
Care
Question 1: A 72-year-old client is admitted with an exacerbation of chronic
obstructive pulmonary disease (COPD). The nurse notes the client has a barrel
chest and is using accessory muscles to breathe. Which age-related change best
explains the barrel chest finding?
A. Increased anterior-posterior diameter due to hyperinflation
B. Decreased lung elasticity from elastin degradation
C. Weakened diaphragm strength from sarcopenia
D. Kyphotic postural changes from osteoporosis
CORRECT ANSWER: A. Increased anterior-posterior diameter due to
hyperinflation
Rationale: In COPD, air trapping leads to hyperinflation of the lungs, which
increases the anterior-posterior diameter of the chest, producing the
characteristic barrel chest appearance. While decreased lung elasticity and
diaphragm weakness contribute to air trapping, the barrel chest itself results from
chronic hyperinflation.
Question 2: A 78-year-old client with hypertension and osteoarthritis tells the
nurse, "I’ve stopped exercising because getting old means I should slow down."
Which response by the nurse is most appropriate?
A. "You’re right; rest is important at your age."
B. "Some physical changes occur with aging, but regular activity can help maintain
your function."
C. "Exercise won’t help your arthritis anyway."
D. "You should only exercise if your doctor orders it."
CORRECT ANSWER: B. "Some physical changes occur with aging, but regular
activity can help maintain your function."
Rationale: Aging is associated with physiologic changes, but inactivity is not a
required consequence. Regular, appropriately prescribed physical activity
supports strength, balance, cardiovascular health, and independence. The nurse
should educate while acknowledging age-related changes.
,Question 3: An 80-year-old client is prescribed a new medication. Which factor
places this client at highest risk for an adverse drug event?
A. The client lives alone
B. The client has a history of falls
C. Age-related decrease in renal clearance
D. The client takes a multivitamin daily
CORRECT ANSWER: C. Age-related decrease in renal clearance
Rationale: Older adults experience reduced glomerular filtration rate and hepatic
blood flow, which prolongs drug half-life and increases the risk of toxicity. While
living alone and fall history are relevant, altered pharmacokinetics is the primary
physiological risk factor.
Question 4: A nurse is assessing a 75-year-old client for dehydration. Which
finding is most consistent with normal age-related changes rather than
dehydration?
A. Dry mucous membranes
B. Decreased skin turgor over the sternum
C. Tenting of skin on the forearm
D. Sunken eyes
CORRECT ANSWER: B. Decreased skin turgor over the sternum
Rationale: Loss of subcutaneous tissue and elastin with aging reduces skin turgor,
especially on the extremities and sternum, making turgor a less reliable indicator
of hydration in older adults. Dehydration should be assessed using other
indicators such as mucous membranes and laboratory values.
Question 5: A 70-year-old client reports difficulty seeing at night while driving.
Which age-related visual change should the nurse suspect?
A. Cataract formation
B. Macular degeneration
C. Decreased accommodation
D. Reduced pupil size and lens rigidity
CORRECT ANSWER: D. Reduced pupil size and lens rigidity
,Rationale: Age-related miosis (reduced pupil size) limits the amount of light
entering the eye, and increased lens rigidity reduces light transmission. These
changes impair night vision and dark adaptation. Cataracts and macular
degeneration are pathologic, not normal aging changes.
Question 6: A nurse is teaching a 68-year-old client about advance directives.
Which statement by the client indicates correct understanding?
A. "A living will tells my doctor what treatments I want if I’m terminally ill."
B. "A healthcare proxy takes effect only after I die."
C. "Advance directives are only for people with cancer."
D. "My family can override my advance directive at any time."
CORRECT ANSWER: A. "A living will tells my doctor what treatments I want if I’m
terminally ill."
Rationale: A living will is a written document specifying the medical treatments a
person wishes to receive or refuse if they become terminally ill or permanently
unconscious. A healthcare proxy designates a decision-maker and takes effect
when the person loses capacity, not after death.
Question 7: An 82-year-old client is admitted with community-acquired
pneumonia. Which age-related respiratory change increases this client’s risk for
infection?
A. Increased residual volume
B. Decreased cough reflex and mucociliary clearance
C. Increased vital capacity
D. Decreased chest wall compliance
CORRECT ANSWER: B. Decreased cough reflex and mucociliary clearance
Rationale: Aging reduces the sensitivity of the cough reflex and impairs
mucociliary transport, allowing secretions and pathogens to accumulate in the
airways. This significantly increases susceptibility to respiratory infections.
Question 8: A nurse is caring for an older adult with chronic kidney disease.
Which laboratory value requires immediate follow-up?
, A. Serum creatinine 1.8 mg/dL
B. Hemoglobin 11.2 g/dL
C. Potassium 6.2 mEq/L
D. BUN 28 mg/dL
CORRECT ANSWER: C. Potassium 6.2 mEq/L
Rationale: Hyperkalemia (potassium >5.5 mEq/L) is a life-threatening complication
of chronic kidney disease because of impaired renal excretion. It can cause fatal
cardiac dysrhythmias and requires immediate intervention.
Question 9: A 76-year-old client with dementia is admitted to the hospital. Which
intervention best reduces the risk of delirium?
A. Use of physical restraints at night
B. Maintaining a consistent routine and familiar objects
C. Administering benzodiazepines for sleep
D. Keeping the room dark and quiet at all times
CORRECT ANSWER: B. Maintaining a consistent routine and familiar objects
Rationale: Delirium prevention in hospitalized older adults focuses on orientation,
familiar stimuli, consistent routines, adequate hydration, and minimizing
restraints and sedatives. Familiar objects and routine reduce disorientation and
agitation.
Question 10: A nurse is assessing an 85-year-old client for urinary incontinence.
The client reports losing urine when laughing or coughing. Which type of
incontinence is this?
A. Urge incontinence
B. Overflow incontinence
C. Functional incontinence
D. Stress incontinence
CORRECT ANSWER: D. Stress incontinence
Rationale: Stress incontinence occurs when increased intra-abdominal pressure
(from coughing, laughing, or sneezing) overcomes urethral sphincter resistance. It
Concepts of Aging & Chronic Illness Study Guide, Exams 1–4 & Final
Exam Prep, Chronic Illness, Gerontology, Aging, Pain Management,
Diabetes, Cardiovascular, Respiratory, Neurological Disorders & Nursing
Care
Question 1: A 72-year-old client is admitted with an exacerbation of chronic
obstructive pulmonary disease (COPD). The nurse notes the client has a barrel
chest and is using accessory muscles to breathe. Which age-related change best
explains the barrel chest finding?
A. Increased anterior-posterior diameter due to hyperinflation
B. Decreased lung elasticity from elastin degradation
C. Weakened diaphragm strength from sarcopenia
D. Kyphotic postural changes from osteoporosis
CORRECT ANSWER: A. Increased anterior-posterior diameter due to
hyperinflation
Rationale: In COPD, air trapping leads to hyperinflation of the lungs, which
increases the anterior-posterior diameter of the chest, producing the
characteristic barrel chest appearance. While decreased lung elasticity and
diaphragm weakness contribute to air trapping, the barrel chest itself results from
chronic hyperinflation.
Question 2: A 78-year-old client with hypertension and osteoarthritis tells the
nurse, "I’ve stopped exercising because getting old means I should slow down."
Which response by the nurse is most appropriate?
A. "You’re right; rest is important at your age."
B. "Some physical changes occur with aging, but regular activity can help maintain
your function."
C. "Exercise won’t help your arthritis anyway."
D. "You should only exercise if your doctor orders it."
CORRECT ANSWER: B. "Some physical changes occur with aging, but regular
activity can help maintain your function."
Rationale: Aging is associated with physiologic changes, but inactivity is not a
required consequence. Regular, appropriately prescribed physical activity
supports strength, balance, cardiovascular health, and independence. The nurse
should educate while acknowledging age-related changes.
,Question 3: An 80-year-old client is prescribed a new medication. Which factor
places this client at highest risk for an adverse drug event?
A. The client lives alone
B. The client has a history of falls
C. Age-related decrease in renal clearance
D. The client takes a multivitamin daily
CORRECT ANSWER: C. Age-related decrease in renal clearance
Rationale: Older adults experience reduced glomerular filtration rate and hepatic
blood flow, which prolongs drug half-life and increases the risk of toxicity. While
living alone and fall history are relevant, altered pharmacokinetics is the primary
physiological risk factor.
Question 4: A nurse is assessing a 75-year-old client for dehydration. Which
finding is most consistent with normal age-related changes rather than
dehydration?
A. Dry mucous membranes
B. Decreased skin turgor over the sternum
C. Tenting of skin on the forearm
D. Sunken eyes
CORRECT ANSWER: B. Decreased skin turgor over the sternum
Rationale: Loss of subcutaneous tissue and elastin with aging reduces skin turgor,
especially on the extremities and sternum, making turgor a less reliable indicator
of hydration in older adults. Dehydration should be assessed using other
indicators such as mucous membranes and laboratory values.
Question 5: A 70-year-old client reports difficulty seeing at night while driving.
Which age-related visual change should the nurse suspect?
A. Cataract formation
B. Macular degeneration
C. Decreased accommodation
D. Reduced pupil size and lens rigidity
CORRECT ANSWER: D. Reduced pupil size and lens rigidity
,Rationale: Age-related miosis (reduced pupil size) limits the amount of light
entering the eye, and increased lens rigidity reduces light transmission. These
changes impair night vision and dark adaptation. Cataracts and macular
degeneration are pathologic, not normal aging changes.
Question 6: A nurse is teaching a 68-year-old client about advance directives.
Which statement by the client indicates correct understanding?
A. "A living will tells my doctor what treatments I want if I’m terminally ill."
B. "A healthcare proxy takes effect only after I die."
C. "Advance directives are only for people with cancer."
D. "My family can override my advance directive at any time."
CORRECT ANSWER: A. "A living will tells my doctor what treatments I want if I’m
terminally ill."
Rationale: A living will is a written document specifying the medical treatments a
person wishes to receive or refuse if they become terminally ill or permanently
unconscious. A healthcare proxy designates a decision-maker and takes effect
when the person loses capacity, not after death.
Question 7: An 82-year-old client is admitted with community-acquired
pneumonia. Which age-related respiratory change increases this client’s risk for
infection?
A. Increased residual volume
B. Decreased cough reflex and mucociliary clearance
C. Increased vital capacity
D. Decreased chest wall compliance
CORRECT ANSWER: B. Decreased cough reflex and mucociliary clearance
Rationale: Aging reduces the sensitivity of the cough reflex and impairs
mucociliary transport, allowing secretions and pathogens to accumulate in the
airways. This significantly increases susceptibility to respiratory infections.
Question 8: A nurse is caring for an older adult with chronic kidney disease.
Which laboratory value requires immediate follow-up?
, A. Serum creatinine 1.8 mg/dL
B. Hemoglobin 11.2 g/dL
C. Potassium 6.2 mEq/L
D. BUN 28 mg/dL
CORRECT ANSWER: C. Potassium 6.2 mEq/L
Rationale: Hyperkalemia (potassium >5.5 mEq/L) is a life-threatening complication
of chronic kidney disease because of impaired renal excretion. It can cause fatal
cardiac dysrhythmias and requires immediate intervention.
Question 9: A 76-year-old client with dementia is admitted to the hospital. Which
intervention best reduces the risk of delirium?
A. Use of physical restraints at night
B. Maintaining a consistent routine and familiar objects
C. Administering benzodiazepines for sleep
D. Keeping the room dark and quiet at all times
CORRECT ANSWER: B. Maintaining a consistent routine and familiar objects
Rationale: Delirium prevention in hospitalized older adults focuses on orientation,
familiar stimuli, consistent routines, adequate hydration, and minimizing
restraints and sedatives. Familiar objects and routine reduce disorientation and
agitation.
Question 10: A nurse is assessing an 85-year-old client for urinary incontinence.
The client reports losing urine when laughing or coughing. Which type of
incontinence is this?
A. Urge incontinence
B. Overflow incontinence
C. Functional incontinence
D. Stress incontinence
CORRECT ANSWER: D. Stress incontinence
Rationale: Stress incontinence occurs when increased intra-abdominal pressure
(from coughing, laughing, or sneezing) overcomes urethral sphincter resistance. It
