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NUR 257 CONCEPTS OF AGING AND CHRONIC
ILLNESS IN NURSING EXAM 4 QUESTIONS
WITH VERIFIED SOLUTIONS
Question 1
An older adult with moderate dementia is admitted with pneumonia. The patient
refuses intravenous fluids. Which ethical principle should guide the provider's
decision to honor the refusal?
A. Beneficence
B. Autonomy
C. Justice
D. Non-maleficence
Correct Answer: B
Rationale: Autonomy respects the patient's right to self-determination, even if the
decision may be unwise. Beneficence would require acting in the patient's best
interest, which may conflict with refusal; justice concerns fairness, and non-
maleficence is about avoiding harm, but the patient's expressed wish takes
precedence when decision-making capacity is present .
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Question 2
Which age-related change most directly explains why an older adult develops
toxicity at a drug dose previously tolerated?
A. Increased gastric pH reducing absorption of weak acids
B. Decreased hepatic first-pass metabolism and reduced glomerular filtration rate
C. Increased total body water expanding the volume of distribution
D. Enhanced hepatic cytochrome P450 enzyme induction
Correct Answer: B
Rationale: Aging reduces hepatic blood flow and phase I metabolism plus declines
GFR, prolonging drug half-life and raising serum levels. Increased gastric pH and
reduced body water (not increased) would lower, not raise, exposure, and CYP
induction is not an aging effect .
Question 3
Which age-related change most increases the risk of hypernatremia and
dehydration in older adults?
A. Increased thirst sensation
B. Decreased renal concentrating ability and blunted thirst
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C. Increased total body water
D. Enhanced aldosterone secretion
Correct Answer: B
Rationale: Aging reduces renal concentrating ability and thirst perception,
predisposing to dehydration and hypernatremia. Increased thirst, increased body
water, and enhanced aldosterone are not age-related changes .
Question 4
A patient with chronic kidney disease and heart failure has a new order for
NSAIDs for osteoarthritis pain. What is the nurse's priority action?
A. Administer as ordered and monitor for bleeding
B. Hold the NSAID and contact the provider to discuss safer alternatives
C. Give with food to reduce gastric irritation
D. Encourage increased fluid intake
Correct Answer: B
Rationale: NSAIDs can worsen renal function and cause fluid retention, both of
which are dangerous in a patient with CKD and heart failure. The nurse should
hold the medication and contact the provider to discuss safer alternatives .
NUR 257 CONCEPTS OF AGING AND CHRONIC
ILLNESS IN NURSING EXAM 4 QUESTIONS
WITH VERIFIED SOLUTIONS
Question 1
An older adult with moderate dementia is admitted with pneumonia. The patient
refuses intravenous fluids. Which ethical principle should guide the provider's
decision to honor the refusal?
A. Beneficence
B. Autonomy
C. Justice
D. Non-maleficence
Correct Answer: B
Rationale: Autonomy respects the patient's right to self-determination, even if the
decision may be unwise. Beneficence would require acting in the patient's best
interest, which may conflict with refusal; justice concerns fairness, and non-
maleficence is about avoiding harm, but the patient's expressed wish takes
precedence when decision-making capacity is present .
,2|Page
Question 2
Which age-related change most directly explains why an older adult develops
toxicity at a drug dose previously tolerated?
A. Increased gastric pH reducing absorption of weak acids
B. Decreased hepatic first-pass metabolism and reduced glomerular filtration rate
C. Increased total body water expanding the volume of distribution
D. Enhanced hepatic cytochrome P450 enzyme induction
Correct Answer: B
Rationale: Aging reduces hepatic blood flow and phase I metabolism plus declines
GFR, prolonging drug half-life and raising serum levels. Increased gastric pH and
reduced body water (not increased) would lower, not raise, exposure, and CYP
induction is not an aging effect .
Question 3
Which age-related change most increases the risk of hypernatremia and
dehydration in older adults?
A. Increased thirst sensation
B. Decreased renal concentrating ability and blunted thirst
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C. Increased total body water
D. Enhanced aldosterone secretion
Correct Answer: B
Rationale: Aging reduces renal concentrating ability and thirst perception,
predisposing to dehydration and hypernatremia. Increased thirst, increased body
water, and enhanced aldosterone are not age-related changes .
Question 4
A patient with chronic kidney disease and heart failure has a new order for
NSAIDs for osteoarthritis pain. What is the nurse's priority action?
A. Administer as ordered and monitor for bleeding
B. Hold the NSAID and contact the provider to discuss safer alternatives
C. Give with food to reduce gastric irritation
D. Encourage increased fluid intake
Correct Answer: B
Rationale: NSAIDs can worsen renal function and cause fluid retention, both of
which are dangerous in a patient with CKD and heart failure. The nurse should
hold the medication and contact the provider to discuss safer alternatives .
