NUR 2214 NURSING CARE OF THE OLDER ADULT QUIZ 4
2026/2027 | Questions and Answers | Already Graded A |
Rasmussen College | Pass Guaranteed
Domain 1: Physiological Changes of Aging (10 Questions)
Q1: A 78-year-old male patient reports difficulty seeing at night and states that colors
appear "washed out." He has no eye pain or redness. Visual acuity testing shows 20/40
vision bilaterally. Which age-related change best explains these findings?
A. Cataracts causing lens opacity and light scattering
B. Presbyopia resulting in difficulty with near vision accommodation
C. Age-related macular degeneration affecting central vision
D. Normal aging changes in the lens and retina reducing light transmission and color
discrimination
Correct Answer: D
Rationale: This patient demonstrates normal age-related visual changes: reduced dark
adaptation (night vision) from decreased rod function and slower regeneration of
rhodopsin, and reduced color discrimination (especially blues and greens) from lens
yellowing and reduced cone function. Visual acuity of 20/40 is within normal limits for
older adults (though not "20/20"). Option A (cataracts) typically causes glare sensitivity,
halos, and progressive vision loss, not specifically night vision issues without other
symptoms. Option B (presbyopia) affects near vision, not night vision or color
perception. Option C (AMD) causes central vision loss, metamorphopsia (distorted
vision), and drusen, not primarily night vision difficulties. The nurse should reassure the
patient about normal aging while ensuring adequate lighting and contrast in the
environment, and scheduling regular ophthalmologic exams to differentiate normal
aging from pathological conditions.
,Q2: A nurse assesses an 82-year-old female and notes her blood pressure is 148/82
mmHg while seated, with a regular pulse of 68 bpm. She reports feeling "fine" and takes
no medications. Which interpretation aligns with current gerontological guidelines?
A. This is normal blood pressure for her age; no intervention needed
B. This indicates Stage 1 hypertension requiring lifestyle modifications and possible
medication
C. This represents isolated systolic hypertension, common in older adults due to
decreased arterial compliance
D. The diastolic pressure is dangerously low and requires immediate intervention
Correct Answer: C
Rationale: Isolated systolic hypertension (ISH—elevated systolic ≥130-140 with normal
diastolic <80-90) is the most common hypertension pattern in adults >60, resulting from
age-related arterial stiffening (loss of elastin, increased collagen, calcification). The
widened pulse pressure (66 mmHg here) reflects decreased compliance. Current
ACC/AHA guidelines classify this as Stage 1 hypertension (systolic 130-139) or Stage 2
if ≥140, requiring evaluation and management, though treatment targets may be
individualized for frail elderly. Option A is incorrect because even "age-related"
hypertension increases cardiovascular risk. Option B is partially correct about
classification but misses the specific ISH pattern explanation. Option D is
incorrect—diastolic 82 is not low; low diastolic (<60) with ISH is concerning for coronary
perfusion risk. The nurse should recognize this pattern, assess orthostatic vitals,
evaluate cardiovascular risk factors, and ensure appropriate follow-up.
Q3: An 85-year-old patient has decreased sensation in the feet bilaterally, reduced ankle
reflexes, and mild gait unsteadiness. These findings are most consistent with:
A. Diabetic peripheral neuropathy
B. Normal age-related peripheral nerve changes
C. Vitamin B12 deficiency causing subacute combined degeneration
,D. Early Parkinson's disease
Correct Answer: B
Rationale: Normal aging causes gradual peripheral nerve changes: decreased nerve
conduction velocity (10-15% slowing), reduced sensory receptors (Pacinian corpuscles
decrease 50% by age 80), impaired proprioception, and decreased deep tendon reflexes
(especially ankle jerks, which may be absent in 50% of those >80). These changes
contribute to gait unsteadiness and increased fall risk even without disease. Option A
requires diabetes history and typically shows stocking-glove pattern, often painful or
burning. Option C causes more pronounced sensory ataxia, cognitive changes, and
macrocytic anemia. Option D causes resting tremor, rigidity, and bradykinesia, not
primarily sensory loss. The nurse should differentiate normal aging from pathology,
implement fall prevention strategies, and ensure regular monitoring for superimposed
disease.
Q4: Which physiological change of aging increases the risk of adverse drug reactions
through altered pharmacokinetics?
A. Increased gastric acid production enhancing drug absorption
B. Decreased glomerular filtration rate reducing renal drug clearance
C. Increased hepatic blood flow accelerating drug metabolism
D. Increased body water expanding drug distribution volume
Correct Answer: B
Rationale: Renal function declines progressively with age: GFR decreases 0.75-1
mL/min/year after age 40, though serum creatinine may remain "normal" due to
decreased muscle mass. This reduces clearance of renally eliminated drugs
(aminoglycosides, digoxin, lithium, metformin, many antibiotics), causing accumulation
and toxicity. Option A is incorrect—gastric acid decreases (atrophic gastritis), affecting
absorption of some drugs (iron, calcium, B12) but not increasing acid. Option C is
, incorrect—hepatic blood flow decreases 40% by age 90, slowing metabolism of
high-extraction drugs. Option D is incorrect—total body water decreases 10-15%,
concentrating water-soluble drugs and increasing toxicity risk.
Q5: A 76-year-old patient has reduced vital capacity, increased residual volume, and
decreased forced expiratory volume. Arterial blood gas shows pH 7.40, PaCO2 42, PaO2
78 mmHg on room air. Which interpretation is most accurate?
A. Severe chronic obstructive pulmonary disease requiring oxygen therapy
B. Normal age-related respiratory changes with mild hypoxemia acceptable for age
C. Acute respiratory failure requiring immediate intervention
D. Pulmonary embolism causing ventilation-perfusion mismatch
Correct Answer: B
Rationale: Normal aging causes: decreased elastic recoil (emphysema-like changes),
chest wall stiffening (kyphosis, calcified costal cartilages), weakened respiratory
muscles, and reduced alveolar surface area. This results in decreased vital capacity (VC
↓ 25-50 mL/year), increased residual volume (RV ↑), and FEV1/FVC ratio maintained but
absolute values decreased. PaO2 declines with age (expected PaO2 ≈ 100 - [age/3]): at
76, expected ~75 mmHg; 78 is acceptable. PaCO2 remains normal as chemoreceptor
response is preserved. Option A requires smoking history, symptoms, and lower
FEV1/FVC ratio. Option C would show acidosis and distress. Option D would show
hypoxemia with respiratory alkalosis and clinical distress.
Q6: Which cardiovascular finding in an 80-year-old patient requires further evaluation
rather than being attributed to normal aging?
A. S4 gallop heard at the apex
B. Decreased heart rate variability
C. New onset atrial fibrillation with rapid ventricular response
D. Slightly widened pulse pressure with systolic hypertension
2026/2027 | Questions and Answers | Already Graded A |
Rasmussen College | Pass Guaranteed
Domain 1: Physiological Changes of Aging (10 Questions)
Q1: A 78-year-old male patient reports difficulty seeing at night and states that colors
appear "washed out." He has no eye pain or redness. Visual acuity testing shows 20/40
vision bilaterally. Which age-related change best explains these findings?
A. Cataracts causing lens opacity and light scattering
B. Presbyopia resulting in difficulty with near vision accommodation
C. Age-related macular degeneration affecting central vision
D. Normal aging changes in the lens and retina reducing light transmission and color
discrimination
Correct Answer: D
Rationale: This patient demonstrates normal age-related visual changes: reduced dark
adaptation (night vision) from decreased rod function and slower regeneration of
rhodopsin, and reduced color discrimination (especially blues and greens) from lens
yellowing and reduced cone function. Visual acuity of 20/40 is within normal limits for
older adults (though not "20/20"). Option A (cataracts) typically causes glare sensitivity,
halos, and progressive vision loss, not specifically night vision issues without other
symptoms. Option B (presbyopia) affects near vision, not night vision or color
perception. Option C (AMD) causes central vision loss, metamorphopsia (distorted
vision), and drusen, not primarily night vision difficulties. The nurse should reassure the
patient about normal aging while ensuring adequate lighting and contrast in the
environment, and scheduling regular ophthalmologic exams to differentiate normal
aging from pathological conditions.
,Q2: A nurse assesses an 82-year-old female and notes her blood pressure is 148/82
mmHg while seated, with a regular pulse of 68 bpm. She reports feeling "fine" and takes
no medications. Which interpretation aligns with current gerontological guidelines?
A. This is normal blood pressure for her age; no intervention needed
B. This indicates Stage 1 hypertension requiring lifestyle modifications and possible
medication
C. This represents isolated systolic hypertension, common in older adults due to
decreased arterial compliance
D. The diastolic pressure is dangerously low and requires immediate intervention
Correct Answer: C
Rationale: Isolated systolic hypertension (ISH—elevated systolic ≥130-140 with normal
diastolic <80-90) is the most common hypertension pattern in adults >60, resulting from
age-related arterial stiffening (loss of elastin, increased collagen, calcification). The
widened pulse pressure (66 mmHg here) reflects decreased compliance. Current
ACC/AHA guidelines classify this as Stage 1 hypertension (systolic 130-139) or Stage 2
if ≥140, requiring evaluation and management, though treatment targets may be
individualized for frail elderly. Option A is incorrect because even "age-related"
hypertension increases cardiovascular risk. Option B is partially correct about
classification but misses the specific ISH pattern explanation. Option D is
incorrect—diastolic 82 is not low; low diastolic (<60) with ISH is concerning for coronary
perfusion risk. The nurse should recognize this pattern, assess orthostatic vitals,
evaluate cardiovascular risk factors, and ensure appropriate follow-up.
Q3: An 85-year-old patient has decreased sensation in the feet bilaterally, reduced ankle
reflexes, and mild gait unsteadiness. These findings are most consistent with:
A. Diabetic peripheral neuropathy
B. Normal age-related peripheral nerve changes
C. Vitamin B12 deficiency causing subacute combined degeneration
,D. Early Parkinson's disease
Correct Answer: B
Rationale: Normal aging causes gradual peripheral nerve changes: decreased nerve
conduction velocity (10-15% slowing), reduced sensory receptors (Pacinian corpuscles
decrease 50% by age 80), impaired proprioception, and decreased deep tendon reflexes
(especially ankle jerks, which may be absent in 50% of those >80). These changes
contribute to gait unsteadiness and increased fall risk even without disease. Option A
requires diabetes history and typically shows stocking-glove pattern, often painful or
burning. Option C causes more pronounced sensory ataxia, cognitive changes, and
macrocytic anemia. Option D causes resting tremor, rigidity, and bradykinesia, not
primarily sensory loss. The nurse should differentiate normal aging from pathology,
implement fall prevention strategies, and ensure regular monitoring for superimposed
disease.
Q4: Which physiological change of aging increases the risk of adverse drug reactions
through altered pharmacokinetics?
A. Increased gastric acid production enhancing drug absorption
B. Decreased glomerular filtration rate reducing renal drug clearance
C. Increased hepatic blood flow accelerating drug metabolism
D. Increased body water expanding drug distribution volume
Correct Answer: B
Rationale: Renal function declines progressively with age: GFR decreases 0.75-1
mL/min/year after age 40, though serum creatinine may remain "normal" due to
decreased muscle mass. This reduces clearance of renally eliminated drugs
(aminoglycosides, digoxin, lithium, metformin, many antibiotics), causing accumulation
and toxicity. Option A is incorrect—gastric acid decreases (atrophic gastritis), affecting
absorption of some drugs (iron, calcium, B12) but not increasing acid. Option C is
, incorrect—hepatic blood flow decreases 40% by age 90, slowing metabolism of
high-extraction drugs. Option D is incorrect—total body water decreases 10-15%,
concentrating water-soluble drugs and increasing toxicity risk.
Q5: A 76-year-old patient has reduced vital capacity, increased residual volume, and
decreased forced expiratory volume. Arterial blood gas shows pH 7.40, PaCO2 42, PaO2
78 mmHg on room air. Which interpretation is most accurate?
A. Severe chronic obstructive pulmonary disease requiring oxygen therapy
B. Normal age-related respiratory changes with mild hypoxemia acceptable for age
C. Acute respiratory failure requiring immediate intervention
D. Pulmonary embolism causing ventilation-perfusion mismatch
Correct Answer: B
Rationale: Normal aging causes: decreased elastic recoil (emphysema-like changes),
chest wall stiffening (kyphosis, calcified costal cartilages), weakened respiratory
muscles, and reduced alveolar surface area. This results in decreased vital capacity (VC
↓ 25-50 mL/year), increased residual volume (RV ↑), and FEV1/FVC ratio maintained but
absolute values decreased. PaO2 declines with age (expected PaO2 ≈ 100 - [age/3]): at
76, expected ~75 mmHg; 78 is acceptable. PaCO2 remains normal as chemoreceptor
response is preserved. Option A requires smoking history, symptoms, and lower
FEV1/FVC ratio. Option C would show acidosis and distress. Option D would show
hypoxemia with respiratory alkalosis and clinical distress.
Q6: Which cardiovascular finding in an 80-year-old patient requires further evaluation
rather than being attributed to normal aging?
A. S4 gallop heard at the apex
B. Decreased heart rate variability
C. New onset atrial fibrillation with rapid ventricular response
D. Slightly widened pulse pressure with systolic hypertension
