NUR 257/ NUR257 Exam 3 – Concepts of
Aging and Chronic Illness in Nursing
Review ACTUAL EXAM 2026/2027 |
Aging and Chronic Illness Nursing |
Verified Q&A | Pass Guaranteed - A+
Graded
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PART A – MULTIPLE CHOICE (Q1–60)
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Q1 (BPSD – non-pharmacologic intervention): A nurse is caring for an 82-year-old patient with
moderate Alzheimer's dementia who is pacing, repeatedly asking for her deceased husband,
and attempting to leave the unit. Which non-pharmacologic intervention should the nurse
implement FIRST?
A) Administer low-dose haloperidol PRN for agitation
B) Place the patient in a geri-chair with a tray table for safety
C) Redirect the patient to a quiet room with familiar music and a life-like doll
D) Apply wrist restraints to prevent elopement
[CORRECT] C
Rationale: The Hartford Institute for Geriatric Nursing and the American Geriatrics Society
(AGS) recommend non-pharmacologic interventions as first-line for behavioral and
psychological symptoms of dementia (BPSD), including environmental modifications,
redirection, and validation therapy. Option B is incorrect because geri-chairs with tray tables are
considered restraints and can increase agitation; Option D violates patient rights and can cause
injury or death. Option A is incorrect because antipsychotics carry a black box warning for
increased mortality in dementia and should only be used short-term when non-pharmacologic
measures fail. Clinical pearl for Galen students: Always assess triggers (pain, hunger, toileting
needs, environment) before considering any pharmacologic intervention for BPSD.
Q2 (Parkinson's disease – carbidopa/levodopa): A 76-year-old patient with Parkinson's disease
reports that his carbidopa/levodopa doses are becoming less effective, with more frequent "off"
periods during the day. Which dietary instruction should the nurse reinforce?
A) Take the medication with a high-protein snack to enhance absorption
B) Take the medication on an empty stomach or with a low-protein meal
C) Increase dietary protein intake to maintain muscle mass
, ) Crush the tablets and mix with applesauce for better absorption
D
[CORRECT] B
Rationale: Dietary amino acids compete with levodopa for absorption across the blood-brain
barrier via the large neutral amino acid transporter; high-protein meals can significantly reduce
levodopa efficacy and worsen "on-off" phenomena. Option A is incorrect because high-protein
intake with doses decreases drug effectiveness; Option C, while protein is important for muscle
maintenance, should be distributed throughout the day rather than concentrated around
medication times. Option D is incorrect because crushing sustained-release formulations can
cause dose dumping and toxicity. Clinical pearl for Galen students: Advise patients to take
levodopa 30 minutes before or 1 hour after meals, and to distribute protein intake evenly across
the day.
Q3 (Beers Criteria 2026 – potentially inappropriate medication): According to the 2026 AGS
Beers Criteria, which medication is potentially inappropriate for an 80-year-old patient with
insomnia and a history of falls?
A) Melatonin 3 mg at bedtime
B) Trazodone 50 mg at bedtime
C) Zolpidem 5 mg at bedtime
D) Ramelteon 8 mg at bedtime
[CORRECT] C
Rationale: The 2026 AGS Beers Criteria classify non-benzodiazepine benzodiazepine receptor
agonist hypnotics (Z-drugs including zolpidem, eszopiclone, zaleplon) as potentially
inappropriate in older adults due to increased risk of falls, fractures, delirium, and cognitive
impairment. Option A is generally considered safe for older adults; Option B, while having
anticholinergic properties at higher doses, is not classified as potentially inappropriate at low
doses for insomnia; Option D is a melatonin receptor agonist with a favorable safety profile in
older adults. Clinical pearl for Galen students: For older adults with insomnia, first-line
interventions include sleep hygiene, cognitive behavioral therapy for insomnia (CBT-I), and
melatonin before considering any pharmacologic agents.
Q4 (Stroke recovery – secondary prevention): A 74-year-old patient is being discharged after an
ischemic stroke. Which medication combination represents optimal secondary prevention
according to current guidelines?
A) Aspirin 81 mg daily, atorvastatin 80 mg daily, and lisinopril 10 mg daily
B) Aspirin 325 mg daily and clopidogrel 75 mg daily indefinitely
C) Warfarin 5 mg daily with a target INR of 3.0–4.0
D) Aspirin 81 mg daily and ibuprofen 400 mg TID PRN for headache
[CORRECT] A
Rationale: Current AHA/ASA guidelines recommend antiplatelet therapy (aspirin 81 mg),
high-intensity statin therapy (atorvastatin 80 mg), and blood pressure control with ACE inhibitors
for secondary stroke prevention; this combination addresses atherosclerosis, thrombosis, and
hypertension. Option B is incorrect because dual antiplatelet therapy (DAPT) is only
recommended for 21–90 days after minor stroke/TIA, not indefinitely, due to bleeding risk.
Option C is incorrect because warfarin is for cardioembolic stroke (atrial fibrillation) with a target
INR of 2.0–3.0, not 3.0–4.0. Option D is incorrect because NSAIDs like ibuprofen interfere with
aspirin's antiplatelet effect and increase GI bleeding risk. Clinical pearl for Galen students: The
," three pillars" of secondary stroke prevention are antithrombotic therapy, statin therapy, and risk
factor modification (BP, diabetes, smoking cessation).
Q5 (Delirium prevention): A nurse is implementing the Hospital Elder Life Program (HELP)
bundle for an 85-year-old patient post-hip fracture repair. Which intervention is MOST effective
for delirium prevention?
A) Administer haloperidol 0.5 mg PO every 6 hours prophylactically
B) Maintain continuous pulse oximetry and bed alarm activation
C) Implement orientation protocols, early mobilization, sleep hygiene, and vision/hearing
optimization
D) Keep the patient NPO until fully alert and oriented
[CORRECT] C
Rationale: The HELP bundle and NICE guidelines recommend multicomponent
non-pharmacologic interventions for delirium prevention, including reorientation, early
mobilization, sleep hygiene, hydration, nutrition, and sensory optimization (glasses, hearing
aids). Option A is incorrect because prophylactic antipsychotics are not recommended and may
worsen outcomes; Option B, while monitoring is important, does not prevent delirium and bed
alarms can increase agitation. Option D is incorrect because maintaining NPO status without
indication leads to dehydration and malnutrition, which are risk factors for delirium. Clinical pearl
for Galen students: The 4 P's of delirium prevention are Pain, Personal items (orientation),
Positioning (early mobilization), and Prevent dehydration/constipation.
Q6 (PAINAD assessment): A nurse is assessing pain in an 86-year-old patient with severe
Alzheimer's dementia who is nonverbal. The patient is breathing normally, appears calm, has
closed eyes with a slight frown, is lying quietly in bed, and does not respond to voice. Using the
PAINAD scale, what is the most likely score?
A) 0 (no pain)
B) 2 (mild pain)
C) 5 (moderate pain)
D) 8 (severe pain)
[CORRECT] B
Rationale: The PAINAD scale scores five domains (breathing, negative vocalization, facial
expression, body language, consolability) on a 0–2 scale each; this patient scores 0 for
breathing (normal), 0 for vocalization (calm), 1 for facial expression (slight frown), 0 for body
language (lying quietly), and 1 for consolability (does not respond to voice), totaling 2, indicating
mild pain. Option A is incorrect because the slight frown and lack of response to voice suggest
some discomfort; Options C and D overestimate pain as there are no signs of severe distress.
Clinical pearl for Galen students: A PAINAD score ≥2 warrants analgesic intervention; reassess
30–60 minutes after intervention in patients with dementia who cannot self-report.
Q7 (Opioid risk in older adults): A 79-year-old patient with metastatic cancer is started on
morphine sulfate 15 mg PO every 4 hours for pain. Which nursing intervention is the HIGHEST
priority?
A) Monitor for euphoria and signs of addiction
B) Initiate a bowel regimen with a stimulant laxative and stool softener
C) Assess for signs of withdrawal every 4 hours
D) Encourage the patient to ambulate independently to prevent deconditioning
, [CORRECT] B
Rationale: Opioid-induced constipation (OIC) occurs in 40–80% of patients on opioids and does
not develop tolerance; prophylactic bowel regimens with stimulant laxatives (senna, bisacodyl)
plus stool softeners are standard of care per CDC 2026 guidelines. Option A is incorrect
because addiction is rare (<1%) in older adults with cancer pain; Option C is incorrect because
withdrawal assessment is not a priority in patients receiving scheduled opioids. Option D is
incorrect because independent ambulation increases fall risk in opioid-naïve elderly patients;
supervised ambulation is preferred. Clinical pearl for Galen students: The adage "start low, go
slow, but go" applies to opioids in older adults—always pair with a bowel regimen and monitor
for sedation, respiratory depression, and falls.
Q8 (Pressure injury staging): A nurse notes a 3 cm × 2 cm wound over the sacrum of an
82-year-old patient. The wound bed is covered with yellow, stringy tissue; the surrounding skin
is erythematous but intact. No bone, tendon, or muscle is visible. How should the nurse stage
this pressure injury?
A) Stage 1
B) Stage 2
C) Stage 3
D) Unstageable
[CORRECT] D
Rationale: According to the NPIAP/EPUAP/PPPIA staging guidelines, a pressure injury is
"unstageable" when slough (yellow, stringy, avascular tissue) or eschar obscures the wound
bed, preventing accurate depth assessment; debridement is needed to stage properly. Option A
is incorrect because Stage 1 presents as non-blanchable erythema on intact skin; Option B is
incorrect because Stage 2 involves partial-thickness loss of skin with a visible pink/red wound
bed. Option C is incorrect because Stage 3 involves full-thickness tissue loss with visible
subcutaneous fat, which cannot be confirmed with slough present. Clinical pearl for Galen
students: Never stage a pressure injury by guessing depth when slough or eschar is present;
document as "unstageable" and initiate appropriate debridement based on patient condition and
goals of care.
Q9 (Multiple sclerosis – symptom management): A 68-year-old patient with multiple sclerosis
reports painful leg spasms that disrupt sleep. Which medication is MOST appropriate for
managing this symptom?
A) Donepezil 10 mg daily
B) Baclofen 10 mg TID
C) Memantine 10 mg BID
D) Levodopa/carbidopa 25/100 mg TID
[CORRECT] B
Rationale: Baclofen is a GABA-B agonist and first-line treatment for spasticity in multiple
sclerosis, reducing painful muscle spasms and improving function. Option A is incorrect
because donepezil is a cholinesterase inhibitor for Alzheimer's dementia and has no effect on
spasticity; Option C is incorrect because memantine is an NMDA receptor antagonist for
moderate-to-severe dementia. Option D is incorrect because levodopa is for Parkinson's
disease and can worsen spasticity in MS. Clinical pearl for Galen students: For MS spasticity,
Aging and Chronic Illness in Nursing
Review ACTUAL EXAM 2026/2027 |
Aging and Chronic Illness Nursing |
Verified Q&A | Pass Guaranteed - A+
Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1–60)
========================================================================
========
Q1 (BPSD – non-pharmacologic intervention): A nurse is caring for an 82-year-old patient with
moderate Alzheimer's dementia who is pacing, repeatedly asking for her deceased husband,
and attempting to leave the unit. Which non-pharmacologic intervention should the nurse
implement FIRST?
A) Administer low-dose haloperidol PRN for agitation
B) Place the patient in a geri-chair with a tray table for safety
C) Redirect the patient to a quiet room with familiar music and a life-like doll
D) Apply wrist restraints to prevent elopement
[CORRECT] C
Rationale: The Hartford Institute for Geriatric Nursing and the American Geriatrics Society
(AGS) recommend non-pharmacologic interventions as first-line for behavioral and
psychological symptoms of dementia (BPSD), including environmental modifications,
redirection, and validation therapy. Option B is incorrect because geri-chairs with tray tables are
considered restraints and can increase agitation; Option D violates patient rights and can cause
injury or death. Option A is incorrect because antipsychotics carry a black box warning for
increased mortality in dementia and should only be used short-term when non-pharmacologic
measures fail. Clinical pearl for Galen students: Always assess triggers (pain, hunger, toileting
needs, environment) before considering any pharmacologic intervention for BPSD.
Q2 (Parkinson's disease – carbidopa/levodopa): A 76-year-old patient with Parkinson's disease
reports that his carbidopa/levodopa doses are becoming less effective, with more frequent "off"
periods during the day. Which dietary instruction should the nurse reinforce?
A) Take the medication with a high-protein snack to enhance absorption
B) Take the medication on an empty stomach or with a low-protein meal
C) Increase dietary protein intake to maintain muscle mass
, ) Crush the tablets and mix with applesauce for better absorption
D
[CORRECT] B
Rationale: Dietary amino acids compete with levodopa for absorption across the blood-brain
barrier via the large neutral amino acid transporter; high-protein meals can significantly reduce
levodopa efficacy and worsen "on-off" phenomena. Option A is incorrect because high-protein
intake with doses decreases drug effectiveness; Option C, while protein is important for muscle
maintenance, should be distributed throughout the day rather than concentrated around
medication times. Option D is incorrect because crushing sustained-release formulations can
cause dose dumping and toxicity. Clinical pearl for Galen students: Advise patients to take
levodopa 30 minutes before or 1 hour after meals, and to distribute protein intake evenly across
the day.
Q3 (Beers Criteria 2026 – potentially inappropriate medication): According to the 2026 AGS
Beers Criteria, which medication is potentially inappropriate for an 80-year-old patient with
insomnia and a history of falls?
A) Melatonin 3 mg at bedtime
B) Trazodone 50 mg at bedtime
C) Zolpidem 5 mg at bedtime
D) Ramelteon 8 mg at bedtime
[CORRECT] C
Rationale: The 2026 AGS Beers Criteria classify non-benzodiazepine benzodiazepine receptor
agonist hypnotics (Z-drugs including zolpidem, eszopiclone, zaleplon) as potentially
inappropriate in older adults due to increased risk of falls, fractures, delirium, and cognitive
impairment. Option A is generally considered safe for older adults; Option B, while having
anticholinergic properties at higher doses, is not classified as potentially inappropriate at low
doses for insomnia; Option D is a melatonin receptor agonist with a favorable safety profile in
older adults. Clinical pearl for Galen students: For older adults with insomnia, first-line
interventions include sleep hygiene, cognitive behavioral therapy for insomnia (CBT-I), and
melatonin before considering any pharmacologic agents.
Q4 (Stroke recovery – secondary prevention): A 74-year-old patient is being discharged after an
ischemic stroke. Which medication combination represents optimal secondary prevention
according to current guidelines?
A) Aspirin 81 mg daily, atorvastatin 80 mg daily, and lisinopril 10 mg daily
B) Aspirin 325 mg daily and clopidogrel 75 mg daily indefinitely
C) Warfarin 5 mg daily with a target INR of 3.0–4.0
D) Aspirin 81 mg daily and ibuprofen 400 mg TID PRN for headache
[CORRECT] A
Rationale: Current AHA/ASA guidelines recommend antiplatelet therapy (aspirin 81 mg),
high-intensity statin therapy (atorvastatin 80 mg), and blood pressure control with ACE inhibitors
for secondary stroke prevention; this combination addresses atherosclerosis, thrombosis, and
hypertension. Option B is incorrect because dual antiplatelet therapy (DAPT) is only
recommended for 21–90 days after minor stroke/TIA, not indefinitely, due to bleeding risk.
Option C is incorrect because warfarin is for cardioembolic stroke (atrial fibrillation) with a target
INR of 2.0–3.0, not 3.0–4.0. Option D is incorrect because NSAIDs like ibuprofen interfere with
aspirin's antiplatelet effect and increase GI bleeding risk. Clinical pearl for Galen students: The
," three pillars" of secondary stroke prevention are antithrombotic therapy, statin therapy, and risk
factor modification (BP, diabetes, smoking cessation).
Q5 (Delirium prevention): A nurse is implementing the Hospital Elder Life Program (HELP)
bundle for an 85-year-old patient post-hip fracture repair. Which intervention is MOST effective
for delirium prevention?
A) Administer haloperidol 0.5 mg PO every 6 hours prophylactically
B) Maintain continuous pulse oximetry and bed alarm activation
C) Implement orientation protocols, early mobilization, sleep hygiene, and vision/hearing
optimization
D) Keep the patient NPO until fully alert and oriented
[CORRECT] C
Rationale: The HELP bundle and NICE guidelines recommend multicomponent
non-pharmacologic interventions for delirium prevention, including reorientation, early
mobilization, sleep hygiene, hydration, nutrition, and sensory optimization (glasses, hearing
aids). Option A is incorrect because prophylactic antipsychotics are not recommended and may
worsen outcomes; Option B, while monitoring is important, does not prevent delirium and bed
alarms can increase agitation. Option D is incorrect because maintaining NPO status without
indication leads to dehydration and malnutrition, which are risk factors for delirium. Clinical pearl
for Galen students: The 4 P's of delirium prevention are Pain, Personal items (orientation),
Positioning (early mobilization), and Prevent dehydration/constipation.
Q6 (PAINAD assessment): A nurse is assessing pain in an 86-year-old patient with severe
Alzheimer's dementia who is nonverbal. The patient is breathing normally, appears calm, has
closed eyes with a slight frown, is lying quietly in bed, and does not respond to voice. Using the
PAINAD scale, what is the most likely score?
A) 0 (no pain)
B) 2 (mild pain)
C) 5 (moderate pain)
D) 8 (severe pain)
[CORRECT] B
Rationale: The PAINAD scale scores five domains (breathing, negative vocalization, facial
expression, body language, consolability) on a 0–2 scale each; this patient scores 0 for
breathing (normal), 0 for vocalization (calm), 1 for facial expression (slight frown), 0 for body
language (lying quietly), and 1 for consolability (does not respond to voice), totaling 2, indicating
mild pain. Option A is incorrect because the slight frown and lack of response to voice suggest
some discomfort; Options C and D overestimate pain as there are no signs of severe distress.
Clinical pearl for Galen students: A PAINAD score ≥2 warrants analgesic intervention; reassess
30–60 minutes after intervention in patients with dementia who cannot self-report.
Q7 (Opioid risk in older adults): A 79-year-old patient with metastatic cancer is started on
morphine sulfate 15 mg PO every 4 hours for pain. Which nursing intervention is the HIGHEST
priority?
A) Monitor for euphoria and signs of addiction
B) Initiate a bowel regimen with a stimulant laxative and stool softener
C) Assess for signs of withdrawal every 4 hours
D) Encourage the patient to ambulate independently to prevent deconditioning
, [CORRECT] B
Rationale: Opioid-induced constipation (OIC) occurs in 40–80% of patients on opioids and does
not develop tolerance; prophylactic bowel regimens with stimulant laxatives (senna, bisacodyl)
plus stool softeners are standard of care per CDC 2026 guidelines. Option A is incorrect
because addiction is rare (<1%) in older adults with cancer pain; Option C is incorrect because
withdrawal assessment is not a priority in patients receiving scheduled opioids. Option D is
incorrect because independent ambulation increases fall risk in opioid-naïve elderly patients;
supervised ambulation is preferred. Clinical pearl for Galen students: The adage "start low, go
slow, but go" applies to opioids in older adults—always pair with a bowel regimen and monitor
for sedation, respiratory depression, and falls.
Q8 (Pressure injury staging): A nurse notes a 3 cm × 2 cm wound over the sacrum of an
82-year-old patient. The wound bed is covered with yellow, stringy tissue; the surrounding skin
is erythematous but intact. No bone, tendon, or muscle is visible. How should the nurse stage
this pressure injury?
A) Stage 1
B) Stage 2
C) Stage 3
D) Unstageable
[CORRECT] D
Rationale: According to the NPIAP/EPUAP/PPPIA staging guidelines, a pressure injury is
"unstageable" when slough (yellow, stringy, avascular tissue) or eschar obscures the wound
bed, preventing accurate depth assessment; debridement is needed to stage properly. Option A
is incorrect because Stage 1 presents as non-blanchable erythema on intact skin; Option B is
incorrect because Stage 2 involves partial-thickness loss of skin with a visible pink/red wound
bed. Option C is incorrect because Stage 3 involves full-thickness tissue loss with visible
subcutaneous fat, which cannot be confirmed with slough present. Clinical pearl for Galen
students: Never stage a pressure injury by guessing depth when slough or eschar is present;
document as "unstageable" and initiate appropriate debridement based on patient condition and
goals of care.
Q9 (Multiple sclerosis – symptom management): A 68-year-old patient with multiple sclerosis
reports painful leg spasms that disrupt sleep. Which medication is MOST appropriate for
managing this symptom?
A) Donepezil 10 mg daily
B) Baclofen 10 mg TID
C) Memantine 10 mg BID
D) Levodopa/carbidopa 25/100 mg TID
[CORRECT] B
Rationale: Baclofen is a GABA-B agonist and first-line treatment for spasticity in multiple
sclerosis, reducing painful muscle spasms and improving function. Option A is incorrect
because donepezil is a cholinesterase inhibitor for Alzheimer's dementia and has no effect on
spasticity; Option C is incorrect because memantine is an NMDA receptor antagonist for
moderate-to-severe dementia. Option D is incorrect because levodopa is for Parkinson's
disease and can worsen spasticity in MS. Clinical pearl for Galen students: For MS spasticity,
