UR 257/ NUR257 Exam 4 – Concepts of
N
Aging and Chronic Illness in Nursing Guide
ACTUAL EXAM 2026/2027 | Aging and Chronic
Illness Nursing Guide | Verified Q&A | Pass
Guaranteed - A+ Graded
=======================================================================
=
======== PART A – MULTIPLE CHOICE (Q1‑60)
Q1 (Chronic disease – HFpEF management): A 78-year-old woman with hypertension, type 2
diabetes, and a recent echocardiogram showing an ejection fraction of 58% with elevated left
ventricular filling pressures is diagnosed with HFpEF. Her current medications include metformin
1000 mg BID, lisinopril 10 mg daily, and hydrochlorothiazide 25 mg daily. Which medication
addition is most appropriate according to 2026 guidelines?
A. Digoxin 0.25 mg daily
B. Empagliflozin 10 mg daily
C. Carvedilol 25 mg BID
D. Spironolactone 100 mg daily
[CORRECT] B
Rationale: The 2026 AHA/ACC/HFSA guidelines recommend SGLT2 inhibitors (empagliflozin or
dapagliflozin) as first-line therapy for HFpEF regardless of diabetes status, based on the
EMPEROR-Preserved trial demonstrating reduced cardiovascular death and heart failure
hospitalizations. Digoxin is not indicated in HFpEF and the Beers Criteria 2026 recommends
doses >0.125 mg/day as potentially inappropriate. While beta-blockers and MRAs have some
evidence, SGLT2 inhibitors now have the strongest recommendation (Class I) for HFpEF.
Clinical pearl: Monitor renal function and volume status when initiating SGLT2 inhibitors in older
adults.
Q2 (Chronic disease – CKD medication dosing): An 82-year-old man with stage 4 CKD (eGFR
22 mL/min/1.73m²) is prescribed gabapentin 300 mg TID for diabetic neuropathy. What is the
nurse's priority action?
A. Administer the medication as ordered
B. Hold the dose and notify the provider to reduce the dose
C. Administer with food to reduce GI upset
D. Increase fluid intake to 3 L/day
[CORRECT] B
Rationale: The Beers Criteria 2026 cautions against gabapentinoids in older adults with reduced
renal function due to accumulation and increased risk of sedation, dizziness, and falls;
gabapentin requires dose reduction when eGFR <30 mL/min/1.73m². Administering as ordered
could cause neuropsychiatric adverse effects and falls in this high-risk patient. While taking with
,food is acceptable, it does not address the critical dosing issue. Clinical pearl: For stage 4-5
CKD, gabapentin should be reduced to 100-300 mg daily and titrated slowly.
Q3 (Chronic disease – diabetes hypoglycemia prevention): A 76-year-old man with type 2
diabetes, CKD stage 3b, and mild cognitive impairment has an A1C of 6.8%. His current
regimen includes glimepiride 4 mg daily and metformin 1000 mg BID. What is the nurse's best
recommendation?
A. Continue current regimen; A1C is at goal
B. Discontinue glimepiride and consider basal insulin
C. Relax A1C target to 7-8% and consider metformin monotherapy
D. Add a GLP-1 receptor agonist to the current regimen
[CORRECT] C
Rationale: The ADA 2026 guidelines and Beers Criteria 2026 recommend relaxed glycemic
targets (A1C 7-8%) for older adults with multiple comorbidities, limited life expectancy, and
cognitive impairment to avoid hypoglycemia; glimepiride (sulfonylurea) is potentially
inappropriate in older adults due to prolonged hypoglycemia risk. Adding insulin or another
agent would increase hypoglycemia risk further. Clinical pearl: The "diabetes treatment pyramid"
for frail older adults prioritizes safety over tight control—avoid sulfonylureas and aim for higher,
safer A1C targets.
Q4 (Chronic disease – COPD exacerbation prevention): A 74-year-old woman with moderate
COPD (FEV1 55% predicted) asks the nurse what she can do to prevent exacerbations. Which
intervention has the strongest evidence for reducing exacerbations?
A. Daily oral theophylline
B. Smoking cessation and annual influenza vaccination
C. Long-term oral corticosteroids
D. Prophylactic antibiotics during winter months
[CORRECT] B
Rationale: Smoking cessation is the single most effective intervention to slow COPD
progression and reduce exacerbations; combined with annual influenza and pneumococcal
vaccination (per 2026 CDC recommendations), this forms the foundation of exacerbation
prevention. Theophylline has a narrow therapeutic index and is potentially inappropriate per
Beers Criteria 2026. Long-term oral steroids cause significant adverse effects in older adults.
Clinical pearl: Ensure this patient also receives the 2026 RSV vaccine (Abrysvo or Arexvy) if not
previously vaccinated, as RSV can cause severe COPD exacerbations in older adults.
Q5 (Chronic disease – osteoarthritis pharmacologic management): An 81-year-old woman with
osteoarthritis of the knees, hypertension, and CKD stage 3a reports knee pain rated 6/10. She
takes lisinopril and metformin. What is the first-line pharmacologic recommendation?
A. Oral ibuprofen 600 mg TID
B. Topical diclofenac gel
C. Oral tramadol 50 mg BID
D. Intra-articular corticosteroid injection
[CORRECT] B
Rationale: The AGS/AAOS 2026 guidelines recommend topical NSAIDs as first-line
pharmacologic therapy for knee osteoarthritis in older adults, as they provide localized pain
relief with minimal systemic absorption and reduced GI/renal/cardiovascular risks compared to
, ral NSAIDs. Oral ibuprofen is potentially inappropriate per Beers Criteria 2026 in patients with
o
CKD and hypertension due to nephrotoxicity and cardiovascular risks. Tramadol is also
potentially inappropriate due to seizure risk and serotonin syndrome. Clinical pearl: Topical
diclofenac has comparable efficacy to oral NSAIDs for knee OA with significantly fewer adverse
effects in older adults.
Q6 (Chronic disease – osteoporosis screening): A 70-year-old woman asks when she should
have her next DEXA scan. Her last scan 3 years ago showed a T-score of -1.8. What is the
nurse's best response?
A. "You don't need another DEXA scan; your bones are normal."
B. "Schedule a DEXA scan now; you are due for rescreening."
C. "Wait until age 75 for your next DEXA scan."
D. "You need a DEXA scan every year because you have osteopenia."
[CORRECT] B
Rationale: The USPSTF 2026 guidelines recommend DEXA screening every 2-5 years for
women 65+ with osteopenia (T-score -1.0 to -2.4); with a T-score of -1.8, this patient is in the
osteopenic range and due for rescreening after 3 years. Normal bone density (T-score ≥ -1.0)
allows for less frequent screening, but osteopenia requires closer monitoring. Annual DEXA is
not recommended and leads to unnecessary radiation exposure. Clinical pearl: A FRAX score
should be calculated for this patient to determine if pharmacologic intervention is warranted
despite osteopenia.
Q7 (Chronic disease – bisphosphonate administration): A nurse is teaching an 82-year-old
woman about alendronate therapy for osteoporosis. Which instruction is most important?
A. "Take the medication with your breakfast and a full glass of water."
B. "Take the medication first thing in the morning on an empty stomach with a full glass of water,
and remain upright for 30 minutes."
C. "You can take this medication at bedtime with a small snack."
D. "Crush the tablet and mix with applesauce if you have difficulty swallowing."
[CORRECT] B
Rationale: Alendronate must be taken on an empty stomach with a full glass of plain water, and
the patient must remain upright for at least 30 minutes to prevent esophageal irritation and
ulceration—this is a black box warning. Taking with food, beverages other than water, or lying
down significantly reduces absorption and increases esophageal injury risk. Crushing
bisphosphonates is contraindicated due to severe mucosal irritation. Clinical pearl: For older
adults with dysphagia or reflux, consider IV zoledronic acid or switching to denosumab to avoid
esophageal complications.
Q8 (Chronic disease – denosumab safety): A 79-year-old woman has been receiving
denosumab 60 mg subcutaneously every 6 months for 5 years for osteoporosis. Her new
provider plans to discontinue the medication. What is the nurse's priority concern?
A. Rebound vertebral fractures
B. Hypocalcemia
C. Osteonecrosis of the jaw
D. Atypical femur fractures
[CORRECT] A
, ationale: Denosumab must not be stopped abruptly without transitioning to another
R
antiresorptive agent (bisphosphonate or alternative) due to the risk of rebound vertebral
fractures and multiple vertebral fractures occurring 7-8 months after discontinuation. While
hypocalcemia can occur during treatment (especially in vitamin D deficient patients), it is not the
primary concern with discontinuation. ONJ and atypical femur fractures are risks during
treatment, not after stopping. Clinical pearl: If denosumab must be stopped, administer a
bisphosphonate 6 months after the last denosumab dose and continue for 1-3 years to prevent
rebound fractures.
Q9 (Chronic disease – fall prevention): A nurse is conducting a fall risk assessment on an
84-year-old man recently hospitalized for pneumonia. Which intervention is most effective for
preventing falls?
A. Restraint use during nighttime hours
B. Multifactorial fall risk assessment with tailored interventions
C. Bed alarm as the primary fall prevention strategy
D. Administering sleep medication to prevent nighttime wandering
[CORRECT] B
Rationale: The AGS/BGS 2026 Clinical Practice Guideline for Prevention of Falls in Older
Persons recommends multifactorial fall risk assessment followed by tailored interventions
(gait/balance training, medication review, vision correction, home modification, vitamin D
supplementation) as the most effective approach. Restraints and bed alarms are not
recommended as primary strategies and can cause harm. Sleep medications increase fall risk
and are potentially inappropriate per Beers Criteria 2026. Clinical pearl: The STEADI (Stopping
Elderly Accidents, Deaths & Injuries) toolkit from the CDC provides an evidence-based
framework for fall prevention in clinical practice.
Q10 (Geriatric pharmacology – Beers Criteria): Which medication is listed as potentially
inappropriate in the Beers Criteria 2026 for older adults due to high risk of severe
hypoglycemia?
A. Metformin
B. Glimepiride
C. Glyburide
D. Sitagliptin
[CORRECT] C
Rationale: The Beers Criteria 2026 lists glyburide (and other long-acting sulfonylureas) as
potentially inappropriate in older adults due to the high risk of severe, prolonged hypoglycemia;
glimepiride is preferred if a sulfonylurea is necessary due to shorter duration and lower
hypoglycemia risk. Metformin is generally safe unless eGFR <30. Sitagliptin (DPP-4 inhibitor)
has minimal hypoglycemia risk. Clinical pearl: When deprescribing in older adults with diabetes,
eliminate sulfonylureas first, then consider relaxing A1C targets before adding complex insulin
regimens.
Q11 (Geriatric pharmacology – anticholinergic burden): A 77-year-old woman with urinary
incontinence, depression, and insomnia takes oxybutynin, amitriptyline, and diphenhydramine.
The nurse calculates her anticholinergic burden. What is the primary concern?
A. Urinary retention only
B. Increased risk of delirium, falls, constipation, and cognitive impairment
N
Aging and Chronic Illness in Nursing Guide
ACTUAL EXAM 2026/2027 | Aging and Chronic
Illness Nursing Guide | Verified Q&A | Pass
Guaranteed - A+ Graded
=======================================================================
=
======== PART A – MULTIPLE CHOICE (Q1‑60)
Q1 (Chronic disease – HFpEF management): A 78-year-old woman with hypertension, type 2
diabetes, and a recent echocardiogram showing an ejection fraction of 58% with elevated left
ventricular filling pressures is diagnosed with HFpEF. Her current medications include metformin
1000 mg BID, lisinopril 10 mg daily, and hydrochlorothiazide 25 mg daily. Which medication
addition is most appropriate according to 2026 guidelines?
A. Digoxin 0.25 mg daily
B. Empagliflozin 10 mg daily
C. Carvedilol 25 mg BID
D. Spironolactone 100 mg daily
[CORRECT] B
Rationale: The 2026 AHA/ACC/HFSA guidelines recommend SGLT2 inhibitors (empagliflozin or
dapagliflozin) as first-line therapy for HFpEF regardless of diabetes status, based on the
EMPEROR-Preserved trial demonstrating reduced cardiovascular death and heart failure
hospitalizations. Digoxin is not indicated in HFpEF and the Beers Criteria 2026 recommends
doses >0.125 mg/day as potentially inappropriate. While beta-blockers and MRAs have some
evidence, SGLT2 inhibitors now have the strongest recommendation (Class I) for HFpEF.
Clinical pearl: Monitor renal function and volume status when initiating SGLT2 inhibitors in older
adults.
Q2 (Chronic disease – CKD medication dosing): An 82-year-old man with stage 4 CKD (eGFR
22 mL/min/1.73m²) is prescribed gabapentin 300 mg TID for diabetic neuropathy. What is the
nurse's priority action?
A. Administer the medication as ordered
B. Hold the dose and notify the provider to reduce the dose
C. Administer with food to reduce GI upset
D. Increase fluid intake to 3 L/day
[CORRECT] B
Rationale: The Beers Criteria 2026 cautions against gabapentinoids in older adults with reduced
renal function due to accumulation and increased risk of sedation, dizziness, and falls;
gabapentin requires dose reduction when eGFR <30 mL/min/1.73m². Administering as ordered
could cause neuropsychiatric adverse effects and falls in this high-risk patient. While taking with
,food is acceptable, it does not address the critical dosing issue. Clinical pearl: For stage 4-5
CKD, gabapentin should be reduced to 100-300 mg daily and titrated slowly.
Q3 (Chronic disease – diabetes hypoglycemia prevention): A 76-year-old man with type 2
diabetes, CKD stage 3b, and mild cognitive impairment has an A1C of 6.8%. His current
regimen includes glimepiride 4 mg daily and metformin 1000 mg BID. What is the nurse's best
recommendation?
A. Continue current regimen; A1C is at goal
B. Discontinue glimepiride and consider basal insulin
C. Relax A1C target to 7-8% and consider metformin monotherapy
D. Add a GLP-1 receptor agonist to the current regimen
[CORRECT] C
Rationale: The ADA 2026 guidelines and Beers Criteria 2026 recommend relaxed glycemic
targets (A1C 7-8%) for older adults with multiple comorbidities, limited life expectancy, and
cognitive impairment to avoid hypoglycemia; glimepiride (sulfonylurea) is potentially
inappropriate in older adults due to prolonged hypoglycemia risk. Adding insulin or another
agent would increase hypoglycemia risk further. Clinical pearl: The "diabetes treatment pyramid"
for frail older adults prioritizes safety over tight control—avoid sulfonylureas and aim for higher,
safer A1C targets.
Q4 (Chronic disease – COPD exacerbation prevention): A 74-year-old woman with moderate
COPD (FEV1 55% predicted) asks the nurse what she can do to prevent exacerbations. Which
intervention has the strongest evidence for reducing exacerbations?
A. Daily oral theophylline
B. Smoking cessation and annual influenza vaccination
C. Long-term oral corticosteroids
D. Prophylactic antibiotics during winter months
[CORRECT] B
Rationale: Smoking cessation is the single most effective intervention to slow COPD
progression and reduce exacerbations; combined with annual influenza and pneumococcal
vaccination (per 2026 CDC recommendations), this forms the foundation of exacerbation
prevention. Theophylline has a narrow therapeutic index and is potentially inappropriate per
Beers Criteria 2026. Long-term oral steroids cause significant adverse effects in older adults.
Clinical pearl: Ensure this patient also receives the 2026 RSV vaccine (Abrysvo or Arexvy) if not
previously vaccinated, as RSV can cause severe COPD exacerbations in older adults.
Q5 (Chronic disease – osteoarthritis pharmacologic management): An 81-year-old woman with
osteoarthritis of the knees, hypertension, and CKD stage 3a reports knee pain rated 6/10. She
takes lisinopril and metformin. What is the first-line pharmacologic recommendation?
A. Oral ibuprofen 600 mg TID
B. Topical diclofenac gel
C. Oral tramadol 50 mg BID
D. Intra-articular corticosteroid injection
[CORRECT] B
Rationale: The AGS/AAOS 2026 guidelines recommend topical NSAIDs as first-line
pharmacologic therapy for knee osteoarthritis in older adults, as they provide localized pain
relief with minimal systemic absorption and reduced GI/renal/cardiovascular risks compared to
, ral NSAIDs. Oral ibuprofen is potentially inappropriate per Beers Criteria 2026 in patients with
o
CKD and hypertension due to nephrotoxicity and cardiovascular risks. Tramadol is also
potentially inappropriate due to seizure risk and serotonin syndrome. Clinical pearl: Topical
diclofenac has comparable efficacy to oral NSAIDs for knee OA with significantly fewer adverse
effects in older adults.
Q6 (Chronic disease – osteoporosis screening): A 70-year-old woman asks when she should
have her next DEXA scan. Her last scan 3 years ago showed a T-score of -1.8. What is the
nurse's best response?
A. "You don't need another DEXA scan; your bones are normal."
B. "Schedule a DEXA scan now; you are due for rescreening."
C. "Wait until age 75 for your next DEXA scan."
D. "You need a DEXA scan every year because you have osteopenia."
[CORRECT] B
Rationale: The USPSTF 2026 guidelines recommend DEXA screening every 2-5 years for
women 65+ with osteopenia (T-score -1.0 to -2.4); with a T-score of -1.8, this patient is in the
osteopenic range and due for rescreening after 3 years. Normal bone density (T-score ≥ -1.0)
allows for less frequent screening, but osteopenia requires closer monitoring. Annual DEXA is
not recommended and leads to unnecessary radiation exposure. Clinical pearl: A FRAX score
should be calculated for this patient to determine if pharmacologic intervention is warranted
despite osteopenia.
Q7 (Chronic disease – bisphosphonate administration): A nurse is teaching an 82-year-old
woman about alendronate therapy for osteoporosis. Which instruction is most important?
A. "Take the medication with your breakfast and a full glass of water."
B. "Take the medication first thing in the morning on an empty stomach with a full glass of water,
and remain upright for 30 minutes."
C. "You can take this medication at bedtime with a small snack."
D. "Crush the tablet and mix with applesauce if you have difficulty swallowing."
[CORRECT] B
Rationale: Alendronate must be taken on an empty stomach with a full glass of plain water, and
the patient must remain upright for at least 30 minutes to prevent esophageal irritation and
ulceration—this is a black box warning. Taking with food, beverages other than water, or lying
down significantly reduces absorption and increases esophageal injury risk. Crushing
bisphosphonates is contraindicated due to severe mucosal irritation. Clinical pearl: For older
adults with dysphagia or reflux, consider IV zoledronic acid or switching to denosumab to avoid
esophageal complications.
Q8 (Chronic disease – denosumab safety): A 79-year-old woman has been receiving
denosumab 60 mg subcutaneously every 6 months for 5 years for osteoporosis. Her new
provider plans to discontinue the medication. What is the nurse's priority concern?
A. Rebound vertebral fractures
B. Hypocalcemia
C. Osteonecrosis of the jaw
D. Atypical femur fractures
[CORRECT] A
, ationale: Denosumab must not be stopped abruptly without transitioning to another
R
antiresorptive agent (bisphosphonate or alternative) due to the risk of rebound vertebral
fractures and multiple vertebral fractures occurring 7-8 months after discontinuation. While
hypocalcemia can occur during treatment (especially in vitamin D deficient patients), it is not the
primary concern with discontinuation. ONJ and atypical femur fractures are risks during
treatment, not after stopping. Clinical pearl: If denosumab must be stopped, administer a
bisphosphonate 6 months after the last denosumab dose and continue for 1-3 years to prevent
rebound fractures.
Q9 (Chronic disease – fall prevention): A nurse is conducting a fall risk assessment on an
84-year-old man recently hospitalized for pneumonia. Which intervention is most effective for
preventing falls?
A. Restraint use during nighttime hours
B. Multifactorial fall risk assessment with tailored interventions
C. Bed alarm as the primary fall prevention strategy
D. Administering sleep medication to prevent nighttime wandering
[CORRECT] B
Rationale: The AGS/BGS 2026 Clinical Practice Guideline for Prevention of Falls in Older
Persons recommends multifactorial fall risk assessment followed by tailored interventions
(gait/balance training, medication review, vision correction, home modification, vitamin D
supplementation) as the most effective approach. Restraints and bed alarms are not
recommended as primary strategies and can cause harm. Sleep medications increase fall risk
and are potentially inappropriate per Beers Criteria 2026. Clinical pearl: The STEADI (Stopping
Elderly Accidents, Deaths & Injuries) toolkit from the CDC provides an evidence-based
framework for fall prevention in clinical practice.
Q10 (Geriatric pharmacology – Beers Criteria): Which medication is listed as potentially
inappropriate in the Beers Criteria 2026 for older adults due to high risk of severe
hypoglycemia?
A. Metformin
B. Glimepiride
C. Glyburide
D. Sitagliptin
[CORRECT] C
Rationale: The Beers Criteria 2026 lists glyburide (and other long-acting sulfonylureas) as
potentially inappropriate in older adults due to the high risk of severe, prolonged hypoglycemia;
glimepiride is preferred if a sulfonylurea is necessary due to shorter duration and lower
hypoglycemia risk. Metformin is generally safe unless eGFR <30. Sitagliptin (DPP-4 inhibitor)
has minimal hypoglycemia risk. Clinical pearl: When deprescribing in older adults with diabetes,
eliminate sulfonylureas first, then consider relaxing A1C targets before adding complex insulin
regimens.
Q11 (Geriatric pharmacology – anticholinergic burden): A 77-year-old woman with urinary
incontinence, depression, and insomnia takes oxybutynin, amitriptyline, and diphenhydramine.
The nurse calculates her anticholinergic burden. What is the primary concern?
A. Urinary retention only
B. Increased risk of delirium, falls, constipation, and cognitive impairment
