NUR 257 EXAM 4: CONCEPTS OF AGING &
CHRONIC ILLNESS (LATEST 2025/2026) –
VERIFIED QUESTIONS, ANSWERS &
RATIONALES – GALEN COLLEGE OF NURSING
Based on the search results, NUR 257 Exam 4 at Galen College of Nursing focuses
on Concepts of Aging and Chronic Illness, including sensory disorders, pain
management, skin integrity, sleep disorders, immunologic/eye conditions,
polypharmacy, palliative care, and chronic disease management. Below is a
comprehensive 100-question practice exam with answers and detailed rationales.
Part 1: Physiological Changes of Aging (Questions 1-12)
1. An 82-year-old patient's laboratory results show a hemoglobin of 11.8 g/dL.
The nurse knows that in older adults, this value:
A) Is critically low and requires emergency blood transfusion
B) May be a normal finding related to age-related hematopoietic changes
C) Indicates iron deficiency anemia requiring immediate iron supplementation
D) Represents polycythemia vera in the geriatric population
Answer: B) May be a normal finding related to age-related hematopoietic
changes
*Rationale: Normal aging is associated with a mild decrease in hemoglobin due to
reduced bone marrow reserve and decreased erythropoietin response. A
hemoglobin of 11.8 g/dL may be within expected range for an older adult and
does not always indicate pathology. However, a sudden drop from baseline would
warrant investigation.*
,2. A nurse is assessing an 80-year-old patient. Which finding is a normal
physiological change of aging?
A) Increased cardiac output
B) Decreased lung elasticity
C) Increased gastric motility
D) Increased saliva production
Answer: B) Decreased lung elasticity
Rationale: Normal aging causes loss of lung elasticity, decreased chest wall
compliance, and increased residual volume. Cardiac output typically decreases
with age. Gastric motility slows, and saliva production decreases (xerostomia) with
aging.
3. An older adult patient reports difficulty seeing at night and needing brighter
light to read. The nurse attributes these changes to:
A) Cataracts requiring immediate surgical referral
B) Normal age-related changes in the lens and pupillary response
C) Early-onset macular degeneration requiring urgent treatment
D) Glaucoma presenting as decreased night vision
Answer: B) Normal age-related changes in the lens and pupillary response
Rationale: Normal aging of the eye includes lens thickening and yellowing,
decreased pupillary size (miosis), and reduced adaptation to changes in light.
These changes impair night vision and require more light for close work. While
cataracts and macular degeneration are common, the symptoms described align
with expected normal age-related visual changes.
4. Which statement BEST explains why older adults are at increased risk for
dehydration?
A) They consume excessive amounts of caffeine and alcohol
B) The kidneys over-compensate by retaining too much fluid
,C) The sensation of thirst diminishes significantly with aging
D) Older adults have increased antidiuretic hormone (ADH) secretion
Answer: C) The sensation of thirst diminishes significantly with aging
Rationale: The thirst mechanism becomes blunted with age—older adults do not
perceive thirst as readily as younger adults even when clinically dehydrated.
Additionally, kidneys lose concentrating ability with age. These factors make older
adults highly susceptible to dehydration.
5. During respiratory assessment of a 75-year-old patient, the nurse notes a
barrel-chest appearance and decreased breath sounds. What is the most
appropriate nursing interpretation?
A) This indicates active COPD exacerbation requiring immediate intervention
B) This is a normal age-related change of the respiratory system
C) This represents pneumonia and should prompt immediate chest X-ray
D) This indicates pulmonary fibrosis and requires specialist referral
Answer: B) This is a normal age-related change of the respiratory system
Rationale: With normal aging, chest wall stiffness increases due to calcification of
costal cartilage, diaphragm weakens, and loss of lung elasticity causes some air
trapping—leading to a mild barrel-chest appearance and slightly decreased breath
sounds. These are expected findings in an older adult without respiratory disease.
6. A 70-year-old patient reports food "tasting bland" and having a poor appetite.
The nurse understands that:
A) Gastric motility increases with aging, causing early satiety
B) Reduced taste buds and olfactory decline are normal age-related changes
C) Depression is the only cause of anorexia in older adults
D) Saliva production increases, diluting food flavors
Answer: B) Reduced taste buds and olfactory decline are normal age-related
changes
, Rationale: Normal aging involves reduced number of taste buds (hypogeusia) and
decreased sense of smell (hyposmia), which are important risk factors for
malnutrition in older adults. Gastric motility slows, and saliva production
decreases with aging.
7. Which skin change is considered a NORMAL physiological manifestation of
aging?
A) Melanoma lesions developing on sun-exposed areas
B) Pitting edema in bilateral lower extremities
C) Decreased skin turgor and increased skin dryness (xerosis)
D) Petechiae appearing on the trunk and extremities
Answer: C) Decreased skin turgor and increased skin dryness (xerosis)
Rationale: Normal skin aging includes decreased collagen production, reduced
sebaceous and sweat gland activity, thinning of dermis and epidermis, and loss of
subcutaneous fat. These changes result in decreased skin turgor and increased
dryness. Melanoma, edema, and petechiae are pathological findings requiring
investigation.
8. A 78-year-old patient reports difficulty staying asleep and waking up with
persistent foot cramps. Which action by the nurse is most appropriate to
promote restful sleep?
A) Offer a late-night caffeinated beverage
B) Encourage a daytime nap of 2–3 hours
C) Establish a consistent bedtime routine and limit evening fluids
D) Advise the patient to exercise vigorously within 1 hour of bedtime
Answer: C) Establish a consistent bedtime routine and limit evening fluids
Rationale: A consistent bedtime routine and limiting evening fluids help promote
sleep hygiene in older adults. Caffeine late in the day and vigorous exercise near
bedtime disrupt sleep; long daytime naps interfere with nighttime sleep.
CHRONIC ILLNESS (LATEST 2025/2026) –
VERIFIED QUESTIONS, ANSWERS &
RATIONALES – GALEN COLLEGE OF NURSING
Based on the search results, NUR 257 Exam 4 at Galen College of Nursing focuses
on Concepts of Aging and Chronic Illness, including sensory disorders, pain
management, skin integrity, sleep disorders, immunologic/eye conditions,
polypharmacy, palliative care, and chronic disease management. Below is a
comprehensive 100-question practice exam with answers and detailed rationales.
Part 1: Physiological Changes of Aging (Questions 1-12)
1. An 82-year-old patient's laboratory results show a hemoglobin of 11.8 g/dL.
The nurse knows that in older adults, this value:
A) Is critically low and requires emergency blood transfusion
B) May be a normal finding related to age-related hematopoietic changes
C) Indicates iron deficiency anemia requiring immediate iron supplementation
D) Represents polycythemia vera in the geriatric population
Answer: B) May be a normal finding related to age-related hematopoietic
changes
*Rationale: Normal aging is associated with a mild decrease in hemoglobin due to
reduced bone marrow reserve and decreased erythropoietin response. A
hemoglobin of 11.8 g/dL may be within expected range for an older adult and
does not always indicate pathology. However, a sudden drop from baseline would
warrant investigation.*
,2. A nurse is assessing an 80-year-old patient. Which finding is a normal
physiological change of aging?
A) Increased cardiac output
B) Decreased lung elasticity
C) Increased gastric motility
D) Increased saliva production
Answer: B) Decreased lung elasticity
Rationale: Normal aging causes loss of lung elasticity, decreased chest wall
compliance, and increased residual volume. Cardiac output typically decreases
with age. Gastric motility slows, and saliva production decreases (xerostomia) with
aging.
3. An older adult patient reports difficulty seeing at night and needing brighter
light to read. The nurse attributes these changes to:
A) Cataracts requiring immediate surgical referral
B) Normal age-related changes in the lens and pupillary response
C) Early-onset macular degeneration requiring urgent treatment
D) Glaucoma presenting as decreased night vision
Answer: B) Normal age-related changes in the lens and pupillary response
Rationale: Normal aging of the eye includes lens thickening and yellowing,
decreased pupillary size (miosis), and reduced adaptation to changes in light.
These changes impair night vision and require more light for close work. While
cataracts and macular degeneration are common, the symptoms described align
with expected normal age-related visual changes.
4. Which statement BEST explains why older adults are at increased risk for
dehydration?
A) They consume excessive amounts of caffeine and alcohol
B) The kidneys over-compensate by retaining too much fluid
,C) The sensation of thirst diminishes significantly with aging
D) Older adults have increased antidiuretic hormone (ADH) secretion
Answer: C) The sensation of thirst diminishes significantly with aging
Rationale: The thirst mechanism becomes blunted with age—older adults do not
perceive thirst as readily as younger adults even when clinically dehydrated.
Additionally, kidneys lose concentrating ability with age. These factors make older
adults highly susceptible to dehydration.
5. During respiratory assessment of a 75-year-old patient, the nurse notes a
barrel-chest appearance and decreased breath sounds. What is the most
appropriate nursing interpretation?
A) This indicates active COPD exacerbation requiring immediate intervention
B) This is a normal age-related change of the respiratory system
C) This represents pneumonia and should prompt immediate chest X-ray
D) This indicates pulmonary fibrosis and requires specialist referral
Answer: B) This is a normal age-related change of the respiratory system
Rationale: With normal aging, chest wall stiffness increases due to calcification of
costal cartilage, diaphragm weakens, and loss of lung elasticity causes some air
trapping—leading to a mild barrel-chest appearance and slightly decreased breath
sounds. These are expected findings in an older adult without respiratory disease.
6. A 70-year-old patient reports food "tasting bland" and having a poor appetite.
The nurse understands that:
A) Gastric motility increases with aging, causing early satiety
B) Reduced taste buds and olfactory decline are normal age-related changes
C) Depression is the only cause of anorexia in older adults
D) Saliva production increases, diluting food flavors
Answer: B) Reduced taste buds and olfactory decline are normal age-related
changes
, Rationale: Normal aging involves reduced number of taste buds (hypogeusia) and
decreased sense of smell (hyposmia), which are important risk factors for
malnutrition in older adults. Gastric motility slows, and saliva production
decreases with aging.
7. Which skin change is considered a NORMAL physiological manifestation of
aging?
A) Melanoma lesions developing on sun-exposed areas
B) Pitting edema in bilateral lower extremities
C) Decreased skin turgor and increased skin dryness (xerosis)
D) Petechiae appearing on the trunk and extremities
Answer: C) Decreased skin turgor and increased skin dryness (xerosis)
Rationale: Normal skin aging includes decreased collagen production, reduced
sebaceous and sweat gland activity, thinning of dermis and epidermis, and loss of
subcutaneous fat. These changes result in decreased skin turgor and increased
dryness. Melanoma, edema, and petechiae are pathological findings requiring
investigation.
8. A 78-year-old patient reports difficulty staying asleep and waking up with
persistent foot cramps. Which action by the nurse is most appropriate to
promote restful sleep?
A) Offer a late-night caffeinated beverage
B) Encourage a daytime nap of 2–3 hours
C) Establish a consistent bedtime routine and limit evening fluids
D) Advise the patient to exercise vigorously within 1 hour of bedtime
Answer: C) Establish a consistent bedtime routine and limit evening fluids
Rationale: A consistent bedtime routine and limiting evening fluids help promote
sleep hygiene in older adults. Caffeine late in the day and vigorous exercise near
bedtime disrupt sleep; long daytime naps interfere with nighttime sleep.
