NUR 257 Chronic Exam 4: Complete
Practice Examination Concepts Of Aging
And Chronic Illness – Galen College Of
Nursing Academic Year: 2025-2026
SECTION 1: PAIN MANAGEMENT IN OLDER ADULTS (Questions
1-15)
1. A nurse is assessing an 82-year-old patient with chronic
osteoarthritis pain. The patient rates pain as 3/10 but is grimacing
and guarding the affected joint. What is the nurse's best action?
A. Document the pain score of 3/10 as accurate
B. Administer PRN analgesic as if pain were 7/10
C. Assess further using a behavioral pain scale
D. Tell the patient pain ratings must match behaviors
Answer: C. Assess further using a behavioral pain scale
Rationale: Older adults may under-report pain due to cultural beliefs,
fear of treatment, or cognitive impairment. Discrepancy between self-
report and behavioral indicators requires further assessment using
validated behavioral pain scales (e.g., PAINAD) especially in those with
cognitive deficits.
,2. A nursing student asks about misconceptions regarding chronic
pain in older adults. Which statement by the student indicates a
need for further teaching?
A. "Chronic pain patients may develop tolerance to opioids"
B. "Depression can both cause and result from chronic pain"
C. "Chronic pain patients often exaggerate their symptoms"
D. "Older adults can become physically dependent on pain medications"
Answer: C. "Chronic pain patients often exaggerate their
symptoms"
Rationale: Believing that patients with chronic pain are manipulative
or exaggerative is a common misconception that leads to under-
treatment of pain. Research shows chronic pain is real and
physiologically based, not a psychological fabrication.
3. A nurse is concerned about preventing "sensitization" in a
hospitalized patient with severe pancreatitis pain. Which approach
is most appropriate?
A. Wait until the patient requests pain medication
B. Administer analgesics around the clock on a scheduled basis
C. Use only non-pharmacologic interventions first
D. Encourage the patient to "tough it out" to prevent addiction
Answer: B. Administer analgesics around the clock on a scheduled
basis
Rationale: Sensitization occurs when patients wait too long to report
pain, resulting in a heightened nervous system response that makes
pain more difficult to relieve. Scheduled pain medication prevents pain
,from becoming severe and reduces the total amount of medication
needed.
4. A patient with chronic low back pain has been on oxycodone for
3 months. The nurse notes the patient requires higher doses for
the same pain relief. This finding suggests:
A. Drug addiction
B. Substance abuse disorder
C. Tolerance
D. Drug-seeking behavior
Answer: C. Tolerance
Rationale: Tolerance is a physiologic adaptation where higher doses
are required to achieve the same effect. This is distinct from
addiction (psychological dependence with compulsive use despite harm).
Tolerance is expected with long-term opioid use and does not indicate
substance abuse.
5. An older adult is started on morphine for cancer-related pain.
Which assessment finding requires the nurse's priority
intervention?
A. Nausea reported after the first dose
B. Respiratory rate of 8 breaths per minute
C. Patient reports feeling "drowsy"
D. Constipation after 3 days of treatment
Answer: B. Respiratory rate of 8 breaths per minute
, Rationale: Respiratory depression is the most serious side effect of
opioid analgesics, characterized by shallow respirations and decreased
respiratory rate. This requires immediate intervention including
potential naloxone administration. Nausea and drowsiness are expected
side effects that often subside, while constipation requires
management but is not immediately life-threatening.
6. Select all that apply: A nurse is teaching a patient about opioid
side effects. Which statements should the nurse include?
A. "Constipation usually resolves after the first week of treatment"
B. "Nausea often improves after a few days of taking the medication"
C. "You should take a stool softener and laxative regularly"
D. "Itching is a sign of allergic reaction and requires stopping the
medication"
E. "Change positions slowly to prevent dizziness"
Answer: B, C, E
Rationale: Nausea often subsides within a few days. Regular stool
softeners and laxatives are needed because opioid-induced constipation
does not resolve spontaneously. Position changes prevent orthostatic
hypotension. Itching (pruritus) is a common non-allergic side effect
treatable with antihistamines, not an indication to stop opioids.
7. An older adult with chronic pain has been reluctant to take
prescribed opioids. Which nursing intervention is most likely to
improve adherence?
A. Tell the patient that pain is expected at their age
B. Assess the patient's specific concerns about opioid use
Practice Examination Concepts Of Aging
And Chronic Illness – Galen College Of
Nursing Academic Year: 2025-2026
SECTION 1: PAIN MANAGEMENT IN OLDER ADULTS (Questions
1-15)
1. A nurse is assessing an 82-year-old patient with chronic
osteoarthritis pain. The patient rates pain as 3/10 but is grimacing
and guarding the affected joint. What is the nurse's best action?
A. Document the pain score of 3/10 as accurate
B. Administer PRN analgesic as if pain were 7/10
C. Assess further using a behavioral pain scale
D. Tell the patient pain ratings must match behaviors
Answer: C. Assess further using a behavioral pain scale
Rationale: Older adults may under-report pain due to cultural beliefs,
fear of treatment, or cognitive impairment. Discrepancy between self-
report and behavioral indicators requires further assessment using
validated behavioral pain scales (e.g., PAINAD) especially in those with
cognitive deficits.
,2. A nursing student asks about misconceptions regarding chronic
pain in older adults. Which statement by the student indicates a
need for further teaching?
A. "Chronic pain patients may develop tolerance to opioids"
B. "Depression can both cause and result from chronic pain"
C. "Chronic pain patients often exaggerate their symptoms"
D. "Older adults can become physically dependent on pain medications"
Answer: C. "Chronic pain patients often exaggerate their
symptoms"
Rationale: Believing that patients with chronic pain are manipulative
or exaggerative is a common misconception that leads to under-
treatment of pain. Research shows chronic pain is real and
physiologically based, not a psychological fabrication.
3. A nurse is concerned about preventing "sensitization" in a
hospitalized patient with severe pancreatitis pain. Which approach
is most appropriate?
A. Wait until the patient requests pain medication
B. Administer analgesics around the clock on a scheduled basis
C. Use only non-pharmacologic interventions first
D. Encourage the patient to "tough it out" to prevent addiction
Answer: B. Administer analgesics around the clock on a scheduled
basis
Rationale: Sensitization occurs when patients wait too long to report
pain, resulting in a heightened nervous system response that makes
pain more difficult to relieve. Scheduled pain medication prevents pain
,from becoming severe and reduces the total amount of medication
needed.
4. A patient with chronic low back pain has been on oxycodone for
3 months. The nurse notes the patient requires higher doses for
the same pain relief. This finding suggests:
A. Drug addiction
B. Substance abuse disorder
C. Tolerance
D. Drug-seeking behavior
Answer: C. Tolerance
Rationale: Tolerance is a physiologic adaptation where higher doses
are required to achieve the same effect. This is distinct from
addiction (psychological dependence with compulsive use despite harm).
Tolerance is expected with long-term opioid use and does not indicate
substance abuse.
5. An older adult is started on morphine for cancer-related pain.
Which assessment finding requires the nurse's priority
intervention?
A. Nausea reported after the first dose
B. Respiratory rate of 8 breaths per minute
C. Patient reports feeling "drowsy"
D. Constipation after 3 days of treatment
Answer: B. Respiratory rate of 8 breaths per minute
, Rationale: Respiratory depression is the most serious side effect of
opioid analgesics, characterized by shallow respirations and decreased
respiratory rate. This requires immediate intervention including
potential naloxone administration. Nausea and drowsiness are expected
side effects that often subside, while constipation requires
management but is not immediately life-threatening.
6. Select all that apply: A nurse is teaching a patient about opioid
side effects. Which statements should the nurse include?
A. "Constipation usually resolves after the first week of treatment"
B. "Nausea often improves after a few days of taking the medication"
C. "You should take a stool softener and laxative regularly"
D. "Itching is a sign of allergic reaction and requires stopping the
medication"
E. "Change positions slowly to prevent dizziness"
Answer: B, C, E
Rationale: Nausea often subsides within a few days. Regular stool
softeners and laxatives are needed because opioid-induced constipation
does not resolve spontaneously. Position changes prevent orthostatic
hypotension. Itching (pruritus) is a common non-allergic side effect
treatable with antihistamines, not an indication to stop opioids.
7. An older adult with chronic pain has been reluctant to take
prescribed opioids. Which nursing intervention is most likely to
improve adherence?
A. Tell the patient that pain is expected at their age
B. Assess the patient's specific concerns about opioid use
