NUR 257/ NUR257 Exam 3 – Concepts of 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 (BPSD – non-pharmacologic intervention): A nurse is caring for an 82-year-old male with
moderate Alzheimer's dementia who becomes agitated and aggressive during evening hours
(sundowning). Which non-pharmacologic intervention should the nurse implement FIRST?
A. Administer low-dose haloperidol PRN
B. Dim the lights and reduce environmental stimuli
C. Restrain the patient to prevent injury
D. Transfer the patient to a private room with minimal supervision
[CORRECT] B
Rationale: The Hartford Institute for Geriatric Nursing and AGS guidelines recommend
non-pharmacologic interventions as first-line for BPSD, including environmental modifications
such as adequate lighting, reducing noise, and maintaining routines; dimming lights
appropriately and minimizing stimuli addresses sundowning triggers. Option A is incorrect
because antipsychotics should not be first-line and carry a black box warning for increased
mortality in elderly patients with dementia. Option C violates patient rights and can increase
agitation. Option D isolates the patient and removes supervision, increasing fall and injury risk.
Clinical pearl: Always assess and modify the environment before considering pharmacologic
interventions for BPSD.
Q2 (Parkinson's disease – carbidopa/levodopa): A 76-year-old with Parkinson's disease reports
that his carbidopa/levodopa doses are becoming less effective, with wearing-off periods
occurring sooner. Which dietary instruction should the nurse reinforce?
A. "Take the medication with a high-protein meal to enhance absorption."
B. "Consume protein evenly throughout the day, avoiding high-protein meals near dosing times."
C. "Increase iron-rich foods to support dopamine production."
D. "Drink grapefruit juice to improve medication metabolism."
[CORRECT] B
Rationale: Dietary protein competes with levodopa for absorption via the large neutral amino
acid transporter in the gut and blood-brain barrier; spacing protein intake away from doses
improves medication efficacy. Option A is incorrect because high-protein meals significantly
,r educe levodopa absorption and worsen the "wearing-off" phenomenon. Option C is incorrect
because iron supplements, not dietary iron, can chelate levodopa and reduce efficacy. Option D
is incorrect because grapefruit juice inhibits CYP3A4 and can alter metabolism of various
medications but does not improve levodopa absorption. Clinical pearl: Teach patients to take
levodopa 30 minutes before or 1 hour after meals, and consider a protein redistribution diet if
motor fluctuations persist.
Q3 (Pain assessment – PAINAD): A nurse is assessing pain in an 85-year-old female with
advanced dementia who is nonverbal. Which tool is MOST appropriate for this assessment?
A. Numeric Rating Scale (NRS)
B. Visual Analog Scale (VAS)
C. PAINAD (Pain Assessment in Advanced Dementia)
D. Brief Pain Inventory (BPI)
[CORRECT] C
Rationale: The PAINAD scale is specifically validated for assessing pain in older adults with
advanced dementia who cannot self-report; it evaluates breathing, vocalization, facial
expression, body language, and consolability. Option A requires cognitive ability to assign
numeric values to pain intensity and is inappropriate for advanced dementia. Option B also
requires the patient to mark a line indicating pain severity, which cognitively impaired patients
cannot reliably complete. Option D is a comprehensive pain assessment tool designed for
patients who can self-report and communicate. Clinical pearl: "If they can't tell you, watch them"
– the PAINAD takes 2-3 minutes to complete and should be used routinely in dementia care.
Q4 (Beers Criteria 2026 – potentially inappropriate medication): According to the 2026 AGS
Beers Criteria, which medication is potentially inappropriate in older adults due to increased risk
of falls and fractures?
A. Metoprolol
B. Lorazepam
C. Lisinopril
D. Metformin
[CORRECT] B
Rationale: The 2026 Beers Criteria classify benzodiazepines (including lorazepam) as
potentially inappropriate in older adults due to risks of falls, fractures, cognitive impairment, and
motor vehicle accidents; they should be avoided or used only with extreme caution. Option A
(beta-blockers) are not Beers-listed when used for appropriate indications like heart failure or
hypertension. Option C (ACE inhibitors) are generally well-tolerated and not on the Beers list.
Option D (metformin) is first-line for type 2 diabetes and not Beers-listed, though renal function
must be monitored. Clinical pearl: If benzodiazepines must be used, limit to short-term use,
lowest effective dose, and implement fall prevention strategies.
Q5 (Delirium prevention): A nurse is caring for a 78-year-old postoperative patient. Which
intervention is MOST effective in preventing delirium?
A. Administering prophylactic haloperidol
B. Maintaining sleep hygiene and early mobilization
C. Keeping the patient sedated to prevent agitation
D. Restricting fluids to reduce nighttime toileting
[CORRECT] B
, ationale: The Hospital Elder Life Program (HELP) and AGS guidelines demonstrate that
R
non-pharmacologic multicomponent interventions—including sleep hygiene, early mobilization,
reorientation, hydration, and vision/hearing optimization—are the most effective delirium
prevention strategies. Option A is incorrect because prophylactic antipsychotics are not
recommended and do not prevent delirium. Option C increases delirium risk by causing
oversedation and immobility. Option D causes dehydration, which is a known risk factor for
delirium. Clinical pearl: The ABCDEF bundle (Awakening, Breathing coordination, Delirium
monitoring, Early mobility, Family engagement) is the gold standard for ICU and postoperative
delirium prevention.
Q6 (Stroke recovery – secondary prevention): A nurse is educating a 72-year-old patient who
had an ischemic stroke 2 weeks ago. Which medication combination is MOST appropriate for
secondary stroke prevention?
A. Aspirin 81 mg daily + atorvastatin 80 mg daily
B. Clopidogrel 75 mg daily + warfarin (target INR 2.0-3.0)
C. Aspirin 325 mg daily + ibuprofen 400 mg TID
D. Dabigatran 150 mg BID + aspirin 81 mg daily (indefinite dual therapy)
[CORRECT] A
Rationale: Current AHA/ASA guidelines recommend antiplatelet therapy (aspirin) and
high-intensity statin therapy for secondary prevention of ischemic stroke; atorvastatin 80 mg is
the standard high-intensity regimen. Option B is incorrect because dual antithrombotic therapy
is not indicated for standard secondary prevention unless the patient has a specific indication
like atrial fibrillation or recent stent placement. Option C is incorrect because ibuprofen, an
NSAID, increases GI bleeding risk and may interfere with aspirin's antiplatelet effects. Option D
is incorrect because indefinite dual antithrombotic therapy significantly increases bleeding risk
without additional stroke prevention benefit. Clinical pearl: For patients with atrial fibrillation
post-stroke, oral anticoagulation replaces antiplatelet therapy, not adds to it.
Q7 (Urinary incontinence – behavioral intervention): A nurse is developing a plan of care for an
80-year-old with urge urinary incontinence. Which intervention should be prioritized?
A. Insert an indwelling urinary catheter for continuous drainage
B. Implement bladder training with scheduled toileting every 2 hours
C. Prescribe oxybutynin extended-release immediately
D. Restrict fluid intake to 1,000 mL per day
[CORRECT] B
Rationale: Bladder training and scheduled toileting are first-line behavioral interventions for urge
incontinence in older adults, supported by the Hartford Institute for Geriatric Nursing; they
retrain the bladder and reduce urgency episodes without medication risks. Option A is incorrect
because indwelling catheters increase UTI risk, cause trauma, and are contraindicated for
uncomplicated incontinence management. Option C is incorrect because anticholinergics are
not first-line due to cognitive impairment, constipation, and urinary retention risks in older adults
(Beers Criteria 2026). Option D causes dehydration, worsens constipation, and increases risk of
UTIs and delirium. Clinical pearl: Start with timed voiding every 2 hours, then gradually extend
intervals by 15-30 minutes as tolerated.
, 8 (Pressure injury – staging): A nurse assesses an 83-year-old bedbound patient and notes a
Q
shallow open ulcer with a red-pink wound bed, without slough or bruising, over the sacrum. How
should this be staged?
A. Stage 1 pressure injury
B. Stage 2 pressure injury
C. Stage 3 pressure injury
D. Unstageable pressure injury
[CORRECT] B
Rationale: A Stage 2 pressure injury presents as partial-thickness loss of skin with exposed
dermis, presenting as a shallow open ulcer with a red or pink wound bed without slough or
bruising, consistent with the NPIAP staging guidelines. Option A describes intact skin with
non-blanchable erythema. Option C involves full-thickness skin loss with visible adipose tissue.
Option D applies when slough or eschar obscures the wound base, preventing staging. Clinical
pearl: Stage 2 injuries can also present as intact or ruptured serum-filled blisters; document
location, dimensions, and wound characteristics for trending.
Q9 (Palliative care – dyspnea management): A nurse is caring for a patient with end-stage
COPD receiving hospice care who reports severe dyspnea. Which intervention is MOST
appropriate?
A. Aggressive fluid resuscitation to improve perfusion
B. Low-dose oral morphine and positioning with a fan
C. High-flow oxygen via non-rebreather mask regardless of SpO2
D. Benzodiazepines as first-line for respiratory distress
[CORRECT] B
Rationale: Low-dose opioids (morphine 2.5-5 mg PO) are the gold standard for refractory
dyspnea in palliative care, reducing the sensation of breathlessness without significantly
compromising respiratory drive; a fan directed at the face stimulates trigeminal nerve receptors
and reduces dyspnea perception. Option A worsens fluid overload and respiratory distress in
COPD patients. Option C is inappropriate because supplemental oxygen is only beneficial if the
patient is hypoxemic; forcing high-flow oxygen on a non-hypoxemic patient causes discomfort
and drying. Option D is incorrect because benzodiazepines treat anxiety associated with
dyspnea but do not address the underlying sensation of breathlessness. Clinical pearl: In
hospice, comfort is the goal—morphine 2.5 mg PO every 4 hours PRN is a standard starting
dose for dyspnea.
Q10 (Elder abuse – recognition): During a home health visit, a nurse notices an 80-year-old
patient has multiple bruises in various stages of healing on the inner arms and appears fearful
when the caregiver enters the room. What is the nurse's FIRST action?
A. Confront the caregiver immediately about the injuries
B. Interview the patient privately and assess safety
C. Wait for the next visit to see if the pattern continues
D. Document findings but take no further action
[CORRECT] B
Rationale: The nurse must first ensure patient safety by interviewing the patient privately (away
from the suspected abuser) to gather information, assess immediate danger, and build trust; this
follows the elder abuse screening protocol recommended by the National Center on Elder
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 (BPSD – non-pharmacologic intervention): A nurse is caring for an 82-year-old male with
moderate Alzheimer's dementia who becomes agitated and aggressive during evening hours
(sundowning). Which non-pharmacologic intervention should the nurse implement FIRST?
A. Administer low-dose haloperidol PRN
B. Dim the lights and reduce environmental stimuli
C. Restrain the patient to prevent injury
D. Transfer the patient to a private room with minimal supervision
[CORRECT] B
Rationale: The Hartford Institute for Geriatric Nursing and AGS guidelines recommend
non-pharmacologic interventions as first-line for BPSD, including environmental modifications
such as adequate lighting, reducing noise, and maintaining routines; dimming lights
appropriately and minimizing stimuli addresses sundowning triggers. Option A is incorrect
because antipsychotics should not be first-line and carry a black box warning for increased
mortality in elderly patients with dementia. Option C violates patient rights and can increase
agitation. Option D isolates the patient and removes supervision, increasing fall and injury risk.
Clinical pearl: Always assess and modify the environment before considering pharmacologic
interventions for BPSD.
Q2 (Parkinson's disease – carbidopa/levodopa): A 76-year-old with Parkinson's disease reports
that his carbidopa/levodopa doses are becoming less effective, with wearing-off periods
occurring sooner. Which dietary instruction should the nurse reinforce?
A. "Take the medication with a high-protein meal to enhance absorption."
B. "Consume protein evenly throughout the day, avoiding high-protein meals near dosing times."
C. "Increase iron-rich foods to support dopamine production."
D. "Drink grapefruit juice to improve medication metabolism."
[CORRECT] B
Rationale: Dietary protein competes with levodopa for absorption via the large neutral amino
acid transporter in the gut and blood-brain barrier; spacing protein intake away from doses
improves medication efficacy. Option A is incorrect because high-protein meals significantly
,r educe levodopa absorption and worsen the "wearing-off" phenomenon. Option C is incorrect
because iron supplements, not dietary iron, can chelate levodopa and reduce efficacy. Option D
is incorrect because grapefruit juice inhibits CYP3A4 and can alter metabolism of various
medications but does not improve levodopa absorption. Clinical pearl: Teach patients to take
levodopa 30 minutes before or 1 hour after meals, and consider a protein redistribution diet if
motor fluctuations persist.
Q3 (Pain assessment – PAINAD): A nurse is assessing pain in an 85-year-old female with
advanced dementia who is nonverbal. Which tool is MOST appropriate for this assessment?
A. Numeric Rating Scale (NRS)
B. Visual Analog Scale (VAS)
C. PAINAD (Pain Assessment in Advanced Dementia)
D. Brief Pain Inventory (BPI)
[CORRECT] C
Rationale: The PAINAD scale is specifically validated for assessing pain in older adults with
advanced dementia who cannot self-report; it evaluates breathing, vocalization, facial
expression, body language, and consolability. Option A requires cognitive ability to assign
numeric values to pain intensity and is inappropriate for advanced dementia. Option B also
requires the patient to mark a line indicating pain severity, which cognitively impaired patients
cannot reliably complete. Option D is a comprehensive pain assessment tool designed for
patients who can self-report and communicate. Clinical pearl: "If they can't tell you, watch them"
– the PAINAD takes 2-3 minutes to complete and should be used routinely in dementia care.
Q4 (Beers Criteria 2026 – potentially inappropriate medication): According to the 2026 AGS
Beers Criteria, which medication is potentially inappropriate in older adults due to increased risk
of falls and fractures?
A. Metoprolol
B. Lorazepam
C. Lisinopril
D. Metformin
[CORRECT] B
Rationale: The 2026 Beers Criteria classify benzodiazepines (including lorazepam) as
potentially inappropriate in older adults due to risks of falls, fractures, cognitive impairment, and
motor vehicle accidents; they should be avoided or used only with extreme caution. Option A
(beta-blockers) are not Beers-listed when used for appropriate indications like heart failure or
hypertension. Option C (ACE inhibitors) are generally well-tolerated and not on the Beers list.
Option D (metformin) is first-line for type 2 diabetes and not Beers-listed, though renal function
must be monitored. Clinical pearl: If benzodiazepines must be used, limit to short-term use,
lowest effective dose, and implement fall prevention strategies.
Q5 (Delirium prevention): A nurse is caring for a 78-year-old postoperative patient. Which
intervention is MOST effective in preventing delirium?
A. Administering prophylactic haloperidol
B. Maintaining sleep hygiene and early mobilization
C. Keeping the patient sedated to prevent agitation
D. Restricting fluids to reduce nighttime toileting
[CORRECT] B
, ationale: The Hospital Elder Life Program (HELP) and AGS guidelines demonstrate that
R
non-pharmacologic multicomponent interventions—including sleep hygiene, early mobilization,
reorientation, hydration, and vision/hearing optimization—are the most effective delirium
prevention strategies. Option A is incorrect because prophylactic antipsychotics are not
recommended and do not prevent delirium. Option C increases delirium risk by causing
oversedation and immobility. Option D causes dehydration, which is a known risk factor for
delirium. Clinical pearl: The ABCDEF bundle (Awakening, Breathing coordination, Delirium
monitoring, Early mobility, Family engagement) is the gold standard for ICU and postoperative
delirium prevention.
Q6 (Stroke recovery – secondary prevention): A nurse is educating a 72-year-old patient who
had an ischemic stroke 2 weeks ago. Which medication combination is MOST appropriate for
secondary stroke prevention?
A. Aspirin 81 mg daily + atorvastatin 80 mg daily
B. Clopidogrel 75 mg daily + warfarin (target INR 2.0-3.0)
C. Aspirin 325 mg daily + ibuprofen 400 mg TID
D. Dabigatran 150 mg BID + aspirin 81 mg daily (indefinite dual therapy)
[CORRECT] A
Rationale: Current AHA/ASA guidelines recommend antiplatelet therapy (aspirin) and
high-intensity statin therapy for secondary prevention of ischemic stroke; atorvastatin 80 mg is
the standard high-intensity regimen. Option B is incorrect because dual antithrombotic therapy
is not indicated for standard secondary prevention unless the patient has a specific indication
like atrial fibrillation or recent stent placement. Option C is incorrect because ibuprofen, an
NSAID, increases GI bleeding risk and may interfere with aspirin's antiplatelet effects. Option D
is incorrect because indefinite dual antithrombotic therapy significantly increases bleeding risk
without additional stroke prevention benefit. Clinical pearl: For patients with atrial fibrillation
post-stroke, oral anticoagulation replaces antiplatelet therapy, not adds to it.
Q7 (Urinary incontinence – behavioral intervention): A nurse is developing a plan of care for an
80-year-old with urge urinary incontinence. Which intervention should be prioritized?
A. Insert an indwelling urinary catheter for continuous drainage
B. Implement bladder training with scheduled toileting every 2 hours
C. Prescribe oxybutynin extended-release immediately
D. Restrict fluid intake to 1,000 mL per day
[CORRECT] B
Rationale: Bladder training and scheduled toileting are first-line behavioral interventions for urge
incontinence in older adults, supported by the Hartford Institute for Geriatric Nursing; they
retrain the bladder and reduce urgency episodes without medication risks. Option A is incorrect
because indwelling catheters increase UTI risk, cause trauma, and are contraindicated for
uncomplicated incontinence management. Option C is incorrect because anticholinergics are
not first-line due to cognitive impairment, constipation, and urinary retention risks in older adults
(Beers Criteria 2026). Option D causes dehydration, worsens constipation, and increases risk of
UTIs and delirium. Clinical pearl: Start with timed voiding every 2 hours, then gradually extend
intervals by 15-30 minutes as tolerated.
, 8 (Pressure injury – staging): A nurse assesses an 83-year-old bedbound patient and notes a
Q
shallow open ulcer with a red-pink wound bed, without slough or bruising, over the sacrum. How
should this be staged?
A. Stage 1 pressure injury
B. Stage 2 pressure injury
C. Stage 3 pressure injury
D. Unstageable pressure injury
[CORRECT] B
Rationale: A Stage 2 pressure injury presents as partial-thickness loss of skin with exposed
dermis, presenting as a shallow open ulcer with a red or pink wound bed without slough or
bruising, consistent with the NPIAP staging guidelines. Option A describes intact skin with
non-blanchable erythema. Option C involves full-thickness skin loss with visible adipose tissue.
Option D applies when slough or eschar obscures the wound base, preventing staging. Clinical
pearl: Stage 2 injuries can also present as intact or ruptured serum-filled blisters; document
location, dimensions, and wound characteristics for trending.
Q9 (Palliative care – dyspnea management): A nurse is caring for a patient with end-stage
COPD receiving hospice care who reports severe dyspnea. Which intervention is MOST
appropriate?
A. Aggressive fluid resuscitation to improve perfusion
B. Low-dose oral morphine and positioning with a fan
C. High-flow oxygen via non-rebreather mask regardless of SpO2
D. Benzodiazepines as first-line for respiratory distress
[CORRECT] B
Rationale: Low-dose opioids (morphine 2.5-5 mg PO) are the gold standard for refractory
dyspnea in palliative care, reducing the sensation of breathlessness without significantly
compromising respiratory drive; a fan directed at the face stimulates trigeminal nerve receptors
and reduces dyspnea perception. Option A worsens fluid overload and respiratory distress in
COPD patients. Option C is inappropriate because supplemental oxygen is only beneficial if the
patient is hypoxemic; forcing high-flow oxygen on a non-hypoxemic patient causes discomfort
and drying. Option D is incorrect because benzodiazepines treat anxiety associated with
dyspnea but do not address the underlying sensation of breathlessness. Clinical pearl: In
hospice, comfort is the goal—morphine 2.5 mg PO every 4 hours PRN is a standard starting
dose for dyspnea.
Q10 (Elder abuse – recognition): During a home health visit, a nurse notices an 80-year-old
patient has multiple bruises in various stages of healing on the inner arms and appears fearful
when the caregiver enters the room. What is the nurse's FIRST action?
A. Confront the caregiver immediately about the injuries
B. Interview the patient privately and assess safety
C. Wait for the next visit to see if the pattern continues
D. Document findings but take no further action
[CORRECT] B
Rationale: The nurse must first ensure patient safety by interviewing the patient privately (away
from the suspected abuser) to gather information, assess immediate danger, and build trust; this
follows the elder abuse screening protocol recommended by the National Center on Elder
