NURS2214
Nursing Care of the older adults
Final Exam Review
(Questions & Solutions)
2025
1
,I. MULTIPLE CHOICE (10)
1. A 72-year-old with congestive heart failure has an S3 gallop on cardiac
auscultation. This finding indicates:
A) Increased left ventricular compliance
B) Left ventricular systolic dysfunction
C) Mitral stenosis
D) Atrial septal defect
ANS: B
Rationale: S3 in adults reflects increased end-systolic volume and
reduced ventricular compliance, typical of systolic dysfunction.
2. A 68-year-old smoker has sudden onset dyspnea. Auscultation reveals
absent breath sounds over the right hemithorax and hyperresonance to
percussion. Most likely diagnosis?
A) Tension pneumothorax
B) Pleural effusion
C) Atelectasis
D) Consolidation
ANS: A
Rationale: Hyperresonance and absent breath sounds suggest air in the
pleural space—pneumothorax.
3. On abdominal exam of a patient with suspected ascites, shifting
dullness is noted. What is the next confirmatory step?
A) Fluid wave test
B) Palpation of liver edge
C) Murphy’s sign
D) Rebound tenderness
ANS: A
Rationale: A positive fluid wave test confirms free fluid in the peritoneum
consistent with ascites.
4. A 54-year-old diabetic has a charred, black area on his foot with absent
2
, dorsalis pedis pulse and cool skin. Which assessment is most
appropriate?
A) Ankle-brachial index
B) Homan’s sign
C) Capillary refill
D) Tinel’s sign
ANS: A
Rationale: ABI quantitatively assesses peripheral arterial perfusion in
suspected PAD.
5. A 30-year-old on neuromuscular blocker shows weak chest rise and
inability to blink, while he is awake. Which monitoring modality assesses
neuromuscular blockade depth?
A) Train-of-four peripheral nerve stimulation
B) Finger stick glucose
C) Bispectral index
D) End-tidal CO₂ only
ANS: A
Rationale: TOF monitoring quantifies degree of neuromuscular blockade.
6. A 65-year-old with abdominal pain has a bruit in the epigastrium and
an elevated BUN/Cr ratio. Suspicion?
A) Renal artery stenosis
B) Appendicitis
C) Cholecystitis
D) Pancreatitis
ANS: A
Rationale: An abdominal bruit with azotemia suggests renovascular
hypertension from RAS.
7. A neurologic exam reveals the patient cannot maintain outstretched
arms without drift or pronation. This test evaluates:
A) Upper motor neuron integrity
B) Proprioception only
C) Vestibular function
3
Nursing Care of the older adults
Final Exam Review
(Questions & Solutions)
2025
1
,I. MULTIPLE CHOICE (10)
1. A 72-year-old with congestive heart failure has an S3 gallop on cardiac
auscultation. This finding indicates:
A) Increased left ventricular compliance
B) Left ventricular systolic dysfunction
C) Mitral stenosis
D) Atrial septal defect
ANS: B
Rationale: S3 in adults reflects increased end-systolic volume and
reduced ventricular compliance, typical of systolic dysfunction.
2. A 68-year-old smoker has sudden onset dyspnea. Auscultation reveals
absent breath sounds over the right hemithorax and hyperresonance to
percussion. Most likely diagnosis?
A) Tension pneumothorax
B) Pleural effusion
C) Atelectasis
D) Consolidation
ANS: A
Rationale: Hyperresonance and absent breath sounds suggest air in the
pleural space—pneumothorax.
3. On abdominal exam of a patient with suspected ascites, shifting
dullness is noted. What is the next confirmatory step?
A) Fluid wave test
B) Palpation of liver edge
C) Murphy’s sign
D) Rebound tenderness
ANS: A
Rationale: A positive fluid wave test confirms free fluid in the peritoneum
consistent with ascites.
4. A 54-year-old diabetic has a charred, black area on his foot with absent
2
, dorsalis pedis pulse and cool skin. Which assessment is most
appropriate?
A) Ankle-brachial index
B) Homan’s sign
C) Capillary refill
D) Tinel’s sign
ANS: A
Rationale: ABI quantitatively assesses peripheral arterial perfusion in
suspected PAD.
5. A 30-year-old on neuromuscular blocker shows weak chest rise and
inability to blink, while he is awake. Which monitoring modality assesses
neuromuscular blockade depth?
A) Train-of-four peripheral nerve stimulation
B) Finger stick glucose
C) Bispectral index
D) End-tidal CO₂ only
ANS: A
Rationale: TOF monitoring quantifies degree of neuromuscular blockade.
6. A 65-year-old with abdominal pain has a bruit in the epigastrium and
an elevated BUN/Cr ratio. Suspicion?
A) Renal artery stenosis
B) Appendicitis
C) Cholecystitis
D) Pancreatitis
ANS: A
Rationale: An abdominal bruit with azotemia suggests renovascular
hypertension from RAS.
7. A neurologic exam reveals the patient cannot maintain outstretched
arms without drift or pronation. This test evaluates:
A) Upper motor neuron integrity
B) Proprioception only
C) Vestibular function
3
