NUR 257 CHRONIC EXAM 3 | 45 ACTUAL QUESTIONS AND ANSWERS | 2026-
2027 UPDATE | 100% CORRECT – GALEN COLLEGE OF NURSING] ACTUAL
QUESTIONS AND CORRECT ANSWERS (LATEST 2026-2027 UPDATE) | COMPLETE
Q&A WITH VERIFIED ANSWERS AND DETAILED RATIONALES | OBJECTIVE
ASSESSMENT PREP | A+ GRADED
Core Domains
Diabetes Mellitus and Glycemic Control
Cardiovascular Disease: Hypertension, Heart Failure, CAD
Chronic Respiratory Disorders: COPD, Asthma
Chronic Kidney Disease and Renal Therapies
Neurological Disorders: Stroke, Parkinson Disease
Musculoskeletal Disorders: Osteoarthritis, Rheumatoid Arthritis
Chronic Pain and Palliative Care
Oncologic Disorders and Complications
Anemia and Hematologic Conditions
Health Promotion and Secondary Prevention
Introduction
This examination evaluates the nursing student’s ability to apply
evidence-based care for patients with chronic illnesses. The 45
multiple-choice questions assess knowledge of pathophysiology, clinical
manifestations, pharmacologic management, and nursing interventions for
major chronic conditions across the adult lifespan. Emphasis is placed
on prioritization, patient education, and the recognition of acute
exacerbations of chronic disease. Each question includes a comprehensive
RATIONALE to reinforce clinical reasoning. Mastery of this content
ensures readiness for the NUR 257 Chronic Exam 3 and for safe, holistic
management of patients living with chronic health challenges.
SECTION ONE: QUESTIONS 1–45
1. A patient with type 2 diabetes has an A1C of 8.9% and is on metformin
1000 mg twice daily. The provider adds empagliflozin. The nurse should
, instruct the patient to report which symptom that may indicate a serious
adverse effect?
A. Weight gain
B. Genital yeast infection
C. Polyuria, polydipsia, nausea, and abdominal pain even with normal blood
glucose
D. Constipation
C. Polyuria, polydipsia, nausea, and abdominal pain even with normal blood
glucose
RATIONALE : SGLT2 inhibitors like empagliflozin can cause euglycemic
diabetic ketoacidosis (DKA), where ketoacidosis develops with normal or only
moderately elevated blood glucose. Classic DKA symptoms must be reported
immediately. Genital yeast infections (B) are common but not life-threatening.
Weight loss, not gain, occurs. Constipation (D) is not a primary side effect.
2. A patient with chronic heart failure is on furosemide, lisinopril, and
carvedilol. The nurse should assess for which clinical indicator that the
patient is decompensating?
A. Weight loss of 1 kg in a week
B. Development of a dry, hacking cough
C. Bilateral crackles in the lung bases and a 3-pound weight gain overnight
D. Blood pressure of 118/76 mm Hg
C. Bilateral crackles in the lung bases and a 3-pound weight gain overnight
RATIONALE : Crackles and rapid weight gain indicate fluid retention and
worsening heart failure. A dry cough (B) is a common side effect of ACE inhibitors,
not necessarily decompensation. Weight loss (A) is not typical. A blood pressure
of 118/76 (D) is within normal limits.
3. A patient with chronic obstructive pulmonary disease (COPD) is admitted
with an acute exacerbation. Arterial blood gas shows pH 7.32,
PaCO₂ 58 mm Hg, HCO₃⁻ 30 mEq/L. The nurse interprets this as:
, A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
B. Partially compensated respiratory acidosis
RATIONALE : The pH is low (acidosis), PaCO₂ is elevated (respiratory cause),
and HCO₃⁻ is elevated (renal compensation). Because the pH is still abnormal,
compensation is partial. In uncompensated acidosis (A), HCO₃⁻ would be normal.
Metabolic alkalosis (C) would have high pH and high HCO₃⁻. Respiratory alkalosis
(D) would have high pH and low PaCO₂.
4. A patient with end-stage renal disease (ESRD) on hemodialysis has a
potassium of 5.9 mEq/L. The nurse should anticipate giving which
medication to rapidly lower the potassium?
A. Calcium gluconate
B. Sodium polystyrene sulfonate (Kayexalate)
C. Regular insulin and 50% dextrose
D. Sevelamer
C. Regular insulin and 50% dextrose
RATIONALE : Insulin drives potassium into cells and is a rapid but temporary
measure. Dextrose prevents hypoglycemia. Calcium gluconate (A) stabilizes
cardiac membranes but does not lower potassium. Kayexalate (B) removes
potassium slowly via the GI tract. Sevelamer (D) is a phosphate binder.
5. A patient with Parkinson disease is started on carbidopa-levodopa. The
nurse should teach the patient to report which finding that could indicate
neuroleptic malignant-like syndrome if the medication is stopped abruptly?
A. Dry mouth
B. Orthostatic hypotension
C. Severe muscle rigidity, fever, and altered mental status
D. Increased appetite
C. Severe muscle rigidity, fever, and altered mental status
2027 UPDATE | 100% CORRECT – GALEN COLLEGE OF NURSING] ACTUAL
QUESTIONS AND CORRECT ANSWERS (LATEST 2026-2027 UPDATE) | COMPLETE
Q&A WITH VERIFIED ANSWERS AND DETAILED RATIONALES | OBJECTIVE
ASSESSMENT PREP | A+ GRADED
Core Domains
Diabetes Mellitus and Glycemic Control
Cardiovascular Disease: Hypertension, Heart Failure, CAD
Chronic Respiratory Disorders: COPD, Asthma
Chronic Kidney Disease and Renal Therapies
Neurological Disorders: Stroke, Parkinson Disease
Musculoskeletal Disorders: Osteoarthritis, Rheumatoid Arthritis
Chronic Pain and Palliative Care
Oncologic Disorders and Complications
Anemia and Hematologic Conditions
Health Promotion and Secondary Prevention
Introduction
This examination evaluates the nursing student’s ability to apply
evidence-based care for patients with chronic illnesses. The 45
multiple-choice questions assess knowledge of pathophysiology, clinical
manifestations, pharmacologic management, and nursing interventions for
major chronic conditions across the adult lifespan. Emphasis is placed
on prioritization, patient education, and the recognition of acute
exacerbations of chronic disease. Each question includes a comprehensive
RATIONALE to reinforce clinical reasoning. Mastery of this content
ensures readiness for the NUR 257 Chronic Exam 3 and for safe, holistic
management of patients living with chronic health challenges.
SECTION ONE: QUESTIONS 1–45
1. A patient with type 2 diabetes has an A1C of 8.9% and is on metformin
1000 mg twice daily. The provider adds empagliflozin. The nurse should
, instruct the patient to report which symptom that may indicate a serious
adverse effect?
A. Weight gain
B. Genital yeast infection
C. Polyuria, polydipsia, nausea, and abdominal pain even with normal blood
glucose
D. Constipation
C. Polyuria, polydipsia, nausea, and abdominal pain even with normal blood
glucose
RATIONALE : SGLT2 inhibitors like empagliflozin can cause euglycemic
diabetic ketoacidosis (DKA), where ketoacidosis develops with normal or only
moderately elevated blood glucose. Classic DKA symptoms must be reported
immediately. Genital yeast infections (B) are common but not life-threatening.
Weight loss, not gain, occurs. Constipation (D) is not a primary side effect.
2. A patient with chronic heart failure is on furosemide, lisinopril, and
carvedilol. The nurse should assess for which clinical indicator that the
patient is decompensating?
A. Weight loss of 1 kg in a week
B. Development of a dry, hacking cough
C. Bilateral crackles in the lung bases and a 3-pound weight gain overnight
D. Blood pressure of 118/76 mm Hg
C. Bilateral crackles in the lung bases and a 3-pound weight gain overnight
RATIONALE : Crackles and rapid weight gain indicate fluid retention and
worsening heart failure. A dry cough (B) is a common side effect of ACE inhibitors,
not necessarily decompensation. Weight loss (A) is not typical. A blood pressure
of 118/76 (D) is within normal limits.
3. A patient with chronic obstructive pulmonary disease (COPD) is admitted
with an acute exacerbation. Arterial blood gas shows pH 7.32,
PaCO₂ 58 mm Hg, HCO₃⁻ 30 mEq/L. The nurse interprets this as:
, A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
B. Partially compensated respiratory acidosis
RATIONALE : The pH is low (acidosis), PaCO₂ is elevated (respiratory cause),
and HCO₃⁻ is elevated (renal compensation). Because the pH is still abnormal,
compensation is partial. In uncompensated acidosis (A), HCO₃⁻ would be normal.
Metabolic alkalosis (C) would have high pH and high HCO₃⁻. Respiratory alkalosis
(D) would have high pH and low PaCO₂.
4. A patient with end-stage renal disease (ESRD) on hemodialysis has a
potassium of 5.9 mEq/L. The nurse should anticipate giving which
medication to rapidly lower the potassium?
A. Calcium gluconate
B. Sodium polystyrene sulfonate (Kayexalate)
C. Regular insulin and 50% dextrose
D. Sevelamer
C. Regular insulin and 50% dextrose
RATIONALE : Insulin drives potassium into cells and is a rapid but temporary
measure. Dextrose prevents hypoglycemia. Calcium gluconate (A) stabilizes
cardiac membranes but does not lower potassium. Kayexalate (B) removes
potassium slowly via the GI tract. Sevelamer (D) is a phosphate binder.
5. A patient with Parkinson disease is started on carbidopa-levodopa. The
nurse should teach the patient to report which finding that could indicate
neuroleptic malignant-like syndrome if the medication is stopped abruptly?
A. Dry mouth
B. Orthostatic hypotension
C. Severe muscle rigidity, fever, and altered mental status
D. Increased appetite
C. Severe muscle rigidity, fever, and altered mental status
