NUR 257 CHRONIC HEALTH NURSING
EXAM QUESTIONS AND ANSWERS
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a serum potassium level
of 6.7 mEq/L and peaked T-waves on the ECG. Which medication should the nurse prioritize
for administration?
A. Sodium polystyrene sulfonate (Kayexalate) orally
B. Furosemide (Lasix) IV push
C. Intravenous Calcium Gluconate
D. Regular Insulin and 50% Dextrose IV
Answer: C
Conceptual Explanation: In the presence of severe hyperkalemia with ECG changes,
intravenous calcium gluconate is the priority to stabilize the myocardial cell membrane and
prevent lethal arrhythmias.
2. A patient with advanced COPD is experiencing worsening dyspnea. Which physiological
change most accurately explains the ‘hypoxic drive’ in this chronic condition?
A. Reliance on low partial pressure of arterial oxygen (PaO2) to stimulate breathing
,B. Decreased sensitivity of central chemoreceptors to pH changes
C. Increased sensitivity to high levels of Carbon Dioxide
D. Hyperventilation caused by excessive bicarbonate retention
Answer: A
Conceptual Explanation: In chronic CO2 retainers, the central chemoreceptors become
desensitized to high CO2, making low oxygen levels the primary stimulus for the
respiratory drive.
3. A nurse is managing a patient with Right-Sided Heart Failure. Which clinical manifestation
should the nurse expect to find during the assessment?
A. Pulmonary crackles and wheezing
B. Paroxysmal nocturnal dyspnea
C. Jugular Venous Distention (JVD) and peripheral edema
D. S3 gallop and pink frothy sputum
Answer: C
Conceptual Explanation: Right-sided heart failure leads to systemic venous congestion,
manifesting as JVD, hepatomegaly, and peripheral edema.
4. When teaching a patient with Rheumatoid Arthritis about Methotrexate therapy, which
instruction is most critical for safety?
A. Avoid taking the medication with fatty meals
, B. Use reliable contraception as the drug is teratogenic
C. Take the medication daily at the same time
D. Increase intake of Vitamin K-rich foods
Answer: B
Conceptual Explanation: Methotrexate is highly teratogenic and requires strict adherence
to contraception. It is also usually taken weekly, not daily.
5. A patient with Type 2 Diabetes has an HbA1c of 8.5%. How should the nurse interpret this
finding?
A. The patient has maintained excellent glucose control over the last month
B. The patient is experiencing frequent episodes of hypoglycemia
C. The patient’s average blood glucose level is approximately 197 mg/dL
D. The patient’s fasting glucose is within the target range
Answer: C
Conceptual Explanation: An HbA1c of 8.5% indicates suboptimal glycemic control over
the past 3 months; the formula (A1c x 28.7) - 46.7 estimates the average glucose.
6. Which assessment finding in a patient with Cirrhosis indicates the development of Hepatic
Encephalopathy?
A. Palmar erythema and pruritus
B. Spider angiomas on the chest
EXAM QUESTIONS AND ANSWERS
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a serum potassium level
of 6.7 mEq/L and peaked T-waves on the ECG. Which medication should the nurse prioritize
for administration?
A. Sodium polystyrene sulfonate (Kayexalate) orally
B. Furosemide (Lasix) IV push
C. Intravenous Calcium Gluconate
D. Regular Insulin and 50% Dextrose IV
Answer: C
Conceptual Explanation: In the presence of severe hyperkalemia with ECG changes,
intravenous calcium gluconate is the priority to stabilize the myocardial cell membrane and
prevent lethal arrhythmias.
2. A patient with advanced COPD is experiencing worsening dyspnea. Which physiological
change most accurately explains the ‘hypoxic drive’ in this chronic condition?
A. Reliance on low partial pressure of arterial oxygen (PaO2) to stimulate breathing
,B. Decreased sensitivity of central chemoreceptors to pH changes
C. Increased sensitivity to high levels of Carbon Dioxide
D. Hyperventilation caused by excessive bicarbonate retention
Answer: A
Conceptual Explanation: In chronic CO2 retainers, the central chemoreceptors become
desensitized to high CO2, making low oxygen levels the primary stimulus for the
respiratory drive.
3. A nurse is managing a patient with Right-Sided Heart Failure. Which clinical manifestation
should the nurse expect to find during the assessment?
A. Pulmonary crackles and wheezing
B. Paroxysmal nocturnal dyspnea
C. Jugular Venous Distention (JVD) and peripheral edema
D. S3 gallop and pink frothy sputum
Answer: C
Conceptual Explanation: Right-sided heart failure leads to systemic venous congestion,
manifesting as JVD, hepatomegaly, and peripheral edema.
4. When teaching a patient with Rheumatoid Arthritis about Methotrexate therapy, which
instruction is most critical for safety?
A. Avoid taking the medication with fatty meals
, B. Use reliable contraception as the drug is teratogenic
C. Take the medication daily at the same time
D. Increase intake of Vitamin K-rich foods
Answer: B
Conceptual Explanation: Methotrexate is highly teratogenic and requires strict adherence
to contraception. It is also usually taken weekly, not daily.
5. A patient with Type 2 Diabetes has an HbA1c of 8.5%. How should the nurse interpret this
finding?
A. The patient has maintained excellent glucose control over the last month
B. The patient is experiencing frequent episodes of hypoglycemia
C. The patient’s average blood glucose level is approximately 197 mg/dL
D. The patient’s fasting glucose is within the target range
Answer: C
Conceptual Explanation: An HbA1c of 8.5% indicates suboptimal glycemic control over
the past 3 months; the formula (A1c x 28.7) - 46.7 estimates the average glucose.
6. Which assessment finding in a patient with Cirrhosis indicates the development of Hepatic
Encephalopathy?
A. Palmar erythema and pruritus
B. Spider angiomas on the chest
