NUR 257 CHRONIC HEALTH EXAM
QUESTIONS AND ANSWERS
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a potassium level of 6.8
mEq/L. Which cardiac monitor finding should the nurse prioritize?
A. Prominent U waves
B. Shortened PR interval
C. Tall, peaked T waves
D. ST-segment elevation
Answer: C
Conceptual Explanation: Hyperkalemia (K+ > 5.0) is a common complication of advanced
CKD and manifests on an EKG as tall, peaked T waves, which can progress to cardiac arrest.
2. When educating a patient with Chronic Obstructive Pulmonary Disease (COPD) on pursed-
lip breathing, the nurse explains that the primary purpose is to:
A. Prevent airway collapse by maintaining positive pressure
B. Increase the respiratory rate to improve oxygenation
C. Strengthen the diaphragm muscle
D. Reduce the production of thick mucus secretions
,Answer: A
Conceptual Explanation: Pursed-lip breathing creates back-pressure in the airways,
preventing bronchiolar collapse and helping to exhale trapped air (CO2) more effectively.
3. A client with Type 2 Diabetes is being evaluated for the ‘Dawn Phenomenon.’ Which
intervention is most appropriate to manage this condition?
A. Increase the evening dose of intermediate-acting insulin
B. Decrease the evening dose of intermediate-acting insulin
C. Provide a high-carbohydrate bedtime snack
D. Avoid exercise in the late afternoon or evening
Answer: A
Conceptual Explanation: The Dawn Phenomenon is characterized by morning
hyperglycemia due to cortisol/GH release. Management involves increasing the evening
insulin dose to counteract the morning rise.
4. Which assessment finding in a patient with right-sided heart failure is most indicative of
systemic venous congestion?
A. Crackles heard in the lung bases
B. Jugular venous distention (JVD)
C. Paroxysmal nocturnal dyspnea
D. Frothy pink-tinged sputum
, Answer: B
Conceptual Explanation: Right-sided heart failure causes blood to back up into the
systemic circulation, leading to JVD, peripheral edema, and hepatomegaly.
5. A patient with Multiple Sclerosis (MS) is experiencing severe fatigue. Which instruction
should the nurse include in the teaching plan?
A. Engage in high-intensity aerobic exercise daily
B. Group activities together in the morning to finish early
C. Schedule frequent rest periods and avoid overheating
D. Take a hot bath every morning to relax muscles
Answer: C
Conceptual Explanation: Fatigue in MS is worsened by heat and overexertion. Pacing
activities and maintaining a cool environment are key management strategies.
6. A client with Liver Cirrhosis develops hepatic encephalopathy. The nurse expects to
administer lactulose to achieve which therapeutic effect?
A. Treat spontaneous bacterial peritonitis
B. Reduce portal hypertension and esophageal pressure
C. Promote the synthesis of clotting factors in the liver
D. Decrease serum ammonia levels through bowel excretion
Answer: D
QUESTIONS AND ANSWERS
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a potassium level of 6.8
mEq/L. Which cardiac monitor finding should the nurse prioritize?
A. Prominent U waves
B. Shortened PR interval
C. Tall, peaked T waves
D. ST-segment elevation
Answer: C
Conceptual Explanation: Hyperkalemia (K+ > 5.0) is a common complication of advanced
CKD and manifests on an EKG as tall, peaked T waves, which can progress to cardiac arrest.
2. When educating a patient with Chronic Obstructive Pulmonary Disease (COPD) on pursed-
lip breathing, the nurse explains that the primary purpose is to:
A. Prevent airway collapse by maintaining positive pressure
B. Increase the respiratory rate to improve oxygenation
C. Strengthen the diaphragm muscle
D. Reduce the production of thick mucus secretions
,Answer: A
Conceptual Explanation: Pursed-lip breathing creates back-pressure in the airways,
preventing bronchiolar collapse and helping to exhale trapped air (CO2) more effectively.
3. A client with Type 2 Diabetes is being evaluated for the ‘Dawn Phenomenon.’ Which
intervention is most appropriate to manage this condition?
A. Increase the evening dose of intermediate-acting insulin
B. Decrease the evening dose of intermediate-acting insulin
C. Provide a high-carbohydrate bedtime snack
D. Avoid exercise in the late afternoon or evening
Answer: A
Conceptual Explanation: The Dawn Phenomenon is characterized by morning
hyperglycemia due to cortisol/GH release. Management involves increasing the evening
insulin dose to counteract the morning rise.
4. Which assessment finding in a patient with right-sided heart failure is most indicative of
systemic venous congestion?
A. Crackles heard in the lung bases
B. Jugular venous distention (JVD)
C. Paroxysmal nocturnal dyspnea
D. Frothy pink-tinged sputum
, Answer: B
Conceptual Explanation: Right-sided heart failure causes blood to back up into the
systemic circulation, leading to JVD, peripheral edema, and hepatomegaly.
5. A patient with Multiple Sclerosis (MS) is experiencing severe fatigue. Which instruction
should the nurse include in the teaching plan?
A. Engage in high-intensity aerobic exercise daily
B. Group activities together in the morning to finish early
C. Schedule frequent rest periods and avoid overheating
D. Take a hot bath every morning to relax muscles
Answer: C
Conceptual Explanation: Fatigue in MS is worsened by heat and overexertion. Pacing
activities and maintaining a cool environment are key management strategies.
6. A client with Liver Cirrhosis develops hepatic encephalopathy. The nurse expects to
administer lactulose to achieve which therapeutic effect?
A. Treat spontaneous bacterial peritonitis
B. Reduce portal hypertension and esophageal pressure
C. Promote the synthesis of clotting factors in the liver
D. Decrease serum ammonia levels through bowel excretion
Answer: D
