NUR 257 Chronic Exam 3 | V1 and V2 | Actual
Questions and Answers | 2026 Updated | 100%
Correct - Galen College.
2026 Exam · 90 Questions · With Rationales
NURati.
257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College.
Question: 1 of 90
A patient with type 2 diabetes on metformin and glipizide is scheduled for a CT scan with IV contrast. Which
combination of actions is most appropriate to prevent contrast-induced nephropathy and hypoglycemia?
A. Hold metformin for 48 hours before and after, continue glipizide, and pre-hydrate.
B. Hold metformin on the day of the procedure only, resume if renal function is normal.
C. Hold glipizide for 24 hours before, continue metformin, and administer acetylcysteine.
D. Hold both metformin and glipizide for 72 hours, and pre-hydrate with normal saline.
PREVIOUS CONTINUE
A patient with type 2 diabetes on metformin and glipizide is scheduled for a CT scan with
IV contrast. Which combination of actions is most appropriate to prevent contrast-induced
nephropathy and hypoglycemia?
(Correct) A. Hold metformin for 48 hours before and after, continue glipizide, and pre-hydrate.
B. Hold metformin on the day of the procedure only, resume if renal function is normal.
C. Hold glipizide for 24 hours before, continue metformin, and administer acetylcysteine.
D. Hold both metformin and glipizide for 72 hours, and pre-hydrate with normal saline.
Correct Answer: A
Current guidelines recommend holding metformin for 48 hours before and after contrast media in patients at
risk for AKI (eGFR <60) to prevent lactic acidosis. Glipizide can be continued but may need dose adjustment;
pre-hydration is standard. Option B is outdated for high-risk patients. Options C and D are incorrect because
glipizide is not typically held for contrast, and holding for 72 hours is excessive.
Page 1 | NUR 257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College. 2026
, NUR 257 Chronic Exam 3 | V1 and V2 | Actual
Questions and Answers | 2026 Updated | 100%
Correct - Galen College.
2026 Exam · 90 Questions · With Rationales
NURati.
257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College.
Question: 2 of 90
Which pathophysiological mechanism best explains the development of diuretic resistance in a patient with
chronic heart failure who is receiving high-dose furosemide?
A. Decreased renal blood flow leads to reduced delivery of furosemide to the loop of Henle.
B. Increased aldosterone levels cause upregulation of sodium channels in the distal tubule.
C. Chronic use of loop diuretics induces hypertrophy of distal tubular cells, increasing sodium reabsorption.
D. Hypoalbuminemia reduces the protein binding of furosemide, decreasing its secretion into the tubule.
PREVIOUS CONTINUE
Which pathophysiological mechanism best explains the development of diuretic
resistance in a patient with chronic heart failure who is receiving high-dose furosemide?
A. Decreased renal blood flow leads to reduced delivery of furosemide to the loop of Henle.
B. Increased aldosterone levels cause upregulation of sodium channels in the distal tubule.
(Correct) C. Chronic use of loop diuretics induces hypertrophy of distal tubular cells, increasing
sodium reabsorption.
D. Hypoalbuminemia reduces the protein binding of furosemide, decreasing its secretion into
the tubule.
Correct Answer: C
Chronic loop diuretic use causes distal tubular hypertrophy, which enhances sodium reabsorption at that site,
diminishing the diuretic's effect-a classic mechanism of diuretic resistance. Option A is a cause of reduced
diuretic delivery but not specific to chronic resistance. Option B is secondary. Option D is incorrect because
furosemide binds to albumin but secretion is via OAT transporters, not dependent on binding.
Page 2 | NUR 257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College. 2026
, NUR 257 Chronic Exam 3 | V1 and V2 | Actual
Questions and Answers | 2026 Updated | 100%
Correct - Galen College.
2026 Exam · 90 Questions · With Rationales
NURati.
257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College.
Question: 3 of 90
A patient with stage 4 chronic kidney disease (CKD) is started on lisinopril for hypertension. What is the most
critical monitoring parameter during the first 2 weeks of therapy?
A. Daily weight and urine output to detect fluid overload.
B. Serum potassium and creatinine levels to detect hyperkalemia and acute kidney injury.
C. Blood pressure readings to titrate the dose effectively.
D. Complete blood count to monitor for ACE-inhibitor-induced neutropenia.
PREVIOUS CONTINUE
A patient with stage 4 chronic kidney disease (CKD) is started on lisinopril for
hypertension. What is the most critical monitoring parameter during the first 2 weeks of
therapy?
A. Daily weight and urine output to detect fluid overload.
(Correct) B. Serum potassium and creatinine levels to detect hyperkalemia and acute kidney injury.
C. Blood pressure readings to titrate the dose effectively.
D. Complete blood count to monitor for ACE-inhibitor-induced neutropenia.
Correct Answer: B
In patients with CKD, ACE inhibitors can cause hyperkalemia and a rise in serum creatinine due to
hemodynamic changes. Monitoring potassium and creatinine within 1-2 weeks is essential. While blood
pressure and weight are important, the most critical are potassium and renal function. Neutropenia is rare and
not the primary concern.
Page 3 | NUR 257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College. 2026
, NUR 257 Chronic Exam 3 | V1 and V2 | Actual
Questions and Answers | 2026 Updated | 100%
Correct - Galen College.
2026 Exam · 90 Questions · With Rationales
NURati.
257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College.
Question: 4 of 90
Which of the following findings would most likely indicate that a patient with chronic obstructive pulmonary
disease (COPD) is experiencing an acute exacerbation rather than a normal day-to-day variation?
A. Increased use of accessory muscles and paradoxical chest wall movement.
B. A morning cough productive of clear sputum that clears with activity.
C. Oxygen saturation of 90% on room air after walking 50 feet.
D. Use of a short-acting bronchodilator twice in one day.
PREVIOUS CONTINUE
Which of the following findings would most likely indicate that a patient with chronic
obstructive pulmonary disease (COPD) is experiencing an acute exacerbation rather than
a normal day-to-day variation?
(Correct) A. Increased use of accessory muscles and paradoxical chest wall movement.
B. A morning cough productive of clear sputum that clears with activity.
C. Oxygen saturation of 90% on room air after walking 50 feet.
D. Use of a short-acting bronchodilator twice in one day.
Correct Answer: A
Acute exacerbation is defined by an acute change in dyspnea, cough, or sputum that is beyond normal
day-to-day variation. Increased accessory muscle use and paradoxical chest wall movement indicate severe
respiratory distress, which is a hallmark of exacerbation. Option B is chronic bronchitis, C is mild exertional
hypoxemia, D may be routine.
Page 4 | NUR 257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College. 2026
Questions and Answers | 2026 Updated | 100%
Correct - Galen College.
2026 Exam · 90 Questions · With Rationales
NURati.
257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College.
Question: 1 of 90
A patient with type 2 diabetes on metformin and glipizide is scheduled for a CT scan with IV contrast. Which
combination of actions is most appropriate to prevent contrast-induced nephropathy and hypoglycemia?
A. Hold metformin for 48 hours before and after, continue glipizide, and pre-hydrate.
B. Hold metformin on the day of the procedure only, resume if renal function is normal.
C. Hold glipizide for 24 hours before, continue metformin, and administer acetylcysteine.
D. Hold both metformin and glipizide for 72 hours, and pre-hydrate with normal saline.
PREVIOUS CONTINUE
A patient with type 2 diabetes on metformin and glipizide is scheduled for a CT scan with
IV contrast. Which combination of actions is most appropriate to prevent contrast-induced
nephropathy and hypoglycemia?
(Correct) A. Hold metformin for 48 hours before and after, continue glipizide, and pre-hydrate.
B. Hold metformin on the day of the procedure only, resume if renal function is normal.
C. Hold glipizide for 24 hours before, continue metformin, and administer acetylcysteine.
D. Hold both metformin and glipizide for 72 hours, and pre-hydrate with normal saline.
Correct Answer: A
Current guidelines recommend holding metformin for 48 hours before and after contrast media in patients at
risk for AKI (eGFR <60) to prevent lactic acidosis. Glipizide can be continued but may need dose adjustment;
pre-hydration is standard. Option B is outdated for high-risk patients. Options C and D are incorrect because
glipizide is not typically held for contrast, and holding for 72 hours is excessive.
Page 1 | NUR 257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College. 2026
, NUR 257 Chronic Exam 3 | V1 and V2 | Actual
Questions and Answers | 2026 Updated | 100%
Correct - Galen College.
2026 Exam · 90 Questions · With Rationales
NURati.
257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College.
Question: 2 of 90
Which pathophysiological mechanism best explains the development of diuretic resistance in a patient with
chronic heart failure who is receiving high-dose furosemide?
A. Decreased renal blood flow leads to reduced delivery of furosemide to the loop of Henle.
B. Increased aldosterone levels cause upregulation of sodium channels in the distal tubule.
C. Chronic use of loop diuretics induces hypertrophy of distal tubular cells, increasing sodium reabsorption.
D. Hypoalbuminemia reduces the protein binding of furosemide, decreasing its secretion into the tubule.
PREVIOUS CONTINUE
Which pathophysiological mechanism best explains the development of diuretic
resistance in a patient with chronic heart failure who is receiving high-dose furosemide?
A. Decreased renal blood flow leads to reduced delivery of furosemide to the loop of Henle.
B. Increased aldosterone levels cause upregulation of sodium channels in the distal tubule.
(Correct) C. Chronic use of loop diuretics induces hypertrophy of distal tubular cells, increasing
sodium reabsorption.
D. Hypoalbuminemia reduces the protein binding of furosemide, decreasing its secretion into
the tubule.
Correct Answer: C
Chronic loop diuretic use causes distal tubular hypertrophy, which enhances sodium reabsorption at that site,
diminishing the diuretic's effect-a classic mechanism of diuretic resistance. Option A is a cause of reduced
diuretic delivery but not specific to chronic resistance. Option B is secondary. Option D is incorrect because
furosemide binds to albumin but secretion is via OAT transporters, not dependent on binding.
Page 2 | NUR 257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College. 2026
, NUR 257 Chronic Exam 3 | V1 and V2 | Actual
Questions and Answers | 2026 Updated | 100%
Correct - Galen College.
2026 Exam · 90 Questions · With Rationales
NURati.
257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College.
Question: 3 of 90
A patient with stage 4 chronic kidney disease (CKD) is started on lisinopril for hypertension. What is the most
critical monitoring parameter during the first 2 weeks of therapy?
A. Daily weight and urine output to detect fluid overload.
B. Serum potassium and creatinine levels to detect hyperkalemia and acute kidney injury.
C. Blood pressure readings to titrate the dose effectively.
D. Complete blood count to monitor for ACE-inhibitor-induced neutropenia.
PREVIOUS CONTINUE
A patient with stage 4 chronic kidney disease (CKD) is started on lisinopril for
hypertension. What is the most critical monitoring parameter during the first 2 weeks of
therapy?
A. Daily weight and urine output to detect fluid overload.
(Correct) B. Serum potassium and creatinine levels to detect hyperkalemia and acute kidney injury.
C. Blood pressure readings to titrate the dose effectively.
D. Complete blood count to monitor for ACE-inhibitor-induced neutropenia.
Correct Answer: B
In patients with CKD, ACE inhibitors can cause hyperkalemia and a rise in serum creatinine due to
hemodynamic changes. Monitoring potassium and creatinine within 1-2 weeks is essential. While blood
pressure and weight are important, the most critical are potassium and renal function. Neutropenia is rare and
not the primary concern.
Page 3 | NUR 257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College. 2026
, NUR 257 Chronic Exam 3 | V1 and V2 | Actual
Questions and Answers | 2026 Updated | 100%
Correct - Galen College.
2026 Exam · 90 Questions · With Rationales
NURati.
257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College.
Question: 4 of 90
Which of the following findings would most likely indicate that a patient with chronic obstructive pulmonary
disease (COPD) is experiencing an acute exacerbation rather than a normal day-to-day variation?
A. Increased use of accessory muscles and paradoxical chest wall movement.
B. A morning cough productive of clear sputum that clears with activity.
C. Oxygen saturation of 90% on room air after walking 50 feet.
D. Use of a short-acting bronchodilator twice in one day.
PREVIOUS CONTINUE
Which of the following findings would most likely indicate that a patient with chronic
obstructive pulmonary disease (COPD) is experiencing an acute exacerbation rather than
a normal day-to-day variation?
(Correct) A. Increased use of accessory muscles and paradoxical chest wall movement.
B. A morning cough productive of clear sputum that clears with activity.
C. Oxygen saturation of 90% on room air after walking 50 feet.
D. Use of a short-acting bronchodilator twice in one day.
Correct Answer: A
Acute exacerbation is defined by an acute change in dyspnea, cough, or sputum that is beyond normal
day-to-day variation. Increased accessory muscle use and paradoxical chest wall movement indicate severe
respiratory distress, which is a hallmark of exacerbation. Option B is chronic bronchitis, C is mild exertional
hypoxemia, D may be routine.
Page 4 | NUR 257 Chronic Exam 3 | V1 and V2 | Actual Questions and Answers | 2026 Updated | 100% Correct - Galen College. 2026
