NUR 257 CHRONIC EXAM 3 – COMPREHENSIVE
QUESTIONS AND ANSWERS | VERIFIED AND
WELL-DETAILED ANSWERS | DETAILED
EXPLANATIONS AND RATIONALES | COMPLETE
EXAM PREPARATION STUDY GUIDE | PRACTICE
QUESTIONS | LATEST EXAM UPDATE
* CORE DOMAINS *
1. Diabetes Mellitus and Metabolic Disorders
2. Cardiovascular Disorders and Heart Failure
3. COPD and Chronic Respiratory Disorders
4. Chronic Kidney Disease and Renal Management
5. Dementia, Delirium, and Neurologic Disorders
6. Stroke and Long-Term Neurologic Rehabilitation
7. Geriatric Syndromes, Falls, and Functional Decline
8. Chronic Disease Self-Management and Patient Education
9. Medication Management and Safety in Older Adults
10. Nursing Prioritization, Assessment, and Professional Decision-Making
Question 1.
A nurse is teaching an older adult with type 2 diabetes about maintaining consistent
nutrition. Which statement indicates correct understanding?
A. “I should skip meals when my glucose is elevated.”
B. “I should eat meals at reasonably consistent times and follow my prescribed meal plan.”
C. “I should avoid all carbohydrates permanently.”
D. “I should eat one large meal each day.”
Correct Answer: B. “I should eat meals at reasonably consistent times and follow my
prescribed meal plan.”
Explanation: Consistent meal timing and appropriate portions help maintain more
predictable glucose levels, particularly when medications can cause hypoglycemia. Skipping
meals can increase the risk of hypoglycemia, and eliminating all carbohydrates is neither
necessary nor generally appropriate.
Question 2.
,Which finding is most characteristic of diabetic ketoacidosis (DKA)?
A. Severe hypoglycemia without acidosis
B. Hyperglycemia with ketosis and metabolic acidosis
C. Hyperglycemia without fluid loss
D. Bradycardia with respiratory alkalosis
Correct Answer: B. Hyperglycemia with ketosis and metabolic acidosis
Explanation: DKA results from significant insulin deficiency and is characterized by
hyperglycemia, ketone production, an elevated anion gap metabolic acidosis, and
dehydration. Although potassium may initially be elevated, total-body potassium is usually
depleted.
Question 3.
Which instruction is most appropriate when teaching diabetic foot care?
A. Soak the feet daily in hot water.
B. Walk barefoot indoors to strengthen the feet.
C. Inspect the feet every day and wear properly fitting footwear.
D. Cut toenails deeply into the corners.
Correct Answer: C. Inspect the feet every day and wear properly fitting footwear.
Explanation: Diabetes can cause neuropathy and impaired circulation, increasing the risk of
unnoticed injury and infection. Daily inspection and properly fitting shoes help prevent
complications. Hot water and barefoot walking increase injury risk.
Question 4.
A client taking insulin becomes shaky, sweaty, and confused. What should the nurse
suspect?
A. Hypernatremia
B. Hypoglycemia
C. Hypercalcemia
D. Diabetic ketoacidosis
Correct Answer: B. Hypoglycemia
Explanation: Sweating, tremors, confusion, weakness, and behavioral changes are common
manifestations of hypoglycemia. A conscious patient should receive a rapid source of glucose
according to the treatment plan.
Question 5.
Which laboratory value provides information about average blood glucose control over
approximately the previous 2–3 months?
,A. Serum glucose
B. Urine ketones
C. Hemoglobin A1c
D. Serum insulin
Correct Answer: C. Hemoglobin A1c
Explanation: Hemoglobin A1c reflects glycemic exposure over the life span of circulating red
blood cells and is therefore useful for evaluating longer-term glucose control rather than a
single glucose reading.
Question 6.
Which statement about metformin requires correction?
A. “I should take it according to my prescribed schedule.”
B. “Gastrointestinal effects may occur.”
C. “My kidney function may need monitoring.”
D. “It works primarily by forcing my pancreas to release large amounts of insulin.”
Correct Answer: D. “It works primarily by forcing my pancreas to release large amounts of
insulin.”
Explanation: Metformin primarily decreases hepatic glucose production and improves
insulin sensitivity. It is not primarily an insulin-secretagogue.
Question 7.
An older adult with diabetes asks why illness can make glucose management more difficult.
Which response is best?
A. “Illness always lowers glucose.”
B. “Stress hormones can increase glucose during illness.”
C. “Diabetes temporarily disappears during illness.”
D. “Insulin becomes unnecessary during infections.”
Correct Answer: B. “Stress hormones can increase glucose during illness.”
Explanation: Acute illness can increase counter-regulatory hormones such as cortisol and
catecholamines, resulting in increased glucose levels. Patients should follow their
individualized sick-day plan and monitor glucose as directed.
Question 8.
Which finding is most concerning in a patient with diabetes?
A. Mild thirst after exercise
B. A small area of intact dry skin
, C. A new nonhealing blister on the foot
D. Increased appetite after physical activity
Correct Answer: C. A new nonhealing blister on the foot
Explanation: A nonhealing foot lesion may indicate impaired circulation, neuropathy,
infection, or developing tissue injury. Prompt assessment is important because diabetic foot
complications can progress rapidly.
Question 9.
Which manifestation is most consistent with hyperosmolar hyperglycemic state (HHS)?
A. Severe hyperglycemia with profound dehydration and minimal ketosis
B. Severe hypoglycemia with diaphoresis
C. Respiratory alkalosis with low glucose
D. Mild hyperglycemia without fluid loss
Correct Answer: A. Severe hyperglycemia with profound dehydration and minimal ketosis
Explanation: HHS typically involves very high glucose, severe dehydration, hyperosmolarity,
and altered mental status. Significant ketoacidosis is generally absent or much less
prominent than in DKA.
Question 10.
A nurse is evaluating diabetic foot-care teaching. Which statement indicates a need for
further education?
A. “I will inspect my feet daily.”
B. “I will wear shoes that fit properly.”
C. “I will use a heating pad if my feet feel cold.”
D. “I will report sores that do not heal.”
Correct Answer: C. “I will use a heating pad if my feet feel cold.”
Explanation: Peripheral neuropathy can reduce the ability to sense excessive heat, creating a
burn risk. Patients should avoid heating pads and other direct heat sources on potentially
insensate feet.
Question 11.
A patient with chronic heart failure is taught to monitor weight at home. Which practice is
best?
A. Weigh once a month.
B. Weigh at different times each day.
C. Weigh each morning under similar conditions.
D. Weigh only when shortness of breath occurs.
QUESTIONS AND ANSWERS | VERIFIED AND
WELL-DETAILED ANSWERS | DETAILED
EXPLANATIONS AND RATIONALES | COMPLETE
EXAM PREPARATION STUDY GUIDE | PRACTICE
QUESTIONS | LATEST EXAM UPDATE
* CORE DOMAINS *
1. Diabetes Mellitus and Metabolic Disorders
2. Cardiovascular Disorders and Heart Failure
3. COPD and Chronic Respiratory Disorders
4. Chronic Kidney Disease and Renal Management
5. Dementia, Delirium, and Neurologic Disorders
6. Stroke and Long-Term Neurologic Rehabilitation
7. Geriatric Syndromes, Falls, and Functional Decline
8. Chronic Disease Self-Management and Patient Education
9. Medication Management and Safety in Older Adults
10. Nursing Prioritization, Assessment, and Professional Decision-Making
Question 1.
A nurse is teaching an older adult with type 2 diabetes about maintaining consistent
nutrition. Which statement indicates correct understanding?
A. “I should skip meals when my glucose is elevated.”
B. “I should eat meals at reasonably consistent times and follow my prescribed meal plan.”
C. “I should avoid all carbohydrates permanently.”
D. “I should eat one large meal each day.”
Correct Answer: B. “I should eat meals at reasonably consistent times and follow my
prescribed meal plan.”
Explanation: Consistent meal timing and appropriate portions help maintain more
predictable glucose levels, particularly when medications can cause hypoglycemia. Skipping
meals can increase the risk of hypoglycemia, and eliminating all carbohydrates is neither
necessary nor generally appropriate.
Question 2.
,Which finding is most characteristic of diabetic ketoacidosis (DKA)?
A. Severe hypoglycemia without acidosis
B. Hyperglycemia with ketosis and metabolic acidosis
C. Hyperglycemia without fluid loss
D. Bradycardia with respiratory alkalosis
Correct Answer: B. Hyperglycemia with ketosis and metabolic acidosis
Explanation: DKA results from significant insulin deficiency and is characterized by
hyperglycemia, ketone production, an elevated anion gap metabolic acidosis, and
dehydration. Although potassium may initially be elevated, total-body potassium is usually
depleted.
Question 3.
Which instruction is most appropriate when teaching diabetic foot care?
A. Soak the feet daily in hot water.
B. Walk barefoot indoors to strengthen the feet.
C. Inspect the feet every day and wear properly fitting footwear.
D. Cut toenails deeply into the corners.
Correct Answer: C. Inspect the feet every day and wear properly fitting footwear.
Explanation: Diabetes can cause neuropathy and impaired circulation, increasing the risk of
unnoticed injury and infection. Daily inspection and properly fitting shoes help prevent
complications. Hot water and barefoot walking increase injury risk.
Question 4.
A client taking insulin becomes shaky, sweaty, and confused. What should the nurse
suspect?
A. Hypernatremia
B. Hypoglycemia
C. Hypercalcemia
D. Diabetic ketoacidosis
Correct Answer: B. Hypoglycemia
Explanation: Sweating, tremors, confusion, weakness, and behavioral changes are common
manifestations of hypoglycemia. A conscious patient should receive a rapid source of glucose
according to the treatment plan.
Question 5.
Which laboratory value provides information about average blood glucose control over
approximately the previous 2–3 months?
,A. Serum glucose
B. Urine ketones
C. Hemoglobin A1c
D. Serum insulin
Correct Answer: C. Hemoglobin A1c
Explanation: Hemoglobin A1c reflects glycemic exposure over the life span of circulating red
blood cells and is therefore useful for evaluating longer-term glucose control rather than a
single glucose reading.
Question 6.
Which statement about metformin requires correction?
A. “I should take it according to my prescribed schedule.”
B. “Gastrointestinal effects may occur.”
C. “My kidney function may need monitoring.”
D. “It works primarily by forcing my pancreas to release large amounts of insulin.”
Correct Answer: D. “It works primarily by forcing my pancreas to release large amounts of
insulin.”
Explanation: Metformin primarily decreases hepatic glucose production and improves
insulin sensitivity. It is not primarily an insulin-secretagogue.
Question 7.
An older adult with diabetes asks why illness can make glucose management more difficult.
Which response is best?
A. “Illness always lowers glucose.”
B. “Stress hormones can increase glucose during illness.”
C. “Diabetes temporarily disappears during illness.”
D. “Insulin becomes unnecessary during infections.”
Correct Answer: B. “Stress hormones can increase glucose during illness.”
Explanation: Acute illness can increase counter-regulatory hormones such as cortisol and
catecholamines, resulting in increased glucose levels. Patients should follow their
individualized sick-day plan and monitor glucose as directed.
Question 8.
Which finding is most concerning in a patient with diabetes?
A. Mild thirst after exercise
B. A small area of intact dry skin
, C. A new nonhealing blister on the foot
D. Increased appetite after physical activity
Correct Answer: C. A new nonhealing blister on the foot
Explanation: A nonhealing foot lesion may indicate impaired circulation, neuropathy,
infection, or developing tissue injury. Prompt assessment is important because diabetic foot
complications can progress rapidly.
Question 9.
Which manifestation is most consistent with hyperosmolar hyperglycemic state (HHS)?
A. Severe hyperglycemia with profound dehydration and minimal ketosis
B. Severe hypoglycemia with diaphoresis
C. Respiratory alkalosis with low glucose
D. Mild hyperglycemia without fluid loss
Correct Answer: A. Severe hyperglycemia with profound dehydration and minimal ketosis
Explanation: HHS typically involves very high glucose, severe dehydration, hyperosmolarity,
and altered mental status. Significant ketoacidosis is generally absent or much less
prominent than in DKA.
Question 10.
A nurse is evaluating diabetic foot-care teaching. Which statement indicates a need for
further education?
A. “I will inspect my feet daily.”
B. “I will wear shoes that fit properly.”
C. “I will use a heating pad if my feet feel cold.”
D. “I will report sores that do not heal.”
Correct Answer: C. “I will use a heating pad if my feet feel cold.”
Explanation: Peripheral neuropathy can reduce the ability to sense excessive heat, creating a
burn risk. Patients should avoid heating pads and other direct heat sources on potentially
insensate feet.
Question 11.
A patient with chronic heart failure is taught to monitor weight at home. Which practice is
best?
A. Weigh once a month.
B. Weigh at different times each day.
C. Weigh each morning under similar conditions.
D. Weigh only when shortness of breath occurs.
