GALEN COLLEGE OF NURSING · NUR 257 EXAM
NUR 257 Exam
NUR 257 Exam - Clinical Judgment & Priority
150 scenario-based questions emphasizing first actions, deterioration, safety, and nursing judgment.
150 A-D + SATA Explained
Practice Questions Exam-Style Items Answer Format
Focus: Priority setting, red flags, medication safety, patient teaching, complications, escalation, and
older-adult clinical judgment.
PassPoint Pro Original practice & revision material
, NUR 257 Exam · Clinical Judgment & Priority
Instructions
Select the best answer for each item. Some questions use “Select all that apply.” The correct answer and detailed explanation appear directly after each
question for active review.
Clinical Judgment & Priority - Questions 1-25
1 During a focused assessment, which presentation in a client with severe hypothyroidism requires emergency evaluation?
A Mild seasonal fatigue
B Possible myxedema coma
C Normal sleepiness after a meal
D Expected medication adjustment
Answer: B. Possible myxedema coma
Explanation: Severe hypothyroidism can rarely progress to myxedema coma with hypothermia, bradycardia, hypotension, and altered
consciousness. This is a medical emergency requiring rapid supportive care and thyroid replacement. It should not be treated as routine fatigue.
2 Which meal choice best supports sodium reduction for a client with heart failure?
A Add salt at the table instead of while cooking
B Rely on cured meats for most protein intake
C Choose minimally processed foods and read labels for sodium content
D Use canned soups daily because they contain fluid
Answer: C. Choose minimally processed foods and read labels for sodium content
Explanation: Processed soups, cured meats, and many packaged foods can contain large amounts of sodium. Reading labels and choosing
minimally processed foods supports fluid management. Sodium goals should follow the individualized treatment plan.
3 Which presentation is most consistent with hyperosmolar hyperglycemic state in an older adult with type 2 diabetes?
A Hyperosmolar hyperglycemic state
B Isolated hypoglycemia
C Simple medication intolerance
D Mild fasting hyperglycemia
Answer: A. Hyperosmolar hyperglycemic state
Explanation: Hyperosmolar hyperglycemic state usually features extreme hyperglycemia, severe dehydration, and neurologic changes with little
or no ketoacidosis. It is especially important to recognize in older adults because dehydration can become profound. Urgent treatment is required.
PassPoint Pro · NUR 257 · Exam Practice Series Page 2
, NUR 257 Exam · Clinical Judgment & Priority
4 The nurse must decide what matters most. which electrolyte abnormality is especially important to monitor in advanced
chronic kidney disease?
A Serum potassium
B Serum lipase
C Serum bilirubin only
D Serum amylase
Answer: A. Serum potassium
Explanation: Reduced renal potassium excretion can lead to hyperkalemia in chronic kidney disease. Significant elevations can cause
dangerous cardiac conduction changes. Symptoms or ECG changes require prompt evaluation.
5 Which change most strongly suggests a COPD exacerbation?
A Stable exercise tolerance
B Usual morning cough without change
C Increasing dyspnea with increased or changed sputum
D Normal appetite and sleep
Answer: C. Increasing dyspnea with increased or changed sputum
Explanation: Worsening dyspnea and increased sputum volume or purulence can signal an acute COPD exacerbation. Early treatment can
reduce progression and hospitalization risk. Stable chronic symptoms are less concerning.
6 The nurse must decide what matters most. which hyperthyroid presentation requires emergency care?
A Thyroid storm
B Mild medication intolerance
C Stable chronic tremor
D Routine heat sensitivity
Answer: A. Thyroid storm
Explanation: Thyroid storm is a life-threatening escalation of thyrotoxicosis characterized by marked fever, tachycardia, and central nervous
system or gastrointestinal symptoms. Immediate emergency treatment is required. Stable chronic symptoms are not equivalent to this crisis.
7 During a focused assessment, which intervention supports bone health and fracture prevention in an older adult with
osteoporosis?
A Smoke to reduce appetite and body weight
B Avoid all activity to protect the bones
C Remove calcium-rich foods from the diet
D Use weight-bearing or resistance activity as tolerated and reduce fall hazards
Answer: D. Use weight-bearing or resistance activity as tolerated and reduce fall hazards
Explanation: Appropriate weight-bearing and resistance activity supports bone and muscle strength, while fall prevention reduces fracture risk.
Nutrition and prescribed osteoporosis therapy are also important. Complete inactivity can worsen deconditioning and balance.
PassPoint Pro · NUR 257 · Exam Practice Series Page 3
, NUR 257 Exam · Clinical Judgment & Priority
8 During a focused assessment, which nursing action protects an AV fistula?
A Assess for a bruit and thrill and avoid blood pressure measurements in that arm
B Use the fistula arm for routine blood draws
C Take blood pressure on the fistula arm every hour
D Apply a tight constrictive dressing over the access
Answer: A. Assess for a bruit and thrill and avoid blood pressure measurements in that arm
Explanation: A bruit and thrill indicate blood flow through the fistula. Compression, venipuncture, and blood pressure cuffs can compromise the
access and should generally be avoided in that arm. Loss of the bruit or thrill requires prompt evaluation.
9 The nurse must decide what matters most. which intervention helps reduce fall risk for a client with Parkinson disease and a
shuffling gait?
A Remove all handrails
B Encourage rushing to overcome freezing
C Use slippery footwear to make turning easier
D Allow extra time, use assistive devices as indicated, and cue deliberate steps
Answer: D. Allow extra time, use assistive devices as indicated, and cue deliberate steps
Explanation: Parkinson disease can impair gait initiation, balance, and turning. Deliberate cueing, adequate time, assistive devices, and a safe
environment can reduce falls. Rushing generally increases instability.
10 Which intervention is most appropriate for chronic insomnia in an older adult before adding sedating medication?
A Use sedatives nightly without review
B Stay in bed most of the day
C Drink caffeine late in the evening
D Use a regular sleep schedule, daytime activity, and limit late caffeine and long naps
Answer: D. Use a regular sleep schedule, daytime activity, and limit late caffeine and long naps
Explanation: Behavioral sleep strategies are often preferred because sedating medications can increase confusion and fall risk in older adults.
Regular timing, daytime activity, and limiting late stimulants can support sleep. Persistent insomnia should be evaluated for pain, mood, breathing
disorders, and medication effects.
11 A client with dementia becomes more restless and confused every evening. Which intervention is most appropriate?
A Increase caffeine late in the day
B Keep the room dark throughout the evening
C Maintain a predictable routine with daytime activity and adequate evening lighting
D Change caregivers and rooms frequently
Answer: C. Maintain a predictable routine with daytime activity and adequate evening lighting
Explanation: A consistent routine, daytime activity, and reduction of evening environmental stressors may lessen sundowning. Adequate lighting
can reduce misinterpretation of shadows. Frequent changes and stimulants may worsen agitation.
PassPoint Pro · NUR 257 · Exam Practice Series Page 4
NUR 257 Exam
NUR 257 Exam - Clinical Judgment & Priority
150 scenario-based questions emphasizing first actions, deterioration, safety, and nursing judgment.
150 A-D + SATA Explained
Practice Questions Exam-Style Items Answer Format
Focus: Priority setting, red flags, medication safety, patient teaching, complications, escalation, and
older-adult clinical judgment.
PassPoint Pro Original practice & revision material
, NUR 257 Exam · Clinical Judgment & Priority
Instructions
Select the best answer for each item. Some questions use “Select all that apply.” The correct answer and detailed explanation appear directly after each
question for active review.
Clinical Judgment & Priority - Questions 1-25
1 During a focused assessment, which presentation in a client with severe hypothyroidism requires emergency evaluation?
A Mild seasonal fatigue
B Possible myxedema coma
C Normal sleepiness after a meal
D Expected medication adjustment
Answer: B. Possible myxedema coma
Explanation: Severe hypothyroidism can rarely progress to myxedema coma with hypothermia, bradycardia, hypotension, and altered
consciousness. This is a medical emergency requiring rapid supportive care and thyroid replacement. It should not be treated as routine fatigue.
2 Which meal choice best supports sodium reduction for a client with heart failure?
A Add salt at the table instead of while cooking
B Rely on cured meats for most protein intake
C Choose minimally processed foods and read labels for sodium content
D Use canned soups daily because they contain fluid
Answer: C. Choose minimally processed foods and read labels for sodium content
Explanation: Processed soups, cured meats, and many packaged foods can contain large amounts of sodium. Reading labels and choosing
minimally processed foods supports fluid management. Sodium goals should follow the individualized treatment plan.
3 Which presentation is most consistent with hyperosmolar hyperglycemic state in an older adult with type 2 diabetes?
A Hyperosmolar hyperglycemic state
B Isolated hypoglycemia
C Simple medication intolerance
D Mild fasting hyperglycemia
Answer: A. Hyperosmolar hyperglycemic state
Explanation: Hyperosmolar hyperglycemic state usually features extreme hyperglycemia, severe dehydration, and neurologic changes with little
or no ketoacidosis. It is especially important to recognize in older adults because dehydration can become profound. Urgent treatment is required.
PassPoint Pro · NUR 257 · Exam Practice Series Page 2
, NUR 257 Exam · Clinical Judgment & Priority
4 The nurse must decide what matters most. which electrolyte abnormality is especially important to monitor in advanced
chronic kidney disease?
A Serum potassium
B Serum lipase
C Serum bilirubin only
D Serum amylase
Answer: A. Serum potassium
Explanation: Reduced renal potassium excretion can lead to hyperkalemia in chronic kidney disease. Significant elevations can cause
dangerous cardiac conduction changes. Symptoms or ECG changes require prompt evaluation.
5 Which change most strongly suggests a COPD exacerbation?
A Stable exercise tolerance
B Usual morning cough without change
C Increasing dyspnea with increased or changed sputum
D Normal appetite and sleep
Answer: C. Increasing dyspnea with increased or changed sputum
Explanation: Worsening dyspnea and increased sputum volume or purulence can signal an acute COPD exacerbation. Early treatment can
reduce progression and hospitalization risk. Stable chronic symptoms are less concerning.
6 The nurse must decide what matters most. which hyperthyroid presentation requires emergency care?
A Thyroid storm
B Mild medication intolerance
C Stable chronic tremor
D Routine heat sensitivity
Answer: A. Thyroid storm
Explanation: Thyroid storm is a life-threatening escalation of thyrotoxicosis characterized by marked fever, tachycardia, and central nervous
system or gastrointestinal symptoms. Immediate emergency treatment is required. Stable chronic symptoms are not equivalent to this crisis.
7 During a focused assessment, which intervention supports bone health and fracture prevention in an older adult with
osteoporosis?
A Smoke to reduce appetite and body weight
B Avoid all activity to protect the bones
C Remove calcium-rich foods from the diet
D Use weight-bearing or resistance activity as tolerated and reduce fall hazards
Answer: D. Use weight-bearing or resistance activity as tolerated and reduce fall hazards
Explanation: Appropriate weight-bearing and resistance activity supports bone and muscle strength, while fall prevention reduces fracture risk.
Nutrition and prescribed osteoporosis therapy are also important. Complete inactivity can worsen deconditioning and balance.
PassPoint Pro · NUR 257 · Exam Practice Series Page 3
, NUR 257 Exam · Clinical Judgment & Priority
8 During a focused assessment, which nursing action protects an AV fistula?
A Assess for a bruit and thrill and avoid blood pressure measurements in that arm
B Use the fistula arm for routine blood draws
C Take blood pressure on the fistula arm every hour
D Apply a tight constrictive dressing over the access
Answer: A. Assess for a bruit and thrill and avoid blood pressure measurements in that arm
Explanation: A bruit and thrill indicate blood flow through the fistula. Compression, venipuncture, and blood pressure cuffs can compromise the
access and should generally be avoided in that arm. Loss of the bruit or thrill requires prompt evaluation.
9 The nurse must decide what matters most. which intervention helps reduce fall risk for a client with Parkinson disease and a
shuffling gait?
A Remove all handrails
B Encourage rushing to overcome freezing
C Use slippery footwear to make turning easier
D Allow extra time, use assistive devices as indicated, and cue deliberate steps
Answer: D. Allow extra time, use assistive devices as indicated, and cue deliberate steps
Explanation: Parkinson disease can impair gait initiation, balance, and turning. Deliberate cueing, adequate time, assistive devices, and a safe
environment can reduce falls. Rushing generally increases instability.
10 Which intervention is most appropriate for chronic insomnia in an older adult before adding sedating medication?
A Use sedatives nightly without review
B Stay in bed most of the day
C Drink caffeine late in the evening
D Use a regular sleep schedule, daytime activity, and limit late caffeine and long naps
Answer: D. Use a regular sleep schedule, daytime activity, and limit late caffeine and long naps
Explanation: Behavioral sleep strategies are often preferred because sedating medications can increase confusion and fall risk in older adults.
Regular timing, daytime activity, and limiting late stimulants can support sleep. Persistent insomnia should be evaluated for pain, mood, breathing
disorders, and medication effects.
11 A client with dementia becomes more restless and confused every evening. Which intervention is most appropriate?
A Increase caffeine late in the day
B Keep the room dark throughout the evening
C Maintain a predictable routine with daytime activity and adequate evening lighting
D Change caregivers and rooms frequently
Answer: C. Maintain a predictable routine with daytime activity and adequate evening lighting
Explanation: A consistent routine, daytime activity, and reduction of evening environmental stressors may lessen sundowning. Adequate lighting
can reduce misinterpretation of shadows. Frequent changes and stimulants may worsen agitation.
PassPoint Pro · NUR 257 · Exam Practice Series Page 4
