GALEN COLLEGE OF NURSING · NUR 257 EXAM
NUR 257 Exam
NUR 257 Exam - Diabetes, Cardiac & Respiratory
150-question system-focused practice set for the major chronic-condition domains.
150 A-D + SATA Explained
Practice Questions Exam-Style Items Answer Format
Focus: Diabetes management and complications, heart failure and cardiovascular care, COPD,
pneumonia, inhalers, oxygen, and teaching.
PassPoint Pro Original practice & revision material
, NUR 257 Exam · Diabetes · Cardiac · Respiratory
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.
Diabetes & Metabolic Care
1 Which action best protects a client with diabetic neuropathy from foot injury?
A Use protective footwear and inspect the feet daily
B Walk barefoot at home to improve circulation
C Test bath water with the feet before entering
D Apply a heating pad directly to numb feet
Answer: A. Use protective footwear and inspect the feet daily
Explanation: Neuropathy can prevent the client from sensing trauma or excessive heat. Protective footwear and daily visual inspection reduce
the chance that a small injury will progress unnoticed. Direct heat and barefoot walking increase injury risk.
2 During morning care, an older adult with diabetes reports tremors and sudden hunger. Capillary glucose is 62 mg/dL. Which
action is the priority?
A Delay treatment and recheck in one hour
B Administer the scheduled long-acting insulin
C Encourage ambulation to raise the glucose
D Give about 15 g of a fast-acting carbohydrate
Answer: D. Give about 15 g of a fast-acting carbohydrate
Explanation: An awake client with symptomatic hypoglycemia who can swallow should receive a fast-acting carbohydrate promptly. Glucose is
then rechecked after a short interval and treatment repeated if needed. Delaying care can allow neuroglycopenic symptoms to worsen.
3 A client with diabetes has influenza and poor appetite. Which statement shows correct sick-day understanding?
A Stop all diabetes medications until normal eating resumes
B Check glucose only if symptoms become severe
C Continue prescribed diabetes therapy as directed and monitor glucose more often
D Avoid fluids to prevent further nausea
Answer: C. Continue prescribed diabetes therapy as directed and monitor glucose more often
Explanation: Illness can raise glucose even when food intake falls, so glucose should be monitored more frequently and prescribed therapy
continued unless the clinician directs otherwise. Hydration is important, and persistent vomiting, marked hyperglycemia, or ketones require prompt
follow-up. Stopping therapy without guidance can precipitate severe hyperglycemia.
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, NUR 257 Exam · Diabetes · Cardiac · Respiratory
4 A client with diabetes has a small foot wound. Which finding requires the most prompt follow-up?
A A stable wound size with no drainage
B Normal skin temperature without tenderness
C Increasing redness, warmth, drainage, or swelling
D Dry intact skin around the wound
Answer: C. Increasing redness, warmth, drainage, or swelling
Explanation: Increasing erythema, warmth, drainage, swelling, or pain can indicate infection and warrants prompt evaluation. Diabetes may
impair wound healing and sensation, allowing infection to progress with few symptoms. Early recognition can prevent deeper tissue involvement.
5 A client with diabetes has nausea, abdominal pain, and rapid deep respirations. Which additional finding is most consistent
with diabetic ketoacidosis?
A Isolated mild hyperglycemia after a meal
B Normal bicarbonate with no ketones
C Low glucose with respiratory alkalosis
D Metabolic acidosis with circulating ketones
Answer: D. Metabolic acidosis with circulating ketones
Explanation: Diabetic ketoacidosis is characterized by hyperglycemia, ketone production, and metabolic acidosis. Respiratory compensation
may produce deep, rapid breathing. The condition requires prompt fluid, electrolyte, and insulin management.
6 Which finding most strongly supports diabetic ketoacidosis rather than uncomplicated hyperglycemia? Which response by
the nurse is most appropriate?
A Low glucose with respiratory alkalosis
B Metabolic acidosis with circulating ketones
C Isolated mild hyperglycemia after a meal
D Normal bicarbonate with no ketones
Answer: B. Metabolic acidosis with circulating ketones
Explanation: Diabetic ketoacidosis is characterized by hyperglycemia, ketone production, and metabolic acidosis. Respiratory compensation
may produce deep, rapid breathing. The condition requires prompt fluid, electrolyte, and insulin management.
7 An older adult has profound dehydration, very high glucose, and altered mental status with minimal ketone production.
Which condition is most likely?
A Hyperosmolar hyperglycemic state
B Mild fasting hyperglycemia
C Simple medication intolerance
D Isolated hypoglycemia
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 3
, NUR 257 Exam · Diabetes · Cardiac · Respiratory
8 A client has firm areas at frequently used insulin injection sites. Which teaching should the nurse reinforce?
A Rotate injection sites within an anatomic area using a consistent pattern
B Inject into the same exact spot every time
C Skip insulin whenever a site feels tender
D Massage the site vigorously after each injection
Answer: A. Rotate injection sites within an anatomic area using a consistent pattern
Explanation: Systematic site rotation helps reduce lipohypertrophy and supports more consistent absorption. Repeated injections into the same
spot can alter tissue and insulin uptake. Insulin should not be skipped without clinical direction.
9 Which instruction about subcutaneous insulin injections is most appropriate? Which response by the nurse is most
appropriate?
A Rotate injection sites within an anatomic area using a consistent pattern
B Inject into the same exact spot every time
C Massage the site vigorously after each injection
D Skip insulin whenever a site feels tender
Answer: A. Rotate injection sites within an anatomic area using a consistent pattern
Explanation: Systematic site rotation helps reduce lipohypertrophy and supports more consistent absorption. Repeated injections into the same
spot can alter tissue and insulin uptake. Insulin should not be skipped without clinical direction.
10 For a hemodynamically compromised client with diabetic ketoacidosis, which action has the highest initial priority?
A Restrict fluids until the glucose normalizes
B Begin isotonic IV fluid replacement as prescribed
C Give oral fluids only
D Administer a long-acting insulin dose and discharge
Answer: B. Begin isotonic IV fluid replacement as prescribed
Explanation: Volume depletion is a major immediate problem in diabetic ketoacidosis, so isotonic fluid replacement is typically an early priority.
Insulin and electrolyte management follow closely and require ongoing monitoring. Oral fluids alone are inadequate for significant dehydration.
11 Which findings can occur with hypoglycemia? Select all that apply.
A Persistent marked hyperglycemia
B Tremor
C Confusion
D Sweating
Answer: B, C, D. Tremor; Confusion; Sweating
Explanation: These selections reflect recommended assessment, safety, or self-management principles for this topic. The remaining option is
inconsistent with safe older-adult chronic-care practice. Apply the same reasoning to similar clinical scenarios rather than memorizing the
wording.
PassPoint Pro · NUR 257 · Exam Practice Series Page 4
NUR 257 Exam
NUR 257 Exam - Diabetes, Cardiac & Respiratory
150-question system-focused practice set for the major chronic-condition domains.
150 A-D + SATA Explained
Practice Questions Exam-Style Items Answer Format
Focus: Diabetes management and complications, heart failure and cardiovascular care, COPD,
pneumonia, inhalers, oxygen, and teaching.
PassPoint Pro Original practice & revision material
, NUR 257 Exam · Diabetes · Cardiac · Respiratory
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.
Diabetes & Metabolic Care
1 Which action best protects a client with diabetic neuropathy from foot injury?
A Use protective footwear and inspect the feet daily
B Walk barefoot at home to improve circulation
C Test bath water with the feet before entering
D Apply a heating pad directly to numb feet
Answer: A. Use protective footwear and inspect the feet daily
Explanation: Neuropathy can prevent the client from sensing trauma or excessive heat. Protective footwear and daily visual inspection reduce
the chance that a small injury will progress unnoticed. Direct heat and barefoot walking increase injury risk.
2 During morning care, an older adult with diabetes reports tremors and sudden hunger. Capillary glucose is 62 mg/dL. Which
action is the priority?
A Delay treatment and recheck in one hour
B Administer the scheduled long-acting insulin
C Encourage ambulation to raise the glucose
D Give about 15 g of a fast-acting carbohydrate
Answer: D. Give about 15 g of a fast-acting carbohydrate
Explanation: An awake client with symptomatic hypoglycemia who can swallow should receive a fast-acting carbohydrate promptly. Glucose is
then rechecked after a short interval and treatment repeated if needed. Delaying care can allow neuroglycopenic symptoms to worsen.
3 A client with diabetes has influenza and poor appetite. Which statement shows correct sick-day understanding?
A Stop all diabetes medications until normal eating resumes
B Check glucose only if symptoms become severe
C Continue prescribed diabetes therapy as directed and monitor glucose more often
D Avoid fluids to prevent further nausea
Answer: C. Continue prescribed diabetes therapy as directed and monitor glucose more often
Explanation: Illness can raise glucose even when food intake falls, so glucose should be monitored more frequently and prescribed therapy
continued unless the clinician directs otherwise. Hydration is important, and persistent vomiting, marked hyperglycemia, or ketones require prompt
follow-up. Stopping therapy without guidance can precipitate severe hyperglycemia.
PassPoint Pro · NUR 257 · Exam Practice Series Page 2
, NUR 257 Exam · Diabetes · Cardiac · Respiratory
4 A client with diabetes has a small foot wound. Which finding requires the most prompt follow-up?
A A stable wound size with no drainage
B Normal skin temperature without tenderness
C Increasing redness, warmth, drainage, or swelling
D Dry intact skin around the wound
Answer: C. Increasing redness, warmth, drainage, or swelling
Explanation: Increasing erythema, warmth, drainage, swelling, or pain can indicate infection and warrants prompt evaluation. Diabetes may
impair wound healing and sensation, allowing infection to progress with few symptoms. Early recognition can prevent deeper tissue involvement.
5 A client with diabetes has nausea, abdominal pain, and rapid deep respirations. Which additional finding is most consistent
with diabetic ketoacidosis?
A Isolated mild hyperglycemia after a meal
B Normal bicarbonate with no ketones
C Low glucose with respiratory alkalosis
D Metabolic acidosis with circulating ketones
Answer: D. Metabolic acidosis with circulating ketones
Explanation: Diabetic ketoacidosis is characterized by hyperglycemia, ketone production, and metabolic acidosis. Respiratory compensation
may produce deep, rapid breathing. The condition requires prompt fluid, electrolyte, and insulin management.
6 Which finding most strongly supports diabetic ketoacidosis rather than uncomplicated hyperglycemia? Which response by
the nurse is most appropriate?
A Low glucose with respiratory alkalosis
B Metabolic acidosis with circulating ketones
C Isolated mild hyperglycemia after a meal
D Normal bicarbonate with no ketones
Answer: B. Metabolic acidosis with circulating ketones
Explanation: Diabetic ketoacidosis is characterized by hyperglycemia, ketone production, and metabolic acidosis. Respiratory compensation
may produce deep, rapid breathing. The condition requires prompt fluid, electrolyte, and insulin management.
7 An older adult has profound dehydration, very high glucose, and altered mental status with minimal ketone production.
Which condition is most likely?
A Hyperosmolar hyperglycemic state
B Mild fasting hyperglycemia
C Simple medication intolerance
D Isolated hypoglycemia
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 3
, NUR 257 Exam · Diabetes · Cardiac · Respiratory
8 A client has firm areas at frequently used insulin injection sites. Which teaching should the nurse reinforce?
A Rotate injection sites within an anatomic area using a consistent pattern
B Inject into the same exact spot every time
C Skip insulin whenever a site feels tender
D Massage the site vigorously after each injection
Answer: A. Rotate injection sites within an anatomic area using a consistent pattern
Explanation: Systematic site rotation helps reduce lipohypertrophy and supports more consistent absorption. Repeated injections into the same
spot can alter tissue and insulin uptake. Insulin should not be skipped without clinical direction.
9 Which instruction about subcutaneous insulin injections is most appropriate? Which response by the nurse is most
appropriate?
A Rotate injection sites within an anatomic area using a consistent pattern
B Inject into the same exact spot every time
C Massage the site vigorously after each injection
D Skip insulin whenever a site feels tender
Answer: A. Rotate injection sites within an anatomic area using a consistent pattern
Explanation: Systematic site rotation helps reduce lipohypertrophy and supports more consistent absorption. Repeated injections into the same
spot can alter tissue and insulin uptake. Insulin should not be skipped without clinical direction.
10 For a hemodynamically compromised client with diabetic ketoacidosis, which action has the highest initial priority?
A Restrict fluids until the glucose normalizes
B Begin isotonic IV fluid replacement as prescribed
C Give oral fluids only
D Administer a long-acting insulin dose and discharge
Answer: B. Begin isotonic IV fluid replacement as prescribed
Explanation: Volume depletion is a major immediate problem in diabetic ketoacidosis, so isotonic fluid replacement is typically an early priority.
Insulin and electrolyte management follow closely and require ongoing monitoring. Oral fluids alone are inadequate for significant dehydration.
11 Which findings can occur with hypoglycemia? Select all that apply.
A Persistent marked hyperglycemia
B Tremor
C Confusion
D Sweating
Answer: B, C, D. Tremor; Confusion; Sweating
Explanation: These selections reflect recommended assessment, safety, or self-management principles for this topic. The remaining option is
inconsistent with safe older-adult chronic-care practice. Apply the same reasoning to similar clinical scenarios rather than memorizing the
wording.
PassPoint Pro · NUR 257 · Exam Practice Series Page 4
