,NUR 257 Exam 3 | Concepts of Aging and Chronic Illness (2026)
Q&A | Galen College
1. A nurse is providing foot care education to a client with type 2 diabetes. Which statement
is the most important instruction to include?
A) Soak feet in hot water daily to promote circulation
B) Check their feet daily, asking a family member for help or using a mirror to examine all
surfaces
C) Apply lotion between the toes to prevent dryness
D) Trim toenails with curved edges to prevent ingrown nails
Correct Answer: Check their feet daily, asking a family member for help or using a mirror to
examine all surfaces
Rationale: Daily foot inspection is critical for early detection of diabetic neuropathic ulcers.
Peripheral neuropathy and vascular disease in diabetes increase injury risk; visual inspection
of plantar surfaces (often requiring mirrors or assistance) prevents missed lesions that could
lead to amputation.
2. A client with type 1 diabetes reports a new onset of urinary incontinence. The nurse
understands this is likely caused by which of the following?
A) Diabetic neuropathy affecting the bladder sphincter
B) Hyperglycemia leading to too much glucose in the urine causing osmotic diuresis
C) Urinary tract infection secondary to immunosuppression
D) Side effect of long-term insulin therapy
Correct Answer: Hyperglycemia leading to too much glucose in the urine causing osmotic
diuresis
,Rationale: Hyperglycemia causes glucose to spill into the urine, creating an osmotic effect
that pulls water into the bladder, leading to polyuria and potentially urgency or
incontinence. This is a common but often overlooked complication of poor glycemic control.
3. To help manage blood glucose levels, the nurse should educate a client with diabetes on
which aspect of their meal schedule?
A) Skip breakfast to reduce overall caloric intake
B) Food should be consumed at a scheduled time each day, with snacks and meals at the
same time
C) Eat only when hungry to prevent overeating
D) Consume all carbohydrates at dinner to sleep through glycemic peaks
Correct Answer: Food should be consumed at a scheduled time each day, with snacks and
meals at the same time
Rationale: Consistent carbohydrate intake and meal timing synchronize with insulin action
peaks (especially for those on fixed insulin regimens), reducing the risk of both
hyperglycemia and hypoglycemia. Scheduled eating patterns are essential for glycemic
control.
4. A 78-year-old patient with type 2 diabetes has an HbA1c of 7.2% on metformin. The
patient has a history of falls and cognitive impairment. What is the most appropriate HbA1c
target?
A) <6.5%
B) <7.0%
C) <7.5%
D) <8.0-8.5%
Correct Answer: <8.0-8.5%
, Rationale: For older adults with multiple comorbidities, limited life expectancy, or cognitive
impairment, less stringent HbA1c targets (7.5-8.5%) are recommended to avoid
hypoglycemia. Tight control increases the risk of falls and adverse cardiovascular events in
this population.
5. A patient with type 2 diabetes is prescribed insulin glargine (Lantus). The nurse should
educate that:
A) It is a clear insulin that should not be mixed with other insulins
B) It is a cloudy insulin that should be rolled before use
C) It has a peak effect at 4-6 hours
D) It is given before meals
Correct Answer: It is a clear insulin that should not be mixed with other insulins
Rationale: Insulin glargine is a clear, long-acting insulin with no pronounced peak. It should
not be mixed with other insulins in the same syringe. It is given once daily at the same time
each day to provide basal coverage.
6. A patient with type 2 diabetes and heart failure is started on an antidiabetic medication.
Which medication is contraindicated?
A) Metformin
B) Empagliflozin
C) Pioglitazone
D) Semaglutide
Correct Answer: Pioglitazone
Rationale: Pioglitazone (a thiazolidinedione) causes fluid retention and can precipitate or
worsen heart failure. It is contraindicated in patients with NYHA class III or IV heart failure.
SGLT2 inhibitors like empagliflozin are actually beneficial in HF.
Q&A | Galen College
1. A nurse is providing foot care education to a client with type 2 diabetes. Which statement
is the most important instruction to include?
A) Soak feet in hot water daily to promote circulation
B) Check their feet daily, asking a family member for help or using a mirror to examine all
surfaces
C) Apply lotion between the toes to prevent dryness
D) Trim toenails with curved edges to prevent ingrown nails
Correct Answer: Check their feet daily, asking a family member for help or using a mirror to
examine all surfaces
Rationale: Daily foot inspection is critical for early detection of diabetic neuropathic ulcers.
Peripheral neuropathy and vascular disease in diabetes increase injury risk; visual inspection
of plantar surfaces (often requiring mirrors or assistance) prevents missed lesions that could
lead to amputation.
2. A client with type 1 diabetes reports a new onset of urinary incontinence. The nurse
understands this is likely caused by which of the following?
A) Diabetic neuropathy affecting the bladder sphincter
B) Hyperglycemia leading to too much glucose in the urine causing osmotic diuresis
C) Urinary tract infection secondary to immunosuppression
D) Side effect of long-term insulin therapy
Correct Answer: Hyperglycemia leading to too much glucose in the urine causing osmotic
diuresis
,Rationale: Hyperglycemia causes glucose to spill into the urine, creating an osmotic effect
that pulls water into the bladder, leading to polyuria and potentially urgency or
incontinence. This is a common but often overlooked complication of poor glycemic control.
3. To help manage blood glucose levels, the nurse should educate a client with diabetes on
which aspect of their meal schedule?
A) Skip breakfast to reduce overall caloric intake
B) Food should be consumed at a scheduled time each day, with snacks and meals at the
same time
C) Eat only when hungry to prevent overeating
D) Consume all carbohydrates at dinner to sleep through glycemic peaks
Correct Answer: Food should be consumed at a scheduled time each day, with snacks and
meals at the same time
Rationale: Consistent carbohydrate intake and meal timing synchronize with insulin action
peaks (especially for those on fixed insulin regimens), reducing the risk of both
hyperglycemia and hypoglycemia. Scheduled eating patterns are essential for glycemic
control.
4. A 78-year-old patient with type 2 diabetes has an HbA1c of 7.2% on metformin. The
patient has a history of falls and cognitive impairment. What is the most appropriate HbA1c
target?
A) <6.5%
B) <7.0%
C) <7.5%
D) <8.0-8.5%
Correct Answer: <8.0-8.5%
, Rationale: For older adults with multiple comorbidities, limited life expectancy, or cognitive
impairment, less stringent HbA1c targets (7.5-8.5%) are recommended to avoid
hypoglycemia. Tight control increases the risk of falls and adverse cardiovascular events in
this population.
5. A patient with type 2 diabetes is prescribed insulin glargine (Lantus). The nurse should
educate that:
A) It is a clear insulin that should not be mixed with other insulins
B) It is a cloudy insulin that should be rolled before use
C) It has a peak effect at 4-6 hours
D) It is given before meals
Correct Answer: It is a clear insulin that should not be mixed with other insulins
Rationale: Insulin glargine is a clear, long-acting insulin with no pronounced peak. It should
not be mixed with other insulins in the same syringe. It is given once daily at the same time
each day to provide basal coverage.
6. A patient with type 2 diabetes and heart failure is started on an antidiabetic medication.
Which medication is contraindicated?
A) Metformin
B) Empagliflozin
C) Pioglitazone
D) Semaglutide
Correct Answer: Pioglitazone
Rationale: Pioglitazone (a thiazolidinedione) causes fluid retention and can precipitate or
worsen heart failure. It is contraindicated in patients with NYHA class III or IV heart failure.
SGLT2 inhibitors like empagliflozin are actually beneficial in HF.
