NUR 257 CHRONIC EXAM 3 -
ADVANCED NURSING CARE FOR
CHRONIC CONDITIONS QUESTIONS
AND ANSWERS WITH VERIFIED
SOLUTIONS 2026/2027 UPDATE
1. A patient with Stage 4 Chronic Kidney Disease (CKD) has a glomerular filtration rate (GFR)
of 22 mL/min. Which electrolyte imbalance is most critical for the nurse to monitor for?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Hypophosphatemia
Answer: C
Conceptual Explanation: In advanced CKD (Stage 4), the kidneys’ ability to excrete
potassium is significantly impaired, leading to hyperkalemia, which can cause life-
threatening cardiac arrhythmias.
,2. A patient undergoing peritoneal dialysis (PD) reports that the drained effluent is cloudy.
What is the priority nursing action?
A. Warm the next bag of dialysate
B. Increase the dwell time
C. Document the finding as normal
D. Notify the healthcare provider and obtain a culture
Answer: D
Conceptual Explanation: Cloudy effluent is the earliest sign of peritonitis, a serious
complication of PD. The nurse must notify the provider and collect a sample for culture and
sensitivity.
3. A patient with an arteriovenous (AV) fistula in the left arm for hemodialysis needs an
assessment. Which finding indicates the fistula is patent?
A. Absence of a pulse in the radial artery
B. Presence of a thrill upon palpation
C. Pitting edema in the left hand
D. Redness and warmth at the site
Answer: B
Conceptual Explanation: A patent AV fistula should have a palpable thrill and an audible
bruit. Absence of these indicates possible clotting or occlusion.
, 4. Which clinical manifestation is characteristic of a patient experiencing a Myasthenic Crisis?
A. Increased salivation and lacrimation
B. Improved muscle strength after Edrophonium (Tensilon) injection
C. Generalized bradycardia
D. Severe abdominal cramping
Answer: B
Conceptual Explanation: In a Myasthenic Crisis, muscle weakness is caused by insufficient
anticholinesterase medication; the Tensilon test will temporarily improve symptoms. A
Cholinergic crisis would show the opposite.
5. A patient with Type 2 Diabetes is being evaluated for Hyperosmolar Hyperglycemic State
(HHS). Which finding distinguishes HHS from Diabetic Ketoacidosis (DKA)?
A. Absence of significant ketosis
B. Serum glucose level of 400 mg/dL
C. Presence of Kussmaul respirations
D. Metabolic acidosis with an elevated anion gap
Answer: A
Conceptual Explanation: HHS is characterized by extreme hyperglycemia and
dehydration but lacks significant ketosis and acidosis because there is enough insulin to
prevent fat breakdown.
ADVANCED NURSING CARE FOR
CHRONIC CONDITIONS QUESTIONS
AND ANSWERS WITH VERIFIED
SOLUTIONS 2026/2027 UPDATE
1. A patient with Stage 4 Chronic Kidney Disease (CKD) has a glomerular filtration rate (GFR)
of 22 mL/min. Which electrolyte imbalance is most critical for the nurse to monitor for?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Hypophosphatemia
Answer: C
Conceptual Explanation: In advanced CKD (Stage 4), the kidneys’ ability to excrete
potassium is significantly impaired, leading to hyperkalemia, which can cause life-
threatening cardiac arrhythmias.
,2. A patient undergoing peritoneal dialysis (PD) reports that the drained effluent is cloudy.
What is the priority nursing action?
A. Warm the next bag of dialysate
B. Increase the dwell time
C. Document the finding as normal
D. Notify the healthcare provider and obtain a culture
Answer: D
Conceptual Explanation: Cloudy effluent is the earliest sign of peritonitis, a serious
complication of PD. The nurse must notify the provider and collect a sample for culture and
sensitivity.
3. A patient with an arteriovenous (AV) fistula in the left arm for hemodialysis needs an
assessment. Which finding indicates the fistula is patent?
A. Absence of a pulse in the radial artery
B. Presence of a thrill upon palpation
C. Pitting edema in the left hand
D. Redness and warmth at the site
Answer: B
Conceptual Explanation: A patent AV fistula should have a palpable thrill and an audible
bruit. Absence of these indicates possible clotting or occlusion.
, 4. Which clinical manifestation is characteristic of a patient experiencing a Myasthenic Crisis?
A. Increased salivation and lacrimation
B. Improved muscle strength after Edrophonium (Tensilon) injection
C. Generalized bradycardia
D. Severe abdominal cramping
Answer: B
Conceptual Explanation: In a Myasthenic Crisis, muscle weakness is caused by insufficient
anticholinesterase medication; the Tensilon test will temporarily improve symptoms. A
Cholinergic crisis would show the opposite.
5. A patient with Type 2 Diabetes is being evaluated for Hyperosmolar Hyperglycemic State
(HHS). Which finding distinguishes HHS from Diabetic Ketoacidosis (DKA)?
A. Absence of significant ketosis
B. Serum glucose level of 400 mg/dL
C. Presence of Kussmaul respirations
D. Metabolic acidosis with an elevated anion gap
Answer: A
Conceptual Explanation: HHS is characterized by extreme hyperglycemia and
dehydration but lacks significant ketosis and acidosis because there is enough insulin to
prevent fat breakdown.
