NUR 257 CHRONIC EXAM 4:
COMPREHENSIVE MANAGEMENT OF
CHRONIC CONDITIONS QUESTIONS
AND ANSWERS WITH VERIFIED
SOLUTIONS 2026/2027 UPDATE
1. A patient with Chronic Kidney Disease (CKD) Stage 4 is prescribed Epoetin alfa. Which
laboratory result is the most critical for the nurse to monitor to prevent complications?
A. Hemoglobin level
B. Serum Potassium level
C. Blood Urea Nitrogen (BUN)
D. Serum Calcium level
Answer: A
Conceptual Explanation: Epoetin alfa is used to treat anemia in CKD. If hemoglobin rises
too quickly (more than 1 g/dL in 2 weeks) or exceeds 11 g/dL, it increases the risk of
serious cardiovascular events and thromboembolism.
2. Which clinical manifestation should the nurse prioritize when assessing a patient with Left-
sided Heart Failure?
A. Crackles at the lung bases
,B. Peripheral dependent edema
C. Jugular venous distention
D. Ascites and abdominal girth increase
Answer: A
Conceptual Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary congestion and crackles. The other options
are signs of right-sided heart failure.
3. A patient with COPD is receiving oxygen via nasal cannula. Which SpO2 range is generally
considered the therapeutic target for this patient population to prevent respiratory
depression?
A. 88% to 92%
B. 92% to 96%
C. 95% to 100%
D. 80% to 85%
Answer: A
Conceptual Explanation: In patients with chronic hypercapnia (COPD), the drive to
breathe is triggered by low oxygen levels rather than high CO2. Maintaining SpO2 between
88-92% prevents the suppression of this hypoxic drive.
, 4. When teaching a patient with Type 2 Diabetes about the long-term complication of
nephropathy, which diagnostic test should the nurse emphasize as an early screening tool?
A. Serum Creatinine
B. Microalbuminuria test
C. 24-hour urine for specific gravity
D. Glycosylated hemoglobin (HbA1c)
Answer: B
Conceptual Explanation: Microalbuminuria is one of the earliest signs of diabetic
nephropathy, indicating that the kidneys are beginning to leak small amounts of protein.
5. A patient with cirrhosis and hepatic encephalopathy is receiving Lactulose. What is the
primary therapeutic goal of this medication?
A. To reduce portal vein pressure
B. To promote the excretion of ammonia in the stool
C. To decrease serum bilirubin levels
D. To prevent the development of esophageal varices
Answer: B
Conceptual Explanation: Lactulose works by trapping ammonia in the gut and acting as a
laxative to expel it, thereby reducing the serum ammonia levels that cause encephalopathy.
COMPREHENSIVE MANAGEMENT OF
CHRONIC CONDITIONS QUESTIONS
AND ANSWERS WITH VERIFIED
SOLUTIONS 2026/2027 UPDATE
1. A patient with Chronic Kidney Disease (CKD) Stage 4 is prescribed Epoetin alfa. Which
laboratory result is the most critical for the nurse to monitor to prevent complications?
A. Hemoglobin level
B. Serum Potassium level
C. Blood Urea Nitrogen (BUN)
D. Serum Calcium level
Answer: A
Conceptual Explanation: Epoetin alfa is used to treat anemia in CKD. If hemoglobin rises
too quickly (more than 1 g/dL in 2 weeks) or exceeds 11 g/dL, it increases the risk of
serious cardiovascular events and thromboembolism.
2. Which clinical manifestation should the nurse prioritize when assessing a patient with Left-
sided Heart Failure?
A. Crackles at the lung bases
,B. Peripheral dependent edema
C. Jugular venous distention
D. Ascites and abdominal girth increase
Answer: A
Conceptual Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to pulmonary congestion and crackles. The other options
are signs of right-sided heart failure.
3. A patient with COPD is receiving oxygen via nasal cannula. Which SpO2 range is generally
considered the therapeutic target for this patient population to prevent respiratory
depression?
A. 88% to 92%
B. 92% to 96%
C. 95% to 100%
D. 80% to 85%
Answer: A
Conceptual Explanation: In patients with chronic hypercapnia (COPD), the drive to
breathe is triggered by low oxygen levels rather than high CO2. Maintaining SpO2 between
88-92% prevents the suppression of this hypoxic drive.
, 4. When teaching a patient with Type 2 Diabetes about the long-term complication of
nephropathy, which diagnostic test should the nurse emphasize as an early screening tool?
A. Serum Creatinine
B. Microalbuminuria test
C. 24-hour urine for specific gravity
D. Glycosylated hemoglobin (HbA1c)
Answer: B
Conceptual Explanation: Microalbuminuria is one of the earliest signs of diabetic
nephropathy, indicating that the kidneys are beginning to leak small amounts of protein.
5. A patient with cirrhosis and hepatic encephalopathy is receiving Lactulose. What is the
primary therapeutic goal of this medication?
A. To reduce portal vein pressure
B. To promote the excretion of ammonia in the stool
C. To decrease serum bilirubin levels
D. To prevent the development of esophageal varices
Answer: B
Conceptual Explanation: Lactulose works by trapping ammonia in the gut and acting as a
laxative to expel it, thereby reducing the serum ammonia levels that cause encephalopathy.
