NUR 257 Chronic Exam 3 Fall
2026/2027 | Galen College of Nursing
Chronic Conditions Exam 3 with
Complete Questions & 100% Correct
Answers
1. A 78-year-old patient with type 2 diabetes has an HbA1c of 8.2%. According to the
ADA 2026 guidelines for older adults, what is the MOST appropriate HbA1c target for
this patient?
A) < 6.0%
B) < 6.5%
C) < 8.0%
D) < 9.0%
Answer: C) < 8.0%
Rationale: For older adults with multiple comorbidities, the ADA recommends a less
stringent HbA1c target of <8.0% to avoid hypoglycemia.
2. Which medication class is now considered FIRST-LINE for patients with type 2
diabetes AND heart failure?
A) Sulfonylureas
B) SGLT2 inhibitors
C) Thiazolidinediones
D) DPP-4 inhibitors
, Answer: B) SGLT2 inhibitors
Rationale: SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) have proven
cardiovascular and renal benefits and are first-line per ADA/AHA 2026 guidelines.
3. A nurse is teaching a patient with COPD about the "pursed-lip breathing" technique.
What is the PRIMARY physiological purpose?
A) Increase oxygen saturation
B) Prevent airway collapse during exhalation
C) Stimulate the cough reflex
D) Reduce mucus production
Answer: B) Prevent airway collapse during exhalation
Rationale: Pursed-lip breathing creates back-pressure that keeps airways open longer
during exhalation, reducing air trapping.
4. Which arterial blood gas (ABG) result is MOST consistent with a COPD exacerbation?
A) pH 7.48, PaCO₂ 35, HCO₃⁻ 24
B) pH 7.35, PaCO₂ 50, HCO₃⁻ 28
C) pH 7.50, PaCO₂ 30, HCO₃⁻ 22
D) pH 7.30, PaCO₂ 60, HCO₃⁻ 24
Answer: B) pH 7.35, PaCO₂ 50, HCO₃⁻ 28
Rationale: This shows compensated respiratory acidosis — elevated CO₂ with near-
normal pH due to renal compensation (elevated HCO₃⁻), typical of chronic COPD.
, 5. A patient with heart failure is prescribed furosemide (Lasix) 40 mg PO daily. Which
electrolyte should the nurse monitor MOST closely?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
Answer: C) Potassium
Rationale: Loop diuretics cause significant potassium wasting, leading to hypokalemia,
which can trigger dangerous cardiac arrhythmias.
6. Which sign is the EARLIEST indicator of worsening heart failure?
A) Jugular vein distention (JVD)
B) Weight gain of 2+ lbs in 24 hours
C) Bilateral pitting edema
D) Dyspnea at rest
Answer: B) Weight gain of 2+ lbs in 24 hours
Rationale: Rapid weight gain indicates fluid retention and is the earliest sign of
decompensated HF, occurring before visible edema or JVD.
7. The nurse is caring for a patient with CKD Stage 4 (eGFR 18 mL/min). Which
medication should be HELD due to renal clearance concerns?
A) Lisinopril
B) Metformin
2026/2027 | Galen College of Nursing
Chronic Conditions Exam 3 with
Complete Questions & 100% Correct
Answers
1. A 78-year-old patient with type 2 diabetes has an HbA1c of 8.2%. According to the
ADA 2026 guidelines for older adults, what is the MOST appropriate HbA1c target for
this patient?
A) < 6.0%
B) < 6.5%
C) < 8.0%
D) < 9.0%
Answer: C) < 8.0%
Rationale: For older adults with multiple comorbidities, the ADA recommends a less
stringent HbA1c target of <8.0% to avoid hypoglycemia.
2. Which medication class is now considered FIRST-LINE for patients with type 2
diabetes AND heart failure?
A) Sulfonylureas
B) SGLT2 inhibitors
C) Thiazolidinediones
D) DPP-4 inhibitors
, Answer: B) SGLT2 inhibitors
Rationale: SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) have proven
cardiovascular and renal benefits and are first-line per ADA/AHA 2026 guidelines.
3. A nurse is teaching a patient with COPD about the "pursed-lip breathing" technique.
What is the PRIMARY physiological purpose?
A) Increase oxygen saturation
B) Prevent airway collapse during exhalation
C) Stimulate the cough reflex
D) Reduce mucus production
Answer: B) Prevent airway collapse during exhalation
Rationale: Pursed-lip breathing creates back-pressure that keeps airways open longer
during exhalation, reducing air trapping.
4. Which arterial blood gas (ABG) result is MOST consistent with a COPD exacerbation?
A) pH 7.48, PaCO₂ 35, HCO₃⁻ 24
B) pH 7.35, PaCO₂ 50, HCO₃⁻ 28
C) pH 7.50, PaCO₂ 30, HCO₃⁻ 22
D) pH 7.30, PaCO₂ 60, HCO₃⁻ 24
Answer: B) pH 7.35, PaCO₂ 50, HCO₃⁻ 28
Rationale: This shows compensated respiratory acidosis — elevated CO₂ with near-
normal pH due to renal compensation (elevated HCO₃⁻), typical of chronic COPD.
, 5. A patient with heart failure is prescribed furosemide (Lasix) 40 mg PO daily. Which
electrolyte should the nurse monitor MOST closely?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
Answer: C) Potassium
Rationale: Loop diuretics cause significant potassium wasting, leading to hypokalemia,
which can trigger dangerous cardiac arrhythmias.
6. Which sign is the EARLIEST indicator of worsening heart failure?
A) Jugular vein distention (JVD)
B) Weight gain of 2+ lbs in 24 hours
C) Bilateral pitting edema
D) Dyspnea at rest
Answer: B) Weight gain of 2+ lbs in 24 hours
Rationale: Rapid weight gain indicates fluid retention and is the earliest sign of
decompensated HF, occurring before visible edema or JVD.
7. The nurse is caring for a patient with CKD Stage 4 (eGFR 18 mL/min). Which
medication should be HELD due to renal clearance concerns?
A) Lisinopril
B) Metformin
