NUR 257 CHRONIC EXAM 3 EXAM– GALEN QUESTIONS AND
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1. A nurse is caring for an older adult client with chronic heart failure who reports a 4-
pound weight gain over the past 48 hours, accompanied by mild dyspnea on exertion.
Which action should the nurse take first?
A. Administer the prescribed oral loop diuretic immediately
B. Auscultate bilateral lung sounds for crackles or wheezes
C. Notify the primary healthcare provider of the rapid weight gain
D. Draw blood for a serum brain natriuretic peptide level
Assessment comes before intervention or reporting. Auscultating lung sounds determines if
fluid overload has progressed to pulmonary congestion.
2. A home health nurse is visiting a client with chronic obstructive pulmonary disease
(COPD) who has a prescribed oxygen flow rate of 2 L/min via nasal cannula. The client
states the oxygen feels restrictive and asks to turn it up to 4 L/min to breathe easier. How
should the nurse respond?
A. Explain that high oxygen concentrations can reduce the respiratory drive in clients with
COPD
B. Instruct the client to use pursed-lip breathing instead of increasing the oxygen flow rate
C. Contact the provider to request an increase in baseline oxygen during periods of activity
D. Allow the client to increase the flow rate temporarily as long as oxygen saturation remains
above 95%
Clients with chronic hypercapnia rely on hypoxic drive to breathe; excessive oxygen
administration can depress ventilation, leading to carbon dioxide narcosis.
3. An adult client with poorly controlled type 2 diabetes mellitus presents to the outpatient
clinic with numbness and a burning sensation in both feet, worse at night. Which
complication does the nurse suspect?
,A. Peripheral artery disease
B. Diabetic peripheral neuropathy
C. Acute Charcot foot deformity
D. Chronic venous insufficiency
Symmetrical distal paresthesias, burning, and numbness that worsen at night are classic
symptoms of chronic sensorimotor diabetic peripheral neuropathy caused by metabolic nerve
damage.
4. A nurse is reviewing discharge instructions for a client diagnosed with chronic kidney
disease (CKD) stage 4. Which dietary modification should the nurse emphasize?
A. Increase intake of dark leafy green vegetables and citrus fruits
B. Restrict dietary intake of sodium, potassium, and phosphorus
C. Maintain a high-protein diet to prevent muscle wasting from uremia
D. Supplement daily fluid intake to at least 3,000 mL to flush the kidneys
As glomerular filtration rate declines, the kidneys cannot excrete sodium, potassium, and
phosphorus, requiring dietary restrictions to prevent dangerous systemic complications.
5. A client with rheumatoid arthritis reports morning joint stiffness lasting over an hour,
symmetrical swelling in the hands, and fatigue. Which diagnostic lab value is most specific
to confirming this diagnosis?
A. Elevated erythrocyte sedimentation rate
B. Positive antinuclear antibody titer
C. Elevated rheumatoid factor and anti-CCP antibodies
D. Decreased serum uric acid levels
Anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor are key
serological markers used to diagnose and assess rheumatoid arthritis.
6. A nurse is assessing a client with long-standing systemic lupus erythematosus (SLE) who
reports extreme fatigue, joint pain, and facial erythema. Which laboratory finding
warrants immediate follow-up by the nurse?
A. Mild microcytic anemia
,B. Elevated serum creatinine and proteinuria
C. Increased erythrocyte sedimentation rate
D. Positive antinuclear antibody screening
Lupus nephritis is a serious and potentially life-threatening complication of SLE; elevated
creatinine and proteinuria indicate renal involvement requiring prompt medical intervention.
7. A client with Parkinson disease is prescribed levodopa-carbidopa. Which finding
indicates the medication is achieving its therapeutic goal?
A. Cessation of disease progression and complete nerve regeneration
B. Reduction in resting tremors, rigidity, and bradykinesia
C. Stabilization of cognitive decline and prevention of dementia
D. Normalization of dopamine levels within the substantia nigra
Levodopa-carbidopa replenishes central dopamine to help control the cardinal motor
symptoms of Parkinson disease, though it does not cure or halt underlying neurodegeneration.
8. A nurse is providing education to a client diagnosed with gastroesophageal reflux disease
(GERD). Which client statement indicates a correct understanding of lifestyle
modifications?
A. I will eat my largest meal right before lying down to ensure adequate caloric intake
B. I should sleep with the head of my bed elevated using blocks or a wedge pillow
C. I can drink peppermint tea every evening to help soothe my stomach lining
D. I will increase my consumption of citrus juices and tomato-based products
Elevating the head of the bed utilizes gravity to prevent gastric acid reflux into the esophagus
during sleep. Peppermint, citrus, and large meals before lying down worsen GERD.
9. A client with chronic stable angina is prescribed sublingual nitroglycerin tablets. Which
instruction should the nurse include when teaching the client about proper administration?
A. Swallow the tablet whole with a full glass of water at the onset of chest pain
B. Place one tablet under the tongue and allow it to dissolve; repeat every 5 minutes for up
to three doses if pain persists
, C. Store the medication in a clear plastic container in the kitchen cabinet for easy access
D. Discard the medication bottle if it causes a stinging or burning sensation under the tongue
Rationale: Sublingual nitroglycerin must dissolve under the tongue for rapid systemic
absorption. A tingling sensation indicates the medication is potent and active. It should be
stored in a dark, airtight glass container.
10. A nurse is caring for a client with cirrhosis who has developed portal hypertension.
Which clinical manifestation is a direct consequence of this condition?
A. Esophageal varices and splenomegaly
B. Elevated serum bilirubin and jaundice
C. Decreased production of clotting factors
D. Elevated serum ammonia and hepatic encephalopathy
Portal hypertension increases resistance to blood flow through the liver, forcing blood into
collateral channels such as esophageal veins and causing backup into the spleen.
11. A client with chronic kidney disease is prescribed oral calcium acetate with meals.
What is the primary therapeutic purpose of this medication?
A. To prevent metabolic acidosis by acting as a systemic buffer
B. To bind dietary phosphorus in the gastrointestinal tract and excrete it in the stool
C. To stimulate the bone marrow to produce red blood cells and treat anemia
D. To lower systemic blood pressure by inducing peripheral vasodilation
In CKD, impaired phosphorus excretion leads to hyperphosphatemia. Calcium-based binders
combine with dietary phosphorus in the gut to prevent its absorption.
12. A nurse is assessing a client with advanced cirrhosis who appears confused, is
disoriented to time and place, and exhibits flapping tremors of the hands when extended.
How should the nurse document these findings?
A. Asterixis secondary to hepatic encephalopathy
B. Akinesia related to parkinsonian side effects
C. Peripheral neuropathy caused by vitamin B deficiency
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS PLUS
RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST| DOWNLOAD
INSTANT PDF
1. A nurse is caring for an older adult client with chronic heart failure who reports a 4-
pound weight gain over the past 48 hours, accompanied by mild dyspnea on exertion.
Which action should the nurse take first?
A. Administer the prescribed oral loop diuretic immediately
B. Auscultate bilateral lung sounds for crackles or wheezes
C. Notify the primary healthcare provider of the rapid weight gain
D. Draw blood for a serum brain natriuretic peptide level
Assessment comes before intervention or reporting. Auscultating lung sounds determines if
fluid overload has progressed to pulmonary congestion.
2. A home health nurse is visiting a client with chronic obstructive pulmonary disease
(COPD) who has a prescribed oxygen flow rate of 2 L/min via nasal cannula. The client
states the oxygen feels restrictive and asks to turn it up to 4 L/min to breathe easier. How
should the nurse respond?
A. Explain that high oxygen concentrations can reduce the respiratory drive in clients with
COPD
B. Instruct the client to use pursed-lip breathing instead of increasing the oxygen flow rate
C. Contact the provider to request an increase in baseline oxygen during periods of activity
D. Allow the client to increase the flow rate temporarily as long as oxygen saturation remains
above 95%
Clients with chronic hypercapnia rely on hypoxic drive to breathe; excessive oxygen
administration can depress ventilation, leading to carbon dioxide narcosis.
3. An adult client with poorly controlled type 2 diabetes mellitus presents to the outpatient
clinic with numbness and a burning sensation in both feet, worse at night. Which
complication does the nurse suspect?
,A. Peripheral artery disease
B. Diabetic peripheral neuropathy
C. Acute Charcot foot deformity
D. Chronic venous insufficiency
Symmetrical distal paresthesias, burning, and numbness that worsen at night are classic
symptoms of chronic sensorimotor diabetic peripheral neuropathy caused by metabolic nerve
damage.
4. A nurse is reviewing discharge instructions for a client diagnosed with chronic kidney
disease (CKD) stage 4. Which dietary modification should the nurse emphasize?
A. Increase intake of dark leafy green vegetables and citrus fruits
B. Restrict dietary intake of sodium, potassium, and phosphorus
C. Maintain a high-protein diet to prevent muscle wasting from uremia
D. Supplement daily fluid intake to at least 3,000 mL to flush the kidneys
As glomerular filtration rate declines, the kidneys cannot excrete sodium, potassium, and
phosphorus, requiring dietary restrictions to prevent dangerous systemic complications.
5. A client with rheumatoid arthritis reports morning joint stiffness lasting over an hour,
symmetrical swelling in the hands, and fatigue. Which diagnostic lab value is most specific
to confirming this diagnosis?
A. Elevated erythrocyte sedimentation rate
B. Positive antinuclear antibody titer
C. Elevated rheumatoid factor and anti-CCP antibodies
D. Decreased serum uric acid levels
Anti-cyclic citrullinated peptide (anti-CCP) antibodies and rheumatoid factor are key
serological markers used to diagnose and assess rheumatoid arthritis.
6. A nurse is assessing a client with long-standing systemic lupus erythematosus (SLE) who
reports extreme fatigue, joint pain, and facial erythema. Which laboratory finding
warrants immediate follow-up by the nurse?
A. Mild microcytic anemia
,B. Elevated serum creatinine and proteinuria
C. Increased erythrocyte sedimentation rate
D. Positive antinuclear antibody screening
Lupus nephritis is a serious and potentially life-threatening complication of SLE; elevated
creatinine and proteinuria indicate renal involvement requiring prompt medical intervention.
7. A client with Parkinson disease is prescribed levodopa-carbidopa. Which finding
indicates the medication is achieving its therapeutic goal?
A. Cessation of disease progression and complete nerve regeneration
B. Reduction in resting tremors, rigidity, and bradykinesia
C. Stabilization of cognitive decline and prevention of dementia
D. Normalization of dopamine levels within the substantia nigra
Levodopa-carbidopa replenishes central dopamine to help control the cardinal motor
symptoms of Parkinson disease, though it does not cure or halt underlying neurodegeneration.
8. A nurse is providing education to a client diagnosed with gastroesophageal reflux disease
(GERD). Which client statement indicates a correct understanding of lifestyle
modifications?
A. I will eat my largest meal right before lying down to ensure adequate caloric intake
B. I should sleep with the head of my bed elevated using blocks or a wedge pillow
C. I can drink peppermint tea every evening to help soothe my stomach lining
D. I will increase my consumption of citrus juices and tomato-based products
Elevating the head of the bed utilizes gravity to prevent gastric acid reflux into the esophagus
during sleep. Peppermint, citrus, and large meals before lying down worsen GERD.
9. A client with chronic stable angina is prescribed sublingual nitroglycerin tablets. Which
instruction should the nurse include when teaching the client about proper administration?
A. Swallow the tablet whole with a full glass of water at the onset of chest pain
B. Place one tablet under the tongue and allow it to dissolve; repeat every 5 minutes for up
to three doses if pain persists
, C. Store the medication in a clear plastic container in the kitchen cabinet for easy access
D. Discard the medication bottle if it causes a stinging or burning sensation under the tongue
Rationale: Sublingual nitroglycerin must dissolve under the tongue for rapid systemic
absorption. A tingling sensation indicates the medication is potent and active. It should be
stored in a dark, airtight glass container.
10. A nurse is caring for a client with cirrhosis who has developed portal hypertension.
Which clinical manifestation is a direct consequence of this condition?
A. Esophageal varices and splenomegaly
B. Elevated serum bilirubin and jaundice
C. Decreased production of clotting factors
D. Elevated serum ammonia and hepatic encephalopathy
Portal hypertension increases resistance to blood flow through the liver, forcing blood into
collateral channels such as esophageal veins and causing backup into the spleen.
11. A client with chronic kidney disease is prescribed oral calcium acetate with meals.
What is the primary therapeutic purpose of this medication?
A. To prevent metabolic acidosis by acting as a systemic buffer
B. To bind dietary phosphorus in the gastrointestinal tract and excrete it in the stool
C. To stimulate the bone marrow to produce red blood cells and treat anemia
D. To lower systemic blood pressure by inducing peripheral vasodilation
In CKD, impaired phosphorus excretion leads to hyperphosphatemia. Calcium-based binders
combine with dietary phosphorus in the gut to prevent its absorption.
12. A nurse is assessing a client with advanced cirrhosis who appears confused, is
disoriented to time and place, and exhibits flapping tremors of the hands when extended.
How should the nurse document these findings?
A. Asterixis secondary to hepatic encephalopathy
B. Akinesia related to parkinsonian side effects
C. Peripheral neuropathy caused by vitamin B deficiency
