Page |1
Question practice test covering Exams 1-4 and the Final Exam, with NCLEX-
style Questions and Detailed Rationales! NUR 257 Chronic Care Nursing –
Complete Practice Test (2026) Actual Questions and Answers | 2026 Update |
100% Correct Galen.
Instructions: Detailed rationales are provided to reinforce clinical reasoning for
chronic care in the older adult population.
DOMAIN 1: Diabetes Mellitus Management in Older Adults (Based on your
Study Guide)
1. The nurse is teaching a 75-year-old client who has diabetes mellitus about
nutrition therapy when taking antidiabetic drugs. Which of the following client
statements indicates a need for further teaching?
A) "I will eat the same amount and quality of food every day."
B) "Eating meals and snacks at the same time every day is important."
C) "I should stick to the food allowed on my diet except for special occasions."
D) "I will consult with a dietitian for meal planning and preparation."
Answer: C
Rationale: As highlighted in your screenshot, special occasions are the #1 reason
patients deviate from their meal plans, leading to hyperglycemia. The nurse should
teach the patient how to adjust their diet or medication for special occasions, not
simply "stick to it" blindly. Options A, B, and D are correct statements for diabetic
management.
2. The home health nurse is caring for an 85-year-old client who is newly
diagnosed with diabetes mellitus (type 2) and has been prescribed metformin.
The client still has questions regarding diet and exercise. Which of the following
actions by the nurse is the priority?
A) Contact the PCP regarding the most recent orders.
B) Perform assessment and answer all client questions.
, Page |2
C) Perform assessment and document all findings.
D) Contact the dietitian and PT regarding orders.
Answer: A
Rationale: According to your screenshot, this is the correct answer. The priority is
to Contact the PCP regarding the most recent orders. A newly diagnosed 85-year-
old on metformin with questions about diet/exercise needs a clear, coordinated
plan. The nurse must clarify the specific orders with the PCP before delegating or
providing education to ensure safety.
3. The nurse is providing care for an older adult client who is suspected of having
diabetes mellitus (type 2). The nurse is aware that which of the following is
often the cause of a delayed diagnosis in the older adult population?
A) There are usually few, if any, symptoms until severe organ damage has been
done.
B) Older adults tend to avoid complaining of not feeling well due to fear of the
unknown.
C) The PCP hesitates to make the diagnosis to preserve quality of life.
D) The symptoms come on so quickly that other body systems are focused on first.
Answer: A
Rationale: Classic symptoms of diabetes (polyuria, polydipsia, polyphagia) are
often absent or blunted in older adults due to a decreased thirst mechanism and
age-related changes in renal glucose threshold. By the time symptoms do appear
(e.g., fatigue, vision changes, neuropathy), significant organ damage has often
already occurred.
4. A 78-year-old patient with type 2 diabetes is prescribed metformin. The nurse
should include which of the following in the patient teaching?
A) "Take this medication on an empty stomach for best absorption."
B) "This medication may cause gastrointestinal upset, so take it with meals."
C) "You will need to check your blood sugar 4 times a day while on this
medication."
D) "Metformin can cause weight gain."
, Page |3
Answer: B
Rationale: Metformin commonly causes GI side effects (nausea, diarrhea).
Administering it with meals significantly reduces these side effects. Metformin
does not typically cause hypoglycemia or weight gain; it is weight-neutral.
5. The nurse is assessing an 82-year-old patient with diabetes for signs of
hypoglycemia. Which of the following findings is most indicative of
hypoglycemia in an older adult?
A) Polyuria and polydipsia
B) Confusion, lethargy, and diaphoresis
C) Fruity breath odor and Kussmaul respirations
D) Bradycardia and hypotension
Answer: B
Rationale: Older adults often present with neuroglycopenic symptoms (confusion,
lethargy, dizziness, weakness) during hypoglycemia rather than the classic
adrenergic symptoms (tachycardia, tremors) seen in younger adults. The nurse
must be vigilant for changes in mental status as a key sign.
6. A home health nurse is assessing the feet of an 80-year-old patient with
diabetes. Which of the following findings requires immediate intervention?
A) A callus on the heel of the foot
B) A small, painless, open ulcer on the plantar surface of the foot
C) Dry, cracked skin on the soles of the feet
D) Thickened toenails
Answer: B
Rationale: A painless ulcer is a hallmark of diabetic neuropathy. Because the
patient cannot feel the injury, it often goes unnoticed until it becomes severely
infected. This requires immediate referral to a wound care specialist or podiatrist.
7. The nurse is teaching an older adult with diabetes about foot care. Which of
the following statements by the patient indicates a need for further teaching?
A) "I will inspect my feet daily with a mirror."
B) "I will soak my feet in warm water every night to soften the calluses."
Question practice test covering Exams 1-4 and the Final Exam, with NCLEX-
style Questions and Detailed Rationales! NUR 257 Chronic Care Nursing –
Complete Practice Test (2026) Actual Questions and Answers | 2026 Update |
100% Correct Galen.
Instructions: Detailed rationales are provided to reinforce clinical reasoning for
chronic care in the older adult population.
DOMAIN 1: Diabetes Mellitus Management in Older Adults (Based on your
Study Guide)
1. The nurse is teaching a 75-year-old client who has diabetes mellitus about
nutrition therapy when taking antidiabetic drugs. Which of the following client
statements indicates a need for further teaching?
A) "I will eat the same amount and quality of food every day."
B) "Eating meals and snacks at the same time every day is important."
C) "I should stick to the food allowed on my diet except for special occasions."
D) "I will consult with a dietitian for meal planning and preparation."
Answer: C
Rationale: As highlighted in your screenshot, special occasions are the #1 reason
patients deviate from their meal plans, leading to hyperglycemia. The nurse should
teach the patient how to adjust their diet or medication for special occasions, not
simply "stick to it" blindly. Options A, B, and D are correct statements for diabetic
management.
2. The home health nurse is caring for an 85-year-old client who is newly
diagnosed with diabetes mellitus (type 2) and has been prescribed metformin.
The client still has questions regarding diet and exercise. Which of the following
actions by the nurse is the priority?
A) Contact the PCP regarding the most recent orders.
B) Perform assessment and answer all client questions.
, Page |2
C) Perform assessment and document all findings.
D) Contact the dietitian and PT regarding orders.
Answer: A
Rationale: According to your screenshot, this is the correct answer. The priority is
to Contact the PCP regarding the most recent orders. A newly diagnosed 85-year-
old on metformin with questions about diet/exercise needs a clear, coordinated
plan. The nurse must clarify the specific orders with the PCP before delegating or
providing education to ensure safety.
3. The nurse is providing care for an older adult client who is suspected of having
diabetes mellitus (type 2). The nurse is aware that which of the following is
often the cause of a delayed diagnosis in the older adult population?
A) There are usually few, if any, symptoms until severe organ damage has been
done.
B) Older adults tend to avoid complaining of not feeling well due to fear of the
unknown.
C) The PCP hesitates to make the diagnosis to preserve quality of life.
D) The symptoms come on so quickly that other body systems are focused on first.
Answer: A
Rationale: Classic symptoms of diabetes (polyuria, polydipsia, polyphagia) are
often absent or blunted in older adults due to a decreased thirst mechanism and
age-related changes in renal glucose threshold. By the time symptoms do appear
(e.g., fatigue, vision changes, neuropathy), significant organ damage has often
already occurred.
4. A 78-year-old patient with type 2 diabetes is prescribed metformin. The nurse
should include which of the following in the patient teaching?
A) "Take this medication on an empty stomach for best absorption."
B) "This medication may cause gastrointestinal upset, so take it with meals."
C) "You will need to check your blood sugar 4 times a day while on this
medication."
D) "Metformin can cause weight gain."
, Page |3
Answer: B
Rationale: Metformin commonly causes GI side effects (nausea, diarrhea).
Administering it with meals significantly reduces these side effects. Metformin
does not typically cause hypoglycemia or weight gain; it is weight-neutral.
5. The nurse is assessing an 82-year-old patient with diabetes for signs of
hypoglycemia. Which of the following findings is most indicative of
hypoglycemia in an older adult?
A) Polyuria and polydipsia
B) Confusion, lethargy, and diaphoresis
C) Fruity breath odor and Kussmaul respirations
D) Bradycardia and hypotension
Answer: B
Rationale: Older adults often present with neuroglycopenic symptoms (confusion,
lethargy, dizziness, weakness) during hypoglycemia rather than the classic
adrenergic symptoms (tachycardia, tremors) seen in younger adults. The nurse
must be vigilant for changes in mental status as a key sign.
6. A home health nurse is assessing the feet of an 80-year-old patient with
diabetes. Which of the following findings requires immediate intervention?
A) A callus on the heel of the foot
B) A small, painless, open ulcer on the plantar surface of the foot
C) Dry, cracked skin on the soles of the feet
D) Thickened toenails
Answer: B
Rationale: A painless ulcer is a hallmark of diabetic neuropathy. Because the
patient cannot feel the injury, it often goes unnoticed until it becomes severely
infected. This requires immediate referral to a wound care specialist or podiatrist.
7. The nurse is teaching an older adult with diabetes about foot care. Which of
the following statements by the patient indicates a need for further teaching?
A) "I will inspect my feet daily with a mirror."
B) "I will soak my feet in warm water every night to soften the calluses."
