NUR 257 CHRONIC HEALTH EXAM
QUESTIONS AND ANSWERS
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a potassium level of 6.2
mEq/L. Which medication should the nurse expect to administer as a priority to stabilize the
cardiac membrane?
A. Sodium polystyrene sulfonate
B. Regular insulin and D50W
C. Calcium gluconate
D. Furosemide
Answer: C
Conceptual Explanation: While other treatments lower potassium levels, calcium
gluconate is the priority to stabilize the myocardium and prevent life-threatening
arrhythmias in the presence of severe hyperkalemia.
2. In a patient with Chronic Obstructive Pulmonary Disease (COPD), the nurse recognizes that
the primary stimulus for breathing is often changed. What is this phenomenon called?
A. Hypercapnic drive
,B. Diffusion limitation
C. Ventilation-perfusion mismatch
D. Hypoxic drive
Answer: D
Conceptual Explanation: In chronic hypercapnia, the central chemoreceptors become
desensitized to CO2, making low oxygen levels (hypoxia) the primary stimulus for
breathing.
3. A client with Type 2 Diabetes is being educated on the ‘Somogyi effect.’ Which statement
by the client indicates an understanding of this phenomenon?
A. ‘My blood sugar drops too low at night, causing my body to release hormones that raise
it by morning.’
B. ‘I should increase my nighttime insulin dose to prevent morning hyperglycemia.’
C. ‘This happens because I am eating too many carbohydrates before bed.’
D. ‘It is a result of the natural release of growth hormone in the early morning hours.’
Answer: A
Conceptual Explanation: The Somogyi effect is rebound hyperglycemia following a period
of untreated hypoglycemia during the night.
4. Which assessment finding is most characteristic of right-sided heart failure?
A. Pulmonary crackles
, B. Paroxysmal nocturnal dyspnea
C. Jugular venous distension (JVD)
D. Frothy pink sputum
Answer: C
Conceptual Explanation: Right-sided heart failure leads to systemic venous congestion,
manifesting as JVD, peripheral edema, and hepatomegaly.
5. A patient taking Lisinopril for chronic hypertension develops a dry, non-productive cough.
What is the physiological mechanism behind this side effect?
A. Accumulation of bradykinin in the lungs
B. Bronchoconstriction from beta-blockade
C. Pulmonary edema from fluid overload
D. Inhibition of surfactant production
Answer: A
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin, which can
accumulate in the respiratory tract and cause a persistent dry cough.
6. Which lab value should the nurse monitor most closely for a patient receiving long-term
Methotrexate for Rheumatoid Arthritis?
A. Serum calcium
B. Thyroid stimulating hormone
QUESTIONS AND ANSWERS
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a potassium level of 6.2
mEq/L. Which medication should the nurse expect to administer as a priority to stabilize the
cardiac membrane?
A. Sodium polystyrene sulfonate
B. Regular insulin and D50W
C. Calcium gluconate
D. Furosemide
Answer: C
Conceptual Explanation: While other treatments lower potassium levels, calcium
gluconate is the priority to stabilize the myocardium and prevent life-threatening
arrhythmias in the presence of severe hyperkalemia.
2. In a patient with Chronic Obstructive Pulmonary Disease (COPD), the nurse recognizes that
the primary stimulus for breathing is often changed. What is this phenomenon called?
A. Hypercapnic drive
,B. Diffusion limitation
C. Ventilation-perfusion mismatch
D. Hypoxic drive
Answer: D
Conceptual Explanation: In chronic hypercapnia, the central chemoreceptors become
desensitized to CO2, making low oxygen levels (hypoxia) the primary stimulus for
breathing.
3. A client with Type 2 Diabetes is being educated on the ‘Somogyi effect.’ Which statement
by the client indicates an understanding of this phenomenon?
A. ‘My blood sugar drops too low at night, causing my body to release hormones that raise
it by morning.’
B. ‘I should increase my nighttime insulin dose to prevent morning hyperglycemia.’
C. ‘This happens because I am eating too many carbohydrates before bed.’
D. ‘It is a result of the natural release of growth hormone in the early morning hours.’
Answer: A
Conceptual Explanation: The Somogyi effect is rebound hyperglycemia following a period
of untreated hypoglycemia during the night.
4. Which assessment finding is most characteristic of right-sided heart failure?
A. Pulmonary crackles
, B. Paroxysmal nocturnal dyspnea
C. Jugular venous distension (JVD)
D. Frothy pink sputum
Answer: C
Conceptual Explanation: Right-sided heart failure leads to systemic venous congestion,
manifesting as JVD, peripheral edema, and hepatomegaly.
5. A patient taking Lisinopril for chronic hypertension develops a dry, non-productive cough.
What is the physiological mechanism behind this side effect?
A. Accumulation of bradykinin in the lungs
B. Bronchoconstriction from beta-blockade
C. Pulmonary edema from fluid overload
D. Inhibition of surfactant production
Answer: A
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin, which can
accumulate in the respiratory tract and cause a persistent dry cough.
6. Which lab value should the nurse monitor most closely for a patient receiving long-term
Methotrexate for Rheumatoid Arthritis?
A. Serum calcium
B. Thyroid stimulating hormone
