NUR 257 CHRONIC HEALTH NURSING
EXAM QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is experiencing respiratory
acidosis. Which arterial blood gas (ABG) result is consistent with compensated respiratory
acidosis?
A. pH 7.36, PaCO2 58 mmHg, HCO3 33 mEq/L
B. pH 7.32, PaCO2 55 mmHg, HCO3 24 mEq/L
C. pH 7.48, PaCO2 30 mmHg, HCO3 20 mEq/L
D. pH 7.25, PaCO2 40 mmHg, HCO3 18 mEq/L
Answer: A
Conceptual Explanation: Compensated respiratory acidosis is characterized by a pH
within the normal range (but on the acidic side), an elevated PaCO2, and an elevated HCO3
as the kidneys retain bicarbonate to buffer the acid.
2. Which clinical manifestation is most indicative of right-sided heart failure rather than left-
sided heart failure?
A. Orthopnea
,B. Crackles in lung bases
C. Dyspnea on exertion
D. Jugular venous distension (JVD)
Answer: D
Conceptual Explanation: Right-sided heart failure causes systemic venous congestion,
leading to JVD, peripheral edema, and hepatomegaly. Left-sided failure leads to pulmonary
congestion (crackles, orthopnea).
3. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse prioritize to protect the heart from arrhythmias?
A. Calcium Gluconate
B. Sodium Polystyrene Sulfonate (Kayexalate)
C. Regular Insulin and D50W
D. Furosemide (Lasix)
Answer: A
Conceptual Explanation: While others help lower potassium, Calcium Gluconate is the
priority to stabilize the myocardial cell membrane and prevent life-threatening
arrhythmias in severe hyperkalemia.
, 4. In managing a patient with Type 2 Diabetes, which HbA1c level indicates that the patient’s
glycemic control has been effective over the past 3 months according to ADA standards?
A. Exactly 6.5%
B. Between 8.0% and 9.0%
C. Less than 7.0%
D. Less than 5.5%
Answer: C
Conceptual Explanation: The American Diabetes Association (ADA) generally
recommends an HbA1c goal of less than 7.0% for most non-pregnant adults with diabetes.
5. A patient taking Lisinopril for chronic hypertension develops a dry, persistent cough. What
is the most likely physiological cause?
A. Bronchospasm from beta-blockade
B. Allergic reaction to the sulfate component
C. Pulmonary edema from heart failure
D. Accumulation of bradykinin
Answer: D
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin, which can
accumulate in the lungs and cause a persistent dry cough in some patients.
EXAM QUESTIONS AND ANSWERS
1. A patient with chronic obstructive pulmonary disease (COPD) is experiencing respiratory
acidosis. Which arterial blood gas (ABG) result is consistent with compensated respiratory
acidosis?
A. pH 7.36, PaCO2 58 mmHg, HCO3 33 mEq/L
B. pH 7.32, PaCO2 55 mmHg, HCO3 24 mEq/L
C. pH 7.48, PaCO2 30 mmHg, HCO3 20 mEq/L
D. pH 7.25, PaCO2 40 mmHg, HCO3 18 mEq/L
Answer: A
Conceptual Explanation: Compensated respiratory acidosis is characterized by a pH
within the normal range (but on the acidic side), an elevated PaCO2, and an elevated HCO3
as the kidneys retain bicarbonate to buffer the acid.
2. Which clinical manifestation is most indicative of right-sided heart failure rather than left-
sided heart failure?
A. Orthopnea
,B. Crackles in lung bases
C. Dyspnea on exertion
D. Jugular venous distension (JVD)
Answer: D
Conceptual Explanation: Right-sided heart failure causes systemic venous congestion,
leading to JVD, peripheral edema, and hepatomegaly. Left-sided failure leads to pulmonary
congestion (crackles, orthopnea).
3. A patient with Chronic Kidney Disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which medication should the nurse prioritize to protect the heart from arrhythmias?
A. Calcium Gluconate
B. Sodium Polystyrene Sulfonate (Kayexalate)
C. Regular Insulin and D50W
D. Furosemide (Lasix)
Answer: A
Conceptual Explanation: While others help lower potassium, Calcium Gluconate is the
priority to stabilize the myocardial cell membrane and prevent life-threatening
arrhythmias in severe hyperkalemia.
, 4. In managing a patient with Type 2 Diabetes, which HbA1c level indicates that the patient’s
glycemic control has been effective over the past 3 months according to ADA standards?
A. Exactly 6.5%
B. Between 8.0% and 9.0%
C. Less than 7.0%
D. Less than 5.5%
Answer: C
Conceptual Explanation: The American Diabetes Association (ADA) generally
recommends an HbA1c goal of less than 7.0% for most non-pregnant adults with diabetes.
5. A patient taking Lisinopril for chronic hypertension develops a dry, persistent cough. What
is the most likely physiological cause?
A. Bronchospasm from beta-blockade
B. Allergic reaction to the sulfate component
C. Pulmonary edema from heart failure
D. Accumulation of bradykinin
Answer: D
Conceptual Explanation: ACE inhibitors prevent the breakdown of bradykinin, which can
accumulate in the lungs and cause a persistent dry cough in some patients.
