NUR 257 CHRONIC HEALTH EXAM
QUESTIONS AND ANSWERS
1. A patient with Stage 4 Chronic Kidney Disease (CKD) has a potassium level of 6.8 mEq/L.
Which provider order should the nurse implement first?
A. Initiate a continuous infusion of regular insulin and D50W
B. Administer oral sodium polystyrene sulfonate (Kayexalate)
C. Prepare the patient for an emergent hemodialysis session
D. Educate the patient on a low-potassium diet
Answer: A
Conceptual Explanation: In severe hyperkalemia, intravenous insulin and glucose are the
fastest way to shift potassium into the cells to prevent cardiac arrest. Hemodialysis and
Kayexalate take longer to lower serum levels.
2. Which assessment finding is most characteristic of a patient experiencing left-sided heart
failure?
A. Jugular venous distension and peripheral edema
B. Crackles in the lung bases and orthopnea
C. Hepatomegaly and abdominal ascites
,D. Splenomegaly and anorexia
Answer: B
Conceptual Explanation: Left-sided heart failure leads to pulmonary congestion,
manifesting as crackles, dyspnea, and orthopnea. Right-sided failure leads to systemic
venous congestion.
3. A patient with Type 2 Diabetes is prescribed Metformin. Which diagnostic test result would
require the nurse to hold the medication and notify the provider?
A. Serum creatinine of 1.8 mg/dL
B. Hemoglobin A1c of 7.2%
C. Fast blood glucose of 140 mg/dL
D. Body Mass Index of 28
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with renal impairment
(creatinine > 1.5 in men or 1.4 in women) due to the risk of lactic acidosis.
4. When teaching a patient with COPD about ‘pursed-lip breathing,’ what is the primary
physiological benefit the nurse should explain?
A. It increases the respiratory rate to clear CO2
B. It strengthens the diaphragm and intercostal muscles
C. It prevents airway collapse by maintaining positive airway pressure
, D. It decreases the fraction of inspired oxygen needed
Answer: C
Conceptual Explanation: Pursed-lip breathing keeps the airways open longer by creating
back pressure, which helps the patient exhale more trapped air (CO2).
5. A patient is diagnosed with Myasthenia Gravis. Which medication should the nurse have
readily available to reverse a cholinergic crisis?
A. Neostigmine
B. Atropine sulfate
C. Pyridostigmine
D. Edrophonium
Answer: B
Conceptual Explanation: Atropine is the antidote for a cholinergic crisis, which is caused
by an overdose of acetylcholinesterase inhibitors.
6. Which laboratory value is most indicative of the efficacy of antiretroviral therapy (ART) in a
patient with HIV?
A. Undetectable viral load
B. CD4+ T-cell count of 350 cells/uL
C. Positive Western Blot test
D. Increased White Blood Cell count
QUESTIONS AND ANSWERS
1. A patient with Stage 4 Chronic Kidney Disease (CKD) has a potassium level of 6.8 mEq/L.
Which provider order should the nurse implement first?
A. Initiate a continuous infusion of regular insulin and D50W
B. Administer oral sodium polystyrene sulfonate (Kayexalate)
C. Prepare the patient for an emergent hemodialysis session
D. Educate the patient on a low-potassium diet
Answer: A
Conceptual Explanation: In severe hyperkalemia, intravenous insulin and glucose are the
fastest way to shift potassium into the cells to prevent cardiac arrest. Hemodialysis and
Kayexalate take longer to lower serum levels.
2. Which assessment finding is most characteristic of a patient experiencing left-sided heart
failure?
A. Jugular venous distension and peripheral edema
B. Crackles in the lung bases and orthopnea
C. Hepatomegaly and abdominal ascites
,D. Splenomegaly and anorexia
Answer: B
Conceptual Explanation: Left-sided heart failure leads to pulmonary congestion,
manifesting as crackles, dyspnea, and orthopnea. Right-sided failure leads to systemic
venous congestion.
3. A patient with Type 2 Diabetes is prescribed Metformin. Which diagnostic test result would
require the nurse to hold the medication and notify the provider?
A. Serum creatinine of 1.8 mg/dL
B. Hemoglobin A1c of 7.2%
C. Fast blood glucose of 140 mg/dL
D. Body Mass Index of 28
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with renal impairment
(creatinine > 1.5 in men or 1.4 in women) due to the risk of lactic acidosis.
4. When teaching a patient with COPD about ‘pursed-lip breathing,’ what is the primary
physiological benefit the nurse should explain?
A. It increases the respiratory rate to clear CO2
B. It strengthens the diaphragm and intercostal muscles
C. It prevents airway collapse by maintaining positive airway pressure
, D. It decreases the fraction of inspired oxygen needed
Answer: C
Conceptual Explanation: Pursed-lip breathing keeps the airways open longer by creating
back pressure, which helps the patient exhale more trapped air (CO2).
5. A patient is diagnosed with Myasthenia Gravis. Which medication should the nurse have
readily available to reverse a cholinergic crisis?
A. Neostigmine
B. Atropine sulfate
C. Pyridostigmine
D. Edrophonium
Answer: B
Conceptual Explanation: Atropine is the antidote for a cholinergic crisis, which is caused
by an overdose of acetylcholinesterase inhibitors.
6. Which laboratory value is most indicative of the efficacy of antiretroviral therapy (ART) in a
patient with HIV?
A. Undetectable viral load
B. CD4+ T-cell count of 350 cells/uL
C. Positive Western Blot test
D. Increased White Blood Cell count
