NUR 257 CHRONIC EXAM 2 -
ADVANCED NURSING CONCEPTS
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a potassium level of 6.8
mEq/L. Which of the following is the priority nursing intervention?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Educate the patient on the importance of adhering to dialysis schedules
C. Restrict dietary intake of high-potassium foods like bananas
D. Place the patient on a cardiac monitor and prepare for IV calcium gluconate
Answer: D
Conceptual Explanation: A potassium level of 6.8 mEq/L is a medical emergency that can
lead to lethal arrhythmias. Placing the patient on a cardiac monitor is the priority, and IV
,calcium gluconate is administered to stabilize the myocardium while other measures lower
potassium levels.
2. A client with COPD is being discharged. Which statement by the client indicates a need for
further teaching regarding oxygen therapy?
A. ‘I will use my oxygen when I feel short of breath during activity.’
B. ‘I can use petroleum jelly to soothe my dry nostrils caused by the nasal cannula.’
C. ‘I should maintain my oxygen flow rate at exactly what the doctor prescribed.’
D. ‘I will avoid being near open flames while my oxygen is in use.’
Answer: B
Conceptual Explanation: Petroleum-based products are flammable and should not be
used with oxygen therapy. Water-soluble lubricants should be used instead to treat
mucosal dryness.
3. Which clinical manifestation is specifically indicative of Left-Sided Heart Failure rather than
Right-Sided Heart Failure?
A. Jugular venous distention (JVD)
B. Peripheral edema in the lower extremities
C. Paroxysmal nocturnal dyspnea (PND)
D. Hepatosplenomegaly and ascites
Answer: C
, Conceptual Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to respiratory symptoms like PND, crackles, and orthopnea.
The other options are signs of systemic congestion related to right-sided failure.
4. A patient with Type 2 Diabetes is scheduled for a CT scan with IV contrast. Which
medication must be held for 48 hours after the procedure to prevent lactic acidosis?
A. Metformin
B. Glipizide
C. Pioglitazone
D. Sitagliptin
Answer: A
Conceptual Explanation: Metformin must be held before and for 48 hours after IV
contrast because both the drug and the contrast are cleared by the kidneys; combined, they
increase the risk of acute renal failure and lactic acidosis.
5. A patient with Multiple Sclerosis (MS) reports severe fatigue that interferes with daily
activities. Which intervention should the nurse recommend?
A. Perform all household chores in the morning to finish early
B. Take hot showers to relax the muscles and improve energy
C. Schedule frequent rest periods and prioritize high-energy tasks
D. Engage in high-intensity aerobic exercise to build stamina
ADVANCED NURSING CONCEPTS
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE
1. A patient with Stage 4 Chronic Kidney Disease (CKD) presents with a potassium level of 6.8
mEq/L. Which of the following is the priority nursing intervention?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Educate the patient on the importance of adhering to dialysis schedules
C. Restrict dietary intake of high-potassium foods like bananas
D. Place the patient on a cardiac monitor and prepare for IV calcium gluconate
Answer: D
Conceptual Explanation: A potassium level of 6.8 mEq/L is a medical emergency that can
lead to lethal arrhythmias. Placing the patient on a cardiac monitor is the priority, and IV
,calcium gluconate is administered to stabilize the myocardium while other measures lower
potassium levels.
2. A client with COPD is being discharged. Which statement by the client indicates a need for
further teaching regarding oxygen therapy?
A. ‘I will use my oxygen when I feel short of breath during activity.’
B. ‘I can use petroleum jelly to soothe my dry nostrils caused by the nasal cannula.’
C. ‘I should maintain my oxygen flow rate at exactly what the doctor prescribed.’
D. ‘I will avoid being near open flames while my oxygen is in use.’
Answer: B
Conceptual Explanation: Petroleum-based products are flammable and should not be
used with oxygen therapy. Water-soluble lubricants should be used instead to treat
mucosal dryness.
3. Which clinical manifestation is specifically indicative of Left-Sided Heart Failure rather than
Right-Sided Heart Failure?
A. Jugular venous distention (JVD)
B. Peripheral edema in the lower extremities
C. Paroxysmal nocturnal dyspnea (PND)
D. Hepatosplenomegaly and ascites
Answer: C
, Conceptual Explanation: Left-sided heart failure causes blood to back up into the
pulmonary circulation, leading to respiratory symptoms like PND, crackles, and orthopnea.
The other options are signs of systemic congestion related to right-sided failure.
4. A patient with Type 2 Diabetes is scheduled for a CT scan with IV contrast. Which
medication must be held for 48 hours after the procedure to prevent lactic acidosis?
A. Metformin
B. Glipizide
C. Pioglitazone
D. Sitagliptin
Answer: A
Conceptual Explanation: Metformin must be held before and for 48 hours after IV
contrast because both the drug and the contrast are cleared by the kidneys; combined, they
increase the risk of acute renal failure and lactic acidosis.
5. A patient with Multiple Sclerosis (MS) reports severe fatigue that interferes with daily
activities. Which intervention should the nurse recommend?
A. Perform all household chores in the morning to finish early
B. Take hot showers to relax the muscles and improve energy
C. Schedule frequent rest periods and prioritize high-energy tasks
D. Engage in high-intensity aerobic exercise to build stamina
