NUR 257 CHRONIC ILLNESS EXAM PREP
ULTIMATE TEST BANK WITH CORRECT
ANSWERS & DETAILED RATIONALES
Master your advanced nursing curriculum with this premium,
comprehensive test bank featuring detailed multiple-choice
questions, accurate answer keys, and fully explained
rationales. Tailored precisely to the rigorous standards of the
NUR 257 curriculum, this study guide reinforces critical
clinical judgment for complex respiratory, renal, cardiac, and
metabolic conditions. It serves as an exceptional resource
for mastering course exams and preparing effectively for the
application-level style of the NCLEX-RN.
Question 1
A nurse is assessing a client with a history of Chronic
Obstructive Pulmonary Disease (COPD) who is experiencing
worsening dyspnea. The client’s oxygen saturation is 88% on
room air. Which oxygen delivery setting should the nurse initiate
first?
• A) Simple face mask at 8 L/min
• B) Nasal cannula at 2 L/min
• C) Non-rebreather mask at 15 L/min
• D) Venturi mask at 40%
,Answer: B
Rationale: Clients with COPD often rely on a hypoxic drive to
breathe, meaning low oxygen levels stimulate their
respiratory center rather than high carbon dioxide levels.
High-flow or high-concentration oxygen can suppress this
drive, leading to respiratory depression. Initial oxygen
therapy should be low-flow (e.g., nasal cannula at 1–2 L/min)
to maintain an oxygen saturation between 88% and 92%
without causing hypercapnia.
Question 2
A client with Type 2 Diabetes Mellitus presents to the clinic for a
routine checkup. The nurse reviews the laboratory results and
notes a Glycated Hemoglobin (HbA1c) level of 8.4%. Which
interpretation by the nurse is correct?
• A) The client’s blood glucose levels have been well
controlled over the past 3 months.
• B) The client has been fasting appropriately prior to the
laboratory draw.
• C) The client’s blood glucose levels have been elevated over
the past 90 days.
• D) The client is experiencing an acute episode of
hypoglycemia.
Answer: C
Rationale: The HbA1c test measures the average blood
glucose control over the previous 2 to 3 months
(approximately 90 to 120 days). A normal level for a non-
,diabetic is below 5.7%, and the target level for most adults
with diabetes is below 7%. A level of 8.4% indicates
persistent hyperglycemia and poor long-term glycemic
control, signaling a need to review the treatment plan,
medication adherence, or dietary habits.
Question 3
The nurse is providing discharge education to a client newly
diagnosed with Chronic Heart Failure (HF). Which statement by
the client indicates a need for further teaching?
• A) "I will weigh myself every morning before breakfast and
after voiding."
• B) "I will limit my sodium intake to less than 2,000 milligrams
per day."
• C) "I will take my prescribed diuretic right before I go to bed
at night."
• D) "I will report a weight gain of 3 pounds in a single day to
my doctor."
Answer: C
Rationale: Diuretics (such as furosemide) should be taken in
the morning or early afternoon to prevent nocturia, which
disrupts sleep and reduces the client's quality of life. Daily
weights are essential for monitoring fluid retention, and a
weight gain of 2–3 pounds in a day or 5 pounds in a week
must be reported. Sodium restriction is a standard
intervention to prevent fluid overload.
, Question 4
A client with Chronic Kidney Disease (CKD) Stage 4 is
prescribed Epoetin alfa. Which laboratory parameter must the
nurse monitor closely to evaluate the therapeutic effectiveness of
this medication?
• A) Serum potassium
• B) Blood urea nitrogen (BUN)
• C) Hemoglobin and hematocrit
• D) Glomerular filtration rate (GFR)
Answer: C
Rationale: Epoetin alfa is a synthetic form of erythropoietin, a
hormone normally produced by the kidneys that stimulates
the bone marrow to produce red blood cells. In Stage 4 CKD,
erythropoietin production is severely diminished, leading to
chronic anemia. The medication is effective if hemoglobin
and hematocrit levels rise into the target therapeutic range. It
does not directly affect potassium, BUN, or GFR.
Question 5
During an assessment of a client with Rheumatoid Arthritis
(RA), the nurse notes bilateral joint swelling, warmth, and severe
morning stiffness lasting longer than 1 hour. Which
pathophysiology explains these clinical manifestations?
• A) Mechanical wear and tear of the articular cartilage over
time.
ULTIMATE TEST BANK WITH CORRECT
ANSWERS & DETAILED RATIONALES
Master your advanced nursing curriculum with this premium,
comprehensive test bank featuring detailed multiple-choice
questions, accurate answer keys, and fully explained
rationales. Tailored precisely to the rigorous standards of the
NUR 257 curriculum, this study guide reinforces critical
clinical judgment for complex respiratory, renal, cardiac, and
metabolic conditions. It serves as an exceptional resource
for mastering course exams and preparing effectively for the
application-level style of the NCLEX-RN.
Question 1
A nurse is assessing a client with a history of Chronic
Obstructive Pulmonary Disease (COPD) who is experiencing
worsening dyspnea. The client’s oxygen saturation is 88% on
room air. Which oxygen delivery setting should the nurse initiate
first?
• A) Simple face mask at 8 L/min
• B) Nasal cannula at 2 L/min
• C) Non-rebreather mask at 15 L/min
• D) Venturi mask at 40%
,Answer: B
Rationale: Clients with COPD often rely on a hypoxic drive to
breathe, meaning low oxygen levels stimulate their
respiratory center rather than high carbon dioxide levels.
High-flow or high-concentration oxygen can suppress this
drive, leading to respiratory depression. Initial oxygen
therapy should be low-flow (e.g., nasal cannula at 1–2 L/min)
to maintain an oxygen saturation between 88% and 92%
without causing hypercapnia.
Question 2
A client with Type 2 Diabetes Mellitus presents to the clinic for a
routine checkup. The nurse reviews the laboratory results and
notes a Glycated Hemoglobin (HbA1c) level of 8.4%. Which
interpretation by the nurse is correct?
• A) The client’s blood glucose levels have been well
controlled over the past 3 months.
• B) The client has been fasting appropriately prior to the
laboratory draw.
• C) The client’s blood glucose levels have been elevated over
the past 90 days.
• D) The client is experiencing an acute episode of
hypoglycemia.
Answer: C
Rationale: The HbA1c test measures the average blood
glucose control over the previous 2 to 3 months
(approximately 90 to 120 days). A normal level for a non-
,diabetic is below 5.7%, and the target level for most adults
with diabetes is below 7%. A level of 8.4% indicates
persistent hyperglycemia and poor long-term glycemic
control, signaling a need to review the treatment plan,
medication adherence, or dietary habits.
Question 3
The nurse is providing discharge education to a client newly
diagnosed with Chronic Heart Failure (HF). Which statement by
the client indicates a need for further teaching?
• A) "I will weigh myself every morning before breakfast and
after voiding."
• B) "I will limit my sodium intake to less than 2,000 milligrams
per day."
• C) "I will take my prescribed diuretic right before I go to bed
at night."
• D) "I will report a weight gain of 3 pounds in a single day to
my doctor."
Answer: C
Rationale: Diuretics (such as furosemide) should be taken in
the morning or early afternoon to prevent nocturia, which
disrupts sleep and reduces the client's quality of life. Daily
weights are essential for monitoring fluid retention, and a
weight gain of 2–3 pounds in a day or 5 pounds in a week
must be reported. Sodium restriction is a standard
intervention to prevent fluid overload.
, Question 4
A client with Chronic Kidney Disease (CKD) Stage 4 is
prescribed Epoetin alfa. Which laboratory parameter must the
nurse monitor closely to evaluate the therapeutic effectiveness of
this medication?
• A) Serum potassium
• B) Blood urea nitrogen (BUN)
• C) Hemoglobin and hematocrit
• D) Glomerular filtration rate (GFR)
Answer: C
Rationale: Epoetin alfa is a synthetic form of erythropoietin, a
hormone normally produced by the kidneys that stimulates
the bone marrow to produce red blood cells. In Stage 4 CKD,
erythropoietin production is severely diminished, leading to
chronic anemia. The medication is effective if hemoglobin
and hematocrit levels rise into the target therapeutic range. It
does not directly affect potassium, BUN, or GFR.
Question 5
During an assessment of a client with Rheumatoid Arthritis
(RA), the nurse notes bilateral joint swelling, warmth, and severe
morning stiffness lasting longer than 1 hour. Which
pathophysiology explains these clinical manifestations?
• A) Mechanical wear and tear of the articular cartilage over
time.
