Galen College of Nursing NUR 257 Chronic Illness
Exam 3 (docx) | 2026/2027 | Aging and Chronic Illness
Q&A | Nursing
1. An older adult with diabetes becomes sweaty and confused before lunch. What should the nurse assess
immediately?
A) Capillary blood glucose
B) Daily weight
C) Serum calcium
D) Visual acuity
Correct Answer: Capillary blood glucose
Rationale: Sweating and acute confusion can indicate hypoglycemia, which requires prompt bedside glucose
testing. A low result in an alert person who can swallow calls for rapid-acting carbohydrate followed by
reassessment. Delaying for unrelated measurements risks worsening neuroglycopenia and loss of
consciousness. Patient education and timely reassessment should be adapted to the older adult’s function,
medication regimen, and support needs.
2. A conscious person with diabetes has a glucose of 58 mg/dL. Which immediate intervention is indicated?
A) Give 15 g of fast-acting carbohydrate
B) Administer scheduled insulin
C) Offer a high-fat meal only
D) Encourage a brisk walk
Correct Answer: Give 15 g of fast-acting carbohydrate
Rationale: The usual first response to mild hypoglycemia in a person able to swallow is approximately 15 grams
of rapidly absorbed carbohydrate. Recheck glucose after about 15 minutes and repeat treatment if it remains
low. Fat slows absorption, while insulin or exercise could worsen the episode. Patient education and timely
reassessment should be adapted to the older adult’s function, medication regimen, and support needs.
3. During diabetes education, which finding should prompt evaluation for peripheral neuropathy?
A) Increased visual acuity
B) Unilateral ear pain
C) Loss of protective sensation in the feet
D) Transient hiccups
Correct Answer: Loss of protective sensation in the feet
Rationale: Peripheral neuropathy can reduce protective sensation, making injuries difficult to detect.
Monofilament assessment and regular foot inspection help identify ulcer risk before tissue breakdown occurs.
Ear pain, hiccups, and sharper vision do not demonstrate the distal sensory impairment characteristic of this
,complication. Patient education and timely reassessment should be adapted to the older adult’s function,
medication regimen, and support needs.
4. A nurse reviews foot-care instructions for an older adult with diabetes. Which practice reduces injury?
A) Inspect the entire feet every day
B) Walk barefoot indoors
C) Apply heat directly to numb feet
D) Trim corns with a razor
Correct Answer: Inspect the entire feet every day
Rationale: Daily inspection helps reveal blisters, pressure areas, and breaks in skin that may go unnoticed with
neuropathy. Footwear and careful nail care further reduce injury. Bare feet, direct heat, and cutting corns create
avoidable risks of burns, wounds, and infection. Patient education and timely reassessment should be adapted
to the older adult’s function, medication regimen, and support needs.
5. What does hemoglobin A1c primarily estimate in diabetes management?
A) Average glycemia over roughly three months
B) Blood glucose during the last hour
C) Current serum ketone concentration
D) Kidney filtration on one day
Correct Answer: Average glycemia over roughly three months
Rationale: Hemoglobin A1c reflects glycation of circulating red cells and approximates glycemia over the
preceding two to three months. It complements, rather than replaces, glucose monitoring for acute decisions.
Anemia or altered red-cell turnover may affect interpretation, so results require clinical context. Patient
education and timely reassessment should be adapted to the older adult’s function, medication regimen, and
support needs.
6. A frail older adult has recurrent hypoglycemia while receiving diabetes treatment. What principle should
guide review?
A) Individualize glycemic goals and simplify risky treatment
B) Intensify all glucose-lowering doses
C) Eliminate every carbohydrate
D) Ignore symptoms if A1c is low
Correct Answer: Individualize glycemic goals and simplify risky treatment
Rationale: Treatment goals in frail older adults should account for functional status, comorbidity, and the
danger of hypoglycemia. Medication review may identify regimens that are unnecessarily complex or aggressive.
Lower A1c is not automatically safer when recurrent episodes threaten cognition, falls, and independence.
Patient education and timely reassessment should be adapted to the older adult’s function, medication
regimen, and support needs.
,7. An older adult with diabetes develops vomiting and cannot eat normally. Which teaching point is most
important?
A) Stop all insulin without advice
B) Avoid drinking any fluids
C) Check glucose only after recovery
D) Follow a written sick-day plan and monitor glucose frequently
Correct Answer: Follow a written sick-day plan and monitor glucose frequently
Rationale: Acute illness can destabilize glucose even when oral intake decreases, so a personalized sick-day
plan is essential. Monitoring, hydration when appropriate, and instructions about medication adjustments help
prevent emergencies. Abruptly stopping insulin without guidance can precipitate severe hyperglycemia or
ketoacidosis. Patient education and timely reassessment should be adapted to the older adult’s function,
medication regimen, and support needs.
8. Which finding is more characteristic of hyperosmolar hyperglycemic state than uncomplicated
hyperglycemia?
A) Profound dehydration with marked hyperglycemia
B) Sudden isolated hearing loss
C) Localized ankle bruising
D) Mild seasonal rhinitis
Correct Answer: Profound dehydration with marked hyperglycemia
Rationale: Hyperosmolar hyperglycemic state commonly involves extreme hyperglycemia, substantial fluid
losses, and altered mental status. It is especially important to recognize in older adults with type 2 diabetes.
Delayed treatment can lead to circulatory compromise, so the findings warrant urgent medical evaluation.
Patient education and timely reassessment should be adapted to the older adult’s function, medication
regimen, and support needs.
9. A person using insulin is found unresponsive and cannot swallow. What is the priority action?
A) Give juice by mouth
B) Activate emergency response and administer prescribed rescue glucagon when available
C) Ask the person to walk
D) Delay action until the next meal
Correct Answer: Activate emergency response and administer prescribed rescue glucagon when available
Rationale: An unconscious person cannot safely receive oral food or fluids because of aspiration risk.
Emergency response and available prescribed glucagon are appropriate while further treatment is arranged.
Rapid assessment and monitoring are necessary because severe hypoglycemia can cause seizures and
persistent neurologic injury. Patient education and timely reassessment should be adapted to the older adult’s
function, medication regimen, and support needs.
10. Which complication is specifically screened for with a dilated retinal examination in diabetes?
, A) Peripheral arterial aneurysm
B) Acute otitis media
C) Diabetic retinopathy
D) Peptic ulcer disease
Correct Answer: Diabetic retinopathy
Rationale: Retinal examination can identify microvascular damage caused by diabetes before major visual
symptoms develop. Early detection supports timely treatment and risk-factor management. The examination
does not diagnose ear infection, gastrointestinal ulceration, or peripheral arterial aneurysm. Patient education
and timely reassessment should be adapted to the older adult’s function, medication regimen, and support
needs.
11. An older adult taking metformin develops severe dehydration and acute kidney injury. Which nursing action
is appropriate?
A) Double the next metformin dose
B) Promptly seek medication review because temporary withholding may be needed
C) Give metformin to treat dehydration
D) Ignore renal function changes
Correct Answer: Promptly seek medication review because temporary withholding may be needed
Rationale: Acute kidney injury can impair metformin clearance, and serious dehydration raises concern about
medication safety. A clinician should review whether metformin should be temporarily held and when it can be
restarted. Dose escalation would not correct dehydration and could increase adverse-event risk. Patient
education and timely reassessment should be adapted to the older adult’s function, medication regimen, and
support needs.
12. Which laboratory measure is commonly used to assess chronic kidney involvement in diabetes?
A) Serum amylase alone
B) Urine albumin-to-creatinine ratio
C) White blood cell differential alone
D) Total bilirubin alone
Correct Answer: Urine albumin-to-creatinine ratio
Rationale: Urine albumin-to-creatinine ratio detects abnormal albumin leakage, an early sign of diabetic kidney
disease. Estimated glomerular filtration rate adds information about filtration function. Neither isolated
pancreatic enzymes nor blood counts substitutes for kidney-specific screening and follow-up. Patient
education and timely reassessment should be adapted to the older adult’s function, medication regimen, and
support needs.
13. An older adult reports fatigue, constipation, cold intolerance, and dry skin. Which disorder is consistent with
this cluster?
A) Hyperthyroidism
Exam 3 (docx) | 2026/2027 | Aging and Chronic Illness
Q&A | Nursing
1. An older adult with diabetes becomes sweaty and confused before lunch. What should the nurse assess
immediately?
A) Capillary blood glucose
B) Daily weight
C) Serum calcium
D) Visual acuity
Correct Answer: Capillary blood glucose
Rationale: Sweating and acute confusion can indicate hypoglycemia, which requires prompt bedside glucose
testing. A low result in an alert person who can swallow calls for rapid-acting carbohydrate followed by
reassessment. Delaying for unrelated measurements risks worsening neuroglycopenia and loss of
consciousness. Patient education and timely reassessment should be adapted to the older adult’s function,
medication regimen, and support needs.
2. A conscious person with diabetes has a glucose of 58 mg/dL. Which immediate intervention is indicated?
A) Give 15 g of fast-acting carbohydrate
B) Administer scheduled insulin
C) Offer a high-fat meal only
D) Encourage a brisk walk
Correct Answer: Give 15 g of fast-acting carbohydrate
Rationale: The usual first response to mild hypoglycemia in a person able to swallow is approximately 15 grams
of rapidly absorbed carbohydrate. Recheck glucose after about 15 minutes and repeat treatment if it remains
low. Fat slows absorption, while insulin or exercise could worsen the episode. Patient education and timely
reassessment should be adapted to the older adult’s function, medication regimen, and support needs.
3. During diabetes education, which finding should prompt evaluation for peripheral neuropathy?
A) Increased visual acuity
B) Unilateral ear pain
C) Loss of protective sensation in the feet
D) Transient hiccups
Correct Answer: Loss of protective sensation in the feet
Rationale: Peripheral neuropathy can reduce protective sensation, making injuries difficult to detect.
Monofilament assessment and regular foot inspection help identify ulcer risk before tissue breakdown occurs.
Ear pain, hiccups, and sharper vision do not demonstrate the distal sensory impairment characteristic of this
,complication. Patient education and timely reassessment should be adapted to the older adult’s function,
medication regimen, and support needs.
4. A nurse reviews foot-care instructions for an older adult with diabetes. Which practice reduces injury?
A) Inspect the entire feet every day
B) Walk barefoot indoors
C) Apply heat directly to numb feet
D) Trim corns with a razor
Correct Answer: Inspect the entire feet every day
Rationale: Daily inspection helps reveal blisters, pressure areas, and breaks in skin that may go unnoticed with
neuropathy. Footwear and careful nail care further reduce injury. Bare feet, direct heat, and cutting corns create
avoidable risks of burns, wounds, and infection. Patient education and timely reassessment should be adapted
to the older adult’s function, medication regimen, and support needs.
5. What does hemoglobin A1c primarily estimate in diabetes management?
A) Average glycemia over roughly three months
B) Blood glucose during the last hour
C) Current serum ketone concentration
D) Kidney filtration on one day
Correct Answer: Average glycemia over roughly three months
Rationale: Hemoglobin A1c reflects glycation of circulating red cells and approximates glycemia over the
preceding two to three months. It complements, rather than replaces, glucose monitoring for acute decisions.
Anemia or altered red-cell turnover may affect interpretation, so results require clinical context. Patient
education and timely reassessment should be adapted to the older adult’s function, medication regimen, and
support needs.
6. A frail older adult has recurrent hypoglycemia while receiving diabetes treatment. What principle should
guide review?
A) Individualize glycemic goals and simplify risky treatment
B) Intensify all glucose-lowering doses
C) Eliminate every carbohydrate
D) Ignore symptoms if A1c is low
Correct Answer: Individualize glycemic goals and simplify risky treatment
Rationale: Treatment goals in frail older adults should account for functional status, comorbidity, and the
danger of hypoglycemia. Medication review may identify regimens that are unnecessarily complex or aggressive.
Lower A1c is not automatically safer when recurrent episodes threaten cognition, falls, and independence.
Patient education and timely reassessment should be adapted to the older adult’s function, medication
regimen, and support needs.
,7. An older adult with diabetes develops vomiting and cannot eat normally. Which teaching point is most
important?
A) Stop all insulin without advice
B) Avoid drinking any fluids
C) Check glucose only after recovery
D) Follow a written sick-day plan and monitor glucose frequently
Correct Answer: Follow a written sick-day plan and monitor glucose frequently
Rationale: Acute illness can destabilize glucose even when oral intake decreases, so a personalized sick-day
plan is essential. Monitoring, hydration when appropriate, and instructions about medication adjustments help
prevent emergencies. Abruptly stopping insulin without guidance can precipitate severe hyperglycemia or
ketoacidosis. Patient education and timely reassessment should be adapted to the older adult’s function,
medication regimen, and support needs.
8. Which finding is more characteristic of hyperosmolar hyperglycemic state than uncomplicated
hyperglycemia?
A) Profound dehydration with marked hyperglycemia
B) Sudden isolated hearing loss
C) Localized ankle bruising
D) Mild seasonal rhinitis
Correct Answer: Profound dehydration with marked hyperglycemia
Rationale: Hyperosmolar hyperglycemic state commonly involves extreme hyperglycemia, substantial fluid
losses, and altered mental status. It is especially important to recognize in older adults with type 2 diabetes.
Delayed treatment can lead to circulatory compromise, so the findings warrant urgent medical evaluation.
Patient education and timely reassessment should be adapted to the older adult’s function, medication
regimen, and support needs.
9. A person using insulin is found unresponsive and cannot swallow. What is the priority action?
A) Give juice by mouth
B) Activate emergency response and administer prescribed rescue glucagon when available
C) Ask the person to walk
D) Delay action until the next meal
Correct Answer: Activate emergency response and administer prescribed rescue glucagon when available
Rationale: An unconscious person cannot safely receive oral food or fluids because of aspiration risk.
Emergency response and available prescribed glucagon are appropriate while further treatment is arranged.
Rapid assessment and monitoring are necessary because severe hypoglycemia can cause seizures and
persistent neurologic injury. Patient education and timely reassessment should be adapted to the older adult’s
function, medication regimen, and support needs.
10. Which complication is specifically screened for with a dilated retinal examination in diabetes?
, A) Peripheral arterial aneurysm
B) Acute otitis media
C) Diabetic retinopathy
D) Peptic ulcer disease
Correct Answer: Diabetic retinopathy
Rationale: Retinal examination can identify microvascular damage caused by diabetes before major visual
symptoms develop. Early detection supports timely treatment and risk-factor management. The examination
does not diagnose ear infection, gastrointestinal ulceration, or peripheral arterial aneurysm. Patient education
and timely reassessment should be adapted to the older adult’s function, medication regimen, and support
needs.
11. An older adult taking metformin develops severe dehydration and acute kidney injury. Which nursing action
is appropriate?
A) Double the next metformin dose
B) Promptly seek medication review because temporary withholding may be needed
C) Give metformin to treat dehydration
D) Ignore renal function changes
Correct Answer: Promptly seek medication review because temporary withholding may be needed
Rationale: Acute kidney injury can impair metformin clearance, and serious dehydration raises concern about
medication safety. A clinician should review whether metformin should be temporarily held and when it can be
restarted. Dose escalation would not correct dehydration and could increase adverse-event risk. Patient
education and timely reassessment should be adapted to the older adult’s function, medication regimen, and
support needs.
12. Which laboratory measure is commonly used to assess chronic kidney involvement in diabetes?
A) Serum amylase alone
B) Urine albumin-to-creatinine ratio
C) White blood cell differential alone
D) Total bilirubin alone
Correct Answer: Urine albumin-to-creatinine ratio
Rationale: Urine albumin-to-creatinine ratio detects abnormal albumin leakage, an early sign of diabetic kidney
disease. Estimated glomerular filtration rate adds information about filtration function. Neither isolated
pancreatic enzymes nor blood counts substitutes for kidney-specific screening and follow-up. Patient
education and timely reassessment should be adapted to the older adult’s function, medication regimen, and
support needs.
13. An older adult reports fatigue, constipation, cold intolerance, and dry skin. Which disorder is consistent with
this cluster?
A) Hyperthyroidism
