NUR 257 Chronic Exam 3 | Questions and Answers | 2025 New Update
| 100% Correct - Galen College of Nursing
Question 1
A nurse is assessing a client with a new diagnosis of left-sided heart failure. Which of the
following findings is a classic manifestation of this condition?
A) Jugular venous distention (JVD)
B) Peripheral pitting edema
C) Dyspnea and crackles in the lungs
D) Hepatomegaly
E) Ascites
Correct Answer: C) Dyspnea and crackles in the lungs
Rationale: Left-sided heart failure occurs when the left ventricle cannot pump blood
effectively to the systemic circulation. This causes blood to back up into the pulmonary
circulation (the lungs). The increased pressure in the pulmonary vessels forces fluid into the
interstitial spaces and alveoli, leading to pulmonary congestion. This manifests as dyspnea
(shortness of breath), orthopnea, and adventitious breath sounds like crackles. JVD,
peripheral edema, hepatomegaly, and ascites are all signs of systemic congestion caused by
right-sided heart failure.
Question 2
A client with chronic obstructive pulmonary disease (COPD) is being taught how to perform
pursed-lip breathing. The nurse should explain that the primary purpose of this technique is to:
A) Increase the respiratory rate to improve oxygenation.
B) Strengthen the diaphragm and intercostal muscles.
C) Promote carbon dioxide retention to trigger the drive to breathe.
D) Prevent airway collapse on exhalation and reduce air trapping.
E) Help mobilize and expectorate thick secretions.
Correct Answer: D) Prevent airway collapse on exhalation and reduce air trapping.
Rationale: In COPD, particularly emphysema, loss of lung elasticity leads to premature
collapse of the small airways during exhalation. This traps stale air in the alveoli. Pursed-
lip breathing works by creating a slight back-pressure (similar to positive end-expiratory
,[Type here]
pressure or PEEP) inside the airways. This back-pressure stents the airways open longer,
allowing for more complete and prolonged exhalation, which helps to empty trapped air
and relieve the sensation of dyspnea.
Question 3
A nurse is reviewing the laboratory results for a client with chronic kidney disease (CKD).
Which of the following findings would be expected?
A) Serum potassium of 3.8 mEq/L
B) Serum creatinine of 5.2 mg/dL
C) Hemoglobin of 15 g/dL
D) Serum calcium of 10.1 mg/dL
E) Serum phosphorus of 3.5 mg/dL
Correct Answer: B) Serum creatinine of 5.2 mg/dL
Rationale: The kidneys are responsible for filtering waste products from the blood,
including creatinine. In chronic kidney disease, the glomerular filtration rate (GFR)
declines, and the kidneys are unable to excrete these waste products effectively. This leads
to an accumulation of creatinine and blood urea nitrogen (BUN) in the blood. A serum
creatinine of 5.2 mg/dL is significantly elevated (normal is approx. 0.6-1.2 mg/dL) and is a
hallmark of renal failure. Anemia (low hemoglobin), hyperkalemia, hyperphosphatemia,
and hypocalcemia are also expected findings in CKD.
Question 4
A client with type 1 diabetes mellitus is brought to the emergency department with suspected
diabetic ketoacidosis (DKA). The nurse would anticipate which of the following assessment
findings?
A) Bradycardia and hypertension
B) Shallow, slow respirations
C) Cold, clammy skin
D) Fruity odor on the breath and Kussmaul respirations
E) Blood glucose level of 150 mg/dL
Correct Answer: D) Fruity odor on the breath and Kussmaul respirations
Rationale: DKA is a state of absolute insulin deficiency, leading to hyperglycemia, ketosis,
,[Type here]
and metabolic acidosis. The body breaks down fat for energy, producing acidic ketone
bodies. One of these ketones, acetone, is volatile and is exhaled, giving the breath a
characteristic fruity smell. To compensate for the severe metabolic acidosis, the body
attempts to blow off carbon dioxide (an acid) through a specific breathing pattern called
Kussmaul respirations, which are deep, rapid, and labored.
Question 5
A nurse is providing discharge teaching to a client with a new diagnosis of hypertension. Which
statement by the client indicates an understanding of the DASH diet?
A) "I should eat more red meat and fewer whole grains."
B) "I will focus on eating more fruits, vegetables, and low-fat dairy products."
C) "The diet primarily involves limiting my fluid intake to 1 liter per day."
D) "I need to add more salt to my food to improve the flavor."
E) "I will avoid all carbohydrates, including bread and pasta."
Correct Answer: B) "I will focus on eating more fruits, vegetables, and low-fat dairy
products."
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet is an evidence-based
eating plan designed to lower blood pressure. Its key principles include a high intake of
fruits, vegetables, and whole grains; consumption of low-fat or fat-free dairy products, fish,
poultry, and nuts; and a reduced intake of sodium, sweets, sugary beverages, and red
meats.
Question 6
A client with a history of deep vein thrombosis (DVT) is being discharged on warfarin. The
nurse must instruct the client to seek immediate medical attention for which of the following
symptoms?
A) Mild fatigue
B) A minor headache
C) A dark, tarry stool
D) Occasional indigestion
E) A slight increase in urine output
, [Type here]
Correct Answer: C) A dark, tarry stool
Rationale: Warfarin is an anticoagulant that increases the risk of bleeding. A dark, tarry
stool (melena) is a cardinal sign of an upper gastrointestinal bleed. This is a serious adverse
effect of the medication and requires immediate medical evaluation. The nurse must teach
the client to recognize and report any signs of unusual bleeding.
Question 7
A client with Crohn's disease is experiencing an acute exacerbation. The nurse would question a
provider's order for which of the following?
A) A low-residue, high-calorie diet.
B) A daily multivitamin supplement.
C) A nonsteroidal anti-inflammatory drug (NSAID) for pain.
D) Corticosteroid therapy.
E) An antidiarrheal medication.
Correct Answer: C) A nonsteroidal anti-inflammatory drug (NSAID) for pain.
Rationale: NSAIDs (e.g., ibuprofen, naproxen) are known to cause gastrointestinal
irritation and can trigger or worsen flare-ups of inflammatory bowel disease (IBD),
including Crohn's disease and ulcerative colitis. They should be avoided in this patient
population. Acetaminophen is a safer analgesic choice.
Question 8
A nurse is reviewing the plan of care for a client with cirrhosis and ascites. Which of the
following nursing interventions is a priority?
A) Encouraging a high-sodium diet.
B) Monitoring abdominal girth daily.
C) Administering aspirin for pain.
D) Restricting fluid intake to 500 mL per day.
E) Placing the client in a supine position.
Correct Answer: B) Monitoring abdominal girth daily.
Rationale: Ascites is the accumulation of fluid in the peritoneal cavity, a major
complication of cirrhosis. Monitoring for changes in fluid status is a priority. Daily
measurement of abdominal girth at the same location (usually the umbilicus) and daily
| 100% Correct - Galen College of Nursing
Question 1
A nurse is assessing a client with a new diagnosis of left-sided heart failure. Which of the
following findings is a classic manifestation of this condition?
A) Jugular venous distention (JVD)
B) Peripheral pitting edema
C) Dyspnea and crackles in the lungs
D) Hepatomegaly
E) Ascites
Correct Answer: C) Dyspnea and crackles in the lungs
Rationale: Left-sided heart failure occurs when the left ventricle cannot pump blood
effectively to the systemic circulation. This causes blood to back up into the pulmonary
circulation (the lungs). The increased pressure in the pulmonary vessels forces fluid into the
interstitial spaces and alveoli, leading to pulmonary congestion. This manifests as dyspnea
(shortness of breath), orthopnea, and adventitious breath sounds like crackles. JVD,
peripheral edema, hepatomegaly, and ascites are all signs of systemic congestion caused by
right-sided heart failure.
Question 2
A client with chronic obstructive pulmonary disease (COPD) is being taught how to perform
pursed-lip breathing. The nurse should explain that the primary purpose of this technique is to:
A) Increase the respiratory rate to improve oxygenation.
B) Strengthen the diaphragm and intercostal muscles.
C) Promote carbon dioxide retention to trigger the drive to breathe.
D) Prevent airway collapse on exhalation and reduce air trapping.
E) Help mobilize and expectorate thick secretions.
Correct Answer: D) Prevent airway collapse on exhalation and reduce air trapping.
Rationale: In COPD, particularly emphysema, loss of lung elasticity leads to premature
collapse of the small airways during exhalation. This traps stale air in the alveoli. Pursed-
lip breathing works by creating a slight back-pressure (similar to positive end-expiratory
,[Type here]
pressure or PEEP) inside the airways. This back-pressure stents the airways open longer,
allowing for more complete and prolonged exhalation, which helps to empty trapped air
and relieve the sensation of dyspnea.
Question 3
A nurse is reviewing the laboratory results for a client with chronic kidney disease (CKD).
Which of the following findings would be expected?
A) Serum potassium of 3.8 mEq/L
B) Serum creatinine of 5.2 mg/dL
C) Hemoglobin of 15 g/dL
D) Serum calcium of 10.1 mg/dL
E) Serum phosphorus of 3.5 mg/dL
Correct Answer: B) Serum creatinine of 5.2 mg/dL
Rationale: The kidneys are responsible for filtering waste products from the blood,
including creatinine. In chronic kidney disease, the glomerular filtration rate (GFR)
declines, and the kidneys are unable to excrete these waste products effectively. This leads
to an accumulation of creatinine and blood urea nitrogen (BUN) in the blood. A serum
creatinine of 5.2 mg/dL is significantly elevated (normal is approx. 0.6-1.2 mg/dL) and is a
hallmark of renal failure. Anemia (low hemoglobin), hyperkalemia, hyperphosphatemia,
and hypocalcemia are also expected findings in CKD.
Question 4
A client with type 1 diabetes mellitus is brought to the emergency department with suspected
diabetic ketoacidosis (DKA). The nurse would anticipate which of the following assessment
findings?
A) Bradycardia and hypertension
B) Shallow, slow respirations
C) Cold, clammy skin
D) Fruity odor on the breath and Kussmaul respirations
E) Blood glucose level of 150 mg/dL
Correct Answer: D) Fruity odor on the breath and Kussmaul respirations
Rationale: DKA is a state of absolute insulin deficiency, leading to hyperglycemia, ketosis,
,[Type here]
and metabolic acidosis. The body breaks down fat for energy, producing acidic ketone
bodies. One of these ketones, acetone, is volatile and is exhaled, giving the breath a
characteristic fruity smell. To compensate for the severe metabolic acidosis, the body
attempts to blow off carbon dioxide (an acid) through a specific breathing pattern called
Kussmaul respirations, which are deep, rapid, and labored.
Question 5
A nurse is providing discharge teaching to a client with a new diagnosis of hypertension. Which
statement by the client indicates an understanding of the DASH diet?
A) "I should eat more red meat and fewer whole grains."
B) "I will focus on eating more fruits, vegetables, and low-fat dairy products."
C) "The diet primarily involves limiting my fluid intake to 1 liter per day."
D) "I need to add more salt to my food to improve the flavor."
E) "I will avoid all carbohydrates, including bread and pasta."
Correct Answer: B) "I will focus on eating more fruits, vegetables, and low-fat dairy
products."
Rationale: The DASH (Dietary Approaches to Stop Hypertension) diet is an evidence-based
eating plan designed to lower blood pressure. Its key principles include a high intake of
fruits, vegetables, and whole grains; consumption of low-fat or fat-free dairy products, fish,
poultry, and nuts; and a reduced intake of sodium, sweets, sugary beverages, and red
meats.
Question 6
A client with a history of deep vein thrombosis (DVT) is being discharged on warfarin. The
nurse must instruct the client to seek immediate medical attention for which of the following
symptoms?
A) Mild fatigue
B) A minor headache
C) A dark, tarry stool
D) Occasional indigestion
E) A slight increase in urine output
, [Type here]
Correct Answer: C) A dark, tarry stool
Rationale: Warfarin is an anticoagulant that increases the risk of bleeding. A dark, tarry
stool (melena) is a cardinal sign of an upper gastrointestinal bleed. This is a serious adverse
effect of the medication and requires immediate medical evaluation. The nurse must teach
the client to recognize and report any signs of unusual bleeding.
Question 7
A client with Crohn's disease is experiencing an acute exacerbation. The nurse would question a
provider's order for which of the following?
A) A low-residue, high-calorie diet.
B) A daily multivitamin supplement.
C) A nonsteroidal anti-inflammatory drug (NSAID) for pain.
D) Corticosteroid therapy.
E) An antidiarrheal medication.
Correct Answer: C) A nonsteroidal anti-inflammatory drug (NSAID) for pain.
Rationale: NSAIDs (e.g., ibuprofen, naproxen) are known to cause gastrointestinal
irritation and can trigger or worsen flare-ups of inflammatory bowel disease (IBD),
including Crohn's disease and ulcerative colitis. They should be avoided in this patient
population. Acetaminophen is a safer analgesic choice.
Question 8
A nurse is reviewing the plan of care for a client with cirrhosis and ascites. Which of the
following nursing interventions is a priority?
A) Encouraging a high-sodium diet.
B) Monitoring abdominal girth daily.
C) Administering aspirin for pain.
D) Restricting fluid intake to 500 mL per day.
E) Placing the client in a supine position.
Correct Answer: B) Monitoring abdominal girth daily.
Rationale: Ascites is the accumulation of fluid in the peritoneal cavity, a major
complication of cirrhosis. Monitoring for changes in fluid status is a priority. Daily
measurement of abdominal girth at the same location (usually the umbilicus) and daily
