NUR 257 Chronic Exam 4 | Questions and
Answers | 2026 New Update | 100%
Correct - Galen College of Nursing
1. A client with chronic obstructive pulmonary disease (COPD) presents with
worsening dyspnea and a productive cough. Which assessment finding is the
most reliable indicator of a developing pneumothorax?
A) Diminished breath sounds on the affected side
B) Sudden onset of sharp, pleuritic chest pain
C) Subcutaneous emphysema around the chest wall
D) A sudden, dramatic decrease in pulse oximetry readings
Answer: B) Sudden onset of sharp, pleuritic chest pain
Explanation: While diminished breath sounds and subcutaneous emphysema can
occur with a pneumothorax, the hallmark and often first presenting symptom is a
sudden, sharp, pleuritic chest pain that worsens with inspiration. A sudden drop
in SpO2 is a late sign and can occur in many conditions.
2. The nurse is caring for a client with heart failure who is receiving a continuous
infusion of dobutamine. Which assessment finding indicates that the medication
is having the desired therapeutic effect?
A) Heart rate decreases from 110 to 80 beats per minute
B) Blood pressure increases from 90/60 to 110/70 mmHg
C) Central venous pressure increases from 8 to 12 mmHg
D) Urine output decreases from 40 to 20 mL/hr
Answer: B) Blood pressure increases from 90/60 to 110/70 mmHg
Explanation: Dobutamine is a positive inotrope that increases cardiac contractility,
thereby increasing cardiac output and blood pressure. An increase in BP indicates
effective perfusion. A decrease in heart rate is not the primary effect; dobutamine
can cause tachycardia. An increase in CVP and a decrease in urine output suggest
worsening failure.
,3. A client with a history of cirrhosis is admitted with hepatic encephalopathy.
Which dietary modification is most appropriate for this client?
A) High-protein diet to promote liver regeneration
B) Low-sodium diet to reduce ascites
C) Low-protein diet to reduce ammonia production
D) High-carbohydrate diet to prevent hypoglycemia
Answer: C) Low-protein diet to reduce ammonia production
Explanation: Hepatic encephalopathy is caused by the accumulation of ammonia
in the blood. A low-protein diet is implemented to decrease the substrate for
ammonia production by intestinal bacteria. High protein would exacerbate the
condition.
4. The healthcare provider orders a 24-hour urine collection for creatinine clearance
on a client with chronic kidney disease. Which action by the nurse is correct
regarding this test?
A) Discard the first voided specimen and note the start time
B) Keep the urine collection container at room temperature
C) Instruct the client to increase fluid intake during the collection
D) Collect all urine in a single container and send to the lab immediately
Answer: A) Discard the first voided specimen and note the start time
Explanation: For a 24-hour urine collection, the first voided specimen is discarded,
and the time is recorded as the start time. All subsequent urine for the next 24
hours is collected. The container should be refrigerated or kept on ice, and fluid
intake does not need to be increased specifically for the test.
5. A client with rheumatoid arthritis is taking methotrexate. The nurse should
monitor the client for which adverse effect?
A) Hyperglycemia
B) Hepatotoxicity
C) Hypertension
D) Nephrogenic diabetes insipidus
Answer: B) Hepatotoxicity
, Explanation: Methotrexate is an immunosuppressant and disease-modifying
antirheumatic drug (DMARD). Hepatotoxicity and bone marrow suppression are
significant adverse effects. Liver function tests should be monitored regularly.
6. The nurse is assessing a client with Parkinson's disease who is taking levodopa-
carbidopa. Which finding indicates a potential adverse effect of this medication?
A) Bradykinesia
B) Muscle rigidity
C) Dyskinesias
D) Resting tremor
Answer: C) Dyskinesias
Explanation: Levodopa-carbidopa can cause dyskinesias (involuntary movements)
as a common adverse effect, particularly with long-term use. Bradykinesia,
rigidity, and tremor are symptoms of Parkinson's disease itself, not adverse
effects of the medication.
7. A client with diabetes mellitus type 1 is brought to the emergency department
with nausea, vomiting, and abdominal pain. The client's breath has a fruity odor.
Which arterial blood gas (ABG) result would the nurse expect?
A) pH 7.32, PaCO2 48, HCO3 30
B) pH 7.48, PaCO2 32, HCO3 22
C) pH 7.25, PaCO2 30, HCO3 14
D) pH 7.55, PaCO2 25, HCO3 20
Answer: C) pH 7.25, PaCO2 30, HCO3 14
Explanation: The client is presenting with signs of diabetic ketoacidosis (DKA),
which is characterized by metabolic acidosis. The ABG would show a low pH
(<7.35), low HCO3 (<22), and a compensatory low PaCO2 due to Kussmaul
breathing. Option C is the only one that shows metabolic acidosis with a low pH
and low bicarbonate.
8. The nurse is teaching a client with a new diagnosis of atrial fibrillation about
anticoagulant therapy with warfarin. Which statement indicates that the client
needs further teaching?
, A) "I will need to have my blood drawn regularly to check my INR."
B) "I should use a soft-bristled toothbrush to prevent bleeding gums."
C) "I will need to avoid eating foods high in vitamin K like spinach and broccoli."
D) "If I miss a dose, I should double the next dose to make up for it."
Answer: D) "If I miss a dose, I should double the next dose to make up for
it."
Explanation: Clients should never double a dose of warfarin if they miss one, as
this significantly increases the risk of bleeding. They should take the missed dose
as soon as remembered if it's the same day, and skip it if it's the next day, then
resume the normal schedule. The other statements are correct.
9. A client is 2 days post-operative following a total hip arthroplasty. Which nursing
intervention is essential to prevent dislocation of the new joint?
A) Keep the client in a high-Fowler's position
B) Maintain the client's legs in an abducted position using a pillow
C) Encourage the client to cross legs at the ankles to stretch
D) Place the client in a prone position for 30 minutes four times daily
Answer: B) Maintain the client's legs in an abducted position using a pillow
Explanation: To prevent dislocation of a hip prosthesis, the client's legs should be
kept abducted (spread apart). Crossing the legs, adducting the legs, or bending
the hip more than 90 degrees puts the client at risk for dislocation. A pillow
between the legs maintains abduction.
10. The nurse is caring for a client with acute pancreatitis. Which laboratory value
would be most concerning?
A) Serum amylase 300 U/L
B) Serum lipase 400 U/L
C) Serum calcium 6.8 mg/dL
D) Blood glucose 140 mg/dL
Answer: C) Serum calcium 6.8 mg/dL
Explanation: In acute pancreatitis, hypocalcemia (calcium <8.5 mg/dL) is a poor
prognostic sign and can indicate fat necrosis and saponification. It may lead to
Answers | 2026 New Update | 100%
Correct - Galen College of Nursing
1. A client with chronic obstructive pulmonary disease (COPD) presents with
worsening dyspnea and a productive cough. Which assessment finding is the
most reliable indicator of a developing pneumothorax?
A) Diminished breath sounds on the affected side
B) Sudden onset of sharp, pleuritic chest pain
C) Subcutaneous emphysema around the chest wall
D) A sudden, dramatic decrease in pulse oximetry readings
Answer: B) Sudden onset of sharp, pleuritic chest pain
Explanation: While diminished breath sounds and subcutaneous emphysema can
occur with a pneumothorax, the hallmark and often first presenting symptom is a
sudden, sharp, pleuritic chest pain that worsens with inspiration. A sudden drop
in SpO2 is a late sign and can occur in many conditions.
2. The nurse is caring for a client with heart failure who is receiving a continuous
infusion of dobutamine. Which assessment finding indicates that the medication
is having the desired therapeutic effect?
A) Heart rate decreases from 110 to 80 beats per minute
B) Blood pressure increases from 90/60 to 110/70 mmHg
C) Central venous pressure increases from 8 to 12 mmHg
D) Urine output decreases from 40 to 20 mL/hr
Answer: B) Blood pressure increases from 90/60 to 110/70 mmHg
Explanation: Dobutamine is a positive inotrope that increases cardiac contractility,
thereby increasing cardiac output and blood pressure. An increase in BP indicates
effective perfusion. A decrease in heart rate is not the primary effect; dobutamine
can cause tachycardia. An increase in CVP and a decrease in urine output suggest
worsening failure.
,3. A client with a history of cirrhosis is admitted with hepatic encephalopathy.
Which dietary modification is most appropriate for this client?
A) High-protein diet to promote liver regeneration
B) Low-sodium diet to reduce ascites
C) Low-protein diet to reduce ammonia production
D) High-carbohydrate diet to prevent hypoglycemia
Answer: C) Low-protein diet to reduce ammonia production
Explanation: Hepatic encephalopathy is caused by the accumulation of ammonia
in the blood. A low-protein diet is implemented to decrease the substrate for
ammonia production by intestinal bacteria. High protein would exacerbate the
condition.
4. The healthcare provider orders a 24-hour urine collection for creatinine clearance
on a client with chronic kidney disease. Which action by the nurse is correct
regarding this test?
A) Discard the first voided specimen and note the start time
B) Keep the urine collection container at room temperature
C) Instruct the client to increase fluid intake during the collection
D) Collect all urine in a single container and send to the lab immediately
Answer: A) Discard the first voided specimen and note the start time
Explanation: For a 24-hour urine collection, the first voided specimen is discarded,
and the time is recorded as the start time. All subsequent urine for the next 24
hours is collected. The container should be refrigerated or kept on ice, and fluid
intake does not need to be increased specifically for the test.
5. A client with rheumatoid arthritis is taking methotrexate. The nurse should
monitor the client for which adverse effect?
A) Hyperglycemia
B) Hepatotoxicity
C) Hypertension
D) Nephrogenic diabetes insipidus
Answer: B) Hepatotoxicity
, Explanation: Methotrexate is an immunosuppressant and disease-modifying
antirheumatic drug (DMARD). Hepatotoxicity and bone marrow suppression are
significant adverse effects. Liver function tests should be monitored regularly.
6. The nurse is assessing a client with Parkinson's disease who is taking levodopa-
carbidopa. Which finding indicates a potential adverse effect of this medication?
A) Bradykinesia
B) Muscle rigidity
C) Dyskinesias
D) Resting tremor
Answer: C) Dyskinesias
Explanation: Levodopa-carbidopa can cause dyskinesias (involuntary movements)
as a common adverse effect, particularly with long-term use. Bradykinesia,
rigidity, and tremor are symptoms of Parkinson's disease itself, not adverse
effects of the medication.
7. A client with diabetes mellitus type 1 is brought to the emergency department
with nausea, vomiting, and abdominal pain. The client's breath has a fruity odor.
Which arterial blood gas (ABG) result would the nurse expect?
A) pH 7.32, PaCO2 48, HCO3 30
B) pH 7.48, PaCO2 32, HCO3 22
C) pH 7.25, PaCO2 30, HCO3 14
D) pH 7.55, PaCO2 25, HCO3 20
Answer: C) pH 7.25, PaCO2 30, HCO3 14
Explanation: The client is presenting with signs of diabetic ketoacidosis (DKA),
which is characterized by metabolic acidosis. The ABG would show a low pH
(<7.35), low HCO3 (<22), and a compensatory low PaCO2 due to Kussmaul
breathing. Option C is the only one that shows metabolic acidosis with a low pH
and low bicarbonate.
8. The nurse is teaching a client with a new diagnosis of atrial fibrillation about
anticoagulant therapy with warfarin. Which statement indicates that the client
needs further teaching?
, A) "I will need to have my blood drawn regularly to check my INR."
B) "I should use a soft-bristled toothbrush to prevent bleeding gums."
C) "I will need to avoid eating foods high in vitamin K like spinach and broccoli."
D) "If I miss a dose, I should double the next dose to make up for it."
Answer: D) "If I miss a dose, I should double the next dose to make up for
it."
Explanation: Clients should never double a dose of warfarin if they miss one, as
this significantly increases the risk of bleeding. They should take the missed dose
as soon as remembered if it's the same day, and skip it if it's the next day, then
resume the normal schedule. The other statements are correct.
9. A client is 2 days post-operative following a total hip arthroplasty. Which nursing
intervention is essential to prevent dislocation of the new joint?
A) Keep the client in a high-Fowler's position
B) Maintain the client's legs in an abducted position using a pillow
C) Encourage the client to cross legs at the ankles to stretch
D) Place the client in a prone position for 30 minutes four times daily
Answer: B) Maintain the client's legs in an abducted position using a pillow
Explanation: To prevent dislocation of a hip prosthesis, the client's legs should be
kept abducted (spread apart). Crossing the legs, adducting the legs, or bending
the hip more than 90 degrees puts the client at risk for dislocation. A pillow
between the legs maintains abduction.
10. The nurse is caring for a client with acute pancreatitis. Which laboratory value
would be most concerning?
A) Serum amylase 300 U/L
B) Serum lipase 400 U/L
C) Serum calcium 6.8 mg/dL
D) Blood glucose 140 mg/dL
Answer: C) Serum calcium 6.8 mg/dL
Explanation: In acute pancreatitis, hypocalcemia (calcium <8.5 mg/dL) is a poor
prognostic sign and can indicate fat necrosis and saponification. It may lead to
