NUR 257 Chronic Exam 3 | 100
Actual Questions and Answers |
2025 Update | 100% Correct With
Rationales (GURANTEED PASS)
Q1. A 78-year-old patient with type 2 diabetes has an HbA1c of 7.2%
on metformin. The patient has a history of falls and cognitive
impairment. What is the most appropriate HbA1c target?
A) <6.5%
B) <7.0%
C) <7.5%
D) <8.0-8.5% ✓
Rationale: For older adults with multiple comorbidities, limited life
expectancy, or cognitive impairment, less stringent HbA1c targets (7.5-
8.5%) are recommended to avoid hypoglycemia. Tight control increases the
risk of falls and adverse cardiovascular events in this population .
Q2. A patient with type 2 diabetes and heart failure is started on an
antidiabetic medication. Which medication is contraindicated?
A) Metformin
B) Empagliflozin
C) Pioglitazone ✓
D) Semaglutide
Rationale: Pioglitazone (a thiazolidinedione) causes fluid retention and can
precipitate or worsen heart failure. It is contraindicated in patients with
NYHA class III or IV heart failure. SGLT2 inhibitors like empagliflozin are
actually beneficial in HF .
, Q3. A patient with type 1 diabetes is found unresponsive with a blood
glucose of 32 mg/dL. IV access is not available. Which action should be
taken first?
A) Administer orange juice orally
B) Administer glucagon 1 mg IM ✓
C) Recheck blood glucose
D) Administer IV dextrose 50%
Rationale: For an unresponsive patient with severe hypoglycemia,
glucagon 1 mg IM is given if IV access is not available. Oral glucose cannot
be given to an unresponsive patient due to aspiration risk .
Q4. A patient with type 2 diabetes and CKD (eGFR 40 mL/min) is on
metformin and glipizide. Which medication is preferred for additional
glycemic control in CKD?
A) Metformin (already on)
B) Glipizide (already on)
C) Empagliflozin (SGLT2 inhibitor) ✓
D) Pioglitazone
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have renal
protective benefits and can be used in CKD (eGFR ≥30). Metformin dose
adjustment is needed at eGFR <45 .
Heart Failure and Cardiovascular
Q5. A 72-year-old male with heart failure with reduced ejection
fraction (HFrEF, EF 35%), hypertension, and type 2 diabetes is on
lisinopril, metformin, and furosemide. Which medication should be
added as part of guideline-directed medical therapy (GDMT) for
HFrEF?
, A) Amlodipine
B) Spironolactone ✓
C) Metformin
D) Pioglitazone
Rationale: Spironolactone (a mineralocorticoid receptor antagonist)
reduces mortality and hospitalizations in HFrEF (RALES trial). It is indicated
for patients with NYHA class II-IV HFrEF and EF ≤35% .
Q6. A 55-year-old Black male with stage 1 hypertension and no other
comorbidities is started on an antihypertensive. Which medication
class is recommended as first-line monotherapy for Black patients?
A) ACE inhibitor
B) ARB
C) Thiazide diuretic or calcium channel blocker ✓
D) Beta-blocker
Rationale: In Black patients, first-line antihypertensives are thiazide
diuretics or calcium channel blockers. ACE inhibitors and ARBs are less
effective as monotherapy in this population due to lower renin levels .
Q7. An 80-year-old with HF and CKD has new fatigue and confusion.
Which medication is most likely causative?
A) Furosemide
B) Lisinopril
C) Digoxin ✓
D) Metoprolol
Rationale: Digoxin toxicity risk increases with chronic kidney disease (CKD),
presenting with fatigue, nausea, confusion, and arrhythmias. Digoxin levels
should be monitored closely in older adults with renal impairment .
, Respiratory
Q8. A 65-year-old male with COPD (GOLD stage 3) on LABA/ICS
reports increased dyspnea and wheezing. What is the most
appropriate next step?
A) Increase LABA/ICS dose
B) Add a long-acting muscarinic antagonist (LAMA) (e.g.,
tiotropium) ✓
C) Prescribe oral prednisone
D) Order a chest x-ray
Rationale: GOLD guidelines recommend adding a LAMA (tiotropium) for
patients with GOLD stage 3 or 4 COPD who remain symptomatic on
LABA/ICS .
Key respiratory assessment focus: Assessment focuses on oxygen
saturation, sputum production, respiratory rate, and subjective reports of
dyspnea. Include complete health history and treatment plans .
Neurocognitive Disorders (The "3 Ds")
Q9. A patient with dementia suddenly becomes more confused and
agitated. What is the priority action?
A) Administer haloperidol as needed
B) Assess for infection (e.g., UTI, pneumonia) ✓
C) Increase environmental stimulation
D) Restrain for safety
Rationale: Acute delirium in dementia is often triggered by infection,
metabolic issues, or medications. A sudden change in mental status in an
older adult should always prompt an assessment for an underlying medical
cause, such as a UTI .
Actual Questions and Answers |
2025 Update | 100% Correct With
Rationales (GURANTEED PASS)
Q1. A 78-year-old patient with type 2 diabetes has an HbA1c of 7.2%
on metformin. The patient has a history of falls and cognitive
impairment. What is the most appropriate HbA1c target?
A) <6.5%
B) <7.0%
C) <7.5%
D) <8.0-8.5% ✓
Rationale: For older adults with multiple comorbidities, limited life
expectancy, or cognitive impairment, less stringent HbA1c targets (7.5-
8.5%) are recommended to avoid hypoglycemia. Tight control increases the
risk of falls and adverse cardiovascular events in this population .
Q2. A patient with type 2 diabetes and heart failure is started on an
antidiabetic medication. Which medication is contraindicated?
A) Metformin
B) Empagliflozin
C) Pioglitazone ✓
D) Semaglutide
Rationale: Pioglitazone (a thiazolidinedione) causes fluid retention and can
precipitate or worsen heart failure. It is contraindicated in patients with
NYHA class III or IV heart failure. SGLT2 inhibitors like empagliflozin are
actually beneficial in HF .
, Q3. A patient with type 1 diabetes is found unresponsive with a blood
glucose of 32 mg/dL. IV access is not available. Which action should be
taken first?
A) Administer orange juice orally
B) Administer glucagon 1 mg IM ✓
C) Recheck blood glucose
D) Administer IV dextrose 50%
Rationale: For an unresponsive patient with severe hypoglycemia,
glucagon 1 mg IM is given if IV access is not available. Oral glucose cannot
be given to an unresponsive patient due to aspiration risk .
Q4. A patient with type 2 diabetes and CKD (eGFR 40 mL/min) is on
metformin and glipizide. Which medication is preferred for additional
glycemic control in CKD?
A) Metformin (already on)
B) Glipizide (already on)
C) Empagliflozin (SGLT2 inhibitor) ✓
D) Pioglitazone
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have renal
protective benefits and can be used in CKD (eGFR ≥30). Metformin dose
adjustment is needed at eGFR <45 .
Heart Failure and Cardiovascular
Q5. A 72-year-old male with heart failure with reduced ejection
fraction (HFrEF, EF 35%), hypertension, and type 2 diabetes is on
lisinopril, metformin, and furosemide. Which medication should be
added as part of guideline-directed medical therapy (GDMT) for
HFrEF?
, A) Amlodipine
B) Spironolactone ✓
C) Metformin
D) Pioglitazone
Rationale: Spironolactone (a mineralocorticoid receptor antagonist)
reduces mortality and hospitalizations in HFrEF (RALES trial). It is indicated
for patients with NYHA class II-IV HFrEF and EF ≤35% .
Q6. A 55-year-old Black male with stage 1 hypertension and no other
comorbidities is started on an antihypertensive. Which medication
class is recommended as first-line monotherapy for Black patients?
A) ACE inhibitor
B) ARB
C) Thiazide diuretic or calcium channel blocker ✓
D) Beta-blocker
Rationale: In Black patients, first-line antihypertensives are thiazide
diuretics or calcium channel blockers. ACE inhibitors and ARBs are less
effective as monotherapy in this population due to lower renin levels .
Q7. An 80-year-old with HF and CKD has new fatigue and confusion.
Which medication is most likely causative?
A) Furosemide
B) Lisinopril
C) Digoxin ✓
D) Metoprolol
Rationale: Digoxin toxicity risk increases with chronic kidney disease (CKD),
presenting with fatigue, nausea, confusion, and arrhythmias. Digoxin levels
should be monitored closely in older adults with renal impairment .
, Respiratory
Q8. A 65-year-old male with COPD (GOLD stage 3) on LABA/ICS
reports increased dyspnea and wheezing. What is the most
appropriate next step?
A) Increase LABA/ICS dose
B) Add a long-acting muscarinic antagonist (LAMA) (e.g.,
tiotropium) ✓
C) Prescribe oral prednisone
D) Order a chest x-ray
Rationale: GOLD guidelines recommend adding a LAMA (tiotropium) for
patients with GOLD stage 3 or 4 COPD who remain symptomatic on
LABA/ICS .
Key respiratory assessment focus: Assessment focuses on oxygen
saturation, sputum production, respiratory rate, and subjective reports of
dyspnea. Include complete health history and treatment plans .
Neurocognitive Disorders (The "3 Ds")
Q9. A patient with dementia suddenly becomes more confused and
agitated. What is the priority action?
A) Administer haloperidol as needed
B) Assess for infection (e.g., UTI, pneumonia) ✓
C) Increase environmental stimulation
D) Restrain for safety
Rationale: Acute delirium in dementia is often triggered by infection,
metabolic issues, or medications. A sudden change in mental status in an
older adult should always prompt an assessment for an underlying medical
cause, such as a UTI .
