NUR 257 Chronic Exam 3:
Comprehensive Review of Aging and
Chronic Illness Management with
300 Questions with Answers Plus
Rationales/Instant download Pdf
Section 1: Diabetes Mellitus Management
Question 1
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%
Answer: D
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 .
,Question 2
A patient with type 2 diabetes is prescribed insulin glargine
(Lantus). The nurse should educate that:
A) It is a clear insulin that should not be mixed with other
insulins
B) It is a cloudy insulin that should be rolled before use
C) It has a peak effect at 4-6 hours
D) It is given before meals
Answer: A
Rationale: Insulin glargine is a clear, long-acting insulin with no
pronounced peak. It should not be mixed with other insulins in
the same syringe. It is given once daily at the same time each
day to provide basal coverage .
Question 3
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
Answer: C
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 .
,Question 4
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%
Answer: B
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. Once awake, oral carbohydrates
should follow .
Question 5
Insulin binding to its receptor on target cells results in:
A) Decreased cellular glucose uptake
B) Increased facilitated cellular diffusion of glucose
C) Increased glycogen breakdown
D) Decreased protein synthesis
Answer: B
Rationale: Insulin binding to its receptor triggers a cascade
that results in increased facilitated diffusion of glucose into cells
through GLUT4 transporters .
, Question 6
The underlying pathogenic mechanism for type 1 diabetes is:
A) Insulin resistance at the cellular level
B) Pancreatic β-cell destruction
C) Autoimmune destruction of pancreatic alpha cells
D) Decreased insulin receptor sensitivity
Answer: B
Rationale: Type 1 diabetes is characterized by autoimmune
destruction of pancreatic beta cells, leading to absolute insulin
deficiency .
Question 7
Which are microvascular complications of diabetes mellitus?
(Select all that apply.)
A) Cardiovascular disease
B) Nephropathy
C) Retinopathy
D) Stroke
E) Neuropathy
Answer: B, C, E
Rationale: Microvascular complications include nephropathy,
retinopathy, and neuropathy. Cardiovascular disease and stroke
are macrovascular complications .
Comprehensive Review of Aging and
Chronic Illness Management with
300 Questions with Answers Plus
Rationales/Instant download Pdf
Section 1: Diabetes Mellitus Management
Question 1
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%
Answer: D
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 .
,Question 2
A patient with type 2 diabetes is prescribed insulin glargine
(Lantus). The nurse should educate that:
A) It is a clear insulin that should not be mixed with other
insulins
B) It is a cloudy insulin that should be rolled before use
C) It has a peak effect at 4-6 hours
D) It is given before meals
Answer: A
Rationale: Insulin glargine is a clear, long-acting insulin with no
pronounced peak. It should not be mixed with other insulins in
the same syringe. It is given once daily at the same time each
day to provide basal coverage .
Question 3
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
Answer: C
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 .
,Question 4
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%
Answer: B
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. Once awake, oral carbohydrates
should follow .
Question 5
Insulin binding to its receptor on target cells results in:
A) Decreased cellular glucose uptake
B) Increased facilitated cellular diffusion of glucose
C) Increased glycogen breakdown
D) Decreased protein synthesis
Answer: B
Rationale: Insulin binding to its receptor triggers a cascade
that results in increased facilitated diffusion of glucose into cells
through GLUT4 transporters .
, Question 6
The underlying pathogenic mechanism for type 1 diabetes is:
A) Insulin resistance at the cellular level
B) Pancreatic β-cell destruction
C) Autoimmune destruction of pancreatic alpha cells
D) Decreased insulin receptor sensitivity
Answer: B
Rationale: Type 1 diabetes is characterized by autoimmune
destruction of pancreatic beta cells, leading to absolute insulin
deficiency .
Question 7
Which are microvascular complications of diabetes mellitus?
(Select all that apply.)
A) Cardiovascular disease
B) Nephropathy
C) Retinopathy
D) Stroke
E) Neuropathy
Answer: B, C, E
Rationale: Microvascular complications include nephropathy,
retinopathy, and neuropathy. Cardiovascular disease and stroke
are macrovascular complications .
