NUR 257 CHRONIC EXAM 1 2026 | VERIFIED
PRACTICE QUESTIONS & ANSWERS | GALEN
COLLEGE COMPLETE STUDY GUIDE WITH
DETAILED RATIONALES
NUR 257 CHRONIC EXAM 1 2026 | VERIFIED PRACTICE QUESTIONS & ANSWERS |
GALEN COLLEGE COMPLETE STUDY GUIDE WITH DETAILED RATIONALES
DOCUMENT OVERVIEW
• This comprehensive study guide contains verified practice questions with detailed
rationales designed to strengthen your understanding of chronic disease
management, nursing assessment, pathophysiology, and clinical interventions
across multiple chronic conditions.
• Use these questions to reinforce key concepts, identify knowledge gaps, practice
test-taking strategies, and build confidence before your NUR 257 Chronic Exam 1 by
reviewing incorrect answers and their detailed explanations.
QUESTIONS
QUESTION 1
A 62-year-old client with a 15-year history of Type 2 diabetes mellitus presents
to the clinic with a fasting blood glucose of 185 mg/dL despite taking
metformin 1000 mg twice daily. The nurse recognizes this as inadequate
glycemic control. Which additional medication would the primary care
provider most likely prescribe to achieve better glucose management?
A) Insulin glargine immediately to replace metformin
B) Sulfonylurea such as glipizide to stimulate pancreatic beta cells
C) Acarbose to slow carbohydrate absorption in the intestines
D) Diuretic to enhance renal excretion of glucose
E) Aspirin to improve insulin sensitivity
, CORRECT ANSWER: B) Sulfonylurea such as glipizide to stimulate
pancreatic beta cells
RATIONALE: When metformin monotherapy fails to achieve glycemic control in
Type 2 diabetes, a second agent is typically added. Sulfonylureas work by
stimulating the pancreas to release more insulin, making them an appropriate
second-line agent. Insulin is usually reserved for later stages when beta cell
function significantly declines. Acarbose is a third-line option. Diuretics and aspirin
do not have direct glucose-lowering effects. The question specifically indicates
inadequate control on current therapy, supporting the addition of another agent
rather than replacement or monotherapy adjustment.
QUESTION 2
A 58-year-old female with hypertension is prescribed lisinopril, an ACE
inhibitor. Which side effect would the nurse specifically counsel the patient to
expect and report immediately?
A) Hyperkalemia and a persistent dry cough
B) Hypoglycemia and weight loss
C) Hypokalemia and increased appetite
D) Tachycardia and tremors
E) Constipation and sedation
CORRECT ANSWER: A) Hyperkalemia and a persistent dry cough
RATIONALE: ACE inhibitors like lisinopril have two characteristic side effects: (1) a
persistent dry cough affecting 10-20% of patients due to accumulation of
bradykinin in the lungs, and (2) hyperkalemia because they decrease aldosterone
secretion, reducing potassium excretion. Patients should report severe cough
immediately as it may indicate angioedema, a serious adverse effect.
Hypoglycemia, weight changes, tachycardia, tremors, constipation, and sedation
are not typical ACE inhibitor effects and represent other drug classes or conditions.
,QUESTION 3
A 70-year-old client with COPD (GOLD Stage 3) is admitted with acute
exacerbation. Arterial blood gas analysis shows pH 7.32, PaCO2 58 mmHg,
HCO3− 26 mEq/L. What acid-base disturbance is this patient experiencing?
A) Metabolic acidosis with partial respiratory compensation
B) Respiratory acidosis with partial metabolic compensation
C) Metabolic alkalosis with respiratory compensation
D) Respiratory alkalosis with metabolic acidosis
E) Mixed acidosis-alkalosis disorder
CORRECT ANSWER: B) Respiratory acidosis with partial metabolic
compensation
RATIONALE: The ABG interpretation requires systematic analysis: (1) pH is low
(7.32) = acidemia; (2) PaCO2 is elevated (58) = respiratory component causing
acidosis; (3) HCO3− is elevated (26) = kidneys are attempting compensation by
retaining bicarbonate. This pattern is respiratory acidosis because the primary
problem (elevated CO2) is respiratory, and the kidneys are compensating (raising
HCO3−). In COPD with acute exacerbation, CO2 retention occurs due to increased
airway resistance and ventilation-perfusion mismatch, leading to hypercapnia and
respiratory acidosis.
QUESTION 4
A 54-year-old male with heart failure (EF 35%) is prescribed furosemide 40 mg
daily and lisinopril. Which assessment finding would most concern the nurse
and require immediate intervention?
A) Mild peripheral edema in the ankles bilaterally
B) Weight gain of 3 pounds in 2 days
C) Blood pressure of 110/68 mmHg
D) Urine output of 2000 mL in 24 hours
, E) Serum potassium of 4.2 mEq/L
CORRECT ANSWER: B) Weight gain of 3 pounds in 2 days
RATIONALE: Rapid weight gain (3 pounds in 2 days equals approximately 1.5 liters
of fluid retention) is a classic early sign of acute decompensation in heart failure
and requires immediate intervention. One pound of body weight equals
approximately 500 mL of fluid; therefore, 3 pounds represents significant fluid
retention indicating worsening heart failure status. This necessitates medication
adjustment, increased diuresis, and possible hospitalization. Mild edema is
expected, BP is stable, urine output is adequate, and potassium is within normal
range (3.5-5.0 mEq/L), so these findings are reassuring rather than concerning.
QUESTION 5
A 66-year-old client with newly diagnosed atrial fibrillation is prescribed
warfarin for stroke prevention. The nurse educates the patient about dietary
vitamin K intake. Which statement by the patient indicates correct
understanding?
A) "I should avoid all foods containing vitamin K because it interferes with warfarin."
B) "I need to maintain consistent vitamin K intake rather than avoid it completely, as
it affects warfarin metabolism."
C) "Vitamin K has no interaction with warfarin, so I can eat unlimited amounts."
D) "I should only eat vitamin K-rich foods on weekends when I take extra warfarin."
E) "Warfarin is water-soluble and is not affected by any dietary factors."
CORRECT ANSWER: B) "I need to maintain consistent vitamin K intake
rather than avoid it completely, as it affects warfarin metabolism."
RATIONALE: Vitamin K is a cofactor for the synthesis of clotting factors II, VII, IX,
and X. Warfarin works by antagonizing vitamin K. The key principle is consistency,
not avoidance. Fluctuating vitamin K intake causes fluctuations in INR values,
making anticoagulation management unstable. Patients should maintain a
consistent diet with stable vitamin K intake and avoid sudden increases or
PRACTICE QUESTIONS & ANSWERS | GALEN
COLLEGE COMPLETE STUDY GUIDE WITH
DETAILED RATIONALES
NUR 257 CHRONIC EXAM 1 2026 | VERIFIED PRACTICE QUESTIONS & ANSWERS |
GALEN COLLEGE COMPLETE STUDY GUIDE WITH DETAILED RATIONALES
DOCUMENT OVERVIEW
• This comprehensive study guide contains verified practice questions with detailed
rationales designed to strengthen your understanding of chronic disease
management, nursing assessment, pathophysiology, and clinical interventions
across multiple chronic conditions.
• Use these questions to reinforce key concepts, identify knowledge gaps, practice
test-taking strategies, and build confidence before your NUR 257 Chronic Exam 1 by
reviewing incorrect answers and their detailed explanations.
QUESTIONS
QUESTION 1
A 62-year-old client with a 15-year history of Type 2 diabetes mellitus presents
to the clinic with a fasting blood glucose of 185 mg/dL despite taking
metformin 1000 mg twice daily. The nurse recognizes this as inadequate
glycemic control. Which additional medication would the primary care
provider most likely prescribe to achieve better glucose management?
A) Insulin glargine immediately to replace metformin
B) Sulfonylurea such as glipizide to stimulate pancreatic beta cells
C) Acarbose to slow carbohydrate absorption in the intestines
D) Diuretic to enhance renal excretion of glucose
E) Aspirin to improve insulin sensitivity
, CORRECT ANSWER: B) Sulfonylurea such as glipizide to stimulate
pancreatic beta cells
RATIONALE: When metformin monotherapy fails to achieve glycemic control in
Type 2 diabetes, a second agent is typically added. Sulfonylureas work by
stimulating the pancreas to release more insulin, making them an appropriate
second-line agent. Insulin is usually reserved for later stages when beta cell
function significantly declines. Acarbose is a third-line option. Diuretics and aspirin
do not have direct glucose-lowering effects. The question specifically indicates
inadequate control on current therapy, supporting the addition of another agent
rather than replacement or monotherapy adjustment.
QUESTION 2
A 58-year-old female with hypertension is prescribed lisinopril, an ACE
inhibitor. Which side effect would the nurse specifically counsel the patient to
expect and report immediately?
A) Hyperkalemia and a persistent dry cough
B) Hypoglycemia and weight loss
C) Hypokalemia and increased appetite
D) Tachycardia and tremors
E) Constipation and sedation
CORRECT ANSWER: A) Hyperkalemia and a persistent dry cough
RATIONALE: ACE inhibitors like lisinopril have two characteristic side effects: (1) a
persistent dry cough affecting 10-20% of patients due to accumulation of
bradykinin in the lungs, and (2) hyperkalemia because they decrease aldosterone
secretion, reducing potassium excretion. Patients should report severe cough
immediately as it may indicate angioedema, a serious adverse effect.
Hypoglycemia, weight changes, tachycardia, tremors, constipation, and sedation
are not typical ACE inhibitor effects and represent other drug classes or conditions.
,QUESTION 3
A 70-year-old client with COPD (GOLD Stage 3) is admitted with acute
exacerbation. Arterial blood gas analysis shows pH 7.32, PaCO2 58 mmHg,
HCO3− 26 mEq/L. What acid-base disturbance is this patient experiencing?
A) Metabolic acidosis with partial respiratory compensation
B) Respiratory acidosis with partial metabolic compensation
C) Metabolic alkalosis with respiratory compensation
D) Respiratory alkalosis with metabolic acidosis
E) Mixed acidosis-alkalosis disorder
CORRECT ANSWER: B) Respiratory acidosis with partial metabolic
compensation
RATIONALE: The ABG interpretation requires systematic analysis: (1) pH is low
(7.32) = acidemia; (2) PaCO2 is elevated (58) = respiratory component causing
acidosis; (3) HCO3− is elevated (26) = kidneys are attempting compensation by
retaining bicarbonate. This pattern is respiratory acidosis because the primary
problem (elevated CO2) is respiratory, and the kidneys are compensating (raising
HCO3−). In COPD with acute exacerbation, CO2 retention occurs due to increased
airway resistance and ventilation-perfusion mismatch, leading to hypercapnia and
respiratory acidosis.
QUESTION 4
A 54-year-old male with heart failure (EF 35%) is prescribed furosemide 40 mg
daily and lisinopril. Which assessment finding would most concern the nurse
and require immediate intervention?
A) Mild peripheral edema in the ankles bilaterally
B) Weight gain of 3 pounds in 2 days
C) Blood pressure of 110/68 mmHg
D) Urine output of 2000 mL in 24 hours
, E) Serum potassium of 4.2 mEq/L
CORRECT ANSWER: B) Weight gain of 3 pounds in 2 days
RATIONALE: Rapid weight gain (3 pounds in 2 days equals approximately 1.5 liters
of fluid retention) is a classic early sign of acute decompensation in heart failure
and requires immediate intervention. One pound of body weight equals
approximately 500 mL of fluid; therefore, 3 pounds represents significant fluid
retention indicating worsening heart failure status. This necessitates medication
adjustment, increased diuresis, and possible hospitalization. Mild edema is
expected, BP is stable, urine output is adequate, and potassium is within normal
range (3.5-5.0 mEq/L), so these findings are reassuring rather than concerning.
QUESTION 5
A 66-year-old client with newly diagnosed atrial fibrillation is prescribed
warfarin for stroke prevention. The nurse educates the patient about dietary
vitamin K intake. Which statement by the patient indicates correct
understanding?
A) "I should avoid all foods containing vitamin K because it interferes with warfarin."
B) "I need to maintain consistent vitamin K intake rather than avoid it completely, as
it affects warfarin metabolism."
C) "Vitamin K has no interaction with warfarin, so I can eat unlimited amounts."
D) "I should only eat vitamin K-rich foods on weekends when I take extra warfarin."
E) "Warfarin is water-soluble and is not affected by any dietary factors."
CORRECT ANSWER: B) "I need to maintain consistent vitamin K intake
rather than avoid it completely, as it affects warfarin metabolism."
RATIONALE: Vitamin K is a cofactor for the synthesis of clotting factors II, VII, IX,
and X. Warfarin works by antagonizing vitamin K. The key principle is consistency,
not avoidance. Fluctuating vitamin K intake causes fluctuations in INR values,
making anticoagulation management unstable. Patients should maintain a
consistent diet with stable vitamin K intake and avoid sudden increases or
