NUR 257 Chronic Exam 3 | 45 Practice Questions & Answers |
2026–2027 UPDATED Study Guide | Galen College of
Nursing | Comprehensive NUR 257 Exam Preparation |
Detailed Answers & Rationales | Chronic Disease
Management, Patient Assessment, Nursing Interventions &
Clinical Decision-Making | High-Yield Exam Review |
Objective Assessment Preparation | Complete Q&A Study
Resource | Latest Updated Study Materials | Prepare With
Confidence
CORE DOMAINS :
• Diabetes Mellitus and Glycemic Control
• Cardiovascular Disease: Hypertension, Heart Failure, CAD
• Chronic Respiratory Disorders: COPD, Asthma
• Chronic Kidney Disease and Renal Therapies
• Neurological Disorders: Stroke, Parkinson Disease
• Musculoskeletal Disorders: Osteoarthritis, Rheumatoid Arthritis
• Chronic Pain and Palliative Care
• Oncologic Disorders and Complications
• Anemia and Hematologic Conditions
• Health Promotion and Secondary Prevention
SECTION 1: DIABETES MELLITUS AND GLYCEMIC CONTROL
Q1. A patient with type 2 diabetes is prescribed empagliflozin (Jardiance). The
nurse should instruct the patient to report which symptom that may indicate a
serious adverse effect?
A. Weight gain
B. Genital yeast infection
,C. Polyuria, polydipsia, nausea, and abdominal pain even with normal blood glucose
D. Constipation
Answer: C. Polyuria, polydipsia, nausea, and abdominal pain even with normal
blood glucose
RATIONALE: SGLT2 inhibitors like empagliflozin can cause euglycemic diabetic
ketoacidosis (DKA), where ketoacidosis develops with normal or only moderately elevated
blood glucose. Classic DKA symptoms must be reported immediately. Genital yeast
infections (B) are common but not life-threatening. Weight loss, not gain, occurs.
Constipation (D) is not a primary side effect.
Q2. A patient with type 1 diabetes reports morning hyperglycemia. The nurse
recognizes that this could be due to:
A. Somogyi effect
B. Dawn phenomenon
C. Both A and B
D. Neither A nor B
Answer: C. Both A and B
RATIONALE: Morning hyperglycemia in type 1 diabetes can be caused by the Somogyi
effect (rebound hyperglycemia following nocturnal hypoglycemia) or the dawn
phenomenon (early morning rise in blood glucose due to growth hormone and cortisol
release). Distinguishing between these requires checking blood glucose at 2 -3 AM.
Q3. A patient with type 2 diabetes is prescribed metformin. Which statement by
the patient indicates a need for further teaching?
A. "I should take this medication with meals to prevent stomach upset."
B. "I will have my kidney function checked regularly."
C. "This medication may cause my urine to turn orange."
D. "I should avoid excessive alcohol consumption while taking this medication."
Answer: C. "This medication may cause my urine to turn orange."
,RATIONALE: Metformin does not cause orange urine. This side effect is associated with
phenazopyridine or rifampin. Metformin should be taken with meals to reduce GI upset
(A), kidney function should be monitored (B), and alcohol should be avoided due to risk of
lactic acidosis (D).
Q4. A patient with diabetes is prescribed insulin glargine (Lantus). The nurse
should teach the patient that this insulin:
A. Should be given with meals
B. Has a peak effect in 2-4 hours
C. Provides basal coverage for 24 hours
D. Is a rapid-acting insulin
Answer: C. Provides basal coverage for 24 hours
RATIONALE: Insulin glargine is a long-acting basal insulin that provides a steady level of
insulin for approximately 24 hours without a pronounced peak. It should not be mixed
with other insulins and is typically given once daily at the same time each day.
Q5. A patient with diabetes is experiencing symptoms of hypoglycemia. The
patient is awake and alert. What is the appropriate initial intervention?
A. Administer glucagon IM
B. Give 15 grams of fast-acting carbohydrate
C. Provide a high-protein snack
D. Administer insulin
Answer: B. Give 15 grams of fast-acting carbohydrate
RATIONALE: For a conscious patient with hypoglycemia, the "Rule of 15" should be
followed: give 15 grams of fast-acting carbohydrate (e.g., 4 oz juice, 3-4 glucose tablets),
recheck blood glucose in 15 minutes, and repeat if necessary. Glucagon (A) is for
unconscious patients or when IV access is unavailable.
, Q6. A patient with type 2 diabetes has a glycosylated hemoglobin (A1C) of 8.5%.
The nurse interprets this as:
A. Excellent glycemic control
B. Fair glycemic control
C. Poor glycemic control
D. Normal for age
Answer: C. Poor glycemic control
RATIONALE: The target A1C for most adults with diabetes is less than 7%. An A1C of
8.5% indicates poor glycemic control over the past 2-3 months and requires intervention
to prevent complications.
Q7. A patient with diabetes is starting on insulin therapy. The patient expresses
fear of needles. The nurse's best response is:
A. "You'll get used to it."
B. "Insulin pens have very fine, short needles that cause minimal discomfort."
C. "We can ask the provider to prescribe oral medications instead."
D. "It's only a small prick."
Answer: B. "Insulin pens have very fine, short needles that cause minimal
discomfort."
RATIONALE: Acknowledging the patient's fear and providing accurate information about
modern insulin delivery devices is therapeutic. Dismissing concerns (A, D) or offering
inappropriate alternatives (C) does not address the patient's anxiety.
Q8. A patient with diabetes is at risk for foot complications. Which instruction
should the nurse include in the teaching plan?
A. Soak feet daily in warm water
B. Use a heating pad to warm cold feet
C. Trim toenails straight across
D. Walk barefoot to improve circulation
2026–2027 UPDATED Study Guide | Galen College of
Nursing | Comprehensive NUR 257 Exam Preparation |
Detailed Answers & Rationales | Chronic Disease
Management, Patient Assessment, Nursing Interventions &
Clinical Decision-Making | High-Yield Exam Review |
Objective Assessment Preparation | Complete Q&A Study
Resource | Latest Updated Study Materials | Prepare With
Confidence
CORE DOMAINS :
• Diabetes Mellitus and Glycemic Control
• Cardiovascular Disease: Hypertension, Heart Failure, CAD
• Chronic Respiratory Disorders: COPD, Asthma
• Chronic Kidney Disease and Renal Therapies
• Neurological Disorders: Stroke, Parkinson Disease
• Musculoskeletal Disorders: Osteoarthritis, Rheumatoid Arthritis
• Chronic Pain and Palliative Care
• Oncologic Disorders and Complications
• Anemia and Hematologic Conditions
• Health Promotion and Secondary Prevention
SECTION 1: DIABETES MELLITUS AND GLYCEMIC CONTROL
Q1. A patient with type 2 diabetes is prescribed empagliflozin (Jardiance). The
nurse should instruct the patient to report which symptom that may indicate a
serious adverse effect?
A. Weight gain
B. Genital yeast infection
,C. Polyuria, polydipsia, nausea, and abdominal pain even with normal blood glucose
D. Constipation
Answer: C. Polyuria, polydipsia, nausea, and abdominal pain even with normal
blood glucose
RATIONALE: SGLT2 inhibitors like empagliflozin can cause euglycemic diabetic
ketoacidosis (DKA), where ketoacidosis develops with normal or only moderately elevated
blood glucose. Classic DKA symptoms must be reported immediately. Genital yeast
infections (B) are common but not life-threatening. Weight loss, not gain, occurs.
Constipation (D) is not a primary side effect.
Q2. A patient with type 1 diabetes reports morning hyperglycemia. The nurse
recognizes that this could be due to:
A. Somogyi effect
B. Dawn phenomenon
C. Both A and B
D. Neither A nor B
Answer: C. Both A and B
RATIONALE: Morning hyperglycemia in type 1 diabetes can be caused by the Somogyi
effect (rebound hyperglycemia following nocturnal hypoglycemia) or the dawn
phenomenon (early morning rise in blood glucose due to growth hormone and cortisol
release). Distinguishing between these requires checking blood glucose at 2 -3 AM.
Q3. A patient with type 2 diabetes is prescribed metformin. Which statement by
the patient indicates a need for further teaching?
A. "I should take this medication with meals to prevent stomach upset."
B. "I will have my kidney function checked regularly."
C. "This medication may cause my urine to turn orange."
D. "I should avoid excessive alcohol consumption while taking this medication."
Answer: C. "This medication may cause my urine to turn orange."
,RATIONALE: Metformin does not cause orange urine. This side effect is associated with
phenazopyridine or rifampin. Metformin should be taken with meals to reduce GI upset
(A), kidney function should be monitored (B), and alcohol should be avoided due to risk of
lactic acidosis (D).
Q4. A patient with diabetes is prescribed insulin glargine (Lantus). The nurse
should teach the patient that this insulin:
A. Should be given with meals
B. Has a peak effect in 2-4 hours
C. Provides basal coverage for 24 hours
D. Is a rapid-acting insulin
Answer: C. Provides basal coverage for 24 hours
RATIONALE: Insulin glargine is a long-acting basal insulin that provides a steady level of
insulin for approximately 24 hours without a pronounced peak. It should not be mixed
with other insulins and is typically given once daily at the same time each day.
Q5. A patient with diabetes is experiencing symptoms of hypoglycemia. The
patient is awake and alert. What is the appropriate initial intervention?
A. Administer glucagon IM
B. Give 15 grams of fast-acting carbohydrate
C. Provide a high-protein snack
D. Administer insulin
Answer: B. Give 15 grams of fast-acting carbohydrate
RATIONALE: For a conscious patient with hypoglycemia, the "Rule of 15" should be
followed: give 15 grams of fast-acting carbohydrate (e.g., 4 oz juice, 3-4 glucose tablets),
recheck blood glucose in 15 minutes, and repeat if necessary. Glucagon (A) is for
unconscious patients or when IV access is unavailable.
, Q6. A patient with type 2 diabetes has a glycosylated hemoglobin (A1C) of 8.5%.
The nurse interprets this as:
A. Excellent glycemic control
B. Fair glycemic control
C. Poor glycemic control
D. Normal for age
Answer: C. Poor glycemic control
RATIONALE: The target A1C for most adults with diabetes is less than 7%. An A1C of
8.5% indicates poor glycemic control over the past 2-3 months and requires intervention
to prevent complications.
Q7. A patient with diabetes is starting on insulin therapy. The patient expresses
fear of needles. The nurse's best response is:
A. "You'll get used to it."
B. "Insulin pens have very fine, short needles that cause minimal discomfort."
C. "We can ask the provider to prescribe oral medications instead."
D. "It's only a small prick."
Answer: B. "Insulin pens have very fine, short needles that cause minimal
discomfort."
RATIONALE: Acknowledging the patient's fear and providing accurate information about
modern insulin delivery devices is therapeutic. Dismissing concerns (A, D) or offering
inappropriate alternatives (C) does not address the patient's anxiety.
Q8. A patient with diabetes is at risk for foot complications. Which instruction
should the nurse include in the teaching plan?
A. Soak feet daily in warm water
B. Use a heating pad to warm cold feet
C. Trim toenails straight across
D. Walk barefoot to improve circulation
