NUR 257 Chronic Exam 3 | Actual Questions and
Answers | 2026/2027 Update | 100% Correct - Galen
Section 1: Diabetes Mellitus and Metabolic Disorders
(Questions 1–50)
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
for this patient?
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 .
2. A nurse is teaching a patient with type 2 diabetes about sick-
day management. Which statement should the nurse include?
A. "When ill, avoid eating or drinking to reduce vomiting"
B. "Monitor your blood glucose levels at least every 4 hours while sick"
,C. "Stop taking insulin if you are unable to eat"
D. "Continue your prescribed exercise regimen even if you are sick"
Answer: B
Rationale: During illness, stress hormones increase blood glucose, so patients should
monitor blood glucose more frequently (every 4 hours) . Patients should continue taking
insulin even when unable to eat. Hydration is essential, and exercise should be modified
during illness.
3. A patient with type 2 diabetes is prescribed metformin. What is
the most important instruction the nurse should give regarding
medication administration?
A. Take on an empty stomach for best absorption
B. Take with meals to reduce gastrointestinal side effects
C. Take only when blood glucose is elevated
D. Double the dose if a meal is missed
Answer: B
Rationale: Metformin should be taken with meals to reduce gastrointestinal side effects
such as nausea and diarrhea. It should be taken consistently as prescribed, not only
when glucose is elevated .
4. A 70-year-old patient is scheduled for a CT scan with IV
contrast. The patient takes metformin for type 2 diabetes. What is
the priority nursing action?
A. Administer metformin as scheduled
B. Hold metformin for 48 hours before the procedure
C. Increase the metformin dose after the procedure
D. Switch the patient to insulin permanently
,Answer: B
Rationale: Metformin must be held for 48 hours before IV contrast CT scans due to the
risk of contrast-induced nephropathy and lactic acidosis. Renal function should be
assessed before restarting metformin .
5. A patient with type 2 diabetes is being educated about foot
care. Which statement by the patient indicates correct
understanding?
A. "I should soak my feet in hot water daily"
B. "I can use a mirror to check the bottoms of my feet"
C. "I should apply lotion between my toes"
D. "I can walk barefoot at home"
Answer: B
Rationale: Patients should inspect their feet daily using a mirror to see the bottoms .
They should not soak feet, apply lotion between toes, or walk barefoot due to risk of
injury and infection .
6. A patient with diabetes and peripheral neuropathy asks why
daily foot care is important. What is the best response?
A. "Foot care prevents fungal infections only"
B. "Neuropathy reduces sensation, so you may not feel injuries that can lead to serious
infection"
C. "Foot care is only needed if you have open sores"
D. "You only need foot care if you have pain"
Answer: B
, Rationale: Neuropathy reduces sensation in the feet, so patients may not feel minor
injuries that can become infected and lead to osteomyelitis. Daily inspection and proper
foot care are essential for prevention .
7. A patient with diabetes is upset about needing to take multiple
insulin injections daily and states, "One shot a day should be
enough." What is the nurse's best response?
A. "You are right; I will ask the provider to change your prescription"
B. "One injection a day cannot provide adequate blood glucose control throughout the
day"
C. "You will get used to it eventually"
D. "Insulin shots are not that painful"
Answer: B
Rationale: Multiple injections are often needed to provide both basal and prandial
coverage. A single daily injection cannot adequately manage blood glucose fluctuations.
The nurse should explain the rationale in a supportive manner .
8. A patient with diabetes reports having new glasses prescribed
but still cannot see clearly. What should the nurse suspect?
A. Normal age-related vision changes
B. Hyperglycemia causing lens swelling
C. Cataracts
D. Glaucoma
Answer: B
Rationale: Hyperglycemia causes fluid shifts in the lens, altering its shape and leading
to blurry vision that persists despite new corrective lenses. Vision typically improves
when blood glucose normalizes .
Answers | 2026/2027 Update | 100% Correct - Galen
Section 1: Diabetes Mellitus and Metabolic Disorders
(Questions 1–50)
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
for this patient?
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 .
2. A nurse is teaching a patient with type 2 diabetes about sick-
day management. Which statement should the nurse include?
A. "When ill, avoid eating or drinking to reduce vomiting"
B. "Monitor your blood glucose levels at least every 4 hours while sick"
,C. "Stop taking insulin if you are unable to eat"
D. "Continue your prescribed exercise regimen even if you are sick"
Answer: B
Rationale: During illness, stress hormones increase blood glucose, so patients should
monitor blood glucose more frequently (every 4 hours) . Patients should continue taking
insulin even when unable to eat. Hydration is essential, and exercise should be modified
during illness.
3. A patient with type 2 diabetes is prescribed metformin. What is
the most important instruction the nurse should give regarding
medication administration?
A. Take on an empty stomach for best absorption
B. Take with meals to reduce gastrointestinal side effects
C. Take only when blood glucose is elevated
D. Double the dose if a meal is missed
Answer: B
Rationale: Metformin should be taken with meals to reduce gastrointestinal side effects
such as nausea and diarrhea. It should be taken consistently as prescribed, not only
when glucose is elevated .
4. A 70-year-old patient is scheduled for a CT scan with IV
contrast. The patient takes metformin for type 2 diabetes. What is
the priority nursing action?
A. Administer metformin as scheduled
B. Hold metformin for 48 hours before the procedure
C. Increase the metformin dose after the procedure
D. Switch the patient to insulin permanently
,Answer: B
Rationale: Metformin must be held for 48 hours before IV contrast CT scans due to the
risk of contrast-induced nephropathy and lactic acidosis. Renal function should be
assessed before restarting metformin .
5. A patient with type 2 diabetes is being educated about foot
care. Which statement by the patient indicates correct
understanding?
A. "I should soak my feet in hot water daily"
B. "I can use a mirror to check the bottoms of my feet"
C. "I should apply lotion between my toes"
D. "I can walk barefoot at home"
Answer: B
Rationale: Patients should inspect their feet daily using a mirror to see the bottoms .
They should not soak feet, apply lotion between toes, or walk barefoot due to risk of
injury and infection .
6. A patient with diabetes and peripheral neuropathy asks why
daily foot care is important. What is the best response?
A. "Foot care prevents fungal infections only"
B. "Neuropathy reduces sensation, so you may not feel injuries that can lead to serious
infection"
C. "Foot care is only needed if you have open sores"
D. "You only need foot care if you have pain"
Answer: B
, Rationale: Neuropathy reduces sensation in the feet, so patients may not feel minor
injuries that can become infected and lead to osteomyelitis. Daily inspection and proper
foot care are essential for prevention .
7. A patient with diabetes is upset about needing to take multiple
insulin injections daily and states, "One shot a day should be
enough." What is the nurse's best response?
A. "You are right; I will ask the provider to change your prescription"
B. "One injection a day cannot provide adequate blood glucose control throughout the
day"
C. "You will get used to it eventually"
D. "Insulin shots are not that painful"
Answer: B
Rationale: Multiple injections are often needed to provide both basal and prandial
coverage. A single daily injection cannot adequately manage blood glucose fluctuations.
The nurse should explain the rationale in a supportive manner .
8. A patient with diabetes reports having new glasses prescribed
but still cannot see clearly. What should the nurse suspect?
A. Normal age-related vision changes
B. Hyperglycemia causing lens swelling
C. Cataracts
D. Glaucoma
Answer: B
Rationale: Hyperglycemia causes fluid shifts in the lens, altering its shape and leading
to blurry vision that persists despite new corrective lenses. Vision typically improves
when blood glucose normalizes .
