NUR 257 Chronic Exam 3:
Comprehensive High-Yield Q&A
Study Guide with Evidence-Based
Rationales for Cardiovascular,
Endocrine, Respiratory, Renal &
Geriatric Chronic Care Nursing
Diabetes Mellitus & Endocrine
Q: A client with diabetes becomes acutely ill with the flu and is unable
to eat. What is the priority education for the nurse to provide?
Correct Answer: Contact the provider; inability to eat or persistent
vomiting requires prompt communication for medication adjustments and
further instructions.
Rationale: Illness commonly raises blood glucose due to increased cortisol,
glucagon, and catecholamine release. Stopping medications without
guidance or doubling doses is unsafe .
Q: A type 2 diabetic client has a blood glucose level of 44 mg/dL. What
action by the nurse is the priority?
Correct Answer: Provide a fast-acting carbohydrate (e.g., 8-ounce glass of
milk).
Rationale: A BG of 44 mg/dL is severe hypoglycemia requiring immediate
,carbohydrate. Milk provides carbohydrate and some protein; after
treatment, BG should be rechecked .
Q: The nurse is teaching a client with diabetes about sick day
management. Which statement indicates understanding?
Correct Answer: "I will check my blood glucose every 4 hours while sick."
Rationale: Frequent glucose monitoring during illness helps detect
hyperglycemia early. Insulin usually should NOT be stopped, and the
patient should contact their provider for specific instructions .
Q: A 78-year-old client with type 2 diabetes has a blood glucose of 50
mg/dL. What is the nurse's first action?
Correct Answer: Give 15 g of simple carbohydrates.
Rationale: Hypoglycemia (blood glucose < 70 mg/dL) requires 15 g of
simple carbohydrates to raise glucose levels. Insulin would worsen
hypoglycemia; treatment is urgent .
Q: What is the primary reason the nurse should teach a client with
diabetes to maintain blood glucose no lower than about 60 mg/dL?
Correct Answer: The brain cannot store glucose and therefore requires a
constant supply.
Rationale: The brain depends almost entirely on circulating glucose for
energy and has minimal storage capacity. Levels below 60 mg/dL risk
neuroglycopenia (confusion, seizures, coma) .
Q: A client with type 2 diabetes has an A1C of 7%. What is the best
explanation by the nurse?
Correct Answer: Average blood glucose was approximately 154 mg/dL
over the past three months, which is above normal.
Rationale: Hemoglobin A1C reflects average glucose over 2–3 months. An
A1C of 7% corresponds to an estimated average glucose of approximately
154 mg/dL .
, Cardiovascular: Heart Failure & Hypertension
Q: A client with heart failure reports a 5-pound weight gain in 3 days.
What is the nurse's priority action?
Correct Answer: Notify the healthcare provider immediately.
Rationale: Rapid weight gain (2–3 lbs in 24 hours or 5 lbs in a week)
indicates fluid retention and worsening heart failure. The provider needs to
evaluate and possibly adjust medications .
Q: The nurse is teaching a client with heart failure about dietary
restrictions. Which statement indicates the client needs further
teaching?
Correct Answer: "I can use salt substitutes freely since they contain no
sodium."
Rationale: Many salt substitutes contain potassium chloride. In heart failure
patients taking ACE inhibitors, ARBs, or potassium-sparing diuretics, this
can cause dangerous hyperkalemia .
Q: A client with CKD stage 4 (eGFR 25 mL/min/1.73m²) and
hypertension has serum potassium of 5.6 mEq/L. Which
antihypertensive medication should be held?
Correct Answer: Lisinopril.
Rationale: ACE inhibitors (lisinopril) can cause hyperkalemia, especially in
CKD. With potassium > 5.5 mEq/L, it should be held. Amlodipine and
metoprolol do not affect potassium .
Q: A 75-year-old client with heart failure has a weight gain of 4 lbs in 2
days. What is the nurse's priority action?
Correct Answer: Notify the healthcare provider.
Rationale: Rapid weight gain in heart failure indicates fluid retention,
requiring provider notification for medication adjustment. Extra diuretic
doses require an order .
Comprehensive High-Yield Q&A
Study Guide with Evidence-Based
Rationales for Cardiovascular,
Endocrine, Respiratory, Renal &
Geriatric Chronic Care Nursing
Diabetes Mellitus & Endocrine
Q: A client with diabetes becomes acutely ill with the flu and is unable
to eat. What is the priority education for the nurse to provide?
Correct Answer: Contact the provider; inability to eat or persistent
vomiting requires prompt communication for medication adjustments and
further instructions.
Rationale: Illness commonly raises blood glucose due to increased cortisol,
glucagon, and catecholamine release. Stopping medications without
guidance or doubling doses is unsafe .
Q: A type 2 diabetic client has a blood glucose level of 44 mg/dL. What
action by the nurse is the priority?
Correct Answer: Provide a fast-acting carbohydrate (e.g., 8-ounce glass of
milk).
Rationale: A BG of 44 mg/dL is severe hypoglycemia requiring immediate
,carbohydrate. Milk provides carbohydrate and some protein; after
treatment, BG should be rechecked .
Q: The nurse is teaching a client with diabetes about sick day
management. Which statement indicates understanding?
Correct Answer: "I will check my blood glucose every 4 hours while sick."
Rationale: Frequent glucose monitoring during illness helps detect
hyperglycemia early. Insulin usually should NOT be stopped, and the
patient should contact their provider for specific instructions .
Q: A 78-year-old client with type 2 diabetes has a blood glucose of 50
mg/dL. What is the nurse's first action?
Correct Answer: Give 15 g of simple carbohydrates.
Rationale: Hypoglycemia (blood glucose < 70 mg/dL) requires 15 g of
simple carbohydrates to raise glucose levels. Insulin would worsen
hypoglycemia; treatment is urgent .
Q: What is the primary reason the nurse should teach a client with
diabetes to maintain blood glucose no lower than about 60 mg/dL?
Correct Answer: The brain cannot store glucose and therefore requires a
constant supply.
Rationale: The brain depends almost entirely on circulating glucose for
energy and has minimal storage capacity. Levels below 60 mg/dL risk
neuroglycopenia (confusion, seizures, coma) .
Q: A client with type 2 diabetes has an A1C of 7%. What is the best
explanation by the nurse?
Correct Answer: Average blood glucose was approximately 154 mg/dL
over the past three months, which is above normal.
Rationale: Hemoglobin A1C reflects average glucose over 2–3 months. An
A1C of 7% corresponds to an estimated average glucose of approximately
154 mg/dL .
, Cardiovascular: Heart Failure & Hypertension
Q: A client with heart failure reports a 5-pound weight gain in 3 days.
What is the nurse's priority action?
Correct Answer: Notify the healthcare provider immediately.
Rationale: Rapid weight gain (2–3 lbs in 24 hours or 5 lbs in a week)
indicates fluid retention and worsening heart failure. The provider needs to
evaluate and possibly adjust medications .
Q: The nurse is teaching a client with heart failure about dietary
restrictions. Which statement indicates the client needs further
teaching?
Correct Answer: "I can use salt substitutes freely since they contain no
sodium."
Rationale: Many salt substitutes contain potassium chloride. In heart failure
patients taking ACE inhibitors, ARBs, or potassium-sparing diuretics, this
can cause dangerous hyperkalemia .
Q: A client with CKD stage 4 (eGFR 25 mL/min/1.73m²) and
hypertension has serum potassium of 5.6 mEq/L. Which
antihypertensive medication should be held?
Correct Answer: Lisinopril.
Rationale: ACE inhibitors (lisinopril) can cause hyperkalemia, especially in
CKD. With potassium > 5.5 mEq/L, it should be held. Amlodipine and
metoprolol do not affect potassium .
Q: A 75-year-old client with heart failure has a weight gain of 4 lbs in 2
days. What is the nurse's priority action?
Correct Answer: Notify the healthcare provider.
Rationale: Rapid weight gain in heart failure indicates fluid retention,
requiring provider notification for medication adjustment. Extra diuretic
doses require an order .
