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NUR 257 Chronic Conditions | Galen College of Nursing | Academic
Year 2026/2027 | Exam 4 Comprehensive Examination | 200 Verified
Questions and Correct Answer Rationales
Question 1
A 68-year-old client with chronic heart failure reports a 4-lb (1.8-kg) weight gain over the past 3
days, increasing bilateral ankle edema, and worsening shortness of breath when lying flat. The
client has been taking prescribed medications but admits to eating several high-sodium meals
recently. Which nursing action is the priority?
A. Encourage the client to increase oral fluid intake
B. Assess respiratory status and oxygen saturation
C. Teach the client to increase dietary potassium
D. Instruct the client to exercise for 30 minutes daily
Answer: B. Assess respiratory status and oxygen saturation
Explanation: A rapid weight gain accompanied by edema and orthopnea suggests worsening
fluid retention and possible exacerbation of heart failure. The priority is assessment of airway
and breathing, including respiratory effort, lung sounds, and oxygen saturation. Increasing fluids
, could worsen congestion. Potassium intake depends on the client's medications and laboratory
results, and exercise should be individualized after the acute problem is addressed.
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Question 2
A client with type 2 diabetes mellitus has been prescribed metformin. During a follow-up visit,
the nurse reviews the client's laboratory results. Which laboratory value is most important for
evaluating the safety of continued metformin therapy?
A. Serum creatinine and estimated glomerular filtration rate
B. Serum calcium and phosphorus
C. Hemoglobin and hematocrit
D. Serum amylase and lipase
Answer: A. Serum creatinine and estimated glomerular filtration rate
Explanation: Metformin is primarily eliminated by the kidneys, so renal function must be
evaluated. Reduced kidney function can increase the risk of metformin accumulation and lactic
acidosis. Serum creatinine and eGFR are therefore important when assessing whether metformin
remains appropriate. The other laboratory values do not directly determine the safety of routine
metformin therapy.
Question 3
, A 72-year-old client with chronic obstructive pulmonary disease (COPD) becomes increasingly
drowsy and difficult to arouse. The client's respiratory rate is 10/min, oxygen saturation is 86%,
and respirations are shallow. Which action should the nurse take first?
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A. Encourage the client to drink warm fluids
B. Assess airway and breathing and provide prescribed oxygen support
C. Place the client flat in bed
D. Administer the client's scheduled oral medication
Answer: B. Assess airway and breathing and provide prescribed oxygen support
Explanation: Increasing somnolence, hypoxemia, and shallow respirations indicate potentially
worsening respiratory failure. The nurse should immediately assess and support airway and
breathing while following the prescribed oxygen and emergency respiratory-management plan.
Positioning the client upright can also facilitate ventilation. Oral medications should not be
administered to a client with decreased consciousness until swallowing and airway safety are
established.
Question 4
A client with chronic kidney disease has a serum potassium level of 6.5 mEq/L (6.5 mmol/L) and
reports generalized muscle weakness. Which assessment finding requires the nurse's immediate
attention?
A. Dry, itchy skin
B. Mild ankle edema
, C. Peaked T waves on the ECG
D. Decreased appetite
Answer: C. Peaked T waves on the ECG
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Explanation: Severe hyperkalemia can cause life-threatening cardiac dysrhythmias. Peaked T
waves are a classic early ECG manifestation of hyperkalemia and require immediate
intervention. Chronic kidney disease reduces potassium excretion, increasing the risk for
dangerous hyperkalemia. Skin changes, edema, and appetite changes are important chronic
kidney disease findings but are not the immediate threat.
Question 5
A client with rheumatoid arthritis reports severe morning stiffness that improves somewhat after
gentle movement. Which nursing intervention is most appropriate?
A. Encourage prolonged bed rest each morning
B. Encourage gentle range-of-motion activity and prescribed exercise
C. Apply ice continuously to affected joints
D. Avoid all physical activity during periods of stiffness
Answer: B. Encourage gentle range-of-motion activity and prescribed exercise
Explanation: Rheumatoid arthritis commonly causes prolonged morning stiffness. Gentle range-
of-motion exercises and appropriately prescribed physical activity help maintain joint mobility,
muscle strength, and function. Excessive rest can contribute to weakness and loss of mobility.
NUR 257 Chronic Conditions | Galen College of Nursing | Academic
Year 2026/2027 | Exam 4 Comprehensive Examination | 200 Verified
Questions and Correct Answer Rationales
Question 1
A 68-year-old client with chronic heart failure reports a 4-lb (1.8-kg) weight gain over the past 3
days, increasing bilateral ankle edema, and worsening shortness of breath when lying flat. The
client has been taking prescribed medications but admits to eating several high-sodium meals
recently. Which nursing action is the priority?
A. Encourage the client to increase oral fluid intake
B. Assess respiratory status and oxygen saturation
C. Teach the client to increase dietary potassium
D. Instruct the client to exercise for 30 minutes daily
Answer: B. Assess respiratory status and oxygen saturation
Explanation: A rapid weight gain accompanied by edema and orthopnea suggests worsening
fluid retention and possible exacerbation of heart failure. The priority is assessment of airway
and breathing, including respiratory effort, lung sounds, and oxygen saturation. Increasing fluids
, could worsen congestion. Potassium intake depends on the client's medications and laboratory
results, and exercise should be individualized after the acute problem is addressed.
Page | 2
Question 2
A client with type 2 diabetes mellitus has been prescribed metformin. During a follow-up visit,
the nurse reviews the client's laboratory results. Which laboratory value is most important for
evaluating the safety of continued metformin therapy?
A. Serum creatinine and estimated glomerular filtration rate
B. Serum calcium and phosphorus
C. Hemoglobin and hematocrit
D. Serum amylase and lipase
Answer: A. Serum creatinine and estimated glomerular filtration rate
Explanation: Metformin is primarily eliminated by the kidneys, so renal function must be
evaluated. Reduced kidney function can increase the risk of metformin accumulation and lactic
acidosis. Serum creatinine and eGFR are therefore important when assessing whether metformin
remains appropriate. The other laboratory values do not directly determine the safety of routine
metformin therapy.
Question 3
, A 72-year-old client with chronic obstructive pulmonary disease (COPD) becomes increasingly
drowsy and difficult to arouse. The client's respiratory rate is 10/min, oxygen saturation is 86%,
and respirations are shallow. Which action should the nurse take first?
Page | 3
A. Encourage the client to drink warm fluids
B. Assess airway and breathing and provide prescribed oxygen support
C. Place the client flat in bed
D. Administer the client's scheduled oral medication
Answer: B. Assess airway and breathing and provide prescribed oxygen support
Explanation: Increasing somnolence, hypoxemia, and shallow respirations indicate potentially
worsening respiratory failure. The nurse should immediately assess and support airway and
breathing while following the prescribed oxygen and emergency respiratory-management plan.
Positioning the client upright can also facilitate ventilation. Oral medications should not be
administered to a client with decreased consciousness until swallowing and airway safety are
established.
Question 4
A client with chronic kidney disease has a serum potassium level of 6.5 mEq/L (6.5 mmol/L) and
reports generalized muscle weakness. Which assessment finding requires the nurse's immediate
attention?
A. Dry, itchy skin
B. Mild ankle edema
, C. Peaked T waves on the ECG
D. Decreased appetite
Answer: C. Peaked T waves on the ECG
Page | 4
Explanation: Severe hyperkalemia can cause life-threatening cardiac dysrhythmias. Peaked T
waves are a classic early ECG manifestation of hyperkalemia and require immediate
intervention. Chronic kidney disease reduces potassium excretion, increasing the risk for
dangerous hyperkalemia. Skin changes, edema, and appetite changes are important chronic
kidney disease findings but are not the immediate threat.
Question 5
A client with rheumatoid arthritis reports severe morning stiffness that improves somewhat after
gentle movement. Which nursing intervention is most appropriate?
A. Encourage prolonged bed rest each morning
B. Encourage gentle range-of-motion activity and prescribed exercise
C. Apply ice continuously to affected joints
D. Avoid all physical activity during periods of stiffness
Answer: B. Encourage gentle range-of-motion activity and prescribed exercise
Explanation: Rheumatoid arthritis commonly causes prolonged morning stiffness. Gentle range-
of-motion exercises and appropriately prescribed physical activity help maintain joint mobility,
muscle strength, and function. Excessive rest can contribute to weakness and loss of mobility.
