NUR 257 Chronic Exam 3 Fall 2025/2026 | Galen College of Nursing Chronic
Conditions Exam 3 with Complete Questions & 100% Correct Answers
### Q1. 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?
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 .
---
### Q2. A patient with type 2 diabetes is prescribed insulin glargine (Lantus). The
nurse should educate that:
A) It is a clear insulin that should not be mixed with other insulins
B) It is a cloudy insulin that should be rolled before use
C) It has a peak effect at 4-6 hours
D) It is given before meals
**Answer:** A
**Rationale:** Insulin glargine is a clear, long-acting insulin with no pronounced
peak. It should not be mixed with other insulins in the same syringe. It is given once
daily at the same time each day to provide basal coverage .
---
, ### Q3. A patient with type 2 diabetes and heart failure is started on an
antidiabetic medication. Which medication is contraindicated?
A) Metformin
B) Empagliflozin
C) Pioglitazone
D) Semaglutide
**Answer:** C
**Rationale:** Pioglitazone (a thiazolidinedione) causes fluid retention and can
precipitate or worsen heart failure. It is contraindicated in patients with NYHA class
III or IV heart failure. SGLT2 inhibitors like empagliflozin are actually beneficial in
HF .
---
### Q4. A patient with type 1 diabetes is found unresponsive with a blood glucose
of 32 mg/dL. IV access is not available. Which action should be taken first?
A) Administer orange juice orally
B) Administer glucagon 1 mg IM
C) Recheck blood glucose
D) Administer IV dextrose 50%
**Answer:** B
**Rationale:** For an unresponsive patient with severe hypoglycemia, glucagon 1
mg IM is given if IV access is not available. Oral glucose cannot be given to an
unresponsive patient due to aspiration risk. Once awake, oral carbohydrates should
follow .
---
### Q5. A 72-year-old male with heart failure with reduced ejection fraction (HFrEF,
EF 35%), hypertension, and type 2 diabetes is on lisinopril, metformin, and
furosemide. Which medication should be added as part of guideline-directed
medical therapy (GDMT) for HFrEF?
Conditions Exam 3 with Complete Questions & 100% Correct Answers
### Q1. 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?
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 .
---
### Q2. A patient with type 2 diabetes is prescribed insulin glargine (Lantus). The
nurse should educate that:
A) It is a clear insulin that should not be mixed with other insulins
B) It is a cloudy insulin that should be rolled before use
C) It has a peak effect at 4-6 hours
D) It is given before meals
**Answer:** A
**Rationale:** Insulin glargine is a clear, long-acting insulin with no pronounced
peak. It should not be mixed with other insulins in the same syringe. It is given once
daily at the same time each day to provide basal coverage .
---
, ### Q3. A patient with type 2 diabetes and heart failure is started on an
antidiabetic medication. Which medication is contraindicated?
A) Metformin
B) Empagliflozin
C) Pioglitazone
D) Semaglutide
**Answer:** C
**Rationale:** Pioglitazone (a thiazolidinedione) causes fluid retention and can
precipitate or worsen heart failure. It is contraindicated in patients with NYHA class
III or IV heart failure. SGLT2 inhibitors like empagliflozin are actually beneficial in
HF .
---
### Q4. A patient with type 1 diabetes is found unresponsive with a blood glucose
of 32 mg/dL. IV access is not available. Which action should be taken first?
A) Administer orange juice orally
B) Administer glucagon 1 mg IM
C) Recheck blood glucose
D) Administer IV dextrose 50%
**Answer:** B
**Rationale:** For an unresponsive patient with severe hypoglycemia, glucagon 1
mg IM is given if IV access is not available. Oral glucose cannot be given to an
unresponsive patient due to aspiration risk. Once awake, oral carbohydrates should
follow .
---
### Q5. A 72-year-old male with heart failure with reduced ejection fraction (HFrEF,
EF 35%), hypertension, and type 2 diabetes is on lisinopril, metformin, and
furosemide. Which medication should be added as part of guideline-directed
medical therapy (GDMT) for HFrEF?
