Unit 3.4: Long-Term Conditions and Chronic Disease Management

• Topic 01

  Diabetes Mellitus

  45 questions
• Topic 02

  Chronic Obstructive Pulmonary Disease

  48 questions
• Topic 03

  Heart Failure and Chronic Kidney Disease

  51 questions
• Topic 04

  Self-Management Support and Health Coaching

  40 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. Which of the following is the classic clinical triad of diabetic ketoacidosis (DKA)?

   • A
     Hyperglycaemia, hyperosmolality, and absence of ketones
   • B
     Hyperglycaemia, ketonaemia or ketonuria, and metabolic acidosis
     Correct answer
   • C
     Hypoglycaemia, ketonaemia, and respiratory alkalosis
   • D
     Hyperglycaemia, elevated sodium, and raised bicarbonate
   Explanation

   DKA is defined by the clinical triad of: hyperglycaemia (glucose typically >11 mmol/L), ketonaemia (blood ketones ≥3 mmol/L) or ketonuria (≥2+ on dipstick), and metabolic acidosis (pH <7.3 or bicarbonate <15 mmol/L). This distinguishes DKA from HHS, which has very high glucose (>30 mmol/L) and hyperosmolality but no significant ketonaemia or acidosis. DKA occurs most commonly in T1DM but can occur in T2DM patients on SGLT2 inhibitors.

2. Which NYHA class describes a patient who is symptomatic at rest and unable to carry out any physical activity without discomfort?

   • A
     NYHA Class II
   • B
     NYHA Class V (this class does not exist in the NYHA classification)
   • C
     NYHA Class IV
     Correct answer
   • D
     NYHA Class III
   Explanation

   The New York Heart Association (NYHA) functional classification describes symptom severity in heart failure: Class I (no limitation, ordinary activity does not cause symptoms), Class II (slight limitation, comfortable at rest), Class III (marked limitation, less than ordinary activity causes symptoms), Class IV (symptoms at rest, unable to carry out any physical activity without discomfort). The NYHA classification is used to guide treatment decisions and measure response. It has only four classes. MRC Grade 5 is a separate dyspnoea scale used in COPD.

3. A patient with known COPD and type 2 respiratory failure is admitted to the ward. Their SpO2 is 90% on 28% Venturi mask oxygen. A healthcare assistant suggests increasing oxygen to 60% non-rebreather mask to improve saturations further. Why would this be inappropriate?

   • A
     Increasing oxygen is always appropriate when a patient appears breathless, regardless of COPD status
   • B
     Oxygen should only be adjusted by a doctor; a nurse should never comment on oxygen delivery device changes
   • C
     The patient's SpO2 is already within the 88–92% target range for their condition; increasing oxygen risks precipitating hypercapnic respiratory failure
     Correct answer
   • D
     The 28% Venturi mask is already delivering the maximum safe dose of oxygen for this patient's condition
   Explanation

   SpO2 of 90% is within the target range of 88–92% for this patient. Increasing to 60% oxygen via non-rebreather mask could drive SpO2 well above 92%, suppressing hypoxic ventilatory drive and worsening V/Q mismatch — both mechanisms contribute to hypercapnia in susceptible COPD patients. The BTS guideline is explicit: titrate oxygen to achieve target SpO2, not maximum possible SpO2. Nurses have a professional duty under the NMC Code to question unsafe medication orders — oxygen is a prescribed medicine.