NUR 257 EXAMINATION BOARD
NUR 257 Chronic Exam 4
Official Practice Exam -- 2026/2027 Edition
Questions: 75 | Time: 90 Minutes | Passing Score: 80% | Recertification
TABLE OF CONTENTS
Section 1: Chronic Illness Management and Health Promotion (15 questions)
Section 2: Cardiovascular and Hematologic Disorders (16 questions)
Section 3: Respiratory and Renal Disorders (15 questions)
Section 4: Neurological and Musculoskeletal Disorders (15 questions)
Section 5: Endocrine and Oncologic Disorders (14 questions)
Answer Key
INSTRUCTIONS
Read each question carefully. Select the ONE best answer from the four options provided.
All questions are equally weighted. There is no penalty for guessing.
You have 90 minutes to complete all 75 questions. A passing score of 80% (60/75) is required.
Mark your answers on the provided answer sheet. Erase any changes completely.
This practice exam reflects the 2026/2027 updated blueprint for NUR 257 Chronic Exam 4.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 1 of 40
, Section 1: Chronic Illness Management and Health Promotion -- 2026/2027
Q1 Question 1 of 75
A 62-year-old woman with type 2 diabetes and hypertension attends a community health fair.
She reports skipping medications on weekends because she feels fine without them. The
nurse should prioritize educating the patient about which consequence of this behavior?
Progressive end-organ damage from sustained subtherapeutic drug levels
Acute hypoglycemic episodes during periods of increased physical activity
Rapid onset of diabetic ketoacidosis due to inconsistent glucose control
Development of medication tolerance requiring escalating dosages over time
Correct Answer: A
Rationale:
Skipping medications leads to sustained periods of subtherapeutic drug levels, allowing persistent
hyperglycemia and hypertension to silently damage end organs. Acute hypoglycemia is unlikely from
omitting medications, and diabetic ketoacidosis is more characteristic of type 1 diabetes with absolute
insulin deficiency.
Q2 Question 2 of 75
A 48-year-old man with chronic obstructive pulmonary disease has smoked one pack per day
for 30 years. He tells the nurse he is not interested in quitting because the damage is already
done. The nurse's best response should emphasize which concept?
The irreversible nature of emphysematous changes makes cessation unlikely to improve
outcomes
Nicotine replacement therapy is only effective in patients with less than a 10-pack-year history
Smoking cessation at any stage slows disease progression and improves treatment
response
Pulmonary rehabilitation outcomes are not influenced by continued tobacco use
Correct Answer: C
Rationale:
Even after decades of smoking, cessation slows the rate of lung function decline and improves
response to bronchodilators. The rate of further damage is significantly reduced by quitting, which is
why cessation remains the single most impactful intervention regardless of disease stage.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 2 of 40
,Q3 Question 3 of 75
A 55-year-old woman with heart failure is readmitted for the third time in four months. She
confides she cannot afford her medications and has been taking half doses to make them
last longer. Which nursing intervention should take priority?
Educating the patient about the importance of full-dose adherence regardless of cost
Requesting the provider switch all medications to once-daily dosing to reduce cost
Arranging home health nursing visits to observe medication administration at home
Contacting social work to explore patient assistance programs and generic alternatives
Correct Answer: D
Rationale:
The root cause is financial, so the priority intervention addresses affordability through patient
assistance programs and generic substitutions. Education alone without removing the financial barrier
will not change behavior, and adjusting dosing frequency does not resolve the cost problem.
Q4 Question 4 of 75
A 70-year-old patient with multiple chronic conditions takes 12 different medications daily.
The nurse notes the patient sometimes confuses the timing of each dose. Which strategy is
most effective in improving medication adherence?
Providing a printed medication schedule organized by time of day for reference
Asking the pharmacy to pre-sort medications into weekly blister packs
Instructing the patient to take all medications at the same time each morning
Reducing the number of medications by asking the provider to discontinue non-essential drugs
Correct Answer: B
Rationale:
Blister packs pre-sorted by the pharmacy eliminate the cognitive burden of sorting multiple medications
by time and day. A printed schedule still requires manual sorting, and combining all medications into
one dose risks drug interactions and ignores pharmacokinetic timing requirements.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 3 of 40
, Q5 Question 5 of 75
A community health nurse is designing a chronic disease self-management program for
adults with arthritis, diabetes, and heart disease. Which theoretical framework is most
appropriate for guiding this program?
Orem's Self-Care Deficit Theory emphasizing the patient's ability to perform self-care
activities
The Health Belief Model focusing on perceived susceptibility and severity of illness
The Transtheoretical Model addressing readiness to change behavior
Maslow's Hierarchy of Needs prioritizing physiological requirements first
Correct Answer: A
Rationale:
Orem's Self-Care Deficit Theory directly addresses the patient's capacity to perform self-care actions
related to their chronic conditions, making it the most appropriate framework for a self-management
program. The other models focus on beliefs, stages of change, or basic needs rather than operational
self-care abilities.
Q6 Question 6 of 75
A 58-year-old man with chronic kidney disease stage 3 asks the nurse about dietary
modifications. His latest lab results show a serum potassium of 5.2 mEq/L and a GFR of 42
mL/min. The nurse should recommend which dietary change?
Increasing dietary protein to 1.5 g/kg/day to prevent muscle wasting
Adding sodium-rich foods to prevent hyponatremia from diuretic therapy
Eliminating all dairy products to reduce phosphorus intake completely
Restricting potassium-rich foods such as bananas, oranges, and potatoes
Correct Answer: D
Rationale:
A serum potassium of 5.2 mEq/L combined with reduced GFR indicates impaired potassium excretion
requiring dietary restriction. High-protein diets are contraindicated in CKD, and complete elimination of
dairy is unnecessary and risks calcium deficiency.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 4 of 40
NUR 257 Chronic Exam 4
Official Practice Exam -- 2026/2027 Edition
Questions: 75 | Time: 90 Minutes | Passing Score: 80% | Recertification
TABLE OF CONTENTS
Section 1: Chronic Illness Management and Health Promotion (15 questions)
Section 2: Cardiovascular and Hematologic Disorders (16 questions)
Section 3: Respiratory and Renal Disorders (15 questions)
Section 4: Neurological and Musculoskeletal Disorders (15 questions)
Section 5: Endocrine and Oncologic Disorders (14 questions)
Answer Key
INSTRUCTIONS
Read each question carefully. Select the ONE best answer from the four options provided.
All questions are equally weighted. There is no penalty for guessing.
You have 90 minutes to complete all 75 questions. A passing score of 80% (60/75) is required.
Mark your answers on the provided answer sheet. Erase any changes completely.
This practice exam reflects the 2026/2027 updated blueprint for NUR 257 Chronic Exam 4.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 1 of 40
, Section 1: Chronic Illness Management and Health Promotion -- 2026/2027
Q1 Question 1 of 75
A 62-year-old woman with type 2 diabetes and hypertension attends a community health fair.
She reports skipping medications on weekends because she feels fine without them. The
nurse should prioritize educating the patient about which consequence of this behavior?
Progressive end-organ damage from sustained subtherapeutic drug levels
Acute hypoglycemic episodes during periods of increased physical activity
Rapid onset of diabetic ketoacidosis due to inconsistent glucose control
Development of medication tolerance requiring escalating dosages over time
Correct Answer: A
Rationale:
Skipping medications leads to sustained periods of subtherapeutic drug levels, allowing persistent
hyperglycemia and hypertension to silently damage end organs. Acute hypoglycemia is unlikely from
omitting medications, and diabetic ketoacidosis is more characteristic of type 1 diabetes with absolute
insulin deficiency.
Q2 Question 2 of 75
A 48-year-old man with chronic obstructive pulmonary disease has smoked one pack per day
for 30 years. He tells the nurse he is not interested in quitting because the damage is already
done. The nurse's best response should emphasize which concept?
The irreversible nature of emphysematous changes makes cessation unlikely to improve
outcomes
Nicotine replacement therapy is only effective in patients with less than a 10-pack-year history
Smoking cessation at any stage slows disease progression and improves treatment
response
Pulmonary rehabilitation outcomes are not influenced by continued tobacco use
Correct Answer: C
Rationale:
Even after decades of smoking, cessation slows the rate of lung function decline and improves
response to bronchodilators. The rate of further damage is significantly reduced by quitting, which is
why cessation remains the single most impactful intervention regardless of disease stage.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 2 of 40
,Q3 Question 3 of 75
A 55-year-old woman with heart failure is readmitted for the third time in four months. She
confides she cannot afford her medications and has been taking half doses to make them
last longer. Which nursing intervention should take priority?
Educating the patient about the importance of full-dose adherence regardless of cost
Requesting the provider switch all medications to once-daily dosing to reduce cost
Arranging home health nursing visits to observe medication administration at home
Contacting social work to explore patient assistance programs and generic alternatives
Correct Answer: D
Rationale:
The root cause is financial, so the priority intervention addresses affordability through patient
assistance programs and generic substitutions. Education alone without removing the financial barrier
will not change behavior, and adjusting dosing frequency does not resolve the cost problem.
Q4 Question 4 of 75
A 70-year-old patient with multiple chronic conditions takes 12 different medications daily.
The nurse notes the patient sometimes confuses the timing of each dose. Which strategy is
most effective in improving medication adherence?
Providing a printed medication schedule organized by time of day for reference
Asking the pharmacy to pre-sort medications into weekly blister packs
Instructing the patient to take all medications at the same time each morning
Reducing the number of medications by asking the provider to discontinue non-essential drugs
Correct Answer: B
Rationale:
Blister packs pre-sorted by the pharmacy eliminate the cognitive burden of sorting multiple medications
by time and day. A printed schedule still requires manual sorting, and combining all medications into
one dose risks drug interactions and ignores pharmacokinetic timing requirements.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 3 of 40
, Q5 Question 5 of 75
A community health nurse is designing a chronic disease self-management program for
adults with arthritis, diabetes, and heart disease. Which theoretical framework is most
appropriate for guiding this program?
Orem's Self-Care Deficit Theory emphasizing the patient's ability to perform self-care
activities
The Health Belief Model focusing on perceived susceptibility and severity of illness
The Transtheoretical Model addressing readiness to change behavior
Maslow's Hierarchy of Needs prioritizing physiological requirements first
Correct Answer: A
Rationale:
Orem's Self-Care Deficit Theory directly addresses the patient's capacity to perform self-care actions
related to their chronic conditions, making it the most appropriate framework for a self-management
program. The other models focus on beliefs, stages of change, or basic needs rather than operational
self-care abilities.
Q6 Question 6 of 75
A 58-year-old man with chronic kidney disease stage 3 asks the nurse about dietary
modifications. His latest lab results show a serum potassium of 5.2 mEq/L and a GFR of 42
mL/min. The nurse should recommend which dietary change?
Increasing dietary protein to 1.5 g/kg/day to prevent muscle wasting
Adding sodium-rich foods to prevent hyponatremia from diuretic therapy
Eliminating all dairy products to reduce phosphorus intake completely
Restricting potassium-rich foods such as bananas, oranges, and potatoes
Correct Answer: D
Rationale:
A serum potassium of 5.2 mEq/L combined with reduced GFR indicates impaired potassium excretion
requiring dietary restriction. High-protein diets are contraindicated in CKD, and complete elimination of
dairy is unnecessary and risks calcium deficiency.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 4 of 40
