NUR 257 CHRONIC ILLNESS NURSING
NUR 257 Chronic Exam 4
Official Practice Exam . 2026/2027 Edition
75 Verified Questions with 100%% Correct Answers | Graded A+
Questions Minutes Passing Score Recertification
75 90 80%% Per Semester
TABLE OF CONTENTS
Section 1: Chronic Cardiovascular and Respiratory Disorders . . . . 18 questions
Section 2: Chronic Neurological and Musculoskeletal Disorders . . . . 16 questions
Section 3: Chronic Endocrine and Renal Disorders . . . . 16 questions
Section 4: Chronic Oncological and Hematologic Disorders . . . . 13 questions
Section 5: Psychosocial and Palliative Care in Chronic Illness . . . . 12 questions
Answer Key . . . . . . . . . . . . . . . . . . . . Final Page
EXAM INSTRUCTIONS
You have 90 minutes to complete this exam. There are 75 multiple-choice questions divided into 5 sections. Each
question has four answer choices (A, B, C, D). Select the single best answer for each question. A score of 80%%
or higher (60 correct out of 75) is required to pass. Read each question carefully. All questions are weighted
equally. There is no penalty for guessing, so you should answer every question. The correct answer and rationale
for each question are provided immediately after the question for study purposes.
Disclaimer: This practice exam is an independent study resource and is not affiliated with, endorsed by, or connected to any
nursing school or academic institution. Content is based on publicly available course information and standard nursing exam
topics.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80%% | Page 1 of 33
, SECTION 1: Chronic Cardiovascular and Respiratory Disorders
Q1 Question 1 of 75
A 68-year-old male with a 10-year history of heart failure presents to the clinic with increasing
dyspnea on exertion, 3+ pitting edema in both lower extremities, and a weight gain of 6 pounds over
the past week. His current medications include lisinopril 20 mg daily, furosemide 40 mg daily, and
metoprolol 50 mg twice daily. The priority nursing intervention is to
A. B. Assess lung sounds and notify the provider of potential fluid overload requiring
medication adjustment
B. A. Increase the metoprolol dose to improve cardiac output
C. C. Encourage the patient to increase fluid intake to prevent dehydration
D. D. Discontinue the lisinopril immediately and monitor blood pressure
Correct Answer: A
Rationale:
The patient's symptoms indicate fluid overload, a common complication of heart failure. The priority is to
assess lung sounds for crackles and notify the provider for potential diuretic adjustment. Increasing
metoprolol (A) without provider orders is inappropriate, increasing fluids (C) would worsen fluid overload,
and discontinuing lisinopril (D) could destabilize heart failure management.
Q2 Question 2 of 75
A 72-year-old female with chronic obstructive pulmonary disease (COPD) is admitted with an acute
exacerbation. Her arterial blood gas results show pH 7.30, PaCO2 58 mmHg, PaO2 58 mmHg, and
HCO3 30 mEq/L. The nurse interprets these results as
A. B. Partially compensated respiratory acidosis
B. A. Uncompensated respiratory alkalosis
C. C. Fully compensated metabolic acidosis
D. D. Uncompensated metabolic alkalosis
Correct Answer: A
Rationale:
The low pH (7.30) with elevated PaCO2 (58) indicates respiratory acidosis, and the elevated HCO3 (30)
shows partial renal compensation. Uncompensated respiratory alkalosis (A) would have a high pH with
low PaCO2, fully compensated metabolic acidosis (C) would have a normal pH, and metabolic alkalosis
(D) would have elevated HCO3 as the primary disturbance.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80%% | Page 2 of 33
,Q3 Question 3 of 75
A 65-year-old male with chronic heart failure has an ejection fraction of 30%. He reports difficulty
performing activities of daily living due to fatigue and shortness of breath. According to the New York
Heart Association (NYHA) classification, this patient's functional status is most consistent with Class
A. A. I
B. B. II
C. C. III
D. D. IV
Correct Answer: C
Rationale:
NYHA Class III is defined as marked limitation of physical activity with comfort only at rest; the patient is
comfortable at rest but less-than-ordinary activity causes fatigue, dyspnea, or angina. Class I (A) has no
limitation, Class II (B) has slight limitation with ordinary activity, and Class IV (D) has symptoms at rest.
Q4 Question 4 of 75
A 70-year-old patient with atrial fibrillation is prescribed warfarin 5 mg daily. The patient's INR is 3.8
with a target range of 2.0 to 3.0. The nurse should
A. B. Hold the warfarin and notify the provider for dose adjustment
B. A. Administer the next dose of warfarin as scheduled
C. C. Administer vitamin K 10 mg intravenously immediately
D. D. Double the warfarin dose to achieve therapeutic levels faster
Correct Answer: A
Rationale:
An INR of 3.8 is above the therapeutic range of 2.0-3.0, indicating increased bleeding risk. The nurse
should hold the warfarin and notify the provider for dose adjustment. Continuing the dose (A) increases
bleeding risk, high-dose IV vitamin K (C) is reserved for serious bleeding or extremely elevated INR, and
doubling the dose (D) would dangerously increase the INR.
Q5 Question 5 of 75
A 58-year-old female with chronic hypertension has been taking hydrochlorothiazide 25 mg daily for 6
months. Her most recent laboratory results show a potassium level of 3.1 mEq/L. The nurse
anticipates that the provider will
A. B. Add a potassium supplement or switch to a potassium-sparing diuretic
B. A. Discontinue the hydrochlorothiazide permanently
C. C. Increase the hydrochlorothiazide dose to improve blood pressure control
D. D. Add a second thiazide diuretic for synergistic effect
Correct Answer: A
, Rationale:
Hydrochlorothiazide commonly causes hypokalemia, and a level of 3.1 mEq/L requires intervention with
potassium supplementation or switching to a potassium-sparing diuretic. Permanent discontinuation (A)
may not be necessary, increasing the dose (C) would worsen hypokalemia, and adding another thiazide
(D) would further deplete potassium.
Q6 Question 6 of 75
A 74-year-old male with a history of myocardial infarction reports new-onset orthopnea and
paroxysmal nocturnal dyspnea. On assessment, the nurse notes bibasilar crackles and an S3 heart
sound. These findings are most indicative of
A. A. Left-sided heart failure
B. B. Right-sided heart failure
C. C. Pulmonary embolism
D. D. Chronic obstructive pulmonary disease
Correct Answer: A
Rationale:
Orthopnea, paroxysmal nocturnal dyspnea, bibasilar crackles, and an S3 heart sound are classic signs
of left-sided heart failure, which causes pulmonary congestion. Right-sided heart failure (B) presents with
peripheral edema and jugular venous distension, pulmonary embolism (C) causes sudden dyspnea and
pleuritic pain, and COPD (D) causes chronic wheezing and prolonged expiration.
Q7 Question 7 of 75
A 62-year-old patient with COPD is being discharged with a new prescription for a metered-dose
inhaler containing albuterol. The nurse teaches the patient that this medication is classified as a
A. B. Short-acting beta-2 agonist that provides quick relief of bronchospasm
B. A. Corticosteroid that reduces airway inflammation
C. C. Long-acting anticholinergic that prevents exacerbations
D. D. Mucolytic agent that thins respiratory secretions
Correct Answer: A
Rationale:
Albuterol is a short-acting beta-2 agonist (SABA) that provides quick relief of bronchospasm by relaxing
bronchial smooth muscle. It is not a corticosteroid (A), not a long-acting anticholinergic (C), and not a
mucolytic (D).
NUR 257 Chronic Exam 4
Official Practice Exam . 2026/2027 Edition
75 Verified Questions with 100%% Correct Answers | Graded A+
Questions Minutes Passing Score Recertification
75 90 80%% Per Semester
TABLE OF CONTENTS
Section 1: Chronic Cardiovascular and Respiratory Disorders . . . . 18 questions
Section 2: Chronic Neurological and Musculoskeletal Disorders . . . . 16 questions
Section 3: Chronic Endocrine and Renal Disorders . . . . 16 questions
Section 4: Chronic Oncological and Hematologic Disorders . . . . 13 questions
Section 5: Psychosocial and Palliative Care in Chronic Illness . . . . 12 questions
Answer Key . . . . . . . . . . . . . . . . . . . . Final Page
EXAM INSTRUCTIONS
You have 90 minutes to complete this exam. There are 75 multiple-choice questions divided into 5 sections. Each
question has four answer choices (A, B, C, D). Select the single best answer for each question. A score of 80%%
or higher (60 correct out of 75) is required to pass. Read each question carefully. All questions are weighted
equally. There is no penalty for guessing, so you should answer every question. The correct answer and rationale
for each question are provided immediately after the question for study purposes.
Disclaimer: This practice exam is an independent study resource and is not affiliated with, endorsed by, or connected to any
nursing school or academic institution. Content is based on publicly available course information and standard nursing exam
topics.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80%% | Page 1 of 33
, SECTION 1: Chronic Cardiovascular and Respiratory Disorders
Q1 Question 1 of 75
A 68-year-old male with a 10-year history of heart failure presents to the clinic with increasing
dyspnea on exertion, 3+ pitting edema in both lower extremities, and a weight gain of 6 pounds over
the past week. His current medications include lisinopril 20 mg daily, furosemide 40 mg daily, and
metoprolol 50 mg twice daily. The priority nursing intervention is to
A. B. Assess lung sounds and notify the provider of potential fluid overload requiring
medication adjustment
B. A. Increase the metoprolol dose to improve cardiac output
C. C. Encourage the patient to increase fluid intake to prevent dehydration
D. D. Discontinue the lisinopril immediately and monitor blood pressure
Correct Answer: A
Rationale:
The patient's symptoms indicate fluid overload, a common complication of heart failure. The priority is to
assess lung sounds for crackles and notify the provider for potential diuretic adjustment. Increasing
metoprolol (A) without provider orders is inappropriate, increasing fluids (C) would worsen fluid overload,
and discontinuing lisinopril (D) could destabilize heart failure management.
Q2 Question 2 of 75
A 72-year-old female with chronic obstructive pulmonary disease (COPD) is admitted with an acute
exacerbation. Her arterial blood gas results show pH 7.30, PaCO2 58 mmHg, PaO2 58 mmHg, and
HCO3 30 mEq/L. The nurse interprets these results as
A. B. Partially compensated respiratory acidosis
B. A. Uncompensated respiratory alkalosis
C. C. Fully compensated metabolic acidosis
D. D. Uncompensated metabolic alkalosis
Correct Answer: A
Rationale:
The low pH (7.30) with elevated PaCO2 (58) indicates respiratory acidosis, and the elevated HCO3 (30)
shows partial renal compensation. Uncompensated respiratory alkalosis (A) would have a high pH with
low PaCO2, fully compensated metabolic acidosis (C) would have a normal pH, and metabolic alkalosis
(D) would have elevated HCO3 as the primary disturbance.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80%% | Page 2 of 33
,Q3 Question 3 of 75
A 65-year-old male with chronic heart failure has an ejection fraction of 30%. He reports difficulty
performing activities of daily living due to fatigue and shortness of breath. According to the New York
Heart Association (NYHA) classification, this patient's functional status is most consistent with Class
A. A. I
B. B. II
C. C. III
D. D. IV
Correct Answer: C
Rationale:
NYHA Class III is defined as marked limitation of physical activity with comfort only at rest; the patient is
comfortable at rest but less-than-ordinary activity causes fatigue, dyspnea, or angina. Class I (A) has no
limitation, Class II (B) has slight limitation with ordinary activity, and Class IV (D) has symptoms at rest.
Q4 Question 4 of 75
A 70-year-old patient with atrial fibrillation is prescribed warfarin 5 mg daily. The patient's INR is 3.8
with a target range of 2.0 to 3.0. The nurse should
A. B. Hold the warfarin and notify the provider for dose adjustment
B. A. Administer the next dose of warfarin as scheduled
C. C. Administer vitamin K 10 mg intravenously immediately
D. D. Double the warfarin dose to achieve therapeutic levels faster
Correct Answer: A
Rationale:
An INR of 3.8 is above the therapeutic range of 2.0-3.0, indicating increased bleeding risk. The nurse
should hold the warfarin and notify the provider for dose adjustment. Continuing the dose (A) increases
bleeding risk, high-dose IV vitamin K (C) is reserved for serious bleeding or extremely elevated INR, and
doubling the dose (D) would dangerously increase the INR.
Q5 Question 5 of 75
A 58-year-old female with chronic hypertension has been taking hydrochlorothiazide 25 mg daily for 6
months. Her most recent laboratory results show a potassium level of 3.1 mEq/L. The nurse
anticipates that the provider will
A. B. Add a potassium supplement or switch to a potassium-sparing diuretic
B. A. Discontinue the hydrochlorothiazide permanently
C. C. Increase the hydrochlorothiazide dose to improve blood pressure control
D. D. Add a second thiazide diuretic for synergistic effect
Correct Answer: A
, Rationale:
Hydrochlorothiazide commonly causes hypokalemia, and a level of 3.1 mEq/L requires intervention with
potassium supplementation or switching to a potassium-sparing diuretic. Permanent discontinuation (A)
may not be necessary, increasing the dose (C) would worsen hypokalemia, and adding another thiazide
(D) would further deplete potassium.
Q6 Question 6 of 75
A 74-year-old male with a history of myocardial infarction reports new-onset orthopnea and
paroxysmal nocturnal dyspnea. On assessment, the nurse notes bibasilar crackles and an S3 heart
sound. These findings are most indicative of
A. A. Left-sided heart failure
B. B. Right-sided heart failure
C. C. Pulmonary embolism
D. D. Chronic obstructive pulmonary disease
Correct Answer: A
Rationale:
Orthopnea, paroxysmal nocturnal dyspnea, bibasilar crackles, and an S3 heart sound are classic signs
of left-sided heart failure, which causes pulmonary congestion. Right-sided heart failure (B) presents with
peripheral edema and jugular venous distension, pulmonary embolism (C) causes sudden dyspnea and
pleuritic pain, and COPD (D) causes chronic wheezing and prolonged expiration.
Q7 Question 7 of 75
A 62-year-old patient with COPD is being discharged with a new prescription for a metered-dose
inhaler containing albuterol. The nurse teaches the patient that this medication is classified as a
A. B. Short-acting beta-2 agonist that provides quick relief of bronchospasm
B. A. Corticosteroid that reduces airway inflammation
C. C. Long-acting anticholinergic that prevents exacerbations
D. D. Mucolytic agent that thins respiratory secretions
Correct Answer: A
Rationale:
Albuterol is a short-acting beta-2 agonist (SABA) that provides quick relief of bronchospasm by relaxing
bronchial smooth muscle. It is not a corticosteroid (A), not a long-acting anticholinergic (C), and not a
mucolytic (D).
