NUR 257 Chronic Exam 4 Actual Exam 2026/2027:
Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Chronic Neurological Disorders | Q1 – Q10
Section 2 | Chronic Endocrine and Metabolic Disorders | Q11 – Q20
Section 3 | Chronic Renal and Genitourinary Disorders | Q21 – Q30
Section 4 | Chronic Gastrointestinal and Hepatic Disorders | Q31 – Q40
Section 5 | Chronic Musculoskeletal and Autoimmune Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CHRONIC NEUROLOGICAL DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 42-year-old woman with relapsing-remitting multiple sclerosis reports urinary urgency
and frequency. She mentions occasional leakage before reaching the bathroom. Her
neuro exam shows mild spasticity in the lower extremities.
A. Teach intermittent self-catheterization to prevent urinary retention and infection. ✓
CORRECT
B. Recommend decreasing fluid intake to 1 liter daily to reduce bladder irritability.
C. Initiate a bladder training program with scheduled voiding every 6 hours.
D. Suggest anticholinergic medication as the first-line approach before assessing
post-void residual.
Correct Answer: A
Rationale: Intermittent self-catheterization is essential for MS patients with detrusor
hyperreflexia and incomplete emptying to prevent retention and recurrent UTIs. Simply
restricting fluids increases risk of dehydration and urinary concentration, while
,scheduled voiding every 6 hours is too infrequent for someone with urgency.
Anticholinergics help overactive bladder but must not be started without first ruling out
retention, which worsens with these drugs.
Question 2 of 50
A 68-year-old man with Parkinson's disease is admitted after a fall at home. His wife
reports he has been taking levodopa/carbidopa whenever he remembers, sometimes
skipping morning doses. His tremor and rigidity have worsened.
A. Increase the levodopa dose to compensate for missed doses and restore dopamine
levels.
B. Emphasize taking medication at the same times daily to maintain steady plasma
levels and prevent motor fluctuations. ✓ CORRECT
C. Switch to taking all doses at bedtime to avoid daytime dyskinesia and improve sleep.
D. Add a dopamine agonist immediately to replace the levodopa that is losing
effectiveness.
Correct Answer: B
Rationale: Levodopa requires consistent timing to maintain stable plasma
concentrations and prevent the wearing-off phenomenon and motor fluctuations that
lead to falls. Increasing doses arbitrarily causes dyskinesia and does not address the
root cause of inconsistent administration. Bedtime dosing is inappropriate because
levodopa has a short half-life and patients need coverage during waking hours. Patients
and families often need a written schedule posted in the kitchen to maintain adherence.
Question 3 of 50
A 76-year-old woman with moderate Alzheimer's disease lives with her daughter. The
daughter reports the patient wanders at night, has started accusing family of stealing,
and recently left the stove on.
,A. Recommend sedative-hypnotics at bedtime to prevent nighttime wandering and
ensure sleep.
B. Suggest the family install deadbolts on all exterior doors to secure the patient inside.
C. Assess home safety and implement environmental modifications such as stove
sensors and door alarms while educating the family on validation therapy. ✓ CORRECT
D. Advise the daughter to place the patient in a locked memory care unit immediately for
professional supervision.
Correct Answer: C
Rationale: Environmental modifications and validation therapy are first-line
nonpharmacologic approaches that preserve dignity and safety while supporting the
caregiver. Sedatives increase fall risk and confusion in elderly patients with dementia
and are not a first-line solution for wandering. While door locks may seem logical, they
must comply with fire codes and do not address the underlying behavioral needs.
Immediate placement is often premature when community resources and home
modifications can extend independent living safely.
Question 4 of 50
A 22-year-old college student with generalized epilepsy has been seizure-free for 18
months on lamotrigine. She asks the campus nurse if she can stop her medication
before spring break. Her EEG remains abnormal.
A. Support her decision since 18 months seizure-free meets the standard for
medication discontinuation in most patients.
B. Explain that stopping abruptly is acceptable if she tapers over two weeks to avoid
withdrawal symptoms.
C. Recommend switching to an over-the-counter herbal supplement that has fewer side
effects for young adults.
D. Advise that medication should not be stopped without neurologist guidance, as
abnormal EEG and abrupt discontinuation significantly increase relapse risk. ✓
CORRECT
Correct Answer: D
, Rationale: Antiepileptic drug discontinuation requires careful neurologist oversight
because abnormal EEG findings and abrupt cessation substantially increase seizure
recurrence risk, which could be life-threatening during activities like swimming or
driving. Eighteen months seizure-free does not automatically justify discontinuation,
especially with persistent EEG abnormalities. Two-week tapering is dangerously fast for
lamotrigine, which requires months-long tapering. Herbal supplements are not
evidence-based substitutes for antiepileptic medications.
Question 5 of 50
A 58-year-old man with ALS reports progressive difficulty swallowing and has lost 12
pounds in six weeks. During the clinic visit, he coughs after sipping water.
A. Refer for a formal swallow evaluation and discuss percutaneous endoscopic
gastrostomy placement before forced vital capacity drops below 50%. ✓ CORRECT
B. Recommend pureed foods and thickened liquids as a permanent solution to maintain
oral intake safely.
C. Suggest high-protein shakes between meals to increase caloric intake and reverse
the weight loss.
D. Teach the patient to tuck his chin down while swallowing, which will prevent
aspiration in all cases.
Correct Answer: A
Rationale: Early referral for swallow evaluation and PEG discussion is critical in ALS
because aspiration pneumonia is a leading cause of morbidity, and PEG placement is
safer when respiratory function is still adequate. Pureed diets and thickened liquids are
temporary measures that do not address the progressive nature of bulbar ALS.
High-protein shakes increase aspiration risk if dysphagia is present, and chin-tuck is a
compensatory technique, not a guarantee against aspiration. Multidisciplinary ALS
clinics coordinate these referrals proactively.
Question 6 of 50
Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Chronic Neurological Disorders | Q1 – Q10
Section 2 | Chronic Endocrine and Metabolic Disorders | Q11 – Q20
Section 3 | Chronic Renal and Genitourinary Disorders | Q21 – Q30
Section 4 | Chronic Gastrointestinal and Hepatic Disorders | Q31 – Q40
Section 5 | Chronic Musculoskeletal and Autoimmune Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CHRONIC NEUROLOGICAL DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 42-year-old woman with relapsing-remitting multiple sclerosis reports urinary urgency
and frequency. She mentions occasional leakage before reaching the bathroom. Her
neuro exam shows mild spasticity in the lower extremities.
A. Teach intermittent self-catheterization to prevent urinary retention and infection. ✓
CORRECT
B. Recommend decreasing fluid intake to 1 liter daily to reduce bladder irritability.
C. Initiate a bladder training program with scheduled voiding every 6 hours.
D. Suggest anticholinergic medication as the first-line approach before assessing
post-void residual.
Correct Answer: A
Rationale: Intermittent self-catheterization is essential for MS patients with detrusor
hyperreflexia and incomplete emptying to prevent retention and recurrent UTIs. Simply
restricting fluids increases risk of dehydration and urinary concentration, while
,scheduled voiding every 6 hours is too infrequent for someone with urgency.
Anticholinergics help overactive bladder but must not be started without first ruling out
retention, which worsens with these drugs.
Question 2 of 50
A 68-year-old man with Parkinson's disease is admitted after a fall at home. His wife
reports he has been taking levodopa/carbidopa whenever he remembers, sometimes
skipping morning doses. His tremor and rigidity have worsened.
A. Increase the levodopa dose to compensate for missed doses and restore dopamine
levels.
B. Emphasize taking medication at the same times daily to maintain steady plasma
levels and prevent motor fluctuations. ✓ CORRECT
C. Switch to taking all doses at bedtime to avoid daytime dyskinesia and improve sleep.
D. Add a dopamine agonist immediately to replace the levodopa that is losing
effectiveness.
Correct Answer: B
Rationale: Levodopa requires consistent timing to maintain stable plasma
concentrations and prevent the wearing-off phenomenon and motor fluctuations that
lead to falls. Increasing doses arbitrarily causes dyskinesia and does not address the
root cause of inconsistent administration. Bedtime dosing is inappropriate because
levodopa has a short half-life and patients need coverage during waking hours. Patients
and families often need a written schedule posted in the kitchen to maintain adherence.
Question 3 of 50
A 76-year-old woman with moderate Alzheimer's disease lives with her daughter. The
daughter reports the patient wanders at night, has started accusing family of stealing,
and recently left the stove on.
,A. Recommend sedative-hypnotics at bedtime to prevent nighttime wandering and
ensure sleep.
B. Suggest the family install deadbolts on all exterior doors to secure the patient inside.
C. Assess home safety and implement environmental modifications such as stove
sensors and door alarms while educating the family on validation therapy. ✓ CORRECT
D. Advise the daughter to place the patient in a locked memory care unit immediately for
professional supervision.
Correct Answer: C
Rationale: Environmental modifications and validation therapy are first-line
nonpharmacologic approaches that preserve dignity and safety while supporting the
caregiver. Sedatives increase fall risk and confusion in elderly patients with dementia
and are not a first-line solution for wandering. While door locks may seem logical, they
must comply with fire codes and do not address the underlying behavioral needs.
Immediate placement is often premature when community resources and home
modifications can extend independent living safely.
Question 4 of 50
A 22-year-old college student with generalized epilepsy has been seizure-free for 18
months on lamotrigine. She asks the campus nurse if she can stop her medication
before spring break. Her EEG remains abnormal.
A. Support her decision since 18 months seizure-free meets the standard for
medication discontinuation in most patients.
B. Explain that stopping abruptly is acceptable if she tapers over two weeks to avoid
withdrawal symptoms.
C. Recommend switching to an over-the-counter herbal supplement that has fewer side
effects for young adults.
D. Advise that medication should not be stopped without neurologist guidance, as
abnormal EEG and abrupt discontinuation significantly increase relapse risk. ✓
CORRECT
Correct Answer: D
, Rationale: Antiepileptic drug discontinuation requires careful neurologist oversight
because abnormal EEG findings and abrupt cessation substantially increase seizure
recurrence risk, which could be life-threatening during activities like swimming or
driving. Eighteen months seizure-free does not automatically justify discontinuation,
especially with persistent EEG abnormalities. Two-week tapering is dangerously fast for
lamotrigine, which requires months-long tapering. Herbal supplements are not
evidence-based substitutes for antiepileptic medications.
Question 5 of 50
A 58-year-old man with ALS reports progressive difficulty swallowing and has lost 12
pounds in six weeks. During the clinic visit, he coughs after sipping water.
A. Refer for a formal swallow evaluation and discuss percutaneous endoscopic
gastrostomy placement before forced vital capacity drops below 50%. ✓ CORRECT
B. Recommend pureed foods and thickened liquids as a permanent solution to maintain
oral intake safely.
C. Suggest high-protein shakes between meals to increase caloric intake and reverse
the weight loss.
D. Teach the patient to tuck his chin down while swallowing, which will prevent
aspiration in all cases.
Correct Answer: A
Rationale: Early referral for swallow evaluation and PEG discussion is critical in ALS
because aspiration pneumonia is a leading cause of morbidity, and PEG placement is
safer when respiratory function is still adequate. Pureed diets and thickened liquids are
temporary measures that do not address the progressive nature of bulbar ALS.
High-protein shakes increase aspiration risk if dysphagia is present, and chin-tuck is a
compensatory technique, not a guarantee against aspiration. Multidisciplinary ALS
clinics coordinate these referrals proactively.
Question 6 of 50
