NUR 257 CHRONIC EXAM 4 2026 – High-Yield Nursing
Practice Questions, Verified Answers & Clinical Rationales
(Pass Exam 4 PDF)
"Ace your NUR 257 Chronic Illness Management Exam 4 on your very first attempt with
this comprehensive 2026 study guide. This instant download features highly predictive
practice questions, verified exact answers, and detailed clinical rationales covering
advanced nursing care for complex chronic conditions, multi-system management, and
patient interventions. Stop stressing over dense medical chapters and download the
precise, high-yield exam architecture you need to protect your GPA and pass today!"
1. A nurse completes an assessment on a 62-year-old patient diagnosed with
Advanced Stage IV Chronic Kidney Disease (CKD). Which laboratory value
requires immediate clinical intervention?
A. Serum Creatinine of 3.2 mg/dL
B. Blood Urea Nitrogen (BUN) of 48 mg/dL
C. Serum Potassium of 6.3 mEq/L
D. Hemoglobin of 9.4 g/dL
Answer: C. Serum Potassium of 6.3 mEq/L
Rationale: A serum potassium level above 6.0 mEq/L indicates severe hyperkalaemia, a
common complication of advanced CKD due to diminished renal excretion. It poses an
immediate risk of lethal cardiac dysrhythmias (e.g., ventricular fibrillation, asystole) and
takes priority over chronically elevated creatinine, BUN, and underlying anemia.
2. A patient with advanced liver cirrhosis is admitted with severe ascites and a
deteriorating mental status. The nurse notes asterixis during the physical
assessment. Which medication should the nurse prepare to administer?
A. Spironolactone
B. Lactulose
C. Furosemide
D. Rifaximin
Answer: B. Lactulose
Rationale: Asterixis (flapping tremor) is a hallmark sign of hepatic encephalopathy,
driven by the accumulation of neurotoxic ammonia in the blood. Lactulose promotes the
,conversion of ammonia to ammonium in the gut, trapping it and accelerating its
excretion via a laxative effect. Rifaximin may be added later as an adjunct antibiotic.
3. While managing a patient on continuous peritoneal dialysis (CAPD), the nurse
notes that the returned dialysate fluid is cloudy and the patient reports localized
abdominal pain. What is the nurse's priority action?
A. Accelerate the infusion rate of the next dialysate cycle.
B. Obtain a sample of the effluent fluid for culture and sensitivity testing and notify the
healthcare provider.
C. Flush the peritoneal catheter line with 500 mL of heparinized normal saline.
D. Reposition the patient from side to side to clear mechanical blockages.
Answer: B. Obtain a sample of the effluent fluid for culture and sensitivity testing
and notify the healthcare provider.
Rationale: Cloudy dialysate fluid accompanied by abdominal pain indicates peritonitis, a
severe and common complication of peritoneal dialysis. The nurse must collect a
sample for culture and sensitivity to identify the pathogen and initiate prompt
intraperitoneal antibiotic therapy.
4. A patient diagnosed with Chronic Obstructive Pulmonary Disease (COPD) is
prescribed home oxygen therapy. Which educational directive must the nurse
emphasize to ensure patient safety?
A. Maintain a baseline oxygen flow rate of at least 6 to 8 L/min via nasal cannula.
B. Avoid using oil-based or petroleum-soluble lotions on the face or nose while oxygen
is flowing.
C. Check that all electrical grounding plugs in the home are disconnected.
D. Use oxygen strictly during active daytime exercises and discontinue use during
sleep.
Answer: B. Avoid using oil-based or petroleum-soluble lotions on the face or
nose while oxygen is flowing.
Rationale: Oxygen acts as an accelerant for combustion. Using oil-based or petroleum
products (like Vaseline) on the face creates a significant fire hazard in an oxygen-rich
environment. Water-soluble products should be substituted. Home oxygen for stable
COPD is usually maintained at a lower flow rate (1–2 L/min) to avoid blunting the
hypoxic respiratory drive.
,5. A patient with a 15-year history of Type 2 Diabetes presents with severe
burning pain, tingling, and numbness in both lower extremities. Which class of
medication is standardly indicated for this chronic condition?
A. Short-acting opioid analgesics
B. Loop diuretics
C. Anticonvulsants or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
D. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Answer: C. Anticonvulsants or Serotonin-Norepinephrine Reuptake Inhibitors
(SNRIs)
Rationale: The patient is exhibiting classic symptoms of diabetic peripheral neuropathy.
First-line pharmacological management for neuropathic pain includes anticonvulsants
(e.g., gabapentin, pregabalin) or SNRIs (e.g., duloxetine), which alter neurotransmitter
transmission rather than traditional opioid or NSAID pathways.
6. Which clinical indicator is evaluated to confirm the long-term glycemic
management and adherence of a patient with Chronic Type 1 Diabetes over the
preceding 90 days?
A. Fasting Blood Glucose level
B. Postprandial insulin assay
C. Glycated Hemoglobin (HbA1c) percentage
D. Urine Ketone verification
Answer: C. Glycated Hemoglobin (HbA1c) percentage
Rationale: Glucose attaches to the hemoglobin component of red blood cells through
glycation. Because red blood cells have an average lifespan of 120 days, the HbA1c
percentage provides an objective index of mean blood glucose trends over the past 2 to
3 months.
7. A nurse is planning care for a patient with severe rheumatoid arthritis (RA)
experiencing persistent morning joint stiffness. Which non-pharmacological
strategy should the nurse include in the care plan?
A. Applying ice packs to inflamed joints for 45 minutes immediately upon waking.
B. Advising a hot shower or warm moist compresses immediately after waking up to
promote vasodilation and joint flexibility.
C. Encouraging high-impact aerobic exercises before breakfast.
D. Keeping the affected limbs completely immobilized using rigid night splints.
Answer: B. Advising a hot shower or warm moist compresses immediately after
waking up to promote vasodilation and joint flexibility.
, Rationale: Heat application reduces muscle spasms, relieves stiffness, and improves
blood flow to affected joints in RA. While cold is used for acute flares, heat is preferred
for morning stiffness. High-impact exercises can cause joint trauma, and prolonged
immobilization worsens contractures.
8. A patient with chronic heart failure is prescribed digoxin and furosemide.
Which laboratory value requires immediate monitoring by the nurse to prevent
drug toxicity?
A. Serum Calcium level
B. Serum Potassium level
C. Total Protein clearance
D. Serum Sodium concentration
Answer: B. Serum Potassium level
Rationale: Furosemide is a potassium-wasting loop diuretic. Hypokalemia (low
potassium) sensitizes the myocardium and significantly increases the risk of digoxin
toxicity, which can trigger dangerous cardiac dysrhythmias even with normal therapeutic
digoxin levels.
9. A nurse provides self-management education to a patient diagnosed with
Chronic Systemic Lupus Erythematosus (SLE). Which point must be included in
the preventative teaching outline?
A. Limit dietary intake of complex carbohydrates to avoid flares.
B. Utilize high-SPF sunscreen and wear protective clothing to minimize ultraviolet (UV)
exposure.
C. Schedule high-intensity physical training sessions during active disease flares.
D. Discontinue corticosteroid therapies immediately when joint symptoms resolve.
Answer: B. Utilize high-SPF sunscreen and wear protective clothing to minimize
ultraviolet (UV) exposure.
Rationale: Photosensitivity is a classic feature of SLE. Exposure to UV light (both
sunlight and tanning beds) can trigger severe cutaneous lesions and exacerbate
systemic flares. Corticosteroids must be tapered gradually under medical supervision
rather than stopped abruptly.
Practice Questions, Verified Answers & Clinical Rationales
(Pass Exam 4 PDF)
"Ace your NUR 257 Chronic Illness Management Exam 4 on your very first attempt with
this comprehensive 2026 study guide. This instant download features highly predictive
practice questions, verified exact answers, and detailed clinical rationales covering
advanced nursing care for complex chronic conditions, multi-system management, and
patient interventions. Stop stressing over dense medical chapters and download the
precise, high-yield exam architecture you need to protect your GPA and pass today!"
1. A nurse completes an assessment on a 62-year-old patient diagnosed with
Advanced Stage IV Chronic Kidney Disease (CKD). Which laboratory value
requires immediate clinical intervention?
A. Serum Creatinine of 3.2 mg/dL
B. Blood Urea Nitrogen (BUN) of 48 mg/dL
C. Serum Potassium of 6.3 mEq/L
D. Hemoglobin of 9.4 g/dL
Answer: C. Serum Potassium of 6.3 mEq/L
Rationale: A serum potassium level above 6.0 mEq/L indicates severe hyperkalaemia, a
common complication of advanced CKD due to diminished renal excretion. It poses an
immediate risk of lethal cardiac dysrhythmias (e.g., ventricular fibrillation, asystole) and
takes priority over chronically elevated creatinine, BUN, and underlying anemia.
2. A patient with advanced liver cirrhosis is admitted with severe ascites and a
deteriorating mental status. The nurse notes asterixis during the physical
assessment. Which medication should the nurse prepare to administer?
A. Spironolactone
B. Lactulose
C. Furosemide
D. Rifaximin
Answer: B. Lactulose
Rationale: Asterixis (flapping tremor) is a hallmark sign of hepatic encephalopathy,
driven by the accumulation of neurotoxic ammonia in the blood. Lactulose promotes the
,conversion of ammonia to ammonium in the gut, trapping it and accelerating its
excretion via a laxative effect. Rifaximin may be added later as an adjunct antibiotic.
3. While managing a patient on continuous peritoneal dialysis (CAPD), the nurse
notes that the returned dialysate fluid is cloudy and the patient reports localized
abdominal pain. What is the nurse's priority action?
A. Accelerate the infusion rate of the next dialysate cycle.
B. Obtain a sample of the effluent fluid for culture and sensitivity testing and notify the
healthcare provider.
C. Flush the peritoneal catheter line with 500 mL of heparinized normal saline.
D. Reposition the patient from side to side to clear mechanical blockages.
Answer: B. Obtain a sample of the effluent fluid for culture and sensitivity testing
and notify the healthcare provider.
Rationale: Cloudy dialysate fluid accompanied by abdominal pain indicates peritonitis, a
severe and common complication of peritoneal dialysis. The nurse must collect a
sample for culture and sensitivity to identify the pathogen and initiate prompt
intraperitoneal antibiotic therapy.
4. A patient diagnosed with Chronic Obstructive Pulmonary Disease (COPD) is
prescribed home oxygen therapy. Which educational directive must the nurse
emphasize to ensure patient safety?
A. Maintain a baseline oxygen flow rate of at least 6 to 8 L/min via nasal cannula.
B. Avoid using oil-based or petroleum-soluble lotions on the face or nose while oxygen
is flowing.
C. Check that all electrical grounding plugs in the home are disconnected.
D. Use oxygen strictly during active daytime exercises and discontinue use during
sleep.
Answer: B. Avoid using oil-based or petroleum-soluble lotions on the face or
nose while oxygen is flowing.
Rationale: Oxygen acts as an accelerant for combustion. Using oil-based or petroleum
products (like Vaseline) on the face creates a significant fire hazard in an oxygen-rich
environment. Water-soluble products should be substituted. Home oxygen for stable
COPD is usually maintained at a lower flow rate (1–2 L/min) to avoid blunting the
hypoxic respiratory drive.
,5. A patient with a 15-year history of Type 2 Diabetes presents with severe
burning pain, tingling, and numbness in both lower extremities. Which class of
medication is standardly indicated for this chronic condition?
A. Short-acting opioid analgesics
B. Loop diuretics
C. Anticonvulsants or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
D. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Answer: C. Anticonvulsants or Serotonin-Norepinephrine Reuptake Inhibitors
(SNRIs)
Rationale: The patient is exhibiting classic symptoms of diabetic peripheral neuropathy.
First-line pharmacological management for neuropathic pain includes anticonvulsants
(e.g., gabapentin, pregabalin) or SNRIs (e.g., duloxetine), which alter neurotransmitter
transmission rather than traditional opioid or NSAID pathways.
6. Which clinical indicator is evaluated to confirm the long-term glycemic
management and adherence of a patient with Chronic Type 1 Diabetes over the
preceding 90 days?
A. Fasting Blood Glucose level
B. Postprandial insulin assay
C. Glycated Hemoglobin (HbA1c) percentage
D. Urine Ketone verification
Answer: C. Glycated Hemoglobin (HbA1c) percentage
Rationale: Glucose attaches to the hemoglobin component of red blood cells through
glycation. Because red blood cells have an average lifespan of 120 days, the HbA1c
percentage provides an objective index of mean blood glucose trends over the past 2 to
3 months.
7. A nurse is planning care for a patient with severe rheumatoid arthritis (RA)
experiencing persistent morning joint stiffness. Which non-pharmacological
strategy should the nurse include in the care plan?
A. Applying ice packs to inflamed joints for 45 minutes immediately upon waking.
B. Advising a hot shower or warm moist compresses immediately after waking up to
promote vasodilation and joint flexibility.
C. Encouraging high-impact aerobic exercises before breakfast.
D. Keeping the affected limbs completely immobilized using rigid night splints.
Answer: B. Advising a hot shower or warm moist compresses immediately after
waking up to promote vasodilation and joint flexibility.
, Rationale: Heat application reduces muscle spasms, relieves stiffness, and improves
blood flow to affected joints in RA. While cold is used for acute flares, heat is preferred
for morning stiffness. High-impact exercises can cause joint trauma, and prolonged
immobilization worsens contractures.
8. A patient with chronic heart failure is prescribed digoxin and furosemide.
Which laboratory value requires immediate monitoring by the nurse to prevent
drug toxicity?
A. Serum Calcium level
B. Serum Potassium level
C. Total Protein clearance
D. Serum Sodium concentration
Answer: B. Serum Potassium level
Rationale: Furosemide is a potassium-wasting loop diuretic. Hypokalemia (low
potassium) sensitizes the myocardium and significantly increases the risk of digoxin
toxicity, which can trigger dangerous cardiac dysrhythmias even with normal therapeutic
digoxin levels.
9. A nurse provides self-management education to a patient diagnosed with
Chronic Systemic Lupus Erythematosus (SLE). Which point must be included in
the preventative teaching outline?
A. Limit dietary intake of complex carbohydrates to avoid flares.
B. Utilize high-SPF sunscreen and wear protective clothing to minimize ultraviolet (UV)
exposure.
C. Schedule high-intensity physical training sessions during active disease flares.
D. Discontinue corticosteroid therapies immediately when joint symptoms resolve.
Answer: B. Utilize high-SPF sunscreen and wear protective clothing to minimize
ultraviolet (UV) exposure.
Rationale: Photosensitivity is a classic feature of SLE. Exposure to UV light (both
sunlight and tanning beds) can trigger severe cutaneous lesions and exacerbate
systemic flares. Corticosteroids must be tapered gradually under medical supervision
rather than stopped abruptly.
