NUR 257: Concepts of Aging and
Chronic Illness – Comprehensive Exam
Review (230 Questions, Answers, and
Detailed Rationales)
Cardiovascular Disorders (Questions 1–35)
1. A patient with chronic heart failure (HFrEF, EF 30%) reports a 5-pound weight
gain in 3 days, increased dyspnea on exertion, and +2 pedal edema. What is the
nurse's priority action?
A) Restrict fluids to 1 L/day
B) Administer prescribed diuretic
C) Assess lung sounds and notify provider
D) Encourage bed rest
Answer: C) Assess lung sounds and notify provider
Rationale: Weight gain of 2–3 lbs in 24 hours or 5 lbs in a week indicates fluid retention
and worsening HF. The priority is to assess for signs of pulmonary congestion (crackles,
dyspnea) and notify the provider for possible medication adjustment. While diuretics
may be ordered, assessment and provider notification precede administration.
,2. Which medication is primarily used to reduce preload in heart failure?
A) Digoxin
B) Nitroglycerin
C) Furosemide
D) Metoprolol
Answer: C) Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload by decreasing circulating
blood volume through diuresis. Nitroglycerin reduces preload via venodilation but is not
the primary medication. Digoxin increases contractility, and metoprolol reduces
afterload and heart rate.
3. A patient with chronic heart failure is prescribed digoxin. Which finding
indicates digoxin toxicity?
A) Heart rate of 72 bpm
B) Serum potassium of 4.0 mEq/L
C) Visual disturbances (yellow halos)
D) Blood pressure of 130/80 mmHg
Answer: C) Visual disturbances (yellow halos)
Rationale: Classic signs of digoxin toxicity include visual disturbances (yellow-green
halos around lights), nausea, vomiting, and cardiac dysrhythmias. Hypokalemia increases
the risk of toxicity.
,4. What is the most common cause of chronic heart failure?
A) Valvular heart disease
B) Coronary artery disease
C) Hypertension
D) Cardiomyopathy
Answer: B) Coronary artery disease
Rationale: CAD leading to myocardial ischemia and infarction is the most common
cause of HF. Hypertension and valvular disease are also significant contributors but less
common than CAD.
5. A patient with heart failure is on a low-sodium diet. What is the recommended
daily sodium restriction for HF patients?
A) < 1,000 mg
B) < 2,000 mg
C) < 3,000 mg
D) < 4,000 mg
Answer: B) < 2,000 mg
Rationale: The American Heart Association recommends limiting sodium to less than
2,000 mg/day for patients with heart failure to reduce fluid retention and preload.
6. Which assessment finding is the earliest indicator of left-sided heart failure?
A) Peripheral edema
, B) Jugular venous distention
C) Dyspnea on exertion
D) Hepatomegaly
Answer: C) Dyspnea on exertion
Rationale: Dyspnea on exertion is an early sign of left-sided HF due to pulmonary
congestion. Peripheral edema, JVD, and hepatomegaly are signs of right-sided HF.
7. A patient with chronic stable angina is prescribed sublingual nitroglycerin. What
instruction should the nurse provide?
A) "Take one tablet every 15 minutes for up to 3 doses."
B) "Take one tablet at the first sign of chest pain; if pain persists after 5 minutes,
call 911."
C) "Chew the tablet for faster absorption."
D) "Store the tablets in the refrigerator."
Answer: B) "Take one tablet at the first sign of chest pain; if pain persists after 5
minutes, call 911."
Rationale: The correct instruction is to take one tablet sublingually at the first sign of
pain. If pain is not relieved after 5 minutes, call 911. Up to 3 tablets may be taken at 5-
minute intervals. Tablets should be stored in a dark, dry place, not refrigerated.
8. Which laboratory value is most specific for diagnosing heart failure?
A) BNP (B-type natriuretic peptide)
Chronic Illness – Comprehensive Exam
Review (230 Questions, Answers, and
Detailed Rationales)
Cardiovascular Disorders (Questions 1–35)
1. A patient with chronic heart failure (HFrEF, EF 30%) reports a 5-pound weight
gain in 3 days, increased dyspnea on exertion, and +2 pedal edema. What is the
nurse's priority action?
A) Restrict fluids to 1 L/day
B) Administer prescribed diuretic
C) Assess lung sounds and notify provider
D) Encourage bed rest
Answer: C) Assess lung sounds and notify provider
Rationale: Weight gain of 2–3 lbs in 24 hours or 5 lbs in a week indicates fluid retention
and worsening HF. The priority is to assess for signs of pulmonary congestion (crackles,
dyspnea) and notify the provider for possible medication adjustment. While diuretics
may be ordered, assessment and provider notification precede administration.
,2. Which medication is primarily used to reduce preload in heart failure?
A) Digoxin
B) Nitroglycerin
C) Furosemide
D) Metoprolol
Answer: C) Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload by decreasing circulating
blood volume through diuresis. Nitroglycerin reduces preload via venodilation but is not
the primary medication. Digoxin increases contractility, and metoprolol reduces
afterload and heart rate.
3. A patient with chronic heart failure is prescribed digoxin. Which finding
indicates digoxin toxicity?
A) Heart rate of 72 bpm
B) Serum potassium of 4.0 mEq/L
C) Visual disturbances (yellow halos)
D) Blood pressure of 130/80 mmHg
Answer: C) Visual disturbances (yellow halos)
Rationale: Classic signs of digoxin toxicity include visual disturbances (yellow-green
halos around lights), nausea, vomiting, and cardiac dysrhythmias. Hypokalemia increases
the risk of toxicity.
,4. What is the most common cause of chronic heart failure?
A) Valvular heart disease
B) Coronary artery disease
C) Hypertension
D) Cardiomyopathy
Answer: B) Coronary artery disease
Rationale: CAD leading to myocardial ischemia and infarction is the most common
cause of HF. Hypertension and valvular disease are also significant contributors but less
common than CAD.
5. A patient with heart failure is on a low-sodium diet. What is the recommended
daily sodium restriction for HF patients?
A) < 1,000 mg
B) < 2,000 mg
C) < 3,000 mg
D) < 4,000 mg
Answer: B) < 2,000 mg
Rationale: The American Heart Association recommends limiting sodium to less than
2,000 mg/day for patients with heart failure to reduce fluid retention and preload.
6. Which assessment finding is the earliest indicator of left-sided heart failure?
A) Peripheral edema
, B) Jugular venous distention
C) Dyspnea on exertion
D) Hepatomegaly
Answer: C) Dyspnea on exertion
Rationale: Dyspnea on exertion is an early sign of left-sided HF due to pulmonary
congestion. Peripheral edema, JVD, and hepatomegaly are signs of right-sided HF.
7. A patient with chronic stable angina is prescribed sublingual nitroglycerin. What
instruction should the nurse provide?
A) "Take one tablet every 15 minutes for up to 3 doses."
B) "Take one tablet at the first sign of chest pain; if pain persists after 5 minutes,
call 911."
C) "Chew the tablet for faster absorption."
D) "Store the tablets in the refrigerator."
Answer: B) "Take one tablet at the first sign of chest pain; if pain persists after 5
minutes, call 911."
Rationale: The correct instruction is to take one tablet sublingually at the first sign of
pain. If pain is not relieved after 5 minutes, call 911. Up to 3 tablets may be taken at 5-
minute intervals. Tablets should be stored in a dark, dry place, not refrigerated.
8. Which laboratory value is most specific for diagnosing heart failure?
A) BNP (B-type natriuretic peptide)
