NUR 4768C Adult Chronic Conditions
Comprehensive Final Exam (Qns & Ans)
2025
Question 1
A 68‑year‑old male with chronic heart failure, type 2 diabetes
mellitus, and chronic kidney disease presents with worsening
dyspnea, fatigue, and increased lower extremity edema. His blood
pressure is 98/62 mm Hg, oxygen saturation is 87% on room air,
and weight has increased by 3 kg over the past week. Which
advanced clinical reasoning step should the nurse prioritize for his
personalized care plan?
A. Immediately increasing his oral diuretic dose
B. Conducting a comprehensive evaluation of his volume status,
reviewing current medications, and assessing for decompensation
C. Scheduling an outpatient echocardiogram and discharging with
written instructions
©2025
,D. Focusing solely on adjusting his diabetic regimen
ANS: B. Conducting a comprehensive evaluation of his
volume status, reviewing current medications, and assessing for
decompensation
Rationale: In adults with multiple chronic illnesses, careful
reassessment—including current weight trends, vital signs, lab
data, and medication adherence—is essential before modifying
treatment. This integrated approach ensures that interventions
address the underlying pathophysiologic changes before making
medication changes.
---
Question 2
A 55‑year‑old female with chronic obstructive pulmonary disease
(COPD) and hypertension is experiencing increasing shortness of
breath and fatigue. In personalizing her care plan, which aspect is
most critical for advanced clinical reasoning?
A. Instituting an immediate increase in respiratory therapy
without further evaluation
B. A thorough review of her oxygenation status, spirometry
results, medication adherence, and environmental exposures
C. Focusing solely on blood pressure control
D. Initiating an aggressive exercise program
©2025
, ANS: B. A thorough review of her oxygenation status,
spirometry results, medication adherence, and environmental
exposures
Rationale: For patients with COPD and comorbid conditions,
personalized care requires integrating objective data (e.g., oxygen
saturation, spirometry) and subjective information (e.g., exposure
to pollutants, medication compliance) to tailor interventions
appropriately.
---
Question 3
A 64‑year‑old male with type 2 diabetes and early diabetic
nephropathy demonstrates a rising HbA1c and worsening
microalbuminuria. Which intervention best supports personalized
nursing care through advanced clinical reasoning?
A. Simply increasing the dose of his hypoglycemic medication
B. Collaborating with a multidisciplinary team to optimize
glycemic and blood pressure control while incorporating dietary
counseling
C. Referring the patient directly for dialysis
D. Advising the patient to exercise more without modifying
medications
©2025
, ANS: B. Collaborating with a multidisciplinary team to
optimize glycemic and blood pressure control while incorporating
dietary counseling
Rationale: Effective management of complex chronic
conditions requires an individualized, multi‐pronged approach.
This strategy ensures that all contributing factors—glycemic
control, blood pressure, lifestyle, and diet—are addressed
collaboratively.
---
Question 4
A nurse uses a risk stratification tool based on age, cholesterol,
blood pressure, and smoking status to estimate a patient’s 10‑year
risk for cardiovascular events. Which tool is most likely being
used?
A. Apgar Score
B. Framingham Risk Score
C. Glasgow Coma Scale
D. BMI Calculator
ANS: B. Framingham Risk Score
Rationale: The Framingham Risk Score is a well-established
quantitative tool used to estimate a patient’s long-term
©2025
Comprehensive Final Exam (Qns & Ans)
2025
Question 1
A 68‑year‑old male with chronic heart failure, type 2 diabetes
mellitus, and chronic kidney disease presents with worsening
dyspnea, fatigue, and increased lower extremity edema. His blood
pressure is 98/62 mm Hg, oxygen saturation is 87% on room air,
and weight has increased by 3 kg over the past week. Which
advanced clinical reasoning step should the nurse prioritize for his
personalized care plan?
A. Immediately increasing his oral diuretic dose
B. Conducting a comprehensive evaluation of his volume status,
reviewing current medications, and assessing for decompensation
C. Scheduling an outpatient echocardiogram and discharging with
written instructions
©2025
,D. Focusing solely on adjusting his diabetic regimen
ANS: B. Conducting a comprehensive evaluation of his
volume status, reviewing current medications, and assessing for
decompensation
Rationale: In adults with multiple chronic illnesses, careful
reassessment—including current weight trends, vital signs, lab
data, and medication adherence—is essential before modifying
treatment. This integrated approach ensures that interventions
address the underlying pathophysiologic changes before making
medication changes.
---
Question 2
A 55‑year‑old female with chronic obstructive pulmonary disease
(COPD) and hypertension is experiencing increasing shortness of
breath and fatigue. In personalizing her care plan, which aspect is
most critical for advanced clinical reasoning?
A. Instituting an immediate increase in respiratory therapy
without further evaluation
B. A thorough review of her oxygenation status, spirometry
results, medication adherence, and environmental exposures
C. Focusing solely on blood pressure control
D. Initiating an aggressive exercise program
©2025
, ANS: B. A thorough review of her oxygenation status,
spirometry results, medication adherence, and environmental
exposures
Rationale: For patients with COPD and comorbid conditions,
personalized care requires integrating objective data (e.g., oxygen
saturation, spirometry) and subjective information (e.g., exposure
to pollutants, medication compliance) to tailor interventions
appropriately.
---
Question 3
A 64‑year‑old male with type 2 diabetes and early diabetic
nephropathy demonstrates a rising HbA1c and worsening
microalbuminuria. Which intervention best supports personalized
nursing care through advanced clinical reasoning?
A. Simply increasing the dose of his hypoglycemic medication
B. Collaborating with a multidisciplinary team to optimize
glycemic and blood pressure control while incorporating dietary
counseling
C. Referring the patient directly for dialysis
D. Advising the patient to exercise more without modifying
medications
©2025
, ANS: B. Collaborating with a multidisciplinary team to
optimize glycemic and blood pressure control while incorporating
dietary counseling
Rationale: Effective management of complex chronic
conditions requires an individualized, multi‐pronged approach.
This strategy ensures that all contributing factors—glycemic
control, blood pressure, lifestyle, and diet—are addressed
collaboratively.
---
Question 4
A nurse uses a risk stratification tool based on age, cholesterol,
blood pressure, and smoking status to estimate a patient’s 10‑year
risk for cardiovascular events. Which tool is most likely being
used?
A. Apgar Score
B. Framingham Risk Score
C. Glasgow Coma Scale
D. BMI Calculator
ANS: B. Framingham Risk Score
Rationale: The Framingham Risk Score is a well-established
quantitative tool used to estimate a patient’s long-term
©2025
