1
NUR 257 Chronic Conditions Galen College of
Nursing Exam 4 Comprehensive Examination
Actual Exam 2026/2027 Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Part I: Cardiovascular & Hematologic Chronic Conditions
(Questions 1-17)
Q1: Mrs. Rodriguez, a 68-year-old woman with a 15-year
history of hypertension, presents to the clinic for her routine
follow-up. Her current blood pressure is 158/94 mmHg despite
taking lisinopril 20 mg daily and hydrochlorothiazide 25 mg
daily. She reports occasional dizziness when standing up quickly
and some swelling in her ankles by the end of the day. Which
nursing intervention is the highest priority at this visit?
A. Teach the patient about dietary sodium restriction of less than
2,000 mg/day
B. Assess for orthostatic hypotension and review medication
timing
C. Encourage the patient to increase her physical activity to 150
minutes per week
,2
D. Schedule a follow-up appointment in one month to reassess
blood pressure
Correct Answer: B
Rationale: The best answer is B because this patient has
uncontrolled hypertension on two medications AND is reporting
symptoms that could indicate orthostatic hypotension (dizziness
on standing) and possible medication side effects (ankle edema
from the thiazide diuretic). Before adding more medications or
focusing solely on lifestyle education, the nurse must first assess
whether her current symptoms are related to her
antihypertensive regimen—this is both a safety issue and
essential data for the provider to make informed prescribing
decisions.
Q2: A patient with chronic heart failure (NYHA Class III) is
being discharged home after an exacerbation. The nurse is
reviewing his medication regimen, which includes furosemide
40 mg PO twice daily, carvedilol 12.5 mg PO twice daily,
lisinopril 10 mg daily, and spironolactone 25 mg daily. Which
statement by the patient indicates he needs further teaching
about his medication management?
A. "I should weigh myself every morning before eating or
drinking anything"
,3
B. "If I gain more than 2 pounds in a day or 5 pounds in a week,
I'll call my doctor"
C. "I'll take my furosemide at bedtime so it doesn't interfere with
my daytime activities"
D. "I need to avoid NSAIDs like ibuprofen for my arthritis pain"
Correct Answer: C
Rationale: This choice is correct because taking a loop diuretic
like furosemide at bedtime is inappropriate—it will cause
nocturia, disrupt sleep, and increase fall risk when getting up to
use the bathroom at night. Diuretics should typically be taken in
the morning (and early afternoon if dosed BID) to allow for
diuresis during waking hours. The other statements show good
understanding of HF self-management principles taught in NUR
257.
Q3: Mr. Thompson, a 62-year-old man with coronary artery
disease, stable angina, and a history of myocardial infarction 3
years ago, calls the clinic nurse reporting chest discomfort. He
describes it as "pressure in the center of my chest" that started
about 20 minutes ago while he was walking up a hill near his
home. He rested and took one sublingual nitroglycerin tablet,
and the pain improved but hasn't completely resolved. His vital
signs at home are: BP 142/88, HR 92, RR 18. What is the most
appropriate nursing action?
, 4
A. Tell him to take a second nitroglycerin tablet and call 911 if
no improvement in 5 minutes
B. Advise him to come to the clinic for an ECG and evaluation
within the next 2 hours
C. Instruct him to take an aspirin 325 mg and wait to see if
symptoms fully resolve
D. Recommend he continue resting and follow up with his
cardiologist next week
Correct Answer: A
Rationale: The best answer is A because this patient has angina
that responded partially but not completely to one nitroglycerin
dose—the standard protocol for stable angina at home is to take
up to 3 doses of nitroglycerin 5 minutes apart, and if pain
persists after the third dose (or if severe, call 911 earlier). Since
he had partial relief, a second dose is appropriate with clear
instructions to seek emergency care if no further improvement.
This follows chronic angina management protocols while
maintaining safety.
Q4: A nurse is reviewing laboratory results for a patient with
chronic heart failure who has been feeling increasingly fatigued
over the past two weeks. The following values are noted:
Sodium: 130 mEq/L
NUR 257 Chronic Conditions Galen College of
Nursing Exam 4 Comprehensive Examination
Actual Exam 2026/2027 Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Part I: Cardiovascular & Hematologic Chronic Conditions
(Questions 1-17)
Q1: Mrs. Rodriguez, a 68-year-old woman with a 15-year
history of hypertension, presents to the clinic for her routine
follow-up. Her current blood pressure is 158/94 mmHg despite
taking lisinopril 20 mg daily and hydrochlorothiazide 25 mg
daily. She reports occasional dizziness when standing up quickly
and some swelling in her ankles by the end of the day. Which
nursing intervention is the highest priority at this visit?
A. Teach the patient about dietary sodium restriction of less than
2,000 mg/day
B. Assess for orthostatic hypotension and review medication
timing
C. Encourage the patient to increase her physical activity to 150
minutes per week
,2
D. Schedule a follow-up appointment in one month to reassess
blood pressure
Correct Answer: B
Rationale: The best answer is B because this patient has
uncontrolled hypertension on two medications AND is reporting
symptoms that could indicate orthostatic hypotension (dizziness
on standing) and possible medication side effects (ankle edema
from the thiazide diuretic). Before adding more medications or
focusing solely on lifestyle education, the nurse must first assess
whether her current symptoms are related to her
antihypertensive regimen—this is both a safety issue and
essential data for the provider to make informed prescribing
decisions.
Q2: A patient with chronic heart failure (NYHA Class III) is
being discharged home after an exacerbation. The nurse is
reviewing his medication regimen, which includes furosemide
40 mg PO twice daily, carvedilol 12.5 mg PO twice daily,
lisinopril 10 mg daily, and spironolactone 25 mg daily. Which
statement by the patient indicates he needs further teaching
about his medication management?
A. "I should weigh myself every morning before eating or
drinking anything"
,3
B. "If I gain more than 2 pounds in a day or 5 pounds in a week,
I'll call my doctor"
C. "I'll take my furosemide at bedtime so it doesn't interfere with
my daytime activities"
D. "I need to avoid NSAIDs like ibuprofen for my arthritis pain"
Correct Answer: C
Rationale: This choice is correct because taking a loop diuretic
like furosemide at bedtime is inappropriate—it will cause
nocturia, disrupt sleep, and increase fall risk when getting up to
use the bathroom at night. Diuretics should typically be taken in
the morning (and early afternoon if dosed BID) to allow for
diuresis during waking hours. The other statements show good
understanding of HF self-management principles taught in NUR
257.
Q3: Mr. Thompson, a 62-year-old man with coronary artery
disease, stable angina, and a history of myocardial infarction 3
years ago, calls the clinic nurse reporting chest discomfort. He
describes it as "pressure in the center of my chest" that started
about 20 minutes ago while he was walking up a hill near his
home. He rested and took one sublingual nitroglycerin tablet,
and the pain improved but hasn't completely resolved. His vital
signs at home are: BP 142/88, HR 92, RR 18. What is the most
appropriate nursing action?
, 4
A. Tell him to take a second nitroglycerin tablet and call 911 if
no improvement in 5 minutes
B. Advise him to come to the clinic for an ECG and evaluation
within the next 2 hours
C. Instruct him to take an aspirin 325 mg and wait to see if
symptoms fully resolve
D. Recommend he continue resting and follow up with his
cardiologist next week
Correct Answer: A
Rationale: The best answer is A because this patient has angina
that responded partially but not completely to one nitroglycerin
dose—the standard protocol for stable angina at home is to take
up to 3 doses of nitroglycerin 5 minutes apart, and if pain
persists after the third dose (or if severe, call 911 earlier). Since
he had partial relief, a second dose is appropriate with clear
instructions to seek emergency care if no further improvement.
This follows chronic angina management protocols while
maintaining safety.
Q4: A nurse is reviewing laboratory results for a patient with
chronic heart failure who has been feeling increasingly fatigued
over the past two weeks. The following values are noted:
Sodium: 130 mEq/L
