NUR 257 Chronic Conditions | Galen College of Nursing Exam 4 Comprehensive Examination | 85 Verified Questions
NUR 257 Chronic Conditions
Galen College of Nursing | Academic Year 2026/2027 | Exam 4 Comprehensive Examination
This exam is aligned with the Galen College of Nursing NUR 257 Chronic Conditions curriculum and reflects
2026/2027 current chronic disease management guidelines. It contains exactly 85 multiple-choice questions
distributed across seven sections covering: (1) Cardiovascular Chronic Conditions (Heart Failure, CAD,
Hypertension, and Dysrhythmias); (2) Respiratory Chronic Conditions (COPD, Asthma, and Restrictive
Disorders); (3) Endocrine Chronic Conditions (Diabetes, Thyroid, and Adrenal Disorders); (4) Renal and
Neurological Chronic Conditions (CKD, Stroke, Seizures, and Neurodegenerative Disorders); (5) Musculoskeletal
and Immunologic Chronic Conditions (OA, RA, Lupus, and HIV); (6) Gastrointestinal and Hematologic Chronic
Conditions (IBD, Cirrhosis, Anemia, and Coagulopathies); and (7) Psychosocial, Palliative, and End-of-Life Care
(Coping, Depression, Advance Directives, and Hospice). Cognitive levels: approximately 30% recall, 50%
application, and 20% analysis. Approximately 80% of questions are scenario-based application and 20% are direct
recall of chronic condition concepts. Each question provides four options (A-D) with one correct answer, marked
[CORRECT] in green, and a detailed rationale with chronic care nursing reasoning covering pathophysiology,
medication management, patient education, and safety considerations. Priority questions include 'Which finding
requires IMMEDIATE follow-up?' and 'Which complication is the client at GREATEST risk for?' formats, patient
education scenarios ('Which instruction should the nurse include in teaching?'), and interdisciplinary care
coordination scenarios reflecting pre-licensure RN-level clinical judgment. Common chronic care nursing errors
(incorrect medication management, misunderstanding dietary restrictions, improper assessment priorities, failure
to recognize complications, incorrect patient education) appear as distractors.
Section 1: Cardiovascular Chronic Conditions
Heart Failure, Coronary Artery Disease, Hypertension, and Dysrhythmias
Page 1 Guidelines
Academic Year 2026/2027 - Aligned with Current Chronic Disease Management
,NUR 257 Chronic Conditions | Galen College of Nursing Exam 4 Comprehensive Examination | 85 Verified Questions
Q1. A 72-year-old client with heart failure with reduced ejection fraction (HFrEF) is prescribed lisinopril,
carvedilol, furosemide, and spironolactone. Which finding on morning assessment requires IMMEDIATE
follow-up?
A. Serum potassium of 3.5 mEq/L
B. Heart rate of 58 bpm while taking carvedilol
C. Serum potassium of 6.1 mEq/L with peaked T waves on the ECG [CORRECT]
D. Daily weight increase of 0.5 kg from the previous day
Correct Answer: C
Rationale
Hyperkalemia (K+ 6.1 mEq/L with peaked T waves) is a life-threatening emergency requiring immediate intervention
because the client is on both an ACE inhibitor (lisinopril) and a potassium-sparing diuretic (spironolactone), which together
significantly raise the risk of dangerous hyperkalemia that can precipitate lethal dysrhythmias. Option A (K+ 3.5) is at the
low end of normal but does not require emergency action. Option B (HR 58) is an expected carvedilol effect; the nurse
should hold the dose only if HR is below approximately 55-60 with symptoms. Option D (0.5 kg/day weight gain) warrants
monitoring but is not immediately life-threatening.
Q2. A client with heart failure is being discharged with instructions to monitor daily weights. Which
statement by the client indicates the teaching has been effective?
A. I will weigh myself once a week at the same time of day
B. I will weigh myself every morning after breakfast and dressing
C. I will weigh myself each morning before eating, after urinating, wearing the same type of clothing
[CORRECT]
D. I will weigh myself before going to bed each night
Correct Answer: C
Rationale
Daily weights must be obtained consistently, ideally first thing in the morning before eating or drinking, after voiding, and
wearing the same clothing, to detect fluid retention early. A weight gain of 2-3 pounds in 24 hours or 5 pounds in a week
signals worsening heart failure and requires immediate provider notification. Options A, B, and D introduce inconsistency in
timing or intake/output status that would distort the trend.
Q3. A client with systolic heart failure has an ejection fraction of 25%. The nurse understands that which
medication class is MOST proven to reduce mortality in this client?
A. Calcium channel blockers
B. Beta blockers (e.g., carvedilol, metoprolol succinate) [CORRECT]
C. Loop diuretics (e.g., furosemide)
D. Nitrates (e.g., nitroglycerin)
Correct Answer: B
Rationale
Beta blockers (carvedilol, metoprolol succinate, bisoprolol) reduce sympathetic overdrive, lower heart rate, improve
ejection fraction, and have been conclusively shown to reduce mortality in HFrEF. They are started once the client is
euvolemic and stable. Calcium channel blockers (Option A) can worsen heart failure and are generally avoided. Loop
diuretics (Option C) provide symptom relief but do not reduce mortality. Nitrates (Option D) provide symptomatic relief but
do not improve survival in chronic HFrEF.
Page 2 Guidelines
Academic Year 2026/2027 - Aligned with Current Chronic Disease Management
, NUR 257 Chronic Conditions | Galen College of Nursing Exam 4 Comprehensive Examination | 85 Verified Questions
Q4. A client is receiving intravenous furosemide for acute decompensated heart failure. Which assessment
finding indicates the medication is having the intended effect?
A. Decreased blood pressure without change in urine output
B. Increased urine output, decreased jugular venous distention, and reduced dyspnea [CORRECT]
C. Increased blood pressure and decreased heart rate
D. Decreased respiratory rate and decreased level of consciousness
Correct Answer: B
Rationale
Furosemide is a loop diuretic used in acute decompensated heart failure to reduce preload and relieve congestion;
effectiveness is shown by increased urine output, decreased jugular venous distention, improved dyspnea, and reduced
crackles. Option A omits urine output, which is the primary indicator. Option C is incorrect: furosemide typically lowers
blood pressure, not raises it. Option D describes respiratory depression/oversedation, not diuretic effectiveness.
Q5. A client with chronic stable angina is prescribed sublingual nitroglycerin. Which instruction should
the nurse include in teaching?
A. Take one tablet every 5 minutes for up to 3 doses; if pain is unrelieved, call 911 [CORRECT]
B. Take the tablet with food to prevent stomach upset
C. Store the tablets in a clear plastic container in direct sunlight
D. Crush the tablet and swallow it with water for faster action
Correct Answer: A
Rationale
Sublingual nitroglycerin is taken as one tablet under the tongue every 5 minutes for up to 3 doses; if chest pain is not
relieved, the client should call 911 immediately because this may signal a myocardial infarction. Nitroglycerin should be
taken under the tongue (not crushed/swallowed, Option D), stored in its original dark glass bottle away from light (not in
clear plastic, Option C), and need not be taken with food (Option B).
Q6. A client post-myocardial infarction is prescribed atorvastatin 80 mg daily. The nurse knows this
medication is given for which primary purpose?
A. To lower blood pressure
B. To prevent dysrhythmias
C. High-intensity statin therapy to stabilize plaques and reduce recurrent cardiovascular events [CORRECT]
D. To relieve chest pain on exertion
Correct Answer: C
Rationale
High-intensity statin therapy (e.g., atorvastatin 80 mg) is initiated after MI to stabilize atherosclerotic plaques, lower LDL
cholesterol, and reduce recurrent events and mortality. It is not for blood pressure (Option A) or dysrhythmias (Option B)
and is not an antianginal (Option D).
Page 3 Guidelines
Academic Year 2026/2027 - Aligned with Current Chronic Disease Management
NUR 257 Chronic Conditions
Galen College of Nursing | Academic Year 2026/2027 | Exam 4 Comprehensive Examination
This exam is aligned with the Galen College of Nursing NUR 257 Chronic Conditions curriculum and reflects
2026/2027 current chronic disease management guidelines. It contains exactly 85 multiple-choice questions
distributed across seven sections covering: (1) Cardiovascular Chronic Conditions (Heart Failure, CAD,
Hypertension, and Dysrhythmias); (2) Respiratory Chronic Conditions (COPD, Asthma, and Restrictive
Disorders); (3) Endocrine Chronic Conditions (Diabetes, Thyroid, and Adrenal Disorders); (4) Renal and
Neurological Chronic Conditions (CKD, Stroke, Seizures, and Neurodegenerative Disorders); (5) Musculoskeletal
and Immunologic Chronic Conditions (OA, RA, Lupus, and HIV); (6) Gastrointestinal and Hematologic Chronic
Conditions (IBD, Cirrhosis, Anemia, and Coagulopathies); and (7) Psychosocial, Palliative, and End-of-Life Care
(Coping, Depression, Advance Directives, and Hospice). Cognitive levels: approximately 30% recall, 50%
application, and 20% analysis. Approximately 80% of questions are scenario-based application and 20% are direct
recall of chronic condition concepts. Each question provides four options (A-D) with one correct answer, marked
[CORRECT] in green, and a detailed rationale with chronic care nursing reasoning covering pathophysiology,
medication management, patient education, and safety considerations. Priority questions include 'Which finding
requires IMMEDIATE follow-up?' and 'Which complication is the client at GREATEST risk for?' formats, patient
education scenarios ('Which instruction should the nurse include in teaching?'), and interdisciplinary care
coordination scenarios reflecting pre-licensure RN-level clinical judgment. Common chronic care nursing errors
(incorrect medication management, misunderstanding dietary restrictions, improper assessment priorities, failure
to recognize complications, incorrect patient education) appear as distractors.
Section 1: Cardiovascular Chronic Conditions
Heart Failure, Coronary Artery Disease, Hypertension, and Dysrhythmias
Page 1 Guidelines
Academic Year 2026/2027 - Aligned with Current Chronic Disease Management
,NUR 257 Chronic Conditions | Galen College of Nursing Exam 4 Comprehensive Examination | 85 Verified Questions
Q1. A 72-year-old client with heart failure with reduced ejection fraction (HFrEF) is prescribed lisinopril,
carvedilol, furosemide, and spironolactone. Which finding on morning assessment requires IMMEDIATE
follow-up?
A. Serum potassium of 3.5 mEq/L
B. Heart rate of 58 bpm while taking carvedilol
C. Serum potassium of 6.1 mEq/L with peaked T waves on the ECG [CORRECT]
D. Daily weight increase of 0.5 kg from the previous day
Correct Answer: C
Rationale
Hyperkalemia (K+ 6.1 mEq/L with peaked T waves) is a life-threatening emergency requiring immediate intervention
because the client is on both an ACE inhibitor (lisinopril) and a potassium-sparing diuretic (spironolactone), which together
significantly raise the risk of dangerous hyperkalemia that can precipitate lethal dysrhythmias. Option A (K+ 3.5) is at the
low end of normal but does not require emergency action. Option B (HR 58) is an expected carvedilol effect; the nurse
should hold the dose only if HR is below approximately 55-60 with symptoms. Option D (0.5 kg/day weight gain) warrants
monitoring but is not immediately life-threatening.
Q2. A client with heart failure is being discharged with instructions to monitor daily weights. Which
statement by the client indicates the teaching has been effective?
A. I will weigh myself once a week at the same time of day
B. I will weigh myself every morning after breakfast and dressing
C. I will weigh myself each morning before eating, after urinating, wearing the same type of clothing
[CORRECT]
D. I will weigh myself before going to bed each night
Correct Answer: C
Rationale
Daily weights must be obtained consistently, ideally first thing in the morning before eating or drinking, after voiding, and
wearing the same clothing, to detect fluid retention early. A weight gain of 2-3 pounds in 24 hours or 5 pounds in a week
signals worsening heart failure and requires immediate provider notification. Options A, B, and D introduce inconsistency in
timing or intake/output status that would distort the trend.
Q3. A client with systolic heart failure has an ejection fraction of 25%. The nurse understands that which
medication class is MOST proven to reduce mortality in this client?
A. Calcium channel blockers
B. Beta blockers (e.g., carvedilol, metoprolol succinate) [CORRECT]
C. Loop diuretics (e.g., furosemide)
D. Nitrates (e.g., nitroglycerin)
Correct Answer: B
Rationale
Beta blockers (carvedilol, metoprolol succinate, bisoprolol) reduce sympathetic overdrive, lower heart rate, improve
ejection fraction, and have been conclusively shown to reduce mortality in HFrEF. They are started once the client is
euvolemic and stable. Calcium channel blockers (Option A) can worsen heart failure and are generally avoided. Loop
diuretics (Option C) provide symptom relief but do not reduce mortality. Nitrates (Option D) provide symptomatic relief but
do not improve survival in chronic HFrEF.
Page 2 Guidelines
Academic Year 2026/2027 - Aligned with Current Chronic Disease Management
, NUR 257 Chronic Conditions | Galen College of Nursing Exam 4 Comprehensive Examination | 85 Verified Questions
Q4. A client is receiving intravenous furosemide for acute decompensated heart failure. Which assessment
finding indicates the medication is having the intended effect?
A. Decreased blood pressure without change in urine output
B. Increased urine output, decreased jugular venous distention, and reduced dyspnea [CORRECT]
C. Increased blood pressure and decreased heart rate
D. Decreased respiratory rate and decreased level of consciousness
Correct Answer: B
Rationale
Furosemide is a loop diuretic used in acute decompensated heart failure to reduce preload and relieve congestion;
effectiveness is shown by increased urine output, decreased jugular venous distention, improved dyspnea, and reduced
crackles. Option A omits urine output, which is the primary indicator. Option C is incorrect: furosemide typically lowers
blood pressure, not raises it. Option D describes respiratory depression/oversedation, not diuretic effectiveness.
Q5. A client with chronic stable angina is prescribed sublingual nitroglycerin. Which instruction should
the nurse include in teaching?
A. Take one tablet every 5 minutes for up to 3 doses; if pain is unrelieved, call 911 [CORRECT]
B. Take the tablet with food to prevent stomach upset
C. Store the tablets in a clear plastic container in direct sunlight
D. Crush the tablet and swallow it with water for faster action
Correct Answer: A
Rationale
Sublingual nitroglycerin is taken as one tablet under the tongue every 5 minutes for up to 3 doses; if chest pain is not
relieved, the client should call 911 immediately because this may signal a myocardial infarction. Nitroglycerin should be
taken under the tongue (not crushed/swallowed, Option D), stored in its original dark glass bottle away from light (not in
clear plastic, Option C), and need not be taken with food (Option B).
Q6. A client post-myocardial infarction is prescribed atorvastatin 80 mg daily. The nurse knows this
medication is given for which primary purpose?
A. To lower blood pressure
B. To prevent dysrhythmias
C. High-intensity statin therapy to stabilize plaques and reduce recurrent cardiovascular events [CORRECT]
D. To relieve chest pain on exertion
Correct Answer: C
Rationale
High-intensity statin therapy (e.g., atorvastatin 80 mg) is initiated after MI to stabilize atherosclerotic plaques, lower LDL
cholesterol, and reduce recurrent events and mortality. It is not for blood pressure (Option A) or dysrhythmias (Option B)
and is not an antianginal (Option D).
Page 3 Guidelines
Academic Year 2026/2027 - Aligned with Current Chronic Disease Management
