1
NUR 257 CHRONIC CONDITIONS EXAM 3 FALL
2026/2027 | Galen College of Nursing | Complete
Questions 100% Correct | Latest Version | Pass
Guaranteed - A+ Graded
Section 1: Chronic Cardiovascular Disease Management (Q1-14)
Q1. A 68-year-old patient is diagnosed with chronic heart failure. An echocardiogram
reveals a left ventricular ejection fraction (LVEF) of 35% with dilated left ventricular
cavity and thin walls. The patient reports dyspnea on exertion and orthopnea. Which
classification of heart failure and initial therapeutic focus is most accurate?
A. Heart failure with preserved ejection fraction (HFpEF); prioritize diuretics and blood
pressure control only
B. Heart failure with reduced ejection fraction (HFrEF); initiate guideline-directed
medical therapy (GDMT) with neurohormonal blockade and SGLT2 inhibition
[CORRECT]
C. Right-sided heart failure; focus on pulmonary vasodilators
D. Acute decompensated heart failure; immediate inpatient inotrope therapy is
required
Rationale: An LVEF of 35% confirms HFrEF (systolic dysfunction). Current
ACC/AHA/HFSA guidelines recommend the "4 pillars" of GDMT: ARNI/ACEi/ARB,
evidence-based beta-blocker, MRA, and SGLT2i. Choice A describes HFpEF (LVEF
≥50%); C misidentifies the primary issue; D assumes acute instability not described.
Correct Answer: B
Q2. A patient with newly diagnosed HFrEF (LVEF 30%) is hospitalized with acute
decompensated heart failure requiring IV diuretics. The inpatient team plans GDMT
initiation. Which medication sequencing aligns with current evidence-based
guidelines?
,2
A. Initiate carvedilol immediately alongside IV diuretics to maximize sympathetic
blockade
B. Start empagliflozin after discharge only when the patient is euvolemic and
hemodynamically stable
C. Initiate ACE inhibitor and evidence-based beta-blocker once euvolemic and stable;
add SGLT2i and MRA during titration as an outpatient [CORRECT]
D. Delay all GDMT until the 3-month cardiology follow-up appointment
Rationale: Beta-blockers should not be initiated during acute decompensation or
active IV diuresis due to risk of worsening hemodynamics. ACEi/BB are started once
stable and euvolemic; SGLT2i and MRA are added sequentially during outpatient
titration. Choice A is unsafe acutely; B delays SGLT2i unnecessarily; D represents
dangerous therapeutic nihilism.
Correct Answer: C
Q3. A patient with HFrEF has been on lisinopril 10 mg daily for 8 weeks but reports a
persistent dry cough that disrupts sleep. The provider considers switching the renin-
angiotensin system blocker. Which substitution best aligns with GDMT and the
patient's tolerance?
A. Discontinue all renin-angiotensin blockade and monitor
B. Switch to losartan (ARB) to avoid ACEi-associated bradykinin cough while
maintaining mortality benefit [CORRECT]
C. Switch to hydralazine-isosorbide as first-line monotherapy
D. Add diphenhydramine to suppress the cough and continue lisinopril
Rationale: ACEi cough is bradykinin-mediated and occurs in 5-20% of patients;
switching to an ARB maintains mortality/morbidity benefit without the cough. Choice
A removes proven life-saving therapy; C is reserved for ACEi/ARB-intolerant African
American patients or advanced disease; D masks symptoms without addressing the
cause.
Correct Answer: B
,3
Q4. A 72-year-old with HFrEF (LVEF 28%), type 2 diabetes, and CKD stage 3b (eGFR
38 mL/min/1.73m²) is not on an SGLT2 inhibitor. The provider is concerned about
initiating dapagliflozin given the reduced eGFR. Which response is correct per current
heart failure and diabetes guidelines?
A. SGLT2 inhibitors are contraindicated when eGFR falls below 45
B. Dapagliflozin is indicated for HFrEF regardless of diabetes status and can be
initiated down to eGFR 20-25, with renal and cardiovascular benefit [CORRECT]
C. SGLT2 inhibitors should only be used in HFpEF, not HFrEF
D. Wait until eGFR improves above 60 before considering SGLT2i therapy
Rationale: Dapagliflozin and empagliflozin are approved for HFrEF down to eGFR 20-
25 mL/min/1.73m² and provide renal protection, reduced HF hospitalization, and
mortality benefit independent of glycemic effect. Choice A uses outdated thresholds;
C incorrectly restricts to HFpEF; D delays evidence-based therapy.
Correct Answer: B
Q5. A patient with HFrEF is already receiving sacubitril/valsartan, carvedilol, and
dapagliflozin. Serum potassium is 4.6 mEq/L and eGFR is 44 mL/min/1.73m². Which
next GDMT step is most appropriate?
A. Add eplerenone (MRA) to complete the 4-pillar foundation, with close potassium
and renal monitoring [CORRECT]
B. Avoid MRA due to eGFR <60 and risk of hyperkalemia
C. Add ivabradine before MRA because heart rate is 72 bpm
D. Increase sacubitril/valsartan to maximum dose before adding any additional
agents
Rationale: MRAs (spironolactone/eplerenone) reduce mortality in HFrEF and should
be added if potassium <5.0 mEq/L and eGFR >30, with monitoring. Choice B is overly
cautious; C adds ivabradine before completing foundational GDMT; D delays MRA
unnecessarily.
Correct Answer: A
, 4
Q6. A 64-year-old with chronic coronary artery disease reports stable exertional chest
pain (CCS Class II) despite being on metoprolol succinate 100 mg daily and
atorvastatin 40 mg. The cardiologist recommends additional antianginal therapy.
Which agent is most appropriate as second-line therapy?
A. Amlodipine or a long-acting nitrate as second-line antianginal therapy [CORRECT]
B. Immediate-release nifedipine for rapid symptom relief
C. Discontinue metoprolol and switch to diltiazem monotherapy
D. Add aspirin 81 mg as the sole additional agent
Rationale: For stable angina on optimal beta-blocker therapy with persistent
symptoms, calcium channel blockers or long-acting nitrates are guideline-
concordant second-line antianginals. Choice B uses immediate-release formulation
associated with reflex tachycardia and adverse events; C removes proven mortality
benefit of beta-blocker; D adds antiplatelet therapy without antianginal effect.
Correct Answer: A
Q7. A 58-year-old patient with hypertension, type 2 diabetes, and CKD stage 3a
presents for follow-up. Blood pressure is 148/94 mmHg on amlodipine 5 mg. Urine
albumin-to-creatinine ratio is 220 mg/g. Which medication adjustment aligns with
ACC/AHA and KDIGO guidelines?
A. Add hydrochlorothiazide and increase amlodipine to 10 mg
B. Add an ACE inhibitor or ARB for renal protection and blood pressure control
[CORRECT]
C. Switch to clonidine for better central blood pressure control
D. Add carvedilol as the next agent to target sympathetic overdrive
Rationale: In hypertension with diabetes and albuminuria (ACR ≥30 mg/g), ACEi or
ARB is first-line for both blood pressure and renal protection. Choice A adds
dihydropyridine CCB and thiazide without renoprotection; C is not first-line for this
clinical picture; D adds beta-blocker without specific renal indication.
Correct Answer: B
NUR 257 CHRONIC CONDITIONS EXAM 3 FALL
2026/2027 | Galen College of Nursing | Complete
Questions 100% Correct | Latest Version | Pass
Guaranteed - A+ Graded
Section 1: Chronic Cardiovascular Disease Management (Q1-14)
Q1. A 68-year-old patient is diagnosed with chronic heart failure. An echocardiogram
reveals a left ventricular ejection fraction (LVEF) of 35% with dilated left ventricular
cavity and thin walls. The patient reports dyspnea on exertion and orthopnea. Which
classification of heart failure and initial therapeutic focus is most accurate?
A. Heart failure with preserved ejection fraction (HFpEF); prioritize diuretics and blood
pressure control only
B. Heart failure with reduced ejection fraction (HFrEF); initiate guideline-directed
medical therapy (GDMT) with neurohormonal blockade and SGLT2 inhibition
[CORRECT]
C. Right-sided heart failure; focus on pulmonary vasodilators
D. Acute decompensated heart failure; immediate inpatient inotrope therapy is
required
Rationale: An LVEF of 35% confirms HFrEF (systolic dysfunction). Current
ACC/AHA/HFSA guidelines recommend the "4 pillars" of GDMT: ARNI/ACEi/ARB,
evidence-based beta-blocker, MRA, and SGLT2i. Choice A describes HFpEF (LVEF
≥50%); C misidentifies the primary issue; D assumes acute instability not described.
Correct Answer: B
Q2. A patient with newly diagnosed HFrEF (LVEF 30%) is hospitalized with acute
decompensated heart failure requiring IV diuretics. The inpatient team plans GDMT
initiation. Which medication sequencing aligns with current evidence-based
guidelines?
,2
A. Initiate carvedilol immediately alongside IV diuretics to maximize sympathetic
blockade
B. Start empagliflozin after discharge only when the patient is euvolemic and
hemodynamically stable
C. Initiate ACE inhibitor and evidence-based beta-blocker once euvolemic and stable;
add SGLT2i and MRA during titration as an outpatient [CORRECT]
D. Delay all GDMT until the 3-month cardiology follow-up appointment
Rationale: Beta-blockers should not be initiated during acute decompensation or
active IV diuresis due to risk of worsening hemodynamics. ACEi/BB are started once
stable and euvolemic; SGLT2i and MRA are added sequentially during outpatient
titration. Choice A is unsafe acutely; B delays SGLT2i unnecessarily; D represents
dangerous therapeutic nihilism.
Correct Answer: C
Q3. A patient with HFrEF has been on lisinopril 10 mg daily for 8 weeks but reports a
persistent dry cough that disrupts sleep. The provider considers switching the renin-
angiotensin system blocker. Which substitution best aligns with GDMT and the
patient's tolerance?
A. Discontinue all renin-angiotensin blockade and monitor
B. Switch to losartan (ARB) to avoid ACEi-associated bradykinin cough while
maintaining mortality benefit [CORRECT]
C. Switch to hydralazine-isosorbide as first-line monotherapy
D. Add diphenhydramine to suppress the cough and continue lisinopril
Rationale: ACEi cough is bradykinin-mediated and occurs in 5-20% of patients;
switching to an ARB maintains mortality/morbidity benefit without the cough. Choice
A removes proven life-saving therapy; C is reserved for ACEi/ARB-intolerant African
American patients or advanced disease; D masks symptoms without addressing the
cause.
Correct Answer: B
,3
Q4. A 72-year-old with HFrEF (LVEF 28%), type 2 diabetes, and CKD stage 3b (eGFR
38 mL/min/1.73m²) is not on an SGLT2 inhibitor. The provider is concerned about
initiating dapagliflozin given the reduced eGFR. Which response is correct per current
heart failure and diabetes guidelines?
A. SGLT2 inhibitors are contraindicated when eGFR falls below 45
B. Dapagliflozin is indicated for HFrEF regardless of diabetes status and can be
initiated down to eGFR 20-25, with renal and cardiovascular benefit [CORRECT]
C. SGLT2 inhibitors should only be used in HFpEF, not HFrEF
D. Wait until eGFR improves above 60 before considering SGLT2i therapy
Rationale: Dapagliflozin and empagliflozin are approved for HFrEF down to eGFR 20-
25 mL/min/1.73m² and provide renal protection, reduced HF hospitalization, and
mortality benefit independent of glycemic effect. Choice A uses outdated thresholds;
C incorrectly restricts to HFpEF; D delays evidence-based therapy.
Correct Answer: B
Q5. A patient with HFrEF is already receiving sacubitril/valsartan, carvedilol, and
dapagliflozin. Serum potassium is 4.6 mEq/L and eGFR is 44 mL/min/1.73m². Which
next GDMT step is most appropriate?
A. Add eplerenone (MRA) to complete the 4-pillar foundation, with close potassium
and renal monitoring [CORRECT]
B. Avoid MRA due to eGFR <60 and risk of hyperkalemia
C. Add ivabradine before MRA because heart rate is 72 bpm
D. Increase sacubitril/valsartan to maximum dose before adding any additional
agents
Rationale: MRAs (spironolactone/eplerenone) reduce mortality in HFrEF and should
be added if potassium <5.0 mEq/L and eGFR >30, with monitoring. Choice B is overly
cautious; C adds ivabradine before completing foundational GDMT; D delays MRA
unnecessarily.
Correct Answer: A
, 4
Q6. A 64-year-old with chronic coronary artery disease reports stable exertional chest
pain (CCS Class II) despite being on metoprolol succinate 100 mg daily and
atorvastatin 40 mg. The cardiologist recommends additional antianginal therapy.
Which agent is most appropriate as second-line therapy?
A. Amlodipine or a long-acting nitrate as second-line antianginal therapy [CORRECT]
B. Immediate-release nifedipine for rapid symptom relief
C. Discontinue metoprolol and switch to diltiazem monotherapy
D. Add aspirin 81 mg as the sole additional agent
Rationale: For stable angina on optimal beta-blocker therapy with persistent
symptoms, calcium channel blockers or long-acting nitrates are guideline-
concordant second-line antianginals. Choice B uses immediate-release formulation
associated with reflex tachycardia and adverse events; C removes proven mortality
benefit of beta-blocker; D adds antiplatelet therapy without antianginal effect.
Correct Answer: A
Q7. A 58-year-old patient with hypertension, type 2 diabetes, and CKD stage 3a
presents for follow-up. Blood pressure is 148/94 mmHg on amlodipine 5 mg. Urine
albumin-to-creatinine ratio is 220 mg/g. Which medication adjustment aligns with
ACC/AHA and KDIGO guidelines?
A. Add hydrochlorothiazide and increase amlodipine to 10 mg
B. Add an ACE inhibitor or ARB for renal protection and blood pressure control
[CORRECT]
C. Switch to clonidine for better central blood pressure control
D. Add carvedilol as the next agent to target sympathetic overdrive
Rationale: In hypertension with diabetes and albuminuria (ACR ≥30 mg/g), ACEi or
ARB is first-line for both blood pressure and renal protection. Choice A adds
dihydropyridine CCB and thiazide without renoprotection; C is not first-line for this
clinical picture; D adds beta-blocker without specific renal indication.
Correct Answer: B
