GALEN COLLEGE OF NURSING
NUR 257 Chronic Exam 4
Official Practice Exam -- 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
75 90 80% Annual
Table of Contents
Section 1: Chronic Cardiovascular and Hematologic Disorders Questions 1--16
Section 2: Chronic Respiratory and Pulmonary Disorders Questions 17--31
Section 3: Chronic Endocrine and Metabolic Disorders Questions 32--46
Section 4: Chronic Neurological and Sensory Disorders Questions 47--61
Section 5: Chronic Renal, Musculoskeletal, and Integumentary Disorders Questions 62--75
Answer Key Final Page
Instructions
This practice exam contains 75 multiple-choice questions divided into 5 sections. You have 90 minutes to
complete the entire exam. Each question has four answer choices (A, B, C, D). Select the single best answer for
each question. A passing score of 80% or higher is required, meaning you must correctly answer at least 60 of 75
questions. Read each question carefully, noting the clinical scenario and all answer options before selecting your
response. Review the rationale provided for each question to reinforce your understanding of key concepts.
Manage your time accordingly, spending approximately 72 seconds per question.
This practice exam is intended for study purposes only and does not guarantee passage of any certification examination.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 1 of 1
,Section 1: Chronic Cardiovascular and Hematologic Disorders2026/2027 | Questions 1--16
Q1. Question 1 of 75
A 68-year-old male with a 10-year history of hypertension presents to the clinic with a blood
pressure of 168/98 mm Hg despite taking lisinopril 20 mg daily. He reports occasional headaches
and mild dyspnea on exertion. The provider plans to add a second antihypertensive agent. Which
medication class is most appropriate to add as a second-line agent for this patient?
A. Potassium-sparing diuretic
B. Thiazide-type diuretic
C. Alpha-1 adrenergic blocker
D. Direct vasodilator
Correct Answer: A
Rationale:
Thiazide diuretics are recommended as first-line add-on therapy for uncomplicated hypertension when
ACE inhibitors alone are insufficient. Hydrochlorothiazide reduces blood volume and enhances the
effectiveness of ACE inhibitors. Alpha-1 blockers and direct vasodilators are not preferred second-line
agents due to side effect profiles and lack of outcome data.
Q2. Question 2 of 75
A 72-year-old female is admitted with acute decompensated heart failure and has a BNP level of
1,200 pg/mL, bilateral crackles in the lung bases, and 3+ pitting edema in both lower extremities.
The nurse is preparing to administer the first dose of furosemide 40 mg IV push. Which
assessment finding requires the nurse to hold the medication and notify the provider?
A. Serum potassium of 2.8 mEq/L
B. Serum sodium of 136 mEq/L
C. Heart rate of 92 beats per minute
D. Blood pressure of 110/68 mm Hg
Correct Answer: D
Rationale:
A serum potassium of 2.8 mEq/L indicates severe hypokalemia, which increases the risk of
life-threatening dysrhythmias, especially when loop diuretics like furosemide cause further potassium
loss. The medication should be held until potassium is replaced. The other values are within acceptable
ranges for a patient with heart failure.
,Q3. Question 3 of 75
A 55-year-old male with newly diagnosed atrial fibrillation has a CHA2DS2-VASc score of 3. The
provider prescribes rivaroxaban 20 mg daily for stroke prevention. The nurse is educating the
patient about this medication. Which statement by the patient indicates a need for further teaching?
A. I should take this medication with my evening meal.
B. I will need regular blood tests to monitor my INR level.
C. I should inform my dentist that I take this blood thinner.
D. I need to report any unusual bruising or bleeding to my provider.
Correct Answer: D
Rationale:
Rivaroxaban is a direct oral anticoagulant that does not require routine INR monitoring, unlike warfarin.
The patient's statement about needing regular INR tests indicates a misunderstanding. Rivaroxaban
should be taken with food for optimal absorption, and patients should report bleeding and inform
healthcare providers about anticoagulant use.
Q4. Question 4 of 75
A 64-year-old female with a history of mitral valve prolapse presents with fever, chills, and a new
holosystolic murmur at the apex. Blood cultures grow Streptococcus bovis. The nurse suspects
infective endocarditis and anticipates which diagnostic finding on the echocardiogram?
A. Vegetation on the mitral valve
B. Dilation of the aortic root
C. Pericardial effusion with tamponade
D. Thickening of the left ventricular wall
Correct Answer: D
Rationale:
Infective endocarditis characteristically presents with vegetations on the affected valve, which in this
case is the mitral valve given the history of mitral valve prolapse and the new apical holosystolic murmur.
Streptococcus bovis is a known causative organism. The other findings are not typical of infective
endocarditis.
, Q5. Question 5 of 75
A 58-year-old male presents to the emergency department with chest pain that began 30 minutes
ago, described as a heavy pressure radiating to his left arm. An ECG shows ST-segment elevation
in leads II, III, and aVF. The nurse recognizes this pattern indicates an infarction in which area of
the heart?
A. Anterior wall
B. Lateral wall
C. Inferior wall
D. Posterior wall
Correct Answer: A
Rationale:
ST-segment elevation in leads II, III, and aVF is the classic ECG pattern for an inferior wall myocardial
infarction, typically caused by occlusion of the right coronary artery. Anterior wall MI shows changes in
V1-V4, lateral wall in I, aVL, V5-V6, and posterior wall shows reciprocal changes in V1-V2.
Q6. Question 6 of 75
A 70-year-old male with peripheral arterial disease complains of calf pain that occurs after walking
two blocks and is relieved by rest. On examination, his posterior tibial pulses are diminished
bilaterally and his ankle-brachial index is 0.65. The nurse recognizes this clinical presentation as
which stage of peripheral arterial disease?
A. Asymptomatic PAD
B. Critical limb ischemia
C. Moderate to severe claudication
D. Mild claudication
Correct Answer: D
Rationale:
An ABI of 0.65 with claudication that occurs after walking two blocks and is relieved by rest indicates
moderate claudication, which is classified as Fontaine Stage II. Critical limb ischemia presents with rest
pain or tissue loss and an ABI below 0.40. Asymptomatic PAD would have a decreased ABI without
symptoms.
NUR 257 Chronic Exam 4
Official Practice Exam -- 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
75 90 80% Annual
Table of Contents
Section 1: Chronic Cardiovascular and Hematologic Disorders Questions 1--16
Section 2: Chronic Respiratory and Pulmonary Disorders Questions 17--31
Section 3: Chronic Endocrine and Metabolic Disorders Questions 32--46
Section 4: Chronic Neurological and Sensory Disorders Questions 47--61
Section 5: Chronic Renal, Musculoskeletal, and Integumentary Disorders Questions 62--75
Answer Key Final Page
Instructions
This practice exam contains 75 multiple-choice questions divided into 5 sections. You have 90 minutes to
complete the entire exam. Each question has four answer choices (A, B, C, D). Select the single best answer for
each question. A passing score of 80% or higher is required, meaning you must correctly answer at least 60 of 75
questions. Read each question carefully, noting the clinical scenario and all answer options before selecting your
response. Review the rationale provided for each question to reinforce your understanding of key concepts.
Manage your time accordingly, spending approximately 72 seconds per question.
This practice exam is intended for study purposes only and does not guarantee passage of any certification examination.
NUR 257 Chronic Exam 4 -- 2026/2027 | Passing Score: 80% | Page 1 of 1
,Section 1: Chronic Cardiovascular and Hematologic Disorders2026/2027 | Questions 1--16
Q1. Question 1 of 75
A 68-year-old male with a 10-year history of hypertension presents to the clinic with a blood
pressure of 168/98 mm Hg despite taking lisinopril 20 mg daily. He reports occasional headaches
and mild dyspnea on exertion. The provider plans to add a second antihypertensive agent. Which
medication class is most appropriate to add as a second-line agent for this patient?
A. Potassium-sparing diuretic
B. Thiazide-type diuretic
C. Alpha-1 adrenergic blocker
D. Direct vasodilator
Correct Answer: A
Rationale:
Thiazide diuretics are recommended as first-line add-on therapy for uncomplicated hypertension when
ACE inhibitors alone are insufficient. Hydrochlorothiazide reduces blood volume and enhances the
effectiveness of ACE inhibitors. Alpha-1 blockers and direct vasodilators are not preferred second-line
agents due to side effect profiles and lack of outcome data.
Q2. Question 2 of 75
A 72-year-old female is admitted with acute decompensated heart failure and has a BNP level of
1,200 pg/mL, bilateral crackles in the lung bases, and 3+ pitting edema in both lower extremities.
The nurse is preparing to administer the first dose of furosemide 40 mg IV push. Which
assessment finding requires the nurse to hold the medication and notify the provider?
A. Serum potassium of 2.8 mEq/L
B. Serum sodium of 136 mEq/L
C. Heart rate of 92 beats per minute
D. Blood pressure of 110/68 mm Hg
Correct Answer: D
Rationale:
A serum potassium of 2.8 mEq/L indicates severe hypokalemia, which increases the risk of
life-threatening dysrhythmias, especially when loop diuretics like furosemide cause further potassium
loss. The medication should be held until potassium is replaced. The other values are within acceptable
ranges for a patient with heart failure.
,Q3. Question 3 of 75
A 55-year-old male with newly diagnosed atrial fibrillation has a CHA2DS2-VASc score of 3. The
provider prescribes rivaroxaban 20 mg daily for stroke prevention. The nurse is educating the
patient about this medication. Which statement by the patient indicates a need for further teaching?
A. I should take this medication with my evening meal.
B. I will need regular blood tests to monitor my INR level.
C. I should inform my dentist that I take this blood thinner.
D. I need to report any unusual bruising or bleeding to my provider.
Correct Answer: D
Rationale:
Rivaroxaban is a direct oral anticoagulant that does not require routine INR monitoring, unlike warfarin.
The patient's statement about needing regular INR tests indicates a misunderstanding. Rivaroxaban
should be taken with food for optimal absorption, and patients should report bleeding and inform
healthcare providers about anticoagulant use.
Q4. Question 4 of 75
A 64-year-old female with a history of mitral valve prolapse presents with fever, chills, and a new
holosystolic murmur at the apex. Blood cultures grow Streptococcus bovis. The nurse suspects
infective endocarditis and anticipates which diagnostic finding on the echocardiogram?
A. Vegetation on the mitral valve
B. Dilation of the aortic root
C. Pericardial effusion with tamponade
D. Thickening of the left ventricular wall
Correct Answer: D
Rationale:
Infective endocarditis characteristically presents with vegetations on the affected valve, which in this
case is the mitral valve given the history of mitral valve prolapse and the new apical holosystolic murmur.
Streptococcus bovis is a known causative organism. The other findings are not typical of infective
endocarditis.
, Q5. Question 5 of 75
A 58-year-old male presents to the emergency department with chest pain that began 30 minutes
ago, described as a heavy pressure radiating to his left arm. An ECG shows ST-segment elevation
in leads II, III, and aVF. The nurse recognizes this pattern indicates an infarction in which area of
the heart?
A. Anterior wall
B. Lateral wall
C. Inferior wall
D. Posterior wall
Correct Answer: A
Rationale:
ST-segment elevation in leads II, III, and aVF is the classic ECG pattern for an inferior wall myocardial
infarction, typically caused by occlusion of the right coronary artery. Anterior wall MI shows changes in
V1-V4, lateral wall in I, aVL, V5-V6, and posterior wall shows reciprocal changes in V1-V2.
Q6. Question 6 of 75
A 70-year-old male with peripheral arterial disease complains of calf pain that occurs after walking
two blocks and is relieved by rest. On examination, his posterior tibial pulses are diminished
bilaterally and his ankle-brachial index is 0.65. The nurse recognizes this clinical presentation as
which stage of peripheral arterial disease?
A. Asymptomatic PAD
B. Critical limb ischemia
C. Moderate to severe claudication
D. Mild claudication
Correct Answer: D
Rationale:
An ABI of 0.65 with claudication that occurs after walking two blocks and is relieved by rest indicates
moderate claudication, which is classified as Fontaine Stage II. Critical limb ischemia presents with rest
pain or tissue loss and an ABI below 0.40. Asymptomatic PAD would have a decreased ABI without
symptoms.
