NUR 257 Chronic Exam 3 Actual Exam 2026/2027: Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Chronic Cardiovascular Conditions | Q1 – Q10
Section 2 | Chronic Respiratory Conditions | Q11 – Q20
Section 3 | Chronic Endocrine & Metabolic Conditions | Q21 – Q30
Section 4 | Chronic Neurologic & Musculoskeletal Conditions | Q31 – Q40
Section 5 | Chronic Renal, Gastrointestinal & Multisystem Conditions | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: CHRONIC CARDIOVASCULAR CONDITIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man with a 15-year history of hypertension presents to the clinic for a
routine follow-up. His home blood pressure log shows readings consistently around
158/96 mmHg despite taking lisinopril 20 mg daily. He reports occasional headaches
and mild ankle swelling. His most recent labs show a serum potassium of 5.2 mEq/L
and a creatinine of 1.6 mg/dL. The nurse practitioner decides to add a second
antihypertensive agent. Which agent would be most appropriate to add at this time?
A. Spironolactone
B. Hydrochlorothiazide
C. Amlodipine ✓ CORRECT
D. Losartan
Correct Answer: C
,Rationale: Amlodipine is a calcium channel blocker that effectively lowers blood
pressure without affecting potassium levels or worsening renal function, making it a
safe addition in this patient with borderline hyperkalemia and mild renal impairment.
Spironolactone and losartan would both further elevate his potassium, which is already
elevated at 5.2 mEq/L. In practice, clinicians often pair ACE inhibitors with
dihydropyridine calcium channel blockers when additional control is needed without
compounding renal or electrolyte risks.
Question 2 of 50
A 54-year-old woman with chronic heart failure with reduced ejection fraction (HFrEF) is
admitted to the telemetry unit with worsening dyspnea and weight gain of 6 pounds
over the past week. Her current medications include metoprolol succinate 50 mg daily,
lisinopril 10 mg daily, and furosemide 40 mg daily. Her vital signs are BP 102/68 mmHg,
HR 88 bpm, RR 24/min, and SpO2 91% on room air. Which medication adjustment
should the nurse anticipate the provider will make first?
A. Increase metoprolol succinate to 100 mg daily
B. Increase furosemide to 80 mg daily ✓ CORRECT
C. Start spironolactone 25 mg daily
D. Discontinue lisinopril
Correct Answer: B
Rationale: Increasing the loop diuretic is the appropriate first step to address acute fluid
overload, as evidenced by the 6-pound weight gain and worsening dyspnea. Increasing
beta-blocker dosage could worsen acute decompensation by further reducing cardiac
output. The nurse should monitor the patient closely for hypotension and electrolyte
shifts after the diuretic dose is increased, since she is already borderline hypotensive.
Question 3 of 50
,A 72-year-old man with atrial fibrillation on warfarin therapy presents to the emergency
department after a fall at home. He hit his head on a concrete step and has a small
frontal scalp laceration. His INR is 4.8, and a non-contrast head CT shows a small
subdural hematoma. The emergency physician orders fresh frozen plasma (FFP) and
vitamin K. The nurse should anticipate that the anticoagulation reversal will take effect
within which timeframe?
A. 1 to 2 hours
B. 6 to 12 hours
C. 12 to 24 hours
D. 24 to 48 hours ✓ CORRECT
Correct Answer: D
Rationale: Vitamin K works by stimulating synthesis of new functional clotting factors in
the liver, and this process typically requires 24 to 48 hours to fully reverse the effects of
warfarin. FFP provides an immediate but temporary supply of clotting factors, so the
patient still needs close neuro monitoring during the transition. Nurses should
remember that vitamin K alone is never sufficient for urgent reversal in acute bleeding,
which is why FFP or four-factor prothrombin complex concentrate is given concurrently.
Question 4 of 50
A 61-year-old woman with peripheral artery disease (PAD) reports increasing pain in her
right calf when walking more than two blocks, which resolves within 5 minutes of rest.
Her ABI was 0.72 six months ago. She currently takes atorvastatin 40 mg daily and
aspirin 81 mg daily. She asks the nurse whether she should stop walking because of the
pain. What is the most appropriate nursing response?
A. "You should avoid walking until the pain completely resolves."
B. "Walk only when you do not feel any pain at all."
C. "Continue walking to the point of moderate discomfort, then rest and resume." ✓
CORRECT
, D. "Walking will not help your condition and may worsen the blockages."
Correct Answer: C
Rationale: Supervised exercise therapy is the cornerstone of PAD management, and
patients should walk to the point of moderate claudication pain, rest until it subsides,
then resume walking to build collateral circulation. Complete rest or avoiding walking
altogether leads to further deconditioning and functional decline. Most patients with
stable claudication benefit from a structured walking program of at least 30 minutes,
three times per week, performed consistently over several months.
Question 5 of 50
A 49-year-old man with dilated cardiomyopathy and an implanted
cardioverter-defibrillator (ICD) calls the clinic reporting that his device delivered a shock
while he was sitting quietly watching television. He denies chest pain, dyspnea,
palpitations, or loss of consciousness. His heart rate is 72 bpm and regular in the office.
Which action should the nurse prioritize?
A. Reassure the patient that the shock was appropriate and no further action is needed
B. Instruct the patient to turn off the ICD using his magnet until he can be seen
C. Schedule urgent device interrogation to determine if the shock was appropriate ✓
CORRECT
D. Order a 12-lead ECG and send the patient home with event monitoring
Correct Answer: C
Rationale: Any ICD shock, even in the absence of symptoms, warrants urgent device
interrogation to determine whether it was appropriate therapy for ventricular arrhythmia
or inappropriate therapy due to lead fracture, oversensing, or supraventricular
tachycardia. Reassuring the patient without data would be premature and potentially
dangerous if the device malfunctioned. Device clinics typically accommodate same-day
or next-day interrogations for shock events, and the nurse should coordinate this
promptly.
Exam-Style Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Chronic Cardiovascular Conditions | Q1 – Q10
Section 2 | Chronic Respiratory Conditions | Q11 – Q20
Section 3 | Chronic Endocrine & Metabolic Conditions | Q21 – Q30
Section 4 | Chronic Neurologic & Musculoskeletal Conditions | Q31 – Q40
Section 5 | Chronic Renal, Gastrointestinal & Multisystem Conditions | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: CHRONIC CARDIOVASCULAR CONDITIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man with a 15-year history of hypertension presents to the clinic for a
routine follow-up. His home blood pressure log shows readings consistently around
158/96 mmHg despite taking lisinopril 20 mg daily. He reports occasional headaches
and mild ankle swelling. His most recent labs show a serum potassium of 5.2 mEq/L
and a creatinine of 1.6 mg/dL. The nurse practitioner decides to add a second
antihypertensive agent. Which agent would be most appropriate to add at this time?
A. Spironolactone
B. Hydrochlorothiazide
C. Amlodipine ✓ CORRECT
D. Losartan
Correct Answer: C
,Rationale: Amlodipine is a calcium channel blocker that effectively lowers blood
pressure without affecting potassium levels or worsening renal function, making it a
safe addition in this patient with borderline hyperkalemia and mild renal impairment.
Spironolactone and losartan would both further elevate his potassium, which is already
elevated at 5.2 mEq/L. In practice, clinicians often pair ACE inhibitors with
dihydropyridine calcium channel blockers when additional control is needed without
compounding renal or electrolyte risks.
Question 2 of 50
A 54-year-old woman with chronic heart failure with reduced ejection fraction (HFrEF) is
admitted to the telemetry unit with worsening dyspnea and weight gain of 6 pounds
over the past week. Her current medications include metoprolol succinate 50 mg daily,
lisinopril 10 mg daily, and furosemide 40 mg daily. Her vital signs are BP 102/68 mmHg,
HR 88 bpm, RR 24/min, and SpO2 91% on room air. Which medication adjustment
should the nurse anticipate the provider will make first?
A. Increase metoprolol succinate to 100 mg daily
B. Increase furosemide to 80 mg daily ✓ CORRECT
C. Start spironolactone 25 mg daily
D. Discontinue lisinopril
Correct Answer: B
Rationale: Increasing the loop diuretic is the appropriate first step to address acute fluid
overload, as evidenced by the 6-pound weight gain and worsening dyspnea. Increasing
beta-blocker dosage could worsen acute decompensation by further reducing cardiac
output. The nurse should monitor the patient closely for hypotension and electrolyte
shifts after the diuretic dose is increased, since she is already borderline hypotensive.
Question 3 of 50
,A 72-year-old man with atrial fibrillation on warfarin therapy presents to the emergency
department after a fall at home. He hit his head on a concrete step and has a small
frontal scalp laceration. His INR is 4.8, and a non-contrast head CT shows a small
subdural hematoma. The emergency physician orders fresh frozen plasma (FFP) and
vitamin K. The nurse should anticipate that the anticoagulation reversal will take effect
within which timeframe?
A. 1 to 2 hours
B. 6 to 12 hours
C. 12 to 24 hours
D. 24 to 48 hours ✓ CORRECT
Correct Answer: D
Rationale: Vitamin K works by stimulating synthesis of new functional clotting factors in
the liver, and this process typically requires 24 to 48 hours to fully reverse the effects of
warfarin. FFP provides an immediate but temporary supply of clotting factors, so the
patient still needs close neuro monitoring during the transition. Nurses should
remember that vitamin K alone is never sufficient for urgent reversal in acute bleeding,
which is why FFP or four-factor prothrombin complex concentrate is given concurrently.
Question 4 of 50
A 61-year-old woman with peripheral artery disease (PAD) reports increasing pain in her
right calf when walking more than two blocks, which resolves within 5 minutes of rest.
Her ABI was 0.72 six months ago. She currently takes atorvastatin 40 mg daily and
aspirin 81 mg daily. She asks the nurse whether she should stop walking because of the
pain. What is the most appropriate nursing response?
A. "You should avoid walking until the pain completely resolves."
B. "Walk only when you do not feel any pain at all."
C. "Continue walking to the point of moderate discomfort, then rest and resume." ✓
CORRECT
, D. "Walking will not help your condition and may worsen the blockages."
Correct Answer: C
Rationale: Supervised exercise therapy is the cornerstone of PAD management, and
patients should walk to the point of moderate claudication pain, rest until it subsides,
then resume walking to build collateral circulation. Complete rest or avoiding walking
altogether leads to further deconditioning and functional decline. Most patients with
stable claudication benefit from a structured walking program of at least 30 minutes,
three times per week, performed consistently over several months.
Question 5 of 50
A 49-year-old man with dilated cardiomyopathy and an implanted
cardioverter-defibrillator (ICD) calls the clinic reporting that his device delivered a shock
while he was sitting quietly watching television. He denies chest pain, dyspnea,
palpitations, or loss of consciousness. His heart rate is 72 bpm and regular in the office.
Which action should the nurse prioritize?
A. Reassure the patient that the shock was appropriate and no further action is needed
B. Instruct the patient to turn off the ICD using his magnet until he can be seen
C. Schedule urgent device interrogation to determine if the shock was appropriate ✓
CORRECT
D. Order a 12-lead ECG and send the patient home with event monitoring
Correct Answer: C
Rationale: Any ICD shock, even in the absence of symptoms, warrants urgent device
interrogation to determine whether it was appropriate therapy for ventricular arrhythmia
or inappropriate therapy due to lead fracture, oversensing, or supraventricular
tachycardia. Reassuring the patient without data would be premature and potentially
dangerous if the device malfunctioned. Device clinics typically accommodate same-day
or next-day interrogations for shock events, and the nurse should coordinate this
promptly.
