NUR 257 CHRONIC EXAM 4 – High-Yield Nursing Practice
Questions, Verified Answers & Clinical Rationales (Pass
Exam 4 PDF)
"Ace your NUR 257 Chronic Illness Management Exam 4 on your very first attempt with
this comprehensive 2026 study guide. This instant download features highly predictive
practice questions, verified exact answers, and detailed clinical rationales covering
advanced nursing care for complex chronic conditions, multi-system management, and
patient interventions. Stop stressing over dense medical chapters and download the
precise, high-yield exam architecture you need to protect your GPA and pass today!"
Question 1
An older adult client with a history of severe osteoporosis is being discharged to home.
Which environmental modification should the nurse prioritize to prevent fragility
fractures?
A) Providing soft, plush slippers for comfort
B) Removing loose throw rugs and clutter from walkways
C) Installing high-wattage fluorescent bulbs in the bedroom
D) Placing low-profile extension cords across traffic zones
Correct Answer: B) Removing loose throw rugs and clutter from walkways
Rationale: Osteoporosis significantly increases the risk of fragility fractures from low-
impact falls. Removing environmental hazards such as loose carpets, throw rugs, and
clutter from walking paths is a primary intervention to reduce fall risks. Soft slippers
increase unstable gait patterns and should be replaced with supportive, non-slip
footwear.
Question 2
,A nurse is providing discharge education to a client who recently underwent surgical
removal of a cataract. Which instruction is vital to prevent permanent vision loss in the
postoperative period?
A) Avoid bending over at the waist or lifting objects heavier than 10 pounds.
B) Keep the eye shield off during daytime napping to encourage visual adaptation.
C) Apply warm, wet compresses to the eye if localized swelling increases.
D) Perform vigorous coughing exercises every two hours to clear secretions.
Correct Answer: A) Avoid bending over at the waist or lifting objects heavier than
10 pounds.
Rationale: Activities that increase intraocular pressure (IOP)—such as bending at the
waist, lifting heavy objects, straining during bowel movements, or vigorous coughing—
can compromise the surgical site and cause permanent vision loss. Eye shields must be
worn during sleep to prevent accidental rubbing.
Question 3
An older adult client presents to the clinic with excruciating pain, redness, and swelling
in the left great toe. The nurse suspects an acute gouty arthritis episode. Which
medication does the nurse anticipate administering as first-line treatment for acute
inflammation?
A) Allopurinol
B) Colchicine
C) Febuxostat
D) Methotrexate [1, 2]
Correct Answer: B) Colchicine [1]
Rationale: Colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs) are standard
first-line therapies for acute gout attacks because they target active inflammation and
diminish urate crystal pain. Allopurinol and febuxostat are xanthine oxidase inhibitors
used for long-term maintenance to lower uric acid levels; starting them during an acute
flare can paradoxically worsen the attack.
Question 4
,A client diagnosed with primary open-angle glaucoma is prescribed timolol ophthalmic
drops. Which assessment finding requires the nurse to hold the medication and notify
the healthcare provider?
A) A baseline intraocular pressure of 24 mmHg
B) A heart rate of 48 beats per minute
C) Complaints of mild, transient eye stinging after drop installation
D) A respiratory rate of 16 breaths per minute [1, 2]
Correct Answer: B) A heart rate of 48 beats per minute [1]
Rationale: Timolol is a non-selective beta-blocker administered topically but absorbed
systemically. It can cause profound bradycardia and bronchospasm. A heart rate below
60 bpm is a critical contraindication that requires holding the dose. Transient stinging is
a common, non-emergent side effect.
Question 5
The nurse is assessing an 82-year-old resident in a long-term care facility who is
complaining of chronic, deep, aching pain in both knees that worsens with weight-
bearing activities and improves with rest. Crepitus is noted upon passive range of
motion. The nurse recognizes these clinical signs as indicative of:
A) Rheumatoid arthritis
B) Osteoarthritis
C) Systemic lupus erythematosus
D) Gouty tophi accumulation [1, 2, 3]
Correct Answer: B) Osteoarthritis [1]
Rationale: Osteoarthritis (degenerative joint disease) typically presents with
asymmetrical, localized joint pain that worsens with activity and improves with rest,
often accompanied by crepitus. Rheumatoid arthritis is a systemic, inflammatory
autoimmune disorder characterized by symmetrical joint pain, prolonged morning
stiffness, and systemic symptoms like fatigue. [1]
Question 6
, An older adult client with severe diabetic peripheral neuropathy describes their lower
extremity pain as a "burning, electric shock-like sensation" that intensifies at night.
Which class of medication should the nurse anticipate administering to manage this
neuropathic pain?
A) Traditional opioid analgesics like morphine
B) Nonsteroidal anti-inflammatory drugs like ibuprofen
C) Anticonvulsants like gabapentin or pregabalin
D) Acetaminophen [1, 2, 3]
Correct Answer: C) Anticonvulsants like gabapentin or pregabalin [1]
Rationale: Neuropathic pain is caused by nerve damage and does not respond well to
traditional nociceptive pain relievers like NSAIDs or acetaminophen. Adjuvant
medications, specifically anticonvulsants (gabapentin) or serotonin-norepinephrine
reuptake inhibitors (SNRIs), are first-line choices to stabilize nerve membranes.
Question 7
The nurse notes a localized, non-blanchable area of erythema over the sacrum of an
immobile bedbound client. The skin remains completely intact. How should the nurse
document this pressure injury stage?
A) Stage 1
B) Stage 2
C) Stage 3
D) Unstageable [1, 2, 3]
Correct Answer: A) Stage 1
Rationale: A Stage 1 pressure injury is defined as intact skin with a localized area of
non-blanchable erythema. Stage 2 involves partial-thickness skin loss with exposed
dermis (such as a blister or shallow ulcer). Stage 3 involves full-thickness skin loss
exposing subcutaneous fat.
Question 8
Questions, Verified Answers & Clinical Rationales (Pass
Exam 4 PDF)
"Ace your NUR 257 Chronic Illness Management Exam 4 on your very first attempt with
this comprehensive 2026 study guide. This instant download features highly predictive
practice questions, verified exact answers, and detailed clinical rationales covering
advanced nursing care for complex chronic conditions, multi-system management, and
patient interventions. Stop stressing over dense medical chapters and download the
precise, high-yield exam architecture you need to protect your GPA and pass today!"
Question 1
An older adult client with a history of severe osteoporosis is being discharged to home.
Which environmental modification should the nurse prioritize to prevent fragility
fractures?
A) Providing soft, plush slippers for comfort
B) Removing loose throw rugs and clutter from walkways
C) Installing high-wattage fluorescent bulbs in the bedroom
D) Placing low-profile extension cords across traffic zones
Correct Answer: B) Removing loose throw rugs and clutter from walkways
Rationale: Osteoporosis significantly increases the risk of fragility fractures from low-
impact falls. Removing environmental hazards such as loose carpets, throw rugs, and
clutter from walking paths is a primary intervention to reduce fall risks. Soft slippers
increase unstable gait patterns and should be replaced with supportive, non-slip
footwear.
Question 2
,A nurse is providing discharge education to a client who recently underwent surgical
removal of a cataract. Which instruction is vital to prevent permanent vision loss in the
postoperative period?
A) Avoid bending over at the waist or lifting objects heavier than 10 pounds.
B) Keep the eye shield off during daytime napping to encourage visual adaptation.
C) Apply warm, wet compresses to the eye if localized swelling increases.
D) Perform vigorous coughing exercises every two hours to clear secretions.
Correct Answer: A) Avoid bending over at the waist or lifting objects heavier than
10 pounds.
Rationale: Activities that increase intraocular pressure (IOP)—such as bending at the
waist, lifting heavy objects, straining during bowel movements, or vigorous coughing—
can compromise the surgical site and cause permanent vision loss. Eye shields must be
worn during sleep to prevent accidental rubbing.
Question 3
An older adult client presents to the clinic with excruciating pain, redness, and swelling
in the left great toe. The nurse suspects an acute gouty arthritis episode. Which
medication does the nurse anticipate administering as first-line treatment for acute
inflammation?
A) Allopurinol
B) Colchicine
C) Febuxostat
D) Methotrexate [1, 2]
Correct Answer: B) Colchicine [1]
Rationale: Colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs) are standard
first-line therapies for acute gout attacks because they target active inflammation and
diminish urate crystal pain. Allopurinol and febuxostat are xanthine oxidase inhibitors
used for long-term maintenance to lower uric acid levels; starting them during an acute
flare can paradoxically worsen the attack.
Question 4
,A client diagnosed with primary open-angle glaucoma is prescribed timolol ophthalmic
drops. Which assessment finding requires the nurse to hold the medication and notify
the healthcare provider?
A) A baseline intraocular pressure of 24 mmHg
B) A heart rate of 48 beats per minute
C) Complaints of mild, transient eye stinging after drop installation
D) A respiratory rate of 16 breaths per minute [1, 2]
Correct Answer: B) A heart rate of 48 beats per minute [1]
Rationale: Timolol is a non-selective beta-blocker administered topically but absorbed
systemically. It can cause profound bradycardia and bronchospasm. A heart rate below
60 bpm is a critical contraindication that requires holding the dose. Transient stinging is
a common, non-emergent side effect.
Question 5
The nurse is assessing an 82-year-old resident in a long-term care facility who is
complaining of chronic, deep, aching pain in both knees that worsens with weight-
bearing activities and improves with rest. Crepitus is noted upon passive range of
motion. The nurse recognizes these clinical signs as indicative of:
A) Rheumatoid arthritis
B) Osteoarthritis
C) Systemic lupus erythematosus
D) Gouty tophi accumulation [1, 2, 3]
Correct Answer: B) Osteoarthritis [1]
Rationale: Osteoarthritis (degenerative joint disease) typically presents with
asymmetrical, localized joint pain that worsens with activity and improves with rest,
often accompanied by crepitus. Rheumatoid arthritis is a systemic, inflammatory
autoimmune disorder characterized by symmetrical joint pain, prolonged morning
stiffness, and systemic symptoms like fatigue. [1]
Question 6
, An older adult client with severe diabetic peripheral neuropathy describes their lower
extremity pain as a "burning, electric shock-like sensation" that intensifies at night.
Which class of medication should the nurse anticipate administering to manage this
neuropathic pain?
A) Traditional opioid analgesics like morphine
B) Nonsteroidal anti-inflammatory drugs like ibuprofen
C) Anticonvulsants like gabapentin or pregabalin
D) Acetaminophen [1, 2, 3]
Correct Answer: C) Anticonvulsants like gabapentin or pregabalin [1]
Rationale: Neuropathic pain is caused by nerve damage and does not respond well to
traditional nociceptive pain relievers like NSAIDs or acetaminophen. Adjuvant
medications, specifically anticonvulsants (gabapentin) or serotonin-norepinephrine
reuptake inhibitors (SNRIs), are first-line choices to stabilize nerve membranes.
Question 7
The nurse notes a localized, non-blanchable area of erythema over the sacrum of an
immobile bedbound client. The skin remains completely intact. How should the nurse
document this pressure injury stage?
A) Stage 1
B) Stage 2
C) Stage 3
D) Unstageable [1, 2, 3]
Correct Answer: A) Stage 1
Rationale: A Stage 1 pressure injury is defined as intact skin with a localized area of
non-blanchable erythema. Stage 2 involves partial-thickness skin loss with exposed
dermis (such as a blister or shallow ulcer). Stage 3 involves full-thickness skin loss
exposing subcutaneous fat.
Question 8
