NUR 257 CHRONIC HEALTH EXAM
QUESTIONS AND ANSWERS
1. A patient with Chronic Obstructive Pulmonary Disease (COPD) is prescribed inhaled
tiotropium. Which finding indicates the medication is effective?
A. Increased expectoration of thick sputum
B. Reduced frequency of nocturnal cough
C. Decreased work of breathing and improved air entry
D. Rapid resolution of acute bronchospasm
Answer: C
Conceptual Explanation: Tiotropium is a long-acting anticholinergic used for
maintenance treatment of COPD to improve lung function and decrease the work of
breathing. It is not a rescue inhaler for acute bronchospasm.
2. When assessing a patient with Stage 3 Chronic Kidney Disease (CKD), which laboratory
value is most indicative of the disease progression?
A. Glomerular Filtration Rate (GFR) of 45 mL/min/1.73 m²
B. Serum Potassium of 4.2 mEq/L
,C. Serum Sodium of 138 mEq/L
D. Blood Urea Nitrogen (BUN) of 15 mg/dL
Answer: A
Conceptual Explanation: Stage 3 CKD is defined by a GFR between 30 and 59
mL/min/1.73 m². Potassium, sodium, and BUN can be affected but GFR is the primary
metric for staging.
3. A patient with Type 2 Diabetes is being evaluated for Glycated Hemoglobin (HbA1c). The
result is 8.5%. What is the nurse’s priority action?
A. Congratulate the patient on meeting the glycemic goal
B. Administer a dose of rapid-acting insulin immediately
C. Advise the patient to increase daily carbohydrate intake
D. Assess the patient’s adherence to diet and medication regimen
Answer: D
Conceptual Explanation: An HbA1c of 8.5% is above the typical goal of less than 7% for
most adults, indicating poor long-term glucose control. The nurse must assess why the
management plan is not being met.
4. Which clinical manifestation is a hallmark sign of Right-Sided Heart Failure?
A. Pulmonary edema and crackles
B. Paroxysmal nocturnal dyspnea
, C. Peripheral edema and jugular venous distention
D. Orthopnea and pink frothy sputum
Answer: C
Conceptual Explanation: Right-sided heart failure causes systemic venous congestion,
leading to peripheral edema, hepatomegaly, and jugular venous distention (JVD).
5. A patient with Rheumatoid Arthritis is prescribed Methotrexate. Which teaching point is
essential for safety?
A. The drug will show full effects within 24 hours
B. Discontinue the medication if joint pain improves
C. Avoid alcohol consumption due to potential hepatotoxicity
D. Take the medication with high-calcium meals
Answer: C
Conceptual Explanation: Methotrexate can cause liver damage (hepatotoxicity); patients
must avoid alcohol and undergo regular liver function tests.
6. In a patient with Chronic Venous Insufficiency (CVI), the nurse expects to find which skin
characteristic?
A. Pale, cool, and shiny skin
B. Punched-out ulcers on the tips of toes
C. Absent pedal pulses and hair loss
QUESTIONS AND ANSWERS
1. A patient with Chronic Obstructive Pulmonary Disease (COPD) is prescribed inhaled
tiotropium. Which finding indicates the medication is effective?
A. Increased expectoration of thick sputum
B. Reduced frequency of nocturnal cough
C. Decreased work of breathing and improved air entry
D. Rapid resolution of acute bronchospasm
Answer: C
Conceptual Explanation: Tiotropium is a long-acting anticholinergic used for
maintenance treatment of COPD to improve lung function and decrease the work of
breathing. It is not a rescue inhaler for acute bronchospasm.
2. When assessing a patient with Stage 3 Chronic Kidney Disease (CKD), which laboratory
value is most indicative of the disease progression?
A. Glomerular Filtration Rate (GFR) of 45 mL/min/1.73 m²
B. Serum Potassium of 4.2 mEq/L
,C. Serum Sodium of 138 mEq/L
D. Blood Urea Nitrogen (BUN) of 15 mg/dL
Answer: A
Conceptual Explanation: Stage 3 CKD is defined by a GFR between 30 and 59
mL/min/1.73 m². Potassium, sodium, and BUN can be affected but GFR is the primary
metric for staging.
3. A patient with Type 2 Diabetes is being evaluated for Glycated Hemoglobin (HbA1c). The
result is 8.5%. What is the nurse’s priority action?
A. Congratulate the patient on meeting the glycemic goal
B. Administer a dose of rapid-acting insulin immediately
C. Advise the patient to increase daily carbohydrate intake
D. Assess the patient’s adherence to diet and medication regimen
Answer: D
Conceptual Explanation: An HbA1c of 8.5% is above the typical goal of less than 7% for
most adults, indicating poor long-term glucose control. The nurse must assess why the
management plan is not being met.
4. Which clinical manifestation is a hallmark sign of Right-Sided Heart Failure?
A. Pulmonary edema and crackles
B. Paroxysmal nocturnal dyspnea
, C. Peripheral edema and jugular venous distention
D. Orthopnea and pink frothy sputum
Answer: C
Conceptual Explanation: Right-sided heart failure causes systemic venous congestion,
leading to peripheral edema, hepatomegaly, and jugular venous distention (JVD).
5. A patient with Rheumatoid Arthritis is prescribed Methotrexate. Which teaching point is
essential for safety?
A. The drug will show full effects within 24 hours
B. Discontinue the medication if joint pain improves
C. Avoid alcohol consumption due to potential hepatotoxicity
D. Take the medication with high-calcium meals
Answer: C
Conceptual Explanation: Methotrexate can cause liver damage (hepatotoxicity); patients
must avoid alcohol and undergo regular liver function tests.
6. In a patient with Chronic Venous Insufficiency (CVI), the nurse expects to find which skin
characteristic?
A. Pale, cool, and shiny skin
B. Punched-out ulcers on the tips of toes
C. Absent pedal pulses and hair loss
