Chronic Disease Management
Competency Exam — Code: NUR-CDM-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1.
A patient with heart failure with reduced ejection fraction reports a 2.5-kg (5.5-lb)
weight gain over 3 days despite adherence to prescribed medications. Which
finding is most concerning?
A. Mild fatigue after walking
B. Increased appetite
C. New orthopnea and bilateral crackles
D. Heart rate of 82/min
Answer: C. New orthopnea and bilateral crackles
,Rationale: New orthopnea and pulmonary crackles strongly suggest worsening
pulmonary congestion from fluid overload and possible acute decompensated
heart failure. Rapid weight gain further supports fluid retention.
2.
A patient with type 2 diabetes taking basal insulin becomes confused, diaphoretic,
and tremulous before lunch. What should the nurse do first?
A. Administer the scheduled insulin
B. Check the patient's blood glucose
C. Encourage the patient to ambulate
D. Obtain a hemoglobin A1c
Answer: B. Check the patient's blood glucose
Rationale: The symptoms are characteristic of hypoglycemia. Blood glucose
should be assessed immediately when feasible, followed by prompt treatment
according to the patient's glucose level and clinical status.
3.
A patient with COPD has a baseline oxygen saturation of 90% on room air. During
an exacerbation, the patient becomes increasingly dyspneic. Which intervention is
most appropriate?
A. Apply high-flow oxygen to achieve 100% saturation
B. Withhold oxygen because of chronic CO₂ retention
C. Titrate supplemental oxygen to the prescribed target range
D. Encourage prolonged breath-holding exercises
Answer: C. Titrate supplemental oxygen to the prescribed target range
,Rationale: Patients with COPD exacerbations should receive supplemental
oxygen when indicated, but excessive oxygen can worsen hypercapnia in
susceptible patients. Oxygen should be carefully titrated to the prescribed
target, commonly around 88–92% in patients at risk for hypercapnic respiratory
failure.
4.
A patient with chronic kidney disease has a potassium level of 6.4 mEq/L and
reports generalized weakness. Which action has the highest priority?
A. Encourage oral fluids
B. Place the patient on cardiac monitoring
C. Administer a potassium supplement
D. Encourage a high-potassium diet
Answer: B. Place the patient on cardiac monitoring
Rationale: Severe hyperkalemia can cause life-threatening cardiac
dysrhythmias. Continuous cardiac monitoring allows early detection of
conduction abnormalities while urgent treatment is initiated.
5.
A patient with hypertension reports taking antihypertensive medication only
when a headache occurs. Which teaching is most important?
A. Antihypertensives should be taken only when symptoms appear
B. Headaches reliably indicate elevated blood pressure
C. Hypertension can be asymptomatic and requires consistent treatment
D. Medication is unnecessary when blood pressure is normal
Answer: C. Hypertension can be asymptomatic and requires consistent
treatment
, Rationale: Hypertension frequently produces no symptoms. Medication
adherence is based on the prescribed regimen rather than subjective symptoms
or occasional blood pressure readings.
6.
A patient with diabetes has a hemoglobin A1c of 10.2% despite taking
medications as prescribed. What should the nurse assess first?
A. Whether the patient understands the treatment plan and administration
technique
B. Whether the patient has eliminated all carbohydrates
C. Whether the patient exercises for 3 hours daily
D. Whether the patient has stopped consuming all dietary fat
Answer: A. Whether the patient understands the treatment plan and
administration technique
Rationale: Persistent hyperglycemia requires assessment of medication
adherence, administration technique, health literacy, diet, activity, access to
medications, and other barriers before assuming treatment failure.
7.
A patient with chronic heart failure asks why daily weights are necessary. Which
response is best?
A. "They determine whether your heart rhythm is normal."
B. "They help detect fluid retention before severe symptoms develop."
C. "They tell us whether your blood pressure medication is working."
D. "They determine whether you are consuming enough protein."
Answer: B. They help detect fluid retention before severe symptoms develop.
Competency Exam — Code: NUR-CDM-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1.
A patient with heart failure with reduced ejection fraction reports a 2.5-kg (5.5-lb)
weight gain over 3 days despite adherence to prescribed medications. Which
finding is most concerning?
A. Mild fatigue after walking
B. Increased appetite
C. New orthopnea and bilateral crackles
D. Heart rate of 82/min
Answer: C. New orthopnea and bilateral crackles
,Rationale: New orthopnea and pulmonary crackles strongly suggest worsening
pulmonary congestion from fluid overload and possible acute decompensated
heart failure. Rapid weight gain further supports fluid retention.
2.
A patient with type 2 diabetes taking basal insulin becomes confused, diaphoretic,
and tremulous before lunch. What should the nurse do first?
A. Administer the scheduled insulin
B. Check the patient's blood glucose
C. Encourage the patient to ambulate
D. Obtain a hemoglobin A1c
Answer: B. Check the patient's blood glucose
Rationale: The symptoms are characteristic of hypoglycemia. Blood glucose
should be assessed immediately when feasible, followed by prompt treatment
according to the patient's glucose level and clinical status.
3.
A patient with COPD has a baseline oxygen saturation of 90% on room air. During
an exacerbation, the patient becomes increasingly dyspneic. Which intervention is
most appropriate?
A. Apply high-flow oxygen to achieve 100% saturation
B. Withhold oxygen because of chronic CO₂ retention
C. Titrate supplemental oxygen to the prescribed target range
D. Encourage prolonged breath-holding exercises
Answer: C. Titrate supplemental oxygen to the prescribed target range
,Rationale: Patients with COPD exacerbations should receive supplemental
oxygen when indicated, but excessive oxygen can worsen hypercapnia in
susceptible patients. Oxygen should be carefully titrated to the prescribed
target, commonly around 88–92% in patients at risk for hypercapnic respiratory
failure.
4.
A patient with chronic kidney disease has a potassium level of 6.4 mEq/L and
reports generalized weakness. Which action has the highest priority?
A. Encourage oral fluids
B. Place the patient on cardiac monitoring
C. Administer a potassium supplement
D. Encourage a high-potassium diet
Answer: B. Place the patient on cardiac monitoring
Rationale: Severe hyperkalemia can cause life-threatening cardiac
dysrhythmias. Continuous cardiac monitoring allows early detection of
conduction abnormalities while urgent treatment is initiated.
5.
A patient with hypertension reports taking antihypertensive medication only
when a headache occurs. Which teaching is most important?
A. Antihypertensives should be taken only when symptoms appear
B. Headaches reliably indicate elevated blood pressure
C. Hypertension can be asymptomatic and requires consistent treatment
D. Medication is unnecessary when blood pressure is normal
Answer: C. Hypertension can be asymptomatic and requires consistent
treatment
, Rationale: Hypertension frequently produces no symptoms. Medication
adherence is based on the prescribed regimen rather than subjective symptoms
or occasional blood pressure readings.
6.
A patient with diabetes has a hemoglobin A1c of 10.2% despite taking
medications as prescribed. What should the nurse assess first?
A. Whether the patient understands the treatment plan and administration
technique
B. Whether the patient has eliminated all carbohydrates
C. Whether the patient exercises for 3 hours daily
D. Whether the patient has stopped consuming all dietary fat
Answer: A. Whether the patient understands the treatment plan and
administration technique
Rationale: Persistent hyperglycemia requires assessment of medication
adherence, administration technique, health literacy, diet, activity, access to
medications, and other barriers before assuming treatment failure.
7.
A patient with chronic heart failure asks why daily weights are necessary. Which
response is best?
A. "They determine whether your heart rhythm is normal."
B. "They help detect fluid retention before severe symptoms develop."
C. "They tell us whether your blood pressure medication is working."
D. "They determine whether you are consuming enough protein."
Answer: B. They help detect fluid retention before severe symptoms develop.
