NUR 257 Chronic Exam 3 Chronic Disease Management
and Clinical Reasoning Actual Exam 2026/2027 |
Complete Exam-Style Questions with Detailed Rationales |
Graded A+ Verified – Pass Guaranteed
### Section 1: Cardiovascular and Hematologic Chronic Conditions
Q1: A patient with chronic heart failure is being discharged home. Which statement by the
patient indicates a need for further teaching regarding daily weight monitoring?
A. "I will weigh myself every morning after using the bathroom and before eating."
B. "I will call the clinic if my weight increases by 3 pounds in one day or 5 pounds in a week."
C. "I will weigh myself at the same time each day using the same scale."
D. "I will only weigh myself on the days I feel short of breath or notice swelling in my
ankles." [CORRECT]
Correct Answer: D
Rationale: This choice is correct because daily weights are a crucial early warning system for
fluid retention in heart failure, regardless of whether the patient currently feels
symptomatic. Waiting for symptoms to appear delays necessary medical intervention.
Q2: You are providing dietary education to a patient newly diagnosed with stage 1
hypertension. Which meal choice best aligns with the DASH (Dietary Approaches to Stop
Hypertension) diet?
A. Grilled chicken breast, quinoa, and a large side salad with olive oil dressing
B. Canned tomato soup, a grilled cheese sandwich, and pickle spears
C. Frozen pizza with extra cheese and a side of garlic bread
D. Beef jerky, salted mixed nuts, and a sports drink [CORRECT]
Correct Answer: A
Rationale: The best answer is the grilled chicken and quinoa meal. This choice is correct
because the DASH diet emphasizes lean proteins, whole grains, and fresh vegetables while
strictly limiting sodium and saturated fats, which are abundant in the other options.
Q3: A patient with chronic stable angina is prescribed sublingual nitroglycerin. Which
instruction is most critical for the nurse to include in the patient's education?
A. "Take up to three tablets, 5 minutes apart, and call 911 if the pain is not relieved after the
third dose." [CORRECT]
B. "Swallow the tablet whole with a full glass of water to ensure it reaches your stomach
quickly."
C. "Store the medication in a clear plastic pillbox to keep it organized and easy to find."
D. "Take one tablet every morning as a preventive measure, even if you have no chest pain."
Correct Answer: A
, Rationale: This matches the principle that sublingual nitroglycerin must be dissolved under
the tongue for rapid absorption, and the 3-dose rule is a vital safety parameter to prevent
myocardial infarction if the pain is actually unstable angina.
Q4: A patient with chronic heart failure has been taking lisinopril for six months and calls the
clinic complaining of a persistent, dry, hacking cough. What is the nurse's best response?
A. "This is a sign that your heart failure is worsening, so you should go to the emergency
department immediately."
B. "You should stop taking the lisinopril today and switch to an over-the-counter cough
suppressant."
C. "This is a common side effect of ACE inhibitors; I will notify your provider to discuss
switching you to an ARB." [CORRECT]
D. "Drink plenty of warm fluids and use a humidifier, as this cough will resolve on its own in
a few weeks."
Correct Answer: C
Rationale: The best answer is to recognize this as a classic, non-dangerous but bothersome
side effect of ACE inhibitors. The appropriate action is to notify the provider for a
medication adjustment, such as switching to an angiotensin II receptor blocker (ARB), rather
than having the patient abruptly stop a critical heart failure medication.
Q5: A patient with chronic atrial fibrillation is being discharged on warfarin. Which dietary
instruction is most important to prevent complications?
A. "Completely eliminate all green, leafy vegetables from your diet to keep your INR stable."
B. "Maintain a consistent intake of vitamin K-rich foods, rather than avoiding them entirely."
[CORRECT]
C. "Increase your intake of cranberry juice daily to help prevent urinary tract infections while
on this medication."
D. "Take your warfarin with a high-fat meal to improve its absorption in the gastrointestinal
tract."
Correct Answer: B
Rationale: This choice is correct because sudden changes in vitamin K intake can drastically
alter warfarin's effectiveness. Consistency, not total avoidance, is the key to maintaining a
stable therapeutic INR.
Q6: You are reviewing the chart of a patient with chronic atrial fibrillation on warfarin who
was just prescribed sulfamethoxazole/trimethoprim for a urinary tract infection. The
patient's current INR is 3.8. What is the most appropriate sequence of actions?
A. Administer the scheduled warfarin dose and recheck the INR in one week.
B. Hold the warfarin dose, notify the provider of the INR and the new antibiotic, and
anticipate a dosage adjustment. [CORRECT]
C. Administer oral vitamin K immediately and discontinue the antibiotic without provider
approval.
D. Increase the warfarin dose to counteract the antibiotic's expected effect on clotting
factors.
Correct Answer: B
Rationale: This choice is correct because sulfamethoxazole/trimethoprim significantly
potentiates warfarin, and an INR of 3.8 is already supratherapeutic. The safest step-by-step
and Clinical Reasoning Actual Exam 2026/2027 |
Complete Exam-Style Questions with Detailed Rationales |
Graded A+ Verified – Pass Guaranteed
### Section 1: Cardiovascular and Hematologic Chronic Conditions
Q1: A patient with chronic heart failure is being discharged home. Which statement by the
patient indicates a need for further teaching regarding daily weight monitoring?
A. "I will weigh myself every morning after using the bathroom and before eating."
B. "I will call the clinic if my weight increases by 3 pounds in one day or 5 pounds in a week."
C. "I will weigh myself at the same time each day using the same scale."
D. "I will only weigh myself on the days I feel short of breath or notice swelling in my
ankles." [CORRECT]
Correct Answer: D
Rationale: This choice is correct because daily weights are a crucial early warning system for
fluid retention in heart failure, regardless of whether the patient currently feels
symptomatic. Waiting for symptoms to appear delays necessary medical intervention.
Q2: You are providing dietary education to a patient newly diagnosed with stage 1
hypertension. Which meal choice best aligns with the DASH (Dietary Approaches to Stop
Hypertension) diet?
A. Grilled chicken breast, quinoa, and a large side salad with olive oil dressing
B. Canned tomato soup, a grilled cheese sandwich, and pickle spears
C. Frozen pizza with extra cheese and a side of garlic bread
D. Beef jerky, salted mixed nuts, and a sports drink [CORRECT]
Correct Answer: A
Rationale: The best answer is the grilled chicken and quinoa meal. This choice is correct
because the DASH diet emphasizes lean proteins, whole grains, and fresh vegetables while
strictly limiting sodium and saturated fats, which are abundant in the other options.
Q3: A patient with chronic stable angina is prescribed sublingual nitroglycerin. Which
instruction is most critical for the nurse to include in the patient's education?
A. "Take up to three tablets, 5 minutes apart, and call 911 if the pain is not relieved after the
third dose." [CORRECT]
B. "Swallow the tablet whole with a full glass of water to ensure it reaches your stomach
quickly."
C. "Store the medication in a clear plastic pillbox to keep it organized and easy to find."
D. "Take one tablet every morning as a preventive measure, even if you have no chest pain."
Correct Answer: A
, Rationale: This matches the principle that sublingual nitroglycerin must be dissolved under
the tongue for rapid absorption, and the 3-dose rule is a vital safety parameter to prevent
myocardial infarction if the pain is actually unstable angina.
Q4: A patient with chronic heart failure has been taking lisinopril for six months and calls the
clinic complaining of a persistent, dry, hacking cough. What is the nurse's best response?
A. "This is a sign that your heart failure is worsening, so you should go to the emergency
department immediately."
B. "You should stop taking the lisinopril today and switch to an over-the-counter cough
suppressant."
C. "This is a common side effect of ACE inhibitors; I will notify your provider to discuss
switching you to an ARB." [CORRECT]
D. "Drink plenty of warm fluids and use a humidifier, as this cough will resolve on its own in
a few weeks."
Correct Answer: C
Rationale: The best answer is to recognize this as a classic, non-dangerous but bothersome
side effect of ACE inhibitors. The appropriate action is to notify the provider for a
medication adjustment, such as switching to an angiotensin II receptor blocker (ARB), rather
than having the patient abruptly stop a critical heart failure medication.
Q5: A patient with chronic atrial fibrillation is being discharged on warfarin. Which dietary
instruction is most important to prevent complications?
A. "Completely eliminate all green, leafy vegetables from your diet to keep your INR stable."
B. "Maintain a consistent intake of vitamin K-rich foods, rather than avoiding them entirely."
[CORRECT]
C. "Increase your intake of cranberry juice daily to help prevent urinary tract infections while
on this medication."
D. "Take your warfarin with a high-fat meal to improve its absorption in the gastrointestinal
tract."
Correct Answer: B
Rationale: This choice is correct because sudden changes in vitamin K intake can drastically
alter warfarin's effectiveness. Consistency, not total avoidance, is the key to maintaining a
stable therapeutic INR.
Q6: You are reviewing the chart of a patient with chronic atrial fibrillation on warfarin who
was just prescribed sulfamethoxazole/trimethoprim for a urinary tract infection. The
patient's current INR is 3.8. What is the most appropriate sequence of actions?
A. Administer the scheduled warfarin dose and recheck the INR in one week.
B. Hold the warfarin dose, notify the provider of the INR and the new antibiotic, and
anticipate a dosage adjustment. [CORRECT]
C. Administer oral vitamin K immediately and discontinue the antibiotic without provider
approval.
D. Increase the warfarin dose to counteract the antibiotic's expected effect on clotting
factors.
Correct Answer: B
Rationale: This choice is correct because sulfamethoxazole/trimethoprim significantly
potentiates warfarin, and an INR of 3.8 is already supratherapeutic. The safest step-by-step
