NUR 257/NUR 257 CHRONIC EXAM 4 NEWEST
ACTUAL EXAM 2026- 2027 COMPLETE EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH DETAILED RATIONALES (100% RELIABLE
SOLUTIONS) RECENTLY UPDATED VERSION
EDITION 2026 NUR 257 EXAM 4 |GUARANTEED PASS
A+ |BRAND NEW |INSTANT DOWNLOAD PDF
A patient with heart failure with reduced ejection fraction (HFrEF) presents with
worsening dyspnea, orthopnea, and a 5-pound weight gain over 3 days. The nurse's
priority action is to:
A. Administer the scheduled beta-blocker as ordered
B. Assess lung sounds, jugular venous distention, and peripheral edema
C. Encourage the patient to restrict oral fluid intake to 1 L per day
D. Notify the provider of the weight gain after completing morning rounds
Answer: B
Rationale: The priority nursing action is a comprehensive assessment to evaluate
the severity of fluid overload and determine if acute decompensation is occurring.
The Galen clinical judgment model emphasizes assessment before intervention.
Lung crackles, JVD, and edema are key indicators of worsening HF. Daily weight
monitoring is critical, but assessment of clinical signs must precede notification or
intervention. Beta-blockers should be held in acute decompensation. Fluid
restriction may be appropriate but is not the priority action.
,The nurse is teaching a patient newly diagnosed with type 2 diabetes about
metformin. Which statement indicates the patient understands the medication's
mechanism of action?
A. "This medication will help my pancreas produce more insulin."
B. "It will decrease the amount of glucose my liver produces and help my
body use insulin better."
C. "I should expect this medication to cause weight gain over time."
D. "This medication works by blocking the absorption of carbohydrates from my
food."
Answer: B
Rationale: Metformin is a biguanide that reduces hepatic glucose production
(gluconeogenesis) and increases peripheral insulin sensitivity, making it the first-
line pharmacologic agent for type 2 diabetes. It does not stimulate insulin secretion
(sulfonylureas do), does not replace insulin (exogenous insulin does), and does not
block carbohydrate absorption (acarbose does). Metformin is weight-neutral or
may cause modest weight loss, not weight gain.
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. The patient becomes drowsy and confused. The nurse
should first:
A. Increase the oxygen flow rate to 4 L/min
B. Assess the patient's arterial blood gas (ABG) results
C. Encourage the patient to use pursed-lip breathing
D. Administer PRN bronchodilator therapy
Answer: B
Rationale: Drowsiness and confusion in a patient with COPD receiving
supplemental oxygen may indicate carbon dioxide retention (hypercapnia) or
oxygen toxicity. The priority is to assess the patient's oxygenation and ventilation
,status via ABG analysis before adjusting oxygen therapy. Increasing oxygen
without assessment could worsen hypercapnia. Pursed-lip breathing and
bronchodilators are useful interventions but are not the immediate priority in this
scenario.
A nurse is assessing a patient with chronic kidney disease (CKD). Which finding
would be of greatest concern?
A. Blood pressure of 145/92 mmHg
B. Serum creatinine of 3.4 mg/dL
C. Urine output of 500 mL in 24 hours
D. Serum potassium level of 6.2 mEq/L
Answer: D
Rationale: Hyperkalemia (serum potassium of 6.2 mEq/L) is a critical finding in
CKD as it can lead to life-threatening cardiac arrhythmias. While an elevated
creatinine and reduced urine output indicate impaired renal function, and
hypertension is common, the immediate threat to life is the elevated potassium
level, which requires urgent intervention.
A nurse is teaching a patient with diabetes about lifestyle modifications. Which of
the following should the nurse emphasize as a priority?
A. Monitoring blood glucose levels
B. Engaging in daily exercise
C. Reducing sodium intake
D. Increasing carbohydrate intake
Answer: A
Rationale: The priority for a diabetic patient is to maintain optimal blood glucose
levels to prevent complications. While exercise and dietary changes are also
important, blood glucose control is the most urgent and foundational self-
, management task. Increasing carbohydrate intake is incorrect and would worsen
glycemic control.
A nurse is assessing a patient with hypertension. Which finding would require
further investigation?
A. Blood pressure of 135/85 mmHg
B. History of smoking
C. Family history of hypertension
D. Elevated blood pressure with symptoms of headache and dizziness
Answer: D
Rationale: Elevated blood pressure accompanied by symptoms such as headache
and dizziness may indicate a hypertensive crisis or target organ damage, requiring
immediate investigation and intervention. A blood pressure of 135/85 mmHg is
prehypertensive, and a history of smoking and family history are risk factors but
are not acute concerns.
Which of the following is a common symptom of a myocardial infarction (MI) in
elderly patients?
A. Severe chest pain
B. Nausea and vomiting
C. Sudden onset of dyspnea
D. Anxiety and palpitations
Answer: B, C
Rationale: In elderly patients, MI may present with atypical symptoms like nausea,
vomiting, and sudden dyspnea, rather than the classic chest pain. Anxiety and
palpitations are less commonly seen in elderly patients as primary presenting
symptoms.
ACTUAL EXAM 2026- 2027 COMPLETE EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH DETAILED RATIONALES (100% RELIABLE
SOLUTIONS) RECENTLY UPDATED VERSION
EDITION 2026 NUR 257 EXAM 4 |GUARANTEED PASS
A+ |BRAND NEW |INSTANT DOWNLOAD PDF
A patient with heart failure with reduced ejection fraction (HFrEF) presents with
worsening dyspnea, orthopnea, and a 5-pound weight gain over 3 days. The nurse's
priority action is to:
A. Administer the scheduled beta-blocker as ordered
B. Assess lung sounds, jugular venous distention, and peripheral edema
C. Encourage the patient to restrict oral fluid intake to 1 L per day
D. Notify the provider of the weight gain after completing morning rounds
Answer: B
Rationale: The priority nursing action is a comprehensive assessment to evaluate
the severity of fluid overload and determine if acute decompensation is occurring.
The Galen clinical judgment model emphasizes assessment before intervention.
Lung crackles, JVD, and edema are key indicators of worsening HF. Daily weight
monitoring is critical, but assessment of clinical signs must precede notification or
intervention. Beta-blockers should be held in acute decompensation. Fluid
restriction may be appropriate but is not the priority action.
,The nurse is teaching a patient newly diagnosed with type 2 diabetes about
metformin. Which statement indicates the patient understands the medication's
mechanism of action?
A. "This medication will help my pancreas produce more insulin."
B. "It will decrease the amount of glucose my liver produces and help my
body use insulin better."
C. "I should expect this medication to cause weight gain over time."
D. "This medication works by blocking the absorption of carbohydrates from my
food."
Answer: B
Rationale: Metformin is a biguanide that reduces hepatic glucose production
(gluconeogenesis) and increases peripheral insulin sensitivity, making it the first-
line pharmacologic agent for type 2 diabetes. It does not stimulate insulin secretion
(sulfonylureas do), does not replace insulin (exogenous insulin does), and does not
block carbohydrate absorption (acarbose does). Metformin is weight-neutral or
may cause modest weight loss, not weight gain.
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen
at 2 L/min via nasal cannula. The patient becomes drowsy and confused. The nurse
should first:
A. Increase the oxygen flow rate to 4 L/min
B. Assess the patient's arterial blood gas (ABG) results
C. Encourage the patient to use pursed-lip breathing
D. Administer PRN bronchodilator therapy
Answer: B
Rationale: Drowsiness and confusion in a patient with COPD receiving
supplemental oxygen may indicate carbon dioxide retention (hypercapnia) or
oxygen toxicity. The priority is to assess the patient's oxygenation and ventilation
,status via ABG analysis before adjusting oxygen therapy. Increasing oxygen
without assessment could worsen hypercapnia. Pursed-lip breathing and
bronchodilators are useful interventions but are not the immediate priority in this
scenario.
A nurse is assessing a patient with chronic kidney disease (CKD). Which finding
would be of greatest concern?
A. Blood pressure of 145/92 mmHg
B. Serum creatinine of 3.4 mg/dL
C. Urine output of 500 mL in 24 hours
D. Serum potassium level of 6.2 mEq/L
Answer: D
Rationale: Hyperkalemia (serum potassium of 6.2 mEq/L) is a critical finding in
CKD as it can lead to life-threatening cardiac arrhythmias. While an elevated
creatinine and reduced urine output indicate impaired renal function, and
hypertension is common, the immediate threat to life is the elevated potassium
level, which requires urgent intervention.
A nurse is teaching a patient with diabetes about lifestyle modifications. Which of
the following should the nurse emphasize as a priority?
A. Monitoring blood glucose levels
B. Engaging in daily exercise
C. Reducing sodium intake
D. Increasing carbohydrate intake
Answer: A
Rationale: The priority for a diabetic patient is to maintain optimal blood glucose
levels to prevent complications. While exercise and dietary changes are also
important, blood glucose control is the most urgent and foundational self-
, management task. Increasing carbohydrate intake is incorrect and would worsen
glycemic control.
A nurse is assessing a patient with hypertension. Which finding would require
further investigation?
A. Blood pressure of 135/85 mmHg
B. History of smoking
C. Family history of hypertension
D. Elevated blood pressure with symptoms of headache and dizziness
Answer: D
Rationale: Elevated blood pressure accompanied by symptoms such as headache
and dizziness may indicate a hypertensive crisis or target organ damage, requiring
immediate investigation and intervention. A blood pressure of 135/85 mmHg is
prehypertensive, and a history of smoking and family history are risk factors but
are not acute concerns.
Which of the following is a common symptom of a myocardial infarction (MI) in
elderly patients?
A. Severe chest pain
B. Nausea and vomiting
C. Sudden onset of dyspnea
D. Anxiety and palpitations
Answer: B, C
Rationale: In elderly patients, MI may present with atypical symptoms like nausea,
vomiting, and sudden dyspnea, rather than the classic chest pain. Anxiety and
palpitations are less commonly seen in elderly patients as primary presenting
symptoms.
