NUR 257 Chronic Exam 4 Fall 2025/2026 |
Galen College of Nursing Chronic
Conditions Exam with Complete Questions
& 100% Correct Answers | Latest Version
Section 1: Chronic Cardiovascular Conditions
1. 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
Correct Answer: B
Rationale: The priority nursing action is a comprehensive assessment to evaluate the
severity of fluid overload. The Galen clinical judgment model emphasizes assessment
before intervention. Lung crackles, JVD, and edema are key indicators of worsening HF.
While daily weight monitoring is critical, 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 immediate priority (Galen NUR 257
Curriculum, 2025; AHA Heart Failure Guidelines, 2025).
2. 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."
Correct Answer: B
Rationale: Metformin is a biguanide that reduces hepatic glucose production
(gluconeogenesis) and increases peripheral insulin sensitivity. It does not stimulate
insulin secretion (sulfonylureas do) and does not block carbohydrate absorption
(acarbose does). Metformin is weight-neutral or may cause modest weight loss, not
weight gain (ADA Standards of Care, 2025).
3. Which medication reduces preload in heart failure?
A. Beta blockers
B. ACE inhibitors
C. Diuretics
D. Digoxin
Correct Answer: C
Rationale: Diuretics reduce circulating volume, lowering preload and decreasing
pulmonary congestion. While ACE inhibitors and beta-blockers are guideline-directed
medical therapies for HFrEF, their primary immediate hemodynamic effect is not preload
reduction. Digoxin is a positive inotrope.
4. The BEST indicator of fluid overload in CHF is:
A. Crackles
B. Edema
C. Daily weight gain
D. Elevated blood pressure
,Correct Answer: C
Rationale: Daily weight gain is the most sensitive and specific indicator of fluid
retention. A weight gain of 2-3 pounds in a day or 5 pounds in a week is a key warning
sign. Crackles and edema are also signs, but they are later manifestations and can be
affected by other factors.
5. A patient with heart failure has an ejection fraction (EF) of 25%. The nurse
understands that this indicates:
A. Preserved systolic function
B. Heart failure with reduced ejection fraction (HFrEF)
C. Normal diastolic function
D. Mild valvular disease
Correct Answer: B
Rationale: Normal EF is 55-70%. An EF of 25% indicates systolic heart failure with
reduced ejection fraction (HFrEF), meaning the left ventricle is not pumping effectively.
Treatment focuses on afterload reduction, diuresis, and inotropic support.
6. A patient with heart failure has jugular venous distention, 3+ pitting edema,
and crackles in the lungs. The nurse should anticipate which intervention?
A. Fluid bolus
B. Diuretic therapy
C. Anticoagulation
D. Beta-blocker initiation
Correct Answer: B
Rationale: The patient is exhibiting signs of acute decompensated heart failure with
fluid overload. The priority intervention is diuretic therapy to reduce volume and
preload. A fluid bolus would worsen the condition. Anticoagulation is not the primary
intervention for fluid overload. Beta-blockers are typically held during acute
decompensation.
, 7. Which assessment finding is most concerning in a patient taking an ACE
inhibitor for hypertension?
A. Dry, persistent cough
B. Serum potassium of 5.4 mEq/L
C. Blood pressure of 118/72 mm Hg
D. Dizziness upon standing
Correct Answer: B
Rationale: ACE inhibitors can cause hyperkalemia. A potassium level of 5.4 mEq/L is
above the normal range (3.5-5.0) and can lead to life-threatening cardiac dysrhythmias.
A dry cough is a common side effect, not an emergency. A BP of 118/72 is acceptable.
Dizziness upon standing is orthostatic hypotension, a common side effect that requires
education but is not as immediately dangerous as hyperkalemia.
8. A patient on a statin for dyslipidemia reports new-onset muscle pain and
weakness. The nurse's priority action is to:
A. Encourage the patient to increase fluid intake
B. Tell the patient to continue the medication and reassess in one week
C. Notify the provider immediately and hold the next dose
D. Administer acetaminophen for pain
Correct Answer: C
Rationale: Muscle pain and weakness can be a sign of statin-induced myopathy or
rhabdomyolysis, a rare but serious adverse effect. The nurse should hold the medication
and notify the provider immediately for further evaluation (e.g., CK levels).
9. The nurse is providing discharge teaching to a patient with chronic stable
angina. Which statement indicates a need for further teaching?
A. "I will take my nitroglycerin tablet before any activity that usually causes chest pain."
B. "If one nitroglycerin tablet doesn't work, I can take up to three more, five minutes
apart."
Galen College of Nursing Chronic
Conditions Exam with Complete Questions
& 100% Correct Answers | Latest Version
Section 1: Chronic Cardiovascular Conditions
1. 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
Correct Answer: B
Rationale: The priority nursing action is a comprehensive assessment to evaluate the
severity of fluid overload. The Galen clinical judgment model emphasizes assessment
before intervention. Lung crackles, JVD, and edema are key indicators of worsening HF.
While daily weight monitoring is critical, 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 immediate priority (Galen NUR 257
Curriculum, 2025; AHA Heart Failure Guidelines, 2025).
2. 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."
Correct Answer: B
Rationale: Metformin is a biguanide that reduces hepatic glucose production
(gluconeogenesis) and increases peripheral insulin sensitivity. It does not stimulate
insulin secretion (sulfonylureas do) and does not block carbohydrate absorption
(acarbose does). Metformin is weight-neutral or may cause modest weight loss, not
weight gain (ADA Standards of Care, 2025).
3. Which medication reduces preload in heart failure?
A. Beta blockers
B. ACE inhibitors
C. Diuretics
D. Digoxin
Correct Answer: C
Rationale: Diuretics reduce circulating volume, lowering preload and decreasing
pulmonary congestion. While ACE inhibitors and beta-blockers are guideline-directed
medical therapies for HFrEF, their primary immediate hemodynamic effect is not preload
reduction. Digoxin is a positive inotrope.
4. The BEST indicator of fluid overload in CHF is:
A. Crackles
B. Edema
C. Daily weight gain
D. Elevated blood pressure
,Correct Answer: C
Rationale: Daily weight gain is the most sensitive and specific indicator of fluid
retention. A weight gain of 2-3 pounds in a day or 5 pounds in a week is a key warning
sign. Crackles and edema are also signs, but they are later manifestations and can be
affected by other factors.
5. A patient with heart failure has an ejection fraction (EF) of 25%. The nurse
understands that this indicates:
A. Preserved systolic function
B. Heart failure with reduced ejection fraction (HFrEF)
C. Normal diastolic function
D. Mild valvular disease
Correct Answer: B
Rationale: Normal EF is 55-70%. An EF of 25% indicates systolic heart failure with
reduced ejection fraction (HFrEF), meaning the left ventricle is not pumping effectively.
Treatment focuses on afterload reduction, diuresis, and inotropic support.
6. A patient with heart failure has jugular venous distention, 3+ pitting edema,
and crackles in the lungs. The nurse should anticipate which intervention?
A. Fluid bolus
B. Diuretic therapy
C. Anticoagulation
D. Beta-blocker initiation
Correct Answer: B
Rationale: The patient is exhibiting signs of acute decompensated heart failure with
fluid overload. The priority intervention is diuretic therapy to reduce volume and
preload. A fluid bolus would worsen the condition. Anticoagulation is not the primary
intervention for fluid overload. Beta-blockers are typically held during acute
decompensation.
, 7. Which assessment finding is most concerning in a patient taking an ACE
inhibitor for hypertension?
A. Dry, persistent cough
B. Serum potassium of 5.4 mEq/L
C. Blood pressure of 118/72 mm Hg
D. Dizziness upon standing
Correct Answer: B
Rationale: ACE inhibitors can cause hyperkalemia. A potassium level of 5.4 mEq/L is
above the normal range (3.5-5.0) and can lead to life-threatening cardiac dysrhythmias.
A dry cough is a common side effect, not an emergency. A BP of 118/72 is acceptable.
Dizziness upon standing is orthostatic hypotension, a common side effect that requires
education but is not as immediately dangerous as hyperkalemia.
8. A patient on a statin for dyslipidemia reports new-onset muscle pain and
weakness. The nurse's priority action is to:
A. Encourage the patient to increase fluid intake
B. Tell the patient to continue the medication and reassess in one week
C. Notify the provider immediately and hold the next dose
D. Administer acetaminophen for pain
Correct Answer: C
Rationale: Muscle pain and weakness can be a sign of statin-induced myopathy or
rhabdomyolysis, a rare but serious adverse effect. The nurse should hold the medication
and notify the provider immediately for further evaluation (e.g., CK levels).
9. The nurse is providing discharge teaching to a patient with chronic stable
angina. Which statement indicates a need for further teaching?
A. "I will take my nitroglycerin tablet before any activity that usually causes chest pain."
B. "If one nitroglycerin tablet doesn't work, I can take up to three more, five minutes
apart."
