Nur 257 Chronic Exam 3 Practice
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
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1. A 72-year-old patient with chronic heart failure (HF) is admitted with
worsening dyspnea and orthopnea. The patient’s current medication
regimen includes lisinopril, furosemide, and carvedilol. The patient’s vital
signs are blood pressure 94/58 mm Hg, heart rate 58 bpm, and respiratory
rate 24 breaths/min. The provider orders an additional dose of intravenous
furosemide. Which assessment finding is the most critical for the nurse to
report to the provider before administering this dose?
A. A serum potassium level of 3.8 mEq/L
B. A serum creatinine level of 1.2 mg/dL
C. A weight gain of 2 kg over the past 24 hours
D. A serum sodium level of 132 mEq/L
Answer: D
Rationale: The patient is already on an ACE inhibitor (lisinopril) and a beta-
blocker (carvedilol), which can predispose them to hyperkalemia and
hypotension. The blood pressure is already low at 94/58, and the heart rate is
bradycardic at 58 bpm. While the serum potassium is within normal limits, the
serum sodium of 132 mEq/L indicates dilutional hyponatremia due to fluid
overload and advanced heart failure. Administering additional furosemide in a
patient with hyponatremia can worsen the electrolyte imbalance and lead to
severe central nervous system complications. The weight gain, serum creatinine,
and potassium are important but do not present an immediate contraindication
for the furosemide dose as the sodium level does.
, 2. The nurse is providing discharge teaching to a patient newly diagnosed with
heart failure with preserved ejection fraction (HFpEF). Which statement by
the patient indicates a correct understanding of the dietary restrictions
required for this condition?
A. “I should limit my daily fluid intake to no more than 3 liters per day.”
B. “I can use salt substitutes freely to flavor my food since they contain
potassium.”
C. “I need to read food labels and limit my sodium intake to less than 2
grams per day.”
D. “I should increase my intake of high-fiber foods to prevent constipation
and fluid retention.”
Answer: C
Rationale: The standard recommendation for patients with heart failure is to
restrict sodium to less than 2 grams (2000 mg) per day. This helps reduce fluid
retention and the workload on the heart. Limiting fluids to 2 liters, not 3, is a
common guideline. Salt substitutes are often high in potassium and can be
dangerous for patients on ACE inhibitors or ARBs due to the risk of
hyperkalemia. While high-fiber foods are generally healthy, they do not directly
manage fluid retention in heart failure.
3. A patient with chronic obstructive pulmonary disease (COPD) and a history
of type 2 diabetes mellitus is prescribed prednisone 40 mg daily for an
acute exacerbation. The nurse is monitoring the patient’s blood glucose
levels. What is the priority nursing action regarding this medication?
A. Administer the prednisone with an antacid to prevent gastrointestinal
bleeding.
B. Monitor blood glucose every 6 hours and adjust the sliding-scale insulin
as prescribed.
C. Instruct the patient to take the prednisone at bedtime to minimize
hyperglycemia.
D. Hold the prednisone if the blood glucose level is above 180 mg/dL.
,Answer: B
Rationale: Corticosteroids like prednisone cause significant hyperglycemia by
promoting gluconeogenesis and insulin resistance. Patients with diabetes will
require close monitoring and likely an increase in their insulin or oral
hypoglycemic needs during steroid therapy. Blood glucose should be monitored
frequently, often every 6 hours, to adjust therapy. Taking prednisone in the
morning is recommended to mimic the body's natural cortisol cycle and
minimize insomnia, not to reduce hyperglycemia. The medication should not be
held for hyperglycemia; instead, the glucose should be managed with insulin.
Administering with antacids is a general precaution but not the priority over
glycemic control.
4. The nurse is caring for a patient with end-stage renal disease (ESRD) who is
on hemodialysis. The patient’s arteriovenous (AV) fistula is in the left arm.
Which of the following nursing actions is appropriate for this patient?
A. Obtain blood pressure readings from the left arm.
B. Perform venipuncture in the left arm for laboratory draws.
C. Assess the thrill and bruit in the left arm every 8 hours.
D. Apply a tight tourniquet above the fistula site if bleeding occurs.
Answer: C
Rationale: The AV fistula is a patient's lifeline for dialysis access. A thrill
(palpable vibration) and a bruit (audible murmur) indicate patency and
adequate blood flow. These should be assessed frequently. Blood pressure
readings, venipunctures, and tight tourniquets should never be performed on
the arm with the AV fistula as they can cause damage, clotting, or infection of
the access site. If bleeding occurs, direct pressure should be applied over the
puncture site, not a tourniquet above it.
5. A 68-year-old patient with a history of coronary artery disease is prescribed
atorvastatin. The patient asks the nurse why they need to take this
medication if their cholesterol levels are “almost normal.” What is the best
response by the nurse?
A. “Atorvastatin is prescribed to help you lose weight and lower your
, triglycerides.”
B. “Atorvastatin has anti-inflammatory effects that help stabilize plaques in
your arteries.”
C. “Atorvastatin will help you achieve a lower blood pressure than your
current medication.”
D. “Atorvastatin is a blood thinner that prevents clots from forming in your
stents.”
Answer: B
Rationale: In patients with coronary artery disease or high cardiovascular risk,
statins like atorvastatin are prescribed not only for their lipid-lowering effects
but also for their pleiotropic effects, which include stabilizing atherosclerotic
plaques and reducing vascular inflammation. This reduces the risk of plaque
rupture, which can lead to myocardial infarction or stroke. Statins do not
primarily cause weight loss, are not indicated for blood pressure lowering, and
are not blood thinners.
6. A patient with chronic liver disease is exhibiting asterixis, confusion, and a
flapping tremor of the hands. The nurse suspects hepatic encephalopathy.
Which medication is the nurse most likely to administer to treat this
condition?
A. Naloxone
B. Lactulose
C. Octreotide
D. Metronidazole
Answer: B
Rationale: Hepatic encephalopathy is caused by the accumulation of ammonia in
the bloodstream due to the liver's inability to convert it to urea. Lactulose is a
non-absorbable disaccharide that acidifies the colon, promoting the conversion
of ammonia (NH3) to ammonium (NH4+), which is then excreted in the stool.
This reduces serum ammonia levels and improves neurological symptoms.
Naloxone is used for opioid overdose. Octreotide is used for esophageal varices.
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A 72-year-old patient with chronic heart failure (HF) is admitted with
worsening dyspnea and orthopnea. The patient’s current medication
regimen includes lisinopril, furosemide, and carvedilol. The patient’s vital
signs are blood pressure 94/58 mm Hg, heart rate 58 bpm, and respiratory
rate 24 breaths/min. The provider orders an additional dose of intravenous
furosemide. Which assessment finding is the most critical for the nurse to
report to the provider before administering this dose?
A. A serum potassium level of 3.8 mEq/L
B. A serum creatinine level of 1.2 mg/dL
C. A weight gain of 2 kg over the past 24 hours
D. A serum sodium level of 132 mEq/L
Answer: D
Rationale: The patient is already on an ACE inhibitor (lisinopril) and a beta-
blocker (carvedilol), which can predispose them to hyperkalemia and
hypotension. The blood pressure is already low at 94/58, and the heart rate is
bradycardic at 58 bpm. While the serum potassium is within normal limits, the
serum sodium of 132 mEq/L indicates dilutional hyponatremia due to fluid
overload and advanced heart failure. Administering additional furosemide in a
patient with hyponatremia can worsen the electrolyte imbalance and lead to
severe central nervous system complications. The weight gain, serum creatinine,
and potassium are important but do not present an immediate contraindication
for the furosemide dose as the sodium level does.
, 2. The nurse is providing discharge teaching to a patient newly diagnosed with
heart failure with preserved ejection fraction (HFpEF). Which statement by
the patient indicates a correct understanding of the dietary restrictions
required for this condition?
A. “I should limit my daily fluid intake to no more than 3 liters per day.”
B. “I can use salt substitutes freely to flavor my food since they contain
potassium.”
C. “I need to read food labels and limit my sodium intake to less than 2
grams per day.”
D. “I should increase my intake of high-fiber foods to prevent constipation
and fluid retention.”
Answer: C
Rationale: The standard recommendation for patients with heart failure is to
restrict sodium to less than 2 grams (2000 mg) per day. This helps reduce fluid
retention and the workload on the heart. Limiting fluids to 2 liters, not 3, is a
common guideline. Salt substitutes are often high in potassium and can be
dangerous for patients on ACE inhibitors or ARBs due to the risk of
hyperkalemia. While high-fiber foods are generally healthy, they do not directly
manage fluid retention in heart failure.
3. A patient with chronic obstructive pulmonary disease (COPD) and a history
of type 2 diabetes mellitus is prescribed prednisone 40 mg daily for an
acute exacerbation. The nurse is monitoring the patient’s blood glucose
levels. What is the priority nursing action regarding this medication?
A. Administer the prednisone with an antacid to prevent gastrointestinal
bleeding.
B. Monitor blood glucose every 6 hours and adjust the sliding-scale insulin
as prescribed.
C. Instruct the patient to take the prednisone at bedtime to minimize
hyperglycemia.
D. Hold the prednisone if the blood glucose level is above 180 mg/dL.
,Answer: B
Rationale: Corticosteroids like prednisone cause significant hyperglycemia by
promoting gluconeogenesis and insulin resistance. Patients with diabetes will
require close monitoring and likely an increase in their insulin or oral
hypoglycemic needs during steroid therapy. Blood glucose should be monitored
frequently, often every 6 hours, to adjust therapy. Taking prednisone in the
morning is recommended to mimic the body's natural cortisol cycle and
minimize insomnia, not to reduce hyperglycemia. The medication should not be
held for hyperglycemia; instead, the glucose should be managed with insulin.
Administering with antacids is a general precaution but not the priority over
glycemic control.
4. The nurse is caring for a patient with end-stage renal disease (ESRD) who is
on hemodialysis. The patient’s arteriovenous (AV) fistula is in the left arm.
Which of the following nursing actions is appropriate for this patient?
A. Obtain blood pressure readings from the left arm.
B. Perform venipuncture in the left arm for laboratory draws.
C. Assess the thrill and bruit in the left arm every 8 hours.
D. Apply a tight tourniquet above the fistula site if bleeding occurs.
Answer: C
Rationale: The AV fistula is a patient's lifeline for dialysis access. A thrill
(palpable vibration) and a bruit (audible murmur) indicate patency and
adequate blood flow. These should be assessed frequently. Blood pressure
readings, venipunctures, and tight tourniquets should never be performed on
the arm with the AV fistula as they can cause damage, clotting, or infection of
the access site. If bleeding occurs, direct pressure should be applied over the
puncture site, not a tourniquet above it.
5. A 68-year-old patient with a history of coronary artery disease is prescribed
atorvastatin. The patient asks the nurse why they need to take this
medication if their cholesterol levels are “almost normal.” What is the best
response by the nurse?
A. “Atorvastatin is prescribed to help you lose weight and lower your
, triglycerides.”
B. “Atorvastatin has anti-inflammatory effects that help stabilize plaques in
your arteries.”
C. “Atorvastatin will help you achieve a lower blood pressure than your
current medication.”
D. “Atorvastatin is a blood thinner that prevents clots from forming in your
stents.”
Answer: B
Rationale: In patients with coronary artery disease or high cardiovascular risk,
statins like atorvastatin are prescribed not only for their lipid-lowering effects
but also for their pleiotropic effects, which include stabilizing atherosclerotic
plaques and reducing vascular inflammation. This reduces the risk of plaque
rupture, which can lead to myocardial infarction or stroke. Statins do not
primarily cause weight loss, are not indicated for blood pressure lowering, and
are not blood thinners.
6. A patient with chronic liver disease is exhibiting asterixis, confusion, and a
flapping tremor of the hands. The nurse suspects hepatic encephalopathy.
Which medication is the nurse most likely to administer to treat this
condition?
A. Naloxone
B. Lactulose
C. Octreotide
D. Metronidazole
Answer: B
Rationale: Hepatic encephalopathy is caused by the accumulation of ammonia in
the bloodstream due to the liver's inability to convert it to urea. Lactulose is a
non-absorbable disaccharide that acidifies the colon, promoting the conversion
of ammonia (NH3) to ammonium (NH4+), which is then excreted in the stool.
This reduces serum ammonia levels and improves neurological symptoms.
Naloxone is used for opioid overdose. Octreotide is used for esophageal varices.
