NUR 257 CHRONIC CONDITIONS | GALEN COLLEGE OF
NURSING | ACADEMIC YEAR 2026/2027 | EXAM 4
COMPREHENSIVE EXAMINATION | 85 VERIFIED QUESTIONS
AND CORRECT ANSWER RATIONALES
Core Domains
Cardiovascular Chronic Conditions
Endocrine and Metabolic Disorders
Respiratory Chronic Conditions
Renal and Genitourinary Chronic Conditions
Neurological Chronic Conditions
Musculoskeletal and Autoimmune Disorders
Cancer and Palliative Care
Health Promotion and Chronic Disease Self-Management
Introduction
This comprehensive examination evaluates nursing knowledge and
clinical judgment in managing clients with chronic conditions
across the lifespan. The assessment covers cardiovascular,
endocrine, respiratory, renal, neurological, musculoskeletal, and
oncological disorders. Questions are structured as multiple-choice
and scenario-based items emphasizing real-world application,
clinical decision-making, and evidence-based practice. Candidates
must demonstrate competency in pathophysiology, assessment,
pharmacological management, client education, and
interdisciplinary collaboration. Each item requires critical thinking
and prioritization consistent with professional nursing practice in
chronic care settings.
,SECTION ONE: QUESTIONS 1–85
1. A nurse is teaching a client with chronic heart failure about
daily weight monitoring. Which instruction is most important?
A. "Weigh yourself once a week at the same time."
B. "Weigh yourself daily at the same time using the same scale."
C. "Weigh yourself only when you feel short of breath."
D. "Weigh yourself after your morning walk."
🟢 Correct answer: B. "Weigh yourself daily at the same time
using the same scale."
🔴 RATIONALE: Daily weight monitoring at the same time with
the same scale is essential for detecting fluid retention early. A
weight gain of 2 to 3 pounds in 24 hours or 5 pounds in one week
indicates worsening heart failure and requires prompt
intervention.
2. A nurse is assessing a client with chronic obstructive
pulmonary disease. Which finding indicates chronic hypoxemia?
A. Clubbing of the fingers
B. Respiratory rate of 18 breaths per minute
C. Pink mucous membranes
D. Oxygen saturation of 95%
🟢 Correct answer: A. Clubbing of the fingers
,🔴 RATIONALE: Clubbing of the fingers is a sign of chronic
hypoxemia commonly seen in clients with COPD. It results from
prolonged low oxygen levels and is characterized by enlarged
fingertips with increased angle of the nail bed.
3. A nurse is reviewing laboratory results for a client with
chronic kidney disease. Which finding requires immediate
intervention?
A. Hemoglobin of 10.2 g/dL
B. Potassium of 6.5 mEq/L
C. Creatinine of 2.8 mg/dL
D. Phosphorus of 4.5 mg/dL
🟢 Correct answer: B. Potassium of 6.5 mEq/L
🔴 RATIONALE: Hyperkalemia is a life-threatening complication of
chronic kidney disease that can cause cardiac dysrhythmias. A
potassium level of 6.5 mEq/L requires immediate intervention.
Normal potassium is 3.5 to 5.0 mEq/L.
4. A nurse is teaching a client with type 2 diabetes about sick-
day management. Which instruction is correct?
A. "Stop taking your insulin when you are sick."
B. "Check your blood glucose every 4 hours."
C. "Restrict fluids to prevent hyperglycemia."
, D. "Skip meals until your fever resolves."
🟢 Correct answer: B. "Check your blood glucose every 4 hours."
🔴 RATIONALE: During illness, blood glucose levels can fluctuate
significantly due to stress hormones. The client should check
blood glucose every 4 hours and continue taking prescribed
medications. Insulin should not be stopped. Adequate hydration is
essential.
5. A nurse is assessing a client with rheumatoid arthritis. Which
finding is most characteristic of this condition?
A. Heberden's nodes
B. Symmetrical joint involvement
C. Asymmetrical joint involvement
D. Morning stiffness lasting 5 minutes
🟢 Correct answer: B. Symmetrical joint involvement
🔴 RATIONALE: Rheumatoid arthritis typically presents with
symmetrical joint involvement, especially in the hands and wrists.
Heberden's nodes are associated with osteoarthritis. Morning
stiffness in RA typically lasts longer than 30 minutes.
6. A nurse is providing education to a client with asthma about
using a peak flow meter. Which action indicates correct
understanding?
NURSING | ACADEMIC YEAR 2026/2027 | EXAM 4
COMPREHENSIVE EXAMINATION | 85 VERIFIED QUESTIONS
AND CORRECT ANSWER RATIONALES
Core Domains
Cardiovascular Chronic Conditions
Endocrine and Metabolic Disorders
Respiratory Chronic Conditions
Renal and Genitourinary Chronic Conditions
Neurological Chronic Conditions
Musculoskeletal and Autoimmune Disorders
Cancer and Palliative Care
Health Promotion and Chronic Disease Self-Management
Introduction
This comprehensive examination evaluates nursing knowledge and
clinical judgment in managing clients with chronic conditions
across the lifespan. The assessment covers cardiovascular,
endocrine, respiratory, renal, neurological, musculoskeletal, and
oncological disorders. Questions are structured as multiple-choice
and scenario-based items emphasizing real-world application,
clinical decision-making, and evidence-based practice. Candidates
must demonstrate competency in pathophysiology, assessment,
pharmacological management, client education, and
interdisciplinary collaboration. Each item requires critical thinking
and prioritization consistent with professional nursing practice in
chronic care settings.
,SECTION ONE: QUESTIONS 1–85
1. A nurse is teaching a client with chronic heart failure about
daily weight monitoring. Which instruction is most important?
A. "Weigh yourself once a week at the same time."
B. "Weigh yourself daily at the same time using the same scale."
C. "Weigh yourself only when you feel short of breath."
D. "Weigh yourself after your morning walk."
🟢 Correct answer: B. "Weigh yourself daily at the same time
using the same scale."
🔴 RATIONALE: Daily weight monitoring at the same time with
the same scale is essential for detecting fluid retention early. A
weight gain of 2 to 3 pounds in 24 hours or 5 pounds in one week
indicates worsening heart failure and requires prompt
intervention.
2. A nurse is assessing a client with chronic obstructive
pulmonary disease. Which finding indicates chronic hypoxemia?
A. Clubbing of the fingers
B. Respiratory rate of 18 breaths per minute
C. Pink mucous membranes
D. Oxygen saturation of 95%
🟢 Correct answer: A. Clubbing of the fingers
,🔴 RATIONALE: Clubbing of the fingers is a sign of chronic
hypoxemia commonly seen in clients with COPD. It results from
prolonged low oxygen levels and is characterized by enlarged
fingertips with increased angle of the nail bed.
3. A nurse is reviewing laboratory results for a client with
chronic kidney disease. Which finding requires immediate
intervention?
A. Hemoglobin of 10.2 g/dL
B. Potassium of 6.5 mEq/L
C. Creatinine of 2.8 mg/dL
D. Phosphorus of 4.5 mg/dL
🟢 Correct answer: B. Potassium of 6.5 mEq/L
🔴 RATIONALE: Hyperkalemia is a life-threatening complication of
chronic kidney disease that can cause cardiac dysrhythmias. A
potassium level of 6.5 mEq/L requires immediate intervention.
Normal potassium is 3.5 to 5.0 mEq/L.
4. A nurse is teaching a client with type 2 diabetes about sick-
day management. Which instruction is correct?
A. "Stop taking your insulin when you are sick."
B. "Check your blood glucose every 4 hours."
C. "Restrict fluids to prevent hyperglycemia."
, D. "Skip meals until your fever resolves."
🟢 Correct answer: B. "Check your blood glucose every 4 hours."
🔴 RATIONALE: During illness, blood glucose levels can fluctuate
significantly due to stress hormones. The client should check
blood glucose every 4 hours and continue taking prescribed
medications. Insulin should not be stopped. Adequate hydration is
essential.
5. A nurse is assessing a client with rheumatoid arthritis. Which
finding is most characteristic of this condition?
A. Heberden's nodes
B. Symmetrical joint involvement
C. Asymmetrical joint involvement
D. Morning stiffness lasting 5 minutes
🟢 Correct answer: B. Symmetrical joint involvement
🔴 RATIONALE: Rheumatoid arthritis typically presents with
symmetrical joint involvement, especially in the hands and wrists.
Heberden's nodes are associated with osteoarthritis. Morning
stiffness in RA typically lasts longer than 30 minutes.
6. A nurse is providing education to a client with asthma about
using a peak flow meter. Which action indicates correct
understanding?
