NUR 257 CHRONIC ILLNESS MANAGEMENT EXAM 2
2026/2027 | 50 Actual Questions | Galen College | 100%
Correct Answers | Pass Guaranteed - A+ Graded
Section 1: Chronic Disease Management - Heart Failure, COPD, Diabetes (Q1-15)
Q1. A 72-year-old patient with heart failure (HF) calls the clinic reporting a 3-pound
weight gain over 2 days and increased dyspnea when climbing stairs. Which
instruction should the nurse provide first?
A. "Continue your current medications and schedule a routine follow-up in 2 weeks"
B. "Increase your furosemide by one tablet today and recheck your weight
tomorrow"
C. "Call 911 immediately; you are having a heart attack"
D. "Check your weight daily, restrict sodium to 2g/day, and contact us if you gain
more than 2 pounds in one day or 5 pounds in a week"
D. "Check your weight daily, restrict sodium to 2g/day, and contact us if you gain
more than 2 pounds in one day or 5 pounds in a week" [CORRECT]
Rationale: A 3-pound gain over 2 days with increased dyspnea indicates early fluid
retention but not acute decompensation requiring emergency care. The standard HF
self-management protocol is daily weights with parameters: call provider for >2 lb in
1 day or >5 lb in 1 week. Patients should NEVER self-titrate diuretics without provider
orders, and this presentation does not indicate MI.
Correct Answer: D
Q2. A patient with COPD is prescribed home oxygen therapy at 2 L/min via nasal
cannula. The patient's SpO2 is 96% on room air at rest but drops to 88% with
ambulation. Which action should the nurse take?
A. Discontinue oxygen since SpO2 is normal at rest
B. Increase flow to 4 L/min to maintain SpO2 >94% during activity
,C. Titrate oxygen to maintain SpO2 88-92% during activity and rest
D. Switch to a non-rebreather mask at 10 L/min
C. Titrate oxygen to maintain SpO2 88-92% during activity and rest [CORRECT]
Rationale: COPD patients with chronic hypercapnia require careful oxygen titration;
target SpO2 is 88-92% to avoid CO2 retention and respiratory acidosis from
suppressing hypoxic drive. Oxygen should NOT be discontinued if desaturation
occurs with activity, and high-flow oxygen or non-rebreather masks can cause
dangerous hypercapnia.
Correct Answer: C
Q3. A patient with Type 2 diabetes has a fasting blood glucose of 142 mg/dL and
HbA1c of 8.2%. The provider adds basal insulin to the current metformin regimen.
Which patient education is most important?
A. "You can stop taking metformin now that you are on insulin"
B. "Rotate injection sites within the same anatomical area to prevent lipodystrophy"
C. "Take your insulin immediately after meals to match food intake"
D. "Store your insulin vials in the freezer for longer shelf life"
B. "Rotate injection sites within the same anatomical area to prevent
lipodystrophy" [CORRECT]
Rationale: Site rotation within the same area (abdomen, thigh, arm) ensures
consistent absorption and prevents lipodystrophy. Metformin is typically continued
with insulin initiation. Basal insulin is administered at the same time daily, not meal-
dependent. Insulin should NEVER be frozen; it is stored at room temperature or
refrigerated.
Correct Answer: B
, Q4. A patient with HF is discharged home on lisinopril, metoprolol, furosemide, and
spironolactone. Which symptom requires immediate emergency department
evaluation?
A. Mild ankle swelling after prolonged standing
B. Dry cough since starting lisinopril 2 weeks ago
C. Sudden severe dyspnea at rest, pink frothy sputum, and confusion
D. Increased urination after taking morning furosemide
C. Sudden severe dyspnea at rest, pink frothy sputum, and confusion [CORRECT]
Rationale: Pink frothy sputum, severe dyspnea at rest, and confusion indicate acute
pulmonary edema and cardiogenic shock—a life-threatening emergency requiring
immediate 911 activation. Mild dependent edema, ACE-inhibitor cough, and diuretic-
induced diuresis are expected findings that do not require emergency care.
Correct Answer: C
Q5. A patient with COPD presents with increased sputum purulence, dyspnea, and
wheezing. The nurse reviews the patient's COPD action plan. Which zone is the
patient in, and what is the appropriate action?
A. Green zone: continue current medications
B. Yellow zone: start rescue inhaler and oral corticosteroids, contact provider
C. Red zone: call 911 immediately
D. Blue zone: increase oxygen flow to 6 L/min
B. Yellow zone: start rescue inhaler and oral corticosteroids, contact provider
[CORRECT]
Rationale: Increased sputum purulence, dyspnea, and wheezing without severe
distress define the yellow zone (worsening symptoms). Green zone is stable, red zone
is severe distress or unresponsive to yellow zone interventions. There is no "blue
zone" in standard COPD action plans, and patients should not self-increase oxygen.
Correct Answer: B
2026/2027 | 50 Actual Questions | Galen College | 100%
Correct Answers | Pass Guaranteed - A+ Graded
Section 1: Chronic Disease Management - Heart Failure, COPD, Diabetes (Q1-15)
Q1. A 72-year-old patient with heart failure (HF) calls the clinic reporting a 3-pound
weight gain over 2 days and increased dyspnea when climbing stairs. Which
instruction should the nurse provide first?
A. "Continue your current medications and schedule a routine follow-up in 2 weeks"
B. "Increase your furosemide by one tablet today and recheck your weight
tomorrow"
C. "Call 911 immediately; you are having a heart attack"
D. "Check your weight daily, restrict sodium to 2g/day, and contact us if you gain
more than 2 pounds in one day or 5 pounds in a week"
D. "Check your weight daily, restrict sodium to 2g/day, and contact us if you gain
more than 2 pounds in one day or 5 pounds in a week" [CORRECT]
Rationale: A 3-pound gain over 2 days with increased dyspnea indicates early fluid
retention but not acute decompensation requiring emergency care. The standard HF
self-management protocol is daily weights with parameters: call provider for >2 lb in
1 day or >5 lb in 1 week. Patients should NEVER self-titrate diuretics without provider
orders, and this presentation does not indicate MI.
Correct Answer: D
Q2. A patient with COPD is prescribed home oxygen therapy at 2 L/min via nasal
cannula. The patient's SpO2 is 96% on room air at rest but drops to 88% with
ambulation. Which action should the nurse take?
A. Discontinue oxygen since SpO2 is normal at rest
B. Increase flow to 4 L/min to maintain SpO2 >94% during activity
,C. Titrate oxygen to maintain SpO2 88-92% during activity and rest
D. Switch to a non-rebreather mask at 10 L/min
C. Titrate oxygen to maintain SpO2 88-92% during activity and rest [CORRECT]
Rationale: COPD patients with chronic hypercapnia require careful oxygen titration;
target SpO2 is 88-92% to avoid CO2 retention and respiratory acidosis from
suppressing hypoxic drive. Oxygen should NOT be discontinued if desaturation
occurs with activity, and high-flow oxygen or non-rebreather masks can cause
dangerous hypercapnia.
Correct Answer: C
Q3. A patient with Type 2 diabetes has a fasting blood glucose of 142 mg/dL and
HbA1c of 8.2%. The provider adds basal insulin to the current metformin regimen.
Which patient education is most important?
A. "You can stop taking metformin now that you are on insulin"
B. "Rotate injection sites within the same anatomical area to prevent lipodystrophy"
C. "Take your insulin immediately after meals to match food intake"
D. "Store your insulin vials in the freezer for longer shelf life"
B. "Rotate injection sites within the same anatomical area to prevent
lipodystrophy" [CORRECT]
Rationale: Site rotation within the same area (abdomen, thigh, arm) ensures
consistent absorption and prevents lipodystrophy. Metformin is typically continued
with insulin initiation. Basal insulin is administered at the same time daily, not meal-
dependent. Insulin should NEVER be frozen; it is stored at room temperature or
refrigerated.
Correct Answer: B
, Q4. A patient with HF is discharged home on lisinopril, metoprolol, furosemide, and
spironolactone. Which symptom requires immediate emergency department
evaluation?
A. Mild ankle swelling after prolonged standing
B. Dry cough since starting lisinopril 2 weeks ago
C. Sudden severe dyspnea at rest, pink frothy sputum, and confusion
D. Increased urination after taking morning furosemide
C. Sudden severe dyspnea at rest, pink frothy sputum, and confusion [CORRECT]
Rationale: Pink frothy sputum, severe dyspnea at rest, and confusion indicate acute
pulmonary edema and cardiogenic shock—a life-threatening emergency requiring
immediate 911 activation. Mild dependent edema, ACE-inhibitor cough, and diuretic-
induced diuresis are expected findings that do not require emergency care.
Correct Answer: C
Q5. A patient with COPD presents with increased sputum purulence, dyspnea, and
wheezing. The nurse reviews the patient's COPD action plan. Which zone is the
patient in, and what is the appropriate action?
A. Green zone: continue current medications
B. Yellow zone: start rescue inhaler and oral corticosteroids, contact provider
C. Red zone: call 911 immediately
D. Blue zone: increase oxygen flow to 6 L/min
B. Yellow zone: start rescue inhaler and oral corticosteroids, contact provider
[CORRECT]
Rationale: Increased sputum purulence, dyspnea, and wheezing without severe
distress define the yellow zone (worsening symptoms). Green zone is stable, red zone
is severe distress or unresponsive to yellow zone interventions. There is no "blue
zone" in standard COPD action plans, and patients should not self-increase oxygen.
Correct Answer: B
