NUR 257 CHRONIC ILLNESS MANAGEMENT EXAM 4
2026/2027 | Galen College | 100% Correct Answers | Latest
Update | Pass Guaranteed - A+ Graded
Section 1: Chronic Mental Health Conditions - Depression, Anxiety, PTSD (Questions
1-12)
Question 1
A 58-year-old patient with type 2 diabetes and coronary artery disease presents for a
routine follow-up. The nurse administers the PHQ-2 screening tool, and the patient
scores 3 (positive for depressed mood and anhedonia). Which action by the nurse is
most appropriate?
A. Reassure the patient that feeling down is normal with chronic illness and schedule
routine follow-up
B. Administer the full PHQ-9 and consider initiating an SSRI if the score is moderate or
above [CORRECT]
C. Immediately refer the patient to inpatient psychiatric care
D. Discontinue the patient's metformin because depression is a known side effect
Rationale: A positive PHQ-2 (score ≥3) requires follow-up with the full PHQ-9 to assess
depression severity and guide treatment decisions. The collaborative care model
(CoCM) supports systematic screening and stepped care. Inpatient referral is
unnecessary without suicidality. Metformin is not associated with depression.
Correct Answer: B
Question 2
,A patient with chronic obstructive pulmonary disease (COPD) scores 15 on the PHQ-9,
indicating moderately severe depression. The patient is already on sertraline 50 mg
daily for 6 weeks with minimal improvement. Using the collaborative care model, which
intervention is most appropriate?
A. Increase the sertraline to 100 mg daily and reassess in 4 weeks [CORRECT]
B. Discontinue sertraline and switch to a benzodiazepine for faster relief
C. Recommend the patient increase physical activity alone and discontinue medication
D. Refer directly to electroconvulsive therapy (ECT) as first-line for chronic illness
depression
Rationale: In the collaborative care model, inadequate response to an initial SSRI dose
after 4-6 weeks warrants dose escalation before switching agents. Sertraline 50 mg is a
subtherapeutic dose for many adults. Benzodiazepines are not first-line for depression.
ECT is reserved for treatment-resistant or severe depression.
Correct Answer: A
Question 3
A nurse is caring for a patient with heart failure who is started on escitalopram for
depression. Which monitoring parameter is most important during the first 2 weeks of
therapy?
A. Liver function tests weekly
B. Blood pressure and heart rate for potential QTc prolongation [CORRECT]
C. Complete blood count for agranulocytosis
D. Serum creatinine for nephrotoxicity
Rationale: Escitalopram and other SSRIs can prolong the QTc interval, which is
particularly concerning in patients with cardiac conditions like heart failure. While SSRIs
are generally safe in cardiac patients, baseline and follow-up ECG monitoring is prudent.
Liver function, agranulocytosis, and nephrotoxicity are not typical SSRI concerns.
,Correct Answer: B
Question 4
A patient with chronic kidney disease stage 4 presents with symptoms of generalized
anxiety disorder. The nurse reviews the GAD-7 score of 12, indicating moderate anxiety.
Which medication would be most appropriate to initiate, considering the patient's renal
function?
A. Duloxetine (SNRI) at standard dosing
B. Sertraline (SSRI) with renal dose adjustment [CORRECT]
C. Lorazepam (benzodiazepine) for rapid symptom control
D. Venlafaxine at maximum dose for dual reuptake inhibition
Rationale: Sertraline is primarily hepatically metabolized and requires minimal renal
adjustment, making it safer in CKD stage 4. Duloxetine and venlafaxine have active
metabolites that may accumulate. Benzodiazepines are not first-line for chronic anxiety
due to dependence, sedation, and fall risk, especially in medically complex patients.
Correct Answer: B
Question 5
A veteran with chronic pain and hypertension is screened for PTSD using the
PC-PTSD-5. The patient answers "yes" to 4 of 5 items (nightmares, avoidance,
hypervigilance, detachment). Which action is most appropriate?
A. Reassure the patient that these symptoms are expected with chronic pain
B. Refer for evidence-based trauma-focused psychotherapy (PE or CPT) and consider
SSRI/SNRI [CORRECT]
C. Prescribe propranolol to block all traumatic memories
D. Advise the patient to avoid all reminders of the trauma
, Rationale: A score of 3 or more on the PC-PTSD-5 indicates probable PTSD requiring
further evaluation and treatment. Evidence-based treatments include trauma-focused
psychotherapies (Prolonged Exposure or Cognitive Processing Therapy) and
FDA-approved medications (sertraline, paroxetine, venlafaxine). Avoidance reinforces
PTSD symptoms.
Correct Answer: B
Question 6
A nurse is implementing cognitive behavioral therapy (CBT) principles with a patient
who has depression and fibromyalgia. The patient states, "I am worthless because I
cannot work anymore." Which CBT technique is most appropriate?
A. Prescribe a higher dose of antidepressant to eliminate negative thoughts
B. Challenge the cognitive distortion using Socratic questioning and behavioral
activation [CORRECT]
C. Agree with the patient that inability to work does reduce worth
D. Suggest the patient avoid discussing work to prevent sadness
Rationale: CBT focuses on identifying and restructuring maladaptive thoughts (cognitive
distortions) through techniques like Socratic questioning, combined with behavioral
activation to increase engagement in meaningful activities. Agreeing with distortions or
avoiding topics reinforces depression. Medication adjustment alone does not address
cognitive patterns.
Correct Answer: B
Question 7
A patient with rheumatoid arthritis and depression reports forgetting to take
methotrexate frequently. The PHQ-9 score is 18 (moderately severe). Which statement
2026/2027 | Galen College | 100% Correct Answers | Latest
Update | Pass Guaranteed - A+ Graded
Section 1: Chronic Mental Health Conditions - Depression, Anxiety, PTSD (Questions
1-12)
Question 1
A 58-year-old patient with type 2 diabetes and coronary artery disease presents for a
routine follow-up. The nurse administers the PHQ-2 screening tool, and the patient
scores 3 (positive for depressed mood and anhedonia). Which action by the nurse is
most appropriate?
A. Reassure the patient that feeling down is normal with chronic illness and schedule
routine follow-up
B. Administer the full PHQ-9 and consider initiating an SSRI if the score is moderate or
above [CORRECT]
C. Immediately refer the patient to inpatient psychiatric care
D. Discontinue the patient's metformin because depression is a known side effect
Rationale: A positive PHQ-2 (score ≥3) requires follow-up with the full PHQ-9 to assess
depression severity and guide treatment decisions. The collaborative care model
(CoCM) supports systematic screening and stepped care. Inpatient referral is
unnecessary without suicidality. Metformin is not associated with depression.
Correct Answer: B
Question 2
,A patient with chronic obstructive pulmonary disease (COPD) scores 15 on the PHQ-9,
indicating moderately severe depression. The patient is already on sertraline 50 mg
daily for 6 weeks with minimal improvement. Using the collaborative care model, which
intervention is most appropriate?
A. Increase the sertraline to 100 mg daily and reassess in 4 weeks [CORRECT]
B. Discontinue sertraline and switch to a benzodiazepine for faster relief
C. Recommend the patient increase physical activity alone and discontinue medication
D. Refer directly to electroconvulsive therapy (ECT) as first-line for chronic illness
depression
Rationale: In the collaborative care model, inadequate response to an initial SSRI dose
after 4-6 weeks warrants dose escalation before switching agents. Sertraline 50 mg is a
subtherapeutic dose for many adults. Benzodiazepines are not first-line for depression.
ECT is reserved for treatment-resistant or severe depression.
Correct Answer: A
Question 3
A nurse is caring for a patient with heart failure who is started on escitalopram for
depression. Which monitoring parameter is most important during the first 2 weeks of
therapy?
A. Liver function tests weekly
B. Blood pressure and heart rate for potential QTc prolongation [CORRECT]
C. Complete blood count for agranulocytosis
D. Serum creatinine for nephrotoxicity
Rationale: Escitalopram and other SSRIs can prolong the QTc interval, which is
particularly concerning in patients with cardiac conditions like heart failure. While SSRIs
are generally safe in cardiac patients, baseline and follow-up ECG monitoring is prudent.
Liver function, agranulocytosis, and nephrotoxicity are not typical SSRI concerns.
,Correct Answer: B
Question 4
A patient with chronic kidney disease stage 4 presents with symptoms of generalized
anxiety disorder. The nurse reviews the GAD-7 score of 12, indicating moderate anxiety.
Which medication would be most appropriate to initiate, considering the patient's renal
function?
A. Duloxetine (SNRI) at standard dosing
B. Sertraline (SSRI) with renal dose adjustment [CORRECT]
C. Lorazepam (benzodiazepine) for rapid symptom control
D. Venlafaxine at maximum dose for dual reuptake inhibition
Rationale: Sertraline is primarily hepatically metabolized and requires minimal renal
adjustment, making it safer in CKD stage 4. Duloxetine and venlafaxine have active
metabolites that may accumulate. Benzodiazepines are not first-line for chronic anxiety
due to dependence, sedation, and fall risk, especially in medically complex patients.
Correct Answer: B
Question 5
A veteran with chronic pain and hypertension is screened for PTSD using the
PC-PTSD-5. The patient answers "yes" to 4 of 5 items (nightmares, avoidance,
hypervigilance, detachment). Which action is most appropriate?
A. Reassure the patient that these symptoms are expected with chronic pain
B. Refer for evidence-based trauma-focused psychotherapy (PE or CPT) and consider
SSRI/SNRI [CORRECT]
C. Prescribe propranolol to block all traumatic memories
D. Advise the patient to avoid all reminders of the trauma
, Rationale: A score of 3 or more on the PC-PTSD-5 indicates probable PTSD requiring
further evaluation and treatment. Evidence-based treatments include trauma-focused
psychotherapies (Prolonged Exposure or Cognitive Processing Therapy) and
FDA-approved medications (sertraline, paroxetine, venlafaxine). Avoidance reinforces
PTSD symptoms.
Correct Answer: B
Question 6
A nurse is implementing cognitive behavioral therapy (CBT) principles with a patient
who has depression and fibromyalgia. The patient states, "I am worthless because I
cannot work anymore." Which CBT technique is most appropriate?
A. Prescribe a higher dose of antidepressant to eliminate negative thoughts
B. Challenge the cognitive distortion using Socratic questioning and behavioral
activation [CORRECT]
C. Agree with the patient that inability to work does reduce worth
D. Suggest the patient avoid discussing work to prevent sadness
Rationale: CBT focuses on identifying and restructuring maladaptive thoughts (cognitive
distortions) through techniques like Socratic questioning, combined with behavioral
activation to increase engagement in meaningful activities. Agreeing with distortions or
avoiding topics reinforces depression. Medication adjustment alone does not address
cognitive patterns.
Correct Answer: B
Question 7
A patient with rheumatoid arthritis and depression reports forgetting to take
methotrexate frequently. The PHQ-9 score is 18 (moderately severe). Which statement
