NUR 257 Chronic Conditions Exam 3
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CHRONIC CARDIOVASCULAR & RESPIRATORY CONDITIONS Q1 – Q10
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Question 1 of 50
A 72-year-old man with a five-year history of systolic heart failure presents for a routine clinic
visit. He reports increasing dyspnea when walking to his mailbox and notices his shoes feel
tight by late afternoon. His current medications include lisinopril, metoprolol, furosemide,
and spironolactone. He weighs himself daily, and his log shows a 4-pound gain over the past
three days. Which nursing action is most appropriate at this time?
A. Advise him to double his furosemide dose for the next two days and recheck his weight
B. Contact the provider to report the weight gain and worsening symptoms for possible
medication adjustment ✓ CORRECT
C. Reassure him that mild weight fluctuations are normal and do not require intervention
D. Instruct him to stop the spironolactone until the edema resolves
Correct Answer: B
Rationale: A 4-pound weight gain over three days accompanied by worsening dyspnea and
peripheral edema indicates fluid retention consistent with acute decompensated heart failure,
which requires provider notification for potential diuretic escalation or other intervention.
Doubling the furosemide independently is unsafe because it can precipitate electrolyte
imbalances and renal dysfunction without laboratory monitoring. Early recognition and
communication of these changes are central to preventing hospitalization in chronic heart
failure management.
Question 2 of 50
,A 68-year-old woman with severe COPD (FEV1 38% predicted) uses 2 L/min nasal cannula
oxygen at home and arrives at the pulmonary clinic with her portable oxygen concentrator.
She mentions that she feels more short of breath when she removes the cannula to eat
dinner, and she wonders if a different oxygen delivery device would help during meals. Her
resting SpO2 on 2 L/min is 89%. Which response best addresses her concern?
A. Recommend switching to a nonrebreather mask during meals to deliver higher oxygen
concentrations
B. Suggest a nasal cannula with pendant tubing that allows oxygen flow during meals without
removing the device ✓ CORRECT
C. Advise her to increase the flow rate to 4 L/min only while eating and then return to 2 L/min
D. Tell her that brief periods off oxygen during meals are harmless and do not require any
device changes
Correct Answer: B
Rationale: A nasal cannula with pendant or swivel tubing allows continuous oxygen delivery
during meals, which is important because eating is an activity that increases oxygen demand
in patients with severe COPD. A nonrebreather mask is inappropriate for home use and would
make eating impossible, and patients should not independently titrate their oxygen flow rates
without a prescription. Maintaining SpO2 above 88-90% during all activities of daily living is
the goal in severe COPD to prevent hypoxic organ stress.
Question 3 of 50
A 55-year-old man with essential hypertension has been taking lisinopril 10 mg daily for six
months. At today's visit, his blood pressure is 138/86 mmHg, down from 158/96 mmHg at
diagnosis. He reports occasional dizziness when standing quickly and mentions he has been
eating more bananas and nuts since starting the medication because he heard they are
heart-healthy. His basic metabolic panel is pending. Which nursing priority is most important
before he leaves the clinic?
A. Reinforce that his blood pressure goal is achieved and no further changes are needed
B. Instruct him to increase his lisinopril to 20 mg daily to reach a lower target
C. Review his dietary potassium intake and verify his metabolic panel results before he
departs ✓ CORRECT
D. Advise him to stop the lisinopril and switch to a calcium channel blocker due to dizziness
Correct Answer: C
Rationale: ACE inhibitors such as lisinopril can cause hyperkalemia, and increasing dietary
potassium from bananas and nuts without monitoring serum levels poses a risk for
dangerous cardiac arrhythmias. His dizziness on standing suggests possible orthostatic
hypotension, which also warrants assessment before medication escalation. Verifying the
metabolic panel ensures safe continuation of therapy and allows for timely dietary or
medication adjustments.
, Question 4 of 50
A 79-year-old woman with nonvalvular atrial fibrillation has been taking warfarin 5 mg daily for
two years with stable INRs between 2.0 and 3.0. She recently completed a five-day course of
ciprofloxacin for a urinary tract infection. Today's INR is 4.2, and she has no signs of
bleeding. Her vital signs are stable. Which action should the nurse take first?
A. Instruct her to skip tonight's warfarin dose and resume 5 mg tomorrow
B. Administer oral vitamin K 2.5 mg immediately in the clinic
C. Hold warfarin for two days and recheck the INR next week
D. Notify the provider, hold the next warfarin dose, and arrange INR recheck within 24-48 hours
✓ CORRECT
Correct Answer: D
Rationale: An INR of 4.2 in an asymptomatic patient on warfarin warrants holding the next
dose and arranging close follow-up rather than empiric vitamin K, which can make
subsequent anticoagulation management difficult. Ciprofloxacin inhibits CYP1A2 and can
potentiate warfarin, so the interaction must be communicated to the provider for dose
adjustment guidance. Prompt notification and scheduled recheck prevent both thrombotic
risk from overcorrection and hemorrhagic risk from continued supratherapeutic
anticoagulation.
Question 5 of 50
A 34-year-old woman with moderate persistent asthma presents for her annual pulmonary
review. She uses her albuterol inhaler four to five days per week for chest tightness and
wakes up coughing about twice a month. She stopped taking her daily inhaled corticosteroid
two months ago because she felt fine and did not like the aftertaste. Her peak flow today is
72% of her personal best. Which intervention is most appropriate?
A. Restart the daily inhaled corticosteroid and provide spacer technique education ✓
CORRECT
B. Prescribe a long-acting bronchodilator to use instead of the inhaled corticosteroid
C. Switch her to a leukotriene receptor antagonist as monotherapy for better adherence
D. Recommend increasing albuterol use to daily preventive dosing
Correct Answer: A
Rationale: Daily albuterol use more than twice weekly, nocturnal symptoms, and a peak flow
of 72% indicate poorly controlled asthma that requires daily anti-inflammatory therapy with
an inhaled corticosteroid. Long-acting bronchodilators or leukotriene modifiers alone are
insufficient for moderate persistent asthma, and using albuterol daily as prevention increases
bronchial hyperreactivity and mortality risk. Proper spacer technique and rinsing the mouth
after use address adherence concerns while maintaining therapeutic efficacy.
Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CHRONIC CARDIOVASCULAR & RESPIRATORY CONDITIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old man with a five-year history of systolic heart failure presents for a routine clinic
visit. He reports increasing dyspnea when walking to his mailbox and notices his shoes feel
tight by late afternoon. His current medications include lisinopril, metoprolol, furosemide,
and spironolactone. He weighs himself daily, and his log shows a 4-pound gain over the past
three days. Which nursing action is most appropriate at this time?
A. Advise him to double his furosemide dose for the next two days and recheck his weight
B. Contact the provider to report the weight gain and worsening symptoms for possible
medication adjustment ✓ CORRECT
C. Reassure him that mild weight fluctuations are normal and do not require intervention
D. Instruct him to stop the spironolactone until the edema resolves
Correct Answer: B
Rationale: A 4-pound weight gain over three days accompanied by worsening dyspnea and
peripheral edema indicates fluid retention consistent with acute decompensated heart failure,
which requires provider notification for potential diuretic escalation or other intervention.
Doubling the furosemide independently is unsafe because it can precipitate electrolyte
imbalances and renal dysfunction without laboratory monitoring. Early recognition and
communication of these changes are central to preventing hospitalization in chronic heart
failure management.
Question 2 of 50
,A 68-year-old woman with severe COPD (FEV1 38% predicted) uses 2 L/min nasal cannula
oxygen at home and arrives at the pulmonary clinic with her portable oxygen concentrator.
She mentions that she feels more short of breath when she removes the cannula to eat
dinner, and she wonders if a different oxygen delivery device would help during meals. Her
resting SpO2 on 2 L/min is 89%. Which response best addresses her concern?
A. Recommend switching to a nonrebreather mask during meals to deliver higher oxygen
concentrations
B. Suggest a nasal cannula with pendant tubing that allows oxygen flow during meals without
removing the device ✓ CORRECT
C. Advise her to increase the flow rate to 4 L/min only while eating and then return to 2 L/min
D. Tell her that brief periods off oxygen during meals are harmless and do not require any
device changes
Correct Answer: B
Rationale: A nasal cannula with pendant or swivel tubing allows continuous oxygen delivery
during meals, which is important because eating is an activity that increases oxygen demand
in patients with severe COPD. A nonrebreather mask is inappropriate for home use and would
make eating impossible, and patients should not independently titrate their oxygen flow rates
without a prescription. Maintaining SpO2 above 88-90% during all activities of daily living is
the goal in severe COPD to prevent hypoxic organ stress.
Question 3 of 50
A 55-year-old man with essential hypertension has been taking lisinopril 10 mg daily for six
months. At today's visit, his blood pressure is 138/86 mmHg, down from 158/96 mmHg at
diagnosis. He reports occasional dizziness when standing quickly and mentions he has been
eating more bananas and nuts since starting the medication because he heard they are
heart-healthy. His basic metabolic panel is pending. Which nursing priority is most important
before he leaves the clinic?
A. Reinforce that his blood pressure goal is achieved and no further changes are needed
B. Instruct him to increase his lisinopril to 20 mg daily to reach a lower target
C. Review his dietary potassium intake and verify his metabolic panel results before he
departs ✓ CORRECT
D. Advise him to stop the lisinopril and switch to a calcium channel blocker due to dizziness
Correct Answer: C
Rationale: ACE inhibitors such as lisinopril can cause hyperkalemia, and increasing dietary
potassium from bananas and nuts without monitoring serum levels poses a risk for
dangerous cardiac arrhythmias. His dizziness on standing suggests possible orthostatic
hypotension, which also warrants assessment before medication escalation. Verifying the
metabolic panel ensures safe continuation of therapy and allows for timely dietary or
medication adjustments.
, Question 4 of 50
A 79-year-old woman with nonvalvular atrial fibrillation has been taking warfarin 5 mg daily for
two years with stable INRs between 2.0 and 3.0. She recently completed a five-day course of
ciprofloxacin for a urinary tract infection. Today's INR is 4.2, and she has no signs of
bleeding. Her vital signs are stable. Which action should the nurse take first?
A. Instruct her to skip tonight's warfarin dose and resume 5 mg tomorrow
B. Administer oral vitamin K 2.5 mg immediately in the clinic
C. Hold warfarin for two days and recheck the INR next week
D. Notify the provider, hold the next warfarin dose, and arrange INR recheck within 24-48 hours
✓ CORRECT
Correct Answer: D
Rationale: An INR of 4.2 in an asymptomatic patient on warfarin warrants holding the next
dose and arranging close follow-up rather than empiric vitamin K, which can make
subsequent anticoagulation management difficult. Ciprofloxacin inhibits CYP1A2 and can
potentiate warfarin, so the interaction must be communicated to the provider for dose
adjustment guidance. Prompt notification and scheduled recheck prevent both thrombotic
risk from overcorrection and hemorrhagic risk from continued supratherapeutic
anticoagulation.
Question 5 of 50
A 34-year-old woman with moderate persistent asthma presents for her annual pulmonary
review. She uses her albuterol inhaler four to five days per week for chest tightness and
wakes up coughing about twice a month. She stopped taking her daily inhaled corticosteroid
two months ago because she felt fine and did not like the aftertaste. Her peak flow today is
72% of her personal best. Which intervention is most appropriate?
A. Restart the daily inhaled corticosteroid and provide spacer technique education ✓
CORRECT
B. Prescribe a long-acting bronchodilator to use instead of the inhaled corticosteroid
C. Switch her to a leukotriene receptor antagonist as monotherapy for better adherence
D. Recommend increasing albuterol use to daily preventive dosing
Correct Answer: A
Rationale: Daily albuterol use more than twice weekly, nocturnal symptoms, and a peak flow
of 72% indicate poorly controlled asthma that requires daily anti-inflammatory therapy with
an inhaled corticosteroid. Long-acting bronchodilators or leukotriene modifiers alone are
insufficient for moderate persistent asthma, and using albuterol daily as prevention increases
bronchial hyperreactivity and mortality risk. Proper spacer technique and rinsing the mouth
after use address adherence concerns while maintaining therapeutic efficacy.
