NUR612/NUR 612 Exam 4 V3 | Advanced
Nursing II Q&A with Rationale | William
Paterson University
1. A 65-year-old male presents with a history of heart failure and is currently classified under
NYHA Class III. Which of the following symptoms best describes his functional capacity?
A. No limitation of physical activity and ordinary physical activity does not cause undue
fatigue.
B. Marked limitation of physical activity where patients are comfortable at rest but less
than ordinary activity causes fatigue.
C. Slight limitation of physical activity where patients are comfortable at rest but ordinary
activity results in fatigue.
D. Inability to carry on any physical activity without discomfort and symptoms are present
even at rest.
Answer: B
Rationale: The New York Heart Association (NYHA) Class III represents marked limitation
in physical activity. In this class, the patient is comfortable only at rest, but even minimal
activity causes significant symptoms like palpitations or dyspnea. This classification helps
clinicians determine the severity of heart failure and guide therapeutic interventions.
,2. When assessing a patient with suspected aortic stenosis, where is the murmur typically
best heard?
A. Second intercostal space at the right sternal border.
B. Fifth intercostal space at the mid-clavicular line.
C. Second intercostal space at the left sternal border.
D. Fourth intercostal space at the left sternal border.
Answer: A
Rationale: Aortic stenosis is characterized by a systolic crescendo-decrescendo murmur.
This specific murmur is most audible at the right second intercostal space. It often radiates
to the carotid arteries and is a key physical finding in valvular heart disease.
3. A patient with COPD is prescribed a Long-Acting Muscarinic Antagonist (LAMA). What is the
primary mechanism of action for this medication?
A. Activation of beta-2 adrenergic receptors.
B. Reduction of systemic inflammation via corticosteroid pathways.
C. Inhibition of acetylcholine at M3 receptors in the airways.
D. Direct relaxation of bronchial smooth muscle through phosphodiesterase inhibition.
Answer: C
Rationale: LAMAs work by blocking the action of acetylcholine on muscarinic receptors in
the lungs. This inhibition prevents bronchoconstriction and helps maintain open airways
, over a long duration. They are considered a cornerstone in the maintenance treatment of
stable COPD.
4. According to the GINA guidelines, what is the preferred first-step treatment for a patient
with mild intermittent asthma?
A. Low-dose ICS-formoterol as needed.
B. SABA as needed only.
C. Daily low-dose ICS with SABA as needed.
D. Medium-dose ICS as maintenance therapy.
Answer: A
Rationale: Recent asthma guidelines have shifted away from SABA-only treatment due to
safety concerns. The preferred approach is now as-needed low-dose ICS-formoterol to
address underlying inflammation immediately during symptoms. This strategy significantly
reduces the risk of severe exacerbations compared to using a bronchodilator alone.
5. Barrett’s esophagus is a serious complication of chronic GERD. Which histological change
defines this condition?
A. Squamous cell hyperplasia.
B. Metaplasia from squamous to columnar epithelium.
C. Atrophy of the mucosal lining.
D. Formation of peptic ulcers in the distal esophagus.
Nursing II Q&A with Rationale | William
Paterson University
1. A 65-year-old male presents with a history of heart failure and is currently classified under
NYHA Class III. Which of the following symptoms best describes his functional capacity?
A. No limitation of physical activity and ordinary physical activity does not cause undue
fatigue.
B. Marked limitation of physical activity where patients are comfortable at rest but less
than ordinary activity causes fatigue.
C. Slight limitation of physical activity where patients are comfortable at rest but ordinary
activity results in fatigue.
D. Inability to carry on any physical activity without discomfort and symptoms are present
even at rest.
Answer: B
Rationale: The New York Heart Association (NYHA) Class III represents marked limitation
in physical activity. In this class, the patient is comfortable only at rest, but even minimal
activity causes significant symptoms like palpitations or dyspnea. This classification helps
clinicians determine the severity of heart failure and guide therapeutic interventions.
,2. When assessing a patient with suspected aortic stenosis, where is the murmur typically
best heard?
A. Second intercostal space at the right sternal border.
B. Fifth intercostal space at the mid-clavicular line.
C. Second intercostal space at the left sternal border.
D. Fourth intercostal space at the left sternal border.
Answer: A
Rationale: Aortic stenosis is characterized by a systolic crescendo-decrescendo murmur.
This specific murmur is most audible at the right second intercostal space. It often radiates
to the carotid arteries and is a key physical finding in valvular heart disease.
3. A patient with COPD is prescribed a Long-Acting Muscarinic Antagonist (LAMA). What is the
primary mechanism of action for this medication?
A. Activation of beta-2 adrenergic receptors.
B. Reduction of systemic inflammation via corticosteroid pathways.
C. Inhibition of acetylcholine at M3 receptors in the airways.
D. Direct relaxation of bronchial smooth muscle through phosphodiesterase inhibition.
Answer: C
Rationale: LAMAs work by blocking the action of acetylcholine on muscarinic receptors in
the lungs. This inhibition prevents bronchoconstriction and helps maintain open airways
, over a long duration. They are considered a cornerstone in the maintenance treatment of
stable COPD.
4. According to the GINA guidelines, what is the preferred first-step treatment for a patient
with mild intermittent asthma?
A. Low-dose ICS-formoterol as needed.
B. SABA as needed only.
C. Daily low-dose ICS with SABA as needed.
D. Medium-dose ICS as maintenance therapy.
Answer: A
Rationale: Recent asthma guidelines have shifted away from SABA-only treatment due to
safety concerns. The preferred approach is now as-needed low-dose ICS-formoterol to
address underlying inflammation immediately during symptoms. This strategy significantly
reduces the risk of severe exacerbations compared to using a bronchodilator alone.
5. Barrett’s esophagus is a serious complication of chronic GERD. Which histological change
defines this condition?
A. Squamous cell hyperplasia.
B. Metaplasia from squamous to columnar epithelium.
C. Atrophy of the mucosal lining.
D. Formation of peptic ulcers in the distal esophagus.
