NUR612/NUR 612 Final Exam V1 |
Advanced Nursing II Q&A with Rationale |
William Paterson University
1. A 58-year-old male with a history of diabetes and hypertension presents for a routine
check-up. According to the ACC/AHA guidelines, what is the recommended blood pressure
target for this patient?
A. < 140/90 mmHg
B. < 120/70 mmHg
C. < 130/80 mmHg
D. < 150/90 mmHg
Answer: C
Rationale: Current clinical guidelines from the ACC/AHA recommend a blood pressure
goal of less than 130/80 mmHg for patients with diabetes and hypertension. This target is
designed to reduce the risk of major cardiovascular events and microvascular
complications. Controlling blood pressure in diabetic patients is critical because they are at
a significantly higher risk for stroke and renal failure.
2. Which of the following laboratory findings is most characteristic of iron deficiency anemia
in an adult patient?
A. High Ferritin and Low TIBC
,B. Normal MCV and High Ferritin
C. Low Ferritin and High TIBC
D. High MCV and Low Ferritin
Answer: C
Rationale: In iron deficiency anemia, ferritin levels are low because iron stores are
depleted, while the Total Iron Binding Capacity (TIBC) increases as the body attempts to
compensate for low iron. The Mean Corpuscular Volume (MCV) is also typically low,
indicating microcytic cells. This combination of lab values is essential for distinguishing
iron deficiency from other types of anemia like anemia of chronic disease.
3. A patient with COPD is categorized as GOLD Group B. Which of the following is the
recommended first-line maintenance therapy for this patient?
A. Long-acting bronchodilator (LAMA or LABA)
B. Inhaled corticosteroid (ICS) monotherapy
C. Short-acting beta-agonist (SABA) as needed
D. Theophylline
Answer: A
Rationale: For patients in GOLD Group B, maintenance therapy with a long-acting
bronchodilator (either LAMA or LABA) is recommended to manage symptoms. Short-acting
bronchodilators are used only for rescue and are not sufficient as primary maintenance for
,this group. Providing consistent long-acting therapy helps improve lung function and
reduce the frequency of exacerbations.
4. What is the mechanism of action for Metformin in the management of Type 2 Diabetes?
A. Decreases hepatic glucose production and improves insulin sensitivity
B. Increases insulin secretion from pancreatic beta cells
C. Delays glucose absorption in the gastrointestinal tract
D. Increases glucose excretion through the kidneys
Answer: A
Rationale: Metformin primarily works by decreasing gluconeogenesis in the liver and
improving the sensitivity of peripheral tissues to insulin. Unlike sulfonylureas, it does not
stimulate insulin secretion and therefore has a lower risk of causing hypoglycemia. It is
generally considered the first-line oral medication for most patients with Type 2 Diabetes
due to its efficacy and safety profile.
5. A 65-year-old female presents with a T-score of -2.8 on her DEXA scan. Which of the
following is the most appropriate diagnosis?
A. Osteopenia
B. Normal bone density
C. Osteoporosis
D. Paget’s disease
, Answer: C
Rationale: A T-score of -2.5 or lower is the diagnostic threshold for osteoporosis according
to the World Health Organization. Patients in this category have a significantly increased
risk of fragility fractures, particularly in the hip and spine. Management typically includes
lifestyle modifications, calcium and vitamin D supplementation, and pharmacological
treatment such as bisphosphonates.
6. Which physical examination finding is most suggestive of an acute flare of Rheumatoid
Arthritis?
A. Asymmetrical joint involvement with Heberden’s nodes
B. Joint pain that improves with rest and worsens with activity
C. Symmetrical joint swelling and morning stiffness lasting > 1 hour
D. Crepitus in the knee joint without systemic symptoms
Answer: C
Rationale: Rheumatoid Arthritis typically presents as a symmetrical inflammatory
polyarthritis that affects the small joints of the hands and feet. Morning stiffness lasting
more than one hour is a hallmark sign that distinguishes it from non-inflammatory
conditions like osteoarthritis. Early identification and referral to a rheumatologist are
crucial for starting disease-modifying antirheumatic drugs (DMARDs) to prevent joint
destruction.
Advanced Nursing II Q&A with Rationale |
William Paterson University
1. A 58-year-old male with a history of diabetes and hypertension presents for a routine
check-up. According to the ACC/AHA guidelines, what is the recommended blood pressure
target for this patient?
A. < 140/90 mmHg
B. < 120/70 mmHg
C. < 130/80 mmHg
D. < 150/90 mmHg
Answer: C
Rationale: Current clinical guidelines from the ACC/AHA recommend a blood pressure
goal of less than 130/80 mmHg for patients with diabetes and hypertension. This target is
designed to reduce the risk of major cardiovascular events and microvascular
complications. Controlling blood pressure in diabetic patients is critical because they are at
a significantly higher risk for stroke and renal failure.
2. Which of the following laboratory findings is most characteristic of iron deficiency anemia
in an adult patient?
A. High Ferritin and Low TIBC
,B. Normal MCV and High Ferritin
C. Low Ferritin and High TIBC
D. High MCV and Low Ferritin
Answer: C
Rationale: In iron deficiency anemia, ferritin levels are low because iron stores are
depleted, while the Total Iron Binding Capacity (TIBC) increases as the body attempts to
compensate for low iron. The Mean Corpuscular Volume (MCV) is also typically low,
indicating microcytic cells. This combination of lab values is essential for distinguishing
iron deficiency from other types of anemia like anemia of chronic disease.
3. A patient with COPD is categorized as GOLD Group B. Which of the following is the
recommended first-line maintenance therapy for this patient?
A. Long-acting bronchodilator (LAMA or LABA)
B. Inhaled corticosteroid (ICS) monotherapy
C. Short-acting beta-agonist (SABA) as needed
D. Theophylline
Answer: A
Rationale: For patients in GOLD Group B, maintenance therapy with a long-acting
bronchodilator (either LAMA or LABA) is recommended to manage symptoms. Short-acting
bronchodilators are used only for rescue and are not sufficient as primary maintenance for
,this group. Providing consistent long-acting therapy helps improve lung function and
reduce the frequency of exacerbations.
4. What is the mechanism of action for Metformin in the management of Type 2 Diabetes?
A. Decreases hepatic glucose production and improves insulin sensitivity
B. Increases insulin secretion from pancreatic beta cells
C. Delays glucose absorption in the gastrointestinal tract
D. Increases glucose excretion through the kidneys
Answer: A
Rationale: Metformin primarily works by decreasing gluconeogenesis in the liver and
improving the sensitivity of peripheral tissues to insulin. Unlike sulfonylureas, it does not
stimulate insulin secretion and therefore has a lower risk of causing hypoglycemia. It is
generally considered the first-line oral medication for most patients with Type 2 Diabetes
due to its efficacy and safety profile.
5. A 65-year-old female presents with a T-score of -2.8 on her DEXA scan. Which of the
following is the most appropriate diagnosis?
A. Osteopenia
B. Normal bone density
C. Osteoporosis
D. Paget’s disease
, Answer: C
Rationale: A T-score of -2.5 or lower is the diagnostic threshold for osteoporosis according
to the World Health Organization. Patients in this category have a significantly increased
risk of fragility fractures, particularly in the hip and spine. Management typically includes
lifestyle modifications, calcium and vitamin D supplementation, and pharmacological
treatment such as bisphosphonates.
6. Which physical examination finding is most suggestive of an acute flare of Rheumatoid
Arthritis?
A. Asymmetrical joint involvement with Heberden’s nodes
B. Joint pain that improves with rest and worsens with activity
C. Symmetrical joint swelling and morning stiffness lasting > 1 hour
D. Crepitus in the knee joint without systemic symptoms
Answer: C
Rationale: Rheumatoid Arthritis typically presents as a symmetrical inflammatory
polyarthritis that affects the small joints of the hands and feet. Morning stiffness lasting
more than one hour is a hallmark sign that distinguishes it from non-inflammatory
conditions like osteoarthritis. Early identification and referral to a rheumatologist are
crucial for starting disease-modifying antirheumatic drugs (DMARDs) to prevent joint
destruction.
