NUR612/NUR 612 Final Exam V3 |
Advanced Nursing II Q&A with Rationale |
William Paterson University
1. Which lab value is most specific for diagnosing an acute myocardial infarction in the
advanced practice setting?
A. Creatine Kinase (CK-MB)
B. Troponin I
C. Myoglobin
D. B-type Natriuretic Peptide (BNP)
Answer: B
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated for several
days following an injury. While CK-MB was once the standard, it is less specific than
troponin because it can be found in skeletal muscle as well. Myoglobin rises quickly but
lacks specificity, and BNP is primarily used to assess heart failure rather than acute
ischemia.
2. A patient with COPD is being managed with a long-acting beta-agonist (LABA). What is the
primary mechanism of this drug class?
A. Reducing airway inflammation through steroid action
B. Blocking muscarinic receptors to prevent bronchoconstriction
,C. Inhibiting phosphodiesterase to increase cAMP
D. Stimulating beta-2 receptors to cause smooth muscle relaxation
Answer: D
Rationale: LABAs act directly on the beta-2 adrenergic receptors located in the lungs to
promote bronchodilation. This mechanism leads to the relaxation of the bronchial smooth
muscles, which improves airflow in patients with chronic obstructive pulmonary disease.
They are designed for long-term maintenance and should not be used as a rescue inhaler
for acute symptoms.
3. What is the gold standard diagnostic test for confirming the presence of H. pylori in a
patient with peptic ulcer disease?
A. Urea Breath Test
B. Serum Antibody Testing
C. Stool Antigen Test
D. Endoscopy with biopsy
Answer: D
Rationale: Endoscopy with a gastric mucosal biopsy remains the definitive gold standard
for diagnosing H. pylori because it allows for direct visualization and histological
examination. While the urea breath test and stool antigen tests are highly accurate non-
invasive methods, they are often used for screening or confirming eradication. Serum
,antibody testing is generally discouraged because it cannot distinguish between active and
past infections.
4. Which of the following physical exam findings is most indicative of a tension
pneumothorax?
A. Tracheal deviation to the contralateral side
B. Increased breath sounds on the affected side
C. Dullness to percussion on the affected side
D. Bradycardia and hypertension
Answer: A
Rationale: Tracheal deviation occurs because the buildup of air in the pleural space
creates high pressure that pushes the mediastinum away from the affected lung. This is a
late and critical sign indicating a life-threatening emergency that requires immediate
needle decompression. Other signs include hyper-resonance to percussion and absent
breath sounds on the side of the collapse.
5. In the management of Type 2 Diabetes, Metformin is frequently the first-line therapy.
What is its primary site of action?
A. Pancreatic beta cells
B. Liver
C. Kidneys
, D. Small intestine
Answer: B
Rationale: Metformin primarily works by decreasing hepatic glucose production and
improving insulin sensitivity in peripheral tissues. It does not stimulate insulin secretion
from the pancreas, which significantly reduces the risk of hypoglycemia compared to
sulfonylureas. It is also known to slightly delay intestinal glucose absorption, contributing
to its overall efficacy.
6. Which of the following is a classic EKG finding associated with Hyperkalemia?
A. Prominent U waves
B. Peaked T waves
C. Prolonged QT interval
D. ST-segment depression
Answer: B
Rationale: Peaked or ‘tented’ T waves are the earliest electrocardiographic manifestation
of hyperkalemia. As potassium levels continue to rise, the PR interval may lengthen and the
QRS complex will eventually widen. If left untreated, this can progress to a sine-wave
pattern and ultimately ventricular fibrillation or asystole.
7. A 55-year-old female presents with symptoms of hypothyroidism. Which laboratory
pattern confirms a primary diagnosis?
A. Low TSH, Low Free T4
Advanced Nursing II Q&A with Rationale |
William Paterson University
1. Which lab value is most specific for diagnosing an acute myocardial infarction in the
advanced practice setting?
A. Creatine Kinase (CK-MB)
B. Troponin I
C. Myoglobin
D. B-type Natriuretic Peptide (BNP)
Answer: B
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated for several
days following an injury. While CK-MB was once the standard, it is less specific than
troponin because it can be found in skeletal muscle as well. Myoglobin rises quickly but
lacks specificity, and BNP is primarily used to assess heart failure rather than acute
ischemia.
2. A patient with COPD is being managed with a long-acting beta-agonist (LABA). What is the
primary mechanism of this drug class?
A. Reducing airway inflammation through steroid action
B. Blocking muscarinic receptors to prevent bronchoconstriction
,C. Inhibiting phosphodiesterase to increase cAMP
D. Stimulating beta-2 receptors to cause smooth muscle relaxation
Answer: D
Rationale: LABAs act directly on the beta-2 adrenergic receptors located in the lungs to
promote bronchodilation. This mechanism leads to the relaxation of the bronchial smooth
muscles, which improves airflow in patients with chronic obstructive pulmonary disease.
They are designed for long-term maintenance and should not be used as a rescue inhaler
for acute symptoms.
3. What is the gold standard diagnostic test for confirming the presence of H. pylori in a
patient with peptic ulcer disease?
A. Urea Breath Test
B. Serum Antibody Testing
C. Stool Antigen Test
D. Endoscopy with biopsy
Answer: D
Rationale: Endoscopy with a gastric mucosal biopsy remains the definitive gold standard
for diagnosing H. pylori because it allows for direct visualization and histological
examination. While the urea breath test and stool antigen tests are highly accurate non-
invasive methods, they are often used for screening or confirming eradication. Serum
,antibody testing is generally discouraged because it cannot distinguish between active and
past infections.
4. Which of the following physical exam findings is most indicative of a tension
pneumothorax?
A. Tracheal deviation to the contralateral side
B. Increased breath sounds on the affected side
C. Dullness to percussion on the affected side
D. Bradycardia and hypertension
Answer: A
Rationale: Tracheal deviation occurs because the buildup of air in the pleural space
creates high pressure that pushes the mediastinum away from the affected lung. This is a
late and critical sign indicating a life-threatening emergency that requires immediate
needle decompression. Other signs include hyper-resonance to percussion and absent
breath sounds on the side of the collapse.
5. In the management of Type 2 Diabetes, Metformin is frequently the first-line therapy.
What is its primary site of action?
A. Pancreatic beta cells
B. Liver
C. Kidneys
, D. Small intestine
Answer: B
Rationale: Metformin primarily works by decreasing hepatic glucose production and
improving insulin sensitivity in peripheral tissues. It does not stimulate insulin secretion
from the pancreas, which significantly reduces the risk of hypoglycemia compared to
sulfonylureas. It is also known to slightly delay intestinal glucose absorption, contributing
to its overall efficacy.
6. Which of the following is a classic EKG finding associated with Hyperkalemia?
A. Prominent U waves
B. Peaked T waves
C. Prolonged QT interval
D. ST-segment depression
Answer: B
Rationale: Peaked or ‘tented’ T waves are the earliest electrocardiographic manifestation
of hyperkalemia. As potassium levels continue to rise, the PR interval may lengthen and the
QRS complex will eventually widen. If left untreated, this can progress to a sine-wave
pattern and ultimately ventricular fibrillation or asystole.
7. A 55-year-old female presents with symptoms of hypothyroidism. Which laboratory
pattern confirms a primary diagnosis?
A. Low TSH, Low Free T4
