NUR 6111 Exam 2 V1 | NUR 6111
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 2) | William
Paterson University
1. A 55-year-old male presents with a persistent blood pressure of 155/95 mmHg over three
office visits. He has no significant past medical history. What is the most appropriate initial
pharmacological intervention?
A. Monitor for another 6 months with lifestyle changes
B. Initiate high-intensity statin therapy
C. Prescribe a loop diuretic
D. Start an ACE inhibitor or ARB
Answer: D
Rationale: According to the JNC-8 guidelines, pharmacological treatment should be
initiated for patients under 60 with a systolic BP of 140 or higher. ACE inhibitors are
recommended as first-line therapy for non-Black patients to prevent target organ damage.
This management strategy aims to reduce the long-term risk of stroke and myocardial
infarction.
2. A patient complains of chronic heartburn and regurgitation, especially after large meals.
Despite lifestyle modifications, symptoms persist. What is the next step in management?
A. Immediate referral for endoscopy
,B. Initiate H2-receptor antagonist therapy
C. Start a daily Proton Pump Inhibitor (PPI)
D. Perform a 24-hour pH monitoring study
Answer: C
Rationale: For patients with classic symptoms of GERD that do not respond to lifestyle
changes, a trial of a daily PPI is the standard of care. PPIs are more effective than H2
blockers at healing esophagitis and providing symptom relief. The medication should
typically be taken 30-60 minutes before the first meal of the day for maximum efficacy.
3. A 68-year-old female smoker presents with progressive dyspnea and a productive cough.
Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65. What is the most likely
diagnosis?
A. Congestive Heart Failure
B. Chronic Obstructive Pulmonary Disease (COPD)
C. Interstital Lung Disease
D. Adult-onset Asthma
Answer: B
Rationale: The GOLD criteria define COPD by a post-bronchodilator FEV1/FVC ratio of less
than 0.70. This finding indicates fixed airflow obstruction which is a hallmark of the
, disease. In a patient with a significant smoking history and classic symptoms, this
spirometry result is diagnostic for COPD.
4. A 42-year-old patient with Type 2 Diabetes has an A1c of 8.5% despite being on Metformin
1000mg twice daily. What is the most appropriate next step in management?
A. Switch Metformin to an SGLT2 inhibitor
B. Increase Metformin to 3000mg daily
C. Discontinue all oral meds and start insulin
D. Add a second agent such as a GLP-1 agonist or SGLT2 inhibitor
Answer: D
Rationale: When the glycemic goal is not achieved with Metformin monotherapy, adding a
second agent is indicated per ADA guidelines. GLP-1 agonists and SGLT2 inhibitors provide
cardiovascular and renal benefits for patients with diabetes. This dual therapy approach
addresses multiple pathophysiological pathways of the disease.
5. A young adult presents with intermittent wheezing and chest tightness twice a week. They
wake up at night with symptoms twice a month. Which category of asthma severity does this
represent?
A. Mild Intermittent
B. Mild Persistent
C. Moderate Persistent
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 2) | William
Paterson University
1. A 55-year-old male presents with a persistent blood pressure of 155/95 mmHg over three
office visits. He has no significant past medical history. What is the most appropriate initial
pharmacological intervention?
A. Monitor for another 6 months with lifestyle changes
B. Initiate high-intensity statin therapy
C. Prescribe a loop diuretic
D. Start an ACE inhibitor or ARB
Answer: D
Rationale: According to the JNC-8 guidelines, pharmacological treatment should be
initiated for patients under 60 with a systolic BP of 140 or higher. ACE inhibitors are
recommended as first-line therapy for non-Black patients to prevent target organ damage.
This management strategy aims to reduce the long-term risk of stroke and myocardial
infarction.
2. A patient complains of chronic heartburn and regurgitation, especially after large meals.
Despite lifestyle modifications, symptoms persist. What is the next step in management?
A. Immediate referral for endoscopy
,B. Initiate H2-receptor antagonist therapy
C. Start a daily Proton Pump Inhibitor (PPI)
D. Perform a 24-hour pH monitoring study
Answer: C
Rationale: For patients with classic symptoms of GERD that do not respond to lifestyle
changes, a trial of a daily PPI is the standard of care. PPIs are more effective than H2
blockers at healing esophagitis and providing symptom relief. The medication should
typically be taken 30-60 minutes before the first meal of the day for maximum efficacy.
3. A 68-year-old female smoker presents with progressive dyspnea and a productive cough.
Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65. What is the most likely
diagnosis?
A. Congestive Heart Failure
B. Chronic Obstructive Pulmonary Disease (COPD)
C. Interstital Lung Disease
D. Adult-onset Asthma
Answer: B
Rationale: The GOLD criteria define COPD by a post-bronchodilator FEV1/FVC ratio of less
than 0.70. This finding indicates fixed airflow obstruction which is a hallmark of the
, disease. In a patient with a significant smoking history and classic symptoms, this
spirometry result is diagnostic for COPD.
4. A 42-year-old patient with Type 2 Diabetes has an A1c of 8.5% despite being on Metformin
1000mg twice daily. What is the most appropriate next step in management?
A. Switch Metformin to an SGLT2 inhibitor
B. Increase Metformin to 3000mg daily
C. Discontinue all oral meds and start insulin
D. Add a second agent such as a GLP-1 agonist or SGLT2 inhibitor
Answer: D
Rationale: When the glycemic goal is not achieved with Metformin monotherapy, adding a
second agent is indicated per ADA guidelines. GLP-1 agonists and SGLT2 inhibitors provide
cardiovascular and renal benefits for patients with diabetes. This dual therapy approach
addresses multiple pathophysiological pathways of the disease.
5. A young adult presents with intermittent wheezing and chest tightness twice a week. They
wake up at night with symptoms twice a month. Which category of asthma severity does this
represent?
A. Mild Intermittent
B. Mild Persistent
C. Moderate Persistent
