NUR 6111 Exam 2 V2 | NUR 6111
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 2) | William
Paterson University
1. A 55-year-old African American male presents with a blood pressure of 152/94 mmHg.
According to JNC 8 guidelines, which of the following is the most appropriate initial
pharmacological treatment?
A. Lisinopril
B. Losartan
C. Metoprolol
D. Amlodipine
Answer: D
Rationale: For African American patients without chronic kidney disease, initial
antihypertensive therapy should include a thiazide-type diuretic or a calcium channel
blocker. Amlodipine is a calcium channel blocker that is effective in this population group.
Starting with an ACE inhibitor or ARB is less effective for blood pressure reduction in this
specific demographic unless comorbid conditions like CKD or DM are present.
2. When evaluating a patient with suspected asthma, which of the following spirometry
results most strongly supports the diagnosis?
A. FEV1/FVC ratio greater than 0.85
,B. An increase in FEV1 of more than 12 percent after bronchodilator inhalation
C. A decrease in FEV1/FVC ratio after exercise
D. Normal peak flow readings throughout the day
Answer: B
Rationale: Reversibility is a hallmark of asthma and is defined as an increase in FEV1 of
12% or more following the administration of a short-acting beta-agonist. This test helps
differentiate asthma from COPD, where airflow obstruction is typically not fully reversible.
Providing objective evidence of airway hyper-responsiveness or reversibility is essential
for a definitive diagnosis in primary care settings.
3. A 68-year-old patient presents with chronic cough, increased sputum production, and a
history of smoking. Spirometry reveals an FEV1/FVC ratio of 0.62. What is the GOLD
classification for this patient’s airflow limitation?
A. Restrictive lung disease
B. Reversible airway disease
C. Acute bronchitis
D. Chronic Obstructive Pulmonary Disease
Answer: D
Rationale: According to the GOLD criteria, a post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of persistent airflow limitation. This value is the standard
,threshold used to diagnose COPD in the clinical setting. Further assessment of symptoms
and exacerbation history is required to determine the specific GOLD group (A-D) for
treatment.
4. Which of the following physical examination findings is most characteristic of Mitral
Regurgitation?
A. Mid-systolic click followed by a late systolic murmur
B. Holosystolic murmur heard best at the apex radiating to the axilla
C. Crescendo-decrescendo systolic murmur at the right upper sternal border
D. Low-pitched rumbling diastolic murmur at the apex
Answer: B
Rationale: Mitral regurgitation typically presents as a high-pitched holosystolic murmur
that is best heard at the apex. This murmur often radiates to the left axilla and is loudest
when the patient is in the left lateral decubitus position. It is caused by the retrograde flow
of blood from the left ventricle into the left atrium during systole.
5. A patient with Type 2 Diabetes has an A1C of 8.2 percent despite lifestyle modifications.
Which medication is considered the first-line pharmacological choice?
A. Metformin
B. Sitagliptin
C. Glipizide
, D. Pioglitazone
Answer: A
Rationale: Metformin remains the preferred initial pharmacological agent for the
treatment of type 2 diabetes due to its efficacy, safety, and low cost. It primarily works by
reducing hepatic glucose production and improving insulin sensitivity. Unless there are
specific contraindications such as severe renal impairment, it should be the first choice for
all newly diagnosed patients.
6. In the management of community-acquired pneumonia, which tool is used to determine if
a patient requires hospitalization?
A. CHADS2 score
B. Framingham Risk Score
C. PHQ-9 questionnaire
D. CURB-65 scale
Answer: D
Rationale: The CURB-65 scale assesses Confusion, Urea, Respiratory rate, Blood pressure,
and Age over 65 to determine pneumonia severity. A score of 0-1 usually suggests
outpatient treatment, while a score of 2 or more indicates the need for hospitalization or
close observation. This evidence-based tool helps primary care providers make safe and
efficient triage decisions.
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 2) | William
Paterson University
1. A 55-year-old African American male presents with a blood pressure of 152/94 mmHg.
According to JNC 8 guidelines, which of the following is the most appropriate initial
pharmacological treatment?
A. Lisinopril
B. Losartan
C. Metoprolol
D. Amlodipine
Answer: D
Rationale: For African American patients without chronic kidney disease, initial
antihypertensive therapy should include a thiazide-type diuretic or a calcium channel
blocker. Amlodipine is a calcium channel blocker that is effective in this population group.
Starting with an ACE inhibitor or ARB is less effective for blood pressure reduction in this
specific demographic unless comorbid conditions like CKD or DM are present.
2. When evaluating a patient with suspected asthma, which of the following spirometry
results most strongly supports the diagnosis?
A. FEV1/FVC ratio greater than 0.85
,B. An increase in FEV1 of more than 12 percent after bronchodilator inhalation
C. A decrease in FEV1/FVC ratio after exercise
D. Normal peak flow readings throughout the day
Answer: B
Rationale: Reversibility is a hallmark of asthma and is defined as an increase in FEV1 of
12% or more following the administration of a short-acting beta-agonist. This test helps
differentiate asthma from COPD, where airflow obstruction is typically not fully reversible.
Providing objective evidence of airway hyper-responsiveness or reversibility is essential
for a definitive diagnosis in primary care settings.
3. A 68-year-old patient presents with chronic cough, increased sputum production, and a
history of smoking. Spirometry reveals an FEV1/FVC ratio of 0.62. What is the GOLD
classification for this patient’s airflow limitation?
A. Restrictive lung disease
B. Reversible airway disease
C. Acute bronchitis
D. Chronic Obstructive Pulmonary Disease
Answer: D
Rationale: According to the GOLD criteria, a post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of persistent airflow limitation. This value is the standard
,threshold used to diagnose COPD in the clinical setting. Further assessment of symptoms
and exacerbation history is required to determine the specific GOLD group (A-D) for
treatment.
4. Which of the following physical examination findings is most characteristic of Mitral
Regurgitation?
A. Mid-systolic click followed by a late systolic murmur
B. Holosystolic murmur heard best at the apex radiating to the axilla
C. Crescendo-decrescendo systolic murmur at the right upper sternal border
D. Low-pitched rumbling diastolic murmur at the apex
Answer: B
Rationale: Mitral regurgitation typically presents as a high-pitched holosystolic murmur
that is best heard at the apex. This murmur often radiates to the left axilla and is loudest
when the patient is in the left lateral decubitus position. It is caused by the retrograde flow
of blood from the left ventricle into the left atrium during systole.
5. A patient with Type 2 Diabetes has an A1C of 8.2 percent despite lifestyle modifications.
Which medication is considered the first-line pharmacological choice?
A. Metformin
B. Sitagliptin
C. Glipizide
, D. Pioglitazone
Answer: A
Rationale: Metformin remains the preferred initial pharmacological agent for the
treatment of type 2 diabetes due to its efficacy, safety, and low cost. It primarily works by
reducing hepatic glucose production and improving insulin sensitivity. Unless there are
specific contraindications such as severe renal impairment, it should be the first choice for
all newly diagnosed patients.
6. In the management of community-acquired pneumonia, which tool is used to determine if
a patient requires hospitalization?
A. CHADS2 score
B. Framingham Risk Score
C. PHQ-9 questionnaire
D. CURB-65 scale
Answer: D
Rationale: The CURB-65 scale assesses Confusion, Urea, Respiratory rate, Blood pressure,
and Age over 65 to determine pneumonia severity. A score of 0-1 usually suggests
outpatient treatment, while a score of 2 or more indicates the need for hospitalization or
close observation. This evidence-based tool helps primary care providers make safe and
efficient triage decisions.
