NUR 6121 Exam 3 V2 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 3) | William Paterson
University
1. A 65-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril 20mg and Metoprolol Succinate
50mg daily. His blood pressure is 138/84 mmHg and his heart rate is 72 bpm. Which of the
following is the most appropriate next step in his pharmacological management according to
current guidelines?
A. Increase the dose of Metoprolol Succinate.
B. Decrease the dose of Lisinopril to prevent hypotension.
C. Add Amlodipine for better blood pressure control.
D. Switch Lisinopril to Sacubitril/Valsartan (Entresto).
Answer: D
Rationale: Current clinical guidelines for the management of HFrEF recommend switching
from an ACE inhibitor or ARB to an Angiotensin Receptor-Neprilysin Inhibitor (ARNI) like
Sacubitril/Valsartan. This transition has been shown to further reduce morbidity and
mortality in patients who remain symptomatic despite standard therapy. A 36-hour
washout period is required when switching from an ACE inhibitor to an ARNI to prevent
angioedema.
,2. When evaluating a 12-lead ECG, the nurse practitioner notes a PR interval of 0.24 seconds
and a QRS complex of 0.08 seconds. All P waves are followed by a QRS complex, and the
rhythm is regular. How should this rhythm be documented?
A. Normal Sinus Rhythm
B. Second-degree AV block Mobitz Type I
C. Third-degree AV block
D. First-degree Atrioventricular (AV) block
Answer: D
Rationale: First-degree AV block is characterized by a prolonged PR interval greater than
0.20 seconds with a 1:1 ratio of P waves to QRS complexes. In this case, the PR interval is
0.24 seconds, which meets the diagnostic criteria for this conduction delay. This condition
is often asymptomatic and usually does not require treatment unless caused by medication
toxicity.
3. A patient presents to the urgent care clinic with complaints of sudden onset sharp chest
pain that improves when leaning forward and worsens when lying flat. On auscultation, a
high-pitched scratching sound is heard. What is the most likely diagnosis?
A. Acute Pericarditis
B. Pulmonary Embolism
C. Myocardial Infarction
D. Aortic Dissection
,Answer: A
Rationale: The clinical presentation of chest pain that is positional and pleuritic is classic
for acute pericarditis. A pericardial friction rub is the pathognomonic physical exam
finding, described as a scratching or grating sound. Diagnosis is often supported by diffuse
ST-segment elevation on a 12-lead ECG.
4. A 72-year-old female with chronic obstructive pulmonary disease (COPD) presents with
increased sputum purulence and worsening dyspnea. Her oxygen saturation is 89% on room
air. Which intervention is considered a priority for managing this acute exacerbation?
A. Administration of systemic corticosteroids.
B. Initiation of high-flow oxygen to reach 100% saturation.
C. Ordering a CT scan of the chest.
D. Performing a bronchoscopy for sputum collection.
Answer: A
Rationale: Systemic corticosteroids are a cornerstone in the management of COPD
exacerbations as they improve lung function and shorten recovery time. While oxygen
therapy is necessary, the goal for COPD patients is typically 88-92% to avoid suppressing
the hypoxic respiratory drive. Antibiotics are also indicated if sputum purulence is present
along with increased dyspnea.
, 5. Which of the following physical examination findings is most indicative of chronic venous
insufficiency rather than peripheral arterial disease?
A. Diminished or absent pedal pulses.
B. Hyperpigmentation of the skin around the ankles.
C. Painless, punched-out ulcers on the toes.
D. Pallor of the limb when elevated.
Answer: B
Rationale: Hyperpigmentation, often described as brawny edema or hemosiderin staining,
occurs in chronic venous insufficiency due to the breakdown of red blood cells in the tissue.
In contrast, peripheral arterial disease typically presents with cool skin, weak pulses, and
dependent rubor. Venous ulcers are usually located near the medial malleolus and are
irregularly shaped.
6. In the management of a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to prevent ventilator-induced lung injury?
A. High tidal volume ventilation.
B. Low tidal volume ventilation (6 mL/kg of predicted body weight).
C. Maintaining a low PEEP (Positive End-Expiratory Pressure).
D. Hyperventilation to keep pCO2 below 35 mmHg.
Answer: B
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 3) | William Paterson
University
1. A 65-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril 20mg and Metoprolol Succinate
50mg daily. His blood pressure is 138/84 mmHg and his heart rate is 72 bpm. Which of the
following is the most appropriate next step in his pharmacological management according to
current guidelines?
A. Increase the dose of Metoprolol Succinate.
B. Decrease the dose of Lisinopril to prevent hypotension.
C. Add Amlodipine for better blood pressure control.
D. Switch Lisinopril to Sacubitril/Valsartan (Entresto).
Answer: D
Rationale: Current clinical guidelines for the management of HFrEF recommend switching
from an ACE inhibitor or ARB to an Angiotensin Receptor-Neprilysin Inhibitor (ARNI) like
Sacubitril/Valsartan. This transition has been shown to further reduce morbidity and
mortality in patients who remain symptomatic despite standard therapy. A 36-hour
washout period is required when switching from an ACE inhibitor to an ARNI to prevent
angioedema.
,2. When evaluating a 12-lead ECG, the nurse practitioner notes a PR interval of 0.24 seconds
and a QRS complex of 0.08 seconds. All P waves are followed by a QRS complex, and the
rhythm is regular. How should this rhythm be documented?
A. Normal Sinus Rhythm
B. Second-degree AV block Mobitz Type I
C. Third-degree AV block
D. First-degree Atrioventricular (AV) block
Answer: D
Rationale: First-degree AV block is characterized by a prolonged PR interval greater than
0.20 seconds with a 1:1 ratio of P waves to QRS complexes. In this case, the PR interval is
0.24 seconds, which meets the diagnostic criteria for this conduction delay. This condition
is often asymptomatic and usually does not require treatment unless caused by medication
toxicity.
3. A patient presents to the urgent care clinic with complaints of sudden onset sharp chest
pain that improves when leaning forward and worsens when lying flat. On auscultation, a
high-pitched scratching sound is heard. What is the most likely diagnosis?
A. Acute Pericarditis
B. Pulmonary Embolism
C. Myocardial Infarction
D. Aortic Dissection
,Answer: A
Rationale: The clinical presentation of chest pain that is positional and pleuritic is classic
for acute pericarditis. A pericardial friction rub is the pathognomonic physical exam
finding, described as a scratching or grating sound. Diagnosis is often supported by diffuse
ST-segment elevation on a 12-lead ECG.
4. A 72-year-old female with chronic obstructive pulmonary disease (COPD) presents with
increased sputum purulence and worsening dyspnea. Her oxygen saturation is 89% on room
air. Which intervention is considered a priority for managing this acute exacerbation?
A. Administration of systemic corticosteroids.
B. Initiation of high-flow oxygen to reach 100% saturation.
C. Ordering a CT scan of the chest.
D. Performing a bronchoscopy for sputum collection.
Answer: A
Rationale: Systemic corticosteroids are a cornerstone in the management of COPD
exacerbations as they improve lung function and shorten recovery time. While oxygen
therapy is necessary, the goal for COPD patients is typically 88-92% to avoid suppressing
the hypoxic respiratory drive. Antibiotics are also indicated if sputum purulence is present
along with increased dyspnea.
, 5. Which of the following physical examination findings is most indicative of chronic venous
insufficiency rather than peripheral arterial disease?
A. Diminished or absent pedal pulses.
B. Hyperpigmentation of the skin around the ankles.
C. Painless, punched-out ulcers on the toes.
D. Pallor of the limb when elevated.
Answer: B
Rationale: Hyperpigmentation, often described as brawny edema or hemosiderin staining,
occurs in chronic venous insufficiency due to the breakdown of red blood cells in the tissue.
In contrast, peripheral arterial disease typically presents with cool skin, weak pulses, and
dependent rubor. Venous ulcers are usually located near the medial malleolus and are
irregularly shaped.
6. In the management of a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to prevent ventilator-induced lung injury?
A. High tidal volume ventilation.
B. Low tidal volume ventilation (6 mL/kg of predicted body weight).
C. Maintaining a low PEEP (Positive End-Expiratory Pressure).
D. Hyperventilation to keep pCO2 below 35 mmHg.
Answer: B
