NUR 6121 Final Exam V2 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Final Exam) | William Paterson
University
1. A 62-year-old male presents with symptoms of Benign Prostatic Hyperplasia (BPH). Which
of the following findings on a Digital Rectal Exam (DRE) would be most consistent with this
diagnosis?
A. Hard, nodular, and asymmetrical gland
B. Soft, boggy, and extremely tender gland
C. Firm, smooth, and symmetrically enlarged gland
D. Small, atrophied, and non-palpable gland
Answer: C
Rationale: In Benign Prostatic Hyperplasia, the prostate gland is typically characterized by
a firm, smooth, and symmetrical enlargement without nodules. A hard or nodular gland
would increase suspicion for prostate cancer, while a boggy and tender gland suggests
acute prostatitis. Healthcare providers must differentiate these findings to determine if
further testing like PSA or biopsy is immediately warranted.
,2. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) presents with
increased sputum purulence and dyspnea. According to the GOLD guidelines, which
medication is indicated for an acute exacerbation?
A. Long-acting Beta Agonist (LABA) monotherapy
B. Inhaled Corticosteroids as the sole agent
C. Short-acting Bronchodilator and Systemic Corticosteroids
D. Oral Leukotriene modifiers
Answer: C
Rationale: The management of an acute COPD exacerbation typically involves the use of
short-acting bronchodilators, such as Albuterol, and a course of systemic corticosteroids.
These interventions aim to reduce airway inflammation and provide rapid relief of
bronchoconstriction. Antibiotics are also considered if there is increased sputum purulence
and volume, suggesting a bacterial infection.
3. Which lab value is the most sensitive indicator for diagnosing Iron Deficiency Anemia (IDA)
in an adult patient?
A. Serum Iron
B. Serum Ferritin
C. Total Iron Binding Capacity (TIBC)
D. Hemoglobin level
,Answer: B
Rationale: Serum Ferritin reflects the total body iron stores and is generally considered
the most sensitive and specific test for iron deficiency. Low ferritin levels indicate depleted
iron reserves even before the hemoglobin levels drop significantly. This test helps
clinicians distinguish IDA from anemia of chronic disease, where ferritin is often normal or
elevated.
4. A 45-year-old female presents with complaints of fatigue, cold intolerance, and weight
gain. Her TSH is 12.4 mIU/L and Free T4 is low. What is the standard starting dose for
Levothyroxine in a healthy adult?
A. 12.5 mcg daily
B. 200 mcg daily
C. 50 mcg daily for all patients
D. 1.6 mcg/kg/day
Answer: D
Rationale: For healthy, non-elderly adults with primary hypothyroidism, the
recommended full replacement dose of Levothyroxine is approximately 1.6 mcg per
kilogram of body weight per day. In elderly patients or those with underlying cardiac
disease, clinicians should ‘start low and go slow,’ often beginning with 12.5 to 25 mcg.
Monitoring involves checking the TSH level every 6 to 8 weeks until a stable euthyroid
state is achieved.
, 5. The nurse practitioner is managing a patient with Type 2 Diabetes who has a current A1c of
8.5% on Metformin. The patient has a history of atherosclerotic cardiovascular disease
(ASCVD). Which class of medication is preferred for addition to their regimen?
A. GLP-1 Receptor Agonists
B. DPP-4 Inhibitors
C. Sulfonylureas
D. Thiazolidinediones
Answer: A
Rationale: Current ADA guidelines recommend GLP-1 receptor agonists with proven
cardiovascular benefit or SGLT2 inhibitors for patients with established ASCVD regardless
of A1c. These medications have been shown to reduce the risk of major adverse
cardiovascular events in clinical trials. Selecting these agents provides glycemic control
while simultaneously addressing the patient’s specific comorbidity profile.
6. A 30-year-old woman reports a sudden onset of severe right lower quadrant abdominal
pain accompanied by nausea. On examination, she has positive McBurney’s sign and
Rebound tenderness. What is the most likely diagnosis?
A. Ectopic Pregnancy
B. Pelvic Inflammatory Disease
C. Ovarian Torsion
D. Acute Appendicitis
Advanced Nursing II | Q&A with Rationale
(NUR6121 Final Exam) | William Paterson
University
1. A 62-year-old male presents with symptoms of Benign Prostatic Hyperplasia (BPH). Which
of the following findings on a Digital Rectal Exam (DRE) would be most consistent with this
diagnosis?
A. Hard, nodular, and asymmetrical gland
B. Soft, boggy, and extremely tender gland
C. Firm, smooth, and symmetrically enlarged gland
D. Small, atrophied, and non-palpable gland
Answer: C
Rationale: In Benign Prostatic Hyperplasia, the prostate gland is typically characterized by
a firm, smooth, and symmetrical enlargement without nodules. A hard or nodular gland
would increase suspicion for prostate cancer, while a boggy and tender gland suggests
acute prostatitis. Healthcare providers must differentiate these findings to determine if
further testing like PSA or biopsy is immediately warranted.
,2. A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) presents with
increased sputum purulence and dyspnea. According to the GOLD guidelines, which
medication is indicated for an acute exacerbation?
A. Long-acting Beta Agonist (LABA) monotherapy
B. Inhaled Corticosteroids as the sole agent
C. Short-acting Bronchodilator and Systemic Corticosteroids
D. Oral Leukotriene modifiers
Answer: C
Rationale: The management of an acute COPD exacerbation typically involves the use of
short-acting bronchodilators, such as Albuterol, and a course of systemic corticosteroids.
These interventions aim to reduce airway inflammation and provide rapid relief of
bronchoconstriction. Antibiotics are also considered if there is increased sputum purulence
and volume, suggesting a bacterial infection.
3. Which lab value is the most sensitive indicator for diagnosing Iron Deficiency Anemia (IDA)
in an adult patient?
A. Serum Iron
B. Serum Ferritin
C. Total Iron Binding Capacity (TIBC)
D. Hemoglobin level
,Answer: B
Rationale: Serum Ferritin reflects the total body iron stores and is generally considered
the most sensitive and specific test for iron deficiency. Low ferritin levels indicate depleted
iron reserves even before the hemoglobin levels drop significantly. This test helps
clinicians distinguish IDA from anemia of chronic disease, where ferritin is often normal or
elevated.
4. A 45-year-old female presents with complaints of fatigue, cold intolerance, and weight
gain. Her TSH is 12.4 mIU/L and Free T4 is low. What is the standard starting dose for
Levothyroxine in a healthy adult?
A. 12.5 mcg daily
B. 200 mcg daily
C. 50 mcg daily for all patients
D. 1.6 mcg/kg/day
Answer: D
Rationale: For healthy, non-elderly adults with primary hypothyroidism, the
recommended full replacement dose of Levothyroxine is approximately 1.6 mcg per
kilogram of body weight per day. In elderly patients or those with underlying cardiac
disease, clinicians should ‘start low and go slow,’ often beginning with 12.5 to 25 mcg.
Monitoring involves checking the TSH level every 6 to 8 weeks until a stable euthyroid
state is achieved.
, 5. The nurse practitioner is managing a patient with Type 2 Diabetes who has a current A1c of
8.5% on Metformin. The patient has a history of atherosclerotic cardiovascular disease
(ASCVD). Which class of medication is preferred for addition to their regimen?
A. GLP-1 Receptor Agonists
B. DPP-4 Inhibitors
C. Sulfonylureas
D. Thiazolidinediones
Answer: A
Rationale: Current ADA guidelines recommend GLP-1 receptor agonists with proven
cardiovascular benefit or SGLT2 inhibitors for patients with established ASCVD regardless
of A1c. These medications have been shown to reduce the risk of major adverse
cardiovascular events in clinical trials. Selecting these agents provides glycemic control
while simultaneously addressing the patient’s specific comorbidity profile.
6. A 30-year-old woman reports a sudden onset of severe right lower quadrant abdominal
pain accompanied by nausea. On examination, she has positive McBurney’s sign and
Rebound tenderness. What is the most likely diagnosis?
A. Ectopic Pregnancy
B. Pelvic Inflammatory Disease
C. Ovarian Torsion
D. Acute Appendicitis
