NUR 6130 Exam 2 V2 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 68-year-old male with HFrEF (ejection fraction 35%) is currently taking lisinopril and
carvedilol. He remains symptomatic with NYHA Class II heart failure. Which of the following is
the most appropriate next step in his pharmacological management?
A. Discontinue carvedilol and initiate metoprolol succinate.
B. Increase the dose of lisinopril to the maximum tolerated.
C. Add an aldosterone antagonist such as spironolactone.
D. Initiate digoxin to improve myocardial contractility.
Answer: C
Rationale: Evidence-based guidelines suggest that mineralocorticoid receptor antagonists
(MRAs) should be added for patients with HFrEF who remain symptomatic despite ACE
inhibitor and beta-blocker therapy. MRAs like spironolactone have been shown to reduce
mortality and hospitalizations in this population. It is essential to monitor serum potassium
and renal function closely after initiation due to the risk of hyperkalemia.
2. According to the GOLD 2023 guidelines, which objective finding is required to confirm the
diagnosis of Chronic Obstructive Pulmonary Disease (COPD)?
A. A total lung capacity (TLC) greater than 120% of predicted.
,B. A chest X-ray showing hyperinflation and a flattened diaphragm.
C. A post-bronchodilator FEV1/FVC ratio of less than 0.70.
D. A CAT score greater than 10 indicating symptomatic disease.
Answer: C
Rationale: Spirometry is the gold standard for diagnosing COPD, specifically requiring a
post-bronchodilator FEV1/FVC ratio below 0.70. This fixed ratio indicates persistent
airflow limitation that is not fully reversible. While imaging and symptom scores provide
supportive data, they are not diagnostic criteria.
3. A 54-year-old female with type 2 diabetes and an A1C of 8.2% is already taking metformin.
She has a history of stage 3 chronic kidney disease (eGFR 45 mL/min). Which medication class
is now preferred to provide both glycemic control and renal protection?
A. Sulfonylureas
B. DPP-4 inhibitors
C. SGLT2 inhibitors
D. Thiazolidinediones
Answer: C
Rationale: SGLT2 inhibitors are strongly recommended for patients with T2DM and CKD
as they reduce the risk of progression to end-stage renal disease. These agents work by
inhibiting glucose reabsorption in the proximal tubule and lowering intraglomerular
,pressure. Patients should be monitored for mycotic infections and volume depletion during
therapy.
4. An APRN is evaluating a 72-year-old patient with new-onset atrial fibrillation. The patient
has a history of hypertension and diabetes but no previous stroke. What is the CHA2DS2-
VASc score and the recommended management?
A. Score of 2; initiation of aspirin 81 mg daily.
B. Score of 1; no anticoagulation required.
C. Score of 3; initiation of oral anticoagulation (DOAC).
D. Score of 4; initiation of dual antiplatelet therapy.
Answer: C
Rationale: The CHA2DS2-VASc score for this patient is 3 (Age 65-74 = 1, Hypertension = 1,
Diabetes = 1). For men with a score of 2 or more and women with a score of 3 or more, oral
anticoagulation is recommended to reduce stroke risk. Direct oral anticoagulants (DOACs)
are generally preferred over warfarin unless valvular disease is present.
5. A 60-year-old patient presents with symptoms of hypothyroidism including fatigue and
weight gain. The TSH is 12.4 mIU/L (High) and Free T4 is 0.6 ng/dL (Low). Which starting dose
of Levothyroxine is most appropriate for this healthy adult?
A. 12.5 mcg daily
B. 25 mcg daily
C. 1.6 mcg/kg/day
, D. 100 mcg daily regardless of weight
Answer: C
Rationale: For healthy, non-elderly adults with primary hypothyroidism, the full
replacement dose of Levothyroxine is approximately 1.6 mcg/kg of ideal body weight. In
contrast, older adults or those with underlying cardiac disease should start at a much lower
dose, such as 25 mcg, to avoid cardiac strain. TSH levels should be re-evaluated 6 to 8
weeks after starting therapy to adjust the dosage.
6. Which physical exam finding is most characteristic of a patient with severe Aortic Stenosis?
A. A mid-systolic click followed by a late systolic murmur.
B. A harsh crescendo-decrescendo systolic murmur at the right upper sternal border.
C. A high-pitched blowing diastolic murmur at the left sternal border.
D. An opening snap followed by a low-pitched diastolic rumble at the apex.
Answer: B
Rationale: Aortic stenosis typically presents with a harsh, crescendo-decrescendo systolic
murmur that radiates to the carotid arteries. It is best heard at the second intercostal space
at the right sternal border. Clinical findings may also include a delayed carotid upstroke
(pulsus parvus et tardus) in severe cases.
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 68-year-old male with HFrEF (ejection fraction 35%) is currently taking lisinopril and
carvedilol. He remains symptomatic with NYHA Class II heart failure. Which of the following is
the most appropriate next step in his pharmacological management?
A. Discontinue carvedilol and initiate metoprolol succinate.
B. Increase the dose of lisinopril to the maximum tolerated.
C. Add an aldosterone antagonist such as spironolactone.
D. Initiate digoxin to improve myocardial contractility.
Answer: C
Rationale: Evidence-based guidelines suggest that mineralocorticoid receptor antagonists
(MRAs) should be added for patients with HFrEF who remain symptomatic despite ACE
inhibitor and beta-blocker therapy. MRAs like spironolactone have been shown to reduce
mortality and hospitalizations in this population. It is essential to monitor serum potassium
and renal function closely after initiation due to the risk of hyperkalemia.
2. According to the GOLD 2023 guidelines, which objective finding is required to confirm the
diagnosis of Chronic Obstructive Pulmonary Disease (COPD)?
A. A total lung capacity (TLC) greater than 120% of predicted.
,B. A chest X-ray showing hyperinflation and a flattened diaphragm.
C. A post-bronchodilator FEV1/FVC ratio of less than 0.70.
D. A CAT score greater than 10 indicating symptomatic disease.
Answer: C
Rationale: Spirometry is the gold standard for diagnosing COPD, specifically requiring a
post-bronchodilator FEV1/FVC ratio below 0.70. This fixed ratio indicates persistent
airflow limitation that is not fully reversible. While imaging and symptom scores provide
supportive data, they are not diagnostic criteria.
3. A 54-year-old female with type 2 diabetes and an A1C of 8.2% is already taking metformin.
She has a history of stage 3 chronic kidney disease (eGFR 45 mL/min). Which medication class
is now preferred to provide both glycemic control and renal protection?
A. Sulfonylureas
B. DPP-4 inhibitors
C. SGLT2 inhibitors
D. Thiazolidinediones
Answer: C
Rationale: SGLT2 inhibitors are strongly recommended for patients with T2DM and CKD
as they reduce the risk of progression to end-stage renal disease. These agents work by
inhibiting glucose reabsorption in the proximal tubule and lowering intraglomerular
,pressure. Patients should be monitored for mycotic infections and volume depletion during
therapy.
4. An APRN is evaluating a 72-year-old patient with new-onset atrial fibrillation. The patient
has a history of hypertension and diabetes but no previous stroke. What is the CHA2DS2-
VASc score and the recommended management?
A. Score of 2; initiation of aspirin 81 mg daily.
B. Score of 1; no anticoagulation required.
C. Score of 3; initiation of oral anticoagulation (DOAC).
D. Score of 4; initiation of dual antiplatelet therapy.
Answer: C
Rationale: The CHA2DS2-VASc score for this patient is 3 (Age 65-74 = 1, Hypertension = 1,
Diabetes = 1). For men with a score of 2 or more and women with a score of 3 or more, oral
anticoagulation is recommended to reduce stroke risk. Direct oral anticoagulants (DOACs)
are generally preferred over warfarin unless valvular disease is present.
5. A 60-year-old patient presents with symptoms of hypothyroidism including fatigue and
weight gain. The TSH is 12.4 mIU/L (High) and Free T4 is 0.6 ng/dL (Low). Which starting dose
of Levothyroxine is most appropriate for this healthy adult?
A. 12.5 mcg daily
B. 25 mcg daily
C. 1.6 mcg/kg/day
, D. 100 mcg daily regardless of weight
Answer: C
Rationale: For healthy, non-elderly adults with primary hypothyroidism, the full
replacement dose of Levothyroxine is approximately 1.6 mcg/kg of ideal body weight. In
contrast, older adults or those with underlying cardiac disease should start at a much lower
dose, such as 25 mcg, to avoid cardiac strain. TSH levels should be re-evaluated 6 to 8
weeks after starting therapy to adjust the dosage.
6. Which physical exam finding is most characteristic of a patient with severe Aortic Stenosis?
A. A mid-systolic click followed by a late systolic murmur.
B. A harsh crescendo-decrescendo systolic murmur at the right upper sternal border.
C. A high-pitched blowing diastolic murmur at the left sternal border.
D. An opening snap followed by a low-pitched diastolic rumble at the apex.
Answer: B
Rationale: Aortic stenosis typically presents with a harsh, crescendo-decrescendo systolic
murmur that radiates to the carotid arteries. It is best heard at the second intercostal space
at the right sternal border. Clinical findings may also include a delayed carotid upstroke
(pulsus parvus et tardus) in severe cases.
