NUR 6130 Exam 2 V1 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 68-year-old male presents with a complaint of sudden onset of severe right great toe
pain, redness, and swelling. He mentions he recently started a new diuretic for hypertension.
Which of the following is the most likely diagnosis?
A. Rheumatoid Arthritis
B. Acute Gouty Arthritis
C. Septic Arthritis
D. Osteoarthritis
Answer: B
Rationale: The clinical presentation of sudden, severe pain in the first
metatarsophalangeal joint is classic for acute gout. Thiazide diuretics are known to
increase uric acid levels, which can precipitate a gout flare-up in susceptible individuals.
Effective management typically involves NSAIDs, colchicine, or corticosteroids depending
on the patient’s comorbidities.
,2. When managing a patient with New York Heart Association (NYHA) Class II Heart Failure,
which medication class is primarily indicated to reduce mortality and inhibit cardiac
remodeling?
A. Loop Diuretics
B. ACE Inhibitors
C. Calcium Channel Blockers
D. Digoxin
Answer: B
Rationale: ACE inhibitors are fundamental in the management of heart failure with
reduced ejection fraction as they block the renin-angiotensin-aldosterone system. This
inhibition prevents the progression of cardiac remodeling and significantly reduces
mortality rates. While loop diuretics manage fluid volume, they do not provide the same
long-term survival benefits as ACE inhibitors.
3. A 72-year-old female with a history of COPD presents with increased sputum purulence
and volume, and increased dyspnea. Her oxygen saturation is 89% on room air. What is the
most appropriate next step in her management?
A. Initiate a 14-day course of high-dose oral steroids
B. Order a stat chest CT to rule out pulmonary embolism
C. Prescribe an antibiotic and systemic corticosteroids
D. Advise the patient to increase the frequency of her SABA only
,Answer: C
Rationale: The presence of the three cardinal symptoms—increased dyspnea, sputum
volume, and sputum purulence—indicates a COPD exacerbation where antibiotics are
beneficial. Systemic corticosteroids are also recommended to improve lung function and
shorten recovery time. Close monitoring of oxygenation is essential to determine if
hospitalization is required.
4. A patient with Type 2 Diabetes has a Hemoglobin A1c of 8.2% despite being on Metformin
1000mg BID. The patient has a history of atherosclerotic cardiovascular disease (ASCVD).
According to current guidelines, which medication should be added next?
A. DPP-4 inhibitor
B. GLP-1 receptor agonist
C. Sulfonylurea
D. Pioglitazone
Answer: B
Rationale: For patients with Type 2 Diabetes and established ASCVD, GLP-1 receptor
agonists with proven cardiovascular benefit are recommended as second-line therapy after
metformin. These medications help reduce major adverse cardiovascular events in addition
to lowering glucose. SGLT2 inhibitors are another alternative, particularly if heart failure is
also present.
, 5. In the evaluation of a 55-year-old patient with chronic kidney disease (CKD), which
laboratory value is the most accurate indicator of overall renal function for staging purposes?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Urine Specific Gravity
D. Estimated Glomerular Filtration Rate (eGFR)
Answer: D
Rationale: The eGFR is the preferred marker for staging chronic kidney disease because it
accounts for age, sex, and race, providing a more accurate reflection of kidney function than
creatinine alone. Serum creatinine can be influenced by muscle mass and diet, making it
less reliable in isolation. Consistent monitoring of eGFR is crucial for guiding medication
dosing and identifying the need for nephrology referral.
6. A 60-year-old patient presents with symptoms of tremor at rest, bradykinesia, and postural
instability. Which of the following is the gold standard pharmacological treatment for this
condition?
A. Donepezil
B. Memantine
C. Levodopa/Carbidopa
D. Selegiline
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 68-year-old male presents with a complaint of sudden onset of severe right great toe
pain, redness, and swelling. He mentions he recently started a new diuretic for hypertension.
Which of the following is the most likely diagnosis?
A. Rheumatoid Arthritis
B. Acute Gouty Arthritis
C. Septic Arthritis
D. Osteoarthritis
Answer: B
Rationale: The clinical presentation of sudden, severe pain in the first
metatarsophalangeal joint is classic for acute gout. Thiazide diuretics are known to
increase uric acid levels, which can precipitate a gout flare-up in susceptible individuals.
Effective management typically involves NSAIDs, colchicine, or corticosteroids depending
on the patient’s comorbidities.
,2. When managing a patient with New York Heart Association (NYHA) Class II Heart Failure,
which medication class is primarily indicated to reduce mortality and inhibit cardiac
remodeling?
A. Loop Diuretics
B. ACE Inhibitors
C. Calcium Channel Blockers
D. Digoxin
Answer: B
Rationale: ACE inhibitors are fundamental in the management of heart failure with
reduced ejection fraction as they block the renin-angiotensin-aldosterone system. This
inhibition prevents the progression of cardiac remodeling and significantly reduces
mortality rates. While loop diuretics manage fluid volume, they do not provide the same
long-term survival benefits as ACE inhibitors.
3. A 72-year-old female with a history of COPD presents with increased sputum purulence
and volume, and increased dyspnea. Her oxygen saturation is 89% on room air. What is the
most appropriate next step in her management?
A. Initiate a 14-day course of high-dose oral steroids
B. Order a stat chest CT to rule out pulmonary embolism
C. Prescribe an antibiotic and systemic corticosteroids
D. Advise the patient to increase the frequency of her SABA only
,Answer: C
Rationale: The presence of the three cardinal symptoms—increased dyspnea, sputum
volume, and sputum purulence—indicates a COPD exacerbation where antibiotics are
beneficial. Systemic corticosteroids are also recommended to improve lung function and
shorten recovery time. Close monitoring of oxygenation is essential to determine if
hospitalization is required.
4. A patient with Type 2 Diabetes has a Hemoglobin A1c of 8.2% despite being on Metformin
1000mg BID. The patient has a history of atherosclerotic cardiovascular disease (ASCVD).
According to current guidelines, which medication should be added next?
A. DPP-4 inhibitor
B. GLP-1 receptor agonist
C. Sulfonylurea
D. Pioglitazone
Answer: B
Rationale: For patients with Type 2 Diabetes and established ASCVD, GLP-1 receptor
agonists with proven cardiovascular benefit are recommended as second-line therapy after
metformin. These medications help reduce major adverse cardiovascular events in addition
to lowering glucose. SGLT2 inhibitors are another alternative, particularly if heart failure is
also present.
, 5. In the evaluation of a 55-year-old patient with chronic kidney disease (CKD), which
laboratory value is the most accurate indicator of overall renal function for staging purposes?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Urine Specific Gravity
D. Estimated Glomerular Filtration Rate (eGFR)
Answer: D
Rationale: The eGFR is the preferred marker for staging chronic kidney disease because it
accounts for age, sex, and race, providing a more accurate reflection of kidney function than
creatinine alone. Serum creatinine can be influenced by muscle mass and diet, making it
less reliable in isolation. Consistent monitoring of eGFR is crucial for guiding medication
dosing and identifying the need for nephrology referral.
6. A 60-year-old patient presents with symptoms of tremor at rest, bradykinesia, and postural
instability. Which of the following is the gold standard pharmacological treatment for this
condition?
A. Donepezil
B. Memantine
C. Levodopa/Carbidopa
D. Selegiline
