NUR 6130 Exam 3 V2 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 3) | William
Paterson University
1. A 55-year-old male presents with persistent retrosternal chest pain and heartburn that
worsens after large meals and when lying down. He has been taking OTC antacids with
minimal relief. What is the most appropriate next step in management for this patient?
A. Immediate referral for a barium swallow study.
B. Initiate a trial of a daily Proton Pump Inhibitor (PPI).
C. Perform an urgent cardiovascular stress test.
D. Prescribe high-dose H2-receptor antagonists.
Answer: B
Rationale: The clinical presentation is highly suggestive of Gastroesophageal Reflux
Disease (GERD) based on the postprandial symptoms and positional worsening. A trial of a
Proton Pump Inhibitor (PPI) for 8 weeks is considered the standard of care for diagnosing
and managing uncomplicated GERD in the primary care setting. If the patient does not
respond to therapy or exhibits ‘alarm’ symptoms, further diagnostic testing like endoscopy
would be warranted.
,2. A 68-year-old female reports a gradual onset of epigastric pain that she describes as a
‘gnawing’ sensation. She notes that the pain is often relieved by eating food but returns 2-3
hours later. Which diagnostic test is the gold standard for confirming the suspected
underlying infection?
A. Urea Breath Test.
B. Stool Antigen Test.
C. Endoscopic biopsy with rapid urease test.
D. Serum H. pylori IgG antibody test.
Answer: C
Rationale: The patient’s symptoms are classic for a duodenal ulcer, which is frequently
associated with Helicobacter pylori infection. While urea breath tests and stool antigens
are excellent non-invasive options, the gold standard for definitive diagnosis is an
endoscopic biopsy followed by a rapid urease test or histology. This method allows for
direct visualization of the gastric mucosa and the detection of the organism simultaneously.
3. During a routine physical exam, a 72-year-old male is found to have a positive Murphy’s
sign. He reports acute onset of right upper quadrant pain radiating to the right scapula,
accompanied by nausea. What is the most likely diagnosis?
A. Acute Pancreatitis.
B. Nephrolithiasis.
C. Peptic Ulcer Perforation.
,D. Acute Cholecystitis.
Answer: D
Rationale: Murphy’s sign is a highly specific physical finding for acute cholecystitis,
occurring when the patient experiences sharp pain and inspiratory arrest upon palpation
of the gallbladder. The radiation of pain to the right scapula (Boas’ sign) is also
characteristic of gallbladder inflammation. Initial management should include an
ultrasound of the right upper quadrant to confirm the presence of gallstones or gallbladder
wall thickening.
4. A patient presents with a history of recurrent episodes of right lower quadrant pain and
non-bloody diarrhea. Colonoscopy reveals ‘cobblestone’ appearing mucosa and transmural
inflammation. Which condition is the patient likely suffering from?
A. Ulcerative Colitis.
B. Crohn’s Disease.
C. Irritable Bowel Syndrome.
D. Ischemic Colitis.
Answer: B
Rationale: Crohn’s disease is characterized by transmural inflammation that can affect any
part of the gastrointestinal tract, often leading to a cobblestone appearance of the mucosa.
Unlike ulcerative colitis, which is limited to the mucosal layer and the colon, Crohn’s
, frequently involves skip lesions and the terminal ileum. Management often requires
immunosuppressive therapy or biologics depending on the severity of the disease.
5. Which of the following laboratory findings is most specific for the diagnosis of acute
pancreatitis?
A. Elevated Serum Lipase.
B. Elevated Serum Amylase.
C. Leukocytosis with left shift.
D. Elevated Alanine Aminotransferase (ALT).
Answer: A
Rationale: Serum lipase is more sensitive and specific than amylase for the diagnosis of
acute pancreatitis because it stays elevated longer and is primarily produced by the
pancreas. While amylase rises quickly, it can be elevated in other conditions such as
salivary gland disorders or bowel obstruction. A lipase level at least three times the upper
limit of normal is typically diagnostic in the appropriate clinical context.
6. A 45-year-old female presents with fatigue, pruritus, and jaundice. Laboratory tests reveal
a significant elevation in Alkaline Phosphatase (ALP) and a positive Antimitochondrial
Antibody (AMA) test. What is the most likely diagnosis?
A. Alcoholic Cirrhosis.
B. Nonalcoholic Steatohepatitis (NASH).
C. Chronic Hepatitis C.
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 3) | William
Paterson University
1. A 55-year-old male presents with persistent retrosternal chest pain and heartburn that
worsens after large meals and when lying down. He has been taking OTC antacids with
minimal relief. What is the most appropriate next step in management for this patient?
A. Immediate referral for a barium swallow study.
B. Initiate a trial of a daily Proton Pump Inhibitor (PPI).
C. Perform an urgent cardiovascular stress test.
D. Prescribe high-dose H2-receptor antagonists.
Answer: B
Rationale: The clinical presentation is highly suggestive of Gastroesophageal Reflux
Disease (GERD) based on the postprandial symptoms and positional worsening. A trial of a
Proton Pump Inhibitor (PPI) for 8 weeks is considered the standard of care for diagnosing
and managing uncomplicated GERD in the primary care setting. If the patient does not
respond to therapy or exhibits ‘alarm’ symptoms, further diagnostic testing like endoscopy
would be warranted.
,2. A 68-year-old female reports a gradual onset of epigastric pain that she describes as a
‘gnawing’ sensation. She notes that the pain is often relieved by eating food but returns 2-3
hours later. Which diagnostic test is the gold standard for confirming the suspected
underlying infection?
A. Urea Breath Test.
B. Stool Antigen Test.
C. Endoscopic biopsy with rapid urease test.
D. Serum H. pylori IgG antibody test.
Answer: C
Rationale: The patient’s symptoms are classic for a duodenal ulcer, which is frequently
associated with Helicobacter pylori infection. While urea breath tests and stool antigens
are excellent non-invasive options, the gold standard for definitive diagnosis is an
endoscopic biopsy followed by a rapid urease test or histology. This method allows for
direct visualization of the gastric mucosa and the detection of the organism simultaneously.
3. During a routine physical exam, a 72-year-old male is found to have a positive Murphy’s
sign. He reports acute onset of right upper quadrant pain radiating to the right scapula,
accompanied by nausea. What is the most likely diagnosis?
A. Acute Pancreatitis.
B. Nephrolithiasis.
C. Peptic Ulcer Perforation.
,D. Acute Cholecystitis.
Answer: D
Rationale: Murphy’s sign is a highly specific physical finding for acute cholecystitis,
occurring when the patient experiences sharp pain and inspiratory arrest upon palpation
of the gallbladder. The radiation of pain to the right scapula (Boas’ sign) is also
characteristic of gallbladder inflammation. Initial management should include an
ultrasound of the right upper quadrant to confirm the presence of gallstones or gallbladder
wall thickening.
4. A patient presents with a history of recurrent episodes of right lower quadrant pain and
non-bloody diarrhea. Colonoscopy reveals ‘cobblestone’ appearing mucosa and transmural
inflammation. Which condition is the patient likely suffering from?
A. Ulcerative Colitis.
B. Crohn’s Disease.
C. Irritable Bowel Syndrome.
D. Ischemic Colitis.
Answer: B
Rationale: Crohn’s disease is characterized by transmural inflammation that can affect any
part of the gastrointestinal tract, often leading to a cobblestone appearance of the mucosa.
Unlike ulcerative colitis, which is limited to the mucosal layer and the colon, Crohn’s
, frequently involves skip lesions and the terminal ileum. Management often requires
immunosuppressive therapy or biologics depending on the severity of the disease.
5. Which of the following laboratory findings is most specific for the diagnosis of acute
pancreatitis?
A. Elevated Serum Lipase.
B. Elevated Serum Amylase.
C. Leukocytosis with left shift.
D. Elevated Alanine Aminotransferase (ALT).
Answer: A
Rationale: Serum lipase is more sensitive and specific than amylase for the diagnosis of
acute pancreatitis because it stays elevated longer and is primarily produced by the
pancreas. While amylase rises quickly, it can be elevated in other conditions such as
salivary gland disorders or bowel obstruction. A lipase level at least three times the upper
limit of normal is typically diagnostic in the appropriate clinical context.
6. A 45-year-old female presents with fatigue, pruritus, and jaundice. Laboratory tests reveal
a significant elevation in Alkaline Phosphatase (ALP) and a positive Antimitochondrial
Antibody (AMA) test. What is the most likely diagnosis?
A. Alcoholic Cirrhosis.
B. Nonalcoholic Steatohepatitis (NASH).
C. Chronic Hepatitis C.
