NUR 6130 Final Exam V1 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Final Exam) | William
Paterson University
1. A 72-year-old male with a history of HFrEF (LVEF 35%) and stage 3 CKD presents for a
follow-up. He is currently on Lisinopril 20mg daily and Carvedilol 12.5mg BID. Which lab value
requires immediate adjustment of his ACE inhibitor?
A. Sodium of 134 mEq/L
B. Serum Creatinine of 1.4 mg/dL
C. Serum Potassium of 5.4 mEq/L
D. BUN of 28 mg/dL
Answer: C
Rationale: Hyperkalemia is a significant risk when using ACE inhibitors in patients with
chronic kidney disease. A potassium level of 5.4 mEq/L is nearing the upper limit where
clinical intervention or medication titration is necessary to prevent cardiac arrhythmias.
Monitoring electrolytes and renal function is a core competency for managing complex
chronic conditions in the elderly.
2. According to the GOLD 2023 guidelines, which medication is the preferred initial treatment
for a patient categorized in Group E (COPD)?
A. SABA as needed
,B. LABA monotherapy
C. ICS + LABA combination
D. LABA + LAMA combination
Answer: D
Rationale: Group E patients are those with high exacerbation risk regardless of their
symptom score. The GOLD 2023 update emphasizes dual bronchodilation with LABA and
LAMA as the initial pharmacological approach for these patients. ICS is typically reserved
for patients with eosinophil counts ≥ 300 or those with frequent exacerbations despite dual
therapy.
3. A 68-year-old woman with Type 2 Diabetes and a history of ASCVD has an A1C of 8.2%.
Which class of medication provides the best cardiovascular benefit while also promoting
weight loss?
A. Sulfonylureas
B. GLP-1 Receptor Agonists
C. DPP-4 Inhibitors
D. Thiazolidinediones
Answer: B
Rationale: GLP-1 receptor agonists like Semaglutide have proven cardiovascular benefits
in patients with established ASCVD. They work by mimicking the incretin effect, enhancing
,glucose-dependent insulin secretion and delaying gastric emptying. This mechanism also
leads to significant weight loss, which is beneficial for managing metabolic syndrome in
APN practice.
4. Which of the following is considered the ‘gold standard’ for diagnosing Obstructive Sleep
Apnea (OSA) in an adult patient reporting excessive daytime somnolence?
A. In-laboratory Polysomnography
B. Epworth Sleepiness Scale
C. Overnight Pulse Oximetry
D. Home Sleep Apnea Testing (HSAT)
Answer: A
Rationale: In-laboratory polysomnography remains the definitive diagnostic tool for OSA
as it monitors multiple physiological parameters including EEG, EOG, and EMG. While HSAT
is convenient, it may underestimate the severity of apnea in patients with significant
comorbidities. Accurate diagnosis is essential before initiating CPAP therapy to ensure
patient safety and compliance.
5. In the management of chronic stable angina, what is the primary mechanism by which
Nitroglycerin relieves chest pain?
A. Increasing heart rate to improve cardiac output
B. Directly inhibiting platelet aggregation
C. Decreasing preload through venous vasodilation
, D. Selective vasoconstriction of peripheral arteries
Answer: C
Rationale: Nitroglycerin acts primarily as a vasodilator, with a more pronounced effect on
the venous system. By dilating the veins, it reduces the amount of blood returning to the
heart, thereby decreasing left ventricular end-diastolic pressure (preload). This reduction
in preload lowers myocardial oxygen demand, effectively relieving anginal symptoms.
6. A patient with a CHADS-VASc score of 4 is diagnosed with new-onset Atrial Fibrillation.
What is the most appropriate long-term management strategy for stroke prevention?
A. Oral Anticoagulation (DOAC or Warfarin)
B. Aspirin 325 mg plus Clopidogrel
C. Aspirin 81 mg daily
D. No anticoagulation is required for a score of 4
Answer: A
Rationale: The CHADS-VASc score is used to determine the risk of stroke in patients with
non-valvular atrial fibrillation. A score of 2 or higher in men (or 3 in women) generally
necessitates oral anticoagulation therapy. DOACs like Apixaban or Rivaroxaban are often
preferred over Warfarin due to their predictable pharmacokinetics and lack of dietary
restrictions.
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Final Exam) | William
Paterson University
1. A 72-year-old male with a history of HFrEF (LVEF 35%) and stage 3 CKD presents for a
follow-up. He is currently on Lisinopril 20mg daily and Carvedilol 12.5mg BID. Which lab value
requires immediate adjustment of his ACE inhibitor?
A. Sodium of 134 mEq/L
B. Serum Creatinine of 1.4 mg/dL
C. Serum Potassium of 5.4 mEq/L
D. BUN of 28 mg/dL
Answer: C
Rationale: Hyperkalemia is a significant risk when using ACE inhibitors in patients with
chronic kidney disease. A potassium level of 5.4 mEq/L is nearing the upper limit where
clinical intervention or medication titration is necessary to prevent cardiac arrhythmias.
Monitoring electrolytes and renal function is a core competency for managing complex
chronic conditions in the elderly.
2. According to the GOLD 2023 guidelines, which medication is the preferred initial treatment
for a patient categorized in Group E (COPD)?
A. SABA as needed
,B. LABA monotherapy
C. ICS + LABA combination
D. LABA + LAMA combination
Answer: D
Rationale: Group E patients are those with high exacerbation risk regardless of their
symptom score. The GOLD 2023 update emphasizes dual bronchodilation with LABA and
LAMA as the initial pharmacological approach for these patients. ICS is typically reserved
for patients with eosinophil counts ≥ 300 or those with frequent exacerbations despite dual
therapy.
3. A 68-year-old woman with Type 2 Diabetes and a history of ASCVD has an A1C of 8.2%.
Which class of medication provides the best cardiovascular benefit while also promoting
weight loss?
A. Sulfonylureas
B. GLP-1 Receptor Agonists
C. DPP-4 Inhibitors
D. Thiazolidinediones
Answer: B
Rationale: GLP-1 receptor agonists like Semaglutide have proven cardiovascular benefits
in patients with established ASCVD. They work by mimicking the incretin effect, enhancing
,glucose-dependent insulin secretion and delaying gastric emptying. This mechanism also
leads to significant weight loss, which is beneficial for managing metabolic syndrome in
APN practice.
4. Which of the following is considered the ‘gold standard’ for diagnosing Obstructive Sleep
Apnea (OSA) in an adult patient reporting excessive daytime somnolence?
A. In-laboratory Polysomnography
B. Epworth Sleepiness Scale
C. Overnight Pulse Oximetry
D. Home Sleep Apnea Testing (HSAT)
Answer: A
Rationale: In-laboratory polysomnography remains the definitive diagnostic tool for OSA
as it monitors multiple physiological parameters including EEG, EOG, and EMG. While HSAT
is convenient, it may underestimate the severity of apnea in patients with significant
comorbidities. Accurate diagnosis is essential before initiating CPAP therapy to ensure
patient safety and compliance.
5. In the management of chronic stable angina, what is the primary mechanism by which
Nitroglycerin relieves chest pain?
A. Increasing heart rate to improve cardiac output
B. Directly inhibiting platelet aggregation
C. Decreasing preload through venous vasodilation
, D. Selective vasoconstriction of peripheral arteries
Answer: C
Rationale: Nitroglycerin acts primarily as a vasodilator, with a more pronounced effect on
the venous system. By dilating the veins, it reduces the amount of blood returning to the
heart, thereby decreasing left ventricular end-diastolic pressure (preload). This reduction
in preload lowers myocardial oxygen demand, effectively relieving anginal symptoms.
6. A patient with a CHADS-VASc score of 4 is diagnosed with new-onset Atrial Fibrillation.
What is the most appropriate long-term management strategy for stroke prevention?
A. Oral Anticoagulation (DOAC or Warfarin)
B. Aspirin 325 mg plus Clopidogrel
C. Aspirin 81 mg daily
D. No anticoagulation is required for a score of 4
Answer: A
Rationale: The CHADS-VASc score is used to determine the risk of stroke in patients with
non-valvular atrial fibrillation. A score of 2 or higher in men (or 3 in women) generally
necessitates oral anticoagulation therapy. DOACs like Apixaban or Rivaroxaban are often
preferred over Warfarin due to their predictable pharmacokinetics and lack of dietary
restrictions.
