NUR 6130 Final Exam V3 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Final Exam) | William
Paterson University
1. A 65-year-old patient with a history of HFrEF presents with worsening fatigue and a
persistent cough. Which medication class is specifically indicated to block the deleterious
effects of the RAAS and reduce mortality in this patient?
A. Loop Diuretics
B. Calcium Channel Blockers
C. ACE Inhibitors
D. Alpha-1 Antagonists
Answer: C
Rationale: ACE inhibitors are a cornerstone of therapy for heart failure with reduced
ejection fraction because they reduce systemic vascular resistance and inhibit ventricular
remodeling. While diuretics are essential for symptom management regarding fluid
overload, they do not provide the same mortality benefit as ACE inhibitors. Calcium
channel blockers are often contraindicated or used with caution in heart failure due to their
negative inotropic effects.
,2. Which of the following physical exam findings is most suggestive of Acute Cholecystitis in
an elderly patient?
A. Positive Rovsing sign
B. Positive Murphy sign
C. Positive McBurney sign
D. Positive Psoas sign
Answer: B
Rationale: A positive Murphy sign occurs when a patient experiences sharp pain and
inspiration arrest upon deep palpation of the right upper quadrant. This finding is highly
specific for gallbladder inflammation and acute cholecystitis. In contrast, Rovsing,
McBurney, and Psoas signs are primarily associated with the assessment of acute
appendicitis.
3. According to the GOLD guidelines for COPD, which of the following is the preferred initial
treatment for a patient in Group B (symptomatic, low risk of exacerbation)?
A. Long-acting bronchodilator (LABA or LAMA)
B. Inhaled Corticosteroid (ICS) monotherapy
C. Short-acting beta-agonist (SABA) PRN
D. Oral Theophylline
Answer: A
,Rationale: Group B COPD patients are symptomatic with a CAT score of 10 or more but
have a low risk of frequent exacerbations. Current GOLD guidelines recommend starting
these patients on a long-acting bronchodilator, either a LABA or a LAMA. Inhaled
corticosteroids are generally reserved for patients with a higher risk of exacerbations or
high eosinophil counts, and are not recommended as monotherapy.
4. A 72-year-old female presents with a T-score of -2.8 on her DXA scan. What is the primary
diagnosis based on WHO criteria?
A. Osteoporosis
B. Normal bone density
C. Osteopenia
D. Osteoarthritis
Answer: A
Rationale: A T-score of -2.5 or lower on a dual-energy X-ray absorptiometry scan is
diagnostic for osteoporosis according to World Health Organization standards. Osteopenia
is defined by a T-score between -1.0 and -2.5. Accurate diagnosis is critical because it
guides the initiation of pharmacotherapy such as bisphosphonates to prevent fractures.
5. In the management of Type 2 Diabetes, which medication class is most likely to cause
hypoglycemia when used as monotherapy?
A. Metformin
B. DPP-4 Inhibitors
, C. Sulfonylureas
D. SGLT2 Inhibitors
Answer: C
Rationale: Sulfonylureas work by stimulating the beta cells of the pancreas to secrete
insulin regardless of blood glucose levels, which significantly increases the risk of
hypoglycemia. Metformin and SGLT2 inhibitors have low risks for hypoglycemia because
they do not directly stimulate insulin secretion. Advanced practice nurses must educate
patients on the signs and symptoms of low blood sugar when prescribing sulfonylureas.
6. A patient presents with a ‘curtain-like’ loss of vision in one eye. This symptom is most
characteristic of which ophthalmic emergency?
A. Retinal Detachment
B. Acute Angle-closure Glaucoma
C. Macular Degeneration
D. Cataracts
Answer: A
Rationale: Retinal detachment typically presents as a sudden, painless loss of vision often
described as a shadow or curtain coming across the visual field. This condition requires
emergent referral to an ophthalmologist to prevent permanent vision loss. In contrast,
acute angle-closure glaucoma is usually associated with severe eye pain and halos around
lights.
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Final Exam) | William
Paterson University
1. A 65-year-old patient with a history of HFrEF presents with worsening fatigue and a
persistent cough. Which medication class is specifically indicated to block the deleterious
effects of the RAAS and reduce mortality in this patient?
A. Loop Diuretics
B. Calcium Channel Blockers
C. ACE Inhibitors
D. Alpha-1 Antagonists
Answer: C
Rationale: ACE inhibitors are a cornerstone of therapy for heart failure with reduced
ejection fraction because they reduce systemic vascular resistance and inhibit ventricular
remodeling. While diuretics are essential for symptom management regarding fluid
overload, they do not provide the same mortality benefit as ACE inhibitors. Calcium
channel blockers are often contraindicated or used with caution in heart failure due to their
negative inotropic effects.
,2. Which of the following physical exam findings is most suggestive of Acute Cholecystitis in
an elderly patient?
A. Positive Rovsing sign
B. Positive Murphy sign
C. Positive McBurney sign
D. Positive Psoas sign
Answer: B
Rationale: A positive Murphy sign occurs when a patient experiences sharp pain and
inspiration arrest upon deep palpation of the right upper quadrant. This finding is highly
specific for gallbladder inflammation and acute cholecystitis. In contrast, Rovsing,
McBurney, and Psoas signs are primarily associated with the assessment of acute
appendicitis.
3. According to the GOLD guidelines for COPD, which of the following is the preferred initial
treatment for a patient in Group B (symptomatic, low risk of exacerbation)?
A. Long-acting bronchodilator (LABA or LAMA)
B. Inhaled Corticosteroid (ICS) monotherapy
C. Short-acting beta-agonist (SABA) PRN
D. Oral Theophylline
Answer: A
,Rationale: Group B COPD patients are symptomatic with a CAT score of 10 or more but
have a low risk of frequent exacerbations. Current GOLD guidelines recommend starting
these patients on a long-acting bronchodilator, either a LABA or a LAMA. Inhaled
corticosteroids are generally reserved for patients with a higher risk of exacerbations or
high eosinophil counts, and are not recommended as monotherapy.
4. A 72-year-old female presents with a T-score of -2.8 on her DXA scan. What is the primary
diagnosis based on WHO criteria?
A. Osteoporosis
B. Normal bone density
C. Osteopenia
D. Osteoarthritis
Answer: A
Rationale: A T-score of -2.5 or lower on a dual-energy X-ray absorptiometry scan is
diagnostic for osteoporosis according to World Health Organization standards. Osteopenia
is defined by a T-score between -1.0 and -2.5. Accurate diagnosis is critical because it
guides the initiation of pharmacotherapy such as bisphosphonates to prevent fractures.
5. In the management of Type 2 Diabetes, which medication class is most likely to cause
hypoglycemia when used as monotherapy?
A. Metformin
B. DPP-4 Inhibitors
, C. Sulfonylureas
D. SGLT2 Inhibitors
Answer: C
Rationale: Sulfonylureas work by stimulating the beta cells of the pancreas to secrete
insulin regardless of blood glucose levels, which significantly increases the risk of
hypoglycemia. Metformin and SGLT2 inhibitors have low risks for hypoglycemia because
they do not directly stimulate insulin secretion. Advanced practice nurses must educate
patients on the signs and symptoms of low blood sugar when prescribing sulfonylureas.
6. A patient presents with a ‘curtain-like’ loss of vision in one eye. This symptom is most
characteristic of which ophthalmic emergency?
A. Retinal Detachment
B. Acute Angle-closure Glaucoma
C. Macular Degeneration
D. Cataracts
Answer: A
Rationale: Retinal detachment typically presents as a sudden, painless loss of vision often
described as a shadow or curtain coming across the visual field. This condition requires
emergent referral to an ophthalmologist to prevent permanent vision loss. In contrast,
acute angle-closure glaucoma is usually associated with severe eye pain and halos around
lights.
