NUR 6130 Exam 4 V3 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 4) | William
Paterson University
1. A 72-year-old female presents with sudden onset of confusion, agitation, and a fluctuating
level of consciousness. What is the most likely diagnosis the APRN should consider first?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Delirium
D. Major Depressive Disorder
Answer: C
Rationale: Delirium is characterized by an acute onset and fluctuating course of cognitive
impairment. Unlike dementia, which is progressive and chronic, delirium is often reversible
and triggered by an underlying medical condition. The APRN must prioritize identifying the
causative factor, such as infection or polypharmacy, to prevent further decline.
2. When managing a pediatric patient with acute otitis media, which clinical finding is the
most specific indicator for a diagnosis requiring antibiotics?
A. Erythema of the tympanic membrane
B. Clear fluid behind the membrane
,C. Presence of ear tugging
D. Bulging of the tympanic membrane
Answer: D
Rationale: Bulging of the tympanic membrane indicates middle ear effusion and
inflammation, which are hallmarks of acute otitis media. While erythema can occur with
crying or fever, bulging is a more specific diagnostic sign. Advanced practice nurses use this
finding to differentiate infectious AOM from otitis media with effusion, ensuring
appropriate antibiotic stewardship.
3. An 80-year-old male with a history of hypertension and heart failure presents for a follow-
up. Using the Beers Criteria, which medication should the APRN consider tapering or
discontinuing?
A. Lisinopril
B. Metoprolol
C. Indomethacin
D. Amlodipine
Answer: C
Rationale: Indomethacin is a non-selective NSAID that is listed on the Beers Criteria as
potentially inappropriate for older adults due to the risk of gastrointestinal bleeding and
kidney injury. In patients with heart failure, NSAIDs can also promote fluid retention and
,exacerbate symptoms. The APRN should evaluate alternative pain management strategies
that pose fewer risks to the geriatric population.
4. A 4-year-old child is brought to the clinic for a routine check-up. Which developmental
milestone should the child have achieved by this age?
A. Tying shoelaces independently
B. Hopping on one foot
C. Drawing a square
D. Printing their first name
Answer: B
Rationale: Hopping on one foot is a gross motor milestone typically achieved by age 4.
Tying shoelaces and printing names are usually mastered later, around age 5 or 6.
Monitoring these milestones allows the APRN to track neurological development and
identify children who may benefit from early intervention services.
5. Which classification of asthma is assigned to a patient who experiences symptoms 3 days
per week and nighttime awakenings 3 times per month?
A. Intermittent
B. Severe Persistent
C. Moderate Persistent
D. Mild Persistent
, Answer: D
Rationale: Mild persistent asthma is characterized by symptoms occurring more than 2
days per week but not daily, and nighttime awakenings 3 to 4 times per month. According
to the NAEPP guidelines, this classification requires the initiation of a daily low-dose
inhaled corticosteroid. The APRN must accurately categorize asthma severity to ensure the
patient receives the correct step-care pharmacological management.
6. A patient with chronic obstructive pulmonary disease (COPD) has a FEV1/FVC ratio of less
than 0.70 and an FEV1 of 65% predicted. According to the GOLD criteria, what is the severity
of this patient’s airflow limitation?
A. GOLD 1: Mild
B. GOLD 4: Very Severe
C. GOLD 3: Severe
D. GOLD 2: Moderate
Answer: D
Rationale: GOLD 2 (Moderate) airflow limitation is defined by an FEV1 between 50% and
79% of the predicted value. This staging is crucial for determining the appropriate
escalation of bronchodilator therapy. The APRN uses these objective spirometry measures
alongside symptom assessment to optimize the management of chronic respiratory
disease.
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 4) | William
Paterson University
1. A 72-year-old female presents with sudden onset of confusion, agitation, and a fluctuating
level of consciousness. What is the most likely diagnosis the APRN should consider first?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Delirium
D. Major Depressive Disorder
Answer: C
Rationale: Delirium is characterized by an acute onset and fluctuating course of cognitive
impairment. Unlike dementia, which is progressive and chronic, delirium is often reversible
and triggered by an underlying medical condition. The APRN must prioritize identifying the
causative factor, such as infection or polypharmacy, to prevent further decline.
2. When managing a pediatric patient with acute otitis media, which clinical finding is the
most specific indicator for a diagnosis requiring antibiotics?
A. Erythema of the tympanic membrane
B. Clear fluid behind the membrane
,C. Presence of ear tugging
D. Bulging of the tympanic membrane
Answer: D
Rationale: Bulging of the tympanic membrane indicates middle ear effusion and
inflammation, which are hallmarks of acute otitis media. While erythema can occur with
crying or fever, bulging is a more specific diagnostic sign. Advanced practice nurses use this
finding to differentiate infectious AOM from otitis media with effusion, ensuring
appropriate antibiotic stewardship.
3. An 80-year-old male with a history of hypertension and heart failure presents for a follow-
up. Using the Beers Criteria, which medication should the APRN consider tapering or
discontinuing?
A. Lisinopril
B. Metoprolol
C. Indomethacin
D. Amlodipine
Answer: C
Rationale: Indomethacin is a non-selective NSAID that is listed on the Beers Criteria as
potentially inappropriate for older adults due to the risk of gastrointestinal bleeding and
kidney injury. In patients with heart failure, NSAIDs can also promote fluid retention and
,exacerbate symptoms. The APRN should evaluate alternative pain management strategies
that pose fewer risks to the geriatric population.
4. A 4-year-old child is brought to the clinic for a routine check-up. Which developmental
milestone should the child have achieved by this age?
A. Tying shoelaces independently
B. Hopping on one foot
C. Drawing a square
D. Printing their first name
Answer: B
Rationale: Hopping on one foot is a gross motor milestone typically achieved by age 4.
Tying shoelaces and printing names are usually mastered later, around age 5 or 6.
Monitoring these milestones allows the APRN to track neurological development and
identify children who may benefit from early intervention services.
5. Which classification of asthma is assigned to a patient who experiences symptoms 3 days
per week and nighttime awakenings 3 times per month?
A. Intermittent
B. Severe Persistent
C. Moderate Persistent
D. Mild Persistent
, Answer: D
Rationale: Mild persistent asthma is characterized by symptoms occurring more than 2
days per week but not daily, and nighttime awakenings 3 to 4 times per month. According
to the NAEPP guidelines, this classification requires the initiation of a daily low-dose
inhaled corticosteroid. The APRN must accurately categorize asthma severity to ensure the
patient receives the correct step-care pharmacological management.
6. A patient with chronic obstructive pulmonary disease (COPD) has a FEV1/FVC ratio of less
than 0.70 and an FEV1 of 65% predicted. According to the GOLD criteria, what is the severity
of this patient’s airflow limitation?
A. GOLD 1: Mild
B. GOLD 4: Very Severe
C. GOLD 3: Severe
D. GOLD 2: Moderate
Answer: D
Rationale: GOLD 2 (Moderate) airflow limitation is defined by an FEV1 between 50% and
79% of the predicted value. This staging is crucial for determining the appropriate
escalation of bronchodilator therapy. The APRN uses these objective spirometry measures
alongside symptom assessment to optimize the management of chronic respiratory
disease.
