NUR 6130 Exam 4 V3 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 4) | William
Paterson University
1. A 65-year-old male with a history of hypertension and Type 2 Diabetes presents with a new
onset of resting tremor and bradykinesia. Which of the following is the most appropriate
initial pharmacological treatment for Parkinson’s disease in this patient?
A. Selegiline
B. Amantadine
C. Benztropine
D. Carbidopa/Levodopa
Answer: D
Rationale: Carbidopa/Levodopa remains the gold standard and most effective treatment
for motor symptoms of Parkinson’s disease, especially in older adults. Levodopa is the
precursor to dopamine, while carbidopa prevents its peripheral breakdown to reduce side
effects like nausea. The clinician must monitor the patient for long-term complications such
as dyskinesias and the ‘wearing-off’ phenomenon.
,2. A 54-year-old female patient presents with chronic epigastric pain that is relieved by food
intake but recurs 2-3 hours later. A urea breath test is positive for H. pylori. Which of the
following is the standard first-line quadruple therapy?
A. Amoxicillin, Clarithromycin, and Omeprazole
B. Amoxicillin, Levofloxacin, and a PPI
C. Ciprofloxacin, Metronidazole, and Ranitidine
D. Bismuth subsalicylate, Metronidazole, Tetracycline, and a PPI
Answer: D
Rationale: Bismuth-based quadruple therapy is now recommended as first-line treatment
due to increasing clarithromycin resistance. This regimen consists of a proton pump
inhibitor (PPI), bismuth, metronidazole, and tetracycline taken for 10 to 14 days. Proper
adherence is critical to ensure eradication and prevent the development of antibiotic-
resistant strains of H. pylori.
3. Which of the following lab findings is most characteristic of primary hyperparathyroidism
in an asymptomatic 60-year-old patient?
A. Low serum calcium and high PTH
B. High serum calcium and low PTH
C. High serum calcium and high PTH
D. Low serum calcium and low PTH
,Answer: C
Rationale: Primary hyperparathyroidism is characterized by the autonomous
overproduction of parathyroid hormone, usually by a benign adenoma. This results in
elevated serum calcium levels due to increased bone resorption and renal calcium
reabsorption. In a normal physiological state, high calcium should suppress PTH; therefore,
a high PTH in the presence of hypercalcemia confirms the diagnosis.
4. An 82-year-old patient is brought to the clinic for a routine wellness exam. According to the
Beers Criteria, which of the following medications should be avoided in this patient due to
high risk of falls?
A. Lisinopril
B. Metformin
C. Atorvastatin
D. Alprazolam
Answer: D
Rationale: Benzodiazepines like alprazolam are listed on the Beers Criteria as potentially
inappropriate for older adults. They increase the risk of cognitive impairment, delirium,
falls, and fractures in the geriatric population. Clinicians should seek non-pharmacological
alternatives or safer medication classes for anxiety or insomnia in the elderly.
, 5. A patient with a history of cirrhosis presents with increasing confusion and a flapping
tremor of the hands (asterixis). Which medication is first-line to reduce ammonia levels?
A. Spironolactone
B. Propranolol
C. Furosemide
D. Lactulose
Answer: D
Rationale: Lactulose is an osmotic laxative that converts ammonia to ammonium in the
gut, which is then excreted in the stool. This process reduces the circulating levels of
ammonia that contribute to hepatic encephalopathy. The dosage should be titrated to
achieve 2-3 soft bowel movements per day while monitoring for dehydration and
electrolyte imbalances.
6. A 45-year-old female presents with symmetric joint pain in her hands and morning stiffness
lasting over an hour. Laboratory results show a positive Rheumatoid Factor and elevated ESR.
Which is the preferred initial disease-modifying antirheumatic drug (DMARD)?
A. Methotrexate
B. Prednisone
C. Naproxen
D. Hydroxychloroquine
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 4) | William
Paterson University
1. A 65-year-old male with a history of hypertension and Type 2 Diabetes presents with a new
onset of resting tremor and bradykinesia. Which of the following is the most appropriate
initial pharmacological treatment for Parkinson’s disease in this patient?
A. Selegiline
B. Amantadine
C. Benztropine
D. Carbidopa/Levodopa
Answer: D
Rationale: Carbidopa/Levodopa remains the gold standard and most effective treatment
for motor symptoms of Parkinson’s disease, especially in older adults. Levodopa is the
precursor to dopamine, while carbidopa prevents its peripheral breakdown to reduce side
effects like nausea. The clinician must monitor the patient for long-term complications such
as dyskinesias and the ‘wearing-off’ phenomenon.
,2. A 54-year-old female patient presents with chronic epigastric pain that is relieved by food
intake but recurs 2-3 hours later. A urea breath test is positive for H. pylori. Which of the
following is the standard first-line quadruple therapy?
A. Amoxicillin, Clarithromycin, and Omeprazole
B. Amoxicillin, Levofloxacin, and a PPI
C. Ciprofloxacin, Metronidazole, and Ranitidine
D. Bismuth subsalicylate, Metronidazole, Tetracycline, and a PPI
Answer: D
Rationale: Bismuth-based quadruple therapy is now recommended as first-line treatment
due to increasing clarithromycin resistance. This regimen consists of a proton pump
inhibitor (PPI), bismuth, metronidazole, and tetracycline taken for 10 to 14 days. Proper
adherence is critical to ensure eradication and prevent the development of antibiotic-
resistant strains of H. pylori.
3. Which of the following lab findings is most characteristic of primary hyperparathyroidism
in an asymptomatic 60-year-old patient?
A. Low serum calcium and high PTH
B. High serum calcium and low PTH
C. High serum calcium and high PTH
D. Low serum calcium and low PTH
,Answer: C
Rationale: Primary hyperparathyroidism is characterized by the autonomous
overproduction of parathyroid hormone, usually by a benign adenoma. This results in
elevated serum calcium levels due to increased bone resorption and renal calcium
reabsorption. In a normal physiological state, high calcium should suppress PTH; therefore,
a high PTH in the presence of hypercalcemia confirms the diagnosis.
4. An 82-year-old patient is brought to the clinic for a routine wellness exam. According to the
Beers Criteria, which of the following medications should be avoided in this patient due to
high risk of falls?
A. Lisinopril
B. Metformin
C. Atorvastatin
D. Alprazolam
Answer: D
Rationale: Benzodiazepines like alprazolam are listed on the Beers Criteria as potentially
inappropriate for older adults. They increase the risk of cognitive impairment, delirium,
falls, and fractures in the geriatric population. Clinicians should seek non-pharmacological
alternatives or safer medication classes for anxiety or insomnia in the elderly.
, 5. A patient with a history of cirrhosis presents with increasing confusion and a flapping
tremor of the hands (asterixis). Which medication is first-line to reduce ammonia levels?
A. Spironolactone
B. Propranolol
C. Furosemide
D. Lactulose
Answer: D
Rationale: Lactulose is an osmotic laxative that converts ammonia to ammonium in the
gut, which is then excreted in the stool. This process reduces the circulating levels of
ammonia that contribute to hepatic encephalopathy. The dosage should be titrated to
achieve 2-3 soft bowel movements per day while monitoring for dehydration and
electrolyte imbalances.
6. A 45-year-old female presents with symmetric joint pain in her hands and morning stiffness
lasting over an hour. Laboratory results show a positive Rheumatoid Factor and elevated ESR.
Which is the preferred initial disease-modifying antirheumatic drug (DMARD)?
A. Methotrexate
B. Prednisone
C. Naproxen
D. Hydroxychloroquine
