NUR 6130 Final Exam V1 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Final Exam) | William
Paterson University
1. A 68-year-old male presents with acute onset of shortness of breath and chest pain.
Physical exam reveals crackles in the lung bases and an S3 gallop. The most likely diagnosis is:
A. Pulmonary Embolism
B. Acute Decompensated Heart Failure
C. Community-Acquired Pneumonia
D. Pneumothorax
Answer: B
Rationale: The presence of an S3 gallop is a highly specific finding for left ventricular heart
failure and volume overload. Crackles at the lung bases indicate pulmonary edema
resulting from elevated wedge pressures. Prompt administration of loop diuretics and
assessment of cardiac output are essential for stabilizing this patient.
2. Which of the following is the first-line medication class for a patient diagnosed with Stage C
Heart Failure with Reduced Ejection Fraction (HFrEF) to improve survival?
A. Calcium Channel Blockers
B. Loop Diuretics
,C. Digoxin
D. ACE Inhibitors or ARNI
Answer: D
Rationale: ACE inhibitors, ARBs, and ARNI therapy are proven to reduce morbidity and
mortality in patients with HFrEF by inhibiting the renin-angiotensin-aldosterone system.
While diuretics manage symptoms of volume overload, they do not provide the same long-
term survival benefits. Beta-blockers and aldosterone antagonists are also considered
foundational therapies for these patients.
3. A 72-year-old patient with COPD presents with increased sputum purulence and increased
dyspnea. Which treatment modification is most indicated according to GOLD guidelines?
A. Inhaled Corticosteroids only
B. Antibiotic therapy
C. Short-acting beta-agonist as needed only
D. Long-term oxygen therapy
Answer: B
Rationale: According to the GOLD criteria, an increase in sputum purulence combined with
increased dyspnea or volume is a cardinal indication for antibiotics. These symptoms
suggest a bacterial exacerbation that requires targeted treatment to prevent further
respiratory decline. Supportive care with bronchodilators and systemic steroids should
also be considered based on the severity.
,4. A patient is admitted with a blood glucose of 750 mg/dL, arterial pH of 7.35, and negative
serum ketones. What is the most likely diagnosis?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Hypoglycemic Unawareness
D. Metabolic Syndrome
Answer: B
Rationale: HHS is characterized by profound hyperglycemia (often >600 mg/dL) and
hyperosmolality without significant ketosis or acidosis. In DKA, the pH is typically lower,
and ketones are present due to insulin deficiency leading to fatty acid metabolism. The
primary treatment for HHS focuses on aggressive fluid resuscitation and gradual insulin
administration.
5. In the management of Acute Kidney Injury (AKI), which finding is most consistent with a
‘Prerenal’ etiology?
A. Urine sodium > 40 mEq/L
B. Presence of muddy brown casts in urine
C. FeNa > 2%
D. Fractional Excretion of Sodium (FeNa) < 1%
Answer: D
, Rationale: A FeNa of less than 1% indicates that the kidneys are appropriately conserving
sodium in response to decreased renal perfusion, which is the hallmark of prerenal
azotemia. In contrast, intrarenal damage like Acute Tubular Necrosis (ATN) typically
results in a FeNa greater than 2% due to tubular dysfunction. Muddy brown casts are also a
specific indicator of ATN rather than prerenal causes.
6. A 55-year-old female presents with sudden onset of ‘the worst headache of her life’
followed by brief loss of consciousness. The most appropriate initial diagnostic test is:
A. Magnetic Resonance Imaging (MRI)
B. Non-contrast Computed Tomography (CT) of the head
C. Lumbar Puncture
D. Electroencephalogram (EEG)
Answer: B
Rationale: A non-contrast CT head is the gold standard for the initial evaluation of a
suspected subarachnoid hemorrhage (SAH). It is highly sensitive for detecting acute blood
in the subarachnoid space and is faster than an MRI. If the CT is negative but clinical
suspicion remains high, a lumbar puncture should be performed to check for
xanthochromia.
7. According to the Surviving Sepsis Campaign, which of the following should be completed
within the first hour of suspected sepsis?
A. Administration of broad-spectrum antibiotics and measurement of lactate
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Final Exam) | William
Paterson University
1. A 68-year-old male presents with acute onset of shortness of breath and chest pain.
Physical exam reveals crackles in the lung bases and an S3 gallop. The most likely diagnosis is:
A. Pulmonary Embolism
B. Acute Decompensated Heart Failure
C. Community-Acquired Pneumonia
D. Pneumothorax
Answer: B
Rationale: The presence of an S3 gallop is a highly specific finding for left ventricular heart
failure and volume overload. Crackles at the lung bases indicate pulmonary edema
resulting from elevated wedge pressures. Prompt administration of loop diuretics and
assessment of cardiac output are essential for stabilizing this patient.
2. Which of the following is the first-line medication class for a patient diagnosed with Stage C
Heart Failure with Reduced Ejection Fraction (HFrEF) to improve survival?
A. Calcium Channel Blockers
B. Loop Diuretics
,C. Digoxin
D. ACE Inhibitors or ARNI
Answer: D
Rationale: ACE inhibitors, ARBs, and ARNI therapy are proven to reduce morbidity and
mortality in patients with HFrEF by inhibiting the renin-angiotensin-aldosterone system.
While diuretics manage symptoms of volume overload, they do not provide the same long-
term survival benefits. Beta-blockers and aldosterone antagonists are also considered
foundational therapies for these patients.
3. A 72-year-old patient with COPD presents with increased sputum purulence and increased
dyspnea. Which treatment modification is most indicated according to GOLD guidelines?
A. Inhaled Corticosteroids only
B. Antibiotic therapy
C. Short-acting beta-agonist as needed only
D. Long-term oxygen therapy
Answer: B
Rationale: According to the GOLD criteria, an increase in sputum purulence combined with
increased dyspnea or volume is a cardinal indication for antibiotics. These symptoms
suggest a bacterial exacerbation that requires targeted treatment to prevent further
respiratory decline. Supportive care with bronchodilators and systemic steroids should
also be considered based on the severity.
,4. A patient is admitted with a blood glucose of 750 mg/dL, arterial pH of 7.35, and negative
serum ketones. What is the most likely diagnosis?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Hypoglycemic Unawareness
D. Metabolic Syndrome
Answer: B
Rationale: HHS is characterized by profound hyperglycemia (often >600 mg/dL) and
hyperosmolality without significant ketosis or acidosis. In DKA, the pH is typically lower,
and ketones are present due to insulin deficiency leading to fatty acid metabolism. The
primary treatment for HHS focuses on aggressive fluid resuscitation and gradual insulin
administration.
5. In the management of Acute Kidney Injury (AKI), which finding is most consistent with a
‘Prerenal’ etiology?
A. Urine sodium > 40 mEq/L
B. Presence of muddy brown casts in urine
C. FeNa > 2%
D. Fractional Excretion of Sodium (FeNa) < 1%
Answer: D
, Rationale: A FeNa of less than 1% indicates that the kidneys are appropriately conserving
sodium in response to decreased renal perfusion, which is the hallmark of prerenal
azotemia. In contrast, intrarenal damage like Acute Tubular Necrosis (ATN) typically
results in a FeNa greater than 2% due to tubular dysfunction. Muddy brown casts are also a
specific indicator of ATN rather than prerenal causes.
6. A 55-year-old female presents with sudden onset of ‘the worst headache of her life’
followed by brief loss of consciousness. The most appropriate initial diagnostic test is:
A. Magnetic Resonance Imaging (MRI)
B. Non-contrast Computed Tomography (CT) of the head
C. Lumbar Puncture
D. Electroencephalogram (EEG)
Answer: B
Rationale: A non-contrast CT head is the gold standard for the initial evaluation of a
suspected subarachnoid hemorrhage (SAH). It is highly sensitive for detecting acute blood
in the subarachnoid space and is faster than an MRI. If the CT is negative but clinical
suspicion remains high, a lumbar puncture should be performed to check for
xanthochromia.
7. According to the Surviving Sepsis Campaign, which of the following should be completed
within the first hour of suspected sepsis?
A. Administration of broad-spectrum antibiotics and measurement of lactate
