WILLIAM PATERSON UNIVERSITY NUR 6121 ADVANCED
PRACTICE NURSING 2 EXAM 3 EXAM BRAND NEW VERSION
2027-2028 Q&A EXAM | ALL QUESTIONS AND ANSWERS PLUS
DETAILED RATIONALES | COMPLETE STUDYGUIDE|
GUARANTEED PASS | DOWNLOAD INSTANT PDF 2027-2028
1. A 58-year-old patient with hypertension has a blood pressure of 168/96 mmHg at an
outpatient visit. The patient reports taking the prescribed medication inconsistently
because of cost. Which action should the advanced practice nurse take FIRST?
A. Add a second antihypertensive medication
B. Assess the patient's barriers to medication adherence and discuss affordable treatment
options
C. Schedule the patient for hospitalization
D. Recommend sodium restriction only
The immediate priority is identifying and addressing the modifiable barrier to adherence.
Escalating therapy without determining whether the current regimen is being taken
appropriately may result in unnecessary treatment and does not address the underlying
problem.
2. A patient taking lisinopril develops persistent dry cough but has no dyspnea, wheezing,
or angioedema. Which medication is the most appropriate alternative?
A. Losartan
B. Propranolol
C. Hydrochlorothiazide
D. Diltiazem
Angiotensin II receptor blockers such as losartan provide similar antihypertensive effects
without the increased incidence of bradykinin-mediated cough associated with ACE inhibitors.
3. A 67-year-old patient with type 2 diabetes has an HbA1c of 9.4% despite adherence to
metformin. The patient has obesity and established atherosclerotic cardiovascular disease.
Which additional medication class is particularly appropriate?
A. Sulfonylurea
B. Thiazolidinedione
C. GLP-1 receptor agonist
D. Alpha-glucosidase inhibitor
GLP-1 receptor agonists can substantially improve glycemic control while promoting weight
loss and providing cardiovascular benefits in appropriate patients with type 2 diabetes and
established cardiovascular disease.
,4. A patient with diabetes reports sweating, tremulousness, palpitations, and confusion
after skipping lunch. A bedside glucose level is 48 mg/dL, and the patient is awake and able
to swallow. What should the nurse recommend immediately?
A. Administer long-acting insulin
B. Give 15–20 g of rapid-acting carbohydrate
C. Give a high-protein meal only
D. Restrict oral intake until glucose normalizes
A conscious patient with symptomatic hypoglycemia should receive approximately 15–20 g of
rapidly absorbed carbohydrate, followed by reassessment of glucose and additional
treatment if needed.
5. During a routine visit, an adult patient reports fatigue, cold intolerance, constipation,
and a 6-kg weight gain. Which laboratory pattern is most consistent with primary
hypothyroidism?
A. Low TSH and high free T4
B. High TSH and low free T4
C. Low TSH and low free T4
D. High TSH and high free T4
Primary hypothyroidism results from inadequate thyroid hormone production by the thyroid
gland. The pituitary responds by increasing TSH secretion, producing a high TSH and low free
T4 pattern.
6. A patient with hyperthyroidism presents with fever, severe agitation, tachycardia,
vomiting, and diarrhea. Which complication should the advanced practice nurse suspect?
A. Myxedema coma
B. Thyroid storm
C. Adrenal insufficiency
D. Nephrotic syndrome
The combination of severe hyperthermia, gastrointestinal symptoms, central nervous system
changes, and marked sympathetic activity is characteristic of thyroid storm, a life-threatening
endocrine emergency.
7. A 45-year-old patient with chronic kidney disease has potassium of 6.7 mEq/L and
peaked T waves on ECG. Which intervention is the immediate priority?
A. Administer IV calcium as prescribed
B. Encourage oral potassium intake
C. Restrict dietary sodium
D. Administer an oral iron supplement
Severe hyperkalemia with ECG changes creates an immediate risk of fatal dysrhythmia. IV
calcium stabilizes the cardiac membrane while definitive measures are initiated to reduce
serum potassium.
,8. A patient with chronic kidney disease is prescribed an NSAID for chronic back pain.
Which concern is most important?
A. Increased vitamin B12 absorption
B. Reduced renal perfusion and worsening kidney function
C. Increased thyroid hormone production
D. Improved glomerular filtration
NSAIDs inhibit prostaglandin synthesis, which can reduce renal blood flow, particularly in
patients with impaired renal function, and may worsen kidney injury.
9. A patient reports polyuria, polydipsia, blurred vision, and recurrent candidal infections.
Which initial laboratory test is most appropriate to evaluate suspected diabetes mellitus?
A. Serum calcium
B. Hemoglobin electrophoresis
C. HbA1c or plasma glucose testing
D. Serum amylase
HbA1c and plasma glucose measurements are standard diagnostic tests for diabetes mellitus
and can establish whether persistent hyperglycemia is present.
10. A patient with newly diagnosed hyperlipidemia asks why lifestyle changes are
recommended even after medication is prescribed. Which response is BEST?
A. "Lifestyle changes are unnecessary if medication is effective."
B. "Lifestyle modification can improve cardiovascular risk factors and complement
pharmacologic therapy."
C. "Medication works only when you exercise daily."
D. "Diet changes primarily prevent anemia."
Dietary improvement, physical activity, weight management, and other lifestyle interventions
can reduce cardiovascular risk and enhance the effectiveness of lipid-lowering therapy.
11. A 72-year-old patient taking warfarin presents with melena and an INR of 7.2. Which
action is most appropriate?
A. Tell the patient to take the next scheduled dose
B. Hold warfarin and urgently evaluate the bleeding while considering reversal therapy
C. Increase the warfarin dose
D. Administer aspirin
A markedly elevated INR accompanied by clinically significant bleeding requires immediate
discontinuation of warfarin and urgent assessment for appropriate reversal and bleeding
management.
12. A patient taking apixaban asks whether routine INR monitoring is necessary. Which
response is correct?
A. "INR must be checked every day."
, B. "INR is required before every dose."
C. "Routine INR monitoring is not used to dose-adjust apixaban."
D. "INR should replace renal function monitoring."
Direct oral anticoagulants such as apixaban do not require routine INR-guided dose
adjustment. Renal function, medication interactions, adherence, and bleeding risk remain
important considerations.
13. A patient with atrial fibrillation has a ventricular rate of 148 beats/minute and reports
palpitations and mild dyspnea. The patient is hemodynamically stable. Which treatment
goal is most appropriate initially?
A. Immediate synchronized cardioversion for every stable patient
B. Ventricular rate control and assessment of stroke-prevention needs
C. Permanent pacemaker placement
D. Discontinuation of all cardiovascular medications
In a hemodynamically stable patient with atrial fibrillation and rapid ventricular response,
rate control and evaluation of thromboembolic risk are key components of management.
14. A patient taking digoxin reports nausea, anorexia, weakness, and yellow-green visual
disturbances. Which action should the nurse take?
A. Reassure the patient that these effects are expected
B. Recommend doubling the next dose
C. Hold the medication and notify the prescribing clinician for evaluation
D. Administer additional potassium without assessment
Gastrointestinal symptoms, weakness, and visual disturbances are classic warning signs of
possible digoxin toxicity. The medication should be withheld pending clinical evaluation and
appropriate testing.
15. A patient with heart failure reports a 3-kg weight gain over four days and increasing
ankle edema. Which interpretation is most appropriate?
A. The weight gain is expected aging
B. The findings suggest fluid retention and possible worsening heart failure
C. The findings indicate improved cardiac function
D. The patient should increase sodium intake
Rapid weight gain with edema is a common indicator of fluid accumulation in heart failure
and warrants assessment of symptoms, medication adherence, dietary sodium intake, and
volume status.
16. A patient with asthma uses a short-acting beta2 agonist several times each day for
symptom relief. What does this pattern most strongly suggest?
A. Excellent asthma control
B. A need to reassess long-term controller therapy
PRACTICE NURSING 2 EXAM 3 EXAM BRAND NEW VERSION
2027-2028 Q&A EXAM | ALL QUESTIONS AND ANSWERS PLUS
DETAILED RATIONALES | COMPLETE STUDYGUIDE|
GUARANTEED PASS | DOWNLOAD INSTANT PDF 2027-2028
1. A 58-year-old patient with hypertension has a blood pressure of 168/96 mmHg at an
outpatient visit. The patient reports taking the prescribed medication inconsistently
because of cost. Which action should the advanced practice nurse take FIRST?
A. Add a second antihypertensive medication
B. Assess the patient's barriers to medication adherence and discuss affordable treatment
options
C. Schedule the patient for hospitalization
D. Recommend sodium restriction only
The immediate priority is identifying and addressing the modifiable barrier to adherence.
Escalating therapy without determining whether the current regimen is being taken
appropriately may result in unnecessary treatment and does not address the underlying
problem.
2. A patient taking lisinopril develops persistent dry cough but has no dyspnea, wheezing,
or angioedema. Which medication is the most appropriate alternative?
A. Losartan
B. Propranolol
C. Hydrochlorothiazide
D. Diltiazem
Angiotensin II receptor blockers such as losartan provide similar antihypertensive effects
without the increased incidence of bradykinin-mediated cough associated with ACE inhibitors.
3. A 67-year-old patient with type 2 diabetes has an HbA1c of 9.4% despite adherence to
metformin. The patient has obesity and established atherosclerotic cardiovascular disease.
Which additional medication class is particularly appropriate?
A. Sulfonylurea
B. Thiazolidinedione
C. GLP-1 receptor agonist
D. Alpha-glucosidase inhibitor
GLP-1 receptor agonists can substantially improve glycemic control while promoting weight
loss and providing cardiovascular benefits in appropriate patients with type 2 diabetes and
established cardiovascular disease.
,4. A patient with diabetes reports sweating, tremulousness, palpitations, and confusion
after skipping lunch. A bedside glucose level is 48 mg/dL, and the patient is awake and able
to swallow. What should the nurse recommend immediately?
A. Administer long-acting insulin
B. Give 15–20 g of rapid-acting carbohydrate
C. Give a high-protein meal only
D. Restrict oral intake until glucose normalizes
A conscious patient with symptomatic hypoglycemia should receive approximately 15–20 g of
rapidly absorbed carbohydrate, followed by reassessment of glucose and additional
treatment if needed.
5. During a routine visit, an adult patient reports fatigue, cold intolerance, constipation,
and a 6-kg weight gain. Which laboratory pattern is most consistent with primary
hypothyroidism?
A. Low TSH and high free T4
B. High TSH and low free T4
C. Low TSH and low free T4
D. High TSH and high free T4
Primary hypothyroidism results from inadequate thyroid hormone production by the thyroid
gland. The pituitary responds by increasing TSH secretion, producing a high TSH and low free
T4 pattern.
6. A patient with hyperthyroidism presents with fever, severe agitation, tachycardia,
vomiting, and diarrhea. Which complication should the advanced practice nurse suspect?
A. Myxedema coma
B. Thyroid storm
C. Adrenal insufficiency
D. Nephrotic syndrome
The combination of severe hyperthermia, gastrointestinal symptoms, central nervous system
changes, and marked sympathetic activity is characteristic of thyroid storm, a life-threatening
endocrine emergency.
7. A 45-year-old patient with chronic kidney disease has potassium of 6.7 mEq/L and
peaked T waves on ECG. Which intervention is the immediate priority?
A. Administer IV calcium as prescribed
B. Encourage oral potassium intake
C. Restrict dietary sodium
D. Administer an oral iron supplement
Severe hyperkalemia with ECG changes creates an immediate risk of fatal dysrhythmia. IV
calcium stabilizes the cardiac membrane while definitive measures are initiated to reduce
serum potassium.
,8. A patient with chronic kidney disease is prescribed an NSAID for chronic back pain.
Which concern is most important?
A. Increased vitamin B12 absorption
B. Reduced renal perfusion and worsening kidney function
C. Increased thyroid hormone production
D. Improved glomerular filtration
NSAIDs inhibit prostaglandin synthesis, which can reduce renal blood flow, particularly in
patients with impaired renal function, and may worsen kidney injury.
9. A patient reports polyuria, polydipsia, blurred vision, and recurrent candidal infections.
Which initial laboratory test is most appropriate to evaluate suspected diabetes mellitus?
A. Serum calcium
B. Hemoglobin electrophoresis
C. HbA1c or plasma glucose testing
D. Serum amylase
HbA1c and plasma glucose measurements are standard diagnostic tests for diabetes mellitus
and can establish whether persistent hyperglycemia is present.
10. A patient with newly diagnosed hyperlipidemia asks why lifestyle changes are
recommended even after medication is prescribed. Which response is BEST?
A. "Lifestyle changes are unnecessary if medication is effective."
B. "Lifestyle modification can improve cardiovascular risk factors and complement
pharmacologic therapy."
C. "Medication works only when you exercise daily."
D. "Diet changes primarily prevent anemia."
Dietary improvement, physical activity, weight management, and other lifestyle interventions
can reduce cardiovascular risk and enhance the effectiveness of lipid-lowering therapy.
11. A 72-year-old patient taking warfarin presents with melena and an INR of 7.2. Which
action is most appropriate?
A. Tell the patient to take the next scheduled dose
B. Hold warfarin and urgently evaluate the bleeding while considering reversal therapy
C. Increase the warfarin dose
D. Administer aspirin
A markedly elevated INR accompanied by clinically significant bleeding requires immediate
discontinuation of warfarin and urgent assessment for appropriate reversal and bleeding
management.
12. A patient taking apixaban asks whether routine INR monitoring is necessary. Which
response is correct?
A. "INR must be checked every day."
, B. "INR is required before every dose."
C. "Routine INR monitoring is not used to dose-adjust apixaban."
D. "INR should replace renal function monitoring."
Direct oral anticoagulants such as apixaban do not require routine INR-guided dose
adjustment. Renal function, medication interactions, adherence, and bleeding risk remain
important considerations.
13. A patient with atrial fibrillation has a ventricular rate of 148 beats/minute and reports
palpitations and mild dyspnea. The patient is hemodynamically stable. Which treatment
goal is most appropriate initially?
A. Immediate synchronized cardioversion for every stable patient
B. Ventricular rate control and assessment of stroke-prevention needs
C. Permanent pacemaker placement
D. Discontinuation of all cardiovascular medications
In a hemodynamically stable patient with atrial fibrillation and rapid ventricular response,
rate control and evaluation of thromboembolic risk are key components of management.
14. A patient taking digoxin reports nausea, anorexia, weakness, and yellow-green visual
disturbances. Which action should the nurse take?
A. Reassure the patient that these effects are expected
B. Recommend doubling the next dose
C. Hold the medication and notify the prescribing clinician for evaluation
D. Administer additional potassium without assessment
Gastrointestinal symptoms, weakness, and visual disturbances are classic warning signs of
possible digoxin toxicity. The medication should be withheld pending clinical evaluation and
appropriate testing.
15. A patient with heart failure reports a 3-kg weight gain over four days and increasing
ankle edema. Which interpretation is most appropriate?
A. The weight gain is expected aging
B. The findings suggest fluid retention and possible worsening heart failure
C. The findings indicate improved cardiac function
D. The patient should increase sodium intake
Rapid weight gain with edema is a common indicator of fluid accumulation in heart failure
and warrants assessment of symptoms, medication adherence, dietary sodium intake, and
volume status.
16. A patient with asthma uses a short-acting beta2 agonist several times each day for
symptom relief. What does this pattern most strongly suggest?
A. Excellent asthma control
B. A need to reassess long-term controller therapy
