NUR612/NUR 612 Exam 3 V1 | Advanced
Nursing II Q&A with Rationale | William
Paterson University
1. A patient presents with sudden onset of shortness of breath and pleuritic chest pain.
Which diagnostic test is the gold standard for confirming a Pulmonary Embolism (PE)?
A. Chest X-ray
B. D-dimer assay
C. CT Angiography (CTA)
D. Arterial Blood Gas (ABG)
Answer: C
Rationale: CT Angiography is considered the gold standard because it provides high
sensitivity and specificity for visualizing thrombi in the pulmonary vasculature. While a D-
dimer is useful for ruling out PE in low-risk patients, it is not definitive for confirmation.
Chest X-rays are often normal in PE cases and are primarily used to rule out other causes of
respiratory distress.
2. In the management of heart failure, which medication class is primarily used to block the
effects of the sympathetic nervous system on the heart?
A. Beta-Blockers
B. ACE Inhibitors
,C. Calcium Channel Blockers
D. Loop Diuretics
Answer: A
Rationale: Beta-blockers inhibit the binding of norepinephrine and epinephrine to beta
receptors, which reduces heart rate and myocardial oxygen demand. This class of
medication is crucial for long-term survival in heart failure patients by preventing cardiac
remodeling. ACE inhibitors, while important, focus on the renin-angiotensin-aldosterone
system rather than the sympathetic nervous system.
3. Which laboratory value is most indicative of chronic kidney disease (CKD) progression over
time?
A. Blood Urea Nitrogen (BUN)
B. Serum Potassium
C. Serum Sodium
D. Glomerular Filtration Rate (GFR)
Answer: D
Rationale: GFR is the most reliable measure of overall kidney function and is used to stage
chronic kidney disease. BUN levels can be influenced by diet, hydration status, and other
non-renal factors, making it less specific than GFR. Tracking the decline in GFR helps
clinicians determine when to initiate dialysis or consider transplant options.
, 4. A patient with Type 2 Diabetes has an A1C of 8.5% despite lifestyle changes. Which
medication is usually the first-line pharmacological treatment?
A. Glipizide
B. Pioglitazone
C. Lantus Insulin
D. Metformin
Answer: D
Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of type
2 diabetes due to its efficacy and safety profile. It works by decreasing hepatic glucose
production and improving insulin sensitivity in peripheral tissues. Unless contraindicated
by renal impairment, it remains the cornerstone of glycemic management for most
patients.
5. When assessing a patient with suspected Cushing’s Syndrome, which physical finding is
most characteristic?
A. Hyperpigmentation of the skin
B. Exophthalmos
C. Central obesity with thin extremities
D. Pretibial myxedema
Answer: C
Nursing II Q&A with Rationale | William
Paterson University
1. A patient presents with sudden onset of shortness of breath and pleuritic chest pain.
Which diagnostic test is the gold standard for confirming a Pulmonary Embolism (PE)?
A. Chest X-ray
B. D-dimer assay
C. CT Angiography (CTA)
D. Arterial Blood Gas (ABG)
Answer: C
Rationale: CT Angiography is considered the gold standard because it provides high
sensitivity and specificity for visualizing thrombi in the pulmonary vasculature. While a D-
dimer is useful for ruling out PE in low-risk patients, it is not definitive for confirmation.
Chest X-rays are often normal in PE cases and are primarily used to rule out other causes of
respiratory distress.
2. In the management of heart failure, which medication class is primarily used to block the
effects of the sympathetic nervous system on the heart?
A. Beta-Blockers
B. ACE Inhibitors
,C. Calcium Channel Blockers
D. Loop Diuretics
Answer: A
Rationale: Beta-blockers inhibit the binding of norepinephrine and epinephrine to beta
receptors, which reduces heart rate and myocardial oxygen demand. This class of
medication is crucial for long-term survival in heart failure patients by preventing cardiac
remodeling. ACE inhibitors, while important, focus on the renin-angiotensin-aldosterone
system rather than the sympathetic nervous system.
3. Which laboratory value is most indicative of chronic kidney disease (CKD) progression over
time?
A. Blood Urea Nitrogen (BUN)
B. Serum Potassium
C. Serum Sodium
D. Glomerular Filtration Rate (GFR)
Answer: D
Rationale: GFR is the most reliable measure of overall kidney function and is used to stage
chronic kidney disease. BUN levels can be influenced by diet, hydration status, and other
non-renal factors, making it less specific than GFR. Tracking the decline in GFR helps
clinicians determine when to initiate dialysis or consider transplant options.
, 4. A patient with Type 2 Diabetes has an A1C of 8.5% despite lifestyle changes. Which
medication is usually the first-line pharmacological treatment?
A. Glipizide
B. Pioglitazone
C. Lantus Insulin
D. Metformin
Answer: D
Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of type
2 diabetes due to its efficacy and safety profile. It works by decreasing hepatic glucose
production and improving insulin sensitivity in peripheral tissues. Unless contraindicated
by renal impairment, it remains the cornerstone of glycemic management for most
patients.
5. When assessing a patient with suspected Cushing’s Syndrome, which physical finding is
most characteristic?
A. Hyperpigmentation of the skin
B. Exophthalmos
C. Central obesity with thin extremities
D. Pretibial myxedema
Answer: C
