NUR 6111 Exam 4 V2 | NUR 6111
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 4) | William
Paterson University
1. A 68-year-old female presents with progressive stiffness in her hands that is worse in the
evening. Examination reveals bony enlargements at the distal interphalangeal (DIP) joints.
What is the most likely diagnosis?
A. Rheumatoid Arthritis
B. Septic Arthritis
C. Psoriatic Arthritis
D. Osteoarthritis
Answer: D
Rationale: The presence of Heberden’s nodes at the DIP joints is a classic finding of
osteoarthritis. Unlike rheumatoid arthritis, osteoarthritis pain typically worsens with
activity and late in the day. Management focuses on non-pharmacological interventions and
pain control with NSAIDs or acetaminophen.
,2. An 45-year-old male presents with acute onset of severe pain, redness, and swelling in the
first metatarsophalangeal joint. Which of the following is the first-line treatment for an acute
flare?
A. Allopurinol
B. Febuxostat
C. Probenecid
D. Indomethacin
Answer: D
Rationale: NSAIDs such as indomethacin are considered first-line therapy for acute gouty
arthritis flares. Allopurinol and febuxostat are urate-lowering therapies and should not be
initiated during an acute attack. Colchicine is also an alternative if NSAIDs are
contraindicated for the patient.
3. A patient with a history of chronic low back pain presents with new-onset urinary
incontinence and ‘saddle anesthesia.’ What is the most appropriate next step in
management?
A. Immediate referral to the Emergency Department for MRI
B. Prescribe muscle relaxants and bed rest
C. Order a Lumbar X-ray
D. Schedule physical therapy evaluation
, Answer: A
Rationale: Saddle anesthesia and bowel or bladder dysfunction are hallmark signs of
Cauda Equina Syndrome, a neurosurgical emergency. Delay in decompression can lead to
permanent neurological deficits and paralysis. An urgent MRI is necessary to confirm the
diagnosis and determine the level of compression.
4. A 30-year-old female reports bilateral, band-like pressure around her head that lasts for
several hours. She denies nausea, vomiting, or photophobia. What is the primary diagnosis?
A. Migraine with Aura
B. Cluster Headache
C. Temporal Arteritis
D. Tension-Type Headache
Answer: D
Rationale: Tension-type headaches are typically described as bilateral, non-pulsating, and
‘band-like’ in quality. They lack the autonomic symptoms associated with cluster headaches
or the gastrointestinal symptoms of migraines. Initial management includes stress
reduction and over-the-counter analgesics.
5. Which of the following physical exam maneuvers is used to evaluate for a meniscus tear in
the knee?
A. Lachman Test
B. McMurray Test
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 4) | William
Paterson University
1. A 68-year-old female presents with progressive stiffness in her hands that is worse in the
evening. Examination reveals bony enlargements at the distal interphalangeal (DIP) joints.
What is the most likely diagnosis?
A. Rheumatoid Arthritis
B. Septic Arthritis
C. Psoriatic Arthritis
D. Osteoarthritis
Answer: D
Rationale: The presence of Heberden’s nodes at the DIP joints is a classic finding of
osteoarthritis. Unlike rheumatoid arthritis, osteoarthritis pain typically worsens with
activity and late in the day. Management focuses on non-pharmacological interventions and
pain control with NSAIDs or acetaminophen.
,2. An 45-year-old male presents with acute onset of severe pain, redness, and swelling in the
first metatarsophalangeal joint. Which of the following is the first-line treatment for an acute
flare?
A. Allopurinol
B. Febuxostat
C. Probenecid
D. Indomethacin
Answer: D
Rationale: NSAIDs such as indomethacin are considered first-line therapy for acute gouty
arthritis flares. Allopurinol and febuxostat are urate-lowering therapies and should not be
initiated during an acute attack. Colchicine is also an alternative if NSAIDs are
contraindicated for the patient.
3. A patient with a history of chronic low back pain presents with new-onset urinary
incontinence and ‘saddle anesthesia.’ What is the most appropriate next step in
management?
A. Immediate referral to the Emergency Department for MRI
B. Prescribe muscle relaxants and bed rest
C. Order a Lumbar X-ray
D. Schedule physical therapy evaluation
, Answer: A
Rationale: Saddle anesthesia and bowel or bladder dysfunction are hallmark signs of
Cauda Equina Syndrome, a neurosurgical emergency. Delay in decompression can lead to
permanent neurological deficits and paralysis. An urgent MRI is necessary to confirm the
diagnosis and determine the level of compression.
4. A 30-year-old female reports bilateral, band-like pressure around her head that lasts for
several hours. She denies nausea, vomiting, or photophobia. What is the primary diagnosis?
A. Migraine with Aura
B. Cluster Headache
C. Temporal Arteritis
D. Tension-Type Headache
Answer: D
Rationale: Tension-type headaches are typically described as bilateral, non-pulsating, and
‘band-like’ in quality. They lack the autonomic symptoms associated with cluster headaches
or the gastrointestinal symptoms of migraines. Initial management includes stress
reduction and over-the-counter analgesics.
5. Which of the following physical exam maneuvers is used to evaluate for a meniscus tear in
the knee?
A. Lachman Test
B. McMurray Test
