NUR 6111 Final Exam V3 | NUR 6111
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Final Exam) | William
Paterson University
1. A 55-year-old male presents with a blood pressure reading of 152/94 mmHg on two
separate occasions. According to JNC 8 guidelines, which of the following is the most
appropriate initial pharmacological intervention for a non-black patient without chronic
kidney disease?
A. Spironolactone
B. Metoprolol
C. Clonidine
D. Lisinopril
Answer: D
Rationale: According to the JNC 8 guidelines, the first-line treatment options for
hypertension in the general non-black population include ACE inhibitors, ARBs, CCBs, or
thiazide-type diuretics. Lisinopril is an ACE inhibitor, which is a recommended starting
agent to reduce cardiovascular morbidity. Beta-blockers like Metoprolol are no longer
considered first-line for primary hypertension management unless a specific compelling
indication exists.
,2. A patient presents with a holosystolic murmur heard best at the apex, radiating to the left
axilla. The nurse practitioner recognizes this as most likely being:
A. Aortic Stenosis
B. Mitral Stenosis
C. Mitral Regurgitation
D. Aortic Regurgitation
Answer: C
Rationale: Mitral regurgitation is characterized by a high-pitched, holosystolic murmur
that is best heard at the apex with the diaphragm of the stethoscope. This murmur typically
radiates to the left axilla and occurs during systole when the mitral valve fails to close
properly. In contrast, aortic stenosis is a mid-systolic ejection murmur heard best at the
second right intercostal space.
3. Which of the following physical examination findings is most indicative of acute
cholecystitis?
A. Murphy’s sign
B. Rovsing’s sign
C. Psoas sign
D. McBurney’s sign
Answer: A
,Rationale: Murphy’s sign is performed by asking the patient to inhale while the clinician
applies pressure to the right upper quadrant; a positive result is the cessation of
inspiration due to pain. This finding is highly specific for gallbladder inflammation or acute
cholecystitis. Psoas, Rovsing’s, and McBurney’s signs are all maneuvers used to assess for
acute appendicitis.
4. A 68-year-old female smoker presents with a chronic cough and increased sputum
production. Her FEV1/FVC ratio is 0.62. Which diagnosis is most supported by these findings?
A. Asthma
B. Congestive Heart Failure
C. Restrictive Lung Disease
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Rationale: COPD is defined by the GOLD criteria as a post-bronchodilator FEV1/FVC ratio
of less than 0.70. The patient’s clinical presentation of chronic cough and smoking history
strongly supports this obstructive diagnosis. Restrictive lung diseases usually present with
a normal or increased FEV1/FVC ratio but decreased total lung volume.
5. The nurse practitioner is managing a patient with type 2 diabetes. The patient’s A1C is 8.2%
despite lifestyle modifications. Which medication is the preferred first-line agent for this
patient?
A. Glyburide
, B. Sitagliptin
C. Pioglitazone
D. Metformin
Answer: D
Rationale: Metformin is the first-line pharmacological treatment for type 2 diabetes
according to American Diabetes Association (ADA) guidelines due to its efficacy and safety
profile. It works primarily by decreasing hepatic glucose production and increasing insulin
sensitivity. Unless contraindicated by renal impairment, it remains the foundation of
glycemic management.
6. During a neurological exam, the patient is unable to close their right eye or smile on the
right side of their face. Which cranial nerve is likely affected?
A. Cranial Nerve VII
B. Cranial Nerve V
C. Cranial Nerve III
D. Cranial Nerve X
Answer: A
Rationale: Cranial Nerve VII, the facial nerve, controls the muscles of facial expression,
including closing the eyes and smiling. Damage to this nerve, often seen in Bell’s Palsy,
results in ipsilateral facial drooping and the inability to perform these movements. Cranial
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Final Exam) | William
Paterson University
1. A 55-year-old male presents with a blood pressure reading of 152/94 mmHg on two
separate occasions. According to JNC 8 guidelines, which of the following is the most
appropriate initial pharmacological intervention for a non-black patient without chronic
kidney disease?
A. Spironolactone
B. Metoprolol
C. Clonidine
D. Lisinopril
Answer: D
Rationale: According to the JNC 8 guidelines, the first-line treatment options for
hypertension in the general non-black population include ACE inhibitors, ARBs, CCBs, or
thiazide-type diuretics. Lisinopril is an ACE inhibitor, which is a recommended starting
agent to reduce cardiovascular morbidity. Beta-blockers like Metoprolol are no longer
considered first-line for primary hypertension management unless a specific compelling
indication exists.
,2. A patient presents with a holosystolic murmur heard best at the apex, radiating to the left
axilla. The nurse practitioner recognizes this as most likely being:
A. Aortic Stenosis
B. Mitral Stenosis
C. Mitral Regurgitation
D. Aortic Regurgitation
Answer: C
Rationale: Mitral regurgitation is characterized by a high-pitched, holosystolic murmur
that is best heard at the apex with the diaphragm of the stethoscope. This murmur typically
radiates to the left axilla and occurs during systole when the mitral valve fails to close
properly. In contrast, aortic stenosis is a mid-systolic ejection murmur heard best at the
second right intercostal space.
3. Which of the following physical examination findings is most indicative of acute
cholecystitis?
A. Murphy’s sign
B. Rovsing’s sign
C. Psoas sign
D. McBurney’s sign
Answer: A
,Rationale: Murphy’s sign is performed by asking the patient to inhale while the clinician
applies pressure to the right upper quadrant; a positive result is the cessation of
inspiration due to pain. This finding is highly specific for gallbladder inflammation or acute
cholecystitis. Psoas, Rovsing’s, and McBurney’s signs are all maneuvers used to assess for
acute appendicitis.
4. A 68-year-old female smoker presents with a chronic cough and increased sputum
production. Her FEV1/FVC ratio is 0.62. Which diagnosis is most supported by these findings?
A. Asthma
B. Congestive Heart Failure
C. Restrictive Lung Disease
D. Chronic Obstructive Pulmonary Disease (COPD)
Answer: D
Rationale: COPD is defined by the GOLD criteria as a post-bronchodilator FEV1/FVC ratio
of less than 0.70. The patient’s clinical presentation of chronic cough and smoking history
strongly supports this obstructive diagnosis. Restrictive lung diseases usually present with
a normal or increased FEV1/FVC ratio but decreased total lung volume.
5. The nurse practitioner is managing a patient with type 2 diabetes. The patient’s A1C is 8.2%
despite lifestyle modifications. Which medication is the preferred first-line agent for this
patient?
A. Glyburide
, B. Sitagliptin
C. Pioglitazone
D. Metformin
Answer: D
Rationale: Metformin is the first-line pharmacological treatment for type 2 diabetes
according to American Diabetes Association (ADA) guidelines due to its efficacy and safety
profile. It works primarily by decreasing hepatic glucose production and increasing insulin
sensitivity. Unless contraindicated by renal impairment, it remains the foundation of
glycemic management.
6. During a neurological exam, the patient is unable to close their right eye or smile on the
right side of their face. Which cranial nerve is likely affected?
A. Cranial Nerve VII
B. Cranial Nerve V
C. Cranial Nerve III
D. Cranial Nerve X
Answer: A
Rationale: Cranial Nerve VII, the facial nerve, controls the muscles of facial expression,
including closing the eyes and smiling. Damage to this nerve, often seen in Bell’s Palsy,
results in ipsilateral facial drooping and the inability to perform these movements. Cranial
