NUR 6121 Exam 3 V3 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 3) | William Paterson
University
1. A 68-year-old male with a history of chronic heart failure presents with increased dyspnea
and orthopnea. Which of the following physical examination findings is the most specific
indicator of volume overload?
A. Peripheral edema in the lower extremities
B. Presence of a third heart sound (S3)
C. Bilateral crackles in the lung bases
D. Hepatojugular reflux and elevated JVP
Answer: D
Rationale: Elevated jugular venous pressure (JVP) and a positive hepatojugular reflux are
highly specific for right-sided congestion and volume overload in heart failure patients.
While peripheral edema and crackles are common, they are less specific as they can occur
in other conditions like venous insufficiency or pneumonia. The presence of S3 indicates
ventricular filling during diastole and is a sign of systolic dysfunction but is less specific for
volume status than JVP.
,2. When managing a patient with stage 3 Chronic Kidney Disease (CKD), which of the
following pharmacological interventions is indicated to slow the progression of renal decline?
A. High-dose loop diuretics
B. Angiotensin-converting enzyme (ACE) inhibitors
C. Non-steroidal anti-inflammatory drugs (NSAIDs)
D. Intravenous aminoglycosides
Answer: B
Rationale: ACE inhibitors or ARBs are the gold standard for reducing intraglomerular
pressure and proteinuria in patients with CKD, which helps slow disease progression.
NSAIDs and aminoglycosides are nephrotoxic and should be avoided to prevent further
injury to the kidneys. Diuretics manage symptoms of fluid overload but do not directly slow
the progression of nephropathy itself.
3. An NP is reviewing the pulmonary function tests (PFTs) of a patient with suspected COPD.
Which of the following results confirms a diagnosis of persistent airflow limitation?
A. FEV1 increase of 15% post-bronchodilator
B. Total Lung Capacity (TLC) < 80% of predicted
C. Post-bronchodilator FEV1/FVC ratio < 0.70
D. Peak Expiratory Flow (PEF) variability > 20%
Answer: C
, Rationale: The GOLD criteria define COPD by a post-bronchodilator FEV1/FVC ratio of less
than 0.70, which indicates fixed airflow obstruction. Significant reversibility (15% increase
in FEV1) is more characteristic of asthma than COPD. Restrictive lung diseases would show
a decreased Total Lung Capacity, whereas COPD usually shows normal or increased TLC
due to air trapping.
4. A 72-year-old patient with atrial fibrillation has a CHA2DS2-VASc score of 4. Which
management strategy is most appropriate for stroke prevention in this patient?
A. Oral anticoagulation with a DOAC or Warfarin
B. Dual antiplatelet therapy (DAPT) with Clopidogrel
C. Daily Aspirin 81 mg therapy
D. Routine echocardiography every 6 months
Answer: A
Rationale: A CHA2DS2-VASc score of 2 or greater in males (or 3 in females) warrants
systemic anticoagulation to reduce the high risk of thromboembolic stroke. Aspirin is no
longer considered sufficient for stroke prevention in atrial fibrillation compared to
anticoagulants. Direct Oral Anticoagulants (DOACs) are generally preferred over Warfarin
due to a better safety profile and lack of monitoring requirements.
5. Which of the following electrolyte abnormalities is most commonly associated with the use
of thiazide diuretics in older adults?
A. Hyperkalemia
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 3) | William Paterson
University
1. A 68-year-old male with a history of chronic heart failure presents with increased dyspnea
and orthopnea. Which of the following physical examination findings is the most specific
indicator of volume overload?
A. Peripheral edema in the lower extremities
B. Presence of a third heart sound (S3)
C. Bilateral crackles in the lung bases
D. Hepatojugular reflux and elevated JVP
Answer: D
Rationale: Elevated jugular venous pressure (JVP) and a positive hepatojugular reflux are
highly specific for right-sided congestion and volume overload in heart failure patients.
While peripheral edema and crackles are common, they are less specific as they can occur
in other conditions like venous insufficiency or pneumonia. The presence of S3 indicates
ventricular filling during diastole and is a sign of systolic dysfunction but is less specific for
volume status than JVP.
,2. When managing a patient with stage 3 Chronic Kidney Disease (CKD), which of the
following pharmacological interventions is indicated to slow the progression of renal decline?
A. High-dose loop diuretics
B. Angiotensin-converting enzyme (ACE) inhibitors
C. Non-steroidal anti-inflammatory drugs (NSAIDs)
D. Intravenous aminoglycosides
Answer: B
Rationale: ACE inhibitors or ARBs are the gold standard for reducing intraglomerular
pressure and proteinuria in patients with CKD, which helps slow disease progression.
NSAIDs and aminoglycosides are nephrotoxic and should be avoided to prevent further
injury to the kidneys. Diuretics manage symptoms of fluid overload but do not directly slow
the progression of nephropathy itself.
3. An NP is reviewing the pulmonary function tests (PFTs) of a patient with suspected COPD.
Which of the following results confirms a diagnosis of persistent airflow limitation?
A. FEV1 increase of 15% post-bronchodilator
B. Total Lung Capacity (TLC) < 80% of predicted
C. Post-bronchodilator FEV1/FVC ratio < 0.70
D. Peak Expiratory Flow (PEF) variability > 20%
Answer: C
, Rationale: The GOLD criteria define COPD by a post-bronchodilator FEV1/FVC ratio of less
than 0.70, which indicates fixed airflow obstruction. Significant reversibility (15% increase
in FEV1) is more characteristic of asthma than COPD. Restrictive lung diseases would show
a decreased Total Lung Capacity, whereas COPD usually shows normal or increased TLC
due to air trapping.
4. A 72-year-old patient with atrial fibrillation has a CHA2DS2-VASc score of 4. Which
management strategy is most appropriate for stroke prevention in this patient?
A. Oral anticoagulation with a DOAC or Warfarin
B. Dual antiplatelet therapy (DAPT) with Clopidogrel
C. Daily Aspirin 81 mg therapy
D. Routine echocardiography every 6 months
Answer: A
Rationale: A CHA2DS2-VASc score of 2 or greater in males (or 3 in females) warrants
systemic anticoagulation to reduce the high risk of thromboembolic stroke. Aspirin is no
longer considered sufficient for stroke prevention in atrial fibrillation compared to
anticoagulants. Direct Oral Anticoagulants (DOACs) are generally preferred over Warfarin
due to a better safety profile and lack of monitoring requirements.
5. Which of the following electrolyte abnormalities is most commonly associated with the use
of thiazide diuretics in older adults?
A. Hyperkalemia
