NUR 6121 Exam 1 V1 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 1) | William Paterson
University
1. A 65-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently
taking Lisinopril and Furosemide. Which medication should the Nurse Practitioner add next to
decrease mortality and slow cardiac remodeling?
A. Amlodipine
B. Digoxin
C. Carvedilol
D. Hydrochlorothiazide
Answer: C
Rationale: Carvedilol is a beta-blocker that has been shown to reduce mortality and
morbidity in patients with systolic heart failure. It works by inhibiting the sympathetic
nervous system and preventing the cardiotoxic effects of chronic catecholamine exposure.
Beta-blockers are a cornerstone of HFrEF management alongside ACE inhibitors or ARBs
and should be initiated once the patient is stable and euvolemic.
2. When interpreting a 12-lead EKG, the Nurse Practitioner notes ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
,B. Right Coronary Artery (RCA)
C. Circumflex Artery (CX)
D. Left Main Artery
Answer: B
Rationale: ST elevation in leads II, III, and aVF is diagnostic for an inferior wall myocardial
infarction. The Right Coronary Artery (RCA) supplies the inferior portion of the left
ventricle in the majority of patients. Accurate localization of the infarction helps the
clinician anticipate potential complications such as bradycardia or heart block.
3. A 58-year-old male presents with a new onset of atrial fibrillation. His CHADS2-VASc score
is 3. What is the recommended management strategy for stroke prevention?
A. Apixaban (Eliquis)
B. Clopidogrel (Plavix)
C. Aspirin 81 mg daily
D. No anticoagulation required
Answer: A
Rationale: A CHADS2-VASc score of 2 or greater in men or 3 or greater in women indicates
a high risk for thromboembolism, necessitating oral anticoagulation. Direct Oral
Anticoagulants (DOACs) like Apixaban are generally preferred over Warfarin due to a
,better safety profile and fewer dietary restrictions. Aspirin and Clopidogrel are no longer
considered sufficient for stroke prevention in non-valvular atrial fibrillation.
4. Which physical exam finding is most suggestive of Aortic Stenosis in an elderly patient?
A. A mid-systolic click at the apex
B. A harsh systolic crescendo-decrescendo murmur at the right upper sternal border
C. A high-pitched holosystolic murmur at the apex radiating to the axilla
D. A soft diastolic blowing murmur at the left sternal border
Answer: B
Rationale: Aortic stenosis is classically characterized by a harsh systolic ejection murmur
heard best at the right second intercostal space. This murmur often radiates to the carotid
arteries and may be associated with a delayed carotid upstroke (pulsus parvus et tardus).
As the valve orifice narrows, the pressure gradient across the valve increases, leading to
left ventricular hypertrophy.
5. A patient with Type 2 Diabetes and Chronic Kidney Disease (Stage 3) has a blood pressure
of 148/92 mmHg. According to JNC-8 guidelines, which medication class is the preferred first-
line treatment?
A. Calcium Channel Blocker
B. Thiazide Diuretic
C. ACE Inhibitor
, D. Beta-Blocker
Answer: C
Rationale: ACE inhibitors or ARBs are the first-line antihypertensive therapy for patients
with Chronic Kidney Disease, regardless of race or diabetic status. These medications
provide renoprotection by dilating the efferent arteriole and reducing intraglomerular
pressure. Monitoring serum creatinine and potassium levels is essential when initiating
these agents in CKD patients.
6. An 82-year-old female presents with confusion, dry mucous membranes, and a blood
glucose level of 850 mg/dL. Her urine is negative for ketones. What is the most likely
diagnosis?
A. Diabetic Ketoacidosis (DKA)
B. Starvation Ketosis
C. Diabetes Insipidus
D. Hyperosmolar Hyperglycemic State (HHS)
Answer: D
Rationale: Hyperosmolar Hyperglycemic State (HHS) is characterized by extreme
hyperglycemia, profound dehydration, and a lack of significant ketosis. It typically occurs in
Type 2 diabetics who have enough insulin to prevent lipolysis but not enough to control
blood glucose levels. Treatment focuses on aggressive fluid resuscitation and insulin
administration.
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 1) | William Paterson
University
1. A 65-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently
taking Lisinopril and Furosemide. Which medication should the Nurse Practitioner add next to
decrease mortality and slow cardiac remodeling?
A. Amlodipine
B. Digoxin
C. Carvedilol
D. Hydrochlorothiazide
Answer: C
Rationale: Carvedilol is a beta-blocker that has been shown to reduce mortality and
morbidity in patients with systolic heart failure. It works by inhibiting the sympathetic
nervous system and preventing the cardiotoxic effects of chronic catecholamine exposure.
Beta-blockers are a cornerstone of HFrEF management alongside ACE inhibitors or ARBs
and should be initiated once the patient is stable and euvolemic.
2. When interpreting a 12-lead EKG, the Nurse Practitioner notes ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
,B. Right Coronary Artery (RCA)
C. Circumflex Artery (CX)
D. Left Main Artery
Answer: B
Rationale: ST elevation in leads II, III, and aVF is diagnostic for an inferior wall myocardial
infarction. The Right Coronary Artery (RCA) supplies the inferior portion of the left
ventricle in the majority of patients. Accurate localization of the infarction helps the
clinician anticipate potential complications such as bradycardia or heart block.
3. A 58-year-old male presents with a new onset of atrial fibrillation. His CHADS2-VASc score
is 3. What is the recommended management strategy for stroke prevention?
A. Apixaban (Eliquis)
B. Clopidogrel (Plavix)
C. Aspirin 81 mg daily
D. No anticoagulation required
Answer: A
Rationale: A CHADS2-VASc score of 2 or greater in men or 3 or greater in women indicates
a high risk for thromboembolism, necessitating oral anticoagulation. Direct Oral
Anticoagulants (DOACs) like Apixaban are generally preferred over Warfarin due to a
,better safety profile and fewer dietary restrictions. Aspirin and Clopidogrel are no longer
considered sufficient for stroke prevention in non-valvular atrial fibrillation.
4. Which physical exam finding is most suggestive of Aortic Stenosis in an elderly patient?
A. A mid-systolic click at the apex
B. A harsh systolic crescendo-decrescendo murmur at the right upper sternal border
C. A high-pitched holosystolic murmur at the apex radiating to the axilla
D. A soft diastolic blowing murmur at the left sternal border
Answer: B
Rationale: Aortic stenosis is classically characterized by a harsh systolic ejection murmur
heard best at the right second intercostal space. This murmur often radiates to the carotid
arteries and may be associated with a delayed carotid upstroke (pulsus parvus et tardus).
As the valve orifice narrows, the pressure gradient across the valve increases, leading to
left ventricular hypertrophy.
5. A patient with Type 2 Diabetes and Chronic Kidney Disease (Stage 3) has a blood pressure
of 148/92 mmHg. According to JNC-8 guidelines, which medication class is the preferred first-
line treatment?
A. Calcium Channel Blocker
B. Thiazide Diuretic
C. ACE Inhibitor
, D. Beta-Blocker
Answer: C
Rationale: ACE inhibitors or ARBs are the first-line antihypertensive therapy for patients
with Chronic Kidney Disease, regardless of race or diabetic status. These medications
provide renoprotection by dilating the efferent arteriole and reducing intraglomerular
pressure. Monitoring serum creatinine and potassium levels is essential when initiating
these agents in CKD patients.
6. An 82-year-old female presents with confusion, dry mucous membranes, and a blood
glucose level of 850 mg/dL. Her urine is negative for ketones. What is the most likely
diagnosis?
A. Diabetic Ketoacidosis (DKA)
B. Starvation Ketosis
C. Diabetes Insipidus
D. Hyperosmolar Hyperglycemic State (HHS)
Answer: D
Rationale: Hyperosmolar Hyperglycemic State (HHS) is characterized by extreme
hyperglycemia, profound dehydration, and a lack of significant ketosis. It typically occurs in
Type 2 diabetics who have enough insulin to prevent lipolysis but not enough to control
blood glucose levels. Treatment focuses on aggressive fluid resuscitation and insulin
administration.
