NUR 6130 Exam 2 V1 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 65-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently
taking an ACE inhibitor and a diuretic. Which of the following medications is most
appropriate to add to improve long-term survival?
A. Amlodipine
B. Hydralazine
C. Digoxin
D. Carvedilol
Answer: D
Rationale: Evidence-based guidelines recommend the use of specific beta-blockers like
Carvedilol for all patients with HFrEF to reduce mortality. This medication should be
initiated when the patient is clinically stable and at a low dose to prevent worsening
symptoms. Unlike calcium channel blockers, beta-blockers have a proven survival benefit
in this specific patient population.
2. According to the GOLD criteria for COPD management, what is the definitive diagnostic
requirement for confirming airflow limitation?
A. Total Lung Capacity > 120% predicted
,B. Oxygen saturation < 88% on room air
C. Improvement in FEV1 by 12% after albuterol
D. Post-bronchodilator FEV1/FVC ratio < 0.70
Answer: D
Rationale: Spirometry is the gold standard for diagnosing and monitoring the progression
of COPD in the clinical setting. A post-bronchodilator FEV1/FVC ratio of less than 0.70
confirms the presence of persistent airflow limitation. This objective measurement is
essential for distinguishing COPD from other reversible obstructive conditions like asthma.
3. An advanced practice nurse is managing a 54-year-old female with Type 2 Diabetes whose
A1C remains at 8.2% despite Metformin. The patient has established Atherosclerotic
Cardiovascular Disease (ASCVD). Which medication class should be prioritized next?
A. Sulfonylureas
B. GLP-1 Receptor Agonists
C. DPP-4 Inhibitors
D. Thiazolidinediones
Answer: B
Rationale: For patients with established ASCVD, GLP-1 receptor agonists with proven
cardiovascular benefit are recommended by the ADA guidelines. These medications help
reduce major adverse cardiovascular events in addition to lowering glucose levels.
,Sulfonylureas are generally avoided as second-line agents in this context due to the risk of
hypoglycemia and lack of cardiac benefit.
4. A 72-year-old male presents with sudden onset of visual loss in the right eye described as a
‘curtain coming down.’ What is the most likely diagnosis?
A. Retinal Detachment
B. Glaucoma
C. Cataract
D. Macular Degeneration
Answer: A
Rationale: The classic presentation of a ‘curtain’ or ‘shade’ being drawn over the eye is
highly indicative of a retinal detachment. This condition is a medical emergency that
requires immediate referral to an ophthalmologist to prevent permanent vision loss. Unlike
cataracts, which develop slowly, retinal detachment presents with acute symptoms often
accompanied by flashes or floaters.
5. In the management of Hypertension, which of the following is a common side effect of
Thiazide diuretics that requires regular monitoring?
A. Hyperkalemia
B. Hyponatremia
C. Metabolic Acidosis
, D. Bradycardia
Answer: B
Rationale: Thiazide diuretics are known to cause electrolyte imbalances, most notably
hyponatremia and hypokalemia. Patients on these medications should have their basic
metabolic panel checked periodically to ensure safe levels. These drugs can also lead to
hyperuricemia, which might trigger gout flares in susceptible individuals.
6. A 60-year-old woman is diagnosed with Osteoporosis based on a T-score of -2.8. What is
the recommended first-line pharmacological treatment?
A. Calcium and Vitamin D only
B. Calcitonin nasal spray
C. Oral Bisphosphonates
D. Teriparatide
Answer: C
Rationale: Oral bisphosphonates are considered the first-line therapy for most patients
diagnosed with osteoporosis to reduce fracture risk. The patient must be educated on
proper administration, including staying upright for 30 minutes to avoid esophageal
irritation. Calcium and Vitamin D are necessary supplements but are insufficient as
monotherapy for a T-score of -2.8.
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 65-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently
taking an ACE inhibitor and a diuretic. Which of the following medications is most
appropriate to add to improve long-term survival?
A. Amlodipine
B. Hydralazine
C. Digoxin
D. Carvedilol
Answer: D
Rationale: Evidence-based guidelines recommend the use of specific beta-blockers like
Carvedilol for all patients with HFrEF to reduce mortality. This medication should be
initiated when the patient is clinically stable and at a low dose to prevent worsening
symptoms. Unlike calcium channel blockers, beta-blockers have a proven survival benefit
in this specific patient population.
2. According to the GOLD criteria for COPD management, what is the definitive diagnostic
requirement for confirming airflow limitation?
A. Total Lung Capacity > 120% predicted
,B. Oxygen saturation < 88% on room air
C. Improvement in FEV1 by 12% after albuterol
D. Post-bronchodilator FEV1/FVC ratio < 0.70
Answer: D
Rationale: Spirometry is the gold standard for diagnosing and monitoring the progression
of COPD in the clinical setting. A post-bronchodilator FEV1/FVC ratio of less than 0.70
confirms the presence of persistent airflow limitation. This objective measurement is
essential for distinguishing COPD from other reversible obstructive conditions like asthma.
3. An advanced practice nurse is managing a 54-year-old female with Type 2 Diabetes whose
A1C remains at 8.2% despite Metformin. The patient has established Atherosclerotic
Cardiovascular Disease (ASCVD). Which medication class should be prioritized next?
A. Sulfonylureas
B. GLP-1 Receptor Agonists
C. DPP-4 Inhibitors
D. Thiazolidinediones
Answer: B
Rationale: For patients with established ASCVD, GLP-1 receptor agonists with proven
cardiovascular benefit are recommended by the ADA guidelines. These medications help
reduce major adverse cardiovascular events in addition to lowering glucose levels.
,Sulfonylureas are generally avoided as second-line agents in this context due to the risk of
hypoglycemia and lack of cardiac benefit.
4. A 72-year-old male presents with sudden onset of visual loss in the right eye described as a
‘curtain coming down.’ What is the most likely diagnosis?
A. Retinal Detachment
B. Glaucoma
C. Cataract
D. Macular Degeneration
Answer: A
Rationale: The classic presentation of a ‘curtain’ or ‘shade’ being drawn over the eye is
highly indicative of a retinal detachment. This condition is a medical emergency that
requires immediate referral to an ophthalmologist to prevent permanent vision loss. Unlike
cataracts, which develop slowly, retinal detachment presents with acute symptoms often
accompanied by flashes or floaters.
5. In the management of Hypertension, which of the following is a common side effect of
Thiazide diuretics that requires regular monitoring?
A. Hyperkalemia
B. Hyponatremia
C. Metabolic Acidosis
, D. Bradycardia
Answer: B
Rationale: Thiazide diuretics are known to cause electrolyte imbalances, most notably
hyponatremia and hypokalemia. Patients on these medications should have their basic
metabolic panel checked periodically to ensure safe levels. These drugs can also lead to
hyperuricemia, which might trigger gout flares in susceptible individuals.
6. A 60-year-old woman is diagnosed with Osteoporosis based on a T-score of -2.8. What is
the recommended first-line pharmacological treatment?
A. Calcium and Vitamin D only
B. Calcitonin nasal spray
C. Oral Bisphosphonates
D. Teriparatide
Answer: C
Rationale: Oral bisphosphonates are considered the first-line therapy for most patients
diagnosed with osteoporosis to reduce fracture risk. The patient must be educated on
proper administration, including staying upright for 30 minutes to avoid esophageal
irritation. Calcium and Vitamin D are necessary supplements but are insufficient as
monotherapy for a T-score of -2.8.
