NUR 6130 Exam 2 V2 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 68-year-old male with a history of heart failure (NYHA Class II) presents for a routine
follow-up. Which of the following medication classes is considered the cornerstone of
therapy to reduce mortality and prevent cardiac remodeling?
A. Loop Diuretics
B. Calcium Channel Blockers
C. ACE Inhibitors
D. Short-acting Nitrates
Answer: C
Rationale: ACE inhibitors are essential in managing heart failure because they inhibit the
renin-angiotensin-aldosterone system, which prevents maladaptive cardiac remodeling.
Clinical evidence consistently shows that ACE inhibitors reduce both morbidity and
mortality in patients with reduced ejection fraction. While loop diuretics help manage fluid
volume, they do not provide the same long-term survival benefits as ACE inhibitors.
,2. A patient with COPD is being evaluated for escalating symptoms. The FEV1/FVC ratio is
0.65 and the FEV1 is 60% of predicted. According to the GOLD guidelines, what is the severity
classification for this patient?
A. GOLD 2 (Moderate)
B. GOLD 1 (Mild)
C. GOLD 3 (Severe)
D. GOLD 4 (Very Severe)
Answer: A
Rationale: The GOLD classification for COPD severity is based on the post-bronchodilator
FEV1 percentage of the predicted value. A FEV1 between 50% and 79% predicted is
classified as GOLD 2 or moderate airflow limitation. This classification is vital for
determining the appropriate escalation of pharmacological therapy, such as adding a long-
acting bronchodilator.
3. A 55-year-old female with Type 2 Diabetes has an eGFR of 28 mL/min/1.73m². Which of the
following actions is most appropriate regarding her Metformin therapy?
A. Continue current dose of 1000mg BID
B. Reduce dose to 500mg daily
C. Switch to a Sulfonylurea
D. Discontinue Metformin immediately
,Answer: D
Rationale: Metformin is contraindicated in patients with an eGFR less than 30
mL/min/1.73m² due to the significantly increased risk of lactic acidosis. The provider must
monitor renal function closely and discontinue the medication if the threshold is breached.
For patients with an eGFR between 30 and 45, the dose should be reduced and the patient
monitored more frequently.
4. When treating an African American patient with primary hypertension and no history of
chronic kidney disease, which medication class is recommended as first-line therapy
according to JNC 8?
A. ACE Inhibitors
B. Beta Blockers
C. Calcium Channel Blockers
D. Angiotensin Receptor Blockers
Answer: C
Rationale: JNC 8 guidelines specify that for the general African American population, initial
antihypertensive treatment should include a thiazide-type diuretic or a calcium channel
blocker. This population tends to respond more effectively to these classes compared to
ACE inhibitors. If the patient had CKD, an ACE inhibitor or ARB would be prioritized
regardless of race.
, 5. A patient presents with a TSH of 8.2 mIU/L and a normal Free T4 level. The patient is
asymptomatic. What is the most appropriate clinical diagnosis?
A. Subclinical Hypothyroidism
B. Primary Hypothyroidism
C. Secondary Hypothyroidism
D. Hyperthyroidism
Answer: A
Rationale: Subclinical hypothyroidism is defined by an elevated serum TSH level in the
presence of a normal Free T4 level. Treatment is often deferred unless the TSH exceeds 10
mIU/L or the patient is symptomatic or has high cardiovascular risk. Monitoring is
required as a portion of these patients may eventually progress to overt hypothyroidism.
6. Which of the following is the preferred first-line agent for the management of an acute
gout flare in a patient with no contraindications?
A. Allopurinol
B. Probenecid
C. Febuxostat
D. Indomethacin
Answer: D
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 68-year-old male with a history of heart failure (NYHA Class II) presents for a routine
follow-up. Which of the following medication classes is considered the cornerstone of
therapy to reduce mortality and prevent cardiac remodeling?
A. Loop Diuretics
B. Calcium Channel Blockers
C. ACE Inhibitors
D. Short-acting Nitrates
Answer: C
Rationale: ACE inhibitors are essential in managing heart failure because they inhibit the
renin-angiotensin-aldosterone system, which prevents maladaptive cardiac remodeling.
Clinical evidence consistently shows that ACE inhibitors reduce both morbidity and
mortality in patients with reduced ejection fraction. While loop diuretics help manage fluid
volume, they do not provide the same long-term survival benefits as ACE inhibitors.
,2. A patient with COPD is being evaluated for escalating symptoms. The FEV1/FVC ratio is
0.65 and the FEV1 is 60% of predicted. According to the GOLD guidelines, what is the severity
classification for this patient?
A. GOLD 2 (Moderate)
B. GOLD 1 (Mild)
C. GOLD 3 (Severe)
D. GOLD 4 (Very Severe)
Answer: A
Rationale: The GOLD classification for COPD severity is based on the post-bronchodilator
FEV1 percentage of the predicted value. A FEV1 between 50% and 79% predicted is
classified as GOLD 2 or moderate airflow limitation. This classification is vital for
determining the appropriate escalation of pharmacological therapy, such as adding a long-
acting bronchodilator.
3. A 55-year-old female with Type 2 Diabetes has an eGFR of 28 mL/min/1.73m². Which of the
following actions is most appropriate regarding her Metformin therapy?
A. Continue current dose of 1000mg BID
B. Reduce dose to 500mg daily
C. Switch to a Sulfonylurea
D. Discontinue Metformin immediately
,Answer: D
Rationale: Metformin is contraindicated in patients with an eGFR less than 30
mL/min/1.73m² due to the significantly increased risk of lactic acidosis. The provider must
monitor renal function closely and discontinue the medication if the threshold is breached.
For patients with an eGFR between 30 and 45, the dose should be reduced and the patient
monitored more frequently.
4. When treating an African American patient with primary hypertension and no history of
chronic kidney disease, which medication class is recommended as first-line therapy
according to JNC 8?
A. ACE Inhibitors
B. Beta Blockers
C. Calcium Channel Blockers
D. Angiotensin Receptor Blockers
Answer: C
Rationale: JNC 8 guidelines specify that for the general African American population, initial
antihypertensive treatment should include a thiazide-type diuretic or a calcium channel
blocker. This population tends to respond more effectively to these classes compared to
ACE inhibitors. If the patient had CKD, an ACE inhibitor or ARB would be prioritized
regardless of race.
, 5. A patient presents with a TSH of 8.2 mIU/L and a normal Free T4 level. The patient is
asymptomatic. What is the most appropriate clinical diagnosis?
A. Subclinical Hypothyroidism
B. Primary Hypothyroidism
C. Secondary Hypothyroidism
D. Hyperthyroidism
Answer: A
Rationale: Subclinical hypothyroidism is defined by an elevated serum TSH level in the
presence of a normal Free T4 level. Treatment is often deferred unless the TSH exceeds 10
mIU/L or the patient is symptomatic or has high cardiovascular risk. Monitoring is
required as a portion of these patients may eventually progress to overt hypothyroidism.
6. Which of the following is the preferred first-line agent for the management of an acute
gout flare in a patient with no contraindications?
A. Allopurinol
B. Probenecid
C. Febuxostat
D. Indomethacin
Answer: D
