NUR 6130 Exam 2 V3 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 65-year-old male with a history of hypertension presents with sharp, tearing chest pain
radiating to his back. His blood pressure is 190/110 mmHg. Which diagnostic test is the gold
standard for confirming an aortic dissection in the acute setting?
A. Transesophageal Echocardiogram (TEE)
B. Chest X-ray
C. Computed Tomography Angiography (CTA)
D. Electrocardiogram (ECG)
Answer: C
Rationale: CTA is considered the gold standard for diagnosing aortic dissection because it
provides rapid, high-resolution imaging of the entire aorta. While TEE is highly sensitive,
CTA is often more readily available in emergency departments and can accurately identify
the extent of the dissection and involvement of major branches. Timely diagnosis is critical
as the mortality rate for untreated dissection increases significantly every hour.
2. An APN is managing a patient with Acute Respiratory Distress Syndrome (ARDS). The goal
is to minimize ventilator-induced lung injury. Which ventilator strategy is most appropriate?
A. Low tidal volume (6 mL/kg) and high PEEP
,B. High tidal volume (10-12 mL/kg) and low PEEP
C. Permissive hypercapnia with high tidal volumes
D. Inverse ratio ventilation without PEEP
Answer: A
Rationale: Evidence-based practice guidelines for ARDS management recommend low
tidal volume ventilation (6 mL/kg of ideal body weight) to prevent overdistension of
alveoli (volutrauma). High PEEP is utilized to keep the alveoli open and improve
oxygenation while preventing cyclical atelectasis (atelectrauma). This lung-protective
strategy has been shown to reduce mortality and increase the number of ventilator-free
days in critically ill patients.
3. A patient with a history of chronic alcoholism presents with fatigue, paresthesias in the
hands and feet, and an unsteady gait. Lab results show a Macrocytic anemia (MCV 115).
Which deficiency is most likely responsible for these neurological symptoms?
A. Vitamin B12 deficiency
B. Iron deficiency
C. Folic Acid deficiency
D. Vitamin B6 deficiency
Answer: A
,Rationale: Vitamin B12 deficiency, often seen in chronic alcoholism or malabsorption
syndromes, results in megaloblastic anemia and distinct neurological impairments such as
peripheral neuropathy and ataxia. Unlike folate deficiency, which also causes macrocytic
anemia, B12 deficiency involves the degeneration of the posterior and lateral columns of
the spinal cord. It is essential for the APN to differentiate these because treating B12
deficiency with only folate will correct the anemia but allow the neurological damage to
progress.
4. During the assessment of a patient with suspected septic shock, the APN notes a Mean
Arterial Pressure (MAP) of 55 mmHg despite adequate fluid resuscitation with 30 mL/kg of
crystalloids. What is the first-line vasopressor of choice?
A. Norepinephrine
B. Dopamine
C. Vasopressin
D. Epinephrine
Answer: A
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after adequate fluid resuscitation. It
functions primarily as an alpha-1 agonist, causing vasoconstriction to increase MAP
without significantly increasing the heart rate compared to dopamine. Maintaining a MAP
of at least 65 mmHg is vital to ensure adequate organ perfusion and prevent multi-organ
dysfunction syndrome.
, 5. A patient presents with sudden onset of atrial fibrillation with a heart rate of 155 bpm and
a blood pressure of 82/50 mmHg. The patient is diaphoretic and complaining of chest pain.
What is the most appropriate immediate action?
A. Administer Diltiazem 20mg IV bolus
B. Initiate Amiodarone infusion
C. Perform synchronized cardioversion
D. Administer Digoxin 0.25mg IV
Answer: C
Rationale: In patients with unstable tachyarrhythmias (hypotension, altered mental status,
signs of shock, or ischemic chest pain), synchronized cardioversion is the immediate
treatment of choice according to ACLS guidelines. Pharmacological interventions like
diltiazem are reserved for stable patients whose primary issue is rate control. Delaying
cardioversion in an unstable patient can lead to clinical deterioration or progression to
cardiac arrest.
6. When evaluating a 70-year-old patient with a systolic crescendo-decrescendo murmur at
the right upper sternal border that radiates to the carotids, the APN should suspect:
A. Mitral Regurgitation
B. Tricuspid Stenosis
C. Aortic Stenosis
D. Pulmonary Regurgitation
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Exam 2) | William
Paterson University
1. A 65-year-old male with a history of hypertension presents with sharp, tearing chest pain
radiating to his back. His blood pressure is 190/110 mmHg. Which diagnostic test is the gold
standard for confirming an aortic dissection in the acute setting?
A. Transesophageal Echocardiogram (TEE)
B. Chest X-ray
C. Computed Tomography Angiography (CTA)
D. Electrocardiogram (ECG)
Answer: C
Rationale: CTA is considered the gold standard for diagnosing aortic dissection because it
provides rapid, high-resolution imaging of the entire aorta. While TEE is highly sensitive,
CTA is often more readily available in emergency departments and can accurately identify
the extent of the dissection and involvement of major branches. Timely diagnosis is critical
as the mortality rate for untreated dissection increases significantly every hour.
2. An APN is managing a patient with Acute Respiratory Distress Syndrome (ARDS). The goal
is to minimize ventilator-induced lung injury. Which ventilator strategy is most appropriate?
A. Low tidal volume (6 mL/kg) and high PEEP
,B. High tidal volume (10-12 mL/kg) and low PEEP
C. Permissive hypercapnia with high tidal volumes
D. Inverse ratio ventilation without PEEP
Answer: A
Rationale: Evidence-based practice guidelines for ARDS management recommend low
tidal volume ventilation (6 mL/kg of ideal body weight) to prevent overdistension of
alveoli (volutrauma). High PEEP is utilized to keep the alveoli open and improve
oxygenation while preventing cyclical atelectasis (atelectrauma). This lung-protective
strategy has been shown to reduce mortality and increase the number of ventilator-free
days in critically ill patients.
3. A patient with a history of chronic alcoholism presents with fatigue, paresthesias in the
hands and feet, and an unsteady gait. Lab results show a Macrocytic anemia (MCV 115).
Which deficiency is most likely responsible for these neurological symptoms?
A. Vitamin B12 deficiency
B. Iron deficiency
C. Folic Acid deficiency
D. Vitamin B6 deficiency
Answer: A
,Rationale: Vitamin B12 deficiency, often seen in chronic alcoholism or malabsorption
syndromes, results in megaloblastic anemia and distinct neurological impairments such as
peripheral neuropathy and ataxia. Unlike folate deficiency, which also causes macrocytic
anemia, B12 deficiency involves the degeneration of the posterior and lateral columns of
the spinal cord. It is essential for the APN to differentiate these because treating B12
deficiency with only folate will correct the anemia but allow the neurological damage to
progress.
4. During the assessment of a patient with suspected septic shock, the APN notes a Mean
Arterial Pressure (MAP) of 55 mmHg despite adequate fluid resuscitation with 30 mL/kg of
crystalloids. What is the first-line vasopressor of choice?
A. Norepinephrine
B. Dopamine
C. Vasopressin
D. Epinephrine
Answer: A
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after adequate fluid resuscitation. It
functions primarily as an alpha-1 agonist, causing vasoconstriction to increase MAP
without significantly increasing the heart rate compared to dopamine. Maintaining a MAP
of at least 65 mmHg is vital to ensure adequate organ perfusion and prevent multi-organ
dysfunction syndrome.
, 5. A patient presents with sudden onset of atrial fibrillation with a heart rate of 155 bpm and
a blood pressure of 82/50 mmHg. The patient is diaphoretic and complaining of chest pain.
What is the most appropriate immediate action?
A. Administer Diltiazem 20mg IV bolus
B. Initiate Amiodarone infusion
C. Perform synchronized cardioversion
D. Administer Digoxin 0.25mg IV
Answer: C
Rationale: In patients with unstable tachyarrhythmias (hypotension, altered mental status,
signs of shock, or ischemic chest pain), synchronized cardioversion is the immediate
treatment of choice according to ACLS guidelines. Pharmacological interventions like
diltiazem are reserved for stable patients whose primary issue is rate control. Delaying
cardioversion in an unstable patient can lead to clinical deterioration or progression to
cardiac arrest.
6. When evaluating a 70-year-old patient with a systolic crescendo-decrescendo murmur at
the right upper sternal border that radiates to the carotids, the APN should suspect:
A. Mitral Regurgitation
B. Tricuspid Stenosis
C. Aortic Stenosis
D. Pulmonary Regurgitation
