NUR 6130 Final Exam V3 | NUR 6130
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Final Exam) | William
Paterson University
1. A 68-year-old male with a history of heart failure presents with increased dyspnea and a
weight gain of 5 pounds over the past two days. Physical examination reveals an S3 heart
sound and 2+ bilateral pedal edema. Which initial intervention is most appropriate for the
Advanced Practice Nurse to order?
A. Increase the dosage of Lisinopril to improve cardiac output
B. Order a stat chest X-ray to evaluate for pulmonary infiltrates
C. Initiate Furosemide 40 mg PO twice daily to address fluid overload
D. Refer the patient to a cardiologist for immediate hospitalization
Answer: C
Rationale: The presence of an S3 gallop is a highly specific indicator of ventricular filling
into a dilated and non-compliant chamber, often seen in heart failure exacerbations. The
patient’s sudden weight gain and peripheral edema strongly suggest fluid volume overload.
Initiating diuretic therapy is the priority to alleviate symptoms and prevent further
respiratory distress.
,2. A patient with Type 2 Diabetes Mellitus has a current HbA1c of 8.6% despite maximal
doses of Metformin. The patient has a documented history of atherosclerotic cardiovascular
disease (ASCVD). Which pharmacological agent should the APN add next according to current
clinical guidelines?
A. Empagliflozin (SGLT2 inhibitor)
B. Glipizide (Sulfonylurea)
C. Sitagliptin (DPP-4 inhibitor)
D. Pioglitazone (TZD)
Answer: A
Rationale: Current ADA guidelines recommend SGLT2 inhibitors or GLP-1 receptor
agonists with proven cardiovascular benefit for patients with T2DM and established ASCVD
regardless of baseline A1c. Empagliflozin has demonstrated significant reductions in major
adverse cardiovascular events and heart failure hospitalizations. This evidence-based
approach prioritizes long-term organ protection alongside glycemic control.
3. A 72-year-old patient is diagnosed with Group B COPD (GOLD criteria). She is currently
using a short-acting beta-agonist (SABA) as needed. Which maintenance therapy is the most
appropriate next step in management?
A. Inhaled Fluticasone (ICS)
B. Oral Theophylline
C. Long-acting Muscarinic Antagonist (LAMA)
,D. Chronic Oral Prednisone
Answer: C
Rationale: For patients in GOLD Group B, maintenance therapy should consist of a long-
acting bronchodilator such as a LAMA or a LABA. LAMAs are often preferred for their
superior efficacy in reducing exacerbation rates compared to LABAs. Inhaled
corticosteroids are generally reserved for patients with high eosinophil counts or frequent
exacerbations not controlled by bronchodilators alone.
4. An 80-year-old female presents with sudden onset confusion, agitation, and visual
hallucinations. Her daughter reports she was ‘normal’ two days ago. Vital signs are stable, but
a urinalysis is positive for nitrites and leukocyte esterase. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Schizophrenia
D. Delirium secondary to UTI
Answer: D
Rationale: Delirium is characterized by an acute, fluctuating change in mental status and is
often triggered by underlying medical conditions in elderly patients. Urinary tract
infections are a common cause of delirium in the geriatric population due to systemic
inflammation and metabolic changes. Unlike dementia, delirium has an abrupt onset and
potential reversibility once the underlying cause is treated.
, 5. A 55-year-old male with chronic gout is currently asymptomatic. His serum uric acid level is
8.2 mg/dL. He has had three flares in the last year. Which medication is the standard first-line
choice for urate-lowering therapy (ULT)?
A. Indomethacin
B. Colchicine
C. Allopurinol
D. Probenecid
Answer: C
Rationale: Allopurinol is the preferred first-line xanthine oxidase inhibitor for urate-
lowering therapy in patients with frequent gout flares. The goal of therapy is to maintain
serum uric acid levels below 6.0 mg/dL to prevent future attacks. Colchicine and NSAIDs
are used for acute flares but do not lower systemic uric acid levels long-term.
6. Which of the following laboratory findings is most diagnostic of iron deficiency anemia in a
patient presenting with fatigue and pica?
A. Low Ferritin levels
B. Elevated Total Iron Binding Capacity (TIBC)
C. Increased Mean Corpuscular Volume (MCV)
D. Reduced Reticulocyte count
Answer: A
Advanced Practice Nursing III | Q&A with
Rationale (NUR6130 Final Exam) | William
Paterson University
1. A 68-year-old male with a history of heart failure presents with increased dyspnea and a
weight gain of 5 pounds over the past two days. Physical examination reveals an S3 heart
sound and 2+ bilateral pedal edema. Which initial intervention is most appropriate for the
Advanced Practice Nurse to order?
A. Increase the dosage of Lisinopril to improve cardiac output
B. Order a stat chest X-ray to evaluate for pulmonary infiltrates
C. Initiate Furosemide 40 mg PO twice daily to address fluid overload
D. Refer the patient to a cardiologist for immediate hospitalization
Answer: C
Rationale: The presence of an S3 gallop is a highly specific indicator of ventricular filling
into a dilated and non-compliant chamber, often seen in heart failure exacerbations. The
patient’s sudden weight gain and peripheral edema strongly suggest fluid volume overload.
Initiating diuretic therapy is the priority to alleviate symptoms and prevent further
respiratory distress.
,2. A patient with Type 2 Diabetes Mellitus has a current HbA1c of 8.6% despite maximal
doses of Metformin. The patient has a documented history of atherosclerotic cardiovascular
disease (ASCVD). Which pharmacological agent should the APN add next according to current
clinical guidelines?
A. Empagliflozin (SGLT2 inhibitor)
B. Glipizide (Sulfonylurea)
C. Sitagliptin (DPP-4 inhibitor)
D. Pioglitazone (TZD)
Answer: A
Rationale: Current ADA guidelines recommend SGLT2 inhibitors or GLP-1 receptor
agonists with proven cardiovascular benefit for patients with T2DM and established ASCVD
regardless of baseline A1c. Empagliflozin has demonstrated significant reductions in major
adverse cardiovascular events and heart failure hospitalizations. This evidence-based
approach prioritizes long-term organ protection alongside glycemic control.
3. A 72-year-old patient is diagnosed with Group B COPD (GOLD criteria). She is currently
using a short-acting beta-agonist (SABA) as needed. Which maintenance therapy is the most
appropriate next step in management?
A. Inhaled Fluticasone (ICS)
B. Oral Theophylline
C. Long-acting Muscarinic Antagonist (LAMA)
,D. Chronic Oral Prednisone
Answer: C
Rationale: For patients in GOLD Group B, maintenance therapy should consist of a long-
acting bronchodilator such as a LAMA or a LABA. LAMAs are often preferred for their
superior efficacy in reducing exacerbation rates compared to LABAs. Inhaled
corticosteroids are generally reserved for patients with high eosinophil counts or frequent
exacerbations not controlled by bronchodilators alone.
4. An 80-year-old female presents with sudden onset confusion, agitation, and visual
hallucinations. Her daughter reports she was ‘normal’ two days ago. Vital signs are stable, but
a urinalysis is positive for nitrites and leukocyte esterase. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Schizophrenia
D. Delirium secondary to UTI
Answer: D
Rationale: Delirium is characterized by an acute, fluctuating change in mental status and is
often triggered by underlying medical conditions in elderly patients. Urinary tract
infections are a common cause of delirium in the geriatric population due to systemic
inflammation and metabolic changes. Unlike dementia, delirium has an abrupt onset and
potential reversibility once the underlying cause is treated.
, 5. A 55-year-old male with chronic gout is currently asymptomatic. His serum uric acid level is
8.2 mg/dL. He has had three flares in the last year. Which medication is the standard first-line
choice for urate-lowering therapy (ULT)?
A. Indomethacin
B. Colchicine
C. Allopurinol
D. Probenecid
Answer: C
Rationale: Allopurinol is the preferred first-line xanthine oxidase inhibitor for urate-
lowering therapy in patients with frequent gout flares. The goal of therapy is to maintain
serum uric acid levels below 6.0 mg/dL to prevent future attacks. Colchicine and NSAIDs
are used for acute flares but do not lower systemic uric acid levels long-term.
6. Which of the following laboratory findings is most diagnostic of iron deficiency anemia in a
patient presenting with fatigue and pica?
A. Low Ferritin levels
B. Elevated Total Iron Binding Capacity (TIBC)
C. Increased Mean Corpuscular Volume (MCV)
D. Reduced Reticulocyte count
Answer: A
