NUR 6111 Exam 3 V2 | NUR 6111
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 3) | William
Paterson University
1. A 62-year-old male with a history of heart failure presents with fatigue. On examination, a
third heart sound (S3) is noted. What is the most likely physiological cause of this finding?
A. Rapid ventricular filling into a dilated ventricle
B. Stiffening of the left ventricle
C. Closure of the semilunar valves
D. Atrial contraction against a resistant ventricle
Answer: A
Rationale: The S3 gallop is a classic sign of heart failure and represents blood entering a
compliant or dilated ventricle during early diastole. It is often referred to as a ventricular
gallop and can be normal in children or athletes but is pathological in older adults.
Management typically involves addressing the underlying fluid overload often seen in
systolic dysfunction.
2. According to the JNC 8 guidelines, what is the initial recommended blood pressure
medication for a 55-year-old African American male with no history of diabetes or chronic
kidney disease?
A. Lisinopril
,B. Losartan
C. Amlodipine
D. Metoprolol
Answer: C
Rationale: For the general African American population, initial antihypertensive treatment
should include a thiazide-type diuretic or a calcium channel blocker (CCB). This
recommendation stems from evidence that these classes are more effective at lowering
blood pressure and reducing cardiovascular outcomes in this demographic. ACE inhibitors
and ARBs are generally less effective as monotherapy in African Americans without specific
comorbidities like CKD.
3. A 45-year-old female presents with a dry cough that began after starting a new medication
for hypertension. Which medication is the most likely cause?
A. Enalapril
B. Hydrochlorothiazide
C. Valsartan
D. Verapamil
Answer: A
Rationale: ACE inhibitors, such as Enalapril, are well-known for causing a dry, non-
productive cough in up to 20% of patients. This side effect is attributed to the accumulation
, of bradykinin in the respiratory tract. If the cough is intolerable, the patient should be
switched to an Angiotensin II Receptor Blocker (ARB) which does not affect bradykinin.
4. A patient with a history of persistent asthma is currently using a low-dose inhaled
corticosteroid (ICS) daily but continues to use their SABA four times a week. What is the next
step in management according to GINA guidelines?
A. Switch to a high-dose ICS
B. Add a Long-Acting Muscarinic Antagonist (LAMA)
C. Add a Long-Acting Beta Agonist (LABA)
D. Add an Oral Corticosteroid
Answer: C
Rationale: For patients whose asthma is not controlled on low-dose ICS alone (Step 2), the
preferred Step 3 management is to add a LABA to the low-dose ICS. This combination
therapy improves lung function and reduces the frequency of exacerbations compared to
doubling the dose of ICS. Clinicians must ensure the patient is also using the inhaler with
proper technique before escalating therapy.
5. Which of the following physical exam findings is most characteristic of chronic obstructive
pulmonary disease (COPD)?
A. Hyperresonance to percussion
B. Dullness to percussion
C. Increased tactile fremitus
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 3) | William
Paterson University
1. A 62-year-old male with a history of heart failure presents with fatigue. On examination, a
third heart sound (S3) is noted. What is the most likely physiological cause of this finding?
A. Rapid ventricular filling into a dilated ventricle
B. Stiffening of the left ventricle
C. Closure of the semilunar valves
D. Atrial contraction against a resistant ventricle
Answer: A
Rationale: The S3 gallop is a classic sign of heart failure and represents blood entering a
compliant or dilated ventricle during early diastole. It is often referred to as a ventricular
gallop and can be normal in children or athletes but is pathological in older adults.
Management typically involves addressing the underlying fluid overload often seen in
systolic dysfunction.
2. According to the JNC 8 guidelines, what is the initial recommended blood pressure
medication for a 55-year-old African American male with no history of diabetes or chronic
kidney disease?
A. Lisinopril
,B. Losartan
C. Amlodipine
D. Metoprolol
Answer: C
Rationale: For the general African American population, initial antihypertensive treatment
should include a thiazide-type diuretic or a calcium channel blocker (CCB). This
recommendation stems from evidence that these classes are more effective at lowering
blood pressure and reducing cardiovascular outcomes in this demographic. ACE inhibitors
and ARBs are generally less effective as monotherapy in African Americans without specific
comorbidities like CKD.
3. A 45-year-old female presents with a dry cough that began after starting a new medication
for hypertension. Which medication is the most likely cause?
A. Enalapril
B. Hydrochlorothiazide
C. Valsartan
D. Verapamil
Answer: A
Rationale: ACE inhibitors, such as Enalapril, are well-known for causing a dry, non-
productive cough in up to 20% of patients. This side effect is attributed to the accumulation
, of bradykinin in the respiratory tract. If the cough is intolerable, the patient should be
switched to an Angiotensin II Receptor Blocker (ARB) which does not affect bradykinin.
4. A patient with a history of persistent asthma is currently using a low-dose inhaled
corticosteroid (ICS) daily but continues to use their SABA four times a week. What is the next
step in management according to GINA guidelines?
A. Switch to a high-dose ICS
B. Add a Long-Acting Muscarinic Antagonist (LAMA)
C. Add a Long-Acting Beta Agonist (LABA)
D. Add an Oral Corticosteroid
Answer: C
Rationale: For patients whose asthma is not controlled on low-dose ICS alone (Step 2), the
preferred Step 3 management is to add a LABA to the low-dose ICS. This combination
therapy improves lung function and reduces the frequency of exacerbations compared to
doubling the dose of ICS. Clinicians must ensure the patient is also using the inhaler with
proper technique before escalating therapy.
5. Which of the following physical exam findings is most characteristic of chronic obstructive
pulmonary disease (COPD)?
A. Hyperresonance to percussion
B. Dullness to percussion
C. Increased tactile fremitus
