NUR 6121 Exam 2 V1 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 2) | William Paterson
University
1. A 54-year-old male presents for a follow-up of his Type 2 Diabetes Mellitus. His
Hemoglobin A1c is 8.2% despite adherence to Metformin 1000mg twice daily. Which of the
following is the most appropriate next step in pharmacological management according to
ADA guidelines?
A. Increase Metformin to 1500mg twice daily
B. Add a GLP-1 receptor agonist or SGLT2 inhibitor
C. Discontinue Metformin and start basal insulin
D. Add a sulfonylurea as the preferred second-line agent
Answer: B
Rationale: The current ADA standards recommend adding a second-line agent when the
A1c target is not met with Metformin monotherapy. For patients with or without
established atherosclerotic cardiovascular disease, GLP-1 receptor agonists or SGLT2
inhibitors are prioritized due to their cardio-renal benefits. Sulfonylureas are no longer the
automatic second-line choice due to hypoglycemia risks and lack of organ protection.
,2. A patient complains of chronic retrosternal burning that radiates to the neck, occurring
primarily after large meals. She has tried OTC antacids with minimal relief. What ‘alarm
symptom’ would necessitate an immediate referral for an esophagogastroduodenoscopy
(EGD)?
A. Odynophagia or dysphagia
B. Occasional belching after meals
C. A history of cigarette smoking
D. Recurrent cough at night
Answer: A
Rationale: Dysphagia (difficulty swallowing) and odynophagia (painful swallowing) are
considered ‘alarm symptoms’ that may indicate esophageal stricture or malignancy. While
nocturnal cough and smoking are relevant to GERD management, they do not carry the
same urgency for diagnostic imaging. An EGD is mandatory in these cases to rule out
Barrett’s esophagus or esophageal adenocarcinoma.
3. Which lab finding is most consistent with a diagnosis of Primary Hyperparathyroidism?
A. Low Serum Calcium and High Phosphorus
B. High Serum Calcium and Low Phosphorus
C. High Serum Calcium and High Phosphorus
D. Low Serum Calcium and Low Phosphorus
,Answer: B
Rationale: Primary hyperparathyroidism is characterized by the overproduction of
parathyroid hormone, which increases bone resorption and renal calcium reabsorption.
This leads to elevated serum calcium levels and increased renal excretion of phosphorus,
resulting in low serum phosphorus. Diagnosis is confirmed by simultaneously elevated PTH
and serum calcium levels.
4. An 68-year-old patient with a history of Chronic Obstructive Pulmonary Disease (COPD)
presents with increased sputum purulence and dyspnea. According to the GOLD criteria,
which antibiotic class is typically first-line for a moderate acute exacerbation?
A. Aminoglycosides
B. First-generation Cephalosporins
C. Penicillin V
D. Macrolides or Tetracyclines
Answer: D
Rationale: For moderate COPD exacerbations, the use of antibiotics like Azithromycin (a
macrolide) or Doxycycline (a tetracycline) is standard practice to target common
pathogens like H. influenzae and S. pneumoniae. The selection is based on the patient’s risk
factors and local resistance patterns. These agents help reduce the duration of symptoms
and prevent further respiratory decline.
, 5. A patient with Chronic Kidney Disease (CKD) Stage 3b presents for evaluation. Which of the
following nutritional interventions is most critical to slow the progression of renal failure?
A. Restricting dietary protein to 0.6-0.8 g/kg/day
B. Increasing dietary protein to 1.5 g/kg/day
C. Increasing sodium intake to maintain blood pressure
D. Supplementing with Vitamin C to acidify urine
Answer: A
Rationale: Protein restriction is a cornerstone of nutritional management in CKD to reduce
the accumulation of nitrogenous waste and decrease glomerular hyperfiltration. High
protein intake can accelerate the decline of GFR by increasing the workload on remaining
nephrons. Monitoring for malnutrition is essential when implementing these dietary
restrictions.
6. During a physical exam, the nurse practitioner elicits a positive Murphy’s sign. This finding
is highly suggestive of which condition?
A. Acute Appendicitis
B. Acute Pancreatitis
C. Nephrolithiasis
D. Acute Cholecystitis
Answer: D
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 2) | William Paterson
University
1. A 54-year-old male presents for a follow-up of his Type 2 Diabetes Mellitus. His
Hemoglobin A1c is 8.2% despite adherence to Metformin 1000mg twice daily. Which of the
following is the most appropriate next step in pharmacological management according to
ADA guidelines?
A. Increase Metformin to 1500mg twice daily
B. Add a GLP-1 receptor agonist or SGLT2 inhibitor
C. Discontinue Metformin and start basal insulin
D. Add a sulfonylurea as the preferred second-line agent
Answer: B
Rationale: The current ADA standards recommend adding a second-line agent when the
A1c target is not met with Metformin monotherapy. For patients with or without
established atherosclerotic cardiovascular disease, GLP-1 receptor agonists or SGLT2
inhibitors are prioritized due to their cardio-renal benefits. Sulfonylureas are no longer the
automatic second-line choice due to hypoglycemia risks and lack of organ protection.
,2. A patient complains of chronic retrosternal burning that radiates to the neck, occurring
primarily after large meals. She has tried OTC antacids with minimal relief. What ‘alarm
symptom’ would necessitate an immediate referral for an esophagogastroduodenoscopy
(EGD)?
A. Odynophagia or dysphagia
B. Occasional belching after meals
C. A history of cigarette smoking
D. Recurrent cough at night
Answer: A
Rationale: Dysphagia (difficulty swallowing) and odynophagia (painful swallowing) are
considered ‘alarm symptoms’ that may indicate esophageal stricture or malignancy. While
nocturnal cough and smoking are relevant to GERD management, they do not carry the
same urgency for diagnostic imaging. An EGD is mandatory in these cases to rule out
Barrett’s esophagus or esophageal adenocarcinoma.
3. Which lab finding is most consistent with a diagnosis of Primary Hyperparathyroidism?
A. Low Serum Calcium and High Phosphorus
B. High Serum Calcium and Low Phosphorus
C. High Serum Calcium and High Phosphorus
D. Low Serum Calcium and Low Phosphorus
,Answer: B
Rationale: Primary hyperparathyroidism is characterized by the overproduction of
parathyroid hormone, which increases bone resorption and renal calcium reabsorption.
This leads to elevated serum calcium levels and increased renal excretion of phosphorus,
resulting in low serum phosphorus. Diagnosis is confirmed by simultaneously elevated PTH
and serum calcium levels.
4. An 68-year-old patient with a history of Chronic Obstructive Pulmonary Disease (COPD)
presents with increased sputum purulence and dyspnea. According to the GOLD criteria,
which antibiotic class is typically first-line for a moderate acute exacerbation?
A. Aminoglycosides
B. First-generation Cephalosporins
C. Penicillin V
D. Macrolides or Tetracyclines
Answer: D
Rationale: For moderate COPD exacerbations, the use of antibiotics like Azithromycin (a
macrolide) or Doxycycline (a tetracycline) is standard practice to target common
pathogens like H. influenzae and S. pneumoniae. The selection is based on the patient’s risk
factors and local resistance patterns. These agents help reduce the duration of symptoms
and prevent further respiratory decline.
, 5. A patient with Chronic Kidney Disease (CKD) Stage 3b presents for evaluation. Which of the
following nutritional interventions is most critical to slow the progression of renal failure?
A. Restricting dietary protein to 0.6-0.8 g/kg/day
B. Increasing dietary protein to 1.5 g/kg/day
C. Increasing sodium intake to maintain blood pressure
D. Supplementing with Vitamin C to acidify urine
Answer: A
Rationale: Protein restriction is a cornerstone of nutritional management in CKD to reduce
the accumulation of nitrogenous waste and decrease glomerular hyperfiltration. High
protein intake can accelerate the decline of GFR by increasing the workload on remaining
nephrons. Monitoring for malnutrition is essential when implementing these dietary
restrictions.
6. During a physical exam, the nurse practitioner elicits a positive Murphy’s sign. This finding
is highly suggestive of which condition?
A. Acute Appendicitis
B. Acute Pancreatitis
C. Nephrolithiasis
D. Acute Cholecystitis
Answer: D
