NUR 6121 Exam 2 V2 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 2) | William Paterson
University
1. A 68-year-old patient with a history of heart failure reports difficulty breathing when
walking to the mailbox but feels fine while resting. How would the Advanced Practice Nurse
classify this according to the NYHA Functional Classification?
A. Class III
B. Class II
C. Class I
D. Class IV
Answer: A
Rationale: NYHA Class III indicates a marked limitation of physical activity where patients
are comfortable only at rest. The description of symptoms occurring with less than
ordinary activity, such as walking short distances, fits this specific category. Understanding
these classifications is essential for determining the intensity of pharmacological
management in heart failure patients.
2. Which of the following findings is considered the ‘gold standard’ for diagnosing Chronic
Obstructive Pulmonary Disease (COPD) in the primary care setting?
A. Presence of a chronic cough for at least 3 months
,B. A chest X-ray showing hyperinflation and flattened diaphragm
C. Oxygen saturation less than 92% on room air
D. A post-bronchodilator FEV1/FVC ratio less than 0.70
Answer: D
Rationale: Spirometry is required to make a clinical diagnosis of COPD, specifically looking
for airflow limitation that is not fully reversible. A post-bronchodilator FEV1/FVC ratio of
less than 0.70 confirms the presence of persistent airflow limitation. This objective
measurement distinguishes COPD from other respiratory conditions like asthma which
may show reversibility.
3. An Advanced Practice Nurse is reviewing the labs of a patient with Chronic Kidney Disease
(CKD). The GFR is 42 mL/min/1.73m2. Which stage of CKD does this represent?
A. Stage 2
B. Stage 3b
C. Stage 3a
D. Stage 4
Answer: B
Rationale: Stage 3b Chronic Kidney Disease is defined by a GFR between 30 and 44
mL/min/1.73m2. Stage 3 is often split into 3a (45-59) and 3b (30-44) to better reflect the
,risk of progression to end-stage renal disease. Accurate staging is vital for determining the
frequency of monitoring and the need for referral to a nephrologist.
4. A 72-year-old patient with Type 2 Diabetes presents with an A1c of 8.2%. The patient has
multiple comorbidities and a history of frequent falls. What is the most appropriate A1c goal
for this individual?
A. Less than 6.5%
B. Less than 8.0%
C. Less than 7.0%
D. Less than 9.0%
Answer: B
Rationale: For older adults with complex health needs and high fall risk, a less stringent
A1c goal of <8.0% or even <8.5% is often recommended to avoid hypoglycemia.
Hypoglycemia in the elderly can lead to catastrophic events like hip fractures or cognitive
decline. Clinical guidelines emphasize individualizing targets based on life expectancy and
the risk-to-benefit ratio of intensive control.
5. A patient is started on an ACE inhibitor for hypertension. Which electrolyte abnormality
must the nurse practitioner monitor closely?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
, D. Hypermagnesemia
Answer: B
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, which in
turn reduces aldosterone secretion. Lower levels of aldosterone lead to the retention of
potassium by the kidneys, increasing the risk of hyperkalemia. This is particularly
concerning in patients who also have underlying renal impairment or who are taking
potassium-sparing diuretics.
6. Which of the following is a hallmark clinical symptom of Giant Cell Arteritis (Temporal
Arteritis) that requires immediate intervention?
A. Lower extremity edema
B. Bilateral wheezing
C. Jaw claudication
D. Increased appetite
Answer: C
Rationale: Jaw claudication is a highly specific symptom of Giant Cell Arteritis, reflecting
ischemia to the masseter muscles. If left untreated, this condition can lead to permanent
vision loss due to ophthalmic artery involvement. Prompt initiation of high-dose
corticosteroids is mandatory when this condition is suspected to prevent irreversible
complications.
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 2) | William Paterson
University
1. A 68-year-old patient with a history of heart failure reports difficulty breathing when
walking to the mailbox but feels fine while resting. How would the Advanced Practice Nurse
classify this according to the NYHA Functional Classification?
A. Class III
B. Class II
C. Class I
D. Class IV
Answer: A
Rationale: NYHA Class III indicates a marked limitation of physical activity where patients
are comfortable only at rest. The description of symptoms occurring with less than
ordinary activity, such as walking short distances, fits this specific category. Understanding
these classifications is essential for determining the intensity of pharmacological
management in heart failure patients.
2. Which of the following findings is considered the ‘gold standard’ for diagnosing Chronic
Obstructive Pulmonary Disease (COPD) in the primary care setting?
A. Presence of a chronic cough for at least 3 months
,B. A chest X-ray showing hyperinflation and flattened diaphragm
C. Oxygen saturation less than 92% on room air
D. A post-bronchodilator FEV1/FVC ratio less than 0.70
Answer: D
Rationale: Spirometry is required to make a clinical diagnosis of COPD, specifically looking
for airflow limitation that is not fully reversible. A post-bronchodilator FEV1/FVC ratio of
less than 0.70 confirms the presence of persistent airflow limitation. This objective
measurement distinguishes COPD from other respiratory conditions like asthma which
may show reversibility.
3. An Advanced Practice Nurse is reviewing the labs of a patient with Chronic Kidney Disease
(CKD). The GFR is 42 mL/min/1.73m2. Which stage of CKD does this represent?
A. Stage 2
B. Stage 3b
C. Stage 3a
D. Stage 4
Answer: B
Rationale: Stage 3b Chronic Kidney Disease is defined by a GFR between 30 and 44
mL/min/1.73m2. Stage 3 is often split into 3a (45-59) and 3b (30-44) to better reflect the
,risk of progression to end-stage renal disease. Accurate staging is vital for determining the
frequency of monitoring and the need for referral to a nephrologist.
4. A 72-year-old patient with Type 2 Diabetes presents with an A1c of 8.2%. The patient has
multiple comorbidities and a history of frequent falls. What is the most appropriate A1c goal
for this individual?
A. Less than 6.5%
B. Less than 8.0%
C. Less than 7.0%
D. Less than 9.0%
Answer: B
Rationale: For older adults with complex health needs and high fall risk, a less stringent
A1c goal of <8.0% or even <8.5% is often recommended to avoid hypoglycemia.
Hypoglycemia in the elderly can lead to catastrophic events like hip fractures or cognitive
decline. Clinical guidelines emphasize individualizing targets based on life expectancy and
the risk-to-benefit ratio of intensive control.
5. A patient is started on an ACE inhibitor for hypertension. Which electrolyte abnormality
must the nurse practitioner monitor closely?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
, D. Hypermagnesemia
Answer: B
Rationale: ACE inhibitors block the conversion of angiotensin I to angiotensin II, which in
turn reduces aldosterone secretion. Lower levels of aldosterone lead to the retention of
potassium by the kidneys, increasing the risk of hyperkalemia. This is particularly
concerning in patients who also have underlying renal impairment or who are taking
potassium-sparing diuretics.
6. Which of the following is a hallmark clinical symptom of Giant Cell Arteritis (Temporal
Arteritis) that requires immediate intervention?
A. Lower extremity edema
B. Bilateral wheezing
C. Jaw claudication
D. Increased appetite
Answer: C
Rationale: Jaw claudication is a highly specific symptom of Giant Cell Arteritis, reflecting
ischemia to the masseter muscles. If left untreated, this condition can lead to permanent
vision loss due to ophthalmic artery involvement. Prompt initiation of high-dose
corticosteroids is mandatory when this condition is suspected to prevent irreversible
complications.
