NUR 6121 Exam 2 V3 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 2) | William Paterson
University
1. A 58-year-old male with a history of hypertension and Type 2 Diabetes presents for a
routine follow-up. His recent laboratory results show a serum creatinine of 1.8 mg/dL and an
estimated Glomerular Filtration Rate (eGFR) of 42 mL/min/1.73m². Based on the KDIGO
guidelines, what is his Stage of Chronic Kidney Disease (CKD)?
A. Stage 2
B. Stage 3b
C. Stage 3a
D. Stage 4
Answer: B
Rationale: Chronic Kidney Disease Stage 3b is defined by an eGFR ranging from 30 to 44
mL/min/1.73m². This stage represents moderate to severe decrease in kidney function and
requires careful monitoring of electrolytes and blood pressure. The patient’s eGFR of 42 fits
precisely within this category, necessitating a review of nephrotoxic medications.
,2. A 45-year-old female presents with symptoms of fatigue, weight gain, and cold intolerance.
Her lab results reveal an elevated TSH of 12.5 mIU/L and a low Free T4. Which of the
following is the most appropriate initial management for this patient?
A. Begin Methimazole 10 mg daily
B. Initiate Levothyroxine at 25-50 mcg daily
C. Order a Thyroid Ultrasound immediately
D. Recheck labs in 6 months without treatment
Answer: B
Rationale: The laboratory findings of elevated TSH and low Free T4 are diagnostic of
primary hypothyroidism. Levothyroxine is the standard of care for replacement therapy,
typically starting at a low dose for middle-aged adults or those with cardiovascular risks.
The goal of therapy is to normalize the TSH level and alleviate clinical symptoms of the
hypometabolic state.
3. A patient with a history of Gastroesophageal Reflux Disease (GERD) reports persistent
symptoms despite eight weeks of daily Proton Pump Inhibitor (PPI) therapy. What is the next
best step in the management of this patient?
A. Refer for an Upper Endoscopy (EGD)
B. Switch to an H2-Receptor Antagonist
C. Increase the PPI to twice daily
D. Add a prokinetic agent like Metoclopramide
,Answer: A
Rationale: Persistent GERD symptoms despite optimal PPI therapy are considered
refractory and warrant further investigation. An Upper Endoscopy is indicated to rule out
complications such as Barrett’s esophagus, peptic strictures, or eosinophilic esophagitis.
This diagnostic procedure allows for direct visualization and biopsy of the esophageal
mucosa to guide subsequent therapy.
4. Which of the following physical examination findings is most specific for a diagnosis of
Acute Cholecystitis?
A. Rovsing’s Sign
B. Murphy’s Sign
C. McBurney’s Point tenderness
D. Psoas Sign
Answer: B
Rationale: Murphy’s Sign is elicited by palpating the right upper quadrant while the
patient takes a deep breath; a positive test is indicated by the patient catching their breath
due to pain. This finding has a high sensitivity for acute cholecystitis when the gallbladder
contacts the examiner’s hand. In contrast, Rovsing’s, McBurney’s, and Psoas signs are
primarily associated with clinical evaluation for appendicitis.
, 5. A 62-year-old patient with Chronic Obstructive Pulmonary Disease (COPD) presents with
increased sputum purulence and worsening dyspnea. According to the GOLD guidelines,
which class of medication is essential for managing this acute exacerbation in addition to
bronchodilators?
A. Inhaled Corticosteroids
B. Long-acting Beta Agonists (LABA)
C. Systemic Corticosteroids
D. Theophylline
Answer: C
Rationale: Systemic corticosteroids, such as oral prednisone, are recommended during
COPD exacerbations to improve lung function and decrease recovery time. They help
reduce airway inflammation and improve oxygenation more effectively than inhaled
versions during the acute phase. The duration of therapy is typically shortened to 5-7 days
to minimize side effects while maximizing therapeutic benefit.
6. In the management of a patient with newly diagnosed Rheumatoid Arthritis (RA), which
medication is considered the first-line Disease-Modifying Antirheumatic Drug (DMARD)?
A. Hydroxychloroquine
B. Prednisone
C. Adalimumab
D. Methotrexate
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 2) | William Paterson
University
1. A 58-year-old male with a history of hypertension and Type 2 Diabetes presents for a
routine follow-up. His recent laboratory results show a serum creatinine of 1.8 mg/dL and an
estimated Glomerular Filtration Rate (eGFR) of 42 mL/min/1.73m². Based on the KDIGO
guidelines, what is his Stage of Chronic Kidney Disease (CKD)?
A. Stage 2
B. Stage 3b
C. Stage 3a
D. Stage 4
Answer: B
Rationale: Chronic Kidney Disease Stage 3b is defined by an eGFR ranging from 30 to 44
mL/min/1.73m². This stage represents moderate to severe decrease in kidney function and
requires careful monitoring of electrolytes and blood pressure. The patient’s eGFR of 42 fits
precisely within this category, necessitating a review of nephrotoxic medications.
,2. A 45-year-old female presents with symptoms of fatigue, weight gain, and cold intolerance.
Her lab results reveal an elevated TSH of 12.5 mIU/L and a low Free T4. Which of the
following is the most appropriate initial management for this patient?
A. Begin Methimazole 10 mg daily
B. Initiate Levothyroxine at 25-50 mcg daily
C. Order a Thyroid Ultrasound immediately
D. Recheck labs in 6 months without treatment
Answer: B
Rationale: The laboratory findings of elevated TSH and low Free T4 are diagnostic of
primary hypothyroidism. Levothyroxine is the standard of care for replacement therapy,
typically starting at a low dose for middle-aged adults or those with cardiovascular risks.
The goal of therapy is to normalize the TSH level and alleviate clinical symptoms of the
hypometabolic state.
3. A patient with a history of Gastroesophageal Reflux Disease (GERD) reports persistent
symptoms despite eight weeks of daily Proton Pump Inhibitor (PPI) therapy. What is the next
best step in the management of this patient?
A. Refer for an Upper Endoscopy (EGD)
B. Switch to an H2-Receptor Antagonist
C. Increase the PPI to twice daily
D. Add a prokinetic agent like Metoclopramide
,Answer: A
Rationale: Persistent GERD symptoms despite optimal PPI therapy are considered
refractory and warrant further investigation. An Upper Endoscopy is indicated to rule out
complications such as Barrett’s esophagus, peptic strictures, or eosinophilic esophagitis.
This diagnostic procedure allows for direct visualization and biopsy of the esophageal
mucosa to guide subsequent therapy.
4. Which of the following physical examination findings is most specific for a diagnosis of
Acute Cholecystitis?
A. Rovsing’s Sign
B. Murphy’s Sign
C. McBurney’s Point tenderness
D. Psoas Sign
Answer: B
Rationale: Murphy’s Sign is elicited by palpating the right upper quadrant while the
patient takes a deep breath; a positive test is indicated by the patient catching their breath
due to pain. This finding has a high sensitivity for acute cholecystitis when the gallbladder
contacts the examiner’s hand. In contrast, Rovsing’s, McBurney’s, and Psoas signs are
primarily associated with clinical evaluation for appendicitis.
, 5. A 62-year-old patient with Chronic Obstructive Pulmonary Disease (COPD) presents with
increased sputum purulence and worsening dyspnea. According to the GOLD guidelines,
which class of medication is essential for managing this acute exacerbation in addition to
bronchodilators?
A. Inhaled Corticosteroids
B. Long-acting Beta Agonists (LABA)
C. Systemic Corticosteroids
D. Theophylline
Answer: C
Rationale: Systemic corticosteroids, such as oral prednisone, are recommended during
COPD exacerbations to improve lung function and decrease recovery time. They help
reduce airway inflammation and improve oxygenation more effectively than inhaled
versions during the acute phase. The duration of therapy is typically shortened to 5-7 days
to minimize side effects while maximizing therapeutic benefit.
6. In the management of a patient with newly diagnosed Rheumatoid Arthritis (RA), which
medication is considered the first-line Disease-Modifying Antirheumatic Drug (DMARD)?
A. Hydroxychloroquine
B. Prednisone
C. Adalimumab
D. Methotrexate
