NUR 6121 Final Exam V1 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Final Exam) | William Paterson
University
1. A 62-year-old patient with chronic obstructive pulmonary disease (COPD) presents with
increased sputum purulence and dyspnea. According to the GOLD guidelines, which category
of medication is the first-line treatment for an acute exacerbation in a patient with a high risk
of future exacerbations?
A. Long-acting muscarinic antagonists (LAMA)
B. Short-acting beta-agonists (SABA)
C. Inhaled corticosteroids monotherapy
D. Oral theophylline
Answer: A
Rationale: In the management of stable COPD, LAMA or LABA are the preferred long-term
treatments for symptomatic patients. For those in Group C or D with frequent
exacerbations, LAMAs have been shown to be more effective in preventing future events.
Inhaled corticosteroids should generally not be used as monotherapy due to the risk of
pneumonia and lack of efficacy compared to bronchodilators.
,2. A 45-year-old female presents with fatigue, cold intolerance, and a TSH level of 12.5 mIU/L.
After starting Levothyroxine 50 mcg daily, when should the Nurse Practitioner re-evaluate the
TSH level?
A. 2 weeks
B. 4 weeks
C. 6 to 8 weeks
D. 6 months
Answer: C
Rationale: Steady-state levels of thyroxine are typically reached after approximately five
half-lives of the drug. Since the half-life of levothyroxine is about 7 days, it takes several
weeks for the full effect of a dosage change to be reflected in the TSH. Monitoring too early
may lead to unnecessary dosage adjustments and potential over-treatment.
3. Which of the following is the preferred initial antihypertensive therapy for a non-African
American patient with newly diagnosed Stage 1 Hypertension and no other comorbidities,
according to JNC 8 guidelines?
A. Beta-blocker
B. ACE Inhibitor
C. Alpha-blocker
D. Loop diuretic
,Answer: B
Rationale: JNC 8 guidelines recommend thiazide-type diuretics, calcium channel blockers,
ACE inhibitors, or ARBs as initial therapy for the general non-black population. Beta-
blockers are no longer recommended as first-line therapy for hypertension unless there is
a specific indication like heart failure or post-MI. The choice between these four classes
should be individualized based on patient tolerance and specific risk factors.
4. A patient with Type 2 Diabetes Mellitus has an A1C of 8.1% while taking Metformin
1000mg twice daily. The patient has a history of atherosclerotic cardiovascular disease
(ASCVD). Which medication class should be added next?
A. DPP-4 Inhibitor
B. GLP-1 Receptor Agonist
C. Sulfonylurea
D. Basal Insulin
Answer: B
Rationale: Current ADA standards recommend that patients with established ASCVD
should be treated with a GLP-1 receptor agonist or an SGLT2 inhibitor with proven
cardiovascular benefit. These agents provide additional glycemic control while reducing
the risk of major adverse cardiovascular events. Sulfonylureas are typically avoided in this
scenario due to weight gain and hypoglycemia risks without cardiovascular protection.
, 5. A 70-year-old male presents with urinary frequency, hesitancy, and a weak stream. His PSA
is 2.4 ng/mL and digital rectal exam reveals a smooth, enlarged prostate. What is the most
appropriate first-line medication to improve his symptoms quickly?
A. Finasteride
B. Tamsulosin
C. Oxybutynin
D. Ciprofloxacin
Answer: B
Rationale: Alpha-1 blockers like tamsulosin work by relaxing the smooth muscle in the
bladder neck and prostate, providing rapid symptom relief for BPH. 5-alpha reductase
inhibitors like finasteride take several months to shrink the prostate and show clinical
benefit. Tamsulosin is the preferred choice for immediate improvement of lower urinary
tract symptoms associated with prostatic enlargement.
6. Which physical exam finding is most suggestive of acute cholecystitis?
A. McBurney’s point tenderness
B. Murphy’s sign
C. Rovsing’s sign
D. CVA tenderness
Answer: B
Advanced Nursing II | Q&A with Rationale
(NUR6121 Final Exam) | William Paterson
University
1. A 62-year-old patient with chronic obstructive pulmonary disease (COPD) presents with
increased sputum purulence and dyspnea. According to the GOLD guidelines, which category
of medication is the first-line treatment for an acute exacerbation in a patient with a high risk
of future exacerbations?
A. Long-acting muscarinic antagonists (LAMA)
B. Short-acting beta-agonists (SABA)
C. Inhaled corticosteroids monotherapy
D. Oral theophylline
Answer: A
Rationale: In the management of stable COPD, LAMA or LABA are the preferred long-term
treatments for symptomatic patients. For those in Group C or D with frequent
exacerbations, LAMAs have been shown to be more effective in preventing future events.
Inhaled corticosteroids should generally not be used as monotherapy due to the risk of
pneumonia and lack of efficacy compared to bronchodilators.
,2. A 45-year-old female presents with fatigue, cold intolerance, and a TSH level of 12.5 mIU/L.
After starting Levothyroxine 50 mcg daily, when should the Nurse Practitioner re-evaluate the
TSH level?
A. 2 weeks
B. 4 weeks
C. 6 to 8 weeks
D. 6 months
Answer: C
Rationale: Steady-state levels of thyroxine are typically reached after approximately five
half-lives of the drug. Since the half-life of levothyroxine is about 7 days, it takes several
weeks for the full effect of a dosage change to be reflected in the TSH. Monitoring too early
may lead to unnecessary dosage adjustments and potential over-treatment.
3. Which of the following is the preferred initial antihypertensive therapy for a non-African
American patient with newly diagnosed Stage 1 Hypertension and no other comorbidities,
according to JNC 8 guidelines?
A. Beta-blocker
B. ACE Inhibitor
C. Alpha-blocker
D. Loop diuretic
,Answer: B
Rationale: JNC 8 guidelines recommend thiazide-type diuretics, calcium channel blockers,
ACE inhibitors, or ARBs as initial therapy for the general non-black population. Beta-
blockers are no longer recommended as first-line therapy for hypertension unless there is
a specific indication like heart failure or post-MI. The choice between these four classes
should be individualized based on patient tolerance and specific risk factors.
4. A patient with Type 2 Diabetes Mellitus has an A1C of 8.1% while taking Metformin
1000mg twice daily. The patient has a history of atherosclerotic cardiovascular disease
(ASCVD). Which medication class should be added next?
A. DPP-4 Inhibitor
B. GLP-1 Receptor Agonist
C. Sulfonylurea
D. Basal Insulin
Answer: B
Rationale: Current ADA standards recommend that patients with established ASCVD
should be treated with a GLP-1 receptor agonist or an SGLT2 inhibitor with proven
cardiovascular benefit. These agents provide additional glycemic control while reducing
the risk of major adverse cardiovascular events. Sulfonylureas are typically avoided in this
scenario due to weight gain and hypoglycemia risks without cardiovascular protection.
, 5. A 70-year-old male presents with urinary frequency, hesitancy, and a weak stream. His PSA
is 2.4 ng/mL and digital rectal exam reveals a smooth, enlarged prostate. What is the most
appropriate first-line medication to improve his symptoms quickly?
A. Finasteride
B. Tamsulosin
C. Oxybutynin
D. Ciprofloxacin
Answer: B
Rationale: Alpha-1 blockers like tamsulosin work by relaxing the smooth muscle in the
bladder neck and prostate, providing rapid symptom relief for BPH. 5-alpha reductase
inhibitors like finasteride take several months to shrink the prostate and show clinical
benefit. Tamsulosin is the preferred choice for immediate improvement of lower urinary
tract symptoms associated with prostatic enlargement.
6. Which physical exam finding is most suggestive of acute cholecystitis?
A. McBurney’s point tenderness
B. Murphy’s sign
C. Rovsing’s sign
D. CVA tenderness
Answer: B
