NUR612/NUR 612 Exam 1 V1 | Advanced
Nursing II Q&A with Rationale | William
Paterson University
1. A 55-year-old patient presents with a blood pressure of 145/92 mmHg on two separate
visits. How should this be classified according to current ACC/AHA guidelines?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 2 hypertension
D. Stage 1 hypertension
Correct Answer: C
Expert Explanation: Stage 2 hypertension is defined as a systolic blood pressure of 140
mmHg or higher or a diastolic blood pressure of 90 mmHg or higher. This patient’s
readings on two separate occasions confirm the diagnosis based on standardized
guidelines. Accurate classification is necessary to determine the appropriate
pharmacological intervention and follow-up schedule.
2. Which of the following physical exam findings is most characteristic of a patient with right-
sided heart failure?
A. Crackles in the lung bases
B. Peripheral edema and jugular venous distention
,C. Paroxysmal nocturnal dyspnea
D. S3 gallop at the apex
Correct Answer: B
Expert Explanation: Right-sided heart failure leads to systemic venous congestion
because the right ventricle is unable to pump blood effectively into the pulmonary
circulation. This results in observable signs such as pitting edema in the lower extremities
and increased jugular venous pressure. In contrast, crackles and nocturnal dyspnea are
more typically associated with pulmonary congestion seen in left-sided heart failure.
3. In the management of COPD, what is the primary purpose of prescribing a Long-Acting
Muscarinic Antagonist (LAMA)?
A. To provide immediate relief during an acute exacerbation
B. To reduce airway inflammation like a corticosteroid
C. To treat underlying bacterial infections in the bronchioles
D. To provide long-term bronchodilation and reduce the frequency of exacerbations
Correct Answer: D
Expert Explanation: LAMAs function by blocking muscarinic receptors on smooth muscle
cells in the airways, leading to prolonged bronchodilation. These medications are used for
maintenance therapy rather than rescue treatment to improve lung function and quality of
life. They have been shown to be superior to LABAs in reducing the risk of exacerbations in
patients with moderate to severe COPD.
, 4. A patient with Type 2 Diabetes has an A1C of 8.5% despite lifestyle modifications. What is
the generally recommended first-line pharmacological treatment?
A. Insulin Glargine
B. Pioglitazone
C. Glyburide
D. Metformin
Correct Answer: D
Expert Explanation: Metformin is the preferred initial pharmacological agent for the
treatment of type 2 diabetes due to its efficacy, safety, and low cost. It works primarily by
decreasing hepatic glucose production and increasing insulin sensitivity in peripheral
tissues. Unless contraindicated by severe renal impairment, it should be the foundation of
the treatment regimen.
5. Which heart murmur is best heard at the second intercostal space, right sternal border, and
typically radiates to the carotids?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral stenosis
D. Aortic regurgitation
Correct Answer: A
Nursing II Q&A with Rationale | William
Paterson University
1. A 55-year-old patient presents with a blood pressure of 145/92 mmHg on two separate
visits. How should this be classified according to current ACC/AHA guidelines?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 2 hypertension
D. Stage 1 hypertension
Correct Answer: C
Expert Explanation: Stage 2 hypertension is defined as a systolic blood pressure of 140
mmHg or higher or a diastolic blood pressure of 90 mmHg or higher. This patient’s
readings on two separate occasions confirm the diagnosis based on standardized
guidelines. Accurate classification is necessary to determine the appropriate
pharmacological intervention and follow-up schedule.
2. Which of the following physical exam findings is most characteristic of a patient with right-
sided heart failure?
A. Crackles in the lung bases
B. Peripheral edema and jugular venous distention
,C. Paroxysmal nocturnal dyspnea
D. S3 gallop at the apex
Correct Answer: B
Expert Explanation: Right-sided heart failure leads to systemic venous congestion
because the right ventricle is unable to pump blood effectively into the pulmonary
circulation. This results in observable signs such as pitting edema in the lower extremities
and increased jugular venous pressure. In contrast, crackles and nocturnal dyspnea are
more typically associated with pulmonary congestion seen in left-sided heart failure.
3. In the management of COPD, what is the primary purpose of prescribing a Long-Acting
Muscarinic Antagonist (LAMA)?
A. To provide immediate relief during an acute exacerbation
B. To reduce airway inflammation like a corticosteroid
C. To treat underlying bacterial infections in the bronchioles
D. To provide long-term bronchodilation and reduce the frequency of exacerbations
Correct Answer: D
Expert Explanation: LAMAs function by blocking muscarinic receptors on smooth muscle
cells in the airways, leading to prolonged bronchodilation. These medications are used for
maintenance therapy rather than rescue treatment to improve lung function and quality of
life. They have been shown to be superior to LABAs in reducing the risk of exacerbations in
patients with moderate to severe COPD.
, 4. A patient with Type 2 Diabetes has an A1C of 8.5% despite lifestyle modifications. What is
the generally recommended first-line pharmacological treatment?
A. Insulin Glargine
B. Pioglitazone
C. Glyburide
D. Metformin
Correct Answer: D
Expert Explanation: Metformin is the preferred initial pharmacological agent for the
treatment of type 2 diabetes due to its efficacy, safety, and low cost. It works primarily by
decreasing hepatic glucose production and increasing insulin sensitivity in peripheral
tissues. Unless contraindicated by severe renal impairment, it should be the foundation of
the treatment regimen.
5. Which heart murmur is best heard at the second intercostal space, right sternal border, and
typically radiates to the carotids?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral stenosis
D. Aortic regurgitation
Correct Answer: A
