NUR612/NUR 612 Exam 2 V1 | Advanced
Nursing II Q&A with Rationale | William
Paterson University
1. A 65-year-old patient presents with a harsh systolic ejection murmur heard best at the
right second intercostal space that radiates to the carotid arteries. What is the most likely
diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Stenosis
D. Aortic Regurgitation
Correct Answer: A
Expert Explanation: Aortic stenosis typically presents as a systolic murmur at the right
upper sternal border. The murmur characteristically radiates to the carotid arteries as
blood is forced through a narrowed valve. In contrast, mitral regurgitation is usually heard
at the apex and radiates to the axilla.
2. Which of the following physical exam findings is most suggestive of heart failure in an older
adult?
A. Presence of an S4 heart sound
B. A physiological split S2
,C. Occasional premature ventricular contractions
D. Presence of an S3 heart sound
Correct Answer: D
Expert Explanation: The S3 heart sound, or ventricular gallop, is a classic sign of fluid
overload and ventricular dysfunction in adults. While an S4 can be normal in elderly
patients due to decreased ventricular compliance, an S3 is highly specific for heart failure.
This sound occurs during the early phase of diastole when blood rushes into an overfilled
or non-compliant ventricle.
3. A patient with a history of COPD presents with increased dyspnea and productive cough.
Which diagnostic tool is the gold standard for confirming the diagnosis and severity of COPD?
A. Chest X-ray
B. Spirometry
C. Arterial Blood Gas (ABG)
D. Pulse Oximetry
Correct Answer: B
Expert Explanation: Spirometry is required to make a clinical diagnosis of COPD by
demonstrating persistent airflow limitation. A post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of airflow obstruction. While chest X-rays can show
hyperinflation, they are not sensitive enough for a definitive diagnosis of COPD stages.
, 4. In the management of hypertension, which medication class is preferred as first-line
therapy for a patient with comorbid Chronic Kidney Disease (CKD)?
A. Calcium Channel Blockers
B. ACE Inhibitors or ARBs
C. Thiazide Diuretics
D. Beta Blockers
Correct Answer: B
Expert Explanation: ACE inhibitors or ARBs are recommended as first-line therapy for
patients with CKD because they provide renoprotective effects. They help reduce
intraglomerular pressure by dilating the efferent arteriole, which slows the progression of
albuminuria. Other antihypertensives may lower blood pressure but do not offer the same
degree of renal protection.
5. A 45-year-old female presents with fatigue and cold intolerance. Lab results show an
elevated TSH and a low free T4. What is the most appropriate next step?
A. Repeat the labs in 6 months
B. Order a Thyroid Ultrasound
C. Initiate Methimazole therapy
D. Initiate Levothyroxine therapy
Correct Answer: D
Nursing II Q&A with Rationale | William
Paterson University
1. A 65-year-old patient presents with a harsh systolic ejection murmur heard best at the
right second intercostal space that radiates to the carotid arteries. What is the most likely
diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Stenosis
D. Aortic Regurgitation
Correct Answer: A
Expert Explanation: Aortic stenosis typically presents as a systolic murmur at the right
upper sternal border. The murmur characteristically radiates to the carotid arteries as
blood is forced through a narrowed valve. In contrast, mitral regurgitation is usually heard
at the apex and radiates to the axilla.
2. Which of the following physical exam findings is most suggestive of heart failure in an older
adult?
A. Presence of an S4 heart sound
B. A physiological split S2
,C. Occasional premature ventricular contractions
D. Presence of an S3 heart sound
Correct Answer: D
Expert Explanation: The S3 heart sound, or ventricular gallop, is a classic sign of fluid
overload and ventricular dysfunction in adults. While an S4 can be normal in elderly
patients due to decreased ventricular compliance, an S3 is highly specific for heart failure.
This sound occurs during the early phase of diastole when blood rushes into an overfilled
or non-compliant ventricle.
3. A patient with a history of COPD presents with increased dyspnea and productive cough.
Which diagnostic tool is the gold standard for confirming the diagnosis and severity of COPD?
A. Chest X-ray
B. Spirometry
C. Arterial Blood Gas (ABG)
D. Pulse Oximetry
Correct Answer: B
Expert Explanation: Spirometry is required to make a clinical diagnosis of COPD by
demonstrating persistent airflow limitation. A post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of airflow obstruction. While chest X-rays can show
hyperinflation, they are not sensitive enough for a definitive diagnosis of COPD stages.
, 4. In the management of hypertension, which medication class is preferred as first-line
therapy for a patient with comorbid Chronic Kidney Disease (CKD)?
A. Calcium Channel Blockers
B. ACE Inhibitors or ARBs
C. Thiazide Diuretics
D. Beta Blockers
Correct Answer: B
Expert Explanation: ACE inhibitors or ARBs are recommended as first-line therapy for
patients with CKD because they provide renoprotective effects. They help reduce
intraglomerular pressure by dilating the efferent arteriole, which slows the progression of
albuminuria. Other antihypertensives may lower blood pressure but do not offer the same
degree of renal protection.
5. A 45-year-old female presents with fatigue and cold intolerance. Lab results show an
elevated TSH and a low free T4. What is the most appropriate next step?
A. Repeat the labs in 6 months
B. Order a Thyroid Ultrasound
C. Initiate Methimazole therapy
D. Initiate Levothyroxine therapy
Correct Answer: D
