NUR611/NUR 611 Final Exam V1 | Adv
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A 55-year-old patient presents with a blood pressure of 152/94 mmHg on two separate
visits. According to JNC 8, what is the recommended initial pharmacological action for a non-
black patient?
A. Implement lifestyle modifications only for the next six months.
B. Start a high-dose beta-blocker immediately to control the heart rate.
C. Prescribe a loop diuretic as the primary maintenance therapy.
D. Initiate a thiazide-type diuretic, ACE inhibitor, ARB, or calcium channel blocker.
Correct Answer: D
Expert Explanation: JNC 8 guidelines specify that for the general non-black population,
initial treatment should include a thiazide-type diuretic, CCB, ACE inhibitor, or ARB. This
patient meets the criteria for Stage 2 hypertension based on multiple readings. Selecting
one of these classes is supported by evidence to reduce cardiovascular morbidity and
mortality.
2. A patient with Type 2 Diabetes Mellitus presents with an A1C of 8.2% despite being on
Metformin 1000mg twice daily. What is the most appropriate next step in management?
A. Switch the patient from Metformin to a sliding scale insulin regimen.
,B. Increase the Metformin dosage to 3000mg daily to reach the target.
C. Add a second oral agent such as a GLP-1 receptor agonist or SGLT2 inhibitor.
D. Discontinue all medications and focus strictly on a ketogenic diet.
Correct Answer: C
Expert Explanation: When a patient’s A1C remains above the target of 7% on
monotherapy, adding a second agent is the standard of care. GLP-1 agonists and SGLT2
inhibitors offer additional benefits such as weight loss and cardiovascular protection. This
approach follows the American Diabetes Association’s stepwise management guidelines for
glycemic control.
3. Which physical exam finding is most indicative of a diagnosis of Community-Acquired
Pneumonia (CAP)?
A. Increased tactile fremitus and dullness to percussion over the affected lobe.
B. The presence of vesicular breath sounds throughout all lung fields.
C. Hyperresonance on percussion and decreased tactile fremitus.
D. Wheezing heard primarily during the expiratory phase of respiration.
Correct Answer: A
Expert Explanation: Consolidation in the lung tissue, characteristic of pneumonia, leads to
increased tactile fremitus because sound travels better through solid or fluid-filled media.
Dullness to percussion is also expected when air-filled lung tissue is replaced by
, inflammatory exudate. These findings help differentiate pneumonia from conditions like
pneumothorax or COPD.
4. An 18-year-old female presents with a sore throat, fever, and cervical lymphadenopathy. A
rapid strep test is negative. What is the next diagnostic priority?
A. Perform a Monospot test to check for Infectious Mononucleosis.
B. Immediately start a course of broad-spectrum Amoxicillin.
C. Order a chest X-ray to rule out secondary bacterial pneumonia.
D. Obtain a throat culture to confirm the negative rapid test result.
Correct Answer: D
Expert Explanation: In pediatric and adolescent patients, a negative rapid antigen
detection test (RADT) for Group A Strep should be confirmed with a throat culture. This is
necessary because the RADT has a lower sensitivity, and missing a diagnosis could lead to
rheumatic fever. If the culture is negative, then other causes like Mononucleosis should be
investigated based on clinical progression.
5. What is the gold standard for diagnosing Chronic Obstructive Pulmonary Disease (COPD)?
A. Spirometry demonstrating an FEV1/FVC ratio of less than 0.70 post-bronchodilator.
B. Pulse oximetry showing a resting oxygen saturation below 92%.
C. A chest X-ray showing hyperinflation and a flattened diaphragm.
D. A sputum culture positive for Haemophilus influenzae.
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A 55-year-old patient presents with a blood pressure of 152/94 mmHg on two separate
visits. According to JNC 8, what is the recommended initial pharmacological action for a non-
black patient?
A. Implement lifestyle modifications only for the next six months.
B. Start a high-dose beta-blocker immediately to control the heart rate.
C. Prescribe a loop diuretic as the primary maintenance therapy.
D. Initiate a thiazide-type diuretic, ACE inhibitor, ARB, or calcium channel blocker.
Correct Answer: D
Expert Explanation: JNC 8 guidelines specify that for the general non-black population,
initial treatment should include a thiazide-type diuretic, CCB, ACE inhibitor, or ARB. This
patient meets the criteria for Stage 2 hypertension based on multiple readings. Selecting
one of these classes is supported by evidence to reduce cardiovascular morbidity and
mortality.
2. A patient with Type 2 Diabetes Mellitus presents with an A1C of 8.2% despite being on
Metformin 1000mg twice daily. What is the most appropriate next step in management?
A. Switch the patient from Metformin to a sliding scale insulin regimen.
,B. Increase the Metformin dosage to 3000mg daily to reach the target.
C. Add a second oral agent such as a GLP-1 receptor agonist or SGLT2 inhibitor.
D. Discontinue all medications and focus strictly on a ketogenic diet.
Correct Answer: C
Expert Explanation: When a patient’s A1C remains above the target of 7% on
monotherapy, adding a second agent is the standard of care. GLP-1 agonists and SGLT2
inhibitors offer additional benefits such as weight loss and cardiovascular protection. This
approach follows the American Diabetes Association’s stepwise management guidelines for
glycemic control.
3. Which physical exam finding is most indicative of a diagnosis of Community-Acquired
Pneumonia (CAP)?
A. Increased tactile fremitus and dullness to percussion over the affected lobe.
B. The presence of vesicular breath sounds throughout all lung fields.
C. Hyperresonance on percussion and decreased tactile fremitus.
D. Wheezing heard primarily during the expiratory phase of respiration.
Correct Answer: A
Expert Explanation: Consolidation in the lung tissue, characteristic of pneumonia, leads to
increased tactile fremitus because sound travels better through solid or fluid-filled media.
Dullness to percussion is also expected when air-filled lung tissue is replaced by
, inflammatory exudate. These findings help differentiate pneumonia from conditions like
pneumothorax or COPD.
4. An 18-year-old female presents with a sore throat, fever, and cervical lymphadenopathy. A
rapid strep test is negative. What is the next diagnostic priority?
A. Perform a Monospot test to check for Infectious Mononucleosis.
B. Immediately start a course of broad-spectrum Amoxicillin.
C. Order a chest X-ray to rule out secondary bacterial pneumonia.
D. Obtain a throat culture to confirm the negative rapid test result.
Correct Answer: D
Expert Explanation: In pediatric and adolescent patients, a negative rapid antigen
detection test (RADT) for Group A Strep should be confirmed with a throat culture. This is
necessary because the RADT has a lower sensitivity, and missing a diagnosis could lead to
rheumatic fever. If the culture is negative, then other causes like Mononucleosis should be
investigated based on clinical progression.
5. What is the gold standard for diagnosing Chronic Obstructive Pulmonary Disease (COPD)?
A. Spirometry demonstrating an FEV1/FVC ratio of less than 0.70 post-bronchodilator.
B. Pulse oximetry showing a resting oxygen saturation below 92%.
C. A chest X-ray showing hyperinflation and a flattened diaphragm.
D. A sputum culture positive for Haemophilus influenzae.
