NUR611/NUR 611 Exam 3 V3 | Adv
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A 62-year-old patient presents with a blood pressure of 154/94 mmHg on two separate
occasions. Which of the following is the most appropriate first-line pharmacologic
intervention for this patient according to JNC 8 guidelines?
A. The provider should recommend immediate referral to a cardiologist.
B. The provider should start the patient on a high-dose beta-blocker.
C. The provider should initiate treatment with a thiazide-type diuretic.
D. The provider should prescribe a calcium channel blocker and an ACE inhibitor together.
Correct Answer: C
Expert Explanation: Thiazide-type diuretics are recommended as one of the first-line
treatment options for hypertension in the general non-black population. Clinical trials have
demonstrated their efficacy in reducing cardiovascular events and improving overall
patient outcomes. The provider must also emphasize lifestyle modifications in conjunction
with pharmacologic therapy to achieve target blood pressure goals.
,2. When managing a patient with chronic obstructive pulmonary disease (COPD) who has
frequent exacerbations, which medication class is primarily indicated for long-term
maintenance?
A. The patient should use a short-acting beta-agonist as needed.
B. The patient should use a nebulized antibiotic for prophylaxis.
C. The patient should take oral corticosteroids on a daily basis.
D. The patient should be prescribed a long-acting muscarinic antagonist.
Correct Answer: D
Expert Explanation: Long-acting muscarinic antagonists (LAMAs) are the cornerstone of
maintenance therapy for patients with COPD who experience frequent symptoms or
exacerbations. These medications work by inducing bronchodilation through the inhibition
of acetylcholine receptors in the airway smooth muscle. Consistent use of LAMAs has been
shown to reduce the rate of hospitalizations and improve the quality of life for these
patients.
3. A patient with type 2 diabetes has an A1C level of 8.5% despite lifestyle modifications.
What is the standard first-line medication for this patient?
A. The provider should prescribe an injectable insulin glargine.
B. The provider should initiate therapy with a sulfonylurea like glipizide.
C. The provider should recommend a DPPIV inhibitor as the first agent.
D. The provider should start the patient on metformin.
,Correct Answer: D
Expert Explanation: Metformin is globally recognized as the preferred initial
pharmacologic agent for the treatment of type 2 diabetes mellitus due to its efficacy and
safety profile. It works primarily by decreasing hepatic glucose production and improving
insulin sensitivity in peripheral tissues. Unless there are specific contraindications such as
severe renal impairment, it remains the foundation of most diabetic treatment regimens.
4. A 45-year-old female reports fatigue, weight gain, and cold intolerance. Her TSH is 12.4
mIU/L and free T4 is low. What is the most likely diagnosis?
A. The patient is suffering from primary hyperthyroidism.
B. The patient has a pituitary adenoma causing secondary hypothyroidism.
C. The patient is experiencing a case of subacute thyroiditis.
D. The patient has developed primary hypothyroidism.
Correct Answer: D
Expert Explanation: The combination of an elevated TSH and a low free T4 is diagnostic of
primary hypothyroidism, often caused by Hashimoto’s thyroiditis. Symptoms such as
fatigue and weight gain are classic clinical manifestations resulting from a slowed
metabolic rate. Treatment typically involves life-long thyroid hormone replacement
therapy with levothyroxine to normalize lab values and alleviate symptoms.
, 5. A patient reports a persistent dry cough after starting a new medication for hypertension.
Which medication is most likely responsible?
A. The patient is likely taking an ARB like Losartan.
B. The patient is likely taking a calcium channel blocker like Amlodipine.
C. The patient is likely taking a beta-blocker like Metoprolol.
D. The patient is likely taking an ACE inhibitor like Lisinopril.
Correct Answer: D
Expert Explanation: ACE inhibitors are well-known for causing a dry, non-productive
cough in a significant percentage of patients due to the accumulation of bradykinin in the
lungs. This side effect is a common reason for patients to discontinue the medication and
switch to an alternative class like ARBs. The cough usually resolves within a few weeks
after the drug is stopped, confirming the association.
6. Which of the following physical exam findings is most suggestive of an acute myocardial
infarction?
A. The patient presents with New-onset ST-segment elevation on ECG.
B. The patient exhibits a loud S3 gallop and peripheral edema.
C. The patient has a normal heart rate and blood pressure.
D. The patient shows clear lung sounds on auscultation.
Correct Answer: A
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A 62-year-old patient presents with a blood pressure of 154/94 mmHg on two separate
occasions. Which of the following is the most appropriate first-line pharmacologic
intervention for this patient according to JNC 8 guidelines?
A. The provider should recommend immediate referral to a cardiologist.
B. The provider should start the patient on a high-dose beta-blocker.
C. The provider should initiate treatment with a thiazide-type diuretic.
D. The provider should prescribe a calcium channel blocker and an ACE inhibitor together.
Correct Answer: C
Expert Explanation: Thiazide-type diuretics are recommended as one of the first-line
treatment options for hypertension in the general non-black population. Clinical trials have
demonstrated their efficacy in reducing cardiovascular events and improving overall
patient outcomes. The provider must also emphasize lifestyle modifications in conjunction
with pharmacologic therapy to achieve target blood pressure goals.
,2. When managing a patient with chronic obstructive pulmonary disease (COPD) who has
frequent exacerbations, which medication class is primarily indicated for long-term
maintenance?
A. The patient should use a short-acting beta-agonist as needed.
B. The patient should use a nebulized antibiotic for prophylaxis.
C. The patient should take oral corticosteroids on a daily basis.
D. The patient should be prescribed a long-acting muscarinic antagonist.
Correct Answer: D
Expert Explanation: Long-acting muscarinic antagonists (LAMAs) are the cornerstone of
maintenance therapy for patients with COPD who experience frequent symptoms or
exacerbations. These medications work by inducing bronchodilation through the inhibition
of acetylcholine receptors in the airway smooth muscle. Consistent use of LAMAs has been
shown to reduce the rate of hospitalizations and improve the quality of life for these
patients.
3. A patient with type 2 diabetes has an A1C level of 8.5% despite lifestyle modifications.
What is the standard first-line medication for this patient?
A. The provider should prescribe an injectable insulin glargine.
B. The provider should initiate therapy with a sulfonylurea like glipizide.
C. The provider should recommend a DPPIV inhibitor as the first agent.
D. The provider should start the patient on metformin.
,Correct Answer: D
Expert Explanation: Metformin is globally recognized as the preferred initial
pharmacologic agent for the treatment of type 2 diabetes mellitus due to its efficacy and
safety profile. It works primarily by decreasing hepatic glucose production and improving
insulin sensitivity in peripheral tissues. Unless there are specific contraindications such as
severe renal impairment, it remains the foundation of most diabetic treatment regimens.
4. A 45-year-old female reports fatigue, weight gain, and cold intolerance. Her TSH is 12.4
mIU/L and free T4 is low. What is the most likely diagnosis?
A. The patient is suffering from primary hyperthyroidism.
B. The patient has a pituitary adenoma causing secondary hypothyroidism.
C. The patient is experiencing a case of subacute thyroiditis.
D. The patient has developed primary hypothyroidism.
Correct Answer: D
Expert Explanation: The combination of an elevated TSH and a low free T4 is diagnostic of
primary hypothyroidism, often caused by Hashimoto’s thyroiditis. Symptoms such as
fatigue and weight gain are classic clinical manifestations resulting from a slowed
metabolic rate. Treatment typically involves life-long thyroid hormone replacement
therapy with levothyroxine to normalize lab values and alleviate symptoms.
, 5. A patient reports a persistent dry cough after starting a new medication for hypertension.
Which medication is most likely responsible?
A. The patient is likely taking an ARB like Losartan.
B. The patient is likely taking a calcium channel blocker like Amlodipine.
C. The patient is likely taking a beta-blocker like Metoprolol.
D. The patient is likely taking an ACE inhibitor like Lisinopril.
Correct Answer: D
Expert Explanation: ACE inhibitors are well-known for causing a dry, non-productive
cough in a significant percentage of patients due to the accumulation of bradykinin in the
lungs. This side effect is a common reason for patients to discontinue the medication and
switch to an alternative class like ARBs. The cough usually resolves within a few weeks
after the drug is stopped, confirming the association.
6. Which of the following physical exam findings is most suggestive of an acute myocardial
infarction?
A. The patient presents with New-onset ST-segment elevation on ECG.
B. The patient exhibits a loud S3 gallop and peripheral edema.
C. The patient has a normal heart rate and blood pressure.
D. The patient shows clear lung sounds on auscultation.
Correct Answer: A
