NUR611/NUR 611 Exam 2 V1 | Adv
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A 62-year-old male with a history of hypertension presents for a routine check-up. His
blood pressure is 152/94 mmHg despite taking lisinopril. Which of the following is the most
appropriate next step in his management?
A. The clinician should double the dose of lisinopril immediately.
B. The clinician should discontinue all medications and monitor for one month.
C. The clinician should add a thiazide-type diuretic to the current regimen.
D. The clinician should recommend reducing physical activity to lower stress.
Correct Answer: C
Expert Explanation: The JNC 8 guidelines suggest adding a second medication if blood
pressure goals are not met with monotherapy. Thiazide diuretics are a preferred second-
line choice for most patients with hypertension. This combination helps address different
physiological pathways to lower blood pressure effectively.
2. Which physical exam finding is most indicative of acute otitis media in a pediatric patient?
A. The patient exhibits a bulging tympanic membrane with impaired mobility.
B. The patient has clear fluid visible behind a translucent membrane.
C. The patient reports pain when the pinna is gently pulled.
,D. The patient shows a small amount of cerumen in the outer canal.
Correct Answer: A
Expert Explanation: Acute otitis media is characterized by inflammation and fluid
accumulation in the middle ear. A bulging tympanic membrane is the most specific sign of
an acute bacterial infection. Impaired mobility during pneumatic otoscopy further confirms
the presence of middle ear effusion.
3. A patient presents with a ‘velvety’ hyperpigmented plaque on the back of the neck. This
finding is most commonly associated with which condition?
A. The patient likely has systemic lupus erythematosus.
B. The patient is showing signs of a primary fungal infection.
C. The patient is most likely exhibiting insulin resistance or Type 2 Diabetes.
D. The patient has a localized allergic reaction to clothing dyes.
Correct Answer: C
Expert Explanation: Acanthosis nigricans is a skin condition characterized by dark,
velvety discoloration in body folds and creases. It is frequently associated with
hyperinsulinemia and insulin resistance. Identifying this finding should prompt the
clinician to screen for metabolic syndrome or diabetes.
4. When treating a patient for Community-Acquired Pneumonia (CAP) who has no
comorbidities and no recent antibiotic use, which is the first-line choice?
A. The provider should start the patient on intravenous Vancomycin.
, B. The provider should prescribe Ciprofloxacin as the primary agent.
C. The provider should recommend over-the-counter cough suppressants only.
D. The provider should prescribe Amoxicillin or Doxycycline.
Correct Answer: D
Expert Explanation: Current guidelines for healthy outpatients with CAP recommend
high-dose amoxicillin or doxycycline as monotherapy. These agents provide adequate
coverage for common pathogens like Streptococcus pneumoniae. Macrolides are only
recommended if local pneumococcal resistance is low.
5. A 30-year-old female presents with a butterfly rash across her cheeks and nose. Which
laboratory test is the most appropriate initial screen for the suspected diagnosis?
A. The provider should order a Serum Potassium level.
B. The provider should order a Complete Blood Count (CBC) with differential.
C. The provider should order a Rapid Plasma Reagin (RPR) test.
D. The provider should order an Anti-nuclear Antibody (ANA) test.
Correct Answer: D
Expert Explanation: A butterfly rash is a classic sign of systemic lupus erythematosus
(SLE). The ANA test is highly sensitive for SLE and serves as the initial screening tool. If the
ANA is positive, further specific tests like anti-dsDNA or anti-Smith antibodies are
warranted.
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A 62-year-old male with a history of hypertension presents for a routine check-up. His
blood pressure is 152/94 mmHg despite taking lisinopril. Which of the following is the most
appropriate next step in his management?
A. The clinician should double the dose of lisinopril immediately.
B. The clinician should discontinue all medications and monitor for one month.
C. The clinician should add a thiazide-type diuretic to the current regimen.
D. The clinician should recommend reducing physical activity to lower stress.
Correct Answer: C
Expert Explanation: The JNC 8 guidelines suggest adding a second medication if blood
pressure goals are not met with monotherapy. Thiazide diuretics are a preferred second-
line choice for most patients with hypertension. This combination helps address different
physiological pathways to lower blood pressure effectively.
2. Which physical exam finding is most indicative of acute otitis media in a pediatric patient?
A. The patient exhibits a bulging tympanic membrane with impaired mobility.
B. The patient has clear fluid visible behind a translucent membrane.
C. The patient reports pain when the pinna is gently pulled.
,D. The patient shows a small amount of cerumen in the outer canal.
Correct Answer: A
Expert Explanation: Acute otitis media is characterized by inflammation and fluid
accumulation in the middle ear. A bulging tympanic membrane is the most specific sign of
an acute bacterial infection. Impaired mobility during pneumatic otoscopy further confirms
the presence of middle ear effusion.
3. A patient presents with a ‘velvety’ hyperpigmented plaque on the back of the neck. This
finding is most commonly associated with which condition?
A. The patient likely has systemic lupus erythematosus.
B. The patient is showing signs of a primary fungal infection.
C. The patient is most likely exhibiting insulin resistance or Type 2 Diabetes.
D. The patient has a localized allergic reaction to clothing dyes.
Correct Answer: C
Expert Explanation: Acanthosis nigricans is a skin condition characterized by dark,
velvety discoloration in body folds and creases. It is frequently associated with
hyperinsulinemia and insulin resistance. Identifying this finding should prompt the
clinician to screen for metabolic syndrome or diabetes.
4. When treating a patient for Community-Acquired Pneumonia (CAP) who has no
comorbidities and no recent antibiotic use, which is the first-line choice?
A. The provider should start the patient on intravenous Vancomycin.
, B. The provider should prescribe Ciprofloxacin as the primary agent.
C. The provider should recommend over-the-counter cough suppressants only.
D. The provider should prescribe Amoxicillin or Doxycycline.
Correct Answer: D
Expert Explanation: Current guidelines for healthy outpatients with CAP recommend
high-dose amoxicillin or doxycycline as monotherapy. These agents provide adequate
coverage for common pathogens like Streptococcus pneumoniae. Macrolides are only
recommended if local pneumococcal resistance is low.
5. A 30-year-old female presents with a butterfly rash across her cheeks and nose. Which
laboratory test is the most appropriate initial screen for the suspected diagnosis?
A. The provider should order a Serum Potassium level.
B. The provider should order a Complete Blood Count (CBC) with differential.
C. The provider should order a Rapid Plasma Reagin (RPR) test.
D. The provider should order an Anti-nuclear Antibody (ANA) test.
Correct Answer: D
Expert Explanation: A butterfly rash is a classic sign of systemic lupus erythematosus
(SLE). The ANA test is highly sensitive for SLE and serves as the initial screening tool. If the
ANA is positive, further specific tests like anti-dsDNA or anti-Smith antibodies are
warranted.
