NUR612/NUR 612 Final Exam V1 |
Advanced Nursing II Q&A with Rationale |
William Paterson University
1. A 45-year-old African American male presents with a blood pressure of 155/95 mmHg.
According to current clinical guidelines, which is the most appropriate first-line
antihypertensive class for this patient?
A. ACE Inhibitor
B. Beta-Blocker
C. Calcium Channel Blocker
D. Loop Diuretic
Correct Answer: C
Expert Explanation: Current guidelines recommend Thiazide-type diuretics or Calcium
Channel Blockers as initial therapy for the general African American population. This
recommendation is based on evidence suggesting these classes are more effective at
lowering blood pressure in this demographic compared to ACE inhibitors. Starting with the
correct class helps reduce the long-term risk of stroke and cardiovascular events.
2. In the management of Type 2 Diabetes, which medication is contraindicated in patients
with a history of medullary thyroid carcinoma?
A. Metformin
,B. Sitagliptin
C. Glipizide
D. Liraglutide
Correct Answer: D
Expert Explanation: GLP-1 receptor agonists such as Liraglutide carry a black box
warning regarding the risk of thyroid C-cell tumors. Patients with a personal or family
history of medullary thyroid carcinoma should avoid this class of medication entirely.
Clinical monitoring for thyroid nodules is often recommended for those currently on this
therapy.
3. A 6-month-old infant is brought in for a well-child visit. Which developmental milestone
should the nurse practitioner expect the child to have achieved?
A. Walking with support
B. Speaking two-word sentences
C. Using a pincer grasp
D. Sitting with support
Correct Answer: D
Expert Explanation: By six months of age, most infants should be able to sit with support
or briefly without support. The pincer grasp is a milestone typically achieved between 9
, and 12 months of age. Walking and complex speech occur much later in the first or second
year of development.
4. Which of the following is the gold standard for diagnosing a pulmonary embolism in a
stable patient?
A. D-dimer assay
B. Chest X-ray
C. Ventilation-Perfusion (V/Q) Scan
D. CT Angiography
Correct Answer: D
Expert Explanation: CT Angiography is considered the preferred imaging modality
because it provides high sensitivity and specificity for detecting clots in the pulmonary
arteries. A D-dimer is useful for ruling out a PE in low-risk patients but cannot confirm a
diagnosis. The V/Q scan is usually reserved for patients with contraindications to IV
contrast, such as renal failure.
5. An 82-year-old female presents with acute confusion, visual hallucinations, and a
fluctuating level of consciousness. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Major Depressive Disorder
C. Delirium
Advanced Nursing II Q&A with Rationale |
William Paterson University
1. A 45-year-old African American male presents with a blood pressure of 155/95 mmHg.
According to current clinical guidelines, which is the most appropriate first-line
antihypertensive class for this patient?
A. ACE Inhibitor
B. Beta-Blocker
C. Calcium Channel Blocker
D. Loop Diuretic
Correct Answer: C
Expert Explanation: Current guidelines recommend Thiazide-type diuretics or Calcium
Channel Blockers as initial therapy for the general African American population. This
recommendation is based on evidence suggesting these classes are more effective at
lowering blood pressure in this demographic compared to ACE inhibitors. Starting with the
correct class helps reduce the long-term risk of stroke and cardiovascular events.
2. In the management of Type 2 Diabetes, which medication is contraindicated in patients
with a history of medullary thyroid carcinoma?
A. Metformin
,B. Sitagliptin
C. Glipizide
D. Liraglutide
Correct Answer: D
Expert Explanation: GLP-1 receptor agonists such as Liraglutide carry a black box
warning regarding the risk of thyroid C-cell tumors. Patients with a personal or family
history of medullary thyroid carcinoma should avoid this class of medication entirely.
Clinical monitoring for thyroid nodules is often recommended for those currently on this
therapy.
3. A 6-month-old infant is brought in for a well-child visit. Which developmental milestone
should the nurse practitioner expect the child to have achieved?
A. Walking with support
B. Speaking two-word sentences
C. Using a pincer grasp
D. Sitting with support
Correct Answer: D
Expert Explanation: By six months of age, most infants should be able to sit with support
or briefly without support. The pincer grasp is a milestone typically achieved between 9
, and 12 months of age. Walking and complex speech occur much later in the first or second
year of development.
4. Which of the following is the gold standard for diagnosing a pulmonary embolism in a
stable patient?
A. D-dimer assay
B. Chest X-ray
C. Ventilation-Perfusion (V/Q) Scan
D. CT Angiography
Correct Answer: D
Expert Explanation: CT Angiography is considered the preferred imaging modality
because it provides high sensitivity and specificity for detecting clots in the pulmonary
arteries. A D-dimer is useful for ruling out a PE in low-risk patients but cannot confirm a
diagnosis. The V/Q scan is usually reserved for patients with contraindications to IV
contrast, such as renal failure.
5. An 82-year-old female presents with acute confusion, visual hallucinations, and a
fluctuating level of consciousness. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Major Depressive Disorder
C. Delirium
