NUR612/NUR 612 Exam 4 V2 | Advanced
Nursing II Q&A with Rationale | William
Paterson University
1. A 55-year-old patient presents with a hemoglobin A1c of 6.8%. Which of the following is
the most appropriate next step in management according to ADA guidelines?
A. Diagnose the patient with prediabetes and recommend lifestyle changes.
B. Confirm the diagnosis with a repeat test unless symptoms are present.
C. Immediately start the patient on high-dose insulin therapy.
D. Screen the patient for type 1 diabetes antibodies.
Correct Answer: B
Expert Explanation: The American Diabetes Association recommends that a diagnosis of
diabetes should be confirmed with a second test result. An A1c of 6.5% or higher is
indicative of diabetes, but confirmation ensures accuracy unless the patient is in a
hyperglycemic crisis. Lifestyle modifications and metformin are usually the first-line
treatments after confirmation.
2. Which of the following physical exam findings is most characteristic of Graves’ disease?
A. Pretibial myxedema and exophthalmos.
B. Hyporeflexia and bradycardia.
C. Dry, coarse skin and periorbital edema.
,D. Weight gain and cold intolerance.
Correct Answer: A
Expert Explanation: Graves’ disease is an autoimmune form of hyperthyroidism that often
presents with specific extrathyroidal manifestations. Exophthalmos is caused by
inflammation of the extraocular muscles and orbital fat. Pretibial myxedema refers to the
localized thickening of the skin on the shins and is a pathognomonic sign.
3. A patient with a history of Hashimoto’s thyroiditis is started on Levothyroxine. When
should the TSH level be re-evaluated?
A. Within 1 to 2 weeks of starting therapy.
B. In exactly 3 days to check for acute toxicity.
C. Only after the patient reports significant weight loss.
D. In 6 to 8 weeks after the initial dose.
Correct Answer: D
Expert Explanation: Levothyroxine has a long half-life of approximately seven days. It
takes about 6 to 8 weeks to reach a steady-state concentration in the blood. Re-checking
the TSH too early may lead to unnecessary dose adjustments that do not reflect the true
physiological response.
4. Which medication is considered first-line for the treatment of acute gouty arthritis?
A. Indomethacin
, B. Febuxostat
C. Allopurinol
D. Lisinopril
Correct Answer: A
Expert Explanation: NSAIDs such as indomethacin are first-line treatments for managing
the pain and inflammation of an acute gout flare. Colchicine or corticosteroids are also
appropriate options depending on the patient’s comorbidities. Allopurinol is used for long-
term urate-lowering therapy and should not be started during an acute attack.
5. A T-score of -2.6 on a DXA scan indicates which of the following conditions?
A. Normal bone mineral density.
B. Osteopenia.
C. Osteoporosis.
D. Osteogenesis imperfecta.
Correct Answer: C
Expert Explanation: The World Health Organization defines osteoporosis as a T-score of -
2.5 or lower. A T-score between -1.0 and -2.5 is classified as osteopenia. This measurement
compares the patient’s bone density to that of a healthy young adult of the same sex.
6. Which of the following is a classic symptom of Parkinson’s disease?
A. Intention tremor that worsens with movement.
Nursing II Q&A with Rationale | William
Paterson University
1. A 55-year-old patient presents with a hemoglobin A1c of 6.8%. Which of the following is
the most appropriate next step in management according to ADA guidelines?
A. Diagnose the patient with prediabetes and recommend lifestyle changes.
B. Confirm the diagnosis with a repeat test unless symptoms are present.
C. Immediately start the patient on high-dose insulin therapy.
D. Screen the patient for type 1 diabetes antibodies.
Correct Answer: B
Expert Explanation: The American Diabetes Association recommends that a diagnosis of
diabetes should be confirmed with a second test result. An A1c of 6.5% or higher is
indicative of diabetes, but confirmation ensures accuracy unless the patient is in a
hyperglycemic crisis. Lifestyle modifications and metformin are usually the first-line
treatments after confirmation.
2. Which of the following physical exam findings is most characteristic of Graves’ disease?
A. Pretibial myxedema and exophthalmos.
B. Hyporeflexia and bradycardia.
C. Dry, coarse skin and periorbital edema.
,D. Weight gain and cold intolerance.
Correct Answer: A
Expert Explanation: Graves’ disease is an autoimmune form of hyperthyroidism that often
presents with specific extrathyroidal manifestations. Exophthalmos is caused by
inflammation of the extraocular muscles and orbital fat. Pretibial myxedema refers to the
localized thickening of the skin on the shins and is a pathognomonic sign.
3. A patient with a history of Hashimoto’s thyroiditis is started on Levothyroxine. When
should the TSH level be re-evaluated?
A. Within 1 to 2 weeks of starting therapy.
B. In exactly 3 days to check for acute toxicity.
C. Only after the patient reports significant weight loss.
D. In 6 to 8 weeks after the initial dose.
Correct Answer: D
Expert Explanation: Levothyroxine has a long half-life of approximately seven days. It
takes about 6 to 8 weeks to reach a steady-state concentration in the blood. Re-checking
the TSH too early may lead to unnecessary dose adjustments that do not reflect the true
physiological response.
4. Which medication is considered first-line for the treatment of acute gouty arthritis?
A. Indomethacin
, B. Febuxostat
C. Allopurinol
D. Lisinopril
Correct Answer: A
Expert Explanation: NSAIDs such as indomethacin are first-line treatments for managing
the pain and inflammation of an acute gout flare. Colchicine or corticosteroids are also
appropriate options depending on the patient’s comorbidities. Allopurinol is used for long-
term urate-lowering therapy and should not be started during an acute attack.
5. A T-score of -2.6 on a DXA scan indicates which of the following conditions?
A. Normal bone mineral density.
B. Osteopenia.
C. Osteoporosis.
D. Osteogenesis imperfecta.
Correct Answer: C
Expert Explanation: The World Health Organization defines osteoporosis as a T-score of -
2.5 or lower. A T-score between -1.0 and -2.5 is classified as osteopenia. This measurement
compares the patient’s bone density to that of a healthy young adult of the same sex.
6. Which of the following is a classic symptom of Parkinson’s disease?
A. Intention tremor that worsens with movement.
