NURS 5463 / NURS5463 Exam 1: (Latest
Update ) Adult Gerontology
Acute Care | Questions & Answers |
Grade A | 100% Correct - UTA
Question 1: A 75-year-old patient presents with acute onset shortness of
breath and generalized fatigue but denies chest pain. Which is the most
likely atypical presentation of an AMI in this patient?
• A) Sharp, pleuritic chest pain
• B) Severe tearing back pain
• C) Dyspnea and diaphoresis
• D) Hemoptysis and calf swelling
Correct Answer: C) Dyspnea and diaphoresis
Rationale: Older adults often experience atypical symptoms during an
acute myocardial infarction (AMI). Instead of classic crushing chest pain,
they may present with dyspnea, diaphoresis, nausea/vomiting (N/V),
altered mental status (AMS), or syncope.
Question 2: A patient reports substernal chest pressure radiating to the
jaw. Vital signs are stable. What differential diagnoses should the provider
prioritize immediately?
• A) GERD, gastritis, and pancreatitis
• B) Musculoskeletal strain and herpes zoster
• C) AMI, PE, PTX, and aortic dissection
, • D) Anxiety and hyperventilation syndrome
Correct Answer: C) AMI, PE, PTX, and aortic dissection
Rationale: The most important and life-threatening differentials for chest
pain include Acute Myocardial Infarction (AMI), Pulmonary Embolism
(PE), Pneumothorax (PTX), and aortic dissection. These must be ruled out
first before considering less emergent etiologies.
Question 3: A 12-lead EKG shows a new Left Bundle Branch Block (LBBB)
in a patient with chest pain. How is this interpreted regarding ST elevation
criteria?
• A) It is a normal variant in patients over 65.
• B) It is considered equivalent to ST elevation.
• C) It indicates a prior old MI rather than an acute event.
• D) It is diagnostic of pericarditis.
Correct Answer: B) It is considered equivalent to ST elevation.
Rationale: In the setting of suspected cardiac ischemia, a new LBBB is
treated with the same urgency as ST-segment elevation. The criteria for ST
elevation is 2mm in men and 1.5mm in women, OR the presence of a new
LBBB in 2 leads.
Question 4: Which laboratory value is the most specific biomarker for
myocardial necrosis?
• A) Creatinine Kinase (CK-MB)
• B) Troponin T
• C) Troponin I
• D) Myoglobin
Correct Answer: C) Troponin I
Rationale: While both Troponin I and T are cardiac specific, Troponin I is
,generally considered more specific to cardiac muscle and has less cross-
reactivity with skeletal muscle injury compared to Troponin T.
Question 5: A patient is being evaluated for a Pulmonary Embolism (PE).
The D-dimer is elevated. Why is this test less reliable in older adults?
• A) It degrades quickly in geriatric blood samples.
• B) It is an acute phase reactant that rises with age and
inflammation.
• C) It only rules in PE and requires a CT regardless of the result.
• D) It is specific to deep vein thrombosis only.
Correct Answer: B) It is an acute phase reactant that rises with age and
inflammation.
Rationale: D-dimer is an acute phase reactant, meaning it can be
elevated due to infection, inflammation, cancer, surgery, or simply
advancing age. Therefore, a positive D-dimer is good for ruling out PE only
when combined with a low clinical probability (Wells score), but not great
for ruling it in.
Question 6: A patient with severe COPD has an oxygen saturation of 84%.
This hypoxemia is most likely caused by which physiological mechanism?
• A) Hypoventilation
• B) Right-to-left shunt
• C) V/Q mismatch
• D) Reduced inspired oxygen tension
Correct Answer: C) V/Q mismatch
Rationale: V/Q (Ventilation/Perfusion) mismatch is the most common
cause of hypoxemia. Conditions like COPD, asthma, and pneumonia
create areas of the lung that are perfused but not ventilated. Unlike a
, shunt, hypoxemia from V/Q mismatch typically improves with
supplemental oxygen.
Question 7: A patient is admitted with respiratory failure. An ABG shows a
PaO2 of 70 mmHg on room air, PaCO2 of 55 mmHg, and a normal A-a
gradient. What is the most likely cause?
• A) Pulmonary Embolism
• B) Hypoventilation
• C) Diffusion impairment
• D) Anatomic shunt
Correct Answer: B) Hypoventilation
Rationale: In hypoventilation, the patient is not moving air effectively,
leading to a high PaCO2. Because the lungs themselves are structurally
normal, the A-a gradient remains normal. Causes include CNS
depression, narcotics, or obesity hypoventilation syndrome.
Question 8: A patient with liver disease and a right-to-left intrapulmonary
shunt is hypoxic. How will this patient likely respond to high-flow oxygen?
• A) Oxygen will correct the hypoxia immediately.
• B) Oxygen will correct the hypoxia but increase the PaCO2.
• C) Oxygen will be difficult to correct the hypoxia.
• D) Oxygen will worsen the shunt.
Correct Answer: C) Oxygen will be difficult to correct the hypoxia.
Rationale: Right-to-left shunts (intracardiac or intrapulmonary) allow
deoxygenated blood to bypass the alveoli entirely. Because the blood
never reaches ventilated areas, applying supplemental oxygen has
minimal effect on the hypoxemia.
Update ) Adult Gerontology
Acute Care | Questions & Answers |
Grade A | 100% Correct - UTA
Question 1: A 75-year-old patient presents with acute onset shortness of
breath and generalized fatigue but denies chest pain. Which is the most
likely atypical presentation of an AMI in this patient?
• A) Sharp, pleuritic chest pain
• B) Severe tearing back pain
• C) Dyspnea and diaphoresis
• D) Hemoptysis and calf swelling
Correct Answer: C) Dyspnea and diaphoresis
Rationale: Older adults often experience atypical symptoms during an
acute myocardial infarction (AMI). Instead of classic crushing chest pain,
they may present with dyspnea, diaphoresis, nausea/vomiting (N/V),
altered mental status (AMS), or syncope.
Question 2: A patient reports substernal chest pressure radiating to the
jaw. Vital signs are stable. What differential diagnoses should the provider
prioritize immediately?
• A) GERD, gastritis, and pancreatitis
• B) Musculoskeletal strain and herpes zoster
• C) AMI, PE, PTX, and aortic dissection
, • D) Anxiety and hyperventilation syndrome
Correct Answer: C) AMI, PE, PTX, and aortic dissection
Rationale: The most important and life-threatening differentials for chest
pain include Acute Myocardial Infarction (AMI), Pulmonary Embolism
(PE), Pneumothorax (PTX), and aortic dissection. These must be ruled out
first before considering less emergent etiologies.
Question 3: A 12-lead EKG shows a new Left Bundle Branch Block (LBBB)
in a patient with chest pain. How is this interpreted regarding ST elevation
criteria?
• A) It is a normal variant in patients over 65.
• B) It is considered equivalent to ST elevation.
• C) It indicates a prior old MI rather than an acute event.
• D) It is diagnostic of pericarditis.
Correct Answer: B) It is considered equivalent to ST elevation.
Rationale: In the setting of suspected cardiac ischemia, a new LBBB is
treated with the same urgency as ST-segment elevation. The criteria for ST
elevation is 2mm in men and 1.5mm in women, OR the presence of a new
LBBB in 2 leads.
Question 4: Which laboratory value is the most specific biomarker for
myocardial necrosis?
• A) Creatinine Kinase (CK-MB)
• B) Troponin T
• C) Troponin I
• D) Myoglobin
Correct Answer: C) Troponin I
Rationale: While both Troponin I and T are cardiac specific, Troponin I is
,generally considered more specific to cardiac muscle and has less cross-
reactivity with skeletal muscle injury compared to Troponin T.
Question 5: A patient is being evaluated for a Pulmonary Embolism (PE).
The D-dimer is elevated. Why is this test less reliable in older adults?
• A) It degrades quickly in geriatric blood samples.
• B) It is an acute phase reactant that rises with age and
inflammation.
• C) It only rules in PE and requires a CT regardless of the result.
• D) It is specific to deep vein thrombosis only.
Correct Answer: B) It is an acute phase reactant that rises with age and
inflammation.
Rationale: D-dimer is an acute phase reactant, meaning it can be
elevated due to infection, inflammation, cancer, surgery, or simply
advancing age. Therefore, a positive D-dimer is good for ruling out PE only
when combined with a low clinical probability (Wells score), but not great
for ruling it in.
Question 6: A patient with severe COPD has an oxygen saturation of 84%.
This hypoxemia is most likely caused by which physiological mechanism?
• A) Hypoventilation
• B) Right-to-left shunt
• C) V/Q mismatch
• D) Reduced inspired oxygen tension
Correct Answer: C) V/Q mismatch
Rationale: V/Q (Ventilation/Perfusion) mismatch is the most common
cause of hypoxemia. Conditions like COPD, asthma, and pneumonia
create areas of the lung that are perfused but not ventilated. Unlike a
, shunt, hypoxemia from V/Q mismatch typically improves with
supplemental oxygen.
Question 7: A patient is admitted with respiratory failure. An ABG shows a
PaO2 of 70 mmHg on room air, PaCO2 of 55 mmHg, and a normal A-a
gradient. What is the most likely cause?
• A) Pulmonary Embolism
• B) Hypoventilation
• C) Diffusion impairment
• D) Anatomic shunt
Correct Answer: B) Hypoventilation
Rationale: In hypoventilation, the patient is not moving air effectively,
leading to a high PaCO2. Because the lungs themselves are structurally
normal, the A-a gradient remains normal. Causes include CNS
depression, narcotics, or obesity hypoventilation syndrome.
Question 8: A patient with liver disease and a right-to-left intrapulmonary
shunt is hypoxic. How will this patient likely respond to high-flow oxygen?
• A) Oxygen will correct the hypoxia immediately.
• B) Oxygen will correct the hypoxia but increase the PaCO2.
• C) Oxygen will be difficult to correct the hypoxia.
• D) Oxygen will worsen the shunt.
Correct Answer: C) Oxygen will be difficult to correct the hypoxia.
Rationale: Right-to-left shunts (intracardiac or intrapulmonary) allow
deoxygenated blood to bypass the alveoli entirely. Because the blood
never reaches ventilated areas, applying supplemental oxygen has
minimal effect on the hypoxemia.
