Nurs 6531 Midterm Examination (Adult-
Gerontology Clinical Decision-Making
Midterm)
Full Subject Title: Advanced Practice Nursing – Adult-
Gerontology Clinical Decision-Making
Exam Title: Midterm Examination
Question 1
A 68-year-old patient presents with sudden onset unilateral weakness and slurred
speech. What is the priority action?
A. Obtain a CT scan in 24 hours
B. Administer aspirin immediately
C. Assess airway, breathing, and circulation
D. Start antihypertensive therapy
Answer: C
Rationale: In suspected acute stroke, the first priority follows ABC principles.
Airway protection is critical because dysphagia and reduced consciousness may
lead to aspiration. While imaging, aspirin, and blood pressure management are
important, they are secondary to stabilizing vital functions. Immediate ABC
assessment ensures the patient can safely proceed to diagnostic and
thrombolytic considerations if indicated.
Question 2
A patient with COPD presents with increased dyspnea and wheezing. Which
arterial blood gas finding is most consistent with acute exacerbation?
,A. pH 7.48, PaCO₂ 30
B. pH 7.30, PaCO₂ 60
C. pH 7.40, PaCO₂ 40
D. pH 7.50, PaCO₂ 20
Answer: B
Rationale: COPD exacerbation often leads to hypoventilation and CO₂ retention,
resulting in respiratory acidosis. A low pH with elevated PaCO₂ indicates
inadequate ventilation. Chronic COPD patients may partially compensate, but
acute exacerbations worsen CO₂ retention. The other options reflect respiratory
alkalosis or normal gas exchange, which are inconsistent with acute
decompensation.
Question 3
Which medication is the first-line treatment for an acute anaphylactic reaction?
A. Diphenhydramine
B. Epinephrine
C. Albuterol
D. Prednisone
Answer: B
Rationale: Epinephrine is the first-line and life-saving treatment for anaphylaxis
because it rapidly reverses airway edema, hypotension, and
bronchoconstriction. Antihistamines and corticosteroids are adjuncts but do not
act quickly enough to address airway compromise. Delay in epinephrine
administration increases mortality risk significantly.
Question 4
A patient with chest pain has ST elevation in leads II, III, and aVF. Which coronary
artery is most likely involved?
,A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Answer: B
Rationale: Inferior wall myocardial infarction is typically associated with
occlusion of the right coronary artery. Leads II, III, and aVF reflect inferior
myocardial territory. The LAD supplies anterior wall regions, while the circumflex
supplies lateral regions. Early identification guides reperfusion therapy
decisions.
Question 5
Which finding is most concerning in a patient with suspected meningitis?
A. Fever and headache
B. Nuchal rigidity
C. Altered mental status
D. Photophobia
Answer: C
Rationale: Altered mental status indicates potential cerebral involvement and
increased intracranial pressure, representing a more severe and life-threatening
manifestation of meningitis. While fever, headache, and nuchal rigidity are
classic signs, mental status changes signal progression and urgency for
immediate intervention.
Question 6
A diabetic patient presents with blood glucose of 580 mg/dL, dehydration, and
confusion. What condition is most likely?
, A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Insulin overdose
Answer: C
Rationale: Hyperosmolar hyperglycemic state (HHS) is characterized by severe
hyperglycemia, dehydration, and altered mental status without significant
ketoacidosis. It is more common in type 2 diabetes. DKA typically presents with
acidosis and ketones, which are not emphasized here.
Question 7
Which laboratory finding is most indicative of acute kidney injury?
A. Elevated creatinine and decreased urine output
B. Elevated calcium levels
C. Increased hemoglobin
D. Decreased potassium with high urine output
Answer: A
Rationale: Acute kidney injury is defined by a rapid decline in renal function,
evidenced by increased serum creatinine and oliguria. These findings reflect
impaired filtration. Electrolyte disturbances may occur, but creatinine elevation
and decreased urine output are primary diagnostic indicators.
Question 8
Which symptom is most suggestive of left-sided heart failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Hepatomegaly
Gerontology Clinical Decision-Making
Midterm)
Full Subject Title: Advanced Practice Nursing – Adult-
Gerontology Clinical Decision-Making
Exam Title: Midterm Examination
Question 1
A 68-year-old patient presents with sudden onset unilateral weakness and slurred
speech. What is the priority action?
A. Obtain a CT scan in 24 hours
B. Administer aspirin immediately
C. Assess airway, breathing, and circulation
D. Start antihypertensive therapy
Answer: C
Rationale: In suspected acute stroke, the first priority follows ABC principles.
Airway protection is critical because dysphagia and reduced consciousness may
lead to aspiration. While imaging, aspirin, and blood pressure management are
important, they are secondary to stabilizing vital functions. Immediate ABC
assessment ensures the patient can safely proceed to diagnostic and
thrombolytic considerations if indicated.
Question 2
A patient with COPD presents with increased dyspnea and wheezing. Which
arterial blood gas finding is most consistent with acute exacerbation?
,A. pH 7.48, PaCO₂ 30
B. pH 7.30, PaCO₂ 60
C. pH 7.40, PaCO₂ 40
D. pH 7.50, PaCO₂ 20
Answer: B
Rationale: COPD exacerbation often leads to hypoventilation and CO₂ retention,
resulting in respiratory acidosis. A low pH with elevated PaCO₂ indicates
inadequate ventilation. Chronic COPD patients may partially compensate, but
acute exacerbations worsen CO₂ retention. The other options reflect respiratory
alkalosis or normal gas exchange, which are inconsistent with acute
decompensation.
Question 3
Which medication is the first-line treatment for an acute anaphylactic reaction?
A. Diphenhydramine
B. Epinephrine
C. Albuterol
D. Prednisone
Answer: B
Rationale: Epinephrine is the first-line and life-saving treatment for anaphylaxis
because it rapidly reverses airway edema, hypotension, and
bronchoconstriction. Antihistamines and corticosteroids are adjuncts but do not
act quickly enough to address airway compromise. Delay in epinephrine
administration increases mortality risk significantly.
Question 4
A patient with chest pain has ST elevation in leads II, III, and aVF. Which coronary
artery is most likely involved?
,A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Answer: B
Rationale: Inferior wall myocardial infarction is typically associated with
occlusion of the right coronary artery. Leads II, III, and aVF reflect inferior
myocardial territory. The LAD supplies anterior wall regions, while the circumflex
supplies lateral regions. Early identification guides reperfusion therapy
decisions.
Question 5
Which finding is most concerning in a patient with suspected meningitis?
A. Fever and headache
B. Nuchal rigidity
C. Altered mental status
D. Photophobia
Answer: C
Rationale: Altered mental status indicates potential cerebral involvement and
increased intracranial pressure, representing a more severe and life-threatening
manifestation of meningitis. While fever, headache, and nuchal rigidity are
classic signs, mental status changes signal progression and urgency for
immediate intervention.
Question 6
A diabetic patient presents with blood glucose of 580 mg/dL, dehydration, and
confusion. What condition is most likely?
, A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Insulin overdose
Answer: C
Rationale: Hyperosmolar hyperglycemic state (HHS) is characterized by severe
hyperglycemia, dehydration, and altered mental status without significant
ketoacidosis. It is more common in type 2 diabetes. DKA typically presents with
acidosis and ketones, which are not emphasized here.
Question 7
Which laboratory finding is most indicative of acute kidney injury?
A. Elevated creatinine and decreased urine output
B. Elevated calcium levels
C. Increased hemoglobin
D. Decreased potassium with high urine output
Answer: A
Rationale: Acute kidney injury is defined by a rapid decline in renal function,
evidenced by increased serum creatinine and oliguria. These findings reflect
impaired filtration. Electrolyte disturbances may occur, but creatinine elevation
and decreased urine output are primary diagnostic indicators.
Question 8
Which symptom is most suggestive of left-sided heart failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Hepatomegaly
