NURS 5463 Exam 3 V1 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 3) |
The University of Texas at Arlington
1. A 65-year-old male is admitted to the ICU with a suspected acute myocardial infarction. His
hemodynamic profile shows a Cardiac Index (CI) of 1.8 L/min/m², a Pulmonary Artery
Occlusion Pressure (PAOP) of 22 mmHg, and a Systemic Vascular Resistance (SVR) of 1800
dynes/sec/cm⁻⁵. Which type of shock is most consistent with these findings?
A. Hypovolemic Shock
B. Anaphylactic Shock
C. Septic Shock
D. Cardiogenic Shock
Answer: D
Rationale: Cardiogenic shock is characterized by a low cardiac index and elevated filling
pressures such as the PAOP. The elevated SVR represents a compensatory mechanism to
maintain mean arterial pressure in the setting of pump failure. This specific hemodynamic
profile is classic for left ventricular failure following an acute myocardial infarction.
,2. In the management of septic shock, which of the following is the recommended first-line
vasopressor for patients who remain hypotensive despite adequate fluid resuscitation?
A. Norepinephrine
B. Epinephrine
C. Dopamine
D. Vasopressin
Answer: A
Rationale: Norepinephrine is recommended as the first-choice vasopressor for septic
shock according to the Surviving Sepsis Campaign guidelines. It provides potent alpha-1
adrenergic stimulation to increase systemic vascular resistance while having minimal
effects on heart rate. Maintaining a mean arterial pressure (MAP) of at least 65 mmHg is
the primary goal of this intervention.
3. A trauma patient arrives in the ER with a suspected tension pneumothorax. Which clinical
sign would most likely be observed?
A. Tracheal deviation toward the affected side
B. Hypertension
C. Absent breath sounds on the affected side
D. Bradycardia
Answer: C
,Rationale: Tension pneumothorax results in a shift of mediastinal structures and
compression of the contralateral lung. Tracheal deviation occurs away from the affected
side, and breath sounds will be absent on the side of the collapse. This condition is a
medical emergency that requires immediate needle decompression followed by chest tube
insertion.
4. Calculate the Cerebral Perfusion Pressure (CPP) for a patient with a Mean Arterial Pressure
(MAP) of 85 mmHg and an Intracranial Pressure (ICP) of 20 mmHg.
A. 105 mmHg
B. 55 mmHg
C. 65 mmHg
D. 45 mmHg
Answer: C
Rationale: CPP is calculated by subtracting the ICP from the MAP (CPP = MAP - ICP). In this
scenario, 85 mmHg minus 20 mmHg equals 65 mmHg. A target CPP of 60 to 70 mmHg is
generally recommended to ensure adequate brain tissue oxygenation in patients with
traumatic brain injury.
5. Which of the following is a primary indication for the use of Mannitol in a neuro-critical
care patient?
A. Treatment of hypotension
B. Prevention of seizures
, C. Reduction of elevated intracranial pressure (ICP)
D. Treatment of hyponatremia
Answer: C
Rationale: Mannitol is an osmotic diuretic used to reduce intracranial pressure by creating
an osmotic gradient that pulls fluid from brain tissue into the vascular space. It is
commonly administered as a bolus to treat acute neurological deterioration or signs of
herniation. Clinicians must monitor serum osmolality and renal function closely when
using this medication.
6. A patient with severe acute pancreatitis develops sudden respiratory distress and
hypoxemia that does not improve with supplemental oxygen. The chest X-ray shows bilateral
infiltrates, and the PAOP is 12 mmHg. What is the most likely diagnosis?
A. Congestive Heart Failure
B. Pulmonary Embolism
C. Acute Respiratory Distress Syndrome (ARDS)
D. Bacterial Pneumonia
Answer: C
Rationale: ARDS is characterized by non-cardiogenic pulmonary edema, which is
confirmed by a PAOP of less than 18 mmHg. The bilateral infiltrates and refractory
hypoxemia are hallmark signs of the inflammatory lung injury seen in ARDS. This condition
often occurs secondary to systemic inflammatory triggers like acute pancreatitis.
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 3) |
The University of Texas at Arlington
1. A 65-year-old male is admitted to the ICU with a suspected acute myocardial infarction. His
hemodynamic profile shows a Cardiac Index (CI) of 1.8 L/min/m², a Pulmonary Artery
Occlusion Pressure (PAOP) of 22 mmHg, and a Systemic Vascular Resistance (SVR) of 1800
dynes/sec/cm⁻⁵. Which type of shock is most consistent with these findings?
A. Hypovolemic Shock
B. Anaphylactic Shock
C. Septic Shock
D. Cardiogenic Shock
Answer: D
Rationale: Cardiogenic shock is characterized by a low cardiac index and elevated filling
pressures such as the PAOP. The elevated SVR represents a compensatory mechanism to
maintain mean arterial pressure in the setting of pump failure. This specific hemodynamic
profile is classic for left ventricular failure following an acute myocardial infarction.
,2. In the management of septic shock, which of the following is the recommended first-line
vasopressor for patients who remain hypotensive despite adequate fluid resuscitation?
A. Norepinephrine
B. Epinephrine
C. Dopamine
D. Vasopressin
Answer: A
Rationale: Norepinephrine is recommended as the first-choice vasopressor for septic
shock according to the Surviving Sepsis Campaign guidelines. It provides potent alpha-1
adrenergic stimulation to increase systemic vascular resistance while having minimal
effects on heart rate. Maintaining a mean arterial pressure (MAP) of at least 65 mmHg is
the primary goal of this intervention.
3. A trauma patient arrives in the ER with a suspected tension pneumothorax. Which clinical
sign would most likely be observed?
A. Tracheal deviation toward the affected side
B. Hypertension
C. Absent breath sounds on the affected side
D. Bradycardia
Answer: C
,Rationale: Tension pneumothorax results in a shift of mediastinal structures and
compression of the contralateral lung. Tracheal deviation occurs away from the affected
side, and breath sounds will be absent on the side of the collapse. This condition is a
medical emergency that requires immediate needle decompression followed by chest tube
insertion.
4. Calculate the Cerebral Perfusion Pressure (CPP) for a patient with a Mean Arterial Pressure
(MAP) of 85 mmHg and an Intracranial Pressure (ICP) of 20 mmHg.
A. 105 mmHg
B. 55 mmHg
C. 65 mmHg
D. 45 mmHg
Answer: C
Rationale: CPP is calculated by subtracting the ICP from the MAP (CPP = MAP - ICP). In this
scenario, 85 mmHg minus 20 mmHg equals 65 mmHg. A target CPP of 60 to 70 mmHg is
generally recommended to ensure adequate brain tissue oxygenation in patients with
traumatic brain injury.
5. Which of the following is a primary indication for the use of Mannitol in a neuro-critical
care patient?
A. Treatment of hypotension
B. Prevention of seizures
, C. Reduction of elevated intracranial pressure (ICP)
D. Treatment of hyponatremia
Answer: C
Rationale: Mannitol is an osmotic diuretic used to reduce intracranial pressure by creating
an osmotic gradient that pulls fluid from brain tissue into the vascular space. It is
commonly administered as a bolus to treat acute neurological deterioration or signs of
herniation. Clinicians must monitor serum osmolality and renal function closely when
using this medication.
6. A patient with severe acute pancreatitis develops sudden respiratory distress and
hypoxemia that does not improve with supplemental oxygen. The chest X-ray shows bilateral
infiltrates, and the PAOP is 12 mmHg. What is the most likely diagnosis?
A. Congestive Heart Failure
B. Pulmonary Embolism
C. Acute Respiratory Distress Syndrome (ARDS)
D. Bacterial Pneumonia
Answer: C
Rationale: ARDS is characterized by non-cardiogenic pulmonary edema, which is
confirmed by a PAOP of less than 18 mmHg. The bilateral infiltrates and refractory
hypoxemia are hallmark signs of the inflammatory lung injury seen in ARDS. This condition
often occurs secondary to systemic inflammatory triggers like acute pancreatitis.
