NURS 5463 Exam 3 V2 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 3) |
The University of Texas at Arlington
1. A 68-year-old male presents with sudden onset of expressive aphasia and right-sided
hemiparesis. The CT scan of the head is negative for hemorrhage. What is the most
appropriate next step in management if the symptoms began 2 hours ago?
A. Initiate IV Alteplase (tPA) after confirming eligibility.
B. Administer 325 mg of Aspirin orally.
C. Perform a lumbar puncture to rule out meningitis.
D. Administer a 20 mg bolus of Labetalol.
Answer: A
Rationale: In the setting of an acute ischemic stroke within the 3 to 4.5-hour window, IV
Alteplase is the gold standard for thrombolytic therapy. A non-contrast CT must first rule
out intracranial hemorrhage to prevent catastrophic bleeding. Early intervention is critical
to salvage the penumbra and improve neurological outcomes for the patient.
2. Which of the following laboratory findings is most characteristic of Diabetic Ketoacidosis
(DKA) rather than Hyperglycemic Hyperosmolar State (HHS)?
A. Serum bicarbonate level of 12 mEq/L.
,B. Serum glucose level of 900 mg/dL.
C. Serum osmolality of 350 mOsm/kg.
D. Absence of ketones in the urine.
Answer: A
Rationale: DKA is characterized by a significant metabolic acidosis, typically with a
bicarbonate level below 18 mEq/L and a positive anion gap. HHS generally presents with
much higher glucose levels and higher osmolality but without the significant ketoacidosis
seen in DKA. This distinction is vital for determining the appropriate insulin and fluid
resuscitation protocols.
3. A patient with a history of small cell lung cancer presents with confusion and a serum
sodium level of 118 mEq/L. The urine osmolality is high, and the patient appears euvolemic.
What is the most likely diagnosis?
A. Diabetes Insipidus (DI)
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
C. Cerebral Salt Wasting
D. Psychogenic Polydipsia
Answer: B
Rationale: SIADH is a common paraneoplastic syndrome associated with small cell lung
cancer leading to excessive ADH secretion. This results in water retention, dilutional
,hyponatremia, and concentrated urine despite euvolemia. Management typically involves
fluid restriction and addressing the underlying cause of the hormonal imbalance.
4. In the management of Hyperkalemia (Potassium 6.8 mEq/L) with associated EKG changes,
which medication should be administered first to stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Insulin with D50W
D. Furosemide (Lasix)
Answer: B
Rationale: Calcium Gluconate or Calcium Chloride is the priority medication to antagonize
the effects of hyperkalemia on the myocardium. While it does not lower the potassium
level, it prevents life-threatening arrhythmias by stabilizing the cardiac cell membrane.
Following stabilization, other agents like insulin or resins are used to actually shift or
remove potassium from the body.
5. Which clinical finding is part of the ‘CRAB’ criteria used to diagnose symptomatic Multiple
Myeloma?
A. Cardiomegaly
B. Renal Insufficiency
C. Alkalosis
, D. Bradycardia
Answer: B
Rationale: The CRAB acronym stands for Calcium elevation, Renal insufficiency, Anemia,
and Bone lesions. These are the hallmark clinical manifestations used to identify end-organ
damage caused by plasma cell dyscrasia. Recognizing these signs early allows for the
prompt initiation of chemotherapy and supportive care.
6. A patient in the ICU develops sudden onset of tachycardia, high fever, and extreme
agitation. Laboratory results show a suppressed TSH and elevated Free T4. What is the
priority treatment for this suspected Thyroid Storm?
A. Levothyroxine IV
B. Hypotonic Saline
C. Amiodarone
D. Propylthiouracil (PTU) or Methimazole
Answer: D
Rationale: Thyroid storm is a life-threatening thyrotoxicosis that requires immediate
inhibition of thyroid hormone synthesis using thioamides like PTU. PTU is often preferred
in acute settings because it also inhibits the peripheral conversion of T4 to the more active
T3. Beta-blockers and steroids are also typically included in the multi-modal treatment
plan to control symptoms and reduce hormonal activity.
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 3) |
The University of Texas at Arlington
1. A 68-year-old male presents with sudden onset of expressive aphasia and right-sided
hemiparesis. The CT scan of the head is negative for hemorrhage. What is the most
appropriate next step in management if the symptoms began 2 hours ago?
A. Initiate IV Alteplase (tPA) after confirming eligibility.
B. Administer 325 mg of Aspirin orally.
C. Perform a lumbar puncture to rule out meningitis.
D. Administer a 20 mg bolus of Labetalol.
Answer: A
Rationale: In the setting of an acute ischemic stroke within the 3 to 4.5-hour window, IV
Alteplase is the gold standard for thrombolytic therapy. A non-contrast CT must first rule
out intracranial hemorrhage to prevent catastrophic bleeding. Early intervention is critical
to salvage the penumbra and improve neurological outcomes for the patient.
2. Which of the following laboratory findings is most characteristic of Diabetic Ketoacidosis
(DKA) rather than Hyperglycemic Hyperosmolar State (HHS)?
A. Serum bicarbonate level of 12 mEq/L.
,B. Serum glucose level of 900 mg/dL.
C. Serum osmolality of 350 mOsm/kg.
D. Absence of ketones in the urine.
Answer: A
Rationale: DKA is characterized by a significant metabolic acidosis, typically with a
bicarbonate level below 18 mEq/L and a positive anion gap. HHS generally presents with
much higher glucose levels and higher osmolality but without the significant ketoacidosis
seen in DKA. This distinction is vital for determining the appropriate insulin and fluid
resuscitation protocols.
3. A patient with a history of small cell lung cancer presents with confusion and a serum
sodium level of 118 mEq/L. The urine osmolality is high, and the patient appears euvolemic.
What is the most likely diagnosis?
A. Diabetes Insipidus (DI)
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
C. Cerebral Salt Wasting
D. Psychogenic Polydipsia
Answer: B
Rationale: SIADH is a common paraneoplastic syndrome associated with small cell lung
cancer leading to excessive ADH secretion. This results in water retention, dilutional
,hyponatremia, and concentrated urine despite euvolemia. Management typically involves
fluid restriction and addressing the underlying cause of the hormonal imbalance.
4. In the management of Hyperkalemia (Potassium 6.8 mEq/L) with associated EKG changes,
which medication should be administered first to stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Insulin with D50W
D. Furosemide (Lasix)
Answer: B
Rationale: Calcium Gluconate or Calcium Chloride is the priority medication to antagonize
the effects of hyperkalemia on the myocardium. While it does not lower the potassium
level, it prevents life-threatening arrhythmias by stabilizing the cardiac cell membrane.
Following stabilization, other agents like insulin or resins are used to actually shift or
remove potassium from the body.
5. Which clinical finding is part of the ‘CRAB’ criteria used to diagnose symptomatic Multiple
Myeloma?
A. Cardiomegaly
B. Renal Insufficiency
C. Alkalosis
, D. Bradycardia
Answer: B
Rationale: The CRAB acronym stands for Calcium elevation, Renal insufficiency, Anemia,
and Bone lesions. These are the hallmark clinical manifestations used to identify end-organ
damage caused by plasma cell dyscrasia. Recognizing these signs early allows for the
prompt initiation of chemotherapy and supportive care.
6. A patient in the ICU develops sudden onset of tachycardia, high fever, and extreme
agitation. Laboratory results show a suppressed TSH and elevated Free T4. What is the
priority treatment for this suspected Thyroid Storm?
A. Levothyroxine IV
B. Hypotonic Saline
C. Amiodarone
D. Propylthiouracil (PTU) or Methimazole
Answer: D
Rationale: Thyroid storm is a life-threatening thyrotoxicosis that requires immediate
inhibition of thyroid hormone synthesis using thioamides like PTU. PTU is often preferred
in acute settings because it also inhibits the peripheral conversion of T4 to the more active
T3. Beta-blockers and steroids are also typically included in the multi-modal treatment
plan to control symptoms and reduce hormonal activity.
