NURS 5463 Exam 4 V1 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 4) |
The University of Texas at Arlington
1. An AGACNP is evaluating a patient with a suspected stroke. The patient has a blood
pressure of 225/125 mmHg and is a candidate for alteplase (tPA). What is the most
appropriate management regarding the blood pressure?
A. Administer tPA immediately as the benefit outweighs the risk of hypertension.
B. Decrease the blood pressure by no more than 10% in the first hour to prevent
hypoperfusion.
C. Lower the blood pressure to < 185/110 mmHg using labetalol or nicardipine prior to tPA
administration.
D. Proceed with tPA and start a nitroprusside drip simultaneously to ensure rapid control.
Answer: C
Rationale: To safely administer tPA in an acute ischemic stroke, the blood pressure must
be lower than 185/110 mmHg. Elevated pressures significantly increase the risk of
hemorrhagic transformation after fibrinolysis. Preferred agents for rapid, titratable control
include intravenous labetalol or nicardipine.
,2. A patient with acute kidney injury (AKI) presents with a BUN:Creatinine ratio of 28:1, a
Urine Sodium of 10 mEq/L, and a FENa of 0.8%. Which underlying pathology is most likely?
A. Acute Tubular Necrosis (ATN)
B. Acute Interstitial Nephritis (AIN)
C. Pre-renal Azotemia
D. Post-renal Obstruction
Answer: C
Rationale: Pre-renal azotemia is characterized by a high BUN:Cr ratio (>20:1) because
urea is reabsorbed while creatinine is not. A FENa less than 1% and low urine sodium
suggest that the renal tubules are functionally intact and attempting to conserve volume. In
contrast, intra-renal causes like ATN would typically show a FENa greater than 2% due to
tubular damage.
3. During a neurologic assessment, the AGACNP notes that a patient with a traumatic brain
injury (TBI) exhibits bradycardia, irregular respirations, and widening pulse pressure. What
does this ‘Cushing’s Triad’ indicate?
A. Early sign of neurogenic shock
B. Impending brain herniation due to increased ICP
C. Compensated autonomic dysreflexia
D. Side effect of high-dose sedative medications
, Answer: B
Rationale: Cushing’s Triad consists of hypertension with a widening pulse pressure,
bradycardia, and irregular respirations (Cheyne-Stokes). This is a late sign of significantly
increased intracranial pressure (ICP) and suggests that brain herniation may be imminent.
Immediate intervention is required to reduce ICP and maintain cerebral perfusion
pressure.
4. A 55-year-old male is being treated for deep vein thrombosis (DVT) with Heparin. On day 4,
his platelet count drops from 250,000 to 90,000/mm³. What is the most appropriate next
step?
A. Continue heparin but monitor platelets every 6 hours.
B. Stop heparin and immediately transition to Warfarin.
C. Discontinue heparin and start a direct thrombin inhibitor like Argatroban.
D. Order a platelet transfusion to prevent spontaneous bleeding.
Answer: C
Rationale: A drop in platelet count of >50% from baseline while on heparin is highly
suspicious for Heparin-Induced Thrombocytopenia (HIT). Heparin must be discontinued
immediately, and an alternative non-heparin anticoagulant like Argatroban should be
initiated. Warfarin is contraindicated in the acute phase of HIT as it can lead to venous limb
gangrene and skin necrosis.
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 4) |
The University of Texas at Arlington
1. An AGACNP is evaluating a patient with a suspected stroke. The patient has a blood
pressure of 225/125 mmHg and is a candidate for alteplase (tPA). What is the most
appropriate management regarding the blood pressure?
A. Administer tPA immediately as the benefit outweighs the risk of hypertension.
B. Decrease the blood pressure by no more than 10% in the first hour to prevent
hypoperfusion.
C. Lower the blood pressure to < 185/110 mmHg using labetalol or nicardipine prior to tPA
administration.
D. Proceed with tPA and start a nitroprusside drip simultaneously to ensure rapid control.
Answer: C
Rationale: To safely administer tPA in an acute ischemic stroke, the blood pressure must
be lower than 185/110 mmHg. Elevated pressures significantly increase the risk of
hemorrhagic transformation after fibrinolysis. Preferred agents for rapid, titratable control
include intravenous labetalol or nicardipine.
,2. A patient with acute kidney injury (AKI) presents with a BUN:Creatinine ratio of 28:1, a
Urine Sodium of 10 mEq/L, and a FENa of 0.8%. Which underlying pathology is most likely?
A. Acute Tubular Necrosis (ATN)
B. Acute Interstitial Nephritis (AIN)
C. Pre-renal Azotemia
D. Post-renal Obstruction
Answer: C
Rationale: Pre-renal azotemia is characterized by a high BUN:Cr ratio (>20:1) because
urea is reabsorbed while creatinine is not. A FENa less than 1% and low urine sodium
suggest that the renal tubules are functionally intact and attempting to conserve volume. In
contrast, intra-renal causes like ATN would typically show a FENa greater than 2% due to
tubular damage.
3. During a neurologic assessment, the AGACNP notes that a patient with a traumatic brain
injury (TBI) exhibits bradycardia, irregular respirations, and widening pulse pressure. What
does this ‘Cushing’s Triad’ indicate?
A. Early sign of neurogenic shock
B. Impending brain herniation due to increased ICP
C. Compensated autonomic dysreflexia
D. Side effect of high-dose sedative medications
, Answer: B
Rationale: Cushing’s Triad consists of hypertension with a widening pulse pressure,
bradycardia, and irregular respirations (Cheyne-Stokes). This is a late sign of significantly
increased intracranial pressure (ICP) and suggests that brain herniation may be imminent.
Immediate intervention is required to reduce ICP and maintain cerebral perfusion
pressure.
4. A 55-year-old male is being treated for deep vein thrombosis (DVT) with Heparin. On day 4,
his platelet count drops from 250,000 to 90,000/mm³. What is the most appropriate next
step?
A. Continue heparin but monitor platelets every 6 hours.
B. Stop heparin and immediately transition to Warfarin.
C. Discontinue heparin and start a direct thrombin inhibitor like Argatroban.
D. Order a platelet transfusion to prevent spontaneous bleeding.
Answer: C
Rationale: A drop in platelet count of >50% from baseline while on heparin is highly
suspicious for Heparin-Induced Thrombocytopenia (HIT). Heparin must be discontinued
immediately, and an alternative non-heparin anticoagulant like Argatroban should be
initiated. Warfarin is contraindicated in the acute phase of HIT as it can lead to venous limb
gangrene and skin necrosis.
