NURS 5463 Exam 1 V3 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 1) |
The University of Texas at Arlington
1. A 68-year-old male with a history of heart failure presents with increased dyspnea and
orthopnea. On examination, you note S3 gallop and bilateral crackles. Which of the following
is the most appropriate next step in management?
A. Initiate aggressive fluid resuscitation
B. Start broad-spectrum antibiotics for pneumonia
C. Administer intravenous loop diuretics
D. Order an urgent pulmonary function test
Answer: C
Rationale: The patient’s clinical presentation of S3 gallop, crackles, and orthopnea is highly
suggestive of acute decompensated heart failure with volume overload. Intravenous loop
diuretics are the first-line treatment to reduce preload and alleviate pulmonary congestion.
Pulmonary function tests are not indicated in the acute setting of suspected cardiogenic
edema.
,2. A patient in the ICU has the following arterial blood gas (ABG) results: pH 7.25, PaCO2 58
mmHg, PaO2 70 mmHg, and HCO3 26 mEq/L. How should the AGACNP interpret these
results?
A. Uncompensated respiratory acidosis
B. Compensated metabolic acidosis
C. Uncompensated metabolic alkalosis
D. Compensated respiratory alkalosis
Answer: A
Rationale: The pH is less than 7.35, indicating acidosis, while the PaCO2 is elevated above
45 mmHg, indicating a respiratory cause. The bicarbonate level is within the normal range,
suggesting that no significant compensation has occurred yet. Therefore, this represents an
uncompensated respiratory acidosis likely due to hypoventilation.
3. Which of the following physical exam findings is most characteristic of a tension
pneumothorax?
A. Dullness to percussion on the affected side
B. Increased tactile fremitus over the lung fields
C. Tracheal deviation toward the contralateral side
D. Inspiratory wheezing and prolonged expiratory phase
Answer: C
, Rationale: Tension pneumothorax causes a shift of mediastinal structures away from the
affected side due to increased intrapleural pressure. Tracheal deviation to the contralateral
side is a late and critical sign of this life-threatening condition. Percussion would reveal
hyper-resonance, not dullness, which is typically found in pleural effusions or
consolidations.
4. A 72-year-old patient with a history of CKD presents with weakness. The ECG shows
peaked T waves and a widened QRS complex. Which medication should be administered first
to stabilize the myocardium?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium gluconate
C. Regular insulin and D50W
D. Albuterol nebulizer treatment
Answer: B
Rationale: Peaked T waves and widened QRS complexes are signs of severe hyperkalemia
which poses an immediate risk of cardiac arrest. Calcium gluconate is administered to
stabilize the myocardial cell membrane and prevent arrhythmias. While insulin and
albuterol help shift potassium into cells, they do not stabilize the membrane directly.
5. According to the Surviving Sepsis Campaign, what is the target Mean Arterial Pressure
(MAP) during the initial resuscitation of a patient in septic shock?
A. At least 65 mmHg
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 1) |
The University of Texas at Arlington
1. A 68-year-old male with a history of heart failure presents with increased dyspnea and
orthopnea. On examination, you note S3 gallop and bilateral crackles. Which of the following
is the most appropriate next step in management?
A. Initiate aggressive fluid resuscitation
B. Start broad-spectrum antibiotics for pneumonia
C. Administer intravenous loop diuretics
D. Order an urgent pulmonary function test
Answer: C
Rationale: The patient’s clinical presentation of S3 gallop, crackles, and orthopnea is highly
suggestive of acute decompensated heart failure with volume overload. Intravenous loop
diuretics are the first-line treatment to reduce preload and alleviate pulmonary congestion.
Pulmonary function tests are not indicated in the acute setting of suspected cardiogenic
edema.
,2. A patient in the ICU has the following arterial blood gas (ABG) results: pH 7.25, PaCO2 58
mmHg, PaO2 70 mmHg, and HCO3 26 mEq/L. How should the AGACNP interpret these
results?
A. Uncompensated respiratory acidosis
B. Compensated metabolic acidosis
C. Uncompensated metabolic alkalosis
D. Compensated respiratory alkalosis
Answer: A
Rationale: The pH is less than 7.35, indicating acidosis, while the PaCO2 is elevated above
45 mmHg, indicating a respiratory cause. The bicarbonate level is within the normal range,
suggesting that no significant compensation has occurred yet. Therefore, this represents an
uncompensated respiratory acidosis likely due to hypoventilation.
3. Which of the following physical exam findings is most characteristic of a tension
pneumothorax?
A. Dullness to percussion on the affected side
B. Increased tactile fremitus over the lung fields
C. Tracheal deviation toward the contralateral side
D. Inspiratory wheezing and prolonged expiratory phase
Answer: C
, Rationale: Tension pneumothorax causes a shift of mediastinal structures away from the
affected side due to increased intrapleural pressure. Tracheal deviation to the contralateral
side is a late and critical sign of this life-threatening condition. Percussion would reveal
hyper-resonance, not dullness, which is typically found in pleural effusions or
consolidations.
4. A 72-year-old patient with a history of CKD presents with weakness. The ECG shows
peaked T waves and a widened QRS complex. Which medication should be administered first
to stabilize the myocardium?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium gluconate
C. Regular insulin and D50W
D. Albuterol nebulizer treatment
Answer: B
Rationale: Peaked T waves and widened QRS complexes are signs of severe hyperkalemia
which poses an immediate risk of cardiac arrest. Calcium gluconate is administered to
stabilize the myocardial cell membrane and prevent arrhythmias. While insulin and
albuterol help shift potassium into cells, they do not stabilize the membrane directly.
5. According to the Surviving Sepsis Campaign, what is the target Mean Arterial Pressure
(MAP) during the initial resuscitation of a patient in septic shock?
A. At least 65 mmHg
