NURS 5463 Exam 4 V3 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 4) |
The University of Texas at Arlington
1. A patient presents with acute chest pain and the ECG shows ST-segment elevation in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A. Left Circumflex Artery
B. Left Main Coronary Artery
C. Left Anterior Descending Artery
D. Right Coronary Artery
Answer: D
Rationale: Leads II, III, and aVF reflect the inferior wall of the left ventricle. In
approximately 80 percent of the population, the inferior wall is supplied by the Right
Coronary Artery. Recognizing this pattern is critical because inferior MIs can be associated
with right ventricular involvement and bradyarrhythmias.
2. Which hemodynamic profile is most consistent with early septic shock?
A. High SVR, Low CO, High PCWP
B. Low SVR, Low CO, High PCWP
C. Low SVR, High CO, Low PCWP
,D. High SVR, High CO, Low PCWP
Answer: C
Rationale: Early septic shock is characterized by a hyperdynamic state known as warm
shock. Massive vasodilation leads to a decrease in systemic vascular resistance (SVR) and a
compensatory increase in cardiac output (CO). Filling pressures like PCWP and CVP are
typically low due to relative hypovolemia from capillary leak.
3. A patient with ARDS is being mechanically ventilated. Which setting is most appropriate for
a lung-protective strategy?
A. Tidal volume of 10-12 mL/kg PBW
B. Plateau pressure greater than 35 cm H2O
C. Low PEEP levels regardless of FiO2
D. Tidal volume of 6 mL/kg PBW
Answer: D
Rationale: Low tidal volume ventilation (6 mL/kg of Predicted Body Weight) is the gold
standard for ARDS management to prevent volutrauma. The goal is to keep plateau
pressures below 30 cm H2O to reduce the risk of barotrauma. This strategy has been
proven to significantly decrease mortality in acute respiratory distress syndrome.
4. Which of the following is a classic clinical finding in Cardiac Tamponade?
A. Wide pulse pressure
, B. Hyper-resonant percussion
C. Systolic murmur at the apex
D. Pulsus paradoxus
Answer: D
Rationale: Pulsus paradoxus is defined as an inspiratory drop in systolic blood pressure
greater than 10 mmHg. It occurs because the pericardial fluid restricts ventricular
expansion, leading to ventricular septal shift toward the left during inspiration. This
finding, along with Beck’s triad, is highly suggestive of tamponade.
5. An AGACNP is managing a patient with Acute Kidney Injury (AKI). The FeNa is calculated to
be less than 1%. What is the most likely etiology?
A. Acute Tubular Necrosis (ATN)
B. Acute Interstitial Nephritis
C. Pre-renal Azotemia
D. Post-renal obstruction
Answer: C
Rationale: A Fractional Excretion of Sodium (FeNa) less than 1 percent indicates that the
kidneys are appropriately conserving sodium. This is characteristic of pre-renal azotemia,
where the renal parenchyma is intact but perfusion is inadequate. In contrast, intra-renal
causes like ATN usually present with a FeNa greater than 2 percent.
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 4) |
The University of Texas at Arlington
1. A patient presents with acute chest pain and the ECG shows ST-segment elevation in leads
II, III, and aVF. Which coronary artery is most likely occluded?
A. Left Circumflex Artery
B. Left Main Coronary Artery
C. Left Anterior Descending Artery
D. Right Coronary Artery
Answer: D
Rationale: Leads II, III, and aVF reflect the inferior wall of the left ventricle. In
approximately 80 percent of the population, the inferior wall is supplied by the Right
Coronary Artery. Recognizing this pattern is critical because inferior MIs can be associated
with right ventricular involvement and bradyarrhythmias.
2. Which hemodynamic profile is most consistent with early septic shock?
A. High SVR, Low CO, High PCWP
B. Low SVR, Low CO, High PCWP
C. Low SVR, High CO, Low PCWP
,D. High SVR, High CO, Low PCWP
Answer: C
Rationale: Early septic shock is characterized by a hyperdynamic state known as warm
shock. Massive vasodilation leads to a decrease in systemic vascular resistance (SVR) and a
compensatory increase in cardiac output (CO). Filling pressures like PCWP and CVP are
typically low due to relative hypovolemia from capillary leak.
3. A patient with ARDS is being mechanically ventilated. Which setting is most appropriate for
a lung-protective strategy?
A. Tidal volume of 10-12 mL/kg PBW
B. Plateau pressure greater than 35 cm H2O
C. Low PEEP levels regardless of FiO2
D. Tidal volume of 6 mL/kg PBW
Answer: D
Rationale: Low tidal volume ventilation (6 mL/kg of Predicted Body Weight) is the gold
standard for ARDS management to prevent volutrauma. The goal is to keep plateau
pressures below 30 cm H2O to reduce the risk of barotrauma. This strategy has been
proven to significantly decrease mortality in acute respiratory distress syndrome.
4. Which of the following is a classic clinical finding in Cardiac Tamponade?
A. Wide pulse pressure
, B. Hyper-resonant percussion
C. Systolic murmur at the apex
D. Pulsus paradoxus
Answer: D
Rationale: Pulsus paradoxus is defined as an inspiratory drop in systolic blood pressure
greater than 10 mmHg. It occurs because the pericardial fluid restricts ventricular
expansion, leading to ventricular septal shift toward the left during inspiration. This
finding, along with Beck’s triad, is highly suggestive of tamponade.
5. An AGACNP is managing a patient with Acute Kidney Injury (AKI). The FeNa is calculated to
be less than 1%. What is the most likely etiology?
A. Acute Tubular Necrosis (ATN)
B. Acute Interstitial Nephritis
C. Pre-renal Azotemia
D. Post-renal obstruction
Answer: C
Rationale: A Fractional Excretion of Sodium (FeNa) less than 1 percent indicates that the
kidneys are appropriately conserving sodium. This is characteristic of pre-renal azotemia,
where the renal parenchyma is intact but perfusion is inadequate. In contrast, intra-renal
causes like ATN usually present with a FeNa greater than 2 percent.
