NURS 5463 Final Exam V1 | NURS 5463
Adult Gerontology Acute Care Review |
Actual Q&A with Rationale (NURS5463
Final Exam) | The University of Texas at
Arlington
1. A 65-year-old male with a history of heart failure presents with increased dyspnea and
orthopnea. Physical exam reveals a S3 gallop and bilateral crackles. Which of the following is
the most appropriate first-line medication to reduce preload in this patient?
A. Furosemide
B. Lisinopril
C. Metoprolol
D. Digoxin
Answer: A
Rationale: Furosemide is a loop diuretic that rapidly reduces intravascular volume and
preload in patients with acute decompensated heart failure. Reducing preload helps
alleviate pulmonary congestion and improves gas exchange. Diuretics remain the
cornerstone of initial management for fluid-overloaded patients in the acute care setting.
,2. According to the Surviving Sepsis Campaign, what is the recommended initial volume of
crystalloid fluid for a patient with sepsis-induced hypoperfusion or a lactate level greater
than or equal to 4 mmol/L?
A. 10 mL/kg
B. 20 mL/kg
C. 30 mL/kg
D. 50 mL/kg
Answer: C
Rationale: The guidelines recommend an initial fluid resuscitation of at least 30 mL/kg of
IV crystalloid fluid within the first 3 hours. This volume is intended to restore intravascular
volume and improve tissue perfusion in the setting of septic shock. Clinical assessment
should guide further fluid administration based on hemodynamic response.
3. A patient in the ICU has developed Acute Respiratory Distress Syndrome (ARDS). The
AGACNP plans to implement lung-protective ventilation. Which tidal volume setting is most
consistent with this strategy?
A. 6 mL/kg of predicted body weight
B. 10 mL/kg of predicted body weight
C. 12 mL/kg of predicted body weight
D. 15 mL/kg of predicted body weight
,Answer: A
Rationale: Lung-protective ventilation for ARDS aims to prevent ventilator-induced lung
injury by using low tidal volumes, typically 6 mL/kg of predicted body weight. This
approach minimizes barotrauma and volutrauma by reducing plateau pressures. It has
been shown to significantly reduce mortality in clinical trials involving ARDS patients.
4. Which of the following laboratory findings is most indicative of Pre-renal Acute Kidney
Injury (AKI)?
A. FENa > 2%
B. BUN to Creatinine ratio > 20:1
C. Urine Sodium > 40 mEq/L
D. Presence of muddy brown casts in urine
Answer: B
Rationale: A BUN to Creatinine ratio greater than 20:1 suggests pre-renal AKI, as the
kidneys increase urea reabsorption in response to decreased perfusion. In pre-renal states,
the tubules remain intact, allowing for concentrated urine and low fractional excretion of
sodium. This distinguishes it from intra-renal causes where tubular damage occurs.
5. A 45-year-old patient with type 1 diabetes presents with nausea, vomiting, and abdominal
pain. Labs show blood glucose 450 mg/dL, pH 7.20, and positive serum ketones. What is the
priority intervention before starting the insulin infusion?
A. Check and correct potassium levels
, B. Administer bicarbonate
C. Obtain an abdominal CT scan
D. Start a dextrose infusion
Answer: A
Rationale: Insulin administration will cause potassium to shift from the extracellular space
into the cells, potentially causing life-threatening hypokalemia. It is critical to ensure the
serum potassium is above 3.3 mEq/L before starting insulin therapy. If potassium is low,
replacement must be prioritized to prevent cardiac arrhythmias.
6. Which characteristic differentiates Hyperosmolar Hyperglycemic State (HHS) from Diabetic
Ketoacidosis (DKA)?
A. Lower blood glucose levels
B. Significant metabolic acidosis
C. Absence of significant ketosis
D. Increased anion gap
Answer: C
Rationale: HHS is characterized by profound hyperglycemia and hyperosmolality without
the significant ketosis or acidosis seen in DKA. Because patients with HHS typically have
enough endogenous insulin to prevent lipolysis, they do not develop ketones. HHS usually
presents with much higher glucose levels and greater dehydration compared to DKA.
Adult Gerontology Acute Care Review |
Actual Q&A with Rationale (NURS5463
Final Exam) | The University of Texas at
Arlington
1. A 65-year-old male with a history of heart failure presents with increased dyspnea and
orthopnea. Physical exam reveals a S3 gallop and bilateral crackles. Which of the following is
the most appropriate first-line medication to reduce preload in this patient?
A. Furosemide
B. Lisinopril
C. Metoprolol
D. Digoxin
Answer: A
Rationale: Furosemide is a loop diuretic that rapidly reduces intravascular volume and
preload in patients with acute decompensated heart failure. Reducing preload helps
alleviate pulmonary congestion and improves gas exchange. Diuretics remain the
cornerstone of initial management for fluid-overloaded patients in the acute care setting.
,2. According to the Surviving Sepsis Campaign, what is the recommended initial volume of
crystalloid fluid for a patient with sepsis-induced hypoperfusion or a lactate level greater
than or equal to 4 mmol/L?
A. 10 mL/kg
B. 20 mL/kg
C. 30 mL/kg
D. 50 mL/kg
Answer: C
Rationale: The guidelines recommend an initial fluid resuscitation of at least 30 mL/kg of
IV crystalloid fluid within the first 3 hours. This volume is intended to restore intravascular
volume and improve tissue perfusion in the setting of septic shock. Clinical assessment
should guide further fluid administration based on hemodynamic response.
3. A patient in the ICU has developed Acute Respiratory Distress Syndrome (ARDS). The
AGACNP plans to implement lung-protective ventilation. Which tidal volume setting is most
consistent with this strategy?
A. 6 mL/kg of predicted body weight
B. 10 mL/kg of predicted body weight
C. 12 mL/kg of predicted body weight
D. 15 mL/kg of predicted body weight
,Answer: A
Rationale: Lung-protective ventilation for ARDS aims to prevent ventilator-induced lung
injury by using low tidal volumes, typically 6 mL/kg of predicted body weight. This
approach minimizes barotrauma and volutrauma by reducing plateau pressures. It has
been shown to significantly reduce mortality in clinical trials involving ARDS patients.
4. Which of the following laboratory findings is most indicative of Pre-renal Acute Kidney
Injury (AKI)?
A. FENa > 2%
B. BUN to Creatinine ratio > 20:1
C. Urine Sodium > 40 mEq/L
D. Presence of muddy brown casts in urine
Answer: B
Rationale: A BUN to Creatinine ratio greater than 20:1 suggests pre-renal AKI, as the
kidneys increase urea reabsorption in response to decreased perfusion. In pre-renal states,
the tubules remain intact, allowing for concentrated urine and low fractional excretion of
sodium. This distinguishes it from intra-renal causes where tubular damage occurs.
5. A 45-year-old patient with type 1 diabetes presents with nausea, vomiting, and abdominal
pain. Labs show blood glucose 450 mg/dL, pH 7.20, and positive serum ketones. What is the
priority intervention before starting the insulin infusion?
A. Check and correct potassium levels
, B. Administer bicarbonate
C. Obtain an abdominal CT scan
D. Start a dextrose infusion
Answer: A
Rationale: Insulin administration will cause potassium to shift from the extracellular space
into the cells, potentially causing life-threatening hypokalemia. It is critical to ensure the
serum potassium is above 3.3 mEq/L before starting insulin therapy. If potassium is low,
replacement must be prioritized to prevent cardiac arrhythmias.
6. Which characteristic differentiates Hyperosmolar Hyperglycemic State (HHS) from Diabetic
Ketoacidosis (DKA)?
A. Lower blood glucose levels
B. Significant metabolic acidosis
C. Absence of significant ketosis
D. Increased anion gap
Answer: C
Rationale: HHS is characterized by profound hyperglycemia and hyperosmolality without
the significant ketosis or acidosis seen in DKA. Because patients with HHS typically have
enough endogenous insulin to prevent lipolysis, they do not develop ketones. HHS usually
presents with much higher glucose levels and greater dehydration compared to DKA.
