FLORIDA BOARD OF NURSING ADULT-
GERONTOLOGY ACUTE CARE EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A 72-year-old patient with septic shock has received 30 mL/kg of
crystalloid. The blood pressure remains 82/48 mmHg, MAP is 59
mmHg, and lactate is 4.2 mmol/L. Which intervention should the
adult-gerontology acute care nurse practitioner prioritize?
A. Administer IV furosemide
B. Initiate norepinephrine infusion
C. Administer sodium bicarbonate immediately
D. Begin a dopamine infusion
Answer: B. Initiate norepinephrine infusion
Rationale: Norepinephrine is the preferred first-line vasopressor for
persistent hypotension in septic shock after adequate initial fluid
resuscitation. The immediate goal is restoration of adequate perfusion,
generally targeting a MAP of at least 65 mmHg. Furosemide would
worsen intravascular depletion, bicarbonate is not routinely indicated
solely for lactic acidosis, and dopamine has a greater risk of
arrhythmias and is not preferred over norepinephrine.
2. A 68-year-old patient develops sudden aphasia and right-sided
weakness 45 minutes before arrival. CT of the head shows no
hemorrhage. Blood glucose is 108 mg/dL, and the patient has no
1
,known anticoagulant use. Which finding would most strongly
contraindicate IV thrombolytic therapy?
A. Blood pressure of 176/98 mmHg
B. Age of 68 years
C. Platelet count of 85,000/mm³
D. Symptom onset 45 minutes ago
Answer: C. Platelet count of 85,000/mm³
Rationale: A platelet count below 100,000/mm³ is a major
contraindication to IV thrombolytic therapy because of the increased
risk of intracranial and systemic hemorrhage. A blood pressure below
185/110 mmHg is generally acceptable for thrombolysis, age alone is
not a contraindication, and presentation within the treatment window
favors consideration of reperfusion therapy.
3. A 76-year-old patient with atrial fibrillation develops
hypotension, altered mental status, chest discomfort, and a
ventricular rate of 190/min. ECG demonstrates atrial fibrillation
with rapid ventricular response. What is the most appropriate
immediate treatment?
A. IV metoprolol
B. IV diltiazem
C. IV amiodarone over several hours
D. Synchronized cardioversion
Answer: D. Synchronized cardioversion
Rationale: Hemodynamic instability caused by tachyarrhythmia
requires immediate synchronized cardioversion. Hypotension, altered
mental status, and ischemic chest discomfort indicate instability. AV-
nodal blockers may worsen hypotension and delay definitive treatment,
2
,while amiodarone is not the fastest intervention for an unstable
patient.
4. A 64-year-old patient presents with crushing substernal chest
pain, diaphoresis, and nausea. ECG demonstrates ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most
likely involved?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery exclusively
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF is most
commonly caused by right coronary artery occlusion, although the left
circumflex artery can also be responsible. When inferior STEMI is
accompanied by hypotension, right ventricular involvement should be
considered and right-sided ECG leads should be obtained.
5. A 71-year-old patient with an inferior STEMI has a blood
pressure of 84/52 mmHg, clear lung sounds, and elevated jugular
venous pressure. Which intervention should be avoided?
A. Careful IV fluid administration
B. Right-sided ECG evaluation
C. Nitroglycerin administration
D. Urgent reperfusion therapy
Answer: C. Nitroglycerin administration
Rationale: The combination of inferior STEMI, hypotension, clear
lungs, and elevated JVP suggests right ventricular infarction. Right
3
, ventricular output is preload dependent, and nitrates reduce preload
and may precipitate severe hypotension. Careful fluid administration
and urgent reperfusion are appropriate while confirming right
ventricular involvement.
6. A 59-year-old patient with severe COPD presents with acute
respiratory distress. ABG shows pH 7.25, PaCO₂ 72 mmHg, PaO₂ 58
mmHg, and HCO₃⁻ 31 mEq/L. Which interpretation is most
accurate?
A. Acute respiratory alkalosis
B. Chronic metabolic acidosis
C. Acute-on-chronic respiratory acidosis
D. Uncompensated metabolic alkalosis
Answer: C. Acute-on-chronic respiratory acidosis
Rationale: The markedly elevated PaCO₂ indicates respiratory
acidosis. The elevated bicarbonate indicates chronic renal
compensation, while the significantly depressed pH suggests an acute
worsening superimposed on chronic CO₂ retention. This pattern is
typical of acute-on-chronic hypercapnic respiratory failure in severe
COPD.
7. A patient with COPD exacerbation is receiving oxygen. The
patient's SpO₂ rises from 82% to 100%, but the patient becomes
increasingly somnolent. What is the most appropriate concern?
A. Oxygen-induced worsening of hypercapnia
B. Acute pulmonary embolism
C. Respiratory alkalosis from excessive ventilation
D. Metabolic alkalosis caused by oxygen
Answer: A. Oxygen-induced worsening of hypercapnia
4
GERONTOLOGY ACUTE CARE EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A 72-year-old patient with septic shock has received 30 mL/kg of
crystalloid. The blood pressure remains 82/48 mmHg, MAP is 59
mmHg, and lactate is 4.2 mmol/L. Which intervention should the
adult-gerontology acute care nurse practitioner prioritize?
A. Administer IV furosemide
B. Initiate norepinephrine infusion
C. Administer sodium bicarbonate immediately
D. Begin a dopamine infusion
Answer: B. Initiate norepinephrine infusion
Rationale: Norepinephrine is the preferred first-line vasopressor for
persistent hypotension in septic shock after adequate initial fluid
resuscitation. The immediate goal is restoration of adequate perfusion,
generally targeting a MAP of at least 65 mmHg. Furosemide would
worsen intravascular depletion, bicarbonate is not routinely indicated
solely for lactic acidosis, and dopamine has a greater risk of
arrhythmias and is not preferred over norepinephrine.
2. A 68-year-old patient develops sudden aphasia and right-sided
weakness 45 minutes before arrival. CT of the head shows no
hemorrhage. Blood glucose is 108 mg/dL, and the patient has no
1
,known anticoagulant use. Which finding would most strongly
contraindicate IV thrombolytic therapy?
A. Blood pressure of 176/98 mmHg
B. Age of 68 years
C. Platelet count of 85,000/mm³
D. Symptom onset 45 minutes ago
Answer: C. Platelet count of 85,000/mm³
Rationale: A platelet count below 100,000/mm³ is a major
contraindication to IV thrombolytic therapy because of the increased
risk of intracranial and systemic hemorrhage. A blood pressure below
185/110 mmHg is generally acceptable for thrombolysis, age alone is
not a contraindication, and presentation within the treatment window
favors consideration of reperfusion therapy.
3. A 76-year-old patient with atrial fibrillation develops
hypotension, altered mental status, chest discomfort, and a
ventricular rate of 190/min. ECG demonstrates atrial fibrillation
with rapid ventricular response. What is the most appropriate
immediate treatment?
A. IV metoprolol
B. IV diltiazem
C. IV amiodarone over several hours
D. Synchronized cardioversion
Answer: D. Synchronized cardioversion
Rationale: Hemodynamic instability caused by tachyarrhythmia
requires immediate synchronized cardioversion. Hypotension, altered
mental status, and ischemic chest discomfort indicate instability. AV-
nodal blockers may worsen hypotension and delay definitive treatment,
2
,while amiodarone is not the fastest intervention for an unstable
patient.
4. A 64-year-old patient presents with crushing substernal chest
pain, diaphoresis, and nausea. ECG demonstrates ST-segment
elevation in leads II, III, and aVF. Which coronary artery is most
likely involved?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery exclusively
D. Left main coronary artery
Answer: B. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF is most
commonly caused by right coronary artery occlusion, although the left
circumflex artery can also be responsible. When inferior STEMI is
accompanied by hypotension, right ventricular involvement should be
considered and right-sided ECG leads should be obtained.
5. A 71-year-old patient with an inferior STEMI has a blood
pressure of 84/52 mmHg, clear lung sounds, and elevated jugular
venous pressure. Which intervention should be avoided?
A. Careful IV fluid administration
B. Right-sided ECG evaluation
C. Nitroglycerin administration
D. Urgent reperfusion therapy
Answer: C. Nitroglycerin administration
Rationale: The combination of inferior STEMI, hypotension, clear
lungs, and elevated JVP suggests right ventricular infarction. Right
3
, ventricular output is preload dependent, and nitrates reduce preload
and may precipitate severe hypotension. Careful fluid administration
and urgent reperfusion are appropriate while confirming right
ventricular involvement.
6. A 59-year-old patient with severe COPD presents with acute
respiratory distress. ABG shows pH 7.25, PaCO₂ 72 mmHg, PaO₂ 58
mmHg, and HCO₃⁻ 31 mEq/L. Which interpretation is most
accurate?
A. Acute respiratory alkalosis
B. Chronic metabolic acidosis
C. Acute-on-chronic respiratory acidosis
D. Uncompensated metabolic alkalosis
Answer: C. Acute-on-chronic respiratory acidosis
Rationale: The markedly elevated PaCO₂ indicates respiratory
acidosis. The elevated bicarbonate indicates chronic renal
compensation, while the significantly depressed pH suggests an acute
worsening superimposed on chronic CO₂ retention. This pattern is
typical of acute-on-chronic hypercapnic respiratory failure in severe
COPD.
7. A patient with COPD exacerbation is receiving oxygen. The
patient's SpO₂ rises from 82% to 100%, but the patient becomes
increasingly somnolent. What is the most appropriate concern?
A. Oxygen-induced worsening of hypercapnia
B. Acute pulmonary embolism
C. Respiratory alkalosis from excessive ventilation
D. Metabolic alkalosis caused by oxygen
Answer: A. Oxygen-induced worsening of hypercapnia
4
