NURS 5463 / NURS5463 EXAM 3
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
• Acute Cardiovascular Disorders
• Acute Respiratory Disorders
• Acute Neurological Disorders
• Acute Gastrointestinal Disorders
• Acute Renal and Genitourinary Disorders
• Endocrine and Metabolic Emergencies
• Infectious Diseases and Sepsis
• Hematological and Oncological Emergencies
• Multisystem Organ Dysfunction and Shock States
• Ethical and Legal Issues in Acute Care
Introduction
This comprehensive examination for NURS 5463 Adult Gerontology Acute Care
Exam 3 is designed to evaluate advanced practice nursing knowledge and
clinical reasoning essential for managing acutely ill adult and geriatric
patients in critical care and acute care settings. The assessment integrates
foundational pathophysiology, evidence-based pharmacological interventions,
advanced diagnostic reasoning, and prioritization of care across major body
systems. Each question reflects real-world clinical scenarios encountered in
intensive care units, emergency departments, and acute care floors,
,challenging the learner to synthesize complex patient data, anticipate clinical
deterioration, and implement life-saving interventions. Mastery of these
competencies is fundamental for safe, competent, and autonomous advanced
practice in adult-gerontology acute care.
SECTION ONE: QUESTIONS 1–100
Question 1
A 72-year-old male with a history of hypertension and type 2 diabetes
presents to the emergency department with acute-onset substernal chest pain
radiating to his left arm. He is diaphoretic and nauseated. The ECG shows ST-
segment elevation in leads V1-V4. Which medication should be administered
FIRST?
A. Sublingual nitroglycerin
B. Aspirin 324 mg chewed
C. Morphine sulfate 4 mg IV
D. Oxygen at 4 L/min via nasal cannula
B
RATIONALE: Aspirin should be administered immediately upon
suspicion of acute myocardial infarction to reduce mortality. Chewing aspirin
allows for rapid absorption and platelet inhibition. Oxygen, nitroglycerin, and
morphine are also indicated but aspirin is the priority first-line therapy.
Question 2
A 65-year-old female with a history of COPD is admitted with acute
respiratory failure. Arterial blood gas (ABG) results show pH 7.25, PaCO2 65
mmHg, and HCO3- 28 mEq/L. Which acid-base disturbance is present?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
,C. Metabolic acidosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
B
RATIONALE: The elevated PaCO2 indicates respiratory acidosis. The pH
is low but not severely so, and the HCO3- is elevated (compensatory
metabolic alkalosis), indicating renal compensation. In chronic respiratory
acidosis, the kidneys retain bicarbonate to buffer the acidosis.
Question 3
A 78-year-old patient with heart failure and reduced ejection fraction (HFrEF)
is admitted with acute decompensated heart failure. The patient is
tachycardic, tachypneic, and has crackles throughout the lung fields. Which
medication is CONTRAINDICATED in this patient?
A. Furosemide
B. Lisinopril
C. Metoprolol succinate
D. Ibuprofen
D
RATIONALE: NSAIDs such as ibuprofen are contraindicated in heart
failure because they cause sodium and water retention, increase systemic
vascular resistance, and reduce the effectiveness of diuretics and ACE
inhibitors, worsening heart failure symptoms.
Question 4
A 68-year-old male with a history of chronic kidney disease stage 4 presents
with confusion, generalized weakness, and ECG changes showing peaked T
waves. Laboratory results reveal serum potassium of 6.9 mEq/L. Which
intervention should the nurse implement FIRST?
A. Administer calcium gluconate IV
B. Administer insulin with dextrose IV
, C. Administer sodium bicarbonate IV
D. Administer kayexalate orally
A
RATIONALE: Calcium gluconate should be administered first to stabilize
the cardiac membrane and prevent life-threatening arrhythmias in
hyperkalemia. Insulin with dextrose, sodium bicarbonate, and kayexalate are
used to shift potassium into cells or remove it from the body but do not
provide immediate cardiac protection.
Question 5
A 75-year-old patient is admitted with acute pancreatitis. Which laboratory
finding is MOST specific for the diagnosis?
A. Elevated serum amylase
B. Elevated serum lipase
C. Elevated serum glucose
D. Elevated white blood cell count
B
RATIONALE: Serum lipase is more specific for acute pancreatitis than
amylase because lipase is produced only by the pancreas. Elevated lipase
(typically three times the upper limit of normal) is highly specific for acute
pancreatitis.
Question 6
A 70-year-old female with a history of atrial fibrillation presents with sudden-
onset left-sided weakness, facial droop, and aphasia. Symptoms began 2
hours ago. Non-contrast head CT shows no evidence of hemorrhage. Which
intervention is MOST appropriate?
A. Administer intravenous tissue plasminogen activator (tPA)
B. Administer aspirin 325 mg orally
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
• Acute Cardiovascular Disorders
• Acute Respiratory Disorders
• Acute Neurological Disorders
• Acute Gastrointestinal Disorders
• Acute Renal and Genitourinary Disorders
• Endocrine and Metabolic Emergencies
• Infectious Diseases and Sepsis
• Hematological and Oncological Emergencies
• Multisystem Organ Dysfunction and Shock States
• Ethical and Legal Issues in Acute Care
Introduction
This comprehensive examination for NURS 5463 Adult Gerontology Acute Care
Exam 3 is designed to evaluate advanced practice nursing knowledge and
clinical reasoning essential for managing acutely ill adult and geriatric
patients in critical care and acute care settings. The assessment integrates
foundational pathophysiology, evidence-based pharmacological interventions,
advanced diagnostic reasoning, and prioritization of care across major body
systems. Each question reflects real-world clinical scenarios encountered in
intensive care units, emergency departments, and acute care floors,
,challenging the learner to synthesize complex patient data, anticipate clinical
deterioration, and implement life-saving interventions. Mastery of these
competencies is fundamental for safe, competent, and autonomous advanced
practice in adult-gerontology acute care.
SECTION ONE: QUESTIONS 1–100
Question 1
A 72-year-old male with a history of hypertension and type 2 diabetes
presents to the emergency department with acute-onset substernal chest pain
radiating to his left arm. He is diaphoretic and nauseated. The ECG shows ST-
segment elevation in leads V1-V4. Which medication should be administered
FIRST?
A. Sublingual nitroglycerin
B. Aspirin 324 mg chewed
C. Morphine sulfate 4 mg IV
D. Oxygen at 4 L/min via nasal cannula
B
RATIONALE: Aspirin should be administered immediately upon
suspicion of acute myocardial infarction to reduce mortality. Chewing aspirin
allows for rapid absorption and platelet inhibition. Oxygen, nitroglycerin, and
morphine are also indicated but aspirin is the priority first-line therapy.
Question 2
A 65-year-old female with a history of COPD is admitted with acute
respiratory failure. Arterial blood gas (ABG) results show pH 7.25, PaCO2 65
mmHg, and HCO3- 28 mEq/L. Which acid-base disturbance is present?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with metabolic compensation
,C. Metabolic acidosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
B
RATIONALE: The elevated PaCO2 indicates respiratory acidosis. The pH
is low but not severely so, and the HCO3- is elevated (compensatory
metabolic alkalosis), indicating renal compensation. In chronic respiratory
acidosis, the kidneys retain bicarbonate to buffer the acidosis.
Question 3
A 78-year-old patient with heart failure and reduced ejection fraction (HFrEF)
is admitted with acute decompensated heart failure. The patient is
tachycardic, tachypneic, and has crackles throughout the lung fields. Which
medication is CONTRAINDICATED in this patient?
A. Furosemide
B. Lisinopril
C. Metoprolol succinate
D. Ibuprofen
D
RATIONALE: NSAIDs such as ibuprofen are contraindicated in heart
failure because they cause sodium and water retention, increase systemic
vascular resistance, and reduce the effectiveness of diuretics and ACE
inhibitors, worsening heart failure symptoms.
Question 4
A 68-year-old male with a history of chronic kidney disease stage 4 presents
with confusion, generalized weakness, and ECG changes showing peaked T
waves. Laboratory results reveal serum potassium of 6.9 mEq/L. Which
intervention should the nurse implement FIRST?
A. Administer calcium gluconate IV
B. Administer insulin with dextrose IV
, C. Administer sodium bicarbonate IV
D. Administer kayexalate orally
A
RATIONALE: Calcium gluconate should be administered first to stabilize
the cardiac membrane and prevent life-threatening arrhythmias in
hyperkalemia. Insulin with dextrose, sodium bicarbonate, and kayexalate are
used to shift potassium into cells or remove it from the body but do not
provide immediate cardiac protection.
Question 5
A 75-year-old patient is admitted with acute pancreatitis. Which laboratory
finding is MOST specific for the diagnosis?
A. Elevated serum amylase
B. Elevated serum lipase
C. Elevated serum glucose
D. Elevated white blood cell count
B
RATIONALE: Serum lipase is more specific for acute pancreatitis than
amylase because lipase is produced only by the pancreas. Elevated lipase
(typically three times the upper limit of normal) is highly specific for acute
pancreatitis.
Question 6
A 70-year-old female with a history of atrial fibrillation presents with sudden-
onset left-sided weakness, facial droop, and aphasia. Symptoms began 2
hours ago. Non-contrast head CT shows no evidence of hemorrhage. Which
intervention is MOST appropriate?
A. Administer intravenous tissue plasminogen activator (tPA)
B. Administer aspirin 325 mg orally
