, NURS 5463 TEST 3 PRACTICE QUESTIONS
Advanced Nursing Practice - Adult Gerontology Acute Care
University of Texas at Arlington (UTA)
100-Question Original Practice Examination
2026/2027 Edition
Practice focus: infectious disease and antimicrobial resistance, febrile neutropenia, hematology and oncology, thrombosis
and anticoagulation, perioperative bridging, oncologic emergencies, critical-care stabilization, and high-acuity adult-
gerontology clinical decision-making.
1. A critically ill patient with suspected septic shock is hypotensive after adequate initial fluid resuscitation.
Which vasopressor is generally first-line?
A) Phenylephrine as routine first choice.
B) Dopamine for all patients.
C) Norepinephrine.
D) Nitroprusside.
Correct Answer: Norepinephrine.
Rationale:
Norepinephrine is generally the preferred initial vasopressor in septic shock because it effectively raises mean arterial pressure
with less tachyarrhythmia risk than dopamine. Other agents may be added or substituted depending on the clinical scenario.
2. Which finding most strongly suggests septic shock rather than uncomplicated sepsis?
A) Leukocytosis alone.
B) Fever alone.
C) Positive urine culture without organ dysfunction.
D) Persistent hypotension requiring vasopressors despite adequate fluids.
Correct Answer: Persistent hypotension requiring vasopressors despite adequate fluids.
Rationale:
Septic shock is defined by profound circulatory and metabolic abnormalities, including vasopressor dependence to maintain
adequate blood pressure after fluids. Fever and leukocytosis are nonspecific and may occur without shock.
3. Why should blood cultures ideally be obtained before antibiotics in suspected severe sepsis when this
does not meaningfully delay therapy?
A) They replace the need for antibiotics.
B) They determine blood pressure response.
C) They immediately sterilize the bloodstream.
D) They improve the chance of identifying the pathogen and guiding de-escalation.
Correct Answer: They improve the chance of identifying the pathogen and guiding de-escalation.
Rationale:
Cultures obtained before antimicrobial exposure are more likely to yield the causative organism and susceptibility pattern.
Antibiotics should not be dangerously delayed in unstable patients, but early cultures support targeted therapy and stewardship.
4. A hospitalized patient develops pneumonia after several days of mechanical ventilation. Which pathogen
category becomes especially important?
A) Only viral pathogens.
B) Only community streptococci.
C) Hospital-acquired multidrug-resistant gram-negative organisms and MRSA.
D) Only anaerobes from dental disease.
Correct Answer: Hospital-acquired multidrug-resistant gram-negative organisms and MRSA.
NURS 5463 Test 3 Practice Questions 1 2026/2027 Edition
, Rationale:
Ventilator-associated pneumonia is associated with hospital flora including Pseudomonas, Acinetobacter, Enterobacterales, and
MRSA depending on local epidemiology and prior antibiotic exposure. Empiric therapy should reflect resistance risk and local
antibiograms.
5. Which risk factor increases the likelihood of MRSA infection?
A) Young age alone.
B) Recent hospitalization with broad-spectrum antibiotic exposure.
C) No prior antibiotics.
D) No healthcare exposure.
Correct Answer: Recent hospitalization with broad-spectrum antibiotic exposure.
Rationale:
MRSA risk rises with healthcare exposure, prior colonization or infection, invasive devices, recent antibiotics, and prolonged
hospitalization. These factors increase colonization pressure and exposure to resistant organisms.
6. Vancomycin-resistant Enterococcus is especially associated with:
A) No prior antimicrobial exposure.
B) Short outpatient visits only.
C) Prior broad-spectrum antibiotic exposure and prolonged hospitalization.
D) Isolated seasonal allergies.
Correct Answer: Prior broad-spectrum antibiotic exposure and prolonged hospitalization.
Rationale:
VRE often emerges in heavily antibiotic-exposed or critically ill patients, particularly in hospitals and long-term care.
Vancomycin, cephalosporins, and other broad-spectrum agents increase selective pressure.
7. Which mechanism is typical of extended-spectrum beta-lactamase-producing Enterobacterales?
A) Complete loss of bacterial ribosomes.
B) Failure to synthesize DNA.
C) Inability to form a cell wall.
D) Enzymatic hydrolysis of many penicillins and cephalosporins.
Correct Answer: Enzymatic hydrolysis of many penicillins and cephalosporins.
Rationale:
ESBL enzymes hydrolyze many beta-lactam antibiotics, especially extended-spectrum cephalosporins and aztreonam.
Carbapenems are often used for serious ESBL infections, depending on source and susceptibility.
8. Which organism is a common ESBL producer?
A) Candida albicans.
B) Escherichia coli.
C) Clostridioides difficile.
D) Staphylococcus epidermidis only.
Correct Answer: Escherichia coli.
Rationale:
ESBL production is common among Enterobacterales, especially E. coli and Klebsiella species. These organisms can cause
urinary, bloodstream, and intra-abdominal infections.
9. Why are carbapenem-resistant Enterobacterales especially concerning?
A) They respond uniformly to penicillin.
B) They are always harmless colonizers.
C) They cannot cause bloodstream infection.
D) Therapeutic options are limited and mortality can be high.
NURS 5463 Test 3 Practice Questions 2 2026/2027 Edition
Advanced Nursing Practice - Adult Gerontology Acute Care
University of Texas at Arlington (UTA)
100-Question Original Practice Examination
2026/2027 Edition
Practice focus: infectious disease and antimicrobial resistance, febrile neutropenia, hematology and oncology, thrombosis
and anticoagulation, perioperative bridging, oncologic emergencies, critical-care stabilization, and high-acuity adult-
gerontology clinical decision-making.
1. A critically ill patient with suspected septic shock is hypotensive after adequate initial fluid resuscitation.
Which vasopressor is generally first-line?
A) Phenylephrine as routine first choice.
B) Dopamine for all patients.
C) Norepinephrine.
D) Nitroprusside.
Correct Answer: Norepinephrine.
Rationale:
Norepinephrine is generally the preferred initial vasopressor in septic shock because it effectively raises mean arterial pressure
with less tachyarrhythmia risk than dopamine. Other agents may be added or substituted depending on the clinical scenario.
2. Which finding most strongly suggests septic shock rather than uncomplicated sepsis?
A) Leukocytosis alone.
B) Fever alone.
C) Positive urine culture without organ dysfunction.
D) Persistent hypotension requiring vasopressors despite adequate fluids.
Correct Answer: Persistent hypotension requiring vasopressors despite adequate fluids.
Rationale:
Septic shock is defined by profound circulatory and metabolic abnormalities, including vasopressor dependence to maintain
adequate blood pressure after fluids. Fever and leukocytosis are nonspecific and may occur without shock.
3. Why should blood cultures ideally be obtained before antibiotics in suspected severe sepsis when this
does not meaningfully delay therapy?
A) They replace the need for antibiotics.
B) They determine blood pressure response.
C) They immediately sterilize the bloodstream.
D) They improve the chance of identifying the pathogen and guiding de-escalation.
Correct Answer: They improve the chance of identifying the pathogen and guiding de-escalation.
Rationale:
Cultures obtained before antimicrobial exposure are more likely to yield the causative organism and susceptibility pattern.
Antibiotics should not be dangerously delayed in unstable patients, but early cultures support targeted therapy and stewardship.
4. A hospitalized patient develops pneumonia after several days of mechanical ventilation. Which pathogen
category becomes especially important?
A) Only viral pathogens.
B) Only community streptococci.
C) Hospital-acquired multidrug-resistant gram-negative organisms and MRSA.
D) Only anaerobes from dental disease.
Correct Answer: Hospital-acquired multidrug-resistant gram-negative organisms and MRSA.
NURS 5463 Test 3 Practice Questions 1 2026/2027 Edition
, Rationale:
Ventilator-associated pneumonia is associated with hospital flora including Pseudomonas, Acinetobacter, Enterobacterales, and
MRSA depending on local epidemiology and prior antibiotic exposure. Empiric therapy should reflect resistance risk and local
antibiograms.
5. Which risk factor increases the likelihood of MRSA infection?
A) Young age alone.
B) Recent hospitalization with broad-spectrum antibiotic exposure.
C) No prior antibiotics.
D) No healthcare exposure.
Correct Answer: Recent hospitalization with broad-spectrum antibiotic exposure.
Rationale:
MRSA risk rises with healthcare exposure, prior colonization or infection, invasive devices, recent antibiotics, and prolonged
hospitalization. These factors increase colonization pressure and exposure to resistant organisms.
6. Vancomycin-resistant Enterococcus is especially associated with:
A) No prior antimicrobial exposure.
B) Short outpatient visits only.
C) Prior broad-spectrum antibiotic exposure and prolonged hospitalization.
D) Isolated seasonal allergies.
Correct Answer: Prior broad-spectrum antibiotic exposure and prolonged hospitalization.
Rationale:
VRE often emerges in heavily antibiotic-exposed or critically ill patients, particularly in hospitals and long-term care.
Vancomycin, cephalosporins, and other broad-spectrum agents increase selective pressure.
7. Which mechanism is typical of extended-spectrum beta-lactamase-producing Enterobacterales?
A) Complete loss of bacterial ribosomes.
B) Failure to synthesize DNA.
C) Inability to form a cell wall.
D) Enzymatic hydrolysis of many penicillins and cephalosporins.
Correct Answer: Enzymatic hydrolysis of many penicillins and cephalosporins.
Rationale:
ESBL enzymes hydrolyze many beta-lactam antibiotics, especially extended-spectrum cephalosporins and aztreonam.
Carbapenems are often used for serious ESBL infections, depending on source and susceptibility.
8. Which organism is a common ESBL producer?
A) Candida albicans.
B) Escherichia coli.
C) Clostridioides difficile.
D) Staphylococcus epidermidis only.
Correct Answer: Escherichia coli.
Rationale:
ESBL production is common among Enterobacterales, especially E. coli and Klebsiella species. These organisms can cause
urinary, bloodstream, and intra-abdominal infections.
9. Why are carbapenem-resistant Enterobacterales especially concerning?
A) They respond uniformly to penicillin.
B) They are always harmless colonizers.
C) They cannot cause bloodstream infection.
D) Therapeutic options are limited and mortality can be high.
NURS 5463 Test 3 Practice Questions 2 2026/2027 Edition
