NURS 5463 Exam 4 V2 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 4) |
The University of Texas at Arlington
1. A 65-year-old male presents with a sudden onset of ‘the worst headache of my life.’ A non-
contrast CT scan reveals a subarachnoid hemorrhage (SAH). Which of the following is the
priority pharmacological intervention to prevent vasospasm?
A. Lisinopril
B. Hydralazine
C. Nitroprusside
D. Nimodipine
Answer: D
Rationale: Nimodipine is a calcium channel blocker specifically indicated to reduce the
incidence and severity of ischemic deficits caused by delayed vasospasm in patients with
SAH. It should be initiated within 96 hours of the hemorrhage. Other antihypertensives like
Nitroprusside are generally avoided because they can increase intracranial pressure via
vasodilation.
,2. A patient in the ICU is being monitored for increased intracranial pressure (ICP) following a
traumatic brain injury. The nurse practitioner notes the ICP is 22 mmHg and the Mean
Arterial Pressure (MAP) is 70 mmHg. What is the Cerebral Perfusion Pressure (CPP)?
A. 92 mmHg
B. 48 mmHg
C. 50 mmHg
D. 60 mmHg
Answer: B
Rationale: CPP is calculated by subtracting the ICP from the MAP (MAP - ICP = CPP). In this
case, 70 mmHg - 22 mmHg equals 48 mmHg. A CPP below 50-60 mmHg is associated with
cerebral ischemia and poor outcomes, requiring immediate intervention to increase MAP
or decrease ICP.
3. A patient with Acute Myeloid Leukemia (AML) undergoing chemotherapy develops a uric
acid level of 12 mg/dL, potassium of 5.8 mEq/L, and phosphorus of 5.5 mg/dL. Which
condition is most likely?
A. Superior Vena Cava Syndrome
B. Hypercalcemia of Malignancy
C. Disseminated Intravascular Coagulation
D. Tumor Lysis Syndrome
,Answer: D
Rationale: Tumor Lysis Syndrome (TLS) occurs when tumor cells release their contents
into the bloodstream, leading to hyperuricemia, hyperkalemia, and hyperphosphatemia.
This often results in secondary hypocalcemia and acute renal failure. Treatment focuses on
aggressive hydration, allopurinol, or rasburicase to manage uric acid levels.
4. In the management of a patient with suspected Disseminated Intravascular Coagulation
(DIC), which laboratory finding is the most sensitive indicator of the condition?
A. Decreased PT/PTT
B. Elevated D-dimer
C. Increased Fibrinogen
D. Increased Hemoglobin
Answer: B
Rationale: D-dimer is a specific polymer resulting from the breakdown of cross-linked
fibrin and is a sensitive indicator of secondary fibrinolysis seen in DIC. In DIC, fibrinogen
levels and platelet counts are typically decreased, while PT and PTT are prolonged. The
presence of schistocytes on a peripheral smear also supports the diagnosis of
microangiopathic hemolytic anemia.
, 5. A 70-year-old female presents with signs of an ischemic stroke. Her symptoms began 2
hours ago. Her blood pressure is 190/110 mmHg. What is the priority management step
regarding her blood pressure prior to administering alteplase (tPA)?
A. Maintain BP at current level to ensure perfusion.
B. Aggressively lower BP to 120/80 mmHg.
C. Lower BP to less than 185/110 mmHg.
D. Administer alteplase immediately regardless of BP.
Answer: C
Rationale: For patients eligible for alteplase, the blood pressure must be maintained below
185/110 mmHg before the infusion starts to reduce the risk of intracranial hemorrhage.
Labetalol or Nicardipine are commonly used to achieve this target. After tPA is started, the
goal is to keep BP below 180/105 mmHg for at least 24 hours.
6. Which of the following is considered the ‘gold standard’ for monitoring intracranial
pressure in a patient with a severe head injury?
A. Intraventricular catheter (Ventriculostomy)
B. Epidural sensor
C. Subdural bolt
D. Transcranial Doppler
Answer: A
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 4) |
The University of Texas at Arlington
1. A 65-year-old male presents with a sudden onset of ‘the worst headache of my life.’ A non-
contrast CT scan reveals a subarachnoid hemorrhage (SAH). Which of the following is the
priority pharmacological intervention to prevent vasospasm?
A. Lisinopril
B. Hydralazine
C. Nitroprusside
D. Nimodipine
Answer: D
Rationale: Nimodipine is a calcium channel blocker specifically indicated to reduce the
incidence and severity of ischemic deficits caused by delayed vasospasm in patients with
SAH. It should be initiated within 96 hours of the hemorrhage. Other antihypertensives like
Nitroprusside are generally avoided because they can increase intracranial pressure via
vasodilation.
,2. A patient in the ICU is being monitored for increased intracranial pressure (ICP) following a
traumatic brain injury. The nurse practitioner notes the ICP is 22 mmHg and the Mean
Arterial Pressure (MAP) is 70 mmHg. What is the Cerebral Perfusion Pressure (CPP)?
A. 92 mmHg
B. 48 mmHg
C. 50 mmHg
D. 60 mmHg
Answer: B
Rationale: CPP is calculated by subtracting the ICP from the MAP (MAP - ICP = CPP). In this
case, 70 mmHg - 22 mmHg equals 48 mmHg. A CPP below 50-60 mmHg is associated with
cerebral ischemia and poor outcomes, requiring immediate intervention to increase MAP
or decrease ICP.
3. A patient with Acute Myeloid Leukemia (AML) undergoing chemotherapy develops a uric
acid level of 12 mg/dL, potassium of 5.8 mEq/L, and phosphorus of 5.5 mg/dL. Which
condition is most likely?
A. Superior Vena Cava Syndrome
B. Hypercalcemia of Malignancy
C. Disseminated Intravascular Coagulation
D. Tumor Lysis Syndrome
,Answer: D
Rationale: Tumor Lysis Syndrome (TLS) occurs when tumor cells release their contents
into the bloodstream, leading to hyperuricemia, hyperkalemia, and hyperphosphatemia.
This often results in secondary hypocalcemia and acute renal failure. Treatment focuses on
aggressive hydration, allopurinol, or rasburicase to manage uric acid levels.
4. In the management of a patient with suspected Disseminated Intravascular Coagulation
(DIC), which laboratory finding is the most sensitive indicator of the condition?
A. Decreased PT/PTT
B. Elevated D-dimer
C. Increased Fibrinogen
D. Increased Hemoglobin
Answer: B
Rationale: D-dimer is a specific polymer resulting from the breakdown of cross-linked
fibrin and is a sensitive indicator of secondary fibrinolysis seen in DIC. In DIC, fibrinogen
levels and platelet counts are typically decreased, while PT and PTT are prolonged. The
presence of schistocytes on a peripheral smear also supports the diagnosis of
microangiopathic hemolytic anemia.
, 5. A 70-year-old female presents with signs of an ischemic stroke. Her symptoms began 2
hours ago. Her blood pressure is 190/110 mmHg. What is the priority management step
regarding her blood pressure prior to administering alteplase (tPA)?
A. Maintain BP at current level to ensure perfusion.
B. Aggressively lower BP to 120/80 mmHg.
C. Lower BP to less than 185/110 mmHg.
D. Administer alteplase immediately regardless of BP.
Answer: C
Rationale: For patients eligible for alteplase, the blood pressure must be maintained below
185/110 mmHg before the infusion starts to reduce the risk of intracranial hemorrhage.
Labetalol or Nicardipine are commonly used to achieve this target. After tPA is started, the
goal is to keep BP below 180/105 mmHg for at least 24 hours.
6. Which of the following is considered the ‘gold standard’ for monitoring intracranial
pressure in a patient with a severe head injury?
A. Intraventricular catheter (Ventriculostomy)
B. Epidural sensor
C. Subdural bolt
D. Transcranial Doppler
Answer: A
