NURS 5463 Exam 1 V2 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 1) |
The University of Texas at Arlington
1. A patient presents with a serum sodium of 122 mEq/L, serum osmolality of 260 mOsm/kg,
and a urine sodium of 45 mEq/L. Which of the following is the most likely diagnosis?
A. Diabetes Insipidus
B. Dehydration
C. Psychogenic Polydipsia
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Answer: D
Rationale: SIADH is characterized by hyponatremia and low serum osmolality in the
presence of inappropriately concentrated urine. The high urine sodium level indicates that
the kidneys are still excreting salt despite the low serum levels. This condition often results
from CNS disorders, malignancies, or certain medications that trigger excessive ADH
release.
2. In the management of a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to prevent barotrauma?
A. High Tidal Volume and low PEEP
,B. High Respiratory Rate with low FiO2
C. Inverse Ratio Ventilation with high Tidal Volume
D. Low Tidal Volume and high PEEP
Answer: D
Rationale: Low tidal volume ventilation, typically 6 mL/kg of predicted body weight, is the
standard of care for ARDS to minimize lung injury. High Positive End-Expiratory Pressure
(PEEP) is used to keep alveoli open and improve oxygenation. This lung-protective strategy
has been shown to decrease mortality in acute care settings.
3. Which hemodynamic profile is most consistent with early septic shock?
A. Low SVR, High CO, Low PCWP
B. High SVR, Low CO, High CVP
C. Low SVR, Low CO, High PCWP
D. Normal SVR, Normal CO, High CVP
Answer: A
Rationale: Early or ‘warm’ septic shock is characterized by massive vasodilation, which
results in a significantly decreased Systemic Vascular Resistance (SVR). To compensate for
the low resistance, the heart increases Cardiac Output (CO), resulting in a hyperdynamic
state. Preload markers like Pulmonary Capillary Wedge Pressure (PCWP) are typically low
due to relative hypovolemia and capillary leak.
, 4. A patient on a ventilator has the following ABG results: pH 7.28, PaCO2 55 mmHg, HCO3 26
mEq/L, and PaO2 80 mmHg. What is the interpretation and the most appropriate
intervention?
A. Metabolic Acidosis; increase PEEP
B. Respiratory Acidosis; increase Minute Ventilation
C. Respiratory Alkalosis; decrease Respiratory Rate
D. Metabolic Alkalosis; decrease Tidal Volume
Answer: B
Rationale: The pH is low and the PaCO2 is high, indicating a primary respiratory acidosis.
Since the patient is on a ventilator, the goal is to increase the clearance of carbon dioxide.
This can be achieved by increasing either the tidal volume or the respiratory rate to
enhance minute ventilation.
5. A 70-year-old male presents with a new-onset holosystolic murmur at the apex that
radiates to the axilla. Which condition is most likely?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: B
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 1) |
The University of Texas at Arlington
1. A patient presents with a serum sodium of 122 mEq/L, serum osmolality of 260 mOsm/kg,
and a urine sodium of 45 mEq/L. Which of the following is the most likely diagnosis?
A. Diabetes Insipidus
B. Dehydration
C. Psychogenic Polydipsia
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Answer: D
Rationale: SIADH is characterized by hyponatremia and low serum osmolality in the
presence of inappropriately concentrated urine. The high urine sodium level indicates that
the kidneys are still excreting salt despite the low serum levels. This condition often results
from CNS disorders, malignancies, or certain medications that trigger excessive ADH
release.
2. In the management of a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to prevent barotrauma?
A. High Tidal Volume and low PEEP
,B. High Respiratory Rate with low FiO2
C. Inverse Ratio Ventilation with high Tidal Volume
D. Low Tidal Volume and high PEEP
Answer: D
Rationale: Low tidal volume ventilation, typically 6 mL/kg of predicted body weight, is the
standard of care for ARDS to minimize lung injury. High Positive End-Expiratory Pressure
(PEEP) is used to keep alveoli open and improve oxygenation. This lung-protective strategy
has been shown to decrease mortality in acute care settings.
3. Which hemodynamic profile is most consistent with early septic shock?
A. Low SVR, High CO, Low PCWP
B. High SVR, Low CO, High CVP
C. Low SVR, Low CO, High PCWP
D. Normal SVR, Normal CO, High CVP
Answer: A
Rationale: Early or ‘warm’ septic shock is characterized by massive vasodilation, which
results in a significantly decreased Systemic Vascular Resistance (SVR). To compensate for
the low resistance, the heart increases Cardiac Output (CO), resulting in a hyperdynamic
state. Preload markers like Pulmonary Capillary Wedge Pressure (PCWP) are typically low
due to relative hypovolemia and capillary leak.
, 4. A patient on a ventilator has the following ABG results: pH 7.28, PaCO2 55 mmHg, HCO3 26
mEq/L, and PaO2 80 mmHg. What is the interpretation and the most appropriate
intervention?
A. Metabolic Acidosis; increase PEEP
B. Respiratory Acidosis; increase Minute Ventilation
C. Respiratory Alkalosis; decrease Respiratory Rate
D. Metabolic Alkalosis; decrease Tidal Volume
Answer: B
Rationale: The pH is low and the PaCO2 is high, indicating a primary respiratory acidosis.
Since the patient is on a ventilator, the goal is to increase the clearance of carbon dioxide.
This can be achieved by increasing either the tidal volume or the respiratory rate to
enhance minute ventilation.
5. A 70-year-old male presents with a new-onset holosystolic murmur at the apex that
radiates to the axilla. Which condition is most likely?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: B
