NURS 5463 Exam 2 V1 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 2) |
The University of Texas at Arlington
1. A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents with increased dyspnea and peripheral edema. Which medication class is considered
the cornerstone for reducing mortality and hospitalizations in this patient population?
A. Loop Diuretics
B. Calcium Channel Blockers
C. Digoxin
D. Angiotensin Receptor-Neprilysin Inhibitors (ARNI)
Answer: D
Rationale: ARNIs like sacubitril/valsartan have been shown to significantly reduce
mortality compared to ACE inhibitors in patients with HFrEF. Loop diuretics are essential
for symptom management and volume control but do not primarily improve long-term
survival. Guidelines now recommend ARNI as a first-line therapy for patients who can
tolerate the medication.
2. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS).
According to the Berlin definition, which PaO2/FiO2 ratio is indicative of ‘Moderate’ ARDS?
A. > 300 mmHg
,B. 201 - 300 mmHg
C. ≤ 100 mmHg
D. 101 - 200 mmHg
Answer: D
Rationale: Moderate ARDS is defined by a PaO2/FiO2 ratio between 101 and 200 mmHg
with a PEEP of at least 5 cmH2O. Mild ARDS falls between 201 and 300 mmHg, while severe
ARDS is defined as a ratio of 100 mmHg or less. Accurate classification is critical for
determining appropriate ventilatory strategies and the need for prone positioning.
3. An AGACNP is managing a patient with hypertensive emergency characterized by an acute
aortic dissection. What is the primary goal for systolic blood pressure and heart rate within
the first hour?
A. SBP < 140 mmHg and HR < 80 bpm
B. SBP < 120 mmHg and HR < 60 bpm
C. Reduce MAP by 25% from baseline
D. SBP 140-150 mmHg and HR 70-90 bpm
Answer: B
Rationale: In cases of acute aortic dissection, rapid lowering of SBP to less than 120 mmHg
and HR to less than 60 bpm is required to reduce shear stress on the aortic wall. Esmolol is
often used as a first-line agent because of its short half-life and ability to control both heart
, rate and blood pressure. This aggressive management differs from other hypertensive
emergencies where the goal is a more gradual reduction of MAP.
4. A 55-year-old female presents with community-acquired pneumonia (CAP). Her CURB-65
score is 3. Based on this score, what is the most appropriate setting for her care?
A. Outpatient management
B. Inpatient medical-surgical floor
C. Observation unit for 24 hours
D. Intensive Care Unit (ICU) assessment
Answer: D
Rationale: A CURB-65 score of 3 or higher indicates a high risk of mortality and typically
warrants inpatient admission, often requiring ICU-level care depending on clinical stability.
The score evaluates Confusion, Urea, Respiratory rate, Blood pressure, and Age over 65.
Identifying high-risk patients early allows for the rapid initiation of intensive antibiotic
therapy and monitoring.
5. Which of the following EKG findings is most suggestive of an acute posterior wall
myocardial infarction?
A. ST-depression and tall R waves in leads V1 and V2
B. ST-elevation in leads V1 to V4
C. Pathologic Q waves in leads II, III, and aVF
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 2) |
The University of Texas at Arlington
1. A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents with increased dyspnea and peripheral edema. Which medication class is considered
the cornerstone for reducing mortality and hospitalizations in this patient population?
A. Loop Diuretics
B. Calcium Channel Blockers
C. Digoxin
D. Angiotensin Receptor-Neprilysin Inhibitors (ARNI)
Answer: D
Rationale: ARNIs like sacubitril/valsartan have been shown to significantly reduce
mortality compared to ACE inhibitors in patients with HFrEF. Loop diuretics are essential
for symptom management and volume control but do not primarily improve long-term
survival. Guidelines now recommend ARNI as a first-line therapy for patients who can
tolerate the medication.
2. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS).
According to the Berlin definition, which PaO2/FiO2 ratio is indicative of ‘Moderate’ ARDS?
A. > 300 mmHg
,B. 201 - 300 mmHg
C. ≤ 100 mmHg
D. 101 - 200 mmHg
Answer: D
Rationale: Moderate ARDS is defined by a PaO2/FiO2 ratio between 101 and 200 mmHg
with a PEEP of at least 5 cmH2O. Mild ARDS falls between 201 and 300 mmHg, while severe
ARDS is defined as a ratio of 100 mmHg or less. Accurate classification is critical for
determining appropriate ventilatory strategies and the need for prone positioning.
3. An AGACNP is managing a patient with hypertensive emergency characterized by an acute
aortic dissection. What is the primary goal for systolic blood pressure and heart rate within
the first hour?
A. SBP < 140 mmHg and HR < 80 bpm
B. SBP < 120 mmHg and HR < 60 bpm
C. Reduce MAP by 25% from baseline
D. SBP 140-150 mmHg and HR 70-90 bpm
Answer: B
Rationale: In cases of acute aortic dissection, rapid lowering of SBP to less than 120 mmHg
and HR to less than 60 bpm is required to reduce shear stress on the aortic wall. Esmolol is
often used as a first-line agent because of its short half-life and ability to control both heart
, rate and blood pressure. This aggressive management differs from other hypertensive
emergencies where the goal is a more gradual reduction of MAP.
4. A 55-year-old female presents with community-acquired pneumonia (CAP). Her CURB-65
score is 3. Based on this score, what is the most appropriate setting for her care?
A. Outpatient management
B. Inpatient medical-surgical floor
C. Observation unit for 24 hours
D. Intensive Care Unit (ICU) assessment
Answer: D
Rationale: A CURB-65 score of 3 or higher indicates a high risk of mortality and typically
warrants inpatient admission, often requiring ICU-level care depending on clinical stability.
The score evaluates Confusion, Urea, Respiratory rate, Blood pressure, and Age over 65.
Identifying high-risk patients early allows for the rapid initiation of intensive antibiotic
therapy and monitoring.
5. Which of the following EKG findings is most suggestive of an acute posterior wall
myocardial infarction?
A. ST-depression and tall R waves in leads V1 and V2
B. ST-elevation in leads V1 to V4
C. Pathologic Q waves in leads II, III, and aVF
