NURS 5463 Exam 2 V3 | NURS 5463 Adult
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 2) |
The University of Texas at Arlington
1. A 65-year-old patient presents with acute chest pain and ST-elevation in leads II, III, and
aVF. Which coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Circumflex Artery
D. Left Main Coronary Artery
Answer: B
Rationale: ST-elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction. The Right Coronary Artery (RCA) supplies the inferior portion of the heart in
approximately 85% of individuals. Prompt identification is crucial as these patients are
often preload dependent and may require fluid resuscitation rather than nitrates.
2. When managing a patient with Septic Shock, which hemodynamic parameter is the primary
indicator of adequate tissue perfusion following fluid resuscitation?
A. Mean Arterial Pressure (MAP) > 65 mmHg
B. Central Venous Pressure (CVP) of 8-12 mmHg
,C. Heart Rate < 100 bpm
D. Serum Lactate normalization
Answer: D
Rationale: While MAP and CVP are important monitoring parameters, serum lactate is a
biochemical marker of anaerobic metabolism and tissue hypoxia. Normalization of lactate
levels indicates successful restoration of cellular perfusion and oxygen delivery. The
Surviving Sepsis Campaign guidelines emphasize lactate clearance as a key resuscitation
target.
3. A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is being transitioned
from Lisinopril to Sacubitril/Valsartan (Entresto). What is the mandatory washout period?
A. 36 hours
B. 24 hours
C. 12 hours
D. 48 hours
Answer: A
Rationale: A 36-hour washout period is required when switching from an ACE inhibitor to
an ARNI to minimize the risk of angioedema. This is because both ACE inhibitors and
neprilysin inhibitors (sacubitril) increase levels of bradykinin. Failure to observe this
period can lead to life-threatening airway compromise due to cumulative bradykinin
effects.
, 4. Which of the following is the most specific EKG finding for a patient with Hyperkalemia?
A. U waves
B. Prolonged QT interval
C. ST segment depression
D. Peaked T waves
Answer: D
Rationale: Peaked, narrow, and symmetrical T waves are the earliest EKG manifestation of
hyperkalemia. As potassium levels continue to rise, the PR interval prolongs, the P wave
disappears, and the QRS complex widens, potentially leading to a sine-wave pattern.
Treatment must be initiated immediately to stabilize the cardiac membrane with calcium
gluconate if EKG changes are present.
5. A 70-year-old male with a history of COPD presents with increased dyspnea and productive
cough. His ABG shows pH 7.32, PaCO2 58, PaO2 62. This is categorized as:
A. Respiratory Alkalosis, uncompensated
B. Respiratory Acidosis, partially compensated
C. Metabolic Acidosis, compensated
D. Metabolic Alkalosis, uncompensated
Answer: B
Gerontology Acute Care Review | Actual
Q&A with Rationale (NURS5463 Exam 2) |
The University of Texas at Arlington
1. A 65-year-old patient presents with acute chest pain and ST-elevation in leads II, III, and
aVF. Which coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Circumflex Artery
D. Left Main Coronary Artery
Answer: B
Rationale: ST-elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction. The Right Coronary Artery (RCA) supplies the inferior portion of the heart in
approximately 85% of individuals. Prompt identification is crucial as these patients are
often preload dependent and may require fluid resuscitation rather than nitrates.
2. When managing a patient with Septic Shock, which hemodynamic parameter is the primary
indicator of adequate tissue perfusion following fluid resuscitation?
A. Mean Arterial Pressure (MAP) > 65 mmHg
B. Central Venous Pressure (CVP) of 8-12 mmHg
,C. Heart Rate < 100 bpm
D. Serum Lactate normalization
Answer: D
Rationale: While MAP and CVP are important monitoring parameters, serum lactate is a
biochemical marker of anaerobic metabolism and tissue hypoxia. Normalization of lactate
levels indicates successful restoration of cellular perfusion and oxygen delivery. The
Surviving Sepsis Campaign guidelines emphasize lactate clearance as a key resuscitation
target.
3. A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is being transitioned
from Lisinopril to Sacubitril/Valsartan (Entresto). What is the mandatory washout period?
A. 36 hours
B. 24 hours
C. 12 hours
D. 48 hours
Answer: A
Rationale: A 36-hour washout period is required when switching from an ACE inhibitor to
an ARNI to minimize the risk of angioedema. This is because both ACE inhibitors and
neprilysin inhibitors (sacubitril) increase levels of bradykinin. Failure to observe this
period can lead to life-threatening airway compromise due to cumulative bradykinin
effects.
, 4. Which of the following is the most specific EKG finding for a patient with Hyperkalemia?
A. U waves
B. Prolonged QT interval
C. ST segment depression
D. Peaked T waves
Answer: D
Rationale: Peaked, narrow, and symmetrical T waves are the earliest EKG manifestation of
hyperkalemia. As potassium levels continue to rise, the PR interval prolongs, the P wave
disappears, and the QRS complex widens, potentially leading to a sine-wave pattern.
Treatment must be initiated immediately to stabilize the cardiac membrane with calcium
gluconate if EKG changes are present.
5. A 70-year-old male with a history of COPD presents with increased dyspnea and productive
cough. His ABG shows pH 7.32, PaCO2 58, PaO2 62. This is categorized as:
A. Respiratory Alkalosis, uncompensated
B. Respiratory Acidosis, partially compensated
C. Metabolic Acidosis, compensated
D. Metabolic Alkalosis, uncompensated
Answer: B
