NURS 5463 Final Exam V2 | NURS 5463
Adult Gerontology Acute Care Review |
Actual Q&A with Rationale (NURS5463
Final Exam) | The University of Texas at
Arlington
1. A 65-year-old male presents with acute onset substernal chest pain radiating to the left
arm. The EKG shows ST-segment elevation in leads V1-V4. Which coronary artery is most
likely occluded?
A. Right Coronary Artery (RCA)
B. Left Anterior Descending (LAD)
C. Left Circumflex (LCx)
D. Posterior Descending Artery (PDA)
Answer: B
Rationale: ST-segment elevation in leads V1 through V4 indicates an anterior wall
myocardial infarction. The Left Anterior Descending (LAD) artery is the primary vessel
responsible for supplying the anterior wall of the left ventricle. Prompt identification of the
culprit vessel helps in prioritizing reperfusion strategies like percutaneous coronary
intervention.
,2. In the management of ARDS, which ventilatory strategy has been shown to improve
survival outcomes?
A. Low tidal volume ventilation (6 mL/kg)
B. High tidal volume ventilation (10-12 mL/kg)
C. Aggressive fluid resuscitation
D. High FiO2 with low PEEP
Answer: A
Rationale: Low tidal volume ventilation (6 mL/kg of predicted body weight) is the gold
standard for ARDS management as per the ARDSnet protocol. This approach minimizes
ventilator-induced lung injury (VILI) by preventing alveolar overdistension. It is often
combined with permissive hypercapnia to protect the lung parenchyma.
3. A patient in the ICU develops sudden hypotension, tachycardia, and increased peak airway
pressures. On physical exam, there is absent breath sounds on the right side and tracheal
deviation to the left. What is the immediate intervention?
A. Perform needle thoracostomy
B. Obtain a stat portable chest X-ray
C. Increase PEEP on the ventilator
D. Administer a 500mL fluid bolus
Answer: A
, Rationale: The clinical presentation is highly suggestive of a tension pneumothorax, which
is a life-threatening emergency. Tracheal deviation and hemodynamic instability
necessitate immediate decompression rather than waiting for imaging. Needle
thoracostomy followed by chest tube placement is the required sequence of care.
4. When evaluating a patient with Acute Kidney Injury (AKI), which fractional excretion of
sodium (FeNa) result is most suggestive of a pre-renal etiology?
A. FeNa > 2%
B. FeNa < 1%
C. FeNa 1-2%
D. FeNa > 4%
Answer: B
Rationale: A FeNa of less than 1% indicates that the kidneys are still functionally intact but
are appropriately conserving sodium in response to decreased perfusion. This is typical of
pre-renal states like dehydration or heart failure where renal blood flow is reduced. In
contrast, higher FeNa values suggest intrinsic renal damage where the tubules can no
longer reabsorb sodium.
5. Which of the following is the preferred initial vasopressor for the management of septic
shock unresponsive to fluid resuscitation?
A. Dopamine
B. Norepinephrine
Adult Gerontology Acute Care Review |
Actual Q&A with Rationale (NURS5463
Final Exam) | The University of Texas at
Arlington
1. A 65-year-old male presents with acute onset substernal chest pain radiating to the left
arm. The EKG shows ST-segment elevation in leads V1-V4. Which coronary artery is most
likely occluded?
A. Right Coronary Artery (RCA)
B. Left Anterior Descending (LAD)
C. Left Circumflex (LCx)
D. Posterior Descending Artery (PDA)
Answer: B
Rationale: ST-segment elevation in leads V1 through V4 indicates an anterior wall
myocardial infarction. The Left Anterior Descending (LAD) artery is the primary vessel
responsible for supplying the anterior wall of the left ventricle. Prompt identification of the
culprit vessel helps in prioritizing reperfusion strategies like percutaneous coronary
intervention.
,2. In the management of ARDS, which ventilatory strategy has been shown to improve
survival outcomes?
A. Low tidal volume ventilation (6 mL/kg)
B. High tidal volume ventilation (10-12 mL/kg)
C. Aggressive fluid resuscitation
D. High FiO2 with low PEEP
Answer: A
Rationale: Low tidal volume ventilation (6 mL/kg of predicted body weight) is the gold
standard for ARDS management as per the ARDSnet protocol. This approach minimizes
ventilator-induced lung injury (VILI) by preventing alveolar overdistension. It is often
combined with permissive hypercapnia to protect the lung parenchyma.
3. A patient in the ICU develops sudden hypotension, tachycardia, and increased peak airway
pressures. On physical exam, there is absent breath sounds on the right side and tracheal
deviation to the left. What is the immediate intervention?
A. Perform needle thoracostomy
B. Obtain a stat portable chest X-ray
C. Increase PEEP on the ventilator
D. Administer a 500mL fluid bolus
Answer: A
, Rationale: The clinical presentation is highly suggestive of a tension pneumothorax, which
is a life-threatening emergency. Tracheal deviation and hemodynamic instability
necessitate immediate decompression rather than waiting for imaging. Needle
thoracostomy followed by chest tube placement is the required sequence of care.
4. When evaluating a patient with Acute Kidney Injury (AKI), which fractional excretion of
sodium (FeNa) result is most suggestive of a pre-renal etiology?
A. FeNa > 2%
B. FeNa < 1%
C. FeNa 1-2%
D. FeNa > 4%
Answer: B
Rationale: A FeNa of less than 1% indicates that the kidneys are still functionally intact but
are appropriately conserving sodium in response to decreased perfusion. This is typical of
pre-renal states like dehydration or heart failure where renal blood flow is reduced. In
contrast, higher FeNa values suggest intrinsic renal damage where the tubules can no
longer reabsorb sodium.
5. Which of the following is the preferred initial vasopressor for the management of septic
shock unresponsive to fluid resuscitation?
A. Dopamine
B. Norepinephrine
