NURS 5463 Final Exam V3 | NURS 5463
Adult Gerontology Acute Care Review |
Actual Q&A with Rationale (NURS5463
Final Exam) | The University of Texas at
Arlington
1. A 68-year-old male with a history of heart failure presents with worsening dyspnea and
peripheral edema. His hemodynamic monitoring reveals a PCWP of 24 mmHg and a Cardiac
Index of 1.7 L/min/m2. Which classification and initial treatment are most appropriate?
A. Warm and dry; initiate IV fluids
B. Cold and wet; initiate IV inotropes and diuretics
C. Cold and dry; initiate aggressive beta-blocker therapy
D. Warm and wet; initiate high-dose vasopressors
Answer: B
Rationale: The patient’s high PCWP indicates pulmonary congestion (wet) and low Cardiac
Index indicates poor perfusion (cold). Initial management must focus on improving
contractility with inotropes and reducing volume with diuretics. Beta-blockers should be
avoided in the acute decompensation phase until the patient is stable and euvolemic.
,2. An ICU patient on mechanical ventilation for ARDS has the following ABG: pH 7.28, PaCO2
55 mmHg, PaO2 62 mmHg, and HCO3 24 mEq/L. Which ventilator adjustment is the most
appropriate next step?
A. Increase the respiratory rate
B. Increase the tidal volume to 10 mL/kg
C. Decrease the PEEP
D. Decrease the FiO2
Answer: A
Rationale: The ABG shows respiratory acidosis, likely due to hypoventilation or the use of
lung-protective low tidal volume strategy. Increasing the respiratory rate will help clear
CO2 and improve the pH without increasing the risk of barotrauma from high tidal
volumes. In ARDS, the goal is to maintain oxygenation while protecting the lungs from
further injury.
3. A 55-year-old female presents with septic shock. Despite receiving 30 mL/kg of crystalloid,
her MAP is 58 mmHg. What is the first-line vasopressor of choice according to the Surviving
Sepsis Guidelines?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Vasopressin
, Answer: B
Rationale: Norepinephrine is the first-line vasopressor for septic shock as it effectively
increases MAP through alpha-adrenergic stimulation. It has a better safety profile
regarding tachyarrhythmias compared to dopamine. If MAP remains low despite
norepinephrine, vasopressin may be added as a second agent.
4. A patient with AKI has a serum potassium level of 6.8 mEq/L and the ECG shows peaked T-
waves. What is the priority intervention?
A. Administer Sodium Polystyrene Sulfonate (Kayexalate)
B. Initiate emergent hemodialysis
C. Start a continuous Albuterol nebulizer
D. Administer Calcium Gluconate IV
Answer: D
Rationale: Calcium gluconate is the priority to stabilize the cardiac membrane and prevent
life-threatening arrhythmias associated with hyperkalemia. While it does not lower
potassium, it provides immediate protection while other measures (like insulin/glucose or
dialysis) are initiated. Kayexalate is no longer recommended for acute management due to
slow onset and potential bowel necrosis.
5. A patient is admitted with a blood glucose of 850 mg/dL, serum osmolality of 340
mOsm/kg, and absent ketones in the urine. What is the most likely diagnosis?
A. Diabetic Ketoacidosis (DKA)
Adult Gerontology Acute Care Review |
Actual Q&A with Rationale (NURS5463
Final Exam) | The University of Texas at
Arlington
1. A 68-year-old male with a history of heart failure presents with worsening dyspnea and
peripheral edema. His hemodynamic monitoring reveals a PCWP of 24 mmHg and a Cardiac
Index of 1.7 L/min/m2. Which classification and initial treatment are most appropriate?
A. Warm and dry; initiate IV fluids
B. Cold and wet; initiate IV inotropes and diuretics
C. Cold and dry; initiate aggressive beta-blocker therapy
D. Warm and wet; initiate high-dose vasopressors
Answer: B
Rationale: The patient’s high PCWP indicates pulmonary congestion (wet) and low Cardiac
Index indicates poor perfusion (cold). Initial management must focus on improving
contractility with inotropes and reducing volume with diuretics. Beta-blockers should be
avoided in the acute decompensation phase until the patient is stable and euvolemic.
,2. An ICU patient on mechanical ventilation for ARDS has the following ABG: pH 7.28, PaCO2
55 mmHg, PaO2 62 mmHg, and HCO3 24 mEq/L. Which ventilator adjustment is the most
appropriate next step?
A. Increase the respiratory rate
B. Increase the tidal volume to 10 mL/kg
C. Decrease the PEEP
D. Decrease the FiO2
Answer: A
Rationale: The ABG shows respiratory acidosis, likely due to hypoventilation or the use of
lung-protective low tidal volume strategy. Increasing the respiratory rate will help clear
CO2 and improve the pH without increasing the risk of barotrauma from high tidal
volumes. In ARDS, the goal is to maintain oxygenation while protecting the lungs from
further injury.
3. A 55-year-old female presents with septic shock. Despite receiving 30 mL/kg of crystalloid,
her MAP is 58 mmHg. What is the first-line vasopressor of choice according to the Surviving
Sepsis Guidelines?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Vasopressin
, Answer: B
Rationale: Norepinephrine is the first-line vasopressor for septic shock as it effectively
increases MAP through alpha-adrenergic stimulation. It has a better safety profile
regarding tachyarrhythmias compared to dopamine. If MAP remains low despite
norepinephrine, vasopressin may be added as a second agent.
4. A patient with AKI has a serum potassium level of 6.8 mEq/L and the ECG shows peaked T-
waves. What is the priority intervention?
A. Administer Sodium Polystyrene Sulfonate (Kayexalate)
B. Initiate emergent hemodialysis
C. Start a continuous Albuterol nebulizer
D. Administer Calcium Gluconate IV
Answer: D
Rationale: Calcium gluconate is the priority to stabilize the cardiac membrane and prevent
life-threatening arrhythmias associated with hyperkalemia. While it does not lower
potassium, it provides immediate protection while other measures (like insulin/glucose or
dialysis) are initiated. Kayexalate is no longer recommended for acute management due to
slow onset and potential bowel necrosis.
5. A patient is admitted with a blood glucose of 850 mg/dL, serum osmolality of 340
mOsm/kg, and absent ketones in the urine. What is the most likely diagnosis?
A. Diabetic Ketoacidosis (DKA)
