NR 574 PRIMARY CARE OF OLDER ADULTS FINAL EXAM
CHAMBERLAIN UNIVERSITY QUESTIONS AND CORRECT
VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 68-year-old man is admitted with an acute anterior ST-elevation myocardial
infarction. Despite successful PCI, he becomes hypotensive with cool extremities,
altered mentation, oliguria, and pulmonary crackles. His blood pressure is 78/46
mmHg, heart rate is 118/min, CVP is elevated, and cardiac output is decreased.
What is the most likely cause of his deterioration?
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Neurogenic shock
Answer: C. Cardiogenic shock
Rationale: Cardiogenic shock results from severe ventricular pump failure after
extensive myocardial infarction. Clinical findings include hypotension, decreased
cardiac output, elevated filling pressures, pulmonary congestion, cool clammy
skin, and end-organ hypoperfusion. Hypovolemic shock presents with low filling
pressures, septic shock initially causes warm extremities, and neurogenic shock
usually produces bradycardia with warm, dry skin.
,Question 2
A 76-year-old woman is brought to the emergency department because her
daughter noticed sudden confusion that developed over several hours. She recently
started oxybutynin for urinary urgency. Physical examination reveals fluctuating
attention and disorganized thinking.
Which assessment tool is most appropriate to confirm the suspected diagnosis?
A. Mini-Cog
B. Montreal Cognitive Assessment (MoCA)
C. Geriatric Depression Scale
D. Confusion Assessment Method (CAM)
Answer: D. Confusion Assessment Method (CAM)
Rationale: CAM is the preferred bedside tool for diagnosing delirium. Delirium
develops acutely, fluctuates throughout the day, and is characterized by inattention
and altered consciousness. Mini-Cog and MoCA assess chronic cognitive
impairment, while the Geriatric Depression Scale evaluates depression.
Question 3
A trauma patient suddenly develops severe respiratory distress after insertion of a
central venous catheter. Assessment reveals absent breath sounds over the right
lung, distended neck veins, hypotension, and tracheal deviation toward the left.
What is the immediate priority intervention?
A. Obtain a stat chest radiograph
B. Administer IV furosemide
C. Perform emergent needle decompression
D. Increase intravenous fluids
Answer: C. Perform emergent needle decompression
,Rationale: The patient demonstrates classic findings of tension pneumothorax, an
immediately life-threatening emergency. Needle decompression should not be
delayed for imaging because obstructive shock rapidly progresses to cardiovascular
collapse.
Question 4
An 83-year-old man with atrial fibrillation reports dizziness when standing. His
blood pressure is 142/78 mmHg while sitting and 116/68 mmHg after standing for
3 minutes.
Which interpretation is most accurate?
A. Normal physiologic aging
B. Orthostatic hypotension
C. Hypertensive urgency
D. Vasovagal syncope
Answer: B. Orthostatic hypotension
Rationale: Orthostatic hypotension is defined as a decrease of at least 20 mmHg
systolic or 10 mmHg diastolic within 3 minutes of standing. Older adults should be
routinely screened because orthostatic hypotension significantly increases fall risk.
Question 5
A mechanically ventilated patient with ARDS has worsening hypoxemia despite
receiving 100% oxygen.
Which ventilator adjustment most effectively improves alveolar recruitment?
A. Lower respiratory rate
B. Increase positive end-expiratory pressure (PEEP)
C. Decrease tidal volume below protective settings
D. Reduce inspiratory time
Answer: B. Increase positive end-expiratory pressure (PEEP)
, Rationale: PEEP maintains alveolar patency, recruits collapsed alveoli, and
improves oxygenation in ARDS. Lung-protective ventilation with low tidal
volumes and adequate PEEP remains the standard approach.
Question 6
An 80-year-old woman with osteoarthritis asks which over-the-counter medication
should generally be avoided because of increased risk for confusion, urinary
retention, and falls according to the Beers Criteria.
A. Acetaminophen
B. Diphenhydramine
C. Calcium carbonate
D. Vitamin D
Answer: B. Diphenhydramine
Rationale: First-generation antihistamines have potent anticholinergic properties
that significantly increase delirium, urinary retention, constipation, and fall risk in
older adults.
Question 7
A patient receiving norepinephrine develops persistent hypotension despite
escalating doses. Laboratory studies reveal severe metabolic acidosis.
Which condition most likely reduces the effectiveness of vasopressors?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Severe metabolic acidosis
D. Mild hypernatremia
Answer: C. Severe metabolic acidosis
Rationale: Severe acidosis reduces vascular responsiveness to catecholamines,
making vasopressors less effective. Correcting the underlying cause of acidosis
improves responsiveness.
CHAMBERLAIN UNIVERSITY QUESTIONS AND CORRECT
VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 68-year-old man is admitted with an acute anterior ST-elevation myocardial
infarction. Despite successful PCI, he becomes hypotensive with cool extremities,
altered mentation, oliguria, and pulmonary crackles. His blood pressure is 78/46
mmHg, heart rate is 118/min, CVP is elevated, and cardiac output is decreased.
What is the most likely cause of his deterioration?
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Neurogenic shock
Answer: C. Cardiogenic shock
Rationale: Cardiogenic shock results from severe ventricular pump failure after
extensive myocardial infarction. Clinical findings include hypotension, decreased
cardiac output, elevated filling pressures, pulmonary congestion, cool clammy
skin, and end-organ hypoperfusion. Hypovolemic shock presents with low filling
pressures, septic shock initially causes warm extremities, and neurogenic shock
usually produces bradycardia with warm, dry skin.
,Question 2
A 76-year-old woman is brought to the emergency department because her
daughter noticed sudden confusion that developed over several hours. She recently
started oxybutynin for urinary urgency. Physical examination reveals fluctuating
attention and disorganized thinking.
Which assessment tool is most appropriate to confirm the suspected diagnosis?
A. Mini-Cog
B. Montreal Cognitive Assessment (MoCA)
C. Geriatric Depression Scale
D. Confusion Assessment Method (CAM)
Answer: D. Confusion Assessment Method (CAM)
Rationale: CAM is the preferred bedside tool for diagnosing delirium. Delirium
develops acutely, fluctuates throughout the day, and is characterized by inattention
and altered consciousness. Mini-Cog and MoCA assess chronic cognitive
impairment, while the Geriatric Depression Scale evaluates depression.
Question 3
A trauma patient suddenly develops severe respiratory distress after insertion of a
central venous catheter. Assessment reveals absent breath sounds over the right
lung, distended neck veins, hypotension, and tracheal deviation toward the left.
What is the immediate priority intervention?
A. Obtain a stat chest radiograph
B. Administer IV furosemide
C. Perform emergent needle decompression
D. Increase intravenous fluids
Answer: C. Perform emergent needle decompression
,Rationale: The patient demonstrates classic findings of tension pneumothorax, an
immediately life-threatening emergency. Needle decompression should not be
delayed for imaging because obstructive shock rapidly progresses to cardiovascular
collapse.
Question 4
An 83-year-old man with atrial fibrillation reports dizziness when standing. His
blood pressure is 142/78 mmHg while sitting and 116/68 mmHg after standing for
3 minutes.
Which interpretation is most accurate?
A. Normal physiologic aging
B. Orthostatic hypotension
C. Hypertensive urgency
D. Vasovagal syncope
Answer: B. Orthostatic hypotension
Rationale: Orthostatic hypotension is defined as a decrease of at least 20 mmHg
systolic or 10 mmHg diastolic within 3 minutes of standing. Older adults should be
routinely screened because orthostatic hypotension significantly increases fall risk.
Question 5
A mechanically ventilated patient with ARDS has worsening hypoxemia despite
receiving 100% oxygen.
Which ventilator adjustment most effectively improves alveolar recruitment?
A. Lower respiratory rate
B. Increase positive end-expiratory pressure (PEEP)
C. Decrease tidal volume below protective settings
D. Reduce inspiratory time
Answer: B. Increase positive end-expiratory pressure (PEEP)
, Rationale: PEEP maintains alveolar patency, recruits collapsed alveoli, and
improves oxygenation in ARDS. Lung-protective ventilation with low tidal
volumes and adequate PEEP remains the standard approach.
Question 6
An 80-year-old woman with osteoarthritis asks which over-the-counter medication
should generally be avoided because of increased risk for confusion, urinary
retention, and falls according to the Beers Criteria.
A. Acetaminophen
B. Diphenhydramine
C. Calcium carbonate
D. Vitamin D
Answer: B. Diphenhydramine
Rationale: First-generation antihistamines have potent anticholinergic properties
that significantly increase delirium, urinary retention, constipation, and fall risk in
older adults.
Question 7
A patient receiving norepinephrine develops persistent hypotension despite
escalating doses. Laboratory studies reveal severe metabolic acidosis.
Which condition most likely reduces the effectiveness of vasopressors?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Severe metabolic acidosis
D. Mild hypernatremia
Answer: C. Severe metabolic acidosis
Rationale: Severe acidosis reduces vascular responsiveness to catecholamines,
making vasopressors less effective. Correcting the underlying cause of acidosis
improves responsiveness.
