,Maryville NURS 620 Exam 3 | Adult-Gerontology
Health Care I (2026) Q&A
1. A 74-year-old female with a history of heart failure presents with two weeks of
progressive dyspnea, orthopnea, and bilateral lower extremity edema. Which of
the following is the most likely underlying cause?
A) Acute exacerbation of COPD
B) Decompensated heart failure
C) Community-acquired pneumonia
D) Pulmonary embolism
Correct Answer: Decompensated heart failure
Rationale: Progressive dyspnea, orthopnea, and bilateral lower extremity edema
in a patient with known heart failure strongly suggest decompensation. COPD
exacerbation typically presents with wheezing and productive cough. Pneumonia
presents with fever and focal lung findings. Pulmonary embolism typically
presents with sudden onset dyspnea and pleuritic chest pain.
2. The nurse practitioner is evaluating a 68-year-old male with a new diagnosis of
atrial fibrillation. His CHA2DS2-VASc score is 4. What is the most appropriate
anticoagulation strategy?
A) Aspirin 81 mg daily
B) Warfarin with INR goal 2.0–3.0
C) No anticoagulation needed
D) Clopidogrel 75 mg daily
,Correct Answer: Warfarin with INR goal 2.0–3.0
Rationale: A CHA2DS2-VASc score of 2 or higher in males warrants
anticoagulation. Warfarin with an INR goal of 2.0–3.0 is appropriate. Aspirin and
clopidogrel are antiplatelet agents, not anticoagulants, and are insufficient for
stroke prevention in high-risk atrial fibrillation. No anticoagulation would leave
the patient at high stroke risk.
3. What is the most common cause of megaloblastic anemia in older adults?
A) Iron deficiency
B) Vitamin B12 deficiency
C) Folate deficiency
D) Chronic kidney disease
Correct Answer: Vitamin B12 deficiency
Rationale: Vitamin B12 deficiency is the most common cause of megaloblastic
anemia in older adults, often due to pernicious anemia or malabsorption. Iron
deficiency causes microcytic anemia. Folate deficiency can cause megaloblastic
anemia but is less common than B12 deficiency in this population. Chronic kidney
disease causes normocytic anemia.
4. A 70-year-old patient on warfarin for atrial fibrillation has an INR of 6.2 and no
active bleeding. Which intervention is most appropriate?
A) Administer vitamin K 10 mg IV
B) Hold warfarin and recheck INR in 24 hours
C) Administer fresh frozen plasma
D) Continue warfarin at the same dose
, Correct Answer: Hold warfarin and recheck INR in 24 hours
Rationale: An INR of 6.2 without bleeding is above therapeutic range but does
not require immediate reversal. The appropriate action is to hold warfarin and
recheck the INR. Vitamin K and fresh frozen plasma are reserved for active
bleeding or INR above 10. Continuing the same dose would worsen the
coagulopathy.
5. According to the American College of Cardiology guidelines, which medication
class is first-line for chronic stable angina in patients without contraindications?
A) Beta-blockers
B) Calcium channel blockers
C) Ranolazine
D) Nitrates
Correct Answer: Beta-blockers
Rationale: Beta-blockers are first-line for chronic stable angina because they
reduce heart rate, contractility, and myocardial oxygen demand. Calcium channel
blockers are alternatives or add-on therapy. Ranolazine is used for refractory
angina. Nitrates are used for acute symptom relief and prophylaxis but are not
first-line chronic therapy.
6. A 62-year-old female presents with fatigue, cold intolerance, weight gain, and
constipation. Her TSH is elevated and free T4 is low. Which condition is most
likely?
A) Hyperthyroidism
Health Care I (2026) Q&A
1. A 74-year-old female with a history of heart failure presents with two weeks of
progressive dyspnea, orthopnea, and bilateral lower extremity edema. Which of
the following is the most likely underlying cause?
A) Acute exacerbation of COPD
B) Decompensated heart failure
C) Community-acquired pneumonia
D) Pulmonary embolism
Correct Answer: Decompensated heart failure
Rationale: Progressive dyspnea, orthopnea, and bilateral lower extremity edema
in a patient with known heart failure strongly suggest decompensation. COPD
exacerbation typically presents with wheezing and productive cough. Pneumonia
presents with fever and focal lung findings. Pulmonary embolism typically
presents with sudden onset dyspnea and pleuritic chest pain.
2. The nurse practitioner is evaluating a 68-year-old male with a new diagnosis of
atrial fibrillation. His CHA2DS2-VASc score is 4. What is the most appropriate
anticoagulation strategy?
A) Aspirin 81 mg daily
B) Warfarin with INR goal 2.0–3.0
C) No anticoagulation needed
D) Clopidogrel 75 mg daily
,Correct Answer: Warfarin with INR goal 2.0–3.0
Rationale: A CHA2DS2-VASc score of 2 or higher in males warrants
anticoagulation. Warfarin with an INR goal of 2.0–3.0 is appropriate. Aspirin and
clopidogrel are antiplatelet agents, not anticoagulants, and are insufficient for
stroke prevention in high-risk atrial fibrillation. No anticoagulation would leave
the patient at high stroke risk.
3. What is the most common cause of megaloblastic anemia in older adults?
A) Iron deficiency
B) Vitamin B12 deficiency
C) Folate deficiency
D) Chronic kidney disease
Correct Answer: Vitamin B12 deficiency
Rationale: Vitamin B12 deficiency is the most common cause of megaloblastic
anemia in older adults, often due to pernicious anemia or malabsorption. Iron
deficiency causes microcytic anemia. Folate deficiency can cause megaloblastic
anemia but is less common than B12 deficiency in this population. Chronic kidney
disease causes normocytic anemia.
4. A 70-year-old patient on warfarin for atrial fibrillation has an INR of 6.2 and no
active bleeding. Which intervention is most appropriate?
A) Administer vitamin K 10 mg IV
B) Hold warfarin and recheck INR in 24 hours
C) Administer fresh frozen plasma
D) Continue warfarin at the same dose
, Correct Answer: Hold warfarin and recheck INR in 24 hours
Rationale: An INR of 6.2 without bleeding is above therapeutic range but does
not require immediate reversal. The appropriate action is to hold warfarin and
recheck the INR. Vitamin K and fresh frozen plasma are reserved for active
bleeding or INR above 10. Continuing the same dose would worsen the
coagulopathy.
5. According to the American College of Cardiology guidelines, which medication
class is first-line for chronic stable angina in patients without contraindications?
A) Beta-blockers
B) Calcium channel blockers
C) Ranolazine
D) Nitrates
Correct Answer: Beta-blockers
Rationale: Beta-blockers are first-line for chronic stable angina because they
reduce heart rate, contractility, and myocardial oxygen demand. Calcium channel
blockers are alternatives or add-on therapy. Ranolazine is used for refractory
angina. Nitrates are used for acute symptom relief and prophylaxis but are not
first-line chronic therapy.
6. A 62-year-old female presents with fatigue, cold intolerance, weight gain, and
constipation. Her TSH is elevated and free T4 is low. Which condition is most
likely?
A) Hyperthyroidism
