3270 Nursing Care of Adults &
Older Adults II
Final Exam Review
(Questions & Solutions)
2025
1
, 1. Multiple Choice
Question:
A 78-year-old female with a history of congestive heart failure (CHF),
chronic kidney disease, and diabetes presents to the emergency
department in acute decompensated heart failure complicated by sepsis.
Which immediate nursing intervention is most critical in stabilizing this
complex, acutely ill older adult?
- A. Initiate intravenous fluid bolus
- B. Administer broad-spectrum antibiotics after obtaining cultures
- C. Increase the rate of diuretic infusion
- D. Prepare for emergent dialysis
Correct ANS:
B. Administer broad-spectrum antibiotics after obtaining cultures
Rationale:
In an older adult with sepsis superimposed on complex chronic
conditions, rapid identification and treatment of the infection are critical.
Obtaining cultures and initiating broad-spectrum antibiotics help
interrupt the septic process while other supportive measures, including
careful fluid management and diuretic therapy, are later adjusted based
on hemodynamic status.
---
2. Fill-in-the-Blank
Question:
In managing acutely ill patients with complex cardiac and renal
comorbidities, monitoring __________ is essential for guiding fluid
management and preventing volume overload.
Correct ANS:
central venous pressure (CVP)
2
, Rationale:
CVP measurement helps assess intravascular volume status and right
ventricular function. In patients with heart failure and renal impairment,
a careful balance is required to avoid exacerbating fluid overload while
ensuring adequate perfusion.
---
3. True/False
Question:
True or False: In the acute care of older adults with multiorgan
dysfunction, early goal-directed therapy (EGDT) is used only in the first
hour of resuscitation and has minimal impact on long-term outcomes.
Correct ANS:
False
Rationale:
EGDT is designed to optimize hemodynamic parameters early in sepsis
and related shock states. Although its strict protocols have evolved, early
hemodynamic optimization can reduce organ failure and improve both
short- and long-term outcomes in acutely ill patients.
---
4. Multiple Response
Question:
When assessing an acutely ill older patient with complex comorbidities,
which of the following clinical indicators should be evaluated? (Select all
that apply)
- A. Mental status changes
- B. Vital signs and hemodynamic parameters
- C. Laboratory markers such as lactate and creatinine
- D. Pain intensity using age-appropriate scales
- E. Family history of chronic disease
3
, Correct ANSs:
A, B, C, D
Rationale:
A comprehensive assessment of an acutely ill older adult must include
mental status evaluation, vital signs (including blood pressure, heart rate,
respiratory rate), key laboratory markers for tissue perfusion and renal
function, and pain assessment. While family history is valuable in a
broader context, it is less acutely relevant than the other parameters for
emergent management.
---
5. Multiple Choice
Question:
A 82-year-old male with a history of chronic obstructive pulmonary
disease (COPD) and heart failure is admitted with severe pneumonia
requiring ventilatory support. Which ventilation strategy is most
appropriate to minimize lung injury in this population?
- A. High tidal volume ventilation
- B. Low tidal volume ventilation with appropriate positive end-expiratory
pressure (PEEP)
- C. Pressure-controlled ventilation with minimal sedation
- D. Rapid weaning to spontaneous breathing trials
Correct ANS:
B. Low tidal volume ventilation with appropriate positive end-expiratory
pressure (PEEP)
Rationale:
Low tidal volume ventilation (typically 6 mL/kg of predicted body weight)
with optimal PEEP minimizes ventilator-induced lung injury, especially in
patients with underlying chronic lung disease and cardiac dysfunction.
This approach is evidence-based and improves outcomes.
4
Older Adults II
Final Exam Review
(Questions & Solutions)
2025
1
, 1. Multiple Choice
Question:
A 78-year-old female with a history of congestive heart failure (CHF),
chronic kidney disease, and diabetes presents to the emergency
department in acute decompensated heart failure complicated by sepsis.
Which immediate nursing intervention is most critical in stabilizing this
complex, acutely ill older adult?
- A. Initiate intravenous fluid bolus
- B. Administer broad-spectrum antibiotics after obtaining cultures
- C. Increase the rate of diuretic infusion
- D. Prepare for emergent dialysis
Correct ANS:
B. Administer broad-spectrum antibiotics after obtaining cultures
Rationale:
In an older adult with sepsis superimposed on complex chronic
conditions, rapid identification and treatment of the infection are critical.
Obtaining cultures and initiating broad-spectrum antibiotics help
interrupt the septic process while other supportive measures, including
careful fluid management and diuretic therapy, are later adjusted based
on hemodynamic status.
---
2. Fill-in-the-Blank
Question:
In managing acutely ill patients with complex cardiac and renal
comorbidities, monitoring __________ is essential for guiding fluid
management and preventing volume overload.
Correct ANS:
central venous pressure (CVP)
2
, Rationale:
CVP measurement helps assess intravascular volume status and right
ventricular function. In patients with heart failure and renal impairment,
a careful balance is required to avoid exacerbating fluid overload while
ensuring adequate perfusion.
---
3. True/False
Question:
True or False: In the acute care of older adults with multiorgan
dysfunction, early goal-directed therapy (EGDT) is used only in the first
hour of resuscitation and has minimal impact on long-term outcomes.
Correct ANS:
False
Rationale:
EGDT is designed to optimize hemodynamic parameters early in sepsis
and related shock states. Although its strict protocols have evolved, early
hemodynamic optimization can reduce organ failure and improve both
short- and long-term outcomes in acutely ill patients.
---
4. Multiple Response
Question:
When assessing an acutely ill older patient with complex comorbidities,
which of the following clinical indicators should be evaluated? (Select all
that apply)
- A. Mental status changes
- B. Vital signs and hemodynamic parameters
- C. Laboratory markers such as lactate and creatinine
- D. Pain intensity using age-appropriate scales
- E. Family history of chronic disease
3
, Correct ANSs:
A, B, C, D
Rationale:
A comprehensive assessment of an acutely ill older adult must include
mental status evaluation, vital signs (including blood pressure, heart rate,
respiratory rate), key laboratory markers for tissue perfusion and renal
function, and pain assessment. While family history is valuable in a
broader context, it is less acutely relevant than the other parameters for
emergent management.
---
5. Multiple Choice
Question:
A 82-year-old male with a history of chronic obstructive pulmonary
disease (COPD) and heart failure is admitted with severe pneumonia
requiring ventilatory support. Which ventilation strategy is most
appropriate to minimize lung injury in this population?
- A. High tidal volume ventilation
- B. Low tidal volume ventilation with appropriate positive end-expiratory
pressure (PEEP)
- C. Pressure-controlled ventilation with minimal sedation
- D. Rapid weaning to spontaneous breathing trials
Correct ANS:
B. Low tidal volume ventilation with appropriate positive end-expiratory
pressure (PEEP)
Rationale:
Low tidal volume ventilation (typically 6 mL/kg of predicted body weight)
with optimal PEEP minimizes ventilator-induced lung injury, especially in
patients with underlying chronic lung disease and cardiac dysfunction.
This approach is evidence-based and improves outcomes.
4
