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NURS 5463 / NURS5463 Exam 4: Adult Gerontology Acute
Care | Questions & Answers (Latest Update 2025 / 2026)
Grade A | 100% Correct – UTA//.
Question:
A 63-year-old man has a 4-minute period of documented expressive aphasia that completely resolved. A workup reveals 70% left internal carotid stenosis and a 50% right internal carotid stenosis. In addition to best medical management, which of the following is the most appropriate treatment?
Answer:
A. Left CEA
Question:
An 84-year-old woman has diabetes and congestive heart failure that is refractory to medical treatment. A right carotid bruit is detected on physical examination. A duplex study suggests a 50% to 75% right carotid stenosis. Which of the following is the most appropriate treatment?
Answer:
A. Medical management
Question:
Which of the following statements regarding carotid artery stenting is most accurate?
Answer:
A. CREST study suggests that older patients have increased combined stroke and death rates in comparison to younger patients
Question:
Which of the following does NOT need to be instituted for a patient following carotid endarterectomy?
Answer:
A. Coumadin to target an INR of 2 to 3
Question:
For which of the following patients is a left carotid endarterectomy most indicated?
Answer:
A. A 70-year-old man with transient loss of vision in the left eye that recovered after 20 minutes, and he has 75% left carotid stenosis
Question:
A 73-year-old woman is evaluated in the ED and transferred to the ICU because of chest pain of 4 hours' duration. Her medical history includes a 20-year history of hypertension and Type II diabetes mellitus. Her medications include metformin, atenolol, and ASA. On physical examination, her blood pressure is 130/84 mm Hg, and her heart rate is 87 beats/min and regular. Her jugular vein is distended to 5 cm while the patient is upright. She has a faint left carotid bruit and bibasilar crackles to one quarter up from the lung bases. A normal S1 and S2 is heard, with a grade II/VI holosystolic murmur heard best at the apex to the axilla. An electrocardiogram from six months ago was normal. The ECG was seen during the chest pain. The initial serum troponin measurement is elevated. She is now admitted to the ICU for an MI. She is free of chest pain while on IV nitroglycerin, and her vital signs are stable. Which of the fol
Answer:
A. Left bundle branch block with normal sinus rhythm
Answer:
C Administer thrombolytics, then transfer to PCI center.
Question:
Which of the following is NOT an accurate description of hypothermia therapy for post-cardiac arrest patients?
Answer:
B Therapeutic hypothermia has a proven effect in reducing the rate of recurrent ventricular fibrillation
Question:
A 64-year-old man who was being treated in the hospital for acute cholecystitis is found to be unresponsive. He was noted to be in VF and underwent chest compressions for several minutes in addition to cardioversion. The patient has return of spontaneous rhythm and vital signs. Which of the following is an important treatment for this patient?
Answer:
A Percutaneous coronary angiography
Question:
Which of the following statements regarding out-of-hospital sudden cardiac arrest (SCA) is true?
Answer:
E Therapeutic hypothermia improves neurological outcome after SCA in patients with depressed mental status after resuscitation.
Question:
What type of MI is this
Answer:
II, III, AvF C. Inferior
Question:
A 59-year-old man complains of severe chest pain that radiates to his back. His brachial pulses appear unequal between his right and left arms. He appears hemodynamically stable. On chest radiography, he has a widened mediastinum. Which of the following is the best next step?
Answer:
B Obtain CT of chest with intravenous contrast.
Question:
A 45-year-old woman with new-onset aortic regurgitation is found to have aortic dissection of the ascending aorta and aortic arch by TEE. She is relatively asymptomatic. Which of the following is the best management?
Answer:
C Surgical repair of the dissection
Question:
A 61-year-old man is found on physical examination to have an asymptomatic AAA. Ultrasound evaluation reveals that the AAA measures 4 cm in diameter. Which of the following is the best surveillance strategy for his AAA?
Answer:
D Ultrasound evaluation every year
Question:
A 68-year-old man with a history of end-stage renal disease is admitted to the hospital for chest pain. On examination, a pericardial friction rub is noted. His ECG shows diffuse ST-segment elevation. Which of the following is the best definitive treatment?
Answer:
Dialysis
Question:
The same is now hospitalized, but there is a delay in initiating treatment. You are called to the bedside because he has become hypotensive with a systolic blood pressure of 85/68 mm Hg, a heart rate of 122 bpm, and pulsus paradoxus. A repeat ECG is unchanged from admission. Which of the following is the most appropriate immediate intervention?
Answer:
Perform echocardiographic-guided pericardiocentesis.
Question:
A 62-year-old man is evaluated for a 7-month history of progressive dyspnea and lower extremity swelling. His medical history is significant for lymphoma treated with chest irradiation 15 years ago and currently in remission. He does not smoke or drink alcohol. On physical exam, vital signs are stable. There is jugular venous distension and jugular venous engorgement with inspiration. Cardiac exam discloses a prominent early diastolic sound but no murmurs or gallops. Lung exam reveals normal breath sounds. Abdominal examination reveals ascites, and lower extremities show 3+ pitting edema. ECG shows normal sinus rhythm with nonspecific diffuse ST-T changes. Urinalysis is normal. Chest radiography shows calcifications around the heart and clear lung fields. Which of the following is the most likely diagnosis?
Answer:
Constrictive pericarditis
Question:
A 35-year-old woman is being seen for shortness of breath of 2 weeks' duration. She denies a history of asthma, smoking, or cough. On examination, her heart rate is 100 bpm, blood pressure is 90/60 mm Hg, and respiratory rate is 20 breaths per min. Her jugular venous pulse was noted at rest to be 2 cm above the sternal notch, increasing to 6 cm above the sternal notch with deep inspiration. Which of the following conditions does she most likely have?
Answer:
Constrictive pericarditis
Question:
A 53-year-old man has been undergoing dialysis for end-stage renal disease due to long-standing diabetes mellitus. He is being seen in the emergency center for progressive dyspnea on exertion. On examination, he is found to have a heart rate of 105 bpm, blood pressure of 90/60 mm Hg, and respiratory rate of 20 breaths per minute. After examination, the clinician suspects cardiac tamponade. Which of the following is the most sensitive finding in this condition?
Answer:
- Drop in systolic blood pressure more than 10 mm Hg during inspiration
Question:
A 35-year-old man is brought into the emergency department after a knife injury to the chest. He is noted to be hypotensive with a blood pressure of 80/40 mm Hg and an elevated jugular venous pulse. Bedside ultrasound examination confirms a large cardiac effusion. While awaiting pericardiocentesis, which of the following is the most important intervention for the patient to receive?
Answer:
Intravenous fluids
A. Less than100 mg/dL
Question:
Which of the following symptoms would categorically suggest a diagnosis of pseudoclaudication over traditional claudication?
Answer:
A. Severe back and leg pain while walking downhill but not uphill
Question:
A 67-year-old man is diagnosed with peripheral arterial disease. Modification of which of the following risk factors would be advisable for this patient?
Answer:
A. Smoking cessation B. Diabetes C. Dyslipidemia D. Hypertension E. All of the above
Question:
A 55year-old man presents to the emergency room with complaints of a severe headache, diplopia, and vomiting. His blood pressure is 210/120 upon arrival. Which of the following is the best next step?
Answer:
Obtain a head CT scan, give an antihypertensive such as nicardipine, and admit to the intensive care unit.
Question:
A 54-year-old woman presents to the ED requesting medication refills on her antihypertensive medications. She has been out of her medications for 2 weeks and cannot get an appointment with her private physician until next week. She normally takes atenolol and hydrochlorothiazide. Her blood pressure is 190/100. The patient has no complaints. She has been waiting for 4 hours and is in a hurry to get back to work. Which of the following is the most appropriate next step?
Answer:
A. Give her a prescription for her medications, instruct her to take them immediately and have her follow-up in 48 hours.
Question:
A 38-year-old man presents to the emergency department after a motor vehicle collision. After complete evaluation it is determined that he sustained a fracture of the right tibia. The patient has a history of hypertension for which he is on pharmacological treatment. The patient is writhing on the gurney in pain. His blood pressure is 210/104. The patient has no complaints except for right leg pain. Which of the following is the most appropriate next step in management?
Answer:
A. Pain control and monitor the patient's blood pressure.
Question:
During your preoperative assessment, a 28-year-old woman complains of dyspnea on exertion. Upon auscultation of her heart, you notice a mid-diastolic rumbling murmur. This murmur is most characteristic of which valvular lesion?
Answer:
Ruptured posteromedial papillary muscle
Question:
A 25-year-old woman is brought to the emergency department following a motor vehicle accident. She has a heart rate of 120 bpm and a blood pressure of 85/55 mmHg. She is saturating 89% while breathing ambient air. A chest radiograph shows pulmonary edema, and an echocardiogram reveals severe mitral regurgitation. Which of the following would be contraindicated in this patient?
Answer:
Initiation of phenylephrine
Question:
A 70-year-old man with rheumatic heart disease complicated by severe mitral regurgitation presents to the emergency department for evaluation of fatigue. Which of the following physical examination findings is not characteristic of this disease?
Answer:
Blowing, holosystolic murmur at the left lower sternal border that increases with inspiration
Question:
A 75-year-old man is found to have asymptomatic AF. Which of the following is the most common complication of his AF long term?
Answer:
Stroke
Question:
An 83-year-old woman with a history of hypertension presents to the emergency department with bright red blood per rectum and a blood pressure of 85/50 mm Hg. Her pulse is 160 beats per minute and irregular. An ECG confirms she is in new onset AF. Which of the following is the best treatment for this patient?
Answer:
Transfusion and IV fluid
Question:
A 72-year-old woman with history of HTN and non-insulin dependent diabetes mellitus is seen in the emergency department for knee pain after tripping and falling. On examination, she has an abrasion and contusion to her knee with negative x-rays. However, her heart rate is 80 beats per minute and irregular to palpation. On ECG, she is diagnosed with AF. She does not recall ever being told about this condition. Which of the following is the best initial treatment for this patient's AF?
Answer:
Question:
What is the most common complication of CPB machine?
Answer:
Short-term memory loss
Question:
A 57-year-old woman develops acute respiratory distress 7 days following CABG. She has a history of adenocarcinoma of the colon. She had been doing well up until this time. The physical examination reveals diminished breath sounds at the lung bases. The CXR reveals atelectasis of the left lower lobe. Which of the following is the most appropriate treatment at this time?
Acute Coronary Syndrome may present atypically in which patient?
Answer:
Elderly
Question:
Which patient is most likely to have chronically elevated troponin levels?
Answer:
A 45-year-old male with an ejection fraction of 35%.
Question:
Post percutaneous treatment for a STEMI the patient should be transferred to which level of care?
Answer:
Intensive care
Question:
An AGACNP is treating a patient with a new onset of NSTEMI and an O2 sat of 94%. Which therapy is most appropriate for the AGACNP to initiate?
Answer:
Enoxaparin (Lovenox) and ASA
Question:
A 55-year-old male is evaluated during a routine examination at your cardiology practice. He has a 2-year history of non-ischemic cardiomyopathy with an ejection fraction of 35%. He denies
any dyspnea and can walk 2 miles a day without symptoms. Past medical history is significant for hypertension. His current medications include lisinopril (Zestril) 40mg daily, carvedilol (Coreg) 25mg BID, and chlorthalidone (Thalitone) 25mg daily. Vitals: 98.6- 65 - 16 - 160/ mmHg. On exam there is no JVD, lungs are clear, and heart rate is regular without murmur or gallops. No edema is present. How should the AGACNP modify this patient's treatment plan?
Answer:
Add amlodpine (Norvasc)
Question:
An 88-year-old patient is sent to the ED by his nursing home in acute decompensated heart failure reduced ejection fraction. His dry weight is 71kg and current weight is 73.5kg. Heart rate is 104, respiratory rate is 30/minute, BP of 120/60 mmHg, O2 sat 89% on RA. Heart rate is regular, lungs have rales in the posterior lung fields and he is using accessory muscles. The initial evaluation of this patient should include which tests?
Answer:
EKG, troponins, BMP
Question:
An 88-year-old patient is sent to the ED by his nursing home in acute decompensated heart failure reduced ejection fraction. His dry weight is 71kg and current weight is 73.5kg. Heart rate is 104, respiratory rate is 30/minute, BP of 120/60 mmHg, O2 sat 89% on RA. Heart rate is regular, lungs have rales in the posterior lung fields and he is using accessory muscles. To which level of care should this patient be admitted?
Answer:
Intensive Care
Question:
A patient experiencing an asthma exacerbation is unarousable and has a decreasing respiratory rate. Which action should the AGACNP take next?
Answer:
Prepare for intubation and admit to the ICU
Question:
A patient's chest x-ray reveals an increased retrosternal airspace and flattened diaphragm. The AGACNP accurately interprets this as evidence of which diagnosis?
Answer:
COPD
Question:
A 48-year-old female with acute pancreatitis is in the ICU and is ventilated. Current vitals are: heart rate 116, BP 92/60 mmHg. Hemodynamics are: CVP 9 mmHg, PAP 29/18 mmHg, PCWP 14 mmHg. Ventilator settings are: Assist Control, Tidal volume 800ml, Rate 14, FiO2 0.85, PEEP 5.0 cm H2O. ABG results are: pH 7.31, PaCO2 48 mmHg, PaO2 62 mmHg. The chest x- ray shows diffuse, fluffy infiltrates. Which intervention is most appropriate for the AGACNP to complete?
Answer:
Increase PEEP 7.5 cm H2O
Question:
A 102-year-old Hispanic female presents to the ED with dyspnea and weakness. Her respiratory rate is 30, O2 sat is 82% on high flow oxygen, BP is 86/60 mmHg. Labs reveal an acute kidney injury with a creatinine of 6.0, and elevated troponins consistent with an acute coronary syndrome. EKG shows inferior wall changes. CXR reveals pulmonary edema and a CT of the head shows an acute ischemic stroke. The patient is not responding. Which topic is most important to discuss with the family?
Answer:
Goals of Care
Question:
A 102-year-old Hispanic female presents to the ED with dyspnea and weakness. Her respiratory rate is 30, O2 sat is 82% on high flow oxygen, BP is 86/60 mmHg. Labs reveal an acute kidney injury with a creatinine of 6.0, and elevated troponins consistent with an acute coronary syndrome. EKG shows inferior wall changes. CXR reveals pulmonary edema and a CT of the head shows an acute CVA. Who is most important for the AGACNP consult?
Answer:
Palliative Care
Question:
When should oral beta blocker therapy be initiated for an individual with acute coronary syndrome?
Answer:
Within 24 hours of onset in those who do not have signs of acute heart failure, evidence of a low output state, increased risk for cardiogenic shock, or other contraindications to beta blockade (PR interval > 0.24 or second or third-degree heart block without a pacemaker, Asthma, reactive airway disease).
Question:
What are the most common risk factors for developing heart failure?
Answer:
Coronary Heart Disease Hypertension
