NURS5463 Exam 4 UTA Latest Update 2024-2025
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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? - CORRECT ANSWER: Palliative Care
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? - CORRECT
ANSWER: Goals of Care
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? - CORRECT ANSWER: Initiation of
phenylephrine
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? - CORRECT ANSWER: Intravenous fluids
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? - CORRECT ANSWER: Constrictive pericarditis
A 36-year-old, 72kg female, is intubated for a severe asthma exacerbation, and is on
the following ventilator settings: Tidal volume 650ml, simultaneous intermittent
mandatory ventilation (SIMV) with a rate of 14, and an Fio2 of 0.75. Her morning ABG
results were: pH 7.18, PaCO2 55 mmHg, HCO3 21 mEq/L. Which order is the most
appropriate in response to this ABG? - CORRECT ANSWER: Administer 1am of sodium
bicarbonate
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? - CORRECT ANSWER: A. Pain control and
monitor the patient's blood pressure.
A 40-year-old patient who is being discharged home after being treated for an acute
decompensated heart failure reduced ejection fraction, admits to not taking his
medications or following his diet. Which response would best help the AGACNP provide
anticipatory guidance? - CORRECT ANSWER: What prevents you from taking your
medications?
A 44-year-old woman presents with worsening fatigue and dyspnea. The pertinent
medical history is that she had rheumatic fever during childhood. Physical examination
finds an early diastolic opening snap with a rumbling late diastolic murmur. A chest
radiograph shows an enlarged left atrium. Which of the following is the most likely
diagnosis? - CORRECT ANSWER: Mitral Stenosis
A 45-year-old man with a past medical history of diabetes, hyperlipidemia, and
hypertension has smoked one pack of cigarettes a day for the past 15 years and drinks
four glasses of wine every weekend. He is found to have an AAA incidentally on CT
imaging of the abdomen. Which of the following is the most important predisposing
factor for the development of his AAA? - CORRECT ANSWER: B Smoking
, 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? - CORRECT ANSWER:
C Surgical repair of the dissection
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? - CORRECT ANSWER:
Increase PEEP 7.5 cm H2O
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? - CORRECT ANSWER: • Drop in
systolic blood pressure more than 10 mm Hg during inspiration
A 54-year-old man is seen at a rural ED with 1 hour of nausea and substernal chest
pain radiating to his jaw. The ECG shows STEMI. PCI is not performed at this hospital
and only performed at a hospital 2 1/2 hours away. Which of the following statements is
most accurate? - CORRECT ANSWER: C Administer thrombolytics, then transfer to PCI
center.
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? - CORRECT ANSWER: A.
Give her a prescription for her medications, instruct her to take them immediately and
have her follow-up in 48 hours.
