3270 Nursing Care of Adults & Older Adults II - Final Exam Review (Qns & Ans) - OSU 2025, Exams of Nursing

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3270 Nursing Care of Adults &

Older Adults II

Final Exam Review

(Questions & Solutions)

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.

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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)

Correct ANS s: 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.

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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.

6. Fill-in-the-Blank Question: The evaluation of a drug’s effect in an individual depends on both its __________ and what the body does to the drug. Correct ANS : pharmacokinetics Rationale: Pharmacokinetics (absorption, distribution, metabolism, and excretion) determines how the body handles the drug and directly influences the drug’s clinical effects. Understanding these principles is crucial when caring for complex, acutely ill patients.

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7. True/False Question: True or False: In older adults, diminished renal function can lead to prolonged drug half‐lives, necessitating dose adjustments to avoid toxicity. Correct ANS : True Rationale: Age-related declines in renal function reduce drug clearance, which increases the risk of accumulation and toxicity. Careful dose adjustments based on creatinine clearance are imperative in geriatric pharmacotherapy.

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Correct ANS : B. Prothrombin time (PT)/International Normalized Ratio (INR) Rationale: Warfarin’s therapeutic effect is monitored by the PT/INR. An elevated INR in an older patient with comorbidities calls for careful reassessment of dosage or drug interactions to prevent further bleeding complications.

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10. Fill-in-the-Blank Question: In the management of sepsis among acutely ill adults, early administration of appropriate __________ is crucial to improve survival outcomes. Correct ANS : antibiotics Rationale: Prompt antibiotic therapy is essential in treating sepsis. Delays in appropriate treatment can result in rapid clinical deterioration and increased mortality, especially in older adults with complex health issues.

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11. True/False Question: True or False: Pain assessment in acutely ill adults should incorporate both self-report and observational tools to ensure accurate evaluation. Correct ANS : True Rationale:

In patients with complex conditions—especially older adults who may have cognitive impairment or communication difficulties—a combined approach using self-report and validated observational scales improves pain management accuracy.

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12. Multiple Response Question: When managing an acutely ill older patient with complex health problems, which of the following factors are vital to consider for optimizing pharmacologic therapy? (Select all that apply)

• A. Age-related pharmacokinetic changes
• B. Polypharmacy and potential drug interactions
• C. Organ function (renal, hepatic)
• D. Cultural beliefs about medications
• E. Medication cost alone Correct ANS s: A, B, C, D Rationale: Optimal pharmacotherapy in acutely ill older adults must account for age-related changes, polypharmacy risks, organ function impairments, and the patient’s cultural context regarding medication use. Cost is an important factor but must be balanced with clinical needs.

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13. Multiple Choice Question: A nurse is caring for a patient in the intensive care unit (ICU) with multi- organ failure. Which clinical scale is most useful for assessing the severity of illness in acutely ill patients?

• A. Glasgow Coma Scale (GCS)

Correct ANS : True Rationale: Older adults often present with atypical symptoms (e.g., confusion instead of chest pain), so clinicians must maintain vigilance and a comprehensive approach to assessment to avoid delays in diagnosis and treatment.

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16. Multiple Response Question: Which assessments are essential when evaluating hemodynamic instability in a patient with complex multiple organ dysfunction? (Select all that apply)

• A. Measurement of blood pressure and heart rate
• B. Assessment of capillary refill and skin perfusion
• C. Monitoring central venous pressure (CVP) or wedge pressure
• D. Evaluation of urine output
• E. Measurement of blood glucose levels exclusively Correct ANS s: A, B, C, D Rationale: Hemodynamic instability is assessed by vital signs, peripheral perfusion, intravascular volume (CVP or pulmonary capillary wedge pressure), and urine output. Although blood glucose is important in overall metabolic control, it is not a primary indicator of hemodynamic status.

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17. Multiple Choice

Question: A 70-year-old patient admitted with septic shock is receiving vasopressor support. Which vasopressor, often used as first-line therapy in septic shock, acts primarily through α-adrenergic receptor stimulation leading to vasoconstriction?

• A. Dobutamine
• B. Norepinephrine
• C. Dopamine
• D. Phenylephrine Correct ANS : B. Norepinephrine Rationale: Norepinephrine is typically the first-line vasopressor for septic shock because it predominantly stimulates α-adrenergic receptors, increasing vascular tone and blood pressure without significantly compromising cardiac output.

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18. Fill-in-the-Blank Question: 

In managing acutely ill patients with complex respiratory failure, the use of __________ ventilation is recommended to minimize ventilator- induced lung injury. Correct ANS : lung-protective Rationale: Lung-protective ventilation strategies (typically low tidal volumes and appropriate PEEP) reduce the risk of barotrauma and volutrauma in patients with acute respiratory distress syndrome (ARDS) or severe pneumonia.

Monitoring lactate, white blood cell count, procalcitonin, and liver enzymes provide valuable information on the metabolic, inflammatory, and organ function status during sepsis treatment. An ECG is useful for cardiac monitoring, but less specific to sepsis response.

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21. Multiple Choice Question: A patient with multi-organ failure is receiving multiple medications. Which strategy is most important to minimize the risk of adverse drug interactions?

• A. Administering medications on a fixed schedule without reviewing concurrent therapy
• B. Utilizing computerized physician order entry (CPOE) systems with integrated drug–drug interaction checks
• C. Relying solely on the prescriber's experience
• D. Administering all drugs via a single IV line Correct ANS : B. Utilizing computerized physician order entry (CPOE) systems with integrated drug–drug interaction checks Rationale: CPOE systems with built-in alerts can help identify potential drug–drug interactions, which is especially critical in patients with complex regimens and compromised organ function.

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22. Fill-in-the-Blank Question: The practice of adjusting drug dosages based on renal function, using calculations such as the Cockcroft–Gault equation to estimate __________ clearance, is essential in geriatric pharmacotherapy.

Correct ANS : creatinine Rationale: Estimating creatinine clearance is key for dosing renally excreted drugs, as older adults often have decreased renal function. This prevents drug accumulation and potential toxicity.

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23. True/False Question: True or False: In acutely ill patients, early mobilization as tolerated is recommended to prevent complications such as deep vein thrombosis and muscle deconditioning, even in the intensive care setting. Correct ANS : True Rationale: Early mobilization has been shown to improve outcomes by reducing the risk of thromboembolic events and preserving muscle strength. It is an evidence-based practice in critical care even for complex patients.

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24. Multiple Response Question: Which non-pharmacologic interventions should be included in the comprehensive care of acutely ill adults with complex conditions? (Select all that apply)

• A. Nutritional support and monitoring
• B. Psychological support and counseling
• C. Physical therapy and early mobilization

26. Fill-in-the-Blank Question: The __________ model in critical care emphasizes the early identification, aggressive management, and continuous monitoring of patients to prevent deterioration. Correct ANS : rapid response Rationale: The rapid response model is built on early recognition and intervention in patients showing signs of clinical decline, which is especially crucial in managing acutely ill patients with complex conditions.

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27. True/False Question: True or False: In acutely ill older adults, atypical presentations (e.g., confusion, falls) may be the only indicators of a serious underlying condition such as sepsis or myocardial infarction. Correct ANS : True Rationale: Older adults often do not present with classic symptoms. Atypical signs such as delirium or falls can be the only clues of severe illness, underscoring the need for vigilant assessment in this population.

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28. Multiple Response Question: Which of the following strategies are evidence-based for reducing

hospital-acquired infections in critically ill older adults? (Select all that apply)

• A. Strict adherence to hand hygiene protocols
• B. Routine use of prophylactic antibiotics for all patients
• C. Implementing central-line bundles
• D. Environmental cleaning and disinfection
• E. Using evidence-based ventilator-associated pneumonia (VAP) prevention measures Correct ANS s: A, C, D, E Rationale: Infection control strategies include rigorous hand hygiene, central-line bundles, environmental cleaning, and VAP prevention protocols. Routine prophylactic antibiotics (B) are not recommended and can contribute to antibiotic resistance.

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29. Multiple Choice Question: 

A nurse is overseeing a care bundle for an older patient with multi-organ failure in the ICU. Which of the following is a key component of the care bundle aimed at preventing pressure injuries?

• A. Frequent repositioning every 2 hours
• B. Application of high-dose topical steroids
• C. Exclusive use of foam mattresses
• D. Early mobilization solely during daytime hours Correct ANS : A. Frequent repositioning every 2 hours Rationale: Repositioning at regular intervals is a cornerstone of preventing pressure

activator). Rationale: Thrombolytic therapy with tPA is the time-sensitive treatment for acute ischemic stroke, aiming to dissolve the clot and restore blood flow to the brain. This is the priority intervention within the established time window. Fill-in-the-Blank: A patient with a history of heart failure is admitted with acute respiratory distress. Auscultation reveals bilateral crackles, and the patient reports shortness of breath. The nurse anticipates an order for __ to help reduce fluid overload. ANS : Diuretics Rationale: Diuretics, such as furosemide, are used to remove excess fluid from the body, a common intervention in heart failure exacerbations leading to pulmonary edema. True/False: In the care of an older adult with pneumonia, it is not essential to assess for atypical symptoms, such as confusion or falls, as these are common age-related changes. ANS : False Rationale: Older adults with pneumonia often present with atypical symptoms like confusion, falls, or changes in functional status. Nurses must be vigilant in recognizing these indicators. Multiple Response: A patient with sepsis is exhibiting signs of septic shock. Which of the

following interventions should the nurse anticipate implementing? (Select all that apply.) a) Administering intravenous antibiotics. b) Administering intravenous fluids. c) Administering vasopressors. d) Restricting fluid intake. ANS : a, b, c Rationale: Sepsis management includes aggressive fluid resuscitation, antibiotic administration, and vasopressors to maintain blood pressure and tissue perfusion. Fluid restriction is not a standard intervention in septic shock. Multiple Choice: A patient with chronic kidney disease (CKD) is admitted with hyperkalemia (potassium level of 6.8 mEq/L). Which medication would the nurse most likely administer first? a) Sodium polystyrene sulfonate (Kayexalate). b) Insulin and dextrose. c) Furosemide (Lasix). d) Calcium gluconate. ANS : d) Calcium gluconate. Rationale: Calcium gluconate is administered to stabilize the cardiac membrane and protect against the cardiotoxic effects of hyperkalemia. Insulin and dextrose are also used to shift potassium into the cells. Fill-in-the-Blank: A patient post-operative after a hip replacement surgery develops