Adult Gerontology ACUTE Care Nurse
Practitioner Certification
Comprehensive Final Test (Qns & Ans)
2025
1. Scenario: An 82‑year‑old woman with a known history of
congestive heart failure presents with acute shortness of breath,
rales, and peripheral edema. Her laboratory values reveal an
elevated B-type natriuretic peptide (BNP) level. Which initial
intervention is most appropriate for managing her acute
decompensated heart failure?
Options:
A) Increase her oral dose of beta-blockers immediately
B) Initiate intravenous diuretic therapy and monitor urine output
C) Schedule an echocardiogram after discharge
D) Instruct the patient on strict bed rest
©2025
, ANS: B) Initiate intravenous diuretic therapy and monitor
urine output
Rationale: In the setting of acute decompensated heart
failure—especially in an older adult—the priority is to reduce
fluid overload. IV diuretics act quickly, and monitoring urine
output allows for assessment of therapeutic effectiveness. This
intervention is more appropriate than solely increasing chronic
medications or delaying diagnostic evaluation.
2. Scenario: A 75‑year‑old man with sepsis secondary to
pneumonia now demonstrates hypotension, tachycardia, and
altered mental status. Laboratory workup reveals an elevated
lactate level. Which component of sepsis management should be
implemented immediately?
Options:
A) Immediate initiation of vasopressor support
B) Rapid fluid resuscitation with crystalloid solutions
C) Withholding antibiotics until full culture results are available
D) Administering analgesics for comfort
ANS: B) Rapid fluid resuscitation with crystalloid solutions
Rationale: Early fluid resuscitation in sepsis is critical to
restore perfusion and reduce lactate levels. While vasopressors
may be required later if hypotension persists, initial aggressive
fluid management is the first-line intervention.
©2025
,3. Scenario: An 80‑year‑old patient with a history of atrial
fibrillation presents with an acute ischemic stroke. The patient is
within the treatment window for thrombolytic therapy. Which
diagnostic study is most critical to confirm eligibility for tissue
plasminogen activator (tPA) administration?
Options:
A) Magnetic resonance imaging (MRI) of the brain
B) Computed tomography (CT) scan of the head without
contrast
C) Electroencephalogram (EEG)
D) Carotid Doppler ultrasonography
ANS: B) Computed tomography (CT) scan of the head
without contrast
Rationale: A non-contrast CT scan is the standard imaging
modality to quickly rule out hemorrhage before administering
tPA, which is particularly crucial in geriatric patients given the
higher risk of bleeding.
4. Scenario: A 78‑year‑old patient with chronic obstructive
pulmonary disease (COPD) presents with acute respiratory
distress. On exam, you note increased work of breathing and
diffuse wheezing. Which noninvasive therapy is most appropriate
to support the patient’s breathing without immediate intubation?
©2025
, Options:
A) High-flow nasal cannula (HFNC) therapy
B) Continuous positive airway pressure (CPAP)
C) Bi-level positive airway pressure (BiPAP)
D) Immediate endotracheal intubation
ANS: C) Bi-level positive airway pressure (BiPAP)
Rationale: BiPAP provides both inspiratory and expiratory
pressure support, which can reduce the work of breathing in acute
COPD exacerbations. It is often beneficial in older adults to avoid
more invasive procedures.
5. Scenario: A 79‑year‑old patient receiving multiple
medications for chronic conditions develops acute confusion and
agitation during her hospital stay. Which factor is the most
significant contributor to this clinical presentation in the acute
care setting?
Options:
A) Untreated depression
B) Inadvertent polypharmacy leading to drug interactions
C) High levels of social isolation
D) Overuse of physical restraints
©2025
Practitioner Certification
Comprehensive Final Test (Qns & Ans)
2025
1. Scenario: An 82‑year‑old woman with a known history of
congestive heart failure presents with acute shortness of breath,
rales, and peripheral edema. Her laboratory values reveal an
elevated B-type natriuretic peptide (BNP) level. Which initial
intervention is most appropriate for managing her acute
decompensated heart failure?
Options:
A) Increase her oral dose of beta-blockers immediately
B) Initiate intravenous diuretic therapy and monitor urine output
C) Schedule an echocardiogram after discharge
D) Instruct the patient on strict bed rest
©2025
, ANS: B) Initiate intravenous diuretic therapy and monitor
urine output
Rationale: In the setting of acute decompensated heart
failure—especially in an older adult—the priority is to reduce
fluid overload. IV diuretics act quickly, and monitoring urine
output allows for assessment of therapeutic effectiveness. This
intervention is more appropriate than solely increasing chronic
medications or delaying diagnostic evaluation.
2. Scenario: A 75‑year‑old man with sepsis secondary to
pneumonia now demonstrates hypotension, tachycardia, and
altered mental status. Laboratory workup reveals an elevated
lactate level. Which component of sepsis management should be
implemented immediately?
Options:
A) Immediate initiation of vasopressor support
B) Rapid fluid resuscitation with crystalloid solutions
C) Withholding antibiotics until full culture results are available
D) Administering analgesics for comfort
ANS: B) Rapid fluid resuscitation with crystalloid solutions
Rationale: Early fluid resuscitation in sepsis is critical to
restore perfusion and reduce lactate levels. While vasopressors
may be required later if hypotension persists, initial aggressive
fluid management is the first-line intervention.
©2025
,3. Scenario: An 80‑year‑old patient with a history of atrial
fibrillation presents with an acute ischemic stroke. The patient is
within the treatment window for thrombolytic therapy. Which
diagnostic study is most critical to confirm eligibility for tissue
plasminogen activator (tPA) administration?
Options:
A) Magnetic resonance imaging (MRI) of the brain
B) Computed tomography (CT) scan of the head without
contrast
C) Electroencephalogram (EEG)
D) Carotid Doppler ultrasonography
ANS: B) Computed tomography (CT) scan of the head
without contrast
Rationale: A non-contrast CT scan is the standard imaging
modality to quickly rule out hemorrhage before administering
tPA, which is particularly crucial in geriatric patients given the
higher risk of bleeding.
4. Scenario: A 78‑year‑old patient with chronic obstructive
pulmonary disease (COPD) presents with acute respiratory
distress. On exam, you note increased work of breathing and
diffuse wheezing. Which noninvasive therapy is most appropriate
to support the patient’s breathing without immediate intubation?
©2025
, Options:
A) High-flow nasal cannula (HFNC) therapy
B) Continuous positive airway pressure (CPAP)
C) Bi-level positive airway pressure (BiPAP)
D) Immediate endotracheal intubation
ANS: C) Bi-level positive airway pressure (BiPAP)
Rationale: BiPAP provides both inspiratory and expiratory
pressure support, which can reduce the work of breathing in acute
COPD exacerbations. It is often beneficial in older adults to avoid
more invasive procedures.
5. Scenario: A 79‑year‑old patient receiving multiple
medications for chronic conditions develops acute confusion and
agitation during her hospital stay. Which factor is the most
significant contributor to this clinical presentation in the acute
care setting?
Options:
A) Untreated depression
B) Inadvertent polypharmacy leading to drug interactions
C) High levels of social isolation
D) Overuse of physical restraints
©2025
