Nsg 430 Exam 1 Questions With Verified Answers Latest Update 2026

NSG 430 EXAM 1 QUESTIONS WITH VERIFIED ANSWERS LATEST UPDATE 2026 Patient stability - Answers -mild signs of deterioration: mild confusion, tachypnea -6-8 hours before cardiac or respiratory arrest PCU vs ICU - Answers -ICU nursing is delivering ICU care to patients wherever they may be -PCU is progressive care units (intermediate or step down) that provide transition between ICU and general care unit at risk for serious complications Complexity of unstable clients - Answers #1: physiologically unstable -critical analysis and decision making #2: risk of complications -frequent assess and treatments, high risk of delirium #3: IV polypharmacy-titration -vasoactive, thrombolytics, sedation, insulin, nutrition #4: advanced tachnology/devices -vents, ICP, svO2, CCRT #5 psychosocial, ethical and safety concerns Needs of caregivers - Answers -information -reassurance -access They need these bc without them they feel powerless and will show signs of this Unstable client S/S - Answers -↓ Level of consciousness, Anxiety, Confusion, Weakness, Restlessness Feeling of impending doom -Cool, clammy skin, Pallor, Cyanosis -Dysrhythmias, Tachycardia -Hypotension, Narrowed pulse pressure -Rapid, weak, thready pulses -Tachypnea, dyspnea, or shallow, irregular respirations -↓ O2 saturation -Temperature dysregulation• Chills -Obvious hemorrhage or injury, Nausea and vomiting Rapid response - Answers FUNCTIONS -identification and activation on client deterioration -initiate response for assessment, intervention, triage -bedside nurse gives SBAR! FAILURE TO RECOGNIZE -failure to recognize changes, diagnostics, clinical deviations from normal, lack of nurse intuition TEAM -respiratory ventilates -nursing supervisor is general support -provider is hospitalist -ICU nurse and assigned client nruse PROTOCOLS -begin tx before provider arrives -O2 airway management -12 EKG -labs, meds -critical thinking in action, contact the provider fast Palliative care vs hospice - Answers PALLIATIVE -*begins during RESTORATIVE or curative health care -indication: diagnosis of a life-limiting illness HOSPICE -life expectancy is 6 months or less -requires physician certification END OF LIFE CARE GOALS -when death is imminent -provide comfort, improve quality of remaining life, ensure dignified death End of life - Answers MANIFESTATIONS -decreased metabolism, body function -respiration ceases first, heart stops beating after a few mins -slow, irregular breathing, cheyne-stokes respirations -inability to cough or clear secretions (death rattle= grunting, gurgling, congested breathing) -*hearing is the last sense to disappear -decreased sensation, perception of pain and touch -blurred vision, absent blink reflex, patient appears to stare, eyelids half open -decreased taste and smell -mottling on hands, feet, arms, legs -cold and clammy skin -cyanosis of nose, nail beds, knees -*waxlike skin when very near death -gradual urinary output decrease, incontinent of urine, unable to urinate -slowing of GI, accumulation of gas, distention and nausea -loss of sphincter control -bowel movement may occur at death -trouble holding bosy posture and alignment -loss of facial muscle time: sagging jaw, difficulty speaking, loss of gag reflex, swallowing is difficult -increased heart rate, then later slowing and weakend pulse -irregular rhythm of heart, decreased BP, delayed absorption of IM or SQ drugs PSYCHOSOCIAL MANIFESTATIONS -altered decision making -anxiety, fear- spirituality associated with decreased dispair -life review -peacefulness, saying goodbyes, withdrawal End of life cont. - Answers -pay attention to nonverbal cues -provide culturally competent care -decisional capacity: ability to consent and refuse care (organ tissue donate, advance directives, resuscitation, etc) -organ donation: with persons consent before death and family permission after death -physician assisted suicide: hastens death Nursing management and role of nurse for end of life care - Answers -relieve suffering -clarify misunderstanding about use of pain meds. addiction is not a concern when providing comfort for terminally ill. -double effect: morally permissible to give a med that has potential for harm if given to relieve pain but *not intended to hasten death GUIDES TO CARE -code of ethics for nurses- relieve suffering -principle of beneficence- care is provided to benefit -standard of care- nursing acts required for safe and competent nursing practices ASSESSMENT -detect s/s from review of body systems -assess for discomfort and pain -legal guidlines for donation of organs and tissues -assess coping of pt and fam -q8hr assess -monitor for system failure, vigilance -*address pain level and respiratory status, emotions -communication: prepare fam for unusual pt communication IMPLEMENTATIONS -coping strategies -care of emotional and physical needs -anger: normal response to grief. grieving person cannot be forced to accept the loss -*elizabeth kubler ross swiss american FEARS OF DEATH -pain -shortness of breath-air hunger-opioids-bronchodilators-o2 -loneliness, abandonment -meaninglessness, life review POSTMORTEM -close pts eyes, replace dentures, wash and position body -allow fam as much time as they need -*as a nurse recognize your values, attitudes and feelings about death Diabetic ketoacidosis (DKA) - Answers -profound deficiency of insulin -most likely occur in type 1 diabetes -characterized: hyperglycemia, ketosis, acidosis, dehydration -ketones cause metabolic acidosis -can be managed outpatient, but may need to hospitalize for severe fluid and electrolyte imbalance, fever, N/V, diarrhea, altered mental state. NEED to be communicating with provider PRECIPITATING FACTORS -illness, infection -inadequate insulin dosage -undiagnosed T1DM -poor self management, neglect MANIFESTATIONS -dehydration, poor skin turgor, dry mucous membranes, tachycardia, orthostatic hypotension -lethargy and weakness early -skin dry and loose, eyes soft and sunken -renal failure which may occur from hypovolemia shock can cause the retention of ketones and glucose which progresses acidosis *IMPORTANT* -abdominal pain, anorexia, nausea,vomiting -*kussumal respirations (rapid, deep breathing by exhalation of excess CO2), sweet fruity breath odor (acetone) -blood glucose or = 250mg/dl -pH lower than 7.30 -serum bicarbonate 16meq/L -moderate to high ketones in urine or serum DKA treatment - Answers #1- ensure airway, administer O2 via NC or non rebreather #2- establish IV access, begin fluid resuscitation. 0.45% or 0.9% NS, add 5% or 10% dextrose when BG approaches 250mg/dl (prevent hypoglycemia and *cerebral edema) #3- regular insulin drip 0.1U/kg/hr #4- potassium replacement as needed. insulin decreases potassium ELECTROLYTE IMBALANCES -potassium: many complications including the heart balanced IV and oral supplements, continuous ECG monitoring ASSESS FOR DKA -assess urine, ECG -once sugars 250, switch from NS to D5 or D10 -try to get in 100s for sugar -table 53.2 emergency management Hyperosmolar hyperglycemic syndrome (HHS) - Answers WHAT IS HHS? -occurs with type 2 diabetes -less common than DKA. HHS usually has enough insulin circulating so that ketoacidosis does not occur -glucose greater than 600 -**neurologic manifestations due to increased serum osmolality: somnolence, coma, seizures, hemiparesis, aphasia -ketones absent or minimal in blood or urine -hypokalemia is not as significant as it is in DKA CAUSES -UTIs, pneumonia, sepsis, acute illness, newly diagnosed T2DM -impaired thirst sensation and or inability to replace fluids TREATMENT -administer IV fluids for dehydration -insulin therapy to reduce blood glucose and serum acetone -electrolytes to correct imbalance -monitor LOC -assess for signs of K imbalance -assess cardiac and vital signs to determine presence of fever, hypovolemic shock, tachycardia, and kussumal respirations FINDINGS FOR HHS - pH 7.4 -HCO3 20 -negative ketons -glucose 800 Hypoglycemia emergency management - Answers CONSCIOUS -eat or drink fast acting carb (15-20g) -wait 15 min, recheck blood glucose, repeat if needed UNCONSCIOUS -glucagon IV or IM -turn pt on side to prevent aspiration SIADH- syndrome of inappropriate ADH - Answers -release of ADH despite normal or low plasma osmolarity PATHO -increased ADH -increased water reabsorption in renal tubules -increased intravascular fluid volume -dilutional hyponatremia and decreased serum osmolality CAUSES -malignant tumors, cancers -head injuries, stroke, infection, guillian-barre, SLE -drugs:tegretol, general anesthesia, opioids, thiazides, SSRI, chemo -hypothyroid, COPD, HIV, adrenal insufficiency MANIFESTATIONS -fluid retention, dilutional hyponatremia, concentrated urine -decreased urine, increased wt, thirst initially, dyspnea on exertion, fatigue DIAGNOSIS -serum sodium 134 -urine specific gravity 1.025 NURSING CARE -monitor I&Os, urine SG, daily wts, vitals -monitor seizures, headache, vomiting -oral care -fluid restriction -loop diuretics (retain Na and Cl) MEDS -demeocycline: blocks effects of ADH, more dilute urine -vasopressor receptor agonists: block activity of ADH to tx hyponatremia -loop diuretics -Na and K supplements: hypertonic saline, replace electrolytes DI- diabetes insipidus - Answers -deficiency of production of ADH -causes: tumor, head injury, CNS infections, renal damage, lithium, renal disease -*decreased renal response! MANIFESTATIONS -polydipsia, polyuria (2-20L/day) -urine SG 1.005 -urine osmolality 100osm/kg, serum 295osm/kg -sodium serum 145 DIAGNOSTICS -water deprivation test and admin of DDAVP. measure ADH after analog of ADH is given MANAGEMENT -*maintain electrolyte balance -hydration, BP, HR, LOC, I&Os MEDICATIONS -central DI: *DDAVP (hormone replacement, monitor pulse) -dietary: low sodium diet -thiazide diuretics reduce flow to the ADH sensitive nephrons -indocine (NSAID)- increase renal responsiveness to ADH Pituitary surgery - Answers -for DI or SIADH surgeries caused by tumors -assess for drainage, visual acuity -notify HCP for excessive bleeding or CSF drainage -check clear drainage with a urine dipstick for glucose and protein- *glucose greater than 30mg/dl indicated CSF leak. risk for meningitis -assess for supraorbital headache: resolves in 72 hours, keep HOB 30 degrees or more. caused by CSF in sinuses Cushing syndrome - Answers CAUSES -glucocorticoids, mineralcorticoids, androgens -medulla hormones- catecholamines= adrenaline, noradrenalin, dopamine -*iatrogenic admin of exogenous corticosteroids -ACTH secrreting pituitary adenoma, adrenal tumors, too much ACTH production by tumors MANIFESTATIONS -moon face, thin and reddened skin, wt gain, centripetal obesity, buffalo hump -purplish-red striae below skin surface on abdomen, breast, buttocks -excess glucocorticoids: hyperglycemia, muscle wasting, weakness, loss of bone matrix, osteoporosis, back pain. loss of collagen, think skin, easily bruises, delay in wound healing -mineralcorticoid excess: hypokalemia, hypertension -adrenal androgen excess: severe acne, gynecomastia, hirsutism -polyuria -awkward gait -enlarged clitoris DIAGNOSTICS -plasma ACTH lo, normal, or elevated, depending on underlying cause -hypokalemia (decreased K+), alkalosis with ACTH syndrome and adrenal carcinoma -increased glucose -dyslipidemia, granulocytosis, lymphycytopenia, eosinopenia -*calcium in urine Cushing syndrome *nursing care - Answers -tx based on cause -surgery, removal of ACTH secreting tumors -discontinue corticosteroid therapy, decreased dose gradually ASSESS -negative feelings, amenorrhea, impotence, decreased libido -anxiety, emotional lability, psychosis -** signs of inflammation, infection, thromboembolism: cjest pain, dyspnea, tachypnea, sudden chest pain MANAGEMENT -high protein diet -correct hypokalemia -comfort and emotional support -post surgery: *high doses of corticosteroids (hydrocortisone) IV during and several days after surgery risk for glycemic control, infection, delayed wound healing -monitor for acute renal insufficiency: vomiting, weakness, dehydration, hypotension, painful joints, pruritis, peeling skin -*taper dose of corticosteroids slowly! -prevent infection, avoid extreme temps, wear medic alert bracelet Addison's disease - Answers CAUSES -lack of glucocorticoids, lack of ACTH, lack of androgens -autoimmune or antibodies destroy adrenal cortex -TB, amyloidosis, fungal infections, AIDS, metastatic cancer MANIFESTATIONS -anorexia, nausea, weakness, fatigue, wt loss. disease advanced before diagnosed -abdominal pain, diarrhea, headache, orthostatic hypotension, salt craving, joint pain -*hyperpigmentation and bronze colored skin Addisons cont. - Answers TRIGGERS -stress (infection, surgery, psychologic distress) -sudden withdrawal of corticosteroid hormone therapy -adrenal surgery -sudden pituitary destruction MANIFESTATIONS -hypotension, tachycardia -dehydration -decreased sodium, increased potassium, decreased glucose -fever, weak, confusion, diarrhea, pain (in lower back or legs), severe vomiting -shock and circulatory collapse DIAGNOSTIC TESTS -*ACTH stimulation test to diagnose insufficiency -ACTH and cortisol rechecked at 30 and 60 minutes. normal response is rise in blood cortisol levels. people with addisons have little to no increase in cortisol levels -*when ACTH test is abnormal, CRH stimulation test is done. high ACTH levels with no cortisol indicates Addisons. absence of ACTH is secondary adrenal insufficiency DIAGNOSTICS -increased K+, decreased Cl, sodium, glucose -increased BUN, ECG changes (peaked T waves), anemia -CT and MRI show if caused by tumor, fungal infections, TB, or adrenal calcification MANAGEMENT -increase sodium -corticosteroid therapy- hydrocortisone (increase during periods of stress), fludrocortisone -women hormone replacement: dehydroepiandrosterone (DHEA) -daily wts, I&Os -watch for signs of cushings -protect pts from extreme light, noise, temperature MED DOSING -glucocorticoids: 2/3 in morning, 1/3 in afternoon -mineralcorticoids (fludrocortisone): given in morning. teach pt how to tak either BP, salt intake increase, report changes to HCP -situations that need corticosteroid adjustment: fever, flu, tooth extraction, rigorous physical activity Addisonian crisis - Answers -shock management -high dose hydrocortisone replacement -0.9% saline and 5% dextrose to reverse hypotension and electrolyte imbalances until BP turns normal -emergency IM hydrocortisone, syringes, instructions for use Corticosteroid therapy - Answers -*do not abruptly stop, monitor for infection, watch glucose in pts with diabetes -not recommended for minor chronic conditions SIDE EFFECTS -↓ Potassium and calcium -↑ Glucose and BP -delayed healing -susceptibility to infection -suppressed immune response -peptic ulcer disease -muscle atrophy/weakness -mood and behavior changes -moon facies, truncal obesity -protein depletion -risk for acute adrenal crisis if therapy is stopped abruptly -hypokalemia, hypocalcemia -increased BP -manifestations of inflammation are suppressed PATIENT TEACHING -take meds in morning -*must NOT be stopped abruptly -high protein, high calcium diet. low in fat and simple carbs like sugar, honey, syrups, candy -ensure adequate rest and sleep, exercise to maintain bone integrity, sodium restrictions if edema occurs -monitor for hyperglycemia -notify provider if experiencing epigastric pain that does not get better with antacids -eye appointments to assess for development of cataracts -get up slowly, use good lighting to avoid injury -maintain good hygiene Hyperthyroidism - Answers -women, ages 20-40 -GRAVES DISEASE CAUSES -toxic goiter, thyroiditis, excess iodine intake, pituitary tumors, thyroid cancer SUBCLINICAL HYPERT -serum TSH below 0.4mlu/l -normal t3 t4 OVERT HYPERT -low or undetectable TSH -increased t3 t4 -symptoms may or may not present Graves disease - Answers -autoimmune, thyroid enlargement CAUSES -decreased iodine supply, cigs smoking, infection, stressful life events -associated with RA, pernicious anemia, SLE, addisons disease, celiac, vitiligo MANIFESTATIONS -increased metabolism, increased tissue sensitivity to sympathetic nervous system stimulation -goiter: may have burits on auscultation -exophthalmos (increased fat deposits and fluid) -cardiovascular: systolic HTN, bounding rapid pulse, palipitations, increased CO, cardiac hypertrophy, systolic murmurs, dysrhythmias, angina -respiratory: dyspnea on exertion, increased RR