NSG 550/ NSG550 Exam 2 V1 – Diagnostic Reasoning for Nurse Practitioners Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 550/ NSG550 Exam 2 V1 – Diagnostic Reasoning for Nurse Practitioners Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A General Adaptation Syndrome Definition Helps the body prepare and response to stresses/danger What are the three stages of the General Adaptation Syndrome? Alarm Stage: Fight-or-Flight Response starts. Body is mobilized. Resistance Stage: The body tries to counteract the alarm stage and return BP to normal. Exhaustion Stage: The person's ability to adapt to the stressors diminishes. Energy sources deplete. Difference between parasympathetic and sympathetic. Sympathetic activates flight or fight, while parasympathetic is responsible for rest and digest. "Sympathetic makes you GO, parasympathetic makes you recognize and go OH WOAH" Examples of Ego-Defense Mechanisms Compensation Conversion Denial Displacement Identification Dissociation Regression Ego-Defense Mechanism: COMPENSATION Making up for one deficiency by emphasizing a different asset. EX: Poor communicator relies on organizational skills. Ego-Defense Mechanism: CONVERSION Unconsciously repressing an anxiety-producing emotional conflict that transforms into symptoms. ANXIETY THAT IS CONVERTED TO PHYSICAL SYMPTOMS EX: Difficulty sleeping, loss of appetite Ego-Defense Mechanism: DENIAL EX: A person refuses to discuss or acknowledge a personal loss. Ego-Defense Mechanism: DISPLACEMENT Transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing one. EX: A angry person who is going through a conflict takes it out on technology that isn't working. Ego-Defense Mechanism: IDENTIFICATION Patterning behavior of another or reproducing of behaviors observed in others Ego-Defense Mechanism: DISSOCIATION experiencing a subjective sense of numbing and a reduced awareness of one's surroundings Ego-Defense Mechanism: REGRESSION coping with a stressor through actions and behaviors associated with an earlier developmental period What is the hallmark sign of PTSD? The person is reliving their trauma. Although a psychiatrist does diagnose the individual with PTSD, what classifies what is traumatizing and what causes PTSD? The individual classifies what is traumatic to them and what causes it. What are the three types of crisis? Developmental Crises: EX: Such as marriage of birth of a child Situational Crises: EX: External source such as job change, motor vehicle crash, severe illness. Adventitious Crises: EX: Natural disaster, man-made disaster, or crime of violence. Second Victim Syndrome When a medical error that results in significant harm to a patient and the family occurs. What are some implementations for stress reduction? Health promotion, regular exercise and rest, support systems, time management, GUIDED IMAGERY AND VISUALS, PROGRESSIVE MUSCLE RELAXATION THERAPIES, journaling, and isolation and loneliness prevention. What are the stages of the sleep cycle? NREM Sleep (75% of night): N1, N2, N3 REM Sleep (25% of night) N1 Stage of Sleep NREM -Lightest level of sleep -If awakened, person feels daydreaming has occurred N2 Stage of Sleep NREM -Relaxation progresses -Brain and muscle activity slow N3 Stage of Sleep NREM -Slow-wave sleep -Deepest stage of sleep -Vital signs lower REM Sleep -Vivid dreams -90 minutes after sleep has begun -Rapid eye movement -Increased blood pressure -Fluctuating heart and respiratory rates -Gastric secretions What are some sleep disorders? Insomnia, narcolepsy, sleep apnea What are some traits of insomnia? Difficulty in falling asleep, frequent awakenings from sleep, short periods of sleep, or sleep that is non-restorative. What are some traits of sleep apnea? The inability to breath and sleep at the same time. They have a lack of airflow through the nose and mouth from periods from 10 seconds to 1 to 2 minutes in length. What are major risk factors for sleep apnea? Structural abnormalities Obesity Hypertension Smoking Heart failure What are some traits of narcolepsy? Dysfunction of processes that regulate sleep and wake states. Excessive daytime sleepiness is the most common complaint. What is cataplexy? Occurs in narcolepsy which is sudden muscle weakness during intense emotions. What are symptoms of sleep deprivation? Physiological symptoms: -blurred vision -clumsiness -decreased reflexes -slow response time -poor reasoning Psychological symptoms: -confusion -sensitivity to pain -irritability -agitated -decreased motivation What are some substances you should not have before bedtime? Alcohol, caffeine, sugary foods, and diuretics. ALCOHOL WILL WORK AS A DIURETIC AND WILL CAUSE BATHROOM USE THROUGHOUT NIGHT. What factors influence one's sleep? Drug and substances, lifestyle, unusual sleep patterns, emotional stress, environment, exercise, and food. What are the appropriate or healthy lengths one should and should not exercise before bed? YOU SHOULD NOT EXERCISE WITHIN 2 HOURS BEFORE BEDTIME. Exercise is OKAY AND GOOD if its TWO OR MORE HOURS BEFORE BEDTIME!!! What are some common topics the nurse should assess for sleep? -Nature of the problem -Signs and symptoms -Onset and duration -Severity -Predisposing factors -Effects on patient What are some questions the nurse should ask to patients with sleep apnea? -Do you or your family snore loudly? -Has anyone told you that you stop breathing during sleep? -Headaches when waking? What are some questions the nurse should ask to patients with narcolepsy? -Do you fall asleep at wrong times? -Losing muscle control or falling? -Vivid, lifelike dreams when sleeping? How to perform sleep hygiene in hospitalized patients? -Teamwork with nurses to develop sleep-hygiene protocol -Maintain the patient's sleep-wake cycle -Provide early physical therapy and mobility -Reduce lighting, telephone volumes, and conversations in hallways -Use hygiene measures such as personal hygiene, room temp, and relaxation methods -Educate family How can you control noise in the hospital for patient's sleep? -Close doors -Reduce telephone and equipment volume -Wear rubber-soled shoes -Turn off equipment -Turn down alarms -Turn off TV -Avoid loud noise SUCH AS FLUSHING TOILET -Quiet hallway conversation Sodium Levels 135-145mEq/L Potassium Levels 3.5-5.0mEq/L Calcium Levels 9.0-10.5mg/dL Phosphate Levels 3.0-4.5mg/dL Magnesium Levels 1.5-2.5mg/dL Chloride Levels 96-106mEq/dL pH Levels 7.35-7.45 A-B PaCO2 Levels 35-45 B-A PaHCO3 Levels 22-26 A-B O2 Saturation Level 95%-100% (92% if COPD) Normal Oral Fluids Daily mL Normal Foods Intake Daily 800-1000mL Metabolism Intake Per Day 300mL Total Fluid Intake Per Day mL Total Skin (insensible and sweat) Output Per Day 500-600mL Total Insensible Lung Output Per Day 400mL Total Gastrointestinal Output Per Day 100-200mL Total Urine Output Per Day mL Total Fluid Output Per Day mL ECF Volume Deficit Definition Body fluids have decreased volume but normal osmolality ECF Volume Excess Definition Body fluids have increased volume but normal osmolality Function of Potassium Allows normal cardiac function Function of Calcium Necessary for muscle contraction Excitability of nerve and muscle cells Function of Magnesium Function of neuromuscular junctions Function of Phosphate Production of ATP Energy source for cellular metabolism Hypernatremia High sodium in blood Hyponatremia Low sodium in blood Hyperkalemia High potassium Hypokalemia Low potassium Hypercalcemia High levels of calcium Hypocalcemia Low levels of calcium Hypermagnesemia High magnesium Hypomagnesemia Low magnesium Traits of respiratory acidosis -Alveolar hypoventilation -Lungs unable to excrete carbon dioxide -Pneumonia, airway obstruction, acute asthma -Impaired respiratory muscle, respiratory fatigue. Traits of Respiratory Alkalosis -Alveolar hyperventilation -Numbness of fingers and toes -Increase rate and depth of respirations Traits of Metabolic Acidosis -Ketoacidosis -Ingestion of acid -Abdominal pain Traits of Metabolic Alkalosis -Excessive vomiting Risk factors for fluid, electrolyte, and acid-base imbalances Very young Very old Diarrhea Vomiting Cancer COPD Traumas (burns, crushes, head injuries, hemorrhages) IV therapy Diuretics How many kilograms of weight gained or lost is equal to how many liters of fluid retained or lost? 1 kg (2.2pounds) gained or lost is equal to 1L of fluid gained or lost. (kg make u skinny!!!) What are sources of fluid intake? Oral, IV, blood transfusions. What are sources of fluid outtake? Skin/lungs/GI, sweat, urination, defecation, vomiting, breathing, wound drainage, NB tube drainage. Difference between self-concept and self-esteem? Self-concept is an individual's view of themselves and their role , while self-esteem is how they feel and value themselves. What is an example of self-concept and self-esteem? Self-concept: I think I'm a good student, because I'm good at time management. Self-Esteem: I have low self-esteem about tests, because I have test anxiety. What is role performance? How a person plays a role or what things they feel they are responsible for doing. What is an example of role performance? If a mom is the bread winner of the house, but now they have to get constant chemo which puts them out a job. What age do we start learning sexual maturity and examining our cultural values and beliefs? 12-19 years What are some common stressors that influence self-concept? Body Image (stroke, arthritis, anorexia nervosa, amputation, scarring) Identity (job loss, marital change, dependency on others, sexuality concerns) Role Performance (career/family imbalance, loss of job, promotion or demotion, change in work environment) What things should give the nurse red flags that the patient is struggling with self-concept? -Avoids eye contact -Slumped posture -Unkempt appearance -Overly apologetic -Frequent crying -Self-harm behaviors Sexual identity definition How a person thinks about himself or herself sexually. It includes gender identity, gender role, and sexual orientation. Sexual dysfunction definition Problems with arousal, desire, or orgasm. What are some sexuality stressors? STI, STD, sexual dysfunction What are some signs of abuse? Injuries (bruises, STI, UTI, pain, difficulty walking or sitting, odor) Behavior (excessive masturbation, physical aggression, social withdrawal, poor relationships, panic attacks, depression, anxiety) What is the goal of contraception? To not get pregnant What are questions the nurse could ask the patient regarding abortion? -What would life look like for you with the baby? With the abortion? -What is your support system? -Do you know someone who has had an abortion? What type of STIs can be cured? Which can't? Bacterial can be cured Viral, such as herpes and HIV, cannot. What can HPV lead to? Cervical cancer. There is a vaccine. Infertility The inability to conceive after 1 year of unprotected intercourse When do miscarriages typically occur and what does it occur from? First trimester (12 weeks) Occurs due to the baby not growing What is the best way to track someone's fluid status? Urine Output What is a sensible loss? Involved in urine output that is able to be MEASURED. If a patient is NPO but the nurse gives them ice chips, is that input? Yes What is the rule for ice chips? Whatever you give them is HALF. EX: If you give a full cup of ice chips, then it is actually a half cup. EX: If you give them 1L of ice chips, then it is actually 500mL. How would you measure fluid status? Fluid output What is the most accurate measure when taking fluid outputs and daily weights? Same clothes, same scale, and same time of day. Consistent. What are symptoms of a patient that is in fluid overload? SOB, nasal flaring, crackle of lungs, JVD distention. What is the main concern of potassium and what is the first thing to do with those whose levels are off? Monitor the heart and cardiac arrhythmias. STAT EKG What are we assessing when looking at sodium imbalances? Blood pressure What electrolyte relaxes as calcium contracts? Magnesium What gland regulates calcium levels? Parathyroid What would we check if a patient's calcium is off? Thyroid levels with blood draw What electrolyte typically gives a positive Chvostek? Calcium True/False: A Chvostek occurs in patients who are chronic alcohol users. TRUE True/False: We need to worry about compensation for this exam. FALSE Common class of medications for hypomagnesemia? Laxatives Common class of medications for hyperkalemia? ACE inhibitors Angiotensin II receptor blockers DIURETICS!!!!!!!!!!!!!! (potassium sparing) Penicillins Common class of medications for hyponatremia? Antidepressants SSRI DIURETICS!!!!!!!!!!!!!! (potassium wasting) NSAIDs Common class of medications for hypercalcemia? Calcium carbonate Common class of medications for hypokalemia? Corticosteroids DIURETICS (potassium sparing)!!!!!!!!!!!!!! Laxatives Penicillins Common class of medications for hypocalcemia? Laxatives Common class of medications for hypermagnesemia? Magnesium hydroxide How do you go about helping a patient solve a problem? Assess Diagnose Plan Implement Evaluate If a patient is down on themselves, what could a nurse ask to help them? "I'm a loser" Nurse: Tell me what are you good at/your positive traits? What is the perfect environment/when should the nurse have a difficult conversation with a patient? Private room, no interruptions, make sure you (the nurse) aren't tired or rushed, pay attention. How many pounds are in a kilogram? 1kg=2.2pounds kg make you skinny!!! Metabolic Acidosis -kidney problem, lungs compensate (blow off CO2) -diabetic ketoacidosis, kidney injury, diarrhea -HYPERVENTILATION -high respiratory rate, hyperkalemia (muscle twitch), confusion Metabolic Alkalosis -kidney problem, lungs compensate (keep CO2) -too many antacids, diuretics, vomiting -HYPOVENTILATION -decrease respiratory rate, hypokalemia (cramps, vomit, weakness) Respiratory Acidosis -lung problem (excessive CO2), kidneys compensate -Drugs (opioids, sedatives) Edema (fluid in lungs) Pneumonia Respiratory center of brain damaged Embolism (pulmonary) Spasms of the bronchi (asthma) Sac elasticity damage (COPD) -HYPOVENTILATION -high respiratory rate, sleepiness, headache Respiratory Alkalosis -lung problem (low CO2), kidney compensate -LOSS OF CO2 (hyperventilation, tachypnea, high temperature) -increased heart rate, chvosteks, confusion