NSG 430 Final: (Latest 2026/2027 Update) Liver Failure, Hepatitis,
Pancreatitis, Burns, & Dermatologic Emergencies | Q&A | Grade A | 100%
Correct (Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical / Critical Care FINAL
Source: NSG 430 Final Blueprint 2026/2027 Format: Q&A Guide with Rationale | Verified Grade A
1. What is cirrhosis?
Correct Answer: End stage of liver disease with fibrosis and nodular regeneration
1. Cirrhosis results from chronic liver injury → fibrosis → loss of liver function.
2. Most common causes in US: hepatitis C and alcohol-induced liver disease.
3. Other causes: biliary cirrhosis, cardiac cirrhosis (right-sided HF), NASH.
2. What are early symptoms of liver cirrhosis?
Correct Answer: Fatigue and enlarged liver (hepatomegaly)
1. Early: fatigue, weakness, anorexia, nausea, hepatomegaly, weight loss.
2. Late signs: jaundice, peripheral edema, ascites, spider angiomas, palmar erythema.
3. Lab abnormalities: low RBC/WBC/platelets (hypersplenism), low thiamin/folate/B12.
3. What are late symptoms and complications of portal hypertension in cirrhosis?
Correct Answer: Portal hypertension, esophageal and gastric varices, peripheral edema, ascites, hepatic
encephalopathy, hepatorenal syndrome (renal failure)
1. Portal hypertension leads to varices (life-threatening hemorrhage risk).
2. Splenomegaly, ascites, and hepatic encephalopathy from ammonia accumulation.
3. Hepatorenal syndrome: renal failure with normal kidney structure; poor prognosis.
4. What is the most life-threatening complication of liver cirrhosis?
Correct Answer: Ruptured esophageal varices (hemorrhage)
1. Variceal hemorrhage has high mortality; presents with hematemesis, melena, hypotension.
2. Treatment: octreotide, endoscopic band ligation, balloon tamponade if refractory.
3. Prevention: nonselective beta-blockers (propranolol, nadolol).
5. How is ascites treated?
Correct Answer: Paracentesis, diuretics (spironolactone + furosemide), albumin infusion
1. Sodium restriction (<2 g/day) first-line; spironolactone (aldosterone antagonist) preferred.
2. Large-volume paracentesis with albumin infusion to prevent post-paracentesis circulatory dysfunction.
3. TIPS (transjugular intrahepatic portosystemic shunt) for refractory ascites.
6. What is spontaneous bacterial peritonitis (SBP)?
Correct Answer: Bacterial infection of ascitic fluid caused by altered immune function in cirrhosis, common after
variceal hemorrhage
1. SBP presents with fever, abdominal pain, altered mental status, worsening ascites.
2. Diagnosis: ascitic fluid PMN >250/mm³; empiric antibiotics (cefotaxime, ceftriaxone).
3. Prophylaxis: norfloxacin or TMP-SMX for high-risk patients.
, 7. What causes hepatic encephalopathy?
Correct Answer: High ammonia levels (from gut bacteria metabolizing protein)
1. Liver failure → inability to detoxify ammonia → neurotoxicity.
2. Triggers: GI bleeding, infection, constipation, electrolyte imbalance, medication nonadherence.
3. Treatment: lactulose (acidifies colon, traps ammonia), rifaximin (decreases ammonia-producing bacteria).
8. What are signs and symptoms of hepatic encephalopathy?
Correct Answer: Changes in neurologic/mental responsiveness, impaired consciousness, sleep disturbances, coma,
asterixis (flapping tremor), apraxia (difficulty writing left to right), fetor hepaticus (musty sweet breath odor)
1. Early: subtle personality changes, reversed sleep-wake cycle, confusion.
2. Asterixis (liver flap) - most common in arms/hands; test by having patient dorsiflex wrists.
3. Fetor hepaticus: musty, sweet odor from mercaptans.
9. What is the treatment for hepatic encephalopathy?
Correct Answer: Lactulose (Cephulac) and rifaximin (Xifaxan)
1. Lactulose promotes ammonia excretion (goal: 2-3 soft stools/day).
2. Rifaximin (antibiotic) reduces ammonia-producing gut bacteria.
3. Identify and treat precipitating cause (infection, bleeding, electrolyte abnormality).
10. What is hepatorenal syndrome?
Correct Answer: Renal failure with azotemia, oliguria, and intractable ascites; structurally normal kidneys
1. Type 1: rapid progressive renal failure (poor prognosis).
2. Type 2: gradual renal impairment associated with refractory ascites.
3. Treatment: liver transplantation (definitive), vasoconstrictors (terlipressin, norepinephrine) + albumin.
11. In what position should the post-liver biopsy patient lay and why?
Correct Answer: Right side to prevent bleeding by compressing the puncture site
1. Patient lies on right side for 2-4 hours post-biopsy to apply pressure.
2. Monitor for bleeding (hypotension, tachycardia, falling Hgb, abdominal pain).p>3. Check vital signs q15min x4, then
q30min x2, then hourly.
12. What is the most life-threatening complication of liver cirrhosis?
Correct Answer: Ruptured esophageal varices (hemorrhage)
1. Variceal bleeding presents with hematemesis, melena, hypotension, tachycardia.
2. Do NOT insert NG tube in suspected varices (can precipitate bleeding).
3. Emergency treatment: stabilize ABCs, octreotide, endoscopic band ligation.
13. True or false: The nurse should insert an NG tube if a patient has a ruptured esophageal varices.
Correct Answer: FALSE - NEVER insert NG tube in a patient with known esophageal varices (risk of
perforation/bleeding)
1. NG tube can traumatize varices and worsen bleeding.
2. If needed for decompression, place gently under direct visualization (endoscopy).
3. Manage airway, provide IV access, blood products, and prepare for endoscopy.
14. What is the preferred vasoconstrictor for actively bleeding esophageal varices?
Correct Answer: Octreotide (synthetic somatostatin analog) – reduces portal pressure
1. Octreotide preferred over vasopressin (fewer side effects: less cardiac ischemia).
2. Continue for 2-5 days after initial control; combine with endoscopic therapy.
3. Vasopressin plus nitroglycerin used if octreotide unavailable.
Pancreatitis, Burns, & Dermatologic Emergencies | Q&A | Grade A | 100%
Correct (Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical / Critical Care FINAL
Source: NSG 430 Final Blueprint 2026/2027 Format: Q&A Guide with Rationale | Verified Grade A
1. What is cirrhosis?
Correct Answer: End stage of liver disease with fibrosis and nodular regeneration
1. Cirrhosis results from chronic liver injury → fibrosis → loss of liver function.
2. Most common causes in US: hepatitis C and alcohol-induced liver disease.
3. Other causes: biliary cirrhosis, cardiac cirrhosis (right-sided HF), NASH.
2. What are early symptoms of liver cirrhosis?
Correct Answer: Fatigue and enlarged liver (hepatomegaly)
1. Early: fatigue, weakness, anorexia, nausea, hepatomegaly, weight loss.
2. Late signs: jaundice, peripheral edema, ascites, spider angiomas, palmar erythema.
3. Lab abnormalities: low RBC/WBC/platelets (hypersplenism), low thiamin/folate/B12.
3. What are late symptoms and complications of portal hypertension in cirrhosis?
Correct Answer: Portal hypertension, esophageal and gastric varices, peripheral edema, ascites, hepatic
encephalopathy, hepatorenal syndrome (renal failure)
1. Portal hypertension leads to varices (life-threatening hemorrhage risk).
2. Splenomegaly, ascites, and hepatic encephalopathy from ammonia accumulation.
3. Hepatorenal syndrome: renal failure with normal kidney structure; poor prognosis.
4. What is the most life-threatening complication of liver cirrhosis?
Correct Answer: Ruptured esophageal varices (hemorrhage)
1. Variceal hemorrhage has high mortality; presents with hematemesis, melena, hypotension.
2. Treatment: octreotide, endoscopic band ligation, balloon tamponade if refractory.
3. Prevention: nonselective beta-blockers (propranolol, nadolol).
5. How is ascites treated?
Correct Answer: Paracentesis, diuretics (spironolactone + furosemide), albumin infusion
1. Sodium restriction (<2 g/day) first-line; spironolactone (aldosterone antagonist) preferred.
2. Large-volume paracentesis with albumin infusion to prevent post-paracentesis circulatory dysfunction.
3. TIPS (transjugular intrahepatic portosystemic shunt) for refractory ascites.
6. What is spontaneous bacterial peritonitis (SBP)?
Correct Answer: Bacterial infection of ascitic fluid caused by altered immune function in cirrhosis, common after
variceal hemorrhage
1. SBP presents with fever, abdominal pain, altered mental status, worsening ascites.
2. Diagnosis: ascitic fluid PMN >250/mm³; empiric antibiotics (cefotaxime, ceftriaxone).
3. Prophylaxis: norfloxacin or TMP-SMX for high-risk patients.
, 7. What causes hepatic encephalopathy?
Correct Answer: High ammonia levels (from gut bacteria metabolizing protein)
1. Liver failure → inability to detoxify ammonia → neurotoxicity.
2. Triggers: GI bleeding, infection, constipation, electrolyte imbalance, medication nonadherence.
3. Treatment: lactulose (acidifies colon, traps ammonia), rifaximin (decreases ammonia-producing bacteria).
8. What are signs and symptoms of hepatic encephalopathy?
Correct Answer: Changes in neurologic/mental responsiveness, impaired consciousness, sleep disturbances, coma,
asterixis (flapping tremor), apraxia (difficulty writing left to right), fetor hepaticus (musty sweet breath odor)
1. Early: subtle personality changes, reversed sleep-wake cycle, confusion.
2. Asterixis (liver flap) - most common in arms/hands; test by having patient dorsiflex wrists.
3. Fetor hepaticus: musty, sweet odor from mercaptans.
9. What is the treatment for hepatic encephalopathy?
Correct Answer: Lactulose (Cephulac) and rifaximin (Xifaxan)
1. Lactulose promotes ammonia excretion (goal: 2-3 soft stools/day).
2. Rifaximin (antibiotic) reduces ammonia-producing gut bacteria.
3. Identify and treat precipitating cause (infection, bleeding, electrolyte abnormality).
10. What is hepatorenal syndrome?
Correct Answer: Renal failure with azotemia, oliguria, and intractable ascites; structurally normal kidneys
1. Type 1: rapid progressive renal failure (poor prognosis).
2. Type 2: gradual renal impairment associated with refractory ascites.
3. Treatment: liver transplantation (definitive), vasoconstrictors (terlipressin, norepinephrine) + albumin.
11. In what position should the post-liver biopsy patient lay and why?
Correct Answer: Right side to prevent bleeding by compressing the puncture site
1. Patient lies on right side for 2-4 hours post-biopsy to apply pressure.
2. Monitor for bleeding (hypotension, tachycardia, falling Hgb, abdominal pain).p>3. Check vital signs q15min x4, then
q30min x2, then hourly.
12. What is the most life-threatening complication of liver cirrhosis?
Correct Answer: Ruptured esophageal varices (hemorrhage)
1. Variceal bleeding presents with hematemesis, melena, hypotension, tachycardia.
2. Do NOT insert NG tube in suspected varices (can precipitate bleeding).
3. Emergency treatment: stabilize ABCs, octreotide, endoscopic band ligation.
13. True or false: The nurse should insert an NG tube if a patient has a ruptured esophageal varices.
Correct Answer: FALSE - NEVER insert NG tube in a patient with known esophageal varices (risk of
perforation/bleeding)
1. NG tube can traumatize varices and worsen bleeding.
2. If needed for decompression, place gently under direct visualization (endoscopy).
3. Manage airway, provide IV access, blood products, and prepare for endoscopy.
14. What is the preferred vasoconstrictor for actively bleeding esophageal varices?
Correct Answer: Octreotide (synthetic somatostatin analog) – reduces portal pressure
1. Octreotide preferred over vasopressin (fewer side effects: less cardiac ischemia).
2. Continue for 2-5 days after initial control; combine with endoscopic therapy.
3. Vasopressin plus nitroglycerin used if octreotide unavailable.
