NSG 430 FINAL: (Latest 2026/2027 Update) Renal, Cardiac, Neurological,
Shock, Hematology, Burns, Trauma | 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 the recommended fluid intake for a patient with pyelonephritis?
Correct Answer: More than 1 L to flush kidneys
1. Increased fluid intake (2-3 L/day) helps flush bacteria from the urinary tract.
2. Pyelonephritis treatment includes IV antibiotics, hydration, and antipyretics.
3. Monitor for urosepsis (fever, hypotension, altered mental status).
2. How is symptomatic bradycardia treated?
Correct Answer: Atropine, pacemaker
1. Atropine 0.5 mg IV q3-5 min (max 3 mg) is first-line for symptomatic bradycardia.
2. If atropine ineffective, transcutaneous pacing or transvenous pacemaker placement.
3. Identify and treat underlying cause (ischemia, medications, electrolyte abnormalities).
3. What is the significance of the Glasgow Coma Scale (GCS)?
Correct Answer: Any change in LOC should be concern; 15 is normal, 8 is not great, 3 is the lowest
1. GCS assesses eye opening, verbal response, and motor response.
2. GCS ≤8 indicates severe brain injury and need for intubation.
3. Serial GCS monitoring detects neurologic deterioration.
4. What is the early sign of increased intracranial pressure (ICP)?
Correct Answer: Restlessness (a change in level of consciousness)
1. Change in LOC is the earliest and most sensitive indicator of increased ICP.
2. Later signs: Cushing's triad (hypertension, bradycardia, irregular respirations).
3. Monitor for pupil changes, motor posturing, and vomiting.
5. What is Cushing's triad?
Correct Answer: Irregular breathing (bradypnea), bradycardia, increased systolic BP — a late sign of increased ICP
1. Cushing's triad indicates brainstem compression and failing compensation.
2. Widened pulse pressure due to rising systolic BP with stable diastolic.
3. Immediate intervention needed to prevent herniation.
6. What is the management priority for traumatic brain injury (TBI)?
Correct Answer: Repeat assessments, anything neuro
1. Frequent neurologic checks (GCS, pupils, motor function) detect deterioration.
2. Maintain cerebral perfusion pressure (CPP 60-70 mmHg), ICP <20 mmHg.
3. Prevent secondary injury: hypoxia, hypotension, hyperthermia, seizures.
, 7. What is the classic presentation of subarachnoid hemorrhage?
Correct Answer: "Worst headache of their life" — elevate HOB, do not limit calorie intake
1. Sudden, severe thunderclap headache from ruptured cerebral aneurysm.
2. Maintain HOB 30° to reduce ICP; monitor for rebleeding, vasospasm, hydrocephalus.
3. Nimodipine reduces vasospasm risk; avoid straining, Valsalva.
8. What are the characteristics of an epidural hematoma?
Correct Answer: Emergency; arterial; brief loss of consciousness and return to lucid state (lucid interval) followed
by rapid deterioration
1. Usually from middle meningeal artery tear; medical emergency requiring surgical evacuation.
2. Lucid interval lasts minutes to hours; then rapid decline with ipsilateral pupil dilation.
3. CT shows biconvex (lens-shaped) hyperdensity.
9. What is the most common cause of intracerebral hematoma?
Correct Answer: Hypertension (HTN)
1. Chronic hypertension causes microaneurysms (Charcot-Bouchard) rupture.
2. Common sites: basal ganglia, thalamus, pons, cerebellum.
3. Strict BP control prevents recurrence; anticoagulation reversal if applicable.
10. What are the characteristics of a subdural hematoma?
Correct Answer: Slower; venous; elderly, falls, alcoholics
1. Bridging vein rupture; acute (<48h), subacute (2-14 days), or chronic (weeks-months).
2. Chronic SDH mimics dementia in elderly; may present with confusion, headache, focal deficits.
3. CT shows crescent-shaped hyperdense (acute) or hypodense (chronic) collection.
11. What are the signs and symptoms of hypokalemia?
Correct Answer: Anorexia, fatigue, arrhythmia — "everything is slow when K+ is low"; replace K+, stop GI losses
1. Hypokalemia (<3.5 mEq/L): muscle weakness, ileus, ECG changes (U waves, flat T waves).
2. Replace potassium orally or IV (max 10 mEq/hr peripheral, 20 mEq/hr central).
3. Foods high in K+: potatoes, tomatoes, avocadoes, bananas, dark leafy greens.
12. What are the signs, symptoms, and treatment of hyperkalemia?
Correct Answer: Muscle weakness, oliguria, respiratory distress, decreased contractility, ECG changes, reflex
changes; above 7 is fatal; treatment "DICK" (D50, IV insulin, calcium gluconate, kayexalate)
1. ECG changes: peaked T waves, widened QRS, sine wave, ventricular fibrillation.
2. Calcium gluconate stabilizes cardiac membrane (acts within minutes).
3. Insulin + D50 shifts K+ into cells; kayexalate or dialysis removes K+.
13. What is the first sign of anaphylaxis?
Correct Answer: Shortness of breath (SOB) — respiratory distress is the earliest sign
1. Anaphylaxis: airway edema, bronchospasm, hypotension; call rapid response.
2. First-line: epinephrine IM (0.3-0.5 mg 1:1000).
3. High-flow oxygen; antihistamines and steroids as adjuncts.
14. A patient has chest pain and SOB — what is the priority action?
Correct Answer: 12-lead EKG within 10 minutes (think MI) and possible cath lab activation
1. Obtain ECG within 10 minutes of arrival for possible STEMI.
2. If ST elevation, activate cath lab for primary PCI (door-to-balloon <90 min).
3. Administer aspirin, nitroglycerin (if SBP >90), morphine for pain.
Shock, Hematology, Burns, Trauma | 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 the recommended fluid intake for a patient with pyelonephritis?
Correct Answer: More than 1 L to flush kidneys
1. Increased fluid intake (2-3 L/day) helps flush bacteria from the urinary tract.
2. Pyelonephritis treatment includes IV antibiotics, hydration, and antipyretics.
3. Monitor for urosepsis (fever, hypotension, altered mental status).
2. How is symptomatic bradycardia treated?
Correct Answer: Atropine, pacemaker
1. Atropine 0.5 mg IV q3-5 min (max 3 mg) is first-line for symptomatic bradycardia.
2. If atropine ineffective, transcutaneous pacing or transvenous pacemaker placement.
3. Identify and treat underlying cause (ischemia, medications, electrolyte abnormalities).
3. What is the significance of the Glasgow Coma Scale (GCS)?
Correct Answer: Any change in LOC should be concern; 15 is normal, 8 is not great, 3 is the lowest
1. GCS assesses eye opening, verbal response, and motor response.
2. GCS ≤8 indicates severe brain injury and need for intubation.
3. Serial GCS monitoring detects neurologic deterioration.
4. What is the early sign of increased intracranial pressure (ICP)?
Correct Answer: Restlessness (a change in level of consciousness)
1. Change in LOC is the earliest and most sensitive indicator of increased ICP.
2. Later signs: Cushing's triad (hypertension, bradycardia, irregular respirations).
3. Monitor for pupil changes, motor posturing, and vomiting.
5. What is Cushing's triad?
Correct Answer: Irregular breathing (bradypnea), bradycardia, increased systolic BP — a late sign of increased ICP
1. Cushing's triad indicates brainstem compression and failing compensation.
2. Widened pulse pressure due to rising systolic BP with stable diastolic.
3. Immediate intervention needed to prevent herniation.
6. What is the management priority for traumatic brain injury (TBI)?
Correct Answer: Repeat assessments, anything neuro
1. Frequent neurologic checks (GCS, pupils, motor function) detect deterioration.
2. Maintain cerebral perfusion pressure (CPP 60-70 mmHg), ICP <20 mmHg.
3. Prevent secondary injury: hypoxia, hypotension, hyperthermia, seizures.
, 7. What is the classic presentation of subarachnoid hemorrhage?
Correct Answer: "Worst headache of their life" — elevate HOB, do not limit calorie intake
1. Sudden, severe thunderclap headache from ruptured cerebral aneurysm.
2. Maintain HOB 30° to reduce ICP; monitor for rebleeding, vasospasm, hydrocephalus.
3. Nimodipine reduces vasospasm risk; avoid straining, Valsalva.
8. What are the characteristics of an epidural hematoma?
Correct Answer: Emergency; arterial; brief loss of consciousness and return to lucid state (lucid interval) followed
by rapid deterioration
1. Usually from middle meningeal artery tear; medical emergency requiring surgical evacuation.
2. Lucid interval lasts minutes to hours; then rapid decline with ipsilateral pupil dilation.
3. CT shows biconvex (lens-shaped) hyperdensity.
9. What is the most common cause of intracerebral hematoma?
Correct Answer: Hypertension (HTN)
1. Chronic hypertension causes microaneurysms (Charcot-Bouchard) rupture.
2. Common sites: basal ganglia, thalamus, pons, cerebellum.
3. Strict BP control prevents recurrence; anticoagulation reversal if applicable.
10. What are the characteristics of a subdural hematoma?
Correct Answer: Slower; venous; elderly, falls, alcoholics
1. Bridging vein rupture; acute (<48h), subacute (2-14 days), or chronic (weeks-months).
2. Chronic SDH mimics dementia in elderly; may present with confusion, headache, focal deficits.
3. CT shows crescent-shaped hyperdense (acute) or hypodense (chronic) collection.
11. What are the signs and symptoms of hypokalemia?
Correct Answer: Anorexia, fatigue, arrhythmia — "everything is slow when K+ is low"; replace K+, stop GI losses
1. Hypokalemia (<3.5 mEq/L): muscle weakness, ileus, ECG changes (U waves, flat T waves).
2. Replace potassium orally or IV (max 10 mEq/hr peripheral, 20 mEq/hr central).
3. Foods high in K+: potatoes, tomatoes, avocadoes, bananas, dark leafy greens.
12. What are the signs, symptoms, and treatment of hyperkalemia?
Correct Answer: Muscle weakness, oliguria, respiratory distress, decreased contractility, ECG changes, reflex
changes; above 7 is fatal; treatment "DICK" (D50, IV insulin, calcium gluconate, kayexalate)
1. ECG changes: peaked T waves, widened QRS, sine wave, ventricular fibrillation.
2. Calcium gluconate stabilizes cardiac membrane (acts within minutes).
3. Insulin + D50 shifts K+ into cells; kayexalate or dialysis removes K+.
13. What is the first sign of anaphylaxis?
Correct Answer: Shortness of breath (SOB) — respiratory distress is the earliest sign
1. Anaphylaxis: airway edema, bronchospasm, hypotension; call rapid response.
2. First-line: epinephrine IM (0.3-0.5 mg 1:1000).
3. High-flow oxygen; antihistamines and steroids as adjuncts.
14. A patient has chest pain and SOB — what is the priority action?
Correct Answer: 12-lead EKG within 10 minutes (think MI) and possible cath lab activation
1. Obtain ECG within 10 minutes of arrival for possible STEMI.
2. If ST elevation, activate cath lab for primary PCI (door-to-balloon <90 min).
3. Administer aspirin, nitroglycerin (if SBP >90), morphine for pain.
