NSG 430 Exam 2: (Latest 2026/2027 Update) Heart Failure, Valvular
Disorders, Acute Kidney Injury, & Renal Emergencies | Q&A | Grade A |
100% Correct (Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical Nursing / Critical Care
Source: NSG 430 Exam 2 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is acute decompensated heart failure (ADHF)?
Correct Answer: Sudden worsening of chronic HF → decreased CO and pulmonary/systemic
congestion; causes dyspnea, crackles, pink frothy sputum
1. ADHF is an acute exacerbation of chronic heart failure often triggered by non-adherence, ischemia, infection,
or high sodium intake.
2. Pulmonary congestion leads to dyspnea, orthopnea, crackles; pink frothy sputum indicates severe pulmonary
edema.
3. Immediate treatment: high Fowler's, oxygen, IV diuretics, vasodilators, and possibly inotropes.
2. What are key diagnostics and management strategies for ADHF?
Correct Answer: Increased BNP (>100), echocardiogram, chest X-ray; treat with O2, IV loop
diuretics, vasodilators, inotropes, morphine; monitor weights and I&O
1. BNP >100 pg/mL indicates heart failure; echo assesses EF and valve function; CXR shows pulmonary
congestion/cardiomegaly.
2. Loop diuretics (furosemide) reduce preload; vasodilators (nitroglycerin) reduce afterload; inotropes
(dobutamine) for low CO.
3. Daily weights (2-3 lb/day loss goal) and strict I&O guide diuretic therapy.
3. What are nursing priorities in ADHF?
Correct Answer: Reduce preload and afterload, improve gas exchange, daily weights, sodium
restriction (2g/day)
1. Preload reduction: diuretics, venodilators (nitro), position (high Fowler's). Afterload reduction: ACE inhibitors,
hydralazine, nitroprusside.
2. Improve gas exchange: O2, NIV (CPAP/BiPAP) for severe dyspnea.
3. Sodium <2 g/day reduces fluid retention; monitor for hypokalemia from diuretics.
4. What is cardiogenic shock?
Correct Answer: Severe LV failure after MI → decreased CO and tissue hypoperfusion; requires
vasopressors, fluids with caution, IABP/VAD support
1. Cardiogenic shock occurs when >40% of LV myocardium is damaged (typically from massive MI).
2. Hemodynamics: CI <2.2 L/min/m², PAWP >15 mmHg, SBP <90 mmHg.
3. Treatment: revascularization (PCI/CABG), inotropes/vasopressors, IABP, or temporary VAD (Impella, ECMO).
, 5. What are classic signs of cardiogenic shock?
Correct Answer: Hypotension, tachycardia, cold clammy skin, low UOP, increased PAWP,
decreased CO
1. Hypotension (SBP <90 mmHg) with signs of poor perfusion: altered mental status, oliguria (<0.5 mL/kg/hr),
cool extremities.
2. PAWP >15 mmHg indicates elevated LV filling pressure; CI <2.2 L/min/m² confirms low output.
3. Distinguish from hypovolemic shock (low PAWP) and distributive shock (warm extremities).
6. What causes infective endocarditis and how is it managed?
Correct Answer: Bacterial infection of valves (IV drug use, prosthetic valves); fever, murmur,
embolic signs; IV abx 4-6 weeks and possible valve surgery
1. Common organisms: Staph aureus (acute), Strep viridans (subacute). Risk factors: IV drug use, prosthetic
valves, poor dentition.
2. Diagnosis: blood cultures (3 sets), TEE for vegetations; Duke criteria.
3. IV antibiotics (4-6 weeks) based on culture; surgery for heart failure, abscess, or recurrent emboli.
7. What are pericarditis hallmarks and complications?
Correct Answer: Sharp pain increased with inspiration, relieved by leaning forward, pericardial
friction rub; risk for tamponade (Beck's triad)
1. Pericarditis pain: pleuritic, worse supine, relieved sitting/leaning forward; friction rub on auscultation.
2. Complications: pericardial effusion → cardiac tamponade (hypotension, JVD, muffled sounds).
3. Treatment: NSAIDs, colchicine; corticosteroids if refractory.
8. What is Beck's triad?
Correct Answer: Hypotension, muffled heart sounds, jugular venous distention (characteristic for
cardiac tamponade)
1. Beck's triad indicates cardiac tamponade from pericardial effusion compressing the heart.
2. Additional finding: pulsus paradoxus (inspiratory drop in BP >10 mmHg).
3. Emergency treatment: pericardiocentesis or pericardial window.
9. What are main valvular disorders and their unique features?
Correct Answer: Mitral Stenosis (loud S1, diastolic murmur); Mitral Regurgitation (S3, holosystolic
murmur); Aortic Stenosis (triad: angina, syncope, dyspnea); Aortic Regurgitation (bounding pulse)
1. Mitral stenosis: opening snap, diastolic rumble; causes LA enlargement, AF, dyspnea.
2. Aortic stenosis: harsh systolic murmur radiating to carotids; syncope with exertion.
3. Aortic regurgitation: decrescendo diastolic murmur, widened pulse pressure, water-hammer pulse.
10. What are key teachings after valve replacement?
Correct Answer: Lifelong warfarin for mechanical valves, antibiotic prophylaxis before dental work,
monitor for heart failure
1. Mechanical valves require lifelong warfarin (INR 2.5-3.5) to prevent thromboembolism.
2. Bioprosthetic valves require anticoagulation for 3-6 months only but both require antibiotic prophylaxis
before dental procedures.
3. Monitor for signs of valve dysfunction or HF (dyspnea, edema, new murmur).
Disorders, Acute Kidney Injury, & Renal Emergencies | Q&A | Grade A |
100% Correct (Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical Nursing / Critical Care
Source: NSG 430 Exam 2 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is acute decompensated heart failure (ADHF)?
Correct Answer: Sudden worsening of chronic HF → decreased CO and pulmonary/systemic
congestion; causes dyspnea, crackles, pink frothy sputum
1. ADHF is an acute exacerbation of chronic heart failure often triggered by non-adherence, ischemia, infection,
or high sodium intake.
2. Pulmonary congestion leads to dyspnea, orthopnea, crackles; pink frothy sputum indicates severe pulmonary
edema.
3. Immediate treatment: high Fowler's, oxygen, IV diuretics, vasodilators, and possibly inotropes.
2. What are key diagnostics and management strategies for ADHF?
Correct Answer: Increased BNP (>100), echocardiogram, chest X-ray; treat with O2, IV loop
diuretics, vasodilators, inotropes, morphine; monitor weights and I&O
1. BNP >100 pg/mL indicates heart failure; echo assesses EF and valve function; CXR shows pulmonary
congestion/cardiomegaly.
2. Loop diuretics (furosemide) reduce preload; vasodilators (nitroglycerin) reduce afterload; inotropes
(dobutamine) for low CO.
3. Daily weights (2-3 lb/day loss goal) and strict I&O guide diuretic therapy.
3. What are nursing priorities in ADHF?
Correct Answer: Reduce preload and afterload, improve gas exchange, daily weights, sodium
restriction (2g/day)
1. Preload reduction: diuretics, venodilators (nitro), position (high Fowler's). Afterload reduction: ACE inhibitors,
hydralazine, nitroprusside.
2. Improve gas exchange: O2, NIV (CPAP/BiPAP) for severe dyspnea.
3. Sodium <2 g/day reduces fluid retention; monitor for hypokalemia from diuretics.
4. What is cardiogenic shock?
Correct Answer: Severe LV failure after MI → decreased CO and tissue hypoperfusion; requires
vasopressors, fluids with caution, IABP/VAD support
1. Cardiogenic shock occurs when >40% of LV myocardium is damaged (typically from massive MI).
2. Hemodynamics: CI <2.2 L/min/m², PAWP >15 mmHg, SBP <90 mmHg.
3. Treatment: revascularization (PCI/CABG), inotropes/vasopressors, IABP, or temporary VAD (Impella, ECMO).
, 5. What are classic signs of cardiogenic shock?
Correct Answer: Hypotension, tachycardia, cold clammy skin, low UOP, increased PAWP,
decreased CO
1. Hypotension (SBP <90 mmHg) with signs of poor perfusion: altered mental status, oliguria (<0.5 mL/kg/hr),
cool extremities.
2. PAWP >15 mmHg indicates elevated LV filling pressure; CI <2.2 L/min/m² confirms low output.
3. Distinguish from hypovolemic shock (low PAWP) and distributive shock (warm extremities).
6. What causes infective endocarditis and how is it managed?
Correct Answer: Bacterial infection of valves (IV drug use, prosthetic valves); fever, murmur,
embolic signs; IV abx 4-6 weeks and possible valve surgery
1. Common organisms: Staph aureus (acute), Strep viridans (subacute). Risk factors: IV drug use, prosthetic
valves, poor dentition.
2. Diagnosis: blood cultures (3 sets), TEE for vegetations; Duke criteria.
3. IV antibiotics (4-6 weeks) based on culture; surgery for heart failure, abscess, or recurrent emboli.
7. What are pericarditis hallmarks and complications?
Correct Answer: Sharp pain increased with inspiration, relieved by leaning forward, pericardial
friction rub; risk for tamponade (Beck's triad)
1. Pericarditis pain: pleuritic, worse supine, relieved sitting/leaning forward; friction rub on auscultation.
2. Complications: pericardial effusion → cardiac tamponade (hypotension, JVD, muffled sounds).
3. Treatment: NSAIDs, colchicine; corticosteroids if refractory.
8. What is Beck's triad?
Correct Answer: Hypotension, muffled heart sounds, jugular venous distention (characteristic for
cardiac tamponade)
1. Beck's triad indicates cardiac tamponade from pericardial effusion compressing the heart.
2. Additional finding: pulsus paradoxus (inspiratory drop in BP >10 mmHg).
3. Emergency treatment: pericardiocentesis or pericardial window.
9. What are main valvular disorders and their unique features?
Correct Answer: Mitral Stenosis (loud S1, diastolic murmur); Mitral Regurgitation (S3, holosystolic
murmur); Aortic Stenosis (triad: angina, syncope, dyspnea); Aortic Regurgitation (bounding pulse)
1. Mitral stenosis: opening snap, diastolic rumble; causes LA enlargement, AF, dyspnea.
2. Aortic stenosis: harsh systolic murmur radiating to carotids; syncope with exertion.
3. Aortic regurgitation: decrescendo diastolic murmur, widened pulse pressure, water-hammer pulse.
10. What are key teachings after valve replacement?
Correct Answer: Lifelong warfarin for mechanical valves, antibiotic prophylaxis before dental work,
monitor for heart failure
1. Mechanical valves require lifelong warfarin (INR 2.5-3.5) to prevent thromboembolism.
2. Bioprosthetic valves require anticoagulation for 3-6 months only but both require antibiotic prophylaxis
before dental procedures.
3. Monitor for signs of valve dysfunction or HF (dyspnea, edema, new murmur).
