NSG-430 Exam 1: (Latest 2026/2027 Update) Endocrine, Hemodynamics,
Respiratory & Critical Care | Q&A | Grade A | 100% Correct (Verified
Answers) – Nursing Program
Subject: NSG-430 – Advanced Medical-Surgical / Critical Care
Source: NSG-430 Exam 1 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the definition of brain death?
Correct Answer: When the whole brain (brainstem and cortex) cease activity OR when the cortex
ceases activity
1. Brain death includes irreversible loss of all brain functions including brainstem reflexes and capacity to
breathe.
2. Cortical death alone (persistent vegetative state) is not legal brain death; whole-brain standard required in
most jurisdictions.
3. Confirmatory tests (EEG, cerebral blood flow) may be used.
2. What are Cheyne-Stokes respirations?
Correct Answer: Alternating rapid & apnea
1. Characterized by crescendo-decrescendo breathing pattern followed by periods of apnea (10-60 sec).
2. Typically seen in heart failure, brainstem injury, or end-of-life; reflects delayed feedback in respiratory
control.
3. Not a normal finding; may indicate neurologic compromise.
3. What is a death rattle?
Correct Answer: Stuck secretions, unable to cough
1. Caused by accumulation of oropharyngeal secretions due to weak cough and swallowing reflexes.
2. Managed with positioning (side-lying), anticholinergics (glycopyrrolate, scopolamine), not routine suctioning.
3. Does not indicate suffering; family education is key.
4. Which sense stays the longest near end of life?
Correct Answer: Hearing
1. Hearing is the last sense to be lost; speak as if patient can hear even if unconscious.
2. Encourage family to talk, play familiar music; assume patient hears until proven otherwise.
3. Avoid loud or negative conversations at bedside.
5. What is one notable skin finding prior to death?
Correct Answer: Waxlike skin
1. Waxlike, pale, or mottled skin due to decreased peripheral perfusion and circulatory shutdown.
2. Often accompanied by coolness beginning in distal extremities progressing centrally.
3. Irreversible sign; indicates hours to days before death.
,6. What is one notable musculoskeletal finding prior to death?
Correct Answer: Slow flaccid paralysis
1. Progressive loss of muscle tone, inability to move or maintain posture due to CNS depression.
2. Often associated with loss of gag reflex, drooping of jaw, and difficulty swallowing.
3. Positioning and oral care become essential to maintain dignity.
7. What are the implications of medication administration nearing death?
Correct Answer: Delayed absorption of IM and SQ meds
1. Peripheral vasoconstriction and poor perfusion reduce absorption from IM/SQ sites.
2. Sublingual, rectal, or IV routes preferred if symptom management required.
3. Anticipate delayed onset; avoid repeated dosing that can lead to toxicity when circulation returns.
8. What is the principle of double effect in palliative care?
Correct Answer: It is okay to give a med that causes harm if it is relieving pain
1. Ethical principle allowing medication that may hasten death (respiratory depression) if primary intent is
pain/symptom relief.
2. Requires that harm is not intended, the benefit outweighs risk, and no alternative exists.
3. Supports aggressive symptom management at end of life.
9. What are four common fears at end of life?
Correct Answer: Pain, shortness of breath, loneliness, meaningless
1. Pain and dyspnea are physical fears; loneliness and meaninglessness are existential/spiritual.
2. Comprehensive palliative care addresses all four with symptom management, presence of family, and
spiritual support.
3. Assessing and validating fears improves quality of dying.
10. What does SaO2 represent?
Correct Answer: Oxygen saturation of arterial blood
1. SaO2 measures percentage of hemoglobin saturated with oxygen in arterial blood; normal 95-100%.
2. SpO2 (pulse oximetry) provides non-invasive estimate; ABG gives direct SaO2.
3. Values below 90% indicate hypoxemia requiring intervention.
11. What does SvO2 represent?
Correct Answer: Mixed venous O2 saturation
1. SvO2 reflects oxygen extraction by tissues; normal 60-80% at rest.
2. Low SvO2 indicates increased extraction (shock, low cardiac output); high SvO2 indicates decreased
extraction (sepsis, shunting).
3. Measured via pulmonary artery catheter.
12. What is SVR (systemic vascular resistance)?
Correct Answer: Opposition to blood flow by systemic vasculature; pressure goes up during
vasoconstriction and down during vasodilation
1. SVR = (MAP-CVP)/CO × 80; reflects left ventricular afterload.
2. Increased in hypovolemia, vasopressors, heart failure; decreased in sepsis, anaphylaxis.
3. Calculated from hemodynamic parameters.
, 13. What is PVR (pulmonary vascular resistance)?
Correct Answer: Opposition to blood flow by pulmonary vasculature; pressure goes up during
vasoconstriction and down during vasodilation
1. PVR = (mPAP-PAWP)/CO × 80; reflects right ventricular afterload.
2. Increased in pulmonary hypertension, PE, hypoxia; decreased with vasodilators.
3. Elevated PVR can cause right heart failure.
14. What is afterload?
Correct Answer: How much fluid when the heart contracts
1. Afterload is the resistance the ventricle must overcome to eject blood (systemic or pulmonary vascular
resistance).
2. Increased afterload increases myocardial work and oxygen demand; decreased afterload improves stroke
volume.
3. Managed with vasodilators (afterload reduction) in heart failure.
15. What is preload?
Correct Answer: How much fluid when the heart is relaxed
1. Preload is ventricular end-diastolic volume (stretch on myocytes before contraction).
2. Estimated by CVP (right) or PAWP (left); increased in fluid overload, decreased in hypovolemia.
3. Diuretics and vasodilators reduce preload in heart failure.
16. What is the purpose of continuous flush irrigation in pressure monitoring?
Correct Answer: Maintains line patency; there is no fluid running in an open artery
1. Continuous flush (3-5 mL/hr) prevents thrombus formation in arterial/central lines.
2. Pressurized bag at 300 mmHg ensures flow against arterial pressure; keeps catheter patent.
3. Prevents clotting and maintains waveform accuracy.
17. What assessment is performed for an arterial line (A-line)?
Correct Answer: Allen test; ensure the a-line does not obstruct the perfusion in the hand
1. Modified Allen test confirms collateral circulation (ulnar artery) before radial artery cannulation.
2. Positive test: hand color returns within 5-10 seconds after releasing ulnar compression.
3. Prevents hand ischemia if radial artery thromboses.
18. What does a transducer do in hemodynamic monitoring?
Correct Answer: Translates waveform
1. Converts mechanical pressure from blood column into electrical signal displayed as waveform and numerical
value.
2. Must be zeroed at phlebostatic axis level; positioned correctly to avoid artifact.
3. Dynamic response testing (square wave) verifies accuracy.
19. What is the phlebostatic axis?
Correct Answer: Heart level, used for transducer
1. Intersection of 4th intercostal space at mid-anterior-posterior chest diameter; approximates right atrial level.
2. Transducer placed at this level ensures accurate pressure readings; every 2 cm off level = 1.5 mmHg error.
3. Re-level and re-zero after patient repositioning.
Respiratory & Critical Care | Q&A | Grade A | 100% Correct (Verified
Answers) – Nursing Program
Subject: NSG-430 – Advanced Medical-Surgical / Critical Care
Source: NSG-430 Exam 1 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What is the definition of brain death?
Correct Answer: When the whole brain (brainstem and cortex) cease activity OR when the cortex
ceases activity
1. Brain death includes irreversible loss of all brain functions including brainstem reflexes and capacity to
breathe.
2. Cortical death alone (persistent vegetative state) is not legal brain death; whole-brain standard required in
most jurisdictions.
3. Confirmatory tests (EEG, cerebral blood flow) may be used.
2. What are Cheyne-Stokes respirations?
Correct Answer: Alternating rapid & apnea
1. Characterized by crescendo-decrescendo breathing pattern followed by periods of apnea (10-60 sec).
2. Typically seen in heart failure, brainstem injury, or end-of-life; reflects delayed feedback in respiratory
control.
3. Not a normal finding; may indicate neurologic compromise.
3. What is a death rattle?
Correct Answer: Stuck secretions, unable to cough
1. Caused by accumulation of oropharyngeal secretions due to weak cough and swallowing reflexes.
2. Managed with positioning (side-lying), anticholinergics (glycopyrrolate, scopolamine), not routine suctioning.
3. Does not indicate suffering; family education is key.
4. Which sense stays the longest near end of life?
Correct Answer: Hearing
1. Hearing is the last sense to be lost; speak as if patient can hear even if unconscious.
2. Encourage family to talk, play familiar music; assume patient hears until proven otherwise.
3. Avoid loud or negative conversations at bedside.
5. What is one notable skin finding prior to death?
Correct Answer: Waxlike skin
1. Waxlike, pale, or mottled skin due to decreased peripheral perfusion and circulatory shutdown.
2. Often accompanied by coolness beginning in distal extremities progressing centrally.
3. Irreversible sign; indicates hours to days before death.
,6. What is one notable musculoskeletal finding prior to death?
Correct Answer: Slow flaccid paralysis
1. Progressive loss of muscle tone, inability to move or maintain posture due to CNS depression.
2. Often associated with loss of gag reflex, drooping of jaw, and difficulty swallowing.
3. Positioning and oral care become essential to maintain dignity.
7. What are the implications of medication administration nearing death?
Correct Answer: Delayed absorption of IM and SQ meds
1. Peripheral vasoconstriction and poor perfusion reduce absorption from IM/SQ sites.
2. Sublingual, rectal, or IV routes preferred if symptom management required.
3. Anticipate delayed onset; avoid repeated dosing that can lead to toxicity when circulation returns.
8. What is the principle of double effect in palliative care?
Correct Answer: It is okay to give a med that causes harm if it is relieving pain
1. Ethical principle allowing medication that may hasten death (respiratory depression) if primary intent is
pain/symptom relief.
2. Requires that harm is not intended, the benefit outweighs risk, and no alternative exists.
3. Supports aggressive symptom management at end of life.
9. What are four common fears at end of life?
Correct Answer: Pain, shortness of breath, loneliness, meaningless
1. Pain and dyspnea are physical fears; loneliness and meaninglessness are existential/spiritual.
2. Comprehensive palliative care addresses all four with symptom management, presence of family, and
spiritual support.
3. Assessing and validating fears improves quality of dying.
10. What does SaO2 represent?
Correct Answer: Oxygen saturation of arterial blood
1. SaO2 measures percentage of hemoglobin saturated with oxygen in arterial blood; normal 95-100%.
2. SpO2 (pulse oximetry) provides non-invasive estimate; ABG gives direct SaO2.
3. Values below 90% indicate hypoxemia requiring intervention.
11. What does SvO2 represent?
Correct Answer: Mixed venous O2 saturation
1. SvO2 reflects oxygen extraction by tissues; normal 60-80% at rest.
2. Low SvO2 indicates increased extraction (shock, low cardiac output); high SvO2 indicates decreased
extraction (sepsis, shunting).
3. Measured via pulmonary artery catheter.
12. What is SVR (systemic vascular resistance)?
Correct Answer: Opposition to blood flow by systemic vasculature; pressure goes up during
vasoconstriction and down during vasodilation
1. SVR = (MAP-CVP)/CO × 80; reflects left ventricular afterload.
2. Increased in hypovolemia, vasopressors, heart failure; decreased in sepsis, anaphylaxis.
3. Calculated from hemodynamic parameters.
, 13. What is PVR (pulmonary vascular resistance)?
Correct Answer: Opposition to blood flow by pulmonary vasculature; pressure goes up during
vasoconstriction and down during vasodilation
1. PVR = (mPAP-PAWP)/CO × 80; reflects right ventricular afterload.
2. Increased in pulmonary hypertension, PE, hypoxia; decreased with vasodilators.
3. Elevated PVR can cause right heart failure.
14. What is afterload?
Correct Answer: How much fluid when the heart contracts
1. Afterload is the resistance the ventricle must overcome to eject blood (systemic or pulmonary vascular
resistance).
2. Increased afterload increases myocardial work and oxygen demand; decreased afterload improves stroke
volume.
3. Managed with vasodilators (afterload reduction) in heart failure.
15. What is preload?
Correct Answer: How much fluid when the heart is relaxed
1. Preload is ventricular end-diastolic volume (stretch on myocytes before contraction).
2. Estimated by CVP (right) or PAWP (left); increased in fluid overload, decreased in hypovolemia.
3. Diuretics and vasodilators reduce preload in heart failure.
16. What is the purpose of continuous flush irrigation in pressure monitoring?
Correct Answer: Maintains line patency; there is no fluid running in an open artery
1. Continuous flush (3-5 mL/hr) prevents thrombus formation in arterial/central lines.
2. Pressurized bag at 300 mmHg ensures flow against arterial pressure; keeps catheter patent.
3. Prevents clotting and maintains waveform accuracy.
17. What assessment is performed for an arterial line (A-line)?
Correct Answer: Allen test; ensure the a-line does not obstruct the perfusion in the hand
1. Modified Allen test confirms collateral circulation (ulnar artery) before radial artery cannulation.
2. Positive test: hand color returns within 5-10 seconds after releasing ulnar compression.
3. Prevents hand ischemia if radial artery thromboses.
18. What does a transducer do in hemodynamic monitoring?
Correct Answer: Translates waveform
1. Converts mechanical pressure from blood column into electrical signal displayed as waveform and numerical
value.
2. Must be zeroed at phlebostatic axis level; positioned correctly to avoid artifact.
3. Dynamic response testing (square wave) verifies accuracy.
19. What is the phlebostatic axis?
Correct Answer: Heart level, used for transducer
1. Intersection of 4th intercostal space at mid-anterior-posterior chest diameter; approximates right atrial level.
2. Transducer placed at this level ensures accurate pressure readings; every 2 cm off level = 1.5 mmHg error.
3. Re-level and re-zero after patient repositioning.
