NSG-430 Exam 1: (Latest 2026/2027 Update) Critical Care, End-of-Life,
Diabetes, & Respiratory Emergencies | Q&A | Grade A | 100% Correct
(Verified Answers)
Subject: Complex Critical Care / Medical-Surgical Nursing
Source: NSG-430 Exam 1 – Comprehensive Review Format: Q&A Guide with Clinical Rationale
1: What is palliative care and when does it begin?
Correct Answer: Care focusing on reducing severity of symptoms; begins during curative or
restorative health care, extends into end-of-life care, with bereavement care following
death.
1. Palliative care can be provided alongside curative treatments, unlike hospice which requires
forgoing cure.
2. Goals include regarding dying as normal, providing symptom relief, affirming life, supporting
holistic care, and supporting family through bereavement.
3. Indicated for life-limiting illnesses: cancer, heart failure, COPD, dementia, ESRD.
2: What is hospice care and what are its requirements?
Correct Answer: Curative care is forgone; requires physician certification that life
expectancy is 6 months or less; initiated after patient/proxy decides not to pursue a cure.
1. Hospice focuses on comfort and quality of life when cure is no longer the goal.
2. Two physicians must certify prognosis of ≤6 months if disease follows normal course.
3. Services include nursing, spiritual care, bereavement support, and symptom management.
3: What are the American Academy of Neurology diagnostic criteria for brain death?
Correct Answer: Coma or unresponsiveness, absence of brainstem reflexes, and apnea.
1. All brain function (cortex and brainstem) must cease for legal brain death declaration.
2. Brain death diagnosis is critical when organ donation is an option.
3. In some states, RNs are legally permitted to pronounce death under specific circumstances.
4: What is Cheyne-Stokes respiration?
Correct Answer: Pattern of breathing characterized by alternating periods of apnea and
rapid deep breathing.
1. Common at end of life due to decreased neurological and respiratory drive.
2. Also seen in heart failure and brain injuries.
3. Different from Kussmaul breathing (consistently rapid/deep without apnea).
,5: Which sense is usually the last to disappear at the end of life?
Correct Answer: Hearing
1. Patients near death can hear even when unresponsive; speak as if they are alert.
2. Hearing is preserved due to minimal energy requirement for auditory processing.
3. Families should be encouraged to talk, reassure, and say goodbye.
6: Describe the physical integumentary changes as death approaches.
Correct Answer: Mottling on hands/feet/arms/legs (purple/white leopard-skin appearance),
cold clammy skin, cyanosis of nose/nail beds/knees, waxlike skin when very near death.
1. Skin cools first on lower extremities, then upper extremities, finally torso unless fever present.
2. Mottling indicates declining circulation and is a sign of imminent death.
3. Positioning and gentle skin care maintain dignity.
7: What is the "death rattle" and what causes it?
Correct Answer: Noisy, wet-sounding respirations caused by mouth breathing and
accumulation of mucus in the airways; also called terminal secretions.
1. Caused by inability to cough or clear secretions as death approaches.
2. Anticholinergics (atropine, scopolamine) may reduce secretions.
3. Repositioning and gentle oral suctioning can provide comfort.
8: How does spirituality affect end-of-life outcomes?
Correct Answer: Spirituality is associated with decreased despair at end of life; involves
beliefs, values, practices related to existential meaning, may or may not include belief in
higher power.
1. Spiritual distress may occur and requires nursing assessment and referral to chaplain or spiritual
care.
2. Respect patient's individual choices regarding spiritual practices—some pursue, some do not.
3. Spirituality does not necessarily equate to religion.
9: What is decisional capacity?
Correct Answer: The ability to consent or refuse care; means the individual has
understanding and appreciation of shared information and capacity to engage in reasoning
process.
1. Decisional capacity is specific to each decision and can fluctuate.
2. Different from competency (legal determination made by court).
3. Essential for advance directives, organ donation consent, and refusal of treatment.
10: What is the principle of double effect in end-of-life care?
Correct Answer: Morally permissible to give a medication that has potential for harm if
given with intent of relieving pain and suffering and not intended to hasten death.
1. Supports aggressive symptom management (opioids for dyspnea/pain) even if respiratory
depression is a possible side effect.
2. Addiction is not a concern for terminally ill patients when goal is comfort.
3. Nurse's moral obligation is to relieve suffering.
, 11: What does AND (Allow Natural Death) mean compared to DNR?
Correct Answer: AND more accurately conveys comfort measures only status; natural
progression to death is not delayed or interrupted; care is supportive, providing comfort
and dignity, allowing nature to take its course.
1. Comfort measures include pain control and symptom management without technological
interference.
2. AND is replacing DNR terminology in many institutions.
3. Care is not withheld—care is provided but focuses on comfort.
12: What guides nursing care at the end of life?
Correct Answer: Code of Ethics for Nurses (relieve suffering), principle of beneficence (care
provided to benefit), and standard of care (nursing acts required for safe/competent
practice).
1. Nurses spend more time with dying patients than any other healthcare professional.
2. After death events, debrief with peers—it is okay to feel emotion.
3. Recognize your own values, attitudes, and feelings about death.
13: How often should assessments be performed for a dying patient in the inpatient
setting?
Correct Answer: At least every 8 hours, more frequently as changes occur.
1. Focus on neuro, cardiovascular, respiratory, I&O, integumentary systems.
2. Monitor for system failure as death approaches; attention to subtle changes requires vigilance.
3. Physical assessments are abbreviated and focused on changes accompanying terminal illness.
14: What are common physical care needs at the end of life?
Correct Answer: Pain, delirium, anxiety, dysphagia, fatigue, dehydration, dyspnea,
myoclonus, skin breakdown, bowel changes, urinary incontinence, nausea/vomiting,
candida.
1. Skin integrity difficult to maintain due to immobility, incontinence, dry skin, nutritional deficits,
anemia, friction, shearing.
2. Dying patients deserve same care as those expected to recover.
3. Discuss goals of care before treatment begins; advance directives should be completed.
15: What are standard postmortem care actions?
Correct Answer: Close patient's eyes, replace dentures, wash and position body; consider
cultural customs, state law, agency policy; remove tubes/dressings if appropriate; straighten
body leaving pillow to support head.
1. Never refer to deceased person as "the body"—maintain respectful language.
2. Allow family as much time as they need with deceased person.
3. In some cultures, family may prepare or assist in preparing body.
Diabetes, & Respiratory Emergencies | Q&A | Grade A | 100% Correct
(Verified Answers)
Subject: Complex Critical Care / Medical-Surgical Nursing
Source: NSG-430 Exam 1 – Comprehensive Review Format: Q&A Guide with Clinical Rationale
1: What is palliative care and when does it begin?
Correct Answer: Care focusing on reducing severity of symptoms; begins during curative or
restorative health care, extends into end-of-life care, with bereavement care following
death.
1. Palliative care can be provided alongside curative treatments, unlike hospice which requires
forgoing cure.
2. Goals include regarding dying as normal, providing symptom relief, affirming life, supporting
holistic care, and supporting family through bereavement.
3. Indicated for life-limiting illnesses: cancer, heart failure, COPD, dementia, ESRD.
2: What is hospice care and what are its requirements?
Correct Answer: Curative care is forgone; requires physician certification that life
expectancy is 6 months or less; initiated after patient/proxy decides not to pursue a cure.
1. Hospice focuses on comfort and quality of life when cure is no longer the goal.
2. Two physicians must certify prognosis of ≤6 months if disease follows normal course.
3. Services include nursing, spiritual care, bereavement support, and symptom management.
3: What are the American Academy of Neurology diagnostic criteria for brain death?
Correct Answer: Coma or unresponsiveness, absence of brainstem reflexes, and apnea.
1. All brain function (cortex and brainstem) must cease for legal brain death declaration.
2. Brain death diagnosis is critical when organ donation is an option.
3. In some states, RNs are legally permitted to pronounce death under specific circumstances.
4: What is Cheyne-Stokes respiration?
Correct Answer: Pattern of breathing characterized by alternating periods of apnea and
rapid deep breathing.
1. Common at end of life due to decreased neurological and respiratory drive.
2. Also seen in heart failure and brain injuries.
3. Different from Kussmaul breathing (consistently rapid/deep without apnea).
,5: Which sense is usually the last to disappear at the end of life?
Correct Answer: Hearing
1. Patients near death can hear even when unresponsive; speak as if they are alert.
2. Hearing is preserved due to minimal energy requirement for auditory processing.
3. Families should be encouraged to talk, reassure, and say goodbye.
6: Describe the physical integumentary changes as death approaches.
Correct Answer: Mottling on hands/feet/arms/legs (purple/white leopard-skin appearance),
cold clammy skin, cyanosis of nose/nail beds/knees, waxlike skin when very near death.
1. Skin cools first on lower extremities, then upper extremities, finally torso unless fever present.
2. Mottling indicates declining circulation and is a sign of imminent death.
3. Positioning and gentle skin care maintain dignity.
7: What is the "death rattle" and what causes it?
Correct Answer: Noisy, wet-sounding respirations caused by mouth breathing and
accumulation of mucus in the airways; also called terminal secretions.
1. Caused by inability to cough or clear secretions as death approaches.
2. Anticholinergics (atropine, scopolamine) may reduce secretions.
3. Repositioning and gentle oral suctioning can provide comfort.
8: How does spirituality affect end-of-life outcomes?
Correct Answer: Spirituality is associated with decreased despair at end of life; involves
beliefs, values, practices related to existential meaning, may or may not include belief in
higher power.
1. Spiritual distress may occur and requires nursing assessment and referral to chaplain or spiritual
care.
2. Respect patient's individual choices regarding spiritual practices—some pursue, some do not.
3. Spirituality does not necessarily equate to religion.
9: What is decisional capacity?
Correct Answer: The ability to consent or refuse care; means the individual has
understanding and appreciation of shared information and capacity to engage in reasoning
process.
1. Decisional capacity is specific to each decision and can fluctuate.
2. Different from competency (legal determination made by court).
3. Essential for advance directives, organ donation consent, and refusal of treatment.
10: What is the principle of double effect in end-of-life care?
Correct Answer: Morally permissible to give a medication that has potential for harm if
given with intent of relieving pain and suffering and not intended to hasten death.
1. Supports aggressive symptom management (opioids for dyspnea/pain) even if respiratory
depression is a possible side effect.
2. Addiction is not a concern for terminally ill patients when goal is comfort.
3. Nurse's moral obligation is to relieve suffering.
, 11: What does AND (Allow Natural Death) mean compared to DNR?
Correct Answer: AND more accurately conveys comfort measures only status; natural
progression to death is not delayed or interrupted; care is supportive, providing comfort
and dignity, allowing nature to take its course.
1. Comfort measures include pain control and symptom management without technological
interference.
2. AND is replacing DNR terminology in many institutions.
3. Care is not withheld—care is provided but focuses on comfort.
12: What guides nursing care at the end of life?
Correct Answer: Code of Ethics for Nurses (relieve suffering), principle of beneficence (care
provided to benefit), and standard of care (nursing acts required for safe/competent
practice).
1. Nurses spend more time with dying patients than any other healthcare professional.
2. After death events, debrief with peers—it is okay to feel emotion.
3. Recognize your own values, attitudes, and feelings about death.
13: How often should assessments be performed for a dying patient in the inpatient
setting?
Correct Answer: At least every 8 hours, more frequently as changes occur.
1. Focus on neuro, cardiovascular, respiratory, I&O, integumentary systems.
2. Monitor for system failure as death approaches; attention to subtle changes requires vigilance.
3. Physical assessments are abbreviated and focused on changes accompanying terminal illness.
14: What are common physical care needs at the end of life?
Correct Answer: Pain, delirium, anxiety, dysphagia, fatigue, dehydration, dyspnea,
myoclonus, skin breakdown, bowel changes, urinary incontinence, nausea/vomiting,
candida.
1. Skin integrity difficult to maintain due to immobility, incontinence, dry skin, nutritional deficits,
anemia, friction, shearing.
2. Dying patients deserve same care as those expected to recover.
3. Discuss goals of care before treatment begins; advance directives should be completed.
15: What are standard postmortem care actions?
Correct Answer: Close patient's eyes, replace dentures, wash and position body; consider
cultural customs, state law, agency policy; remove tubes/dressings if appropriate; straighten
body leaving pillow to support head.
1. Never refer to deceased person as "the body"—maintain respectful language.
2. Allow family as much time as they need with deceased person.
3. In some cultures, family may prepare or assist in preparing body.
