NSG 430 Final Exam Pt 1: (Latest 2026/2027 Update) Critical Care, Shock,
Burns, Medications, & Professional Nursing | Q&A | Grade A | 100%
Correct (Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical / Critical Care FINAL
Source: NSG 430 Final Exam Part 1 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What blood product do you administer in a patient who has overdosed on warfarin?
Correct Answer: Fresh frozen plasma (FFP) or vitamin K
1. FFP contains clotting factors reversed by warfarin; vitamin K takes 12-24 hours for effect.
2. For life-threatening bleeding or INR >4.5, FFP and IV vitamin K 10 mg given.
3. Prothrombin complex concentrate (PCC) is alternative with lower volume.
2. A patient develops pyelonephritis after being on vancomycin. What information would the nurse tell the
HCP?
Correct Answer: Nephrotoxicity – notify HCP of elevated creatinine
1. Vancomycin causes nephrotoxicity and ototoxicity; monitor trough levels (10-20 mcg/mL).
2. Rising creatinine indicates kidney injury; may need dose adjustment or alternative antibiotic.
3. Ensure adequate hydration; avoid other nephrotoxic drugs (NSAIDs, contrast).
3. What should the nurse assess if a patient comes in with suspected Stevens-Johnson syndrome?
Correct Answer: If the patient has taken any new medication (within the past 1-4 weeks)
1. SJS/TEN is severe mucocutaneous drug reaction; causative drugs: sulfonamides, anticonvulsants, allopurinol, NSAIDs.
2. Assess for rash, blisters, mucosal involvement (oral, ocular, genital), fever.
3. Immediate drug discontinuation; burn unit admission for supportive care.
4. A patient with late-stage cirrhosis develops portal hypertension. Which complications can develop?
(Select all that apply)
Correct Answer: Splenomegaly, gastric varices, esophageal varices, ascites, asterixis, difficulty with handwriting
(asterixis and handwriting difficulty indicate hepatic encephalopathy)
1. Portal hypertension leads to varices (esophageal, gastric), splenomegaly (hypersplenism), ascites (low albumin +
increased pressure).
2. Asterixis ("liver flap") and handwriting changes are early signs of hepatic encephalopathy.
3. Other complications: hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis.
5. Which lab values are consistent with DKA? (Select all that apply)
Correct Answer: Serum glucose 524, HCO3 level of 10, pH of 7.22
1. DKA: glucose >250, pH <7.35, HCO3 <15, ketones positive, anion gap >12.
2. Serum glucose 524 indicates hyperglycemia; HCO3 10 indicates severe acidosis.
3. pH 7.22 confirms metabolic acidosis; negative ketones would suggest HHS.
, 6. What is a Whipple procedure?
Correct Answer: Removal of part of the pancreas, part of the stomach, and the duodenum, and the gallbladder,
with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum
1. Pancreaticoduodenectomy for periampullary/pancreatic cancer; high morbidity.
2. Post-op: monitor for pancreatic leak (amylase-rich drainage), bleeding, delayed gastric emptying.
3. Nutritional support: pancreatic enzyme replacement, insulin management.
7. A patient with pyelonephritis on vancomycin – what would you tell HCP?
Correct Answer: Nephrotoxic – report elevated creatinine
1. Pyelonephritis requires adequate antibiotic therapy; vancomycin dose adjusted for renal function.
2. Monitor serum creatinine daily; trough vancomycin level before 3rd or 4th dose.
3. Alternative: ceftriaxone, cefepime, or carbapenems if nephrotoxicity concern.
8. Terminally ill patient with severe pain – what management is needed?
Correct Answer: PCA pump (patient-controlled analgesia)
1. PCA provides rapid pain control while avoiding over-sedation; patient activates demand dose.
2. Continuous opioid infusion with demand dosing for severe terminal pain.
3. Monitor for respiratory depression; constipation prophylaxis essential (senna, docusate).
9. A 28-year-old patient with deep human bite wounds on the left hand – which action will the nurse plan
to take?
Correct Answer: Teach the patient the reason for the use of prophylactic antibiotics
1. Human bites have high infection risk (Eikenella corrodens, Staph aureus, anaerobes).
2. Prophylactic antibiotics: amoxicillin-clavulanate or clindamycin + ciprofloxacin.
3. Wounds left open (do not suture); tetanus prophylaxis; HIV/Hep B PEP if indicated.
10. A patient has been admitted with meningococcal meningitis. Which observation by the nurse requires
action?
Correct Answer: Walking in patient's room without a mask (requires droplet precautions – mask within 3 feet)
1. Meningococcal meningitis requires droplet precautions for 24 hours after antibiotics.
2. Staff and visitors should wear surgical mask when within 3 feet of patient.
3. Prophylaxis for close contacts: rifampin, ciprofloxacin, or ceftriaxone.
11. When a brain-injured patient responds to nail pressure with internal rotation, adduction, and flexion of
the arms, the nurse reports this response as?
Correct Answer: Decorticate posturing (flexion and adduction of upper extremities)
1. Decorticate: arms flexed, adducted, legs extended (lesion above red nucleus).
2. Decerebrate: arms extended, externally rotated (worse prognosis, brainstem lesion).
3. Any posturing indicates severe brain injury; monitor for deterioration.
12. Patient with massive trauma and possible spinal cord injury is admitted to ED. Which assessment helps
confirm neurogenic shock?
Correct Answer: C7 injury, low heart rate/hypotension (bradycardia + hypotension + dry warm skin)
1. Neurogenic shock from sympathetic disruption (injuries above T6).
2. Hallmark: hypotension with bradycardia (unlike hypovolemic shock with tachycardia).
3. Treatment: vasopressors (norepinephrine), atropine, fluids cautiously.
Burns, Medications, & Professional Nursing | Q&A | Grade A | 100%
Correct (Verified Answers) – Nursing Program
Subject: NSG 430 – Advanced Medical-Surgical / Critical Care FINAL
Source: NSG 430 Final Exam Part 1 Blueprint 2026/2027
Format: Q&A Guide with Rationale | Verified Grade A
1. What blood product do you administer in a patient who has overdosed on warfarin?
Correct Answer: Fresh frozen plasma (FFP) or vitamin K
1. FFP contains clotting factors reversed by warfarin; vitamin K takes 12-24 hours for effect.
2. For life-threatening bleeding or INR >4.5, FFP and IV vitamin K 10 mg given.
3. Prothrombin complex concentrate (PCC) is alternative with lower volume.
2. A patient develops pyelonephritis after being on vancomycin. What information would the nurse tell the
HCP?
Correct Answer: Nephrotoxicity – notify HCP of elevated creatinine
1. Vancomycin causes nephrotoxicity and ototoxicity; monitor trough levels (10-20 mcg/mL).
2. Rising creatinine indicates kidney injury; may need dose adjustment or alternative antibiotic.
3. Ensure adequate hydration; avoid other nephrotoxic drugs (NSAIDs, contrast).
3. What should the nurse assess if a patient comes in with suspected Stevens-Johnson syndrome?
Correct Answer: If the patient has taken any new medication (within the past 1-4 weeks)
1. SJS/TEN is severe mucocutaneous drug reaction; causative drugs: sulfonamides, anticonvulsants, allopurinol, NSAIDs.
2. Assess for rash, blisters, mucosal involvement (oral, ocular, genital), fever.
3. Immediate drug discontinuation; burn unit admission for supportive care.
4. A patient with late-stage cirrhosis develops portal hypertension. Which complications can develop?
(Select all that apply)
Correct Answer: Splenomegaly, gastric varices, esophageal varices, ascites, asterixis, difficulty with handwriting
(asterixis and handwriting difficulty indicate hepatic encephalopathy)
1. Portal hypertension leads to varices (esophageal, gastric), splenomegaly (hypersplenism), ascites (low albumin +
increased pressure).
2. Asterixis ("liver flap") and handwriting changes are early signs of hepatic encephalopathy.
3. Other complications: hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis.
5. Which lab values are consistent with DKA? (Select all that apply)
Correct Answer: Serum glucose 524, HCO3 level of 10, pH of 7.22
1. DKA: glucose >250, pH <7.35, HCO3 <15, ketones positive, anion gap >12.
2. Serum glucose 524 indicates hyperglycemia; HCO3 10 indicates severe acidosis.
3. pH 7.22 confirms metabolic acidosis; negative ketones would suggest HHS.
, 6. What is a Whipple procedure?
Correct Answer: Removal of part of the pancreas, part of the stomach, and the duodenum, and the gallbladder,
with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum
1. Pancreaticoduodenectomy for periampullary/pancreatic cancer; high morbidity.
2. Post-op: monitor for pancreatic leak (amylase-rich drainage), bleeding, delayed gastric emptying.
3. Nutritional support: pancreatic enzyme replacement, insulin management.
7. A patient with pyelonephritis on vancomycin – what would you tell HCP?
Correct Answer: Nephrotoxic – report elevated creatinine
1. Pyelonephritis requires adequate antibiotic therapy; vancomycin dose adjusted for renal function.
2. Monitor serum creatinine daily; trough vancomycin level before 3rd or 4th dose.
3. Alternative: ceftriaxone, cefepime, or carbapenems if nephrotoxicity concern.
8. Terminally ill patient with severe pain – what management is needed?
Correct Answer: PCA pump (patient-controlled analgesia)
1. PCA provides rapid pain control while avoiding over-sedation; patient activates demand dose.
2. Continuous opioid infusion with demand dosing for severe terminal pain.
3. Monitor for respiratory depression; constipation prophylaxis essential (senna, docusate).
9. A 28-year-old patient with deep human bite wounds on the left hand – which action will the nurse plan
to take?
Correct Answer: Teach the patient the reason for the use of prophylactic antibiotics
1. Human bites have high infection risk (Eikenella corrodens, Staph aureus, anaerobes).
2. Prophylactic antibiotics: amoxicillin-clavulanate or clindamycin + ciprofloxacin.
3. Wounds left open (do not suture); tetanus prophylaxis; HIV/Hep B PEP if indicated.
10. A patient has been admitted with meningococcal meningitis. Which observation by the nurse requires
action?
Correct Answer: Walking in patient's room without a mask (requires droplet precautions – mask within 3 feet)
1. Meningococcal meningitis requires droplet precautions for 24 hours after antibiotics.
2. Staff and visitors should wear surgical mask when within 3 feet of patient.
3. Prophylaxis for close contacts: rifampin, ciprofloxacin, or ceftriaxone.
11. When a brain-injured patient responds to nail pressure with internal rotation, adduction, and flexion of
the arms, the nurse reports this response as?
Correct Answer: Decorticate posturing (flexion and adduction of upper extremities)
1. Decorticate: arms flexed, adducted, legs extended (lesion above red nucleus).
2. Decerebrate: arms extended, externally rotated (worse prognosis, brainstem lesion).
3. Any posturing indicates severe brain injury; monitor for deterioration.
12. Patient with massive trauma and possible spinal cord injury is admitted to ED. Which assessment helps
confirm neurogenic shock?
Correct Answer: C7 injury, low heart rate/hypotension (bradycardia + hypotension + dry warm skin)
1. Neurogenic shock from sympathetic disruption (injuries above T6).
2. Hallmark: hypotension with bradycardia (unlike hypovolemic shock with tachycardia).
3. Treatment: vasopressors (norepinephrine), atropine, fluids cautiously.
