NSG 506 Exam 1 Study Guide

NSG 506 Exam 1 Study Guide

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University of Phoenix

NSG/506 Transition to Advanced Practice Nursing

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506 Exam 1 Study Guide: Older Adult Care

Older adult care questions on Exam 1 primarily focus on differentiating dementia, delirium, and depression, while understanding the effects of polypharmacy and age-friendly nursing care. Recognizing baseline cognitive function is essential because many conditions are identified by changes from a patient’s normal mental status.

Dementia

Dementia is a chronic, progressive decline in cognitive function that interferes with daily living. It develops gradually, primarily affects memory and orientation, and does not alter the patient’s level of consciousness. Common types include Alzheimer’s disease, vascular dementia, Parkinson’s disease dementia, Lewy body dementia, and frontotemporal dementia. Establishing the patient’s baseline cognitive status is critical for accurate assessment.

Delirium

Delirium is an acute and often reversible change in mental status characterized by altered attention, disorganized thinking, and fluctuating consciousness. Unlike dementia, delirium develops suddenly and represents a change from baseline. Common causes include infection, dehydration, hypoxia, medication effects, urinary retention, fecal impaction, and abnormal blood glucose levels.

Delirium is classified into three types:

• Hyperactive: agitation, restlessness, disruptive behavior

• Hypoactive: lethargy, sluggishness, withdrawal

• Mixed: alternating hyperactive and hypoactive symptoms

Older adults with severe agitation may receive low-dose haloperidol (0.5 mg initially; maximum 3–5 mg/day).

Depression

Depression is common in older adults and may occur alongside dementia. Diagnosis includes a depressed mood or loss of interest in activities with at least four additional symptoms. Unlike dementia, depression is potentially reversible with appropriate treatment and should never be considered a normal part of aging.

Polypharmacy

Polypharmacy refers to the inappropriate use of multiple medications, while polymedicine describes the appropriate use of several medications to manage multiple chronic illnesses. Polypharmacy increases the risk of adverse drug reactions, drug interactions, poor medication adherence, and reduced quality of life. High-risk medications include warfarin, insulin, and digoxin. The Beers Criteria remains the gold standard for identifying potentially inappropriate medications in older adults.

The 4Ms Framework

The 4Ms Framework guides age-friendly healthcare by focusing on what matters most to the patient, ensuring medications are necessary and safe, preventing and managing dementia, delirium, and depression, and maintaining mobility to preserve independence and reduce fall risk.

Acute coronary syndrome (ACS), heart failure, and pediatric cardiac disorders are high-yield Exam 1 topics. Focus on recognizing disease patterns, interpreting assessment findings, understanding diagnostic tests, and identifying priority nursing interventions.

Acute Coronary Syndrome (ACS)

Acute coronary syndrome refers to a sudden reduction in blood flow to the heart and includes unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Myocardial infarction occurs when blood flow is significantly reduced or completely blocked, causing irreversible myocardial damage if ischemia persists for approximately 30–40 minutes.

NSTEMI usually presents with ST-segment depression or T-wave inversion on the ECG and elevated cardiac biomarkers, while STEMI involves complete coronary artery occlusion with ST-segment elevation and requires immediate reperfusion therapy. Chest pain lasting longer than 15 minutes, especially when unrelieved by rest, should always be treated as a medical emergency.

Heart Failure

Heart failure is the inability of the heart to pump enough blood to meet the body’s metabolic demands. It commonly develops after myocardial infarction or long-standing hypertension and often results in decreased cardiac output with activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS).

Left-sided heart failure is the most common form and leads to pulmonary congestion because blood backs up into the lungs. Right-sided heart failure causes systemic venous congestion, resulting in peripheral edema, jugular venous distention, hepatomegaly, and weight gain from fluid retention. Diagnosis commonly includes an ECG, echocardiogram, and measurement of B-type natriuretic peptide (BNP).

Common manifestations include:

• Dyspnea and orthopnea

• Pulmonary edema

• Fatigue and exercise intolerance

• Peripheral edema

• Weight gain

• Reduced cardiac output

Congenital Heart Disease

Congenital heart disease (CHD) is usually caused by genetic abnormalities or environmental factors affecting fetal cardiac development. Risk factors include chromosomal disorders such as Trisomy 21, Trisomy 18, Trisomy 13, DiGeorge syndrome, and maternal conditions including diabetes, lupus, rubella infection, and exposure to medications such as lithium during pregnancy.

Congestive Heart Failure in Children

Pediatric heart failure commonly results from congenital heart defects or infectious causes. Early recognition is important because infants often present differently than adults.

Common signs include:

• Resting tachycardia

• Feeding difficulties

• Poor weight gain or failure to thrive

• Respiratory distress

• Excessive sweating during feeding

• Fatigue or irritability

• Frequent respiratory infections

• Exercise intolerance in older children

NSG 506 Exam 1 Study Guide

Management focuses on improving cardiac function and decreasing workload. Daily weight monitoring is essential to evaluate fluid status. Treatment often includes diuretics such as furosemide (Lasix), digoxin, high-calorie nutrition, clustered nursing care to conserve energy, and limiting feeding duration while maintaining head elevation. Vomiting in a child receiving digoxin may indicate toxicity and requires immediate evaluation.

Cardiovascular Assessment

Several diagnostic tests are commonly used to evaluate cardiac structure and function.

Electrocardiogram (ECG/EKG) records the heart’s electrical activity and helps identify dysrhythmias, ischemia, and myocardial infarction.

Chest X-ray (CXR) evaluates heart size, pulmonary congestion, and major blood vessels.

Echocardiography (TTE or TEE) uses ultrasound to assess cardiac anatomy, valve function, chamber size, and ventricular performance.

Cardiac CT and MRI provide detailed three-dimensional images of cardiac structures and usually require contrast administration.

Cardiac catheterization is an invasive procedure that directly measures intracardiac pressures and evaluates coronary arteries. Because the procedure typically uses the femoral artery or vein, nursing priorities include frequent assessment of vital signs, bleeding, distal circulation, and maintaining the affected extremity flat for several hours after the procedure.

Cardiopulmonary Bypass (CPB)

Cardiopulmonary bypass temporarily replaces the function of the heart and lungs during open-heart surgery by circulating oxygenated blood throughout the body.

Potential postoperative complications include:

• Inflammatory response

• Temperature instability

• Fluid and electrolyte shifts

• Bleeding disorders

• Atelectasis

• Renal dysfunction

• Myocardial stunning

• Increased infection risk

Careful monitoring during the postoperative period is essential to identify these complications early.

Pulmonary Blood Flow and Cardiac Shunts

Normal circulation maintains equal pulmonary and systemic blood flow with a pulmonary-to-systemic blood flow ratio (Qp:Qs) of 1:1. Systemic vascular resistance (SVR) is normally greater than pulmonary vascular resistance (PVR).

Left-to-right shunts are acyanotic defects that increase pulmonary blood flow. Oxygenated blood returns to the lungs instead of circulating through the body, causing pulmonary overcirculation while the child typically remains pink in appearance. These defects produce a Qp:Qs ratio greater than 1 because pulmonary blood flow exceeds systemic blood flow.

Key Exam Tips

Focus on distinguishing NSTEMI from STEMI, recognizing the clinical features of left- versus right-sided heart failure, identifying common pediatric heart failure manifestations, understanding indications for major cardiac diagnostic tests, and remembering the priority nursing assessments following cardiac catheterization. Pediatric questions frequently emphasize feeding intolerance, poor growth, and daily weight monitoring, while adult questions often focus on cardiac output, pulmonary congestion, and evidence-based treatment priorities.

References

American Heart Association. (2025). Advanced Cardiovascular Life Support (ACLS) Provider Manual. American Heart Association.

Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2023). Wong’s nursing care of infants and children (13th ed.). Elsevier.

Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M., Kwong, J., & Roberts, D. (2023). Medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Lilley, L. L., Collins, S. R., & Snyder, J. S. (2023). Pharmacology and the nursing process (10th ed.). Elsevier.