NSG 506 Exam 1 Study Guide

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University of Phoenix

NSG/506 Transition to Advanced Practice Nursing

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NSG 506 Exam 1 Study Guide

Older adult care and cardiovascular disorders are among the highest-yield topics for NSG 506 Exam 1. To succeed, students should be able to differentiate dementia, delirium, and depression, recognize the risks of polypharmacy, apply age-friendly nursing principles, distinguish acute coronary syndrome (ACS) from heart failure, identify common pediatric cardiac disorders, and prioritize nursing assessments and interventions. Understanding these concepts supports safe, evidence-based nursing care and improves clinical decision-making.

Older Adult Care: Essential Nursing Concepts

Caring for older adults requires recognizing normal age-related changes while identifying conditions that require immediate intervention. A patient’s baseline cognitive status is one of the most important assessment findings because many acute illnesses present as changes from their normal mental function.

Dementia

Dementia is a chronic, progressive decline in cognitive function that interferes with daily living and independence. Symptoms develop gradually and worsen over time.

Key Characteristics

• Gradual onset with progressive decline

• Memory impairment is the earliest and most common symptom

• Problems with orientation, judgment, language, and executive function

• Consciousness usually remains normal

• Changes are generally irreversible, although progression may be slowed with treatment

Common types of dementia include:

• Alzheimer’s disease

• Vascular dementia

• Lewy body dementia

• Parkinson’s disease dementia

• Frontotemporal dementia

Because dementia develops slowly, nurses should always compare current findings with the patient’s established cognitive baseline.

Delirium

Delirium is an acute, fluctuating disturbance of attention and cognition that develops over hours to days. Unlike dementia, delirium is usually reversible when the underlying cause is identified and treated promptly.

Common Causes of Delirium

• Infection

• Dehydration

• Hypoxia

• Medication effects

• Urinary retention

• Fecal impaction

• Electrolyte abnormalities

• Hypoglycemia or hyperglycemia

Types of Delirium

Hyperactive Delirium

• Agitation

• Restlessness

• Hallucinations

• Aggressive behavior

Hypoactive Delirium

• Lethargy

• Reduced responsiveness

• Withdrawal

• Slowed movements

Mixed Delirium

Alternates between hyperactive and hypoactive symptoms.

In severe agitation that threatens patient safety, low-dose haloperidol may be prescribed according to institutional protocols.

Depression in Older Adults

Depression is common among older adults but should never be considered a normal part of aging. It frequently coexists with dementia and may resemble cognitive impairment.

Diagnosis typically includes:

• Persistent depressed mood or loss of interest

• At least four additional depressive symptoms, such as:

  • Sleep disturbances

  • Appetite changes

  • Fatigue

  • Feelings of worthlessness

  • Difficulty concentrating

  • Suicidal thoughts

Unlike dementia, depression is potentially reversible with appropriate treatment.

Dementia vs. Delirium vs. Depression

Polypharmacy in Older Adults

Polypharmacy refers to the inappropriate use of multiple medications, increasing the likelihood of medication-related complications.

Polymedicine, in contrast, describes the appropriate use of multiple medications to manage several chronic diseases.

Risks of Polypharmacy

• Adverse drug reactions

• Drug-drug interactions

• Falls

• Medication nonadherence

• Hospitalization

• Reduced quality of life

High-risk medications commonly tested include:

• Warfarin

• Insulin

• Digoxin

The Beers Criteria remains the primary evidence-based tool for identifying potentially inappropriate medications in older adults.

The 4Ms Framework for Age-Friendly Care

The 4Ms Framework guides healthcare providers in delivering safe, person-centered care.

What Matters

Align care with the patient’s goals and preferences.

Medication

Use only medications that are necessary, effective, and safe.

Mentation

Prevent, identify, and manage:

• Dementia

• Delirium

• Depression

Mobility

Maintain independence while reducing fall risk.

Acute Coronary Syndrome (ACS)

Acute coronary syndrome describes a sudden reduction in coronary blood flow that causes myocardial ischemia.

ACS includes:

• Unstable angina

• Non-ST-elevation myocardial infarction (NSTEMI)

• ST-elevation myocardial infarction (STEMI)

When coronary blood flow remains blocked for approximately 30–40 minutes, irreversible myocardial injury occurs.

NSTEMI vs. STEMI

NSTEMI

• Partial coronary artery occlusion

• ST-segment depression or T-wave inversion

• Elevated cardiac biomarkers

• Requires urgent medical treatment

STEMI

• Complete coronary artery occlusion

• ST-segment elevation

• Requires immediate reperfusion therapy

Chest pain lasting longer than 15 minutes that is not relieved by rest should always be treated as a medical emergency.

Heart Failure

Heart failure occurs when the heart cannot pump enough blood to meet the body’s metabolic needs.

Common causes include:

• Previous myocardial infarction

• Long-standing hypertension

• Cardiomyopathy

Compensatory activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) initially helps maintain cardiac output but ultimately worsens heart failure.

Left-Sided vs. Right-Sided Heart Failure

Left-Sided Heart Failure

Blood backs up into the lungs, leading to pulmonary congestion.

Common findings include:

• Dyspnea

• Orthopnea

• Pulmonary edema

• Fatigue

• Reduced exercise tolerance

Right-Sided Heart Failure

Blood backs up into the systemic circulation.

Common findings include:

• Peripheral edema

• Jugular venous distention

• Hepatomegaly

• Ascites

• Weight gain

Diagnostic Tests for Heart Failure

Common diagnostic studies include:

• Electrocardiogram (ECG)

• Echocardiogram

• B-type natriuretic peptide (BNP)

• Chest X-ray

Congenital Heart Disease (CHD)

Congenital heart disease results from abnormal fetal cardiac development and is influenced by genetic and environmental factors.

Common Risk Factors

• Trisomy 21

• Trisomy 18

• Trisomy 13

• DiGeorge syndrome

• Maternal diabetes

• Maternal lupus

• Rubella infection

• Lithium exposure during pregnancy

Pediatric Congestive Heart Failure

Heart failure in children most commonly develops secondary to congenital heart defects.

Early recognition is essential because infants often present differently from adults.

Common Clinical Manifestations

• Resting tachycardia

• Feeding difficulty

• Poor weight gain

• Failure to thrive

• Respiratory distress

• Sweating during feeding

• Irritability

• Frequent respiratory infections

• Exercise intolerance in older children

Management focuses on improving cardiac output while reducing myocardial workload.

Treatment commonly includes:

• Furosemide (Lasix)

• Digoxin

• High-calorie nutrition

• Daily weight monitoring

• Clustered nursing care

• Limited feeding duration

• Head elevation during feeding

Vomiting in a child receiving digoxin should be considered a possible sign of toxicity and requires immediate assessment.

Cardiovascular Diagnostic Tests

Electrocardiogram (ECG)

Evaluates:

• Cardiac rhythm

• Myocardial ischemia

• Myocardial infarction

Chest X-ray

Assesses:

• Heart size

• Pulmonary congestion

• Major thoracic vessels

Echocardiography

Evaluates:

• Valve function

• Chamber size

• Ventricular performance

• Cardiac anatomy

Cardiac CT and MRI

Provide detailed three-dimensional imaging of cardiac structures, often using contrast.

Cardiac Catheterization

Measures intracardiac pressures and evaluates coronary arteries.

Priority nursing care after catheterization includes:

• Monitoring vital signs

• Assessing for bleeding

• Evaluating distal pulses and circulation

• Keeping the affected extremity flat according to institutional protocol

Cardiopulmonary Bypass (CPB)

Cardiopulmonary bypass temporarily replaces heart and lung function during open-heart surgery.

Potential postoperative complications include:

• Systemic inflammatory response

• Bleeding

• Fluid and electrolyte imbalance

• Atelectasis

• Renal dysfunction

• Myocardial stunning

• Temperature instability

• Increased infection risk

Close postoperative monitoring is essential for early detection and intervention.

Pulmonary Blood Flow and Cardiac Shunts

Normal circulation maintains a pulmonary-to-systemic blood flow ratio (Qp:Qs) of 1:1.

Left-to-right shunts increase pulmonary blood flow, producing:

• Pulmonary overcirculation

• Acyanotic heart defects

• Qp:Qs ratio greater than 1

• Pink appearance despite abnormal circulation

Understanding shunt physiology is essential for pediatric cardiac nursing.

High-Yield Exam Tips

Focus on mastering these frequently tested concepts:

• Differentiate dementia, delirium, and depression.

• Recognize causes and complications of polypharmacy.

• Apply the 4Ms Framework to age-friendly care.

• Distinguish NSTEMI from STEMI using ECG findings and cardiac biomarkers.

• Compare left-sided and right-sided heart failure.

• Identify pediatric heart failure symptoms.

• Know indications for major cardiovascular diagnostic tests.

• Prioritize nursing care after cardiac catheterization.

• Recognize digoxin toxicity in children.

• Understand pulmonary blood flow and left-to-right cardiac shunts.

Key Clinical Facts

• Delirium develops suddenly and is often reversible when the underlying cause is treated.

• Dementia progresses slowly and generally does not affect consciousness.

• Depression is treatable and should never be considered a normal part of aging.

• The Beers Criteria helps identify potentially inappropriate medications in older adults.

• STEMI requires immediate reperfusion because complete coronary artery occlusion causes rapid myocardial damage.

• Left-sided heart failure primarily causes pulmonary symptoms, whereas right-sided heart failure causes systemic fluid overload.

• Daily weight is one of the most sensitive indicators of fluid status in heart failure.

• Feeding intolerance, poor growth, and excessive sweating during feeding are classic signs of pediatric heart failure.

Frequently Asked Questions (FAQs)

What is the difference between dementia and delirium?

Dementia is a gradual, progressive decline in cognitive function, while delirium develops suddenly, fluctuates throughout the day, and is often reversible after treating the underlying cause.

Why is baseline cognitive function important in older adults?

Baseline cognitive status allows healthcare providers to recognize acute changes that may indicate delirium, infection, medication toxicity, or other serious conditions.

What is polypharmacy?

Polypharmacy is the inappropriate use of multiple medications, increasing the risk of adverse drug events, falls, drug interactions, and hospitalization.

What are the 4Ms of age-friendly healthcare?

The 4Ms include What Matters, Medication, Mentation, and Mobility, providing a framework for delivering safe, evidence-based care to older adults.

How do NSTEMI and STEMI differ?

NSTEMI usually involves partial coronary artery blockage with ST-segment depression or T-wave inversion, whereas STEMI results from complete coronary artery occlusion and presents with ST-segment elevation requiring immediate reperfusion.

What are the hallmark symptoms of left-sided heart failure?

Common symptoms include dyspnea, orthopnea, pulmonary edema, fatigue, and reduced exercise tolerance due to pulmonary congestion.

What are common signs of heart failure in children?

Pediatric heart failure often presents with feeding difficulties, poor weight gain, tachycardia, sweating during feeding, respiratory distress, irritability, and exercise intolerance in older children.

References

American Geriatrics Society. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372

American Heart Association. (2025). Advanced Cardiovascular Life Support (ACLS) Provider Manual. American Heart Association. https://cpr.heart.org

Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2023). Wong’s nursing care of infants and children (13th ed.). Elsevier. https://www.us.elsevierhealth.com

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. https://www.us.elsevierhealth.com

NSG 506 Exam 1 Study Guide

Lilley, L. L., Collins, S. R., & Snyder, J. S. (2023). Pharmacology and the nursing process (10th ed.). Elsevier. https://www.us.elsevierhealth.com

The Institute for Healthcare Improvement. (2024). Age-Friendly Health Systems: The 4Ms Framework. https://www.ihi.org/initiatives/age-friendly-health-systems