Adult Health 1 NURS 3620 Final Exam Blueprint Fall 2022
Final Exam 100 questions
This blueprint is provided to help assist you in preparation for the unit exam.
NOTE: You are responsible for all the content discussed in the class, lecture outlines, provided in each Unit
Blueprint and required readings.
Exam 1 Material - 22 questions
Red is what Slagele specifically said in the review!!!
Surgical nursing (Pre-op, Intra-op, and Post Op) -6
Pre-Op medications -1: Versed, antianxiety
Informed consent -1: Nurse witnesses and explains, surgeon actually writes it
Pre and Post Op teaching -1: put it in writing because meds may make them forget
Cancer -2
Chemo -1: vesicant needs central line, IV line can have tissue breakdown, if leak in line stop it
Monitor weight everyday
Radiation -1: external: skin irritation, have much time you spend with patient with internal radiation
HIV -2: substance abuse, unprotected sexual activity, breastfeeding,
Worry about opportunistic infections: pneumonia, candidiasis
Hematology (Anemia, Leukemia, Hodgkin and Non-Hodgkin, Multiple Myeloma, Sickle Cell) -7
● Sickle Cell triggered: high altitude, stress, crescent shape
● Leukemia
○ ALL, AML, CLL, CML
○ ALL = kids
■ Bone, joint and abdominal pain
○ CLL, AML, CML= adults
■ CLL= no symptoms
● Anemia
○ Iron deficiency
■ Pale, swelling tongue
■ Blood loss: endoscopy or colonoscopy to find bleeding
■ Treatment
● Bleeding: packed RBC transfusion
● Iron by mouth with vitamin c (orange juice) through straw
■ Monitor for liver problems in patients taking iron supplements
○ Pernicious- Vitamin B12 deficiency
■ Sore red beefy tongue, parentheses of feet and hands
■ Cobalamin monthly for life
○ Folic Acid deficiency
■ Cirrhosis, esophageal varices, GI problems
■ Replacement therapy: 1 mg/day and 5 mg/day for alcoholics
○ Aplastic: autoimmune pancytopenia
■ Petechiae, bruising, nosebleeds
■ Watch out for infection and hemorrhage complications
● Sickle Cell Anemia: genetic, more prominent in African Americans
○ Abnormal crescent shaped RBCs
○ Grayish cast to skin, gallstones, fever, swelling, tenderness, tachypnea, hypertension, n/v
○ Maintain adequate hydration
● Hodgkins: Reed Sternberg cells
○ Night sweats, weight loss, weakness, fatigue, fever, chills, tachycardia
○ Chemotherapy ABVD
● Non Hodgkin's: B, T, Natural killer cells (NT)
○ Painless lymph node enlargement, symptoms dependent on where disease is present
○ Special care for skin in radiation field, fertility issues
● Multiple Myeloma: cancerous plasma cells destroy bone marrow and bone
○ S&S: skeletal pain, osteoporosis, collapse of vertebrae
○ Tests: MRI/CT, bone marrow analysis
○ Treatment: corticosteroid, chemotherapy
○ Management: move carefully, measures for DVT
Exam 2 -20 questions
Respiratory -1
Asthma -1
● Medications
○ Quick relief (rescue) bronchodilator
■ Albuterol- b2 agonist
■ Atrovent- anticholinergic
○ Long term (control) corticosteroids
■ Inhaled fluticasone
■ Oral - prednisone
■ LTMA- singulair
■ Anti-IgE- omalizumab
○ Long acting Bronchodilator
■ Salmeterol- inhaled beta 2 agonist
■ Albuterol- oral b2
● 6 is max volume of oxygen on nasal cannula
Emphysema -1: destruction of the alveoli, COPD
● Teach pursed lip breathing
○ In through the nose for two counts then out through mouth with pursed lips
● Smoking = risk factor
TB -2: airborne precaution
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Symptoms don’t occur until 2-3 weeks after infection
3 consecutive sputum
Skin test takes 48 hours
Meds: RIPE (Rifampin, isoniazid, pyrazinamide, ethambutol)
○ Direct observation therapy to make sure that they are doing it (weekly)
COPD -2
● Symptoms
○ Barrel chest 1:1 ap diameter versus the normal 2:1
○ Tripod position: hunched over, hands on knees- takes the pressure of breathing off of lungs
○ Pursed lip breathing
● Spirometry: give SABA and compare to normal reference
○ FEV/FVC ratio less than 70% = COPD
● Drugs: Bronchodilator, Roflumilast- decrease exacerbation frequency
Bronchoscopy -1
● Give local anesthetic spray to get rid of gag reflex, test after due to risk for aspiration
Pneumonia -1: aspiration, fluid in the lungs
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Cause: changes with aging, cigarette smoking, air pollution, aspiration
Symptoms: crackles, egophony, increased fremitus, pleural effusion
Test: sputum study & gram stain- identify organism for antibiotics
Treatment: hydration- thins and loosens secretions, frequent small meals and foods in high calories
Diagnosed with chest x-ray
HAI -1
● Hospital has to pay for it
● Document EVERYTHING! To make sure that they don’t already have something
● CAUTI is the number 1 followed by pressure ulcers and falls
ABG’s -3:
● pH 7.35-7.45, CO2 35-45, Bicarb (HCO3) 22-26
Hypertension -1: Silent Killer!
● Hypertensive crisis symptoms: severe headache, dyspnea, anxiety, nosebleeds
● Secondary Hypertension: has a cause that can be fixed
Intermittent claudication -1: pain induced by exercise and relieved with rest
● Drugs: cilostazol, pentoxifylline
● Exercise: 30-45 min/day, 2x per week
DVT -2
● Red, warm, painful, swollen, unilateral
● Hypovolemia
● Check skin, pulses
○ Get doppler if you can’t feel pulses
Congestive Heart Failure -2
● Heart ain’t pumping like it’s supposed to
● Right sided: hepatomegaly, JVD, edema
● Left sided: pulmonary congestion
Raynaud’s -1: PATIENT TEACHING!!
● Not the freezer section
● Avoid temperature extremes, gloves, stop tobacco and caffeine, decrease stress
● Immerse hands in warm water to decrease vasospasm
Exam 3 -35 questions
Diabetes -1
● Difference between dka and hhs
DKA -1
I.
Diabetic Ketoacidosis
A. What are the clinical manifestations?
1. Dehydration: Dry mucous membranes, tachycardia, and orthostatic hypotension. Dry and loose
skin, eyes soft and sunken. Abdominal pain with n/v. Fruity breath
2. Kussmaul respirations: rapid deep breathing associated with dyspnea
a) Body’s attempt to reverse metabolic acidosis through the exhalation of excess CO2
B. What is the treatment?
1. Administer IV fluids, IV administration of short-acting insulin, electrolyte replacement
2. Check ketones for bg 240 every 3-4 hours
HHS -2
I.
Hyperosmolar Hyperglycemic Syndrome (HHS)
A. What are the clinical manifestations?
1. Somnolence, coma, seizures, hemiparesis, aphasia
2. Blood glucose level over 600 mg/dL
B. What is the treatment?
1. Immediate IV administration of insulin and either 0.9% or 0.45% NaCl (saline)
a) Large amount of fluid replacement
2. Once glucose falls to 250 mg/dL IV fluids containing dextrose are given to prevent
hypoglycemia
3. Electrolytes monitored and replaced as needed
Insulin -1: do you know what types are out there and how they are used and work, sliding scale type
1. Rapid acting
a) Aspart (Novolog), glulisine (Apidra), lispro (Humalog)
b) Onset: 10-30 minutes
c) Peak: 30-3 hours
d) Duration: 3-5 hours
e) Can be given IV
2. Short acting
a) Regular (Humulin R, Novolin R)
b) Onset: 30-60 minutes
c) Peak: 2-5 hours
d) Duration: 5-8 hours
3. Intermediate acting
a) NPH (Humulin N, Novolin N)
(1) Never give IV
(2) Cloudy one
(3) Gently agitate do not shake
b) Onset: 1.5-4 hours
c) Peak: 4-12 hours
d) Duration: 12-18 hours
4. Long acting
a) Degludec (Tresiba), detemir (levemir), glargine (basaglar, lantus, toujeo), insulin
glargine (basaglar)
b) Onset: 0.8-4 hours
c) Peak:none
d) Duration: 16-24 hours
GI - 3
● What is an ileal conduit?
○ Urinary diversion: makes pouch for urine
● Know difference between colectomy and colostomy
○ Colectomy: right with anastomosis
■ Took bad part of intestines and put it back together
○ Colostomy: took it out and didn’t have enough to connect back together or are giving the colon time to
rest
■ Beefy red and swollen after surgery
■ Putting on a colostomy bag
Gastritis -1
D. Gastritis (Acute & Chronic)
➔ Cause
◆ Drug-related
● Regular NSAIDs
◆ Diet (acidic and fatty foods)
◆ Helibacter Pylori
➔ Clinical Manifestations
◆ Gnawing burning pain or indigestion of the abdomen
➔ Diagnostic Studies
◆ EGD with biopsy
◆ Assess for H Pylori
◆ CBC for anemia
◆ Stool look for occult blood
◆ Serum test
➔ Nursing and Interprofessional Care (Treatment)
◆ Acute
● Find out the cause and stop it
● Medications that block acid and promote healing
○ H2 receptor blockers
○ PPIs
◆ Chronic
● It it’s h pylori antibiotics
● Pernicious anemia kabolimen therapy
Colectomy -1: Removal of the colon
● Cause: toxic megacolon caused by ulcerative colitis; High WBC can be indicative of toxic megacolon
○ Also colorectal cancer and polyps
Colostomy - 2: Opening of the colon (relieve bowel obstruction)
● Cause: colon cancer, fecal incontinence/constipation, hernia
● Can be temporary and put back
Gastroscopy -1
● Tissue obtained for H pylori infection for patients with peptic ulcer
EGD - 2: visualizes mucosal lining of the stomach with flexible endoscope
● Ulcers, tumors, and varices can be seen and a biopsy can be obtained
● Diagnose and treat upper GI problems
● Goes down nose or mouth and looks at esophagus
○ Goes down to the tip of the stomach
○ Cannot look at the colon
If you were looking for GI bleed what scope would you use? EGD
Ulcers -4
Peptic Ulcer Disease:
● Cause: H pylori, NSAIDs
● Symptoms: burning stomach pain, feeling of fullness, bloating and belching, fatty food intolerance,
heartburn and nausea
○ Stress and spicy foods make it worse
○ Pain is worse on an empty stomach
● Complications: hemorrhage, perforation, gastric outlet obstruction q
● Treatment: PPI for 14 days, goal is to reduce gastric acid secretion
Know the difference between ulcerative colitis and Crohn’s
Ulcerative Colitis: continuous inflammation in mucosal layer of colon
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Symptoms: bloody diarrhea and abdominal pain
Complications: electrolyte imbalance; toxic megacolon
Keep an eye on: liver function and bone density
Tests
○ CBC: anemia from blood loss
○ Electrolyte imbalance: diarrhea
○ Albumin: protein loss from diarrhea
○ Stool: blood, mucus, pus can determine infection
○ Colonoscopy: determines extent of disease
● Surgery: proctocolectomy
Crohn’s -2: cobblestone inflammation of all layers of the bowel wall
● Symptoms: Cramping, rectal bleeding, diarrhea, abdominal pain
● Complications: fistulas, small intestine cancer (screen!)
● Surgery
○ Reanastomosis: Resect disease segments
○ Strictureplasty: opens narrowed areas obstructing bowel
■ Reduces the risk for developing small bowel syndrome
Dumping syndrome – 1 : Complication of gastric surgery
● 15-30 minutes after meal
● Intervention: smaller meals 6 times a day; lay down after meal to give time to rest; discourage foods
high in sugar; eat slowly and stop eating when feeling full
N/V -3
● Can lead to electrolyte imbalance
○ Know sodium and potassium levels
● Find the cause before medicating
● How long has it been going on?
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Coffee ground color got into the gastric acid and it’s been in the stomach for a while
Hiatal Hernia - 2
● Sliding: person lays supine and stomach slides into diaphragm goes back to proper placement when
person stands
● Paraesophageal/ rolling= MEDICAL EMERGENCY!
○ Stomach rolls up and forms pocket
● Cause: structural changes, increase intraabdominal pressure (obesity, pregnancy)
● Symptoms: heartburn, chest pain, dyspepsia, regurgitation
● Tests: barium swallow, EGD
● Conservative treatment: eliminate constricting garments, avoid lifting
● Surgery
○ Nissen Fundoplication- fundus of stomach wrapped around esophagus
○ Herniorrhaphy- closure of hiatal defect
Renal/Urology
Majority UTIs are located where? The bladder and urethra (lower urinary tract)
Cystoscopy -1
● Removes small kidney stones in bladder
● Can confirm bladder cancer
Kidney stones -1
● Symptoms: sharp, severe, and sudden flank pain; n/v due to pain; hematuria; renal colic (ureters
response to stone); kidney stone dance (cannot sit still)
○ Drink fluids
Lithotripsy -2
● Breaks up larger kidney stones
● ESWL for large stones: fluoroscopy or ultrasound focuses over the affected kidney, high-voltage spark
○ Breaks into: pebbles
○ Complication: steinstrasse- ureter becomes blocked by smaller pieces of kidney stone
● Percutaneous lithotripsy: inserted through small flank incision
○ Breaks into: sand-like particles
TURP -1: Removal of prostate tissue using resectoscope
● For people w/ BPH
● Complications: bleeding, clot retention, hyponatremia
Bladder Cancer -1
● No pain!
● Don’t know that they have it until it is too late
● Blood in the urine
Prostate Cancer -1
● PSA checked starting at age 50, 40 for person with family history, 45 for person with risk factors
● Symptoms similar to BPH: pain in the lumbosacral area that radiates down to the hips or legs
IVP -1: provides images of the urinary tract
● Are you allergic to shellfish or iodine
Exam 4 - 16 questions
Seizures -2
● Staticus elipictus: medical emergency
○ IV lorazepam to stop it
Medications - 3
● Dilantin
○ Toxicity know it
■ 10-20
Fractures -2
● Open fracture through the skin
○ Has to be put back together = open reduction (internal or external)
■ Internal: plates and screws directly on the bone
■ External: pins through outside of the skin
● Pin care: done daily and monitor for infection
Sprain/Strain -2
● Rest, Ice, Compression, Elevation
Dislocation - 1
● Pain meds!
● Goes into a splint or cast after placed back into place
Open vs Closed Reduction -1
Amputation -1
Cast Care -1
● Plaster of paris = concrete, takes a long time to cure and dry
○ Very impressionable
■ Palms not fingertips
○ Lower extremity wait 24 hours before weight bearing
Compartment syndrome -1
● Worry about blood flow and nervous system
● Check pulses and pain that does not resolve with pain meds
Osteoarthritis -1
● Know difference between OA and RA
○ OA: staying the same spot for long periods
○ RA: hurts on BOTH sides
Parkinson’s -1
● Worry about falls and nutritional deficits from not being able to feed themselves
Dosage Calculations – 5
Medication –2 (in addition to specific disease)
Total = 100
SATA –20