Exam Blue Print
Diabetes (17 Questions)
Objectives:
1.
Compare and contrast the physiology of T1DM and T2DM (1 question)
a. TYPE 1
i. Autoimmune
ii. Antibodies present
iii. Will always require insulin b/d they don’t make any
iv. S/S
1. Polydipsia
2. Polyuria
3. Polyphagia
4. Fatigue
5. Unintentional weight loss
6. Body type – thin, normal or obese
v. TX
1. Insulin always required
b. TYPE 2
i. Progressive defect of pancreas
ii. Takes 9-12 yrs to develop
iii. Oral meds & progressive insulin
iv. S/S
1. Often none
2. Fatigue
3. Recurrent infections
4. Polyuria
5. Polydipsia
6. Polyphagia
7. Body type – overweight or obese, possibly average
v. TX
1. Insulin may be required
c.
2. Discuss commonly reported symptoms for diabetes (1 question)
a. Frequent urination (polyuria)
b. Increased thirst (poly??)
c. Excess fatigue
d. Weight gain/weight loss
e. Blurry vision
f. Excess sleep
g. Slow healing
3. Discuss risk factors and diagnostic testing for T1DM, T2DM, and GDM
a. T1DM diagnostic tests: antibodies, FBG, A1c (1 question)
i. beta cell specific antibodies present
b. T2DM diagnostic tests: FBG, A1c (1 question)
i.
c. GDM diagnostic tests (1 question)
i. glucose challenge test oro-glucose– blood drawn within 1 hour of
sweet glucose drink
ii. Risk Factors:
1. Miscarriage
2. Pre-eclampsia
3. HTN
4. Proteinuria
5. Intrauterine fetal demise
6. Birth trauma
7. Increased risk of c-section
8. Stillbirth
9. Macrosomia (increased birth weight >9lbs)
10. Icreased risk of child being obese and DM
d. RISK FACTORS FOR HYPOGLYCEMIA:
i. Older adults
ii. Previous hypoglycemia
4. Interpret diagnostic and physical findings in diabetes (1question)
a. PREDIABETES:
i. A1c = 5.7%-6.4%
ii. FBG = 100-125
iii. Pancreas @ 50%
b. DIABETES:
i. A1c = >6.4%
ii. FBG = >199
iii. Pancrease @ 20%
5. Discuss complications and issues in persons with diabetes (4 questions)
a.
6. Develop nursing interventions and teaching plan with strategies for patients and
caregivers with diabetes (1 question)
a.
7. Compare and contrast the use of various types of
a. oral therapies (1 question)
b. insulin (1 question)
c.
d.
e. SGLT2 inhibitors, helps to excrete more glucose rather than putting it back
into the bloodstream
f. INSULIN:
i.
ii. KEEP: keeping it constant day & night
1. Usually taken at night
2. NO HOLD NPO
iii. COVER: cover for coming carbs
1. HOLD IF NPO
iv. CORRECT: correct current BG
1. NO HOLD IF NPO
2. >140, will give in order to get BG <100
8. Describe priority nursing care for HHS (1 question)
a. >600 BG
9. Describe priority nursing care for DKA (2 questions)
a. >250 BG
10. List symptoms and immediate care priorities for hyperglycemia and hypoglycemia
and discuss monitoring parameters in diabetics and issues with
hyper/hypoglycemia management (1 question)
REQUIRED READINGS: Lewis 11th Edition: pages 1108- 1142
Urinary Disorders (17 Questions)
1.
Obtain significant subjective and objective data related to the urinary system from
a patient (1 question)
 LOWER URINARY TRACT
1. SUBJECTIVE:
1. EMPTYING:
1. Dysuria
2. Hesitancy
3. Intermittency
4. Post-void dribble
5. Urinary retention
6. Foul-smelling urine
2. STORAGE
1. Urinary frequency
2. Urgency
3. Incontinence
4. Nocturia
5. Nocturnal enuresis
6. Suprapubic discomfort
3. OTHER
1. Hematuria
2. Cloudy urine
3. OLDER ADULTS – cognitive impairment, decreased
apetite, nonlocal abdominal discomfort (HTN,
tachycardia, tachypnea, afebrile)
 OBJECTIVE
1. Unremarkable vitals
2. FEVER NOT a reliable sign
3. Don’t trust older patients
4. Abdominal Assessment:
1. Inspect
2. Auscultate
3. Percuss
4. Palpate
5. Findings:
1. Normoactive bowel sounds x4
2. Suprapubic tenderness w/ palp
3. Abdominal discomfort
6. URINALYSIS IS PRIORITY DX STUDY
7. LOWER URINARY TRACT DX
1. WBCs (>5)
2. Leukocyte esterase (+/large)
3. Nitrites (+/large)
2.
Link the age-related changes of the urinary system to the differences in clinical
manifestations of a UTI (1 question)
 Decreased BF of kidneys over time
 Weakened muscle tone in ureter, bladder & urethra
 Menopause decreased estrogen, leading vaginal thinness
 KIDNEYS:
1. Decreased amount of renal tissue
2. Decreased number of nephrons & renal blood vessels
3. Decreased function of loop of henle & tubules
4. Decreased renal BF leads to decreased GFR leads to
decreased ability to concentrate urine and altered excretion of
water E+ and acid-base
 URETER/BLADDER/URETHRA:
1. Decreased elasticity & muscle tone
2. Weakened urinary sphincter
3. Decreased bladder capacity
4. FEMALE: decreased elasticity & muscle tone leads to
increased infections and incontinence
5. MALE: enlarged prostate leads to altered urinary
3.
Assess UTI risk factors (1 question)
 Catheters
 Pregnancy
 Chronic health conditions
 Sexual activity
 BC
 Personal hygiene (douching, etc)
 Immunocompromised
 Post-menopausal
 Increased urinary stasis
 CAUSES:
1. Pathogens – E. coli
4.
Perform a physical assessment of the urinary system using appropriate
techniques (included with other objectives)




LOWER UTI
Vital signs unremarkable
Fever is NOT a reliable VS
Inspect, Auscultate, Percuss, Palpate abdominal
1. Will find abdominal discomfort
2. Suprapubic tenderness w/ palpation
 UPPER UTI
1. FEBRILE (BUT NOT A RELIABLE SIGN)
2. Tachycardia
3. Tachypnea
4. HTN
 Inspect, Auscultate, Percuss, Palpate abdominal
1. Will find unilateral or bilateral CVA tenderness
2. Unilateral or bilateral flank pain
5.
Distinguish normal from abnormal findings of a physical assessment of the
urinary system and distinguish lower vs upper UTI clinical manifestations (1 question)
 Concern: <0.5mL/kg/hr
 OIliguria: <400 mL/day
 PYELONEPHRITIS – renal inflammation
1. Lower UTI that ascends to renal medulla
2. S/S:
1. Costovertebral angle tenderness (CVA)
2. Flank pain
3. Fever/chills
4. Nausea/vomiting
5. Malaise
6. Dysuria
7. Urgency
8. Frequency
9. Suprapubic pressure
3. DX:
1. WBC
2. Casts (WBCs)
3. Leukocyte esterase
4. Nitrites
 CYSTITIS – bladder inflammation
1. S/S
1. Dysuria
2. Hesitancy
3. Intermittency
4. Post-void dribbling
5. Urinary retention
6. Foul-smelling urine
7. Urinary frequency
8. Urgency
9. Invontinence


10. Nocturia
11. Nocturnal enuresis
12. Suprapubic discomfort
13. OLDER ADULTS:
1. Nonlocalized abdominal pain
2. Decreased apetite
3. Cognitive impairment
4. Gen. deterioration: HTN, tachycardia, tachypnea,
afebrile
2. DX:
1. UA is PRIORITY TEST
2. WBCs >5
3. Leukocyte esterase (+/large)
4. Nitrites (+/large)
5. AFTER confirmation of basteriuia (nitrites) and pyuria
(leukocyte esterase), UC may be collected via clean catch
or catheter
3. TX:
1. Uncomplicated – antibiotics 3-5 days
2. Complicated – antibiotics 7-10 days
3. Pyridium – CHANGES URINE COLOR
4. EDUCATION
1. Regular emptying (3-4 hrs)
2. Wipe front to back
3. Increase fluid intake (3L/day)
4. Shower>bath
URETHRITIS – urethra inflammation
1. S/S:
1. Dysuria
2. Urgency
3. Frequency
4. Possible discharge
5. Purulent discharge = gonococcal urethritis
6. Clear discharge = nongonococcal urethritis
2. CAUSE
1. STI
3. TX:
1. Based on cause
4. EDUCATION:
1. Avoid vaginal sprays
2. No sex for 7 days
3. No alcohol during and 72 hours after metronidazole
UROSEPSIS:
1. S/S:
1. Febrile
2. Elevated vitals
3. Elevated WBCs
4. Elevated lactic acid
5. Altered mental status
 UNCOMPLICATED
1. Non-pregnant females
2. Only involves bladder
 COMPLICATED
1. Occurs due to anatomical or functional abnormalities
6.
Describe the nursing responsibilities related to diagnostic studies of the urinary
system (UA) (1 question)
7.
Identify the treatment options in a patient with a diagnosis of a UTI (1 question)
8.
Nephrolithiasis: clinical manifestations, nursing management, associated
treatments (percutaneous nephrolithotomy), and associated patient education
(percutaneous nephrolithotomy) (3 questions)
 Kidney stone
 Urinary hesitancy
 Pain
 Tenderness
 Oliguria/anuria
 UA
 +RBC, crystals, possible UTI
 CT scan
 24 hour urine catch
 TX
 Morphine & toridol, Flomax
9.
Distinguish urinary incontinence types and associated treatments (2 questions)
10.
Identify CAUTI prevention care (1 question)
11.
Distinguish urinary diversions types, associated education, and potential
complications (2 questions)
12.
Describe male urinary issues i.e. BPH and prostate cancer including treatment
(TURP), nursing management, and diagnostic tests
 TURP complications (1question)
 TURP CBI (1 question)
 dx text prostate CA (1 question)
REQUIRED READINGS: Lewis 11th Edition: 1007-1023, 1024-1030 (stop at chronic
pyelonephritis), 1030 (urethritis), 1035 (urinary tract calculi)-1040 (stop at strictures),
1045 (urinary incontinence)-1052, 1054 (urinary diversions)-1057, 1254-1268
MSK Disorders (17 Questions)
1.
Describe relevant physical assessments for fracture including hip fracture (1
question)
a. ABCDE assessment
b. Open Reduction
c. Closed Reduction
d. Skin Traction:
i. Short term 48-72 hours before surgery
ii. Used to decrease muscle spasms
iii. Skin assessment is PRIORITY
iv. Assess key pressure points Q2-4 hrs
v. Buck’s traction = hip, knee, femur fracture
e. Skeletal traction:
i. Balanced suspension traction
ii. LONG-TERM
iii. Major complications are infection
iv. Pin care provided Qshift (BID)
v. Increase frequency of care if drainage is noted
f. Halo Traction
i. Move patient as a unit
g. NURSING ASSESSMENT FOR FRACTURES
i. Check for bleeding/hemorrhaging
ii. Check skin for lacerations, temp, perfusion, bruising, edema
iii. Check cap refill, pulses
iv. Check neurovascular for paresthesia (late sign), absent or decreased
sensation, hyper-sensation
2.
Describe cast care in terms of patient education (1 question)
a. CASTING AND SPLINTING
i. Always placed distal to proximal
ii. Elevate extremity for first 24hours post cast (above heart level)
iii. Always tell patients to keep it elevated
iv. Achey and dull pain is expected finding
v. NOTIFY PROVIDER
1. Extreme pain
3.
2. Pins & needles (paresthesia)
3. Swelling with pain & discoloration of toes/fingers
4. Pain during movement
5. Burning or tingling
6. Sores or foul odor under cast
Summarize surgical treatment for fracture
A.
A.
B.
C.
D.
EXTERNAL FIXATION:
Ongoing assessment for pin loosening and infection
Infection may require removal of device
Educate patient about pin care
Chlorohexidine often used for pin care
4.
Summarize complications associated with bone fracture: compartment
syndrome, fat embolus, and osteomyelitis (3 questions)
a. COMPARTMENT SYNDROME
i. 6 P’s:
1. PAIN – out of proportion to injury, unmanaged by opiods
2. PARASTHESIA – numb/tingle
3. POIKILOTHERMIA – coolness of extremity
4. PALLOR – loss of color
5. PARALYSIS – loss of function
6. PULSELESSNESS – decreased/absent peripheral pulses
ii. DO NOT
1. Elevate the extremity above heart
2. Apply cold compresses
3. Both of these will vasoconstrict
b. VENOUS THROMBOEMBOLISM (VTE)
i. High risk for ortho surgical pt, admin prophylactic anticoagulants
ii. NURSING CONSIDERATIONS:
1. Encourage early ambulation
2. Bedside SCDs (sequential compression devices)
3. Encourage fluids & prevent hemoconcentration
4. Monitor for manifestations like swollen, reddened calf of affected
extremity
5. Pt should dorsiflex and plantar flex ankle of affected LE against
resistance & ROM exercises on unaffected leg
c. FAT EMBOLISM SYNDROME
i. Contributes to mortality associate w/ fractures
ii. Most associated fractures are long bones, ribs, tibia, and pelvis
iii. EARLY SIGNS:
1. Chest pain, tachypnea, cyanosis, dyspnea/resp distress,
apprehension, tachycardia, hypoxemia
2. Headache, confusion, acute reduced mental acuity
iv. LATE SIGNS:
1. Petechiae on neck, anterior chest wall, axilla, buccal membrane,
and conjunctiva of eye distinguishes FES from PE – happens
because of occlusion of dermal capillaries
5.
Describe teaching for a patient who had a hip fracture surgery (anterior and
posterior hip replacements) (3 questions)
a. HIP FRACTURE
i. Bucks traction pre-op
ii. Assess for pain
iii. Assess skin
iv. Surgery – pins to the site
v. POSTERIOR HIP PRECAUTIONS
1. DOS
a. Elevated toilet seat/riser
b. Long handled shoe horn
c. Chair in shower
d. Pillow between legs for 6 weeks post-op
e. Knee/hip in neutral straight position
f. Notify provider if severe pain
g. Discuss risk factors for prosthetic joint infection with
dentist
2. DON’T
a. Flex greater than 90 degrees
vi. ANTERIOR HIP APPROACH
1. ADVANTAGE
a. Lower risk dislocation
b. Less damage to muscle
c. Less pain, quicker rehab
2. DISADVANTAGE
a. More difficult surgery
b. Limitations to what can be fixed
c. Incision problems
3. PATIENT SHOULD BE OUT OF BED AND IN A CHAIR THE DAY
AFTER THEIR OPERATION
4. DAILY WALKING REGIMEN
5. USE CAN ON UNAFFECTED EXTREMITY
6.
Compare and contrast symptoms and treatments for OA and RA (4 questions)
a. OA
i. Non inflammatory
ii. Slow, progressive NON-INFLAMMATORY disorder of diarthrodial joints
iii. CAUSES:
1. Obesity – modifiable
2. Mechanical stress, work requiring frequent kneeling - modifiable
3. Estrogen – nonmodifiable
4. Typically affects one side of the body
5. Stiffness with inactivity (think morning)
6. Bouchard’s node deformity (proximal)
7. Heberden’s node deformity (distal)
iv. ASSESSMENT:
1. Assess ADLs and determine patient goals
v. NURSING CONSIDERATIONS:
1. Priority is nondrug management such as swimming, weight
reduction, rest & joint protection, acupuncture, heat & cold
2. Drug therapy – NSAIDs, steroid cream
vi. EDUCATION:
1. Maintain healthy weight
b. RA
i.
ii.
iii.
iv.
v.
vi.
Systemic, autoimmune issue
Symmetrical problems
Morning stiffness 60 minutes – several hours
Ulnar drift
Boutonniere deformity
PSYCH considerations:
1. Consider this
vii. DX:
1. CBC, ESR, CRP, RF, anti-CCP, ANA
2. Xray
3. Synovial fluid analysis
viii. MANAGEMENT:
1. Nutritional & weight management
ix. DRUGS:
1. Disease-modifying antirheumatic drugs (DMARDs)
2. Biologic response modifiers (BRMs)
3. NSAIDs
4. Intra-articular or systemic corticosteroids
x. INTERPROFESSIONAL CARE
1. OT
2. PT
3. Social worker
7.
Discuss assessment findings for both OA and RA and summarize how they differ
(1 question)
8.
Describe the underlying pathophysiology, diagnostic tests, risk factors,
prevention, and management (pharm and non-pharm) for gout (1 question)
a. GOUT
i. Painful flares lasting days to weeks
ii. Uric acid crystals in 1 or more joints
iii. Metabolic syndrome (obesity, HTN, hyperlipidemia, insulin resistance)
b. DRUGS
i. Colchicine
ii. NSAIDs
iii. Corticosteroids
iv. CHRONIC – Allopurinol to prevent future attacks
c. EDUCATION
i. Avoid purine foods: alcohol, soft drinks, seafood, liver
9.
Describe the underlying pathophysiology, diagnostic tests, risk factors,
prevention, and management (pharm and non-pharm) for osteoporosis (3 questions)
a. OSTEOPOROSIS
i. Silent thief
ii. DEXA <-2.5 = yes
iii. PATHO:
1. Bone resorption exceeds deposition
2. Menopause – rapid estrogen loss = osteoporosis risk
iv. RISK FACTOR:
1. Low body weight
2. Low calcium & vitamin D
3. Corticosteroids & anti-seizure meds
4. Alcohol use
5. Women
6. Men w/ significant smoking HX
7. Family HX
v. CLINICAL MANIFESTSIONS:
1. Spontaneous fractures are early signs
vi. DX:
1. DEXA scan is gold standard
vii. MANAGEMENT:
1. Calcium
2. Vitamin D
3. Biphosphonates (Fosamax)
a. Inhibits osteoclast-mediated bone resporption
b. Stay upright for 30 mins after taking with full glass of
water
4. Dairy, fortified foods, fish, fruits & veg
5. Weight bearing exercise
6. Walking is preferred to high-impact aerobics like running
7. NOT swimming, unless you have weights added
REQUIRED READINGS: Lewis 11th edition: 1429 – 1440 (Physiology), 1450 – 1459
(Fractures, nursing management, and complications), 1463 - 1466 (Hip Fracture), 1492
– 1494 osteoporosis, 1499 – 1509 (OA and RA), 1513 – 1514 Gout