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Nursing B28: Medical Surgical Nursing 4
Final Examination Study Guide
The final exam will be cumulative, and, therefore will represent all previously learned materials. The
BOTTOM LINE is that you will have to able to effectively demonstrate clinical judgment and critical thinking
through the integration of the nursing process --- in every level of cognitive thinking including remembering,
understanding, applying, analyzing, evaluating, and creating.
The purpose of this study guide is to help you focus your studies. It is NOT a substitute for the course
and unit objectives. Students are responsible for ALL unit and course objectives, and their associated
required assignments and materials outlined in the landscape objectives, covered either in lecture or as /
or independent study.
Professional Issues and Practice
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Identify patient and family stressors and effective nursing strategies.
Job related stress ---identify common stressors and measures to reduce them
Review AACN’s / SCCM’s / ENA /MICN mission, vision and goals.
Criteria for admission to critical care units
Core measures / care bundles
Review Nat’l Patient Safety Goals – the concept of
QSEN and IOM
Review and distinguish scope of practice / delegation / and be able to apply
Role of the RN & Interim Permittee functions / scope
Advocacy / delegation / leadership / conflict management / patient abandonment / floating / RN Supervisor
Concepts for Nursing Practice
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Review One Legacy lecture
o Definition of brain death.
o When / why do you notify One Legacy
o Who approaches family / significant others / Factors affecting consent rates
o Determinants / clinical manifestations for brain death
o Apnea test --determinants
o Misconceptions regarding organ donation
Ways to help maintain patient orientation to surroundings
Review sensory deprivation and sensory overload
Ventilation
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Review Acute Resp Failure /PE /chest trauma/ PPH
o Differentiate between Type I vs. Type II / Correlate with clinical picture.
Review ARDS
o Defining criteria / Treatments / Nursing Process Review / early & late abgs / FiO2 /PaO2 ratio
Lumber puncture / intubation & mechanical ventilation /artificial airways/O2 devices.
o Procedure, positioning, indications, complications, and nursing interventions./diagnoses
Chest tube insertion -- pneumo / hemo
o Review A & P; 3 bottle systems; care of a client with chest tube, including procedure, nursing assessment,
interventions, and evaluation, and troubleshooting for problems.
Lung sounds
o Differentiate between normal and adventious lung sounds.
o Identify /differentiate between bronchial, pleural friction rub, rhonchi, E------A
Differentiate between early and late signs of hypoxemia
Modes and adjuncts of mechanical ventilation
o Caring for a ventilated client--- assessment and evaluation. Nurses role / responsibilities /alarms
ABG’s--- Interpret and troubleshoot / Correlate to clinical picture ( including ventilated clients)
Wean screen criteria / weaning intolerance
VAP protocols
Trauma – differentiate level of trauma systems, blunt vs. penetrating trauma
Identify secondary prevention
Skull fractures – signs an sx of basilar skull fractures
Disaster triage --- the tag system.. (black, red, yellow, green) correlate type of victims for each colors
Flail chest / Becks triad / cardiac contusion / tamponade
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Circulation
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Review / recognize rhythm strips including defining criteria and associated treatment
Temporary pacemakers
o Recognize / differentiate between various types of paced beats (atrial / ventricular)
o Differentiate between external transcutaneous, permanent, temporary pacing
o Caring for clients with pacemakers / education
Lead placement using 3 lead systems Leads I, II, III and MCL 1
Recognize atrial and ventricular depolarization and repolarization, and, how they are represented on the EKG.
Heart sounds
o --- S1, S2, S3, S4 --- know during what phase and what the valves are doing.
IABP
o know indications for, assessment of, and potential complications of client w / IABP
CAD, angina (types), MI, ACS, valvular heart disease (causes / cardiac cycle)
CHF – define, differentiate, recognize, and integrate supportive data.
DIC --- correlate laboratory findings/ pathophysiology / nursing interventions. Recognize management outcomes
CHF know common medications for treating CHF and associated laboratory and diagnostic data. Differentiate
between right and left, systolic and diastolic failure, and relate to hemodynamic monitoring
Aneurysms- define and differentiate types and correlate presenting s/sx and treatment
Describe, define, s/s, & relate nursing interventions for clients with pericardial effusion and cardiac tamponade
Review all diagnostic procedures
Hemodynamics
o Know normal parameters and be able to apply to case scenarios.
o Define and understand pre-load, after-load, CO/CI, stroke volume, EF,SVR, PVR,
o Relate to different shocks
o Identify dicrotic notch on waveform tracings
o Identify / distinguish between RA, RV, PA, and wedged waveforms
o Calculate MAP
Define hypertensive crisis and associate appropriate treatment options – definitions / know medications
Metabolic
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Significance of hypo / hyperkalemia as related to EKG
Treatment for Hyperkalemia
DI vs. SIADH
o Identify patients dx through assessment, laboratory and diagnostic data
o Identify and prioritize appropriate treatment plan / medications/ and interventions
Regulation /protective
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Differentiate between the four classifications of shock.
o Incorporate hemodynamics into classes of shock
Recognize, identify continuum of septic shock.
Differentiate types of burn injuries / causative
Burn classification by depth and extent of injury.
Calculate the total body surface area involved in a burn injury using the rule of nines.
Fluid resuscitation Use the Parkland formula to establish the correct rate and timing of fluid replacement.
Define MODS. Explain / relate collaborative management, for clients with MODS.
Describe the indications, complications, and nursing implications associated with fluid resuscitation of the burn client
Discuss common pharmacological agents used for the burn client and the patient with MODS.
Pain management --- 5 step process / scales
Hypothermia, heat related, and near drowning
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Perceptual / cognitive
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GBS
o Etiology and symptoms
Define ICP, CPP
o Know the associated nursing and medical assessments and interventions including related diagnostic
procedures, equipment, positioning, nursing interventions, and meds.
o Normal values for, and, how to calculate CPP, MAP, ICP
Differentiate between decorticate and decerebrate posturing
Motor reflexes and Cranial nerve tests
o Dolls eye, Cold caloric test, Babinski, papillary constriction, cough, gag, corneal
o What it indicates, what CN is represented, and describe what you would see if present /absent, who can
perform each test.
Spinal Cord Injury
Traumatic Brain Injury – basilar skull fracture… type, clinical presentation (battles sign, oto/rhinorrhea, raccoons
eyes)
Deferentiating between CSF vs. nasal drainage / dural tear “halo” test
GCS
NMB / TOF
Elimination
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ARF
o Review management including diet and medications, common side effects/ complications of ARF
Dialysis accesses
o Differentiate between the types of dialysis accesses / placement /
Define and differentiate between oliguria, anuria, azotemia
Differentiate between pre-post-intra renal failure and associated causes and treatment
Discuss the phases of acute renal failure and differentiate chronic vs. acute renal failure.
RAAS – identify sequencing of events.
Define ATN, relate causes and interventions.
Employ effective nursing interventions.. Think about contrast induced ATN how to prevent it, monitor for it, and
manage it.
Relate age related changes for ARF
Nursing Dx
Nutrition / fluid balance
Assess and care for a client with NGT
Blood transfusions
Crystalloid vs. colloid therapies, and appropriate for use
TPN infusion --- nursing cares, line management
Dietary intake / COPD, renal and respiratory failure
Other
Focus on application, analysis and evaluation
Think about related nursing diagnosis to all of the above.
Think about and relate all parts of the nursing process to each disease process.
There will be math questions on the exam, such as, PO, SQ, weight based, IV gtt and ml/ hr,
mcg/kg/min, so please bring your calculator.
Blank paper will be provided.
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