Summary
Summary NURS 366 Final Exam Study Guide
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- Virginia Commonwealth University
Final Exam Study Guide for Nurs 366.
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1Final Exam Breakdown
Comprehensive Content
Integument 1
Male GU 1
Musculoskeletal 1
Neurology 4
Hematology 15
Oncology 13
Pulmonary 30
Total 65
Integument (1)
Differentiate between pharmacologic agents used to treat skin disorders – mechanism of action, indications
of use, and adverse side effects
Topical Glucocorticoids → creams, ointment, or gel
● Uses: To relieve inflammation and itching
● Apply thin film & gently rub into the skin
○ High potency agents – only for 2-3 weeks
○ Moderate potency – chronic dermatitis
■ Do not use occlusive bandages → can greatly increase absorption
● Adverse effects:
○ Local rxns → thinning of skin, stretch marks, purpura, telangiectasia, hypertrichosis
○ Systemic toxicity:
■ More likely w/ higher doses and long-term therapy
■ Growth retardation in children
■ Adrenal suppression
● Other Skin Disorders:
○ Treatment:
■ Ex: MRSA (bacterial infections) → antibiotic therapy, mupirocin (Bactroban) –
ointment
■ Ex: Fungal → topical/oral antifungal agents (Azoles)
■ Ex: Cutaneous vasculitis → immunosuppressants, corticosteroids
■ Ex: Hives → antihistamines & steroids
■ Ex: Scleroderma → immunosuppressive therapy & UV light therapy
Male GU (1)
Compare and contrast the pathology and symptoms of benign prostatic hyperplasia with prostate cancer
Benign Prostatic Hyperplasia (BPH): enlarged prostate gland → associated with urethral compression
● Mechanical obstruction: excessive growth of epithelial cells
● Dynamic obstruction: excessive growth of smooth muscle cells
, 2
○ S/S: urinary hesitancy, urinary urgency, increased urinary frequency, dysuria, nocturia, dribbling,
incomplete bladder emptying, straining when voiding
Prostate cancer: 2nd most common non-skin cancer in men → good prognosis
● Asymptomatic until advanced
● Risk factors: diet, hormones (androgen), vasectomy, chronic inflammation
● More than 95% are adenocarcinomas
● S/S: nocturia, increased void frequency, straining when voiding, weak urine flow
Musculoskeletal (1)
Differentiate between Nonbiologic and Biologic DMARDs: indications for use and adverse effects
Nonbiologic DMARDs:
● Methotrexate → most rapid acting, 3-6 weeks = first line of therapy
○ Indications for use: severe and active rheumatoid arthritis (ACR)
○ Adverse effects: hepatic fibrosis, bone marrow suppression, GI ulceration, and pneumonitis
● Sulfasalazine → pts who cannot tolerate other medication (ex: salicylates or NSAIDs)
○ Indications for use: RA
○ Mechanism of Action: anti-inflammatory and immunomodulatory actions
○ Adverse effects: GI side effects may be intolerable
Biologic DMARDs:
● Tumor Necrosis Factor (TNF) inhibitors
○ Indications for use: RA
○ Mechanism of Action: suppress immune function; work on neutralizing TNF
● Immune/inflammatory response initiated by:
Cytokines → break down bone → inflammation of the synovial fluid
○ Adverse effects: pose risk of serious infection
Neurology (4)
Differentiate between the perception of pain (i.e. three systems and definitions of pain perception)
Sensory/Discriminative System Identifies presence, character, location &
intensity of pain
Ex: OLD CARTS = description
Motivational/Affective System Determines individual’s conditioned
avoidance behaviors & emotional responses to
pain
Ex: condition a child (teach first, to avoid
dangerous things) → “NO, don’t touch, HOT”
Cognitive/Evaluative System Overlies individual’s learned behavior
concerning experience of pain → can
modulate perception of pain
, 3
Ex: person tolerates injection despite knowing
it may hurt
Pain Threshold Lowest amount of stimuli perceived as pain
Perceptual Dominance Pain at one location may cause an increase in
threshold in another location
Ex: Chronic back pain < twisted ankle
Pain Tolerance The greatest intensity of pain a person can
endure
Describe how the brain affects the following: level of consciousness, pattern of breathing, vomiting,
pupillary changes, oculomotor responses, and motor responses.
Neurologic functions critical to evaluation of consciousness
Clinical Manifestations:
● Level of Consciousness: alert & oriented (person, place, time, & event)
○ Most critical clinical index of nervous system function
○ “Red flag” when LOC has been altered
● Pattern of Breathing: (rate, rhythm, pattern)
○ Post-hyperventilation apnea (PHVA) – ↓ LOC, brainstem centers regulate the breathing
pattern by responding only to changes in PaCO2, no apnea
○ Cheyne-Stokes respirations (CSR) – abnormal rhythm of ventilation w/ alternating periods of
tachypnea and apnea; ↑ PaCO2 = tachypnea; ↓ PaCO2 = apnea; cycles
● Pupillary reaction: ‘PERRL’ – measure pupillary size/reaction; Abnormal Findings: 1st assessment
→ size 3, reassess → size 5 = swelling + edema ⇒ potential TBI
○ Indicates presence & level of brainstem dysfunction
○ Brainstem – controls homeostatic functions (vitals)
● Oculomotor Responses:
○ Resting, spontaneous, and reflexive eye movements that change at various levels of brain
dysfunction in comatose individuals
■ Fixed, dilated pupils = bad
■ For coma pt: can move head (manually) side to side and open eyes
● CANNOT MOVE pt’s head w/ spinal cord or cervical injury = DANGEROUS!
● Motor Responses: evaluates level of brain dysfunction/location of brain damage
■ Normal Findings: 5/5 → symmetrical movement & strength
■ Abnormal Findings: stroke on RT side of brain → LT weakness/paralysis
● Coma pt → pinch to observe for reflex/movement
● Vomiting, yawning, hiccups: complex reflex-life motor responses
○ Ex: brain injury → projectile vomiting w/ no pre-warning S/S (no fast heartbeat or salivation)
○ Hiccups/Yawning → not intentional; natural reflex/response
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