Exam 1 & 2 & Final Study Guide BUNDLE – NUR2502 / NUR 2502 (Latest 2023 / 2024) : Multidimensional Care III / MDC 3 – Rasmussen

This BUNDLE consists of 3 (three) sets of Exam | 1 & 2 & Final / 3 | Study Guide NUR2502 / NUR 2502 Multidimensional Care III / MDC 3 – Rasmussen

NUR 2502 Multidimensional Care III

NUR 2502 MDC III – Exam 1 Study Guide

*This is not an exhaustive list of what is on the exam, it is meant to help guide your studying. *

Review the following diseases/disorders:
 Breast Cancer
o Health promotion and maintenance
 Mammography
 Annual screening at age 45 start
 Women 55+ can switch to mammograms every 2 years
 clinical breast exam
 done at least every 3 years for women between 20-30 years old and every year
for asymptomatic women over 40 years old
 self-breast exam
 should be done monthly to increase breast self-awareness
 premenopausal women to examine breasts 1 week after the menstrual period
 high risk screening
 high risk= family history (mother, sister) of cancer or positive for genetic
factors
o cancer screening should start at the age which the affected cancer
patient was initially diagnosed
o Risk factors
 Lack of exercise, family hx, diet, alcohol consumption, obesity, not breastfeeding,
breast implants, smoking, medications (birth control, hormone therapy), no
pregnancies
o Types
 Noninvasive breast cancer
 DCIS- cancer cells are located within the duct and have not invaded the
surrounding tissue
 LCIS- cells that are contained in the lobules appear to be cancer cells but are
not. Indicates a risk of developing breast cancer.
 Invasive breast cancer
 Infiltrating ductal carcinoma- the cancer cells originate in the mammary
ducts and spread to the surrounding tissue
o Nursing Interventions (pg 1445)
 Excisional Biopsy teaching
 Refrain from saying the lump/mass is cancer unless diagnosed
 Reason is to determine if it is cancer or not
 Making sure she knows the removal of the mass is allowing us to further
evaluate for cancer
 Pain medication will be provided to ensure comfort
 Fibrocystic Breast Disorder
o Fibrocystic changes of the breast affecting the lobules, ducts and stromal tissues

o Non-cancerous changes that give the breast a lumpy texture
o Risk factors
 Premenopausal between 20-50 years of age and hormone replacement therapy
 Endometrial Cancer
o Caused by cancerous cells that originate in the inner lining of the uterus and grows slowly
o Adenocarcinoma is the most common
o Staging
 Stage 1- cancer cells are confined to the endometrium
 Stage 2- cancer cells spread to the cervix
 Stage 3- cancer cells invade the vagina and lymph nodes
 Stage 4- cancer cells have spread to the bowel or bladder
o Risk factors
 Obesity, family hx, women in reproductive years, diabetes, hypertension, uterine
polyps, late menopause, smoking, medications (birth control, chemo), no pregnancies
 Cervical Cancer
o Diagnosed early through preventative screening
o Associated with human papilloma virus
o Symptoms
 Leg swelling, bloody stools, pain or bleeding after intercourse, abdominal pain,
dizziness, fatigue, menstrual irregularities
o Risk factors
 Sexually active girls and young women, infections with HPV, multiple births,
smoking, younger than 18 for first intercourse, multiple sex partners, African
American, oral contraceptive use, history of STIs, obesity, poor diet, family hx of
cervical cancer, HIV/AIDS, high-fat diet, intrauterine exposure to diethylstilbestrol
 Uterine Leiomyoma
o Benign, slow growing solid tumor that occurs from the overgrowth of smooth muscle and
connective tissue in the uterus
o Aka fibroids or myomas
o Symptoms
 No bleeding to heavy bleeding during menstrual period
 Prolonged periods
 Pelivic pain
o Classifications
 Intramural- contained in the uterine wall within the muscle layer
 Submucosal- protrudes into the cavity of the uterus and can cause bleeding
 Subserosal-protrudes through the outer surface of the uterine wall
o Risk factors
 Genetics
 No pregnancies
 Vulvovaginitis
o Inflammation of the lower genital tract due to an imbalance of hormones and normal flora
of the vagina and vulva resulting in vaginal discharge, itching, irritation, painful urination,
and pain during intercourse
o Risk factors
 Multiple sex partners, use of vaginal sprays, use of douches, use of perfumed soaps,
reduced estrogen levels
 Toxic shock syndrome
o Caused by staphylococcus aureus—menstruation and tampon use
o Exotoxins produced by the bacteria cross into the blood stream
 Onset generally 5 days after the start of menstruation
o Risk factors
 Use of highly-absorbency tampons, hx of use of diaphragm, use of contraceptive
sponges, immunosuppression, deep skin infection

NUR 2502 Multidimensional Care III

NUR 2502 MDC III – Exam 2 Study Guide

Physical assessment
 Lung sounds:
o Bronchial
o Bronchovesicular
o Vesicular
 Adventitious sounds:
o Crackles: evident with fluid in lungs
o Wheezes: decrease in ventilation due to swelling of bronchioles
o Rhonchus: mucus or infiltration in lungs
o Pleural friction rub: noted when pt is experiencing fluid in pleural space
(around lung tissue)
 Other indications of respiratory adequacy:
o Skin/mucus membrane changes
 Gums, throat
 Cyanosis of skin
o Clubbing of fingers
 Related to hypoxia – not enough O2 in tissues
o Weight loss
o Unevenly developed muscles – especially in chest region
o General appearance
o Endurance (activity tolerance)
 Diagnostic assessment:
o RBC – determine issue of hemoglobin
o ABG – determine acidosis or alkalosis
o Sputum – rule out bacteria
o Xray, CT – determine nodules vs fluid buildup
o Pulse ox, capnometry – how much Co2 pt is getting out of lungs
o PFTs (Pulmonary function tests)– how well lungs are moving air in/out
 Flow rates, diffusion capacity, gas exchange, airway resistance,
distribution of ventilation
o Exercise testing
o Invasive diagnostic assessments:
 Bronchoscopy
 Camera that allows us to view airway; may need to be
intubated

 Be careful with reaccumulating of fluid in lungs and infection!
Monitor pt closely after!
 Thoracentesis
 Needle that aspirates the pleural fluid or air from the lungs
 Lung biopsy
 Check for cancer
 Follow up care: assess vital, breath sounds at least every 4
hours for 24 hours
o Risk for collapsed lungs (pneumothorax)
 Assess resp distress
 Report reduced/absent breath sounds immediately (concerned
about pneumothorax)
 Monitor for hemoptysis – bloody sputum
Head and Neck Cancer
 Squamous cell carcinoma and slow growing
o Treatable at early stage
 Begins in mucosa that is chronically irritated, becoming tougher and thicker
o Leukoplakia (white patchy) and erythroplakia (red, velvety) lesions
 Risk factors: tobacco and alcohol use
o Voice abuse (singers), chronic laryngitis, exposure to chemical/dusts, poor oral
hygiene, long-term GERD, oral HPV
Assessment:
 Lumps in mouth, throat, neck
 Difficulty swallowing
 Color changes in mouth
 Oral lesions or sore that does not heal in 2 weeks
o Hoarseness, sore throat
 Persistent, unilateral ear pain
 Persistent, unexplained oral bleeding
 Numbness of mouth, lips, face
 Change in fit in dentures
 SOB
 Burning sensation when drinking citrus or hot liquids
Interpreting:
 PRIORITY:
o Potential airway obstruction
o Potential for aspiration
 Head of bed at 30 degrees, pt may be put on thick liquids
o Anxiety – risk for SOB and lack of O2
o Decreased self-esteem
o Suck on saline, ice, gargle with mouth sprays
Treatment:
 Radiation – stay out of sun, do not shave area, teach pt to wear protective clothing, cleanse
with mild sop daily
 Chemo
 Cordectomy – removal of vocal cords (laryngeal cancer)
 Laryngectomy – removal of larynx
o Post op care:
 Priority is airway maintenance and gas exchange
 Wound flap, reconstructive tissue care
 HEMORRHAGE – can create obstruction of airway
 Wound break down

NUR 2502 Multidimensional Care III

NUR 2502 MDC III – Final Exam / Exam 3 Study Guide

note this is not a comprehensive list of all that is included on your exam, but should be used
instead to guide/direct your studying*

Exam 3: 75 questions, 150 points, 120 minutes to complete
Covers only module 7-10 (not comprehensive)

 Iggy chapters:
 Chapter 35: Care of Patients with Cardiac Problems
 Chapter 34: Care of Patients with Dysrhythmias
 Chapter 36: Care of Patients with Vascular Problems
 Chapter 38: Care of Patients with Acute Coronary Syndromes
 Chapter 39: Assessment of the Hematological System
 Chapter 40: Care of Patients with Hematological Problems

 Heart Failure- Left and Right know this very well!
o Cause
 Faulty heart valves (4): stenosis, regurg, infected
 Arrhythmias (A-fib, tachycardia)
 Infarction (MI, CAD)
 Lineage (family hx, congenital)
 Uncontrolled HTN
 Recreational drug use (cocaine, alcohol)
 Evaders (virus, infection)
o Know what’s important to teach in discharge teaching
 Low sodium diet, fluid restriction, vaccinations, exercise as tolerated, daily weights,
smoking cessation, limit alcohol, med compliance
o What are clinical manifestations of left sided heart failure and/or right sided heart failure
 Left Side
 Pulmonary congestion, cough, crackles in lungs, anorexia, decreased CO,
oliguria, fatigue, heaviness in arms or legs, chest discomfort, palpitations,
fast heartbeat, nonproductive cough, dyspnea, orthopnea, using extra pillows
at night, paroxysmal nocturnal dyspnea, dizziness, acute confusion, gaining
weight
 Right Side
 Weight gain, Fatigue, ascites, increased venous pressure, enlarged
liver/spleen, may be secondary to COPD, distended jugular veins, anorexia,

weight gain, GI distress, dependent edema, pitting edema, lethargic,
irregular HR (a-fib), nocturia, swelling

o How is heart failure diagnosed?
 Electrolytes, renal function tests
 ECG- thickening of heart muscles and dysrhythmias
 ECHO- enlargement
 Decreased cardiac function tests
 CXR- enlargement
 Stress tests
 Cardiac catheterization- identifies degree of heart failure
 BNP lab: biomarker, determines the degree of heart failure (>500 HF, >900 severe
HF)
 ABGs- hypoxemia
o What educational teaching is important to teach the client regarding fluid management at
home?
 Control volume overload: monitor sodium, potassium, BUN, creatinine and fluid
intake, dietary salt restrictions, diuretics, symptoms to report, daily weight checks,
fluid restriction
o Interventions
 Position: high fowlers, dangle their legs if possible
 Reassurance and anxiety reduction
 Education: modify lifestyle, medications, O2 therapy
 Surgery: CABG
 Heart failure Self-management health teaching
 Monitor medications
 Educate: Prevent readmission!!
 Valve diseases know each type very well-fill out chart below
o What predispositions increase risk for valve abnormalities?
 Older age
 Hx of certain infections that affect the heart
 Hx of heart disease or heart attack
 High BP, high cholesterol, diabetes
 Congenital heart disease
o What are clinical manifestations of each valvular disorder?
 Mitral stenosis
 Dyspnea on exertion, orthopnea, PND, palpitations, dry cough, hemoptysis,
pulmonary edema, pulse can change from normal to irregular as patient
decompensates
 Mitral regurgitation