Exam Study Guide BUNDLE for NUR2392 / NUR 2392 Multidimensional Care II / MDC 2 – Rasmussen University. Contains study guide for Exam 1, Exam 2 and Final Exam. HAPPY STUDYING…
NUR 2392 Multidimensional Care II
Multidimensional Care II Exam 1 Study Guide 2023 / 2024
*The exam questions are not limited to only what is listed on
this guide, please refer to your chapter readings and module
materials
Ch. 21: Principles of Cancer Development
● Benign vs. Malignant cells
○ Benign:
■ Specific Morphology- they resemble the tissue they originated
from (they look like the host).
■ Small Nuclear to Cytoplasmic Ratio- they have a similar
structure inside the cell to normal cells and small nucleus.
■ Specific Function- they contribute to the body in some way.
■ Tight Adherence- they bind close together.
■ No Migration- they do not move around the body or invade other
tissue sites.
■ Orderly Growth-they grow at a normal rate.
■ Euploidy- they have a normal amount of chromosomes per cell.
○ Malignant (Cancer):
■ Anaplasia- loss of appearance of the parent cell.
■ Large Nuclear to Cytoplasmic Ratio- they have a large nucleus
and occupy space.
■ Specific Functions are Lost- they serve no purpose to the body.
■ Loose Adherence- loose binding of the cells, causing potential
spread into the blood and body.
■ Migration/Metastasis- spreads and moves easily.
■ Loss of cellular regulation and contact- the cells will crowd,
push, and grow on top of other cells.
■ Rapid Cell Division- the cells will be produced and grow at a
faster rate
■ Aneuploidy- abnormal number of chromosomes per cell.
● Seven warning signs of cancer
○ “CAUTION”
■ C: changes in bowel or bladder habits
■ A: a sore that does not heal or mouth sources (mucositis)
■ U: unusual bleeding or discharge
■ T: thickening of a lump in a tissue
■ I: indigestion and dysphagia
■ O: obvious change in a wart or mole
■ N: nagging cough
● Cancer development stages of malignancy
○ Initiation: the normal cell becomes damaged which is irreversible and
can lead to cancer developing
○ Promotion: repeat exposures to a damaging stimuli enhances growthmutations can cause this
○ Progression: because of repeat exposures, there is an increase in
production of malignant cells
○ Metastasis: movement of the cancer cells
■ Malignant transformation: some cells will divide enough to form
a tumor area on top of tissue.
■ Tumor vascularization: cancer cells secrete tumor angiogenesis
factor stimulating the blood vessels to bud and for channels to
grow.
■ Blood Vessel Penetration: cancer cells break off from the main
tumor and enzymes on the surface of the tumor cells make holes
in the blood vessels, allowing the cancer cells to enter blood
vessels and travel around the body.
■ Arrest and Invasion: cancer cells clump up in the blood vessel
walls and invade new tissue aera to support continued growth of
cancer cells and new tumors.
● Cancer classification: monitor tumor growth, aggression, progression, and to
determine appropriate treatment.
○ Tumor grading: based on cellular aspects of cancer.
■ Based on the aggressiveness of the cancer cell and
differentiation from the normal tissue.
● G0: the grade cannot be determined
● G1: Tumor cells are well differentiated and closely
resemble the normal cells from which they arose.This
grade is considered a low grade of malignant
change.These tumors are malignant but are relatively
slow growing.
● G2: Tumor cells are moderately differentiated; they still
retain some of the characteristics of normal cells, but also
have more malignant characteristics than do G1 tumor
cells.
● G3: Tumor cells are poorly differentiated, but the tissue of
origin can usually be established.The cells have few
normal cell characteristics.
● G4: Tumor cells are poorly differentiated and retain no
normal cell characteristics.Determination of the tissue of
origin is difficult and perhaps impossible.
○ Plodiy: based on the number of chromosomes the cell has
■ Cancer cells will have an abnormal number of chromosomes in
their cells.
● Euploidy: normal amount of cell chromosomes- 46 with 23
pairs.
● Aneuploidy: abnormal number and formation of
chromosomes in cancer cells.
○ Staging: determines the exact location of the cancer, how large the
tumor is, and if it is spreading.
■ Clinical staging: assesses patient symptoms to determine size
and spread.
■ Surgical staging: assesses size, number, sites, and spread by
visualization at surgery.
■ Pathological staging: determining the tumor size, number, sites,
and spread by pathologic examination of tissues obtained at
surgery.
○ TNM- tumor, node, metastasis
■ Describes the anatomic extent of cancers. 1-4. 1 is that there is
no spreading or is small and 4 is that there is a large spread and
that the tumor is large also.
● Primary tumor (T): how large the tumor is .
○ Tx: primary tumor cannot be assessed
○ T0: no evidence of primary tumor
○ Tis: carcinoma in situ- pre cancer
○ T1, T2, T3, T4: increasing size and/or local extent of
primary tumor
● Regional lymph nodes (N): based on how many nodes the
tumor takes over in the body.
○ Nx: regional lymph nodes cannot be assessed
○ N0: no regional lymph node metastasis
○ N1, N2, N3: increasing involvement of regional
lymph nodes
● Distant metastasis (M): if the cancer is moving or not
moving.
○ Mx: presence of distant metastasis cannot be
assessed
○ M0: no distant metastasis
○ M1: distant metastasis
○ Doubling time: the amount of time it takes for a tumor to double in
size. Will help determine tumor growth.
○ Mitotic index: the percentage of actively dividing cells within a tumor.
○ Cancers are classified by the tissue they originate from. Other ways to
classify cancer include: biologic behavior, anatomic site, and degree of
differentiation
■ Adeno = epithelial
■ Chondro = cartilage
■ Fibro = fibrous connective
■ Glio = glial cells (brain)
■ Hemangio = blood vessel
■ Hepato = liver
■ Leiomyo = smooth muscle
■ Lipo = fat/adipose
■ Lympho = lymphoid tissue
■ Melano = pigment producing cells
■ Meningioma = meninges
■ Neuro = nerve tissues
■ Osteo = bone
■ Renal = kidney
■ Rhabdo = skeletal muscle
■ Squamous = epithelial layer, mucous membranes, organ lining
● Cancer prevention (primary vs. secondary)
○ Primary
■ Use of sunscreen
■ Stop tobacco use
■ Use PPE in workplace
■ Reduce alcohol consumption
■ Modify diet
■ Limit sexual partners/safe sex practices
■ Remove at-risk tissue: removing polyps, breast tissue, etc
NUR 2392 Multidimensional Care II
Multidimensional Care II Exam 2 Study Guide 2023 / 2024
*The exam questions are not limited to only what is listed on
this guide, please refer to your chapter readings and module
materials
Chapter 12 – Assessment and Care of Patients with Problems of Acid-Base Balance
● ABG ranges and analysis
o Normal Ranges:
▪ pH: 7.35-7.45 7.35-7.4= acidosis 7.4-7.45= alkalosis
▪ PaCO2: 35-45
▪ HCO3: 22-26
▪ PaO2: 80-100
o Abnormal Ranges:
▪ Acidosis
● pH: ↓ 7.35
● PaCO2: ↑ 45
● HCO3: ↓ 22
▪ Alkalosis
● pH: ↑ 7.45
● PaCO2: ↓ 35
● HCO3: ↑ 26
▪ PaO2 is abnormal when it is ↓ 80
o How to solve ABG imbalances:
▪ First, look at pH- determine if it is acidic, alkaline, or normal
● If in normal range – determine if the pH is more acidic
(7.35-7.4), or alkaline (7.4-7.45)- this will help us
determine compensation
▪ Next, look at PaCO2- determine if it is below 35 (or more
alkaline), in normal range, or above 45 (or more acidic).
▪ Then, look at the HCO3- determine if it is below 22 (or acidic), in
normal range, or above 26 (or alkaline).
▪ Once all readings have been determined, use the ROME method
to determine the ABG imbalance.
● Respiratory Opposite- the pH and CO2 levels will be in
opposite directions, Metabolic Equal- the Ph and HCO3
levels will be in the same or equal direction.
▪ Next look at the PaO2. In our respiratory clients, we must look
at this to determine if there is enough oxygen getting into the
lungs or not. If it is lower than 80, then we know there is not
enough perfusion of oxygen within the arterial blood and that
there is breathing difficulty somewhere.
▪ Then we must determine if the patient is fully compensated,
partially compensated, or uncompensated.
● Fully Compensated vs. Partially Compensated vs. Uncompensated
o Compensation occurs when there is an acid base imbalance and the
body attempts to correct an abnormality within the other body system.
▪ First the pH will be affected due to being a buffer. Must look to
see if it is normal, abnormal, acidic, alkaline.
▪ Then we will look at PaCO2 and HCO3. Whichever value is
abnormal, that is your compensation.
o Fully Compensated: The body has placed the pH back to normal.
However, there will be other systems with abnormal ranges. The
abnormal value is the body systems that are compensating. pH normal
and HCO3 and PaCO2 are both abnormal. 7.37, 60, 18
o Partially Compensated: The body is compensating for the pH and for
both the PaCO2 and HCO3. This places all 3 levels abnormal. This
shows that the respiratory and kidneys are compensating to get the pH
back to normal. 7.3, 50, 18
o Uncompensated: The body is not in a state of compensation yet, so
there is an abnormality of the pH and either the PaCO2 or HCO3, but
not both. 7.3, 60, 24
● Buffers
o Chemical (bicarbonate and intracellular fluid) and protein buffers
(albumin and globulins)
▪ First line of defense
● Either bind or release hydrogen ions as needed
● Respond quickly to changes in pH
o Respiratory buffers
▪ Second line of defense
● Control the level of hydrogen ions (within minutes) in the
blood through the control of CO2 levels
● When a chemoreceptor senses a change in the level of
CO2, a signal is sent to the brain to alter the rate and
depth of respirations.
o Hyperventilation: Decrease in hydrogen ions (helps
to blow off excess hydrogen ions), decreased PaCO2.
Central chemoreceptors inhibited.
o Hypoventilation: Increase in hydrogen ions,
increased PaCO2. Central chemoreceptors
stimulated.
o Kidney buffers
▪ Kidneys are the third line of defense.
● This buffering system is much slower to respond (24-48
hours), but it is the most effective buffering system with
the longest duration. (kidney movement of bicarbonate,
formation of acids [HPO4 -1 + H+ → H2PO4 2-], and
formation of ammonium [NH3+ + H+ → NH4+])
● Kidneys control the movement of bicarbonate in the urine.
Bicarbonate can be reabsorbed into the bloodstream or
excreted in the urine in response to blood levels of
hydrogen.
● Kidneys can also produce more bicarbonate when needed.
o High hydrogen ions: Bicarbonate reabsorption and
production
o Low hydrogen ions: Bicarbonate excretion
● pH Regulation
o The pH is the expression of the balance between carbon dioxide (CO2),
which is regulated by the lungs, and bicarbonate (HCO 3-), a base
regulated by the kidneys. The greater the concentration of hydrogen,
the more acidic the body fluids and the lower the pH. The lower the
concentration of hydrogen, the more alkaline the body fluids and the
higher the pH.
o Example:
o When excess carbon dioxide is produced, the equation shifts to the
right, causing an increase in hydrogen ions (and a decrease in pH).
▪ Whenever the CO2 level changes, the pH changes to the same
degree, in the opposite direction
▪ When the CO2 level of a liquid increases, the pH drops,
indicating more free hydrogen ions (more acidic)
NUR 2392 Multidimensional Care II
Multidimensional Care II Final Exam Study Guide 2023 / 2024
*The exam questions are not limited to only what is listed on
this guide. Please refer to your chapter readings, recordings,
and module materials. ATI has additional practice questions for
review in Learning Systems RN 3.0.
Ch. 56 – Care of Patients with Noninflammatory Intestinal Disorders
● Nonmechanical (ileus) vs. mechanical obstruction (intussusception, volvulus,
etc.)
o Non-mechanical: results from neurological disturbances that affect the
muscles. Can be primary or secondary (often based on anesthesia
medications). Remember to assess the patient’s bowel tones for
complications from this!
▪ Paralytic Ileus: the bowel is not impacted by a physical
obstruction, but because of a lack of peristalsis as a result of
neuromuscular disturbance, causing backup of fecal contents
and abdominal distention and potentially leakage of stool
contents into the peritoneum space can occur, causing
inflammation and infection, decreased electrolyte levels and
reduced blood volume.
o Mechanical: from a structural disturbance of the bowel.
▪ Adhesions: scar tissue from surgery that builds up and causes
obstruction
▪ Benign or malignant tumors
▪ Appendicitis complications: if the appendix bursts, often the
contents will cause disruptions in fecal matter flow.
▪ Hernia: protrusion of the bowel through an opening that should
not be there, causing pain and blockages.
▪ Fecal impactions: from constipation
▪ Strictures: from crohn’s or radiation
▪ Intussusception: telescoping of the bowel into itself.
▪ Volvulus: twisting of the bowels, allowing nothing to go through.
o Physical Assessment
▪ Obstipation: severe constipation that may last for days without
any passage of stools. Diarrhea may be present in partial
obstructions
▪ Failure to pass gas
▪ Vomiting that may be foul smelling or coffee ground like.
▪ Abdominal Distention: abdominal when assess will be firm,
swollen, and painful
▪ Peristaltic waves: movement of the intestine, then stopping
▪ Borborygmi: high pitch gurgling bowel sounds
o Diagnostics:
▪ Barium Swallow
▪ CT with contrast
▪ Ultrasound
o Nursing Care:
▪ Monitor vitals
▪ Assess abdomen 2 times a day for bowel tones, distention, and
passing for gas
▪ Monitor F/E,I/O, lab values for disturbances- may need to give
IV fluid replacement due to potential loss of electrolytes such as
NS
▪ Manage NG tube- often will be a salem sump tube
▪ Ensure tube patency
▪ Check initial tube placement with XRAY
▪ May need suction and decompression for the obstruction
● Metabolic alkalosis is a concern
▪ Check for tube placement (pH 0-4)
▪ Irrigate tube
▪ NPO status
▪ Perform mouth and nare care
▪ Place patient in a semi fowler’s position
▪ Give pain medications
▪ Give alvimopan.
o Surgery
▪ Exploratory laparotomy: will allow the provider to relieve and
locate the obstruction. may be large or small incisions.
▪ The RN should teach the patient about what to expect after such
as NG tube insertion and a clear liquid diet that will advance as
tolerated. Potential N and V.
o Patient Teaching
▪ Patients should eat high fiber foods, like raw fruits and veggies.
▪ Drink lots of water
▪ Do not use routine laxatives as they have a potential to become
abused. and cause damage to the abdominal muscles.
▪ Daily exercise needed to promote gastric motility
▪ Take bulk forming products and a stool softener.
▪ Sit on the toilet or commode rather than the bedpan.
▪ Must report and abdominal pain, distention, N,V,constipation
▪ Teach about incision care
▪ Drug therapy will often include percocet, stool softener.
● Polyps
o Small growths that are attached to the intestinal mucosa that are
often benign but can become malignant.
o Adenomatous: polyps that have the potential to become malignant
▪ Villious
▪ Tubular
o Hyperplastic: little chance to become cancerous polyps
o Malignant: those polyps that are cancerous when developed
o Familial adenomatous polyposis and hereditary nonpolyposis are
inherited that will eventually progress to colorectal cancer
o Assessment:
▪ Asymptomatic and usually discovered on a routine colonoscopy
screening
▪ May cause bleeding, obstruction or intussusception
o Diagnostics: biopsy and will often be removed at time of finding.
o Patient teaching: follow ups may be needed for complete polyp
removals. Teach about bleeding, abdominal distention and pain and
blood in the stool after the procedure.
● Colorectal cancer labs (CEA), diagnostics
o Fecal occult blood test (FOBT) – positive test indicates bleeding in the
GI tract
▪ Patient needs to avoid aspirin, vitamin C, iron and red meat for
48 hours before giving stool specimen
▪ Also, assess whether the patient is taking anti-inflammatory
drugs, need to be discontinued
▪ Negative results do not completely rule out the possibility of
CRC
o Carcinoembryonic antigen (CEA) – an oncofetal antigen is elevated in
many people with CRC
▪ Normal value is less than 5 ng/mL
▪ This protein is not specifically associated with the CRC, and it
may be elevated in the presence of other benign or malignant
diseases and in smokers
▪ It is often used to monitor the effectiveness of treatment and to
identify disease recurrence
● Imaging Assessment
○ Sigmoidoscopy – provides visualization of the lower colon using
a fiberoptic scope
○ Colonoscopy – provides better visualization of polyps and small
lesions than does a barium enema alone
● Irritable bowel syndrome health teaching and testing (hydrogen breath test)
o Types
▪ IBS C: constipation
▪ IBS D: diarrhea
▪ IBS M: mixed constipation and diarrhea
▪ IBS A/U: alternating constipation and diarrhea or unknown
o Hydrogen breath test or small-bowel bacterial overgrowth breath test.
When small-intestinal bacterial overgrowth or malabsorption of
nutrients is present, an excess of hydrogen is produced. Some of this
hydrogen is absorbed into the bloodstream and travels to the lungs
where it is exhaled. Patients with IBS often exhale an increased
amount of hydrogen.
o Teach the patient that he or she will need to be NPO (may have water)
for at least 12 hours before the hydrogen breath test. At the beginning
of the test, the patient blows into a hydrogen analyzer. Then, small
amounts of test sugar are ingested, depending on the purpose of the
test, and additional breath samples are taken every 15 minutes for 1 to
5 hours
● Teaching and nutrition
● Dietary fiber and bulk help produce bulky, soft stools and
establish regular elimination habits.
● The patient should consume 30-40 g of fiber each day
● Eating regular meals, drinking 8-10 glasses of water each day,
and chewing food slowly help promote normal bowel function.
● Drug therapy depends on main symptoms of IBS
○ Constipation-predominant IBS treated with bulk forming
laxatives
○ Diarrhea-predominant treated with antidiarrheals