NUR 380Medical Surgical Final Exam Blueprint
Blueprint: NUR 380 Final Exam Medical Surgical Nursing (65 questions)
For illnesses & injuries assigned this semester, focus on:
1. Topics: Almost every condition & clinical manifestations will be addressed, with an emphasis on
prioritization & a focused assessment, including:
Topics Pages
Part A: Neurological assessment, head & spinal 2
cord injuries, Multiple Sclerosis, Parkinson’s
Disease, CVA, TIAs, epilepsy, meningitis,
Myasthenia Gravis, Guillain-Barre’ Syndrome,
Alzheimer’s disease
Part B: All endocrine disorders 40
Part C: Anemias, hemophilia, blood product 55
therapy, GI bleeding, sickle cell anemia,
thrombocytopenia, leukemia, multiple myeloma,
aplastic anemia
Part D: GI & biliary disorders; i.e. peptic ulcer 68
disease, appendicitis, peritonitis, cirrhosis, hepatic
encephalopathy
Part E: Renal disorders, i.e. UTIs, cystitis, 82
pyelonephritis, glomerulonephritis, Nephrotic
Syndrome, renal injury & failure
Part F: Musculoskeletal problems, i.e. traumatic 96
injuries & fractures, potential complications of
fractures & of their treatment.
2. For all of the above, focus on:
a. Normal changes related to aging which impact signs of illness & response to illness.
b. Recommended health promotion activities and illness prevention activities.
c. Risk factors associated with these conditions.
d. Nursing responsibilities for postoperative surgical procedures.
e. Nursing responsibilities for orthopedic interventions, i.e. traction, casts, ORIF, prosthetic hip
replacement
f. Bloodwork results, interpretation based on the patient problem, & nursing implications.
g. Nursing responsibilities associated with the assessment & diagnostic procedures frequently
performed to diagnose common illnesses and injuries.
h. Identify the highest priority nursing diagnoses associated with illnesses and injuries.
i. La Charity questions: all topics (Chapter 17 may be excluded).
1
,NUR 380Medical Surgical Final Exam Blueprint
Medical Surgical Final Exam Blueprint
A. Neurological assessment, head & spinal cord injuries, Multiple Sclerosis, Parkinson’s Disease ,
CVA, TIAs, epilepsy, meningitis, Myasthenia Gravis, Guillain-Barre’ Syndrome, Alzheimer’s disease
1. Neurological Assessment, Head and Spinal Cord Injuries
Chapter 65
Structures of the Nervous System
1. Central nervous system:
a. Brain
b. Spinal cord
2. Peripheral nervous system:
a. Cranial nerves
b. Spinal nerves
c. Autonomic nervous system
The Brain
1. Cerebrum: 2 hemispheres, hypothalamus, thalamus, & basal ganglia
2. Brain stem: midbrain, pons,
medulla oblongata; the closer to the
spinal cord, the more primitive the
functions
3. Cerebellum
Cerebral Function
Cerebrum: responsible for
integration (making sense) of data
Corpus callosum transmits
information between hemispheres:
sensation, memory, & learned
discrimination
Lateralization: right-handed
dominant (& some left-handed) have cerebral dominance on left side for verbal, linguistic, arithmetic,
calculation & analytic functions
Non-dominant hemisphere: spatial, geometric, visual, pattern, & musical functions
Clinical manifestations depend on which lobe is affected (frontal, parietal, temporal, occipital)
Thalamus
Sits above the brain stem
Router: sorts data & sends to other
critical areas
Hypothalamus: homeostasis for
temperature, osmolarity, circadian
rhythms
Posterior pituitary gland: secretion of
hormones, maintain water balance, i.e.
oxytocin, ADH
Basal Ganglia
Sits below the corpus callosum &
cerebral cortex
Contains groups of nuclei (ganglia)
which share the same function
Motor control, both excitatory &
inhibitory
Manifested in Parkinson’s Disease
Cerebral Cortex (80% of the Brain)
1. Frontal lobe: executive functions:
concentration, abstract thought, planning, analytic processing, storage of information & memory, motor
function, judgment, personality, emotional control, inhibitions
2
,NUR 380Medical Surgical Final Exam Blueprint
2. Parietal: analysis & relay of sensory information from the environment to other critical areas, proprioception,
size & shapes
3. Temporal: auditory reception & memory of sound, music, & language
4. Occipital: interpretation & memory of visual imagery, language, hearing
Brain Stem Function
Breathing, circulation, & digestion
o Midbrain: connects pons & cerebellum with the hemispheres, containing sensory & motor
pathways for visual & auditory reflexes
o Pons: bridge between 2 halves of cerebellum, & between medulla and midbrain; motor/sensory
pathways & respiration
o Medulla Oblongata: filters & routs motor fibers brain to spinal cord & sensory fibers from the
spinal cord to the brain
Decussation: fibers cross over at this level (implications for stroke)
Cranial nerves 9-12 originate here
Contains reflex centers for respiration, BP, heart rate, cough/gag, vomiting, swallowing, sneezing
Reticular formation for sleep-wake cycles & arousal
Cerebellar Function
Cerebellum: sits behind pons & midbrain, & beneath the occipital lobe
Sensory input needed for smooth coordinated movement
Body control & coordination (sports)
Motion memory (how to ride a bike)
Fine motion movements
Proprioception: Awareness of postural body in space (postural) (without looking at body parts)
Focused Assessment of the Nervous System
Health history: Critical information
1. History of the present illness: onset, severity, location, fluctuations, aggravating & relieving factors
2. Interview allows the nurse to observe overall appearance, mental status, posture, movement & affect
3. Medical record: previous trauma?
4. Family information: genetics
5. History of falls, alcohol, meds, illicit drugs
6. May need to ask yes/no questions
Common Symptoms
1. Pain: usually indicates injury, i.e. hemorrhage, spinal disk disease, tumor
2. Seizures: abnormal electrical discharges resulting in changes in sensation, motor function, perceptions,
consciousness; may be brief such as blank stare or full blown, i.e. fever, alcohol/drug withdrawal,
hypoglycemia, epilepsy
3. Dizziness or vertigo: sensation of imbalance or movement; sensation of room spinning
o Visual disturbances: decreased acuity, blindness, diplopia, nystagmus; due to neurological disease,
aging, tumor, stroke
o Muscle weakness or rigidity: can cause wide variation in signs & symptoms; can be acute or
progressive
o Abnormal sensation or absence: may be d/t central or peripheral disease, small or large muscle
groups, acute or chronic
Physical Assessment
Why is it more challenging to examine the brain & spinal cord? (p. 1921)
5 parts:
1. Consciousness & cognition
2. Cranial nerves
3. Motor system
4. Sensory system
5. Reflexes
Assessment of Consciousness & Cognition
Be specific & concrete; avoid judgements
1. Mental status: orientation to time, person, & place
2. Overall appearance
3
, NUR 380Medical Surgical Final Exam Blueprint
3. Facial expression
4. Personal hygiene
5. Memory: remote (long-term), recent memory, immediate (now)
o Intellectual function: patient with average IQ can count back from 100 by 7
o Thought content: coherent, natural, clear, spontaneous? Any fixed ideas, dwelling on dark thoughts,
hallucinations?
o Emotional status: stable mood? Irritable, angry, anxious,
apathetic, flat, euphoric?
o Language ability: understand & communicate spoken &
written
Level of Consciousness
Most sensitive indicator of neurologic function
1. Alertness
2. Ability to follow commands
3. If not, then work backwards to more simple responses (more
primitive areas of the brain): eye opening, verbal response, & motor
response
4. What does it require – loud voice, touch, noxious (painful) stimuli?
Glasgow Coma Scale: Level of Consciousness
Neurological Assessment
Cranial Nerves: what nurses usually assess
o III: oculomotor -> pupillary response to light, size of pupils,
open eyelids
o VII: Facial -> observe for symmetry during smiling
o IX: Glossopharyngeal -> swallowing reflex
o X: Vagus -> cough & gag reflex
Motor function & strength:
o Note tone, spasticity, rigidity
o Ask patient to squeeze your hands & release grip; note
symmetry
o Ask patient to push feet against your hands; note symmetry
o Document as MAE X 4 (Moves all extremities equally x 4
limbs)
o Record as strength as absent, weak, moderate, or strong, or as
on page 1924 (1-5)
4
Blueprint: NUR 380 Final Exam Medical Surgical Nursing (65 questions)
For illnesses & injuries assigned this semester, focus on:
1. Topics: Almost every condition & clinical manifestations will be addressed, with an emphasis on
prioritization & a focused assessment, including:
Topics Pages
Part A: Neurological assessment, head & spinal 2
cord injuries, Multiple Sclerosis, Parkinson’s
Disease, CVA, TIAs, epilepsy, meningitis,
Myasthenia Gravis, Guillain-Barre’ Syndrome,
Alzheimer’s disease
Part B: All endocrine disorders 40
Part C: Anemias, hemophilia, blood product 55
therapy, GI bleeding, sickle cell anemia,
thrombocytopenia, leukemia, multiple myeloma,
aplastic anemia
Part D: GI & biliary disorders; i.e. peptic ulcer 68
disease, appendicitis, peritonitis, cirrhosis, hepatic
encephalopathy
Part E: Renal disorders, i.e. UTIs, cystitis, 82
pyelonephritis, glomerulonephritis, Nephrotic
Syndrome, renal injury & failure
Part F: Musculoskeletal problems, i.e. traumatic 96
injuries & fractures, potential complications of
fractures & of their treatment.
2. For all of the above, focus on:
a. Normal changes related to aging which impact signs of illness & response to illness.
b. Recommended health promotion activities and illness prevention activities.
c. Risk factors associated with these conditions.
d. Nursing responsibilities for postoperative surgical procedures.
e. Nursing responsibilities for orthopedic interventions, i.e. traction, casts, ORIF, prosthetic hip
replacement
f. Bloodwork results, interpretation based on the patient problem, & nursing implications.
g. Nursing responsibilities associated with the assessment & diagnostic procedures frequently
performed to diagnose common illnesses and injuries.
h. Identify the highest priority nursing diagnoses associated with illnesses and injuries.
i. La Charity questions: all topics (Chapter 17 may be excluded).
1
,NUR 380Medical Surgical Final Exam Blueprint
Medical Surgical Final Exam Blueprint
A. Neurological assessment, head & spinal cord injuries, Multiple Sclerosis, Parkinson’s Disease ,
CVA, TIAs, epilepsy, meningitis, Myasthenia Gravis, Guillain-Barre’ Syndrome, Alzheimer’s disease
1. Neurological Assessment, Head and Spinal Cord Injuries
Chapter 65
Structures of the Nervous System
1. Central nervous system:
a. Brain
b. Spinal cord
2. Peripheral nervous system:
a. Cranial nerves
b. Spinal nerves
c. Autonomic nervous system
The Brain
1. Cerebrum: 2 hemispheres, hypothalamus, thalamus, & basal ganglia
2. Brain stem: midbrain, pons,
medulla oblongata; the closer to the
spinal cord, the more primitive the
functions
3. Cerebellum
Cerebral Function
Cerebrum: responsible for
integration (making sense) of data
Corpus callosum transmits
information between hemispheres:
sensation, memory, & learned
discrimination
Lateralization: right-handed
dominant (& some left-handed) have cerebral dominance on left side for verbal, linguistic, arithmetic,
calculation & analytic functions
Non-dominant hemisphere: spatial, geometric, visual, pattern, & musical functions
Clinical manifestations depend on which lobe is affected (frontal, parietal, temporal, occipital)
Thalamus
Sits above the brain stem
Router: sorts data & sends to other
critical areas
Hypothalamus: homeostasis for
temperature, osmolarity, circadian
rhythms
Posterior pituitary gland: secretion of
hormones, maintain water balance, i.e.
oxytocin, ADH
Basal Ganglia
Sits below the corpus callosum &
cerebral cortex
Contains groups of nuclei (ganglia)
which share the same function
Motor control, both excitatory &
inhibitory
Manifested in Parkinson’s Disease
Cerebral Cortex (80% of the Brain)
1. Frontal lobe: executive functions:
concentration, abstract thought, planning, analytic processing, storage of information & memory, motor
function, judgment, personality, emotional control, inhibitions
2
,NUR 380Medical Surgical Final Exam Blueprint
2. Parietal: analysis & relay of sensory information from the environment to other critical areas, proprioception,
size & shapes
3. Temporal: auditory reception & memory of sound, music, & language
4. Occipital: interpretation & memory of visual imagery, language, hearing
Brain Stem Function
Breathing, circulation, & digestion
o Midbrain: connects pons & cerebellum with the hemispheres, containing sensory & motor
pathways for visual & auditory reflexes
o Pons: bridge between 2 halves of cerebellum, & between medulla and midbrain; motor/sensory
pathways & respiration
o Medulla Oblongata: filters & routs motor fibers brain to spinal cord & sensory fibers from the
spinal cord to the brain
Decussation: fibers cross over at this level (implications for stroke)
Cranial nerves 9-12 originate here
Contains reflex centers for respiration, BP, heart rate, cough/gag, vomiting, swallowing, sneezing
Reticular formation for sleep-wake cycles & arousal
Cerebellar Function
Cerebellum: sits behind pons & midbrain, & beneath the occipital lobe
Sensory input needed for smooth coordinated movement
Body control & coordination (sports)
Motion memory (how to ride a bike)
Fine motion movements
Proprioception: Awareness of postural body in space (postural) (without looking at body parts)
Focused Assessment of the Nervous System
Health history: Critical information
1. History of the present illness: onset, severity, location, fluctuations, aggravating & relieving factors
2. Interview allows the nurse to observe overall appearance, mental status, posture, movement & affect
3. Medical record: previous trauma?
4. Family information: genetics
5. History of falls, alcohol, meds, illicit drugs
6. May need to ask yes/no questions
Common Symptoms
1. Pain: usually indicates injury, i.e. hemorrhage, spinal disk disease, tumor
2. Seizures: abnormal electrical discharges resulting in changes in sensation, motor function, perceptions,
consciousness; may be brief such as blank stare or full blown, i.e. fever, alcohol/drug withdrawal,
hypoglycemia, epilepsy
3. Dizziness or vertigo: sensation of imbalance or movement; sensation of room spinning
o Visual disturbances: decreased acuity, blindness, diplopia, nystagmus; due to neurological disease,
aging, tumor, stroke
o Muscle weakness or rigidity: can cause wide variation in signs & symptoms; can be acute or
progressive
o Abnormal sensation or absence: may be d/t central or peripheral disease, small or large muscle
groups, acute or chronic
Physical Assessment
Why is it more challenging to examine the brain & spinal cord? (p. 1921)
5 parts:
1. Consciousness & cognition
2. Cranial nerves
3. Motor system
4. Sensory system
5. Reflexes
Assessment of Consciousness & Cognition
Be specific & concrete; avoid judgements
1. Mental status: orientation to time, person, & place
2. Overall appearance
3
, NUR 380Medical Surgical Final Exam Blueprint
3. Facial expression
4. Personal hygiene
5. Memory: remote (long-term), recent memory, immediate (now)
o Intellectual function: patient with average IQ can count back from 100 by 7
o Thought content: coherent, natural, clear, spontaneous? Any fixed ideas, dwelling on dark thoughts,
hallucinations?
o Emotional status: stable mood? Irritable, angry, anxious,
apathetic, flat, euphoric?
o Language ability: understand & communicate spoken &
written
Level of Consciousness
Most sensitive indicator of neurologic function
1. Alertness
2. Ability to follow commands
3. If not, then work backwards to more simple responses (more
primitive areas of the brain): eye opening, verbal response, & motor
response
4. What does it require – loud voice, touch, noxious (painful) stimuli?
Glasgow Coma Scale: Level of Consciousness
Neurological Assessment
Cranial Nerves: what nurses usually assess
o III: oculomotor -> pupillary response to light, size of pupils,
open eyelids
o VII: Facial -> observe for symmetry during smiling
o IX: Glossopharyngeal -> swallowing reflex
o X: Vagus -> cough & gag reflex
Motor function & strength:
o Note tone, spasticity, rigidity
o Ask patient to squeeze your hands & release grip; note
symmetry
o Ask patient to push feet against your hands; note symmetry
o Document as MAE X 4 (Moves all extremities equally x 4
limbs)
o Record as strength as absent, weak, moderate, or strong, or as
on page 1924 (1-5)
4
