MED SURG (NURS 242)
PREPARATION FOR PROFESSIONAL
NURSING EXAM 4 STUDY GUIDE
COMPLETE AND VERIFIED A PRAIRIE
STATE COLLEGE.
, NUR 242 Exam 4 Study Guidelines
Recap Notes
Cholesterol Values
LDL/HDL/Total Cholesterol
HDL = greater than 40
LDL = less than 100
Total Cholesterol = less than 200
Lipids less than 150 males and less than 135 females
Heart Placements
2nd intercostal right sternum = aorta valve
2nd intercostal left sternum = pulmonic valve
Erb’s point best s1 s2nsound is 3rd intercostal to left of sternum – Not required to identify in cpe
Tricuspid valve 4th intercostal space left of sternum
Mitral 5th intercostal space mid clavicular, apical under breast tissue.
Healthy heart Diet/Exercise = low fat low cholesterol low sodium diet, moderate regular exercise needs program
regimen and increase omega 3, manage stress, and smoking cessation class or quitting
Cardiac
Topics: HTN, PAD, Amputation, DVT, CAD, HF, Ventricular Tachycardia, Ventricular Fibrillation, Sinus rhythm,
Sinus bradycardia, Sinus Tachycardia. Don’t forget to review cardiac meds: ACE inhibitors, beta blockers, calcium
channel blockers, cardiotonic (digoxin), diuretics (potassium sparing and non-sparing). Review labs such as
cholesterol and lipid levels, aPTT, PTT and PT normal range and therapeutic levels, BNP, troponin level for CAD
(to rule out MI). Review heart sounds/placement.
HTN – Persistent BP of 140/90 and above
• Pre-hypertension – what is it? What does it look like
• Hypertension
o What are the risk factors? – modifiable vs non-modifiable
o What does it look like?
o How is it treated?
▪ Include addressing medication teaching, safety, such as, monitoring parameters and what
to do.
• Malignant hypertension – What is it? What does it look like? How is it treated?
Hypertension – Normal Blood Pressure is 120/80
Prehypertension
1
, NUR 242 Exam 4 Study Guidelines
• 121-139 (systolic)
• 81-89 (diastolic)
• Gets worse over time
Hypertension
• Persistent elevation of systolic or diastolic – NEEDS MORE THAN ONE READING TO DIAGNOSE
needs a trend.
• What is the current standard???
• 140 systolic
• 90 diastolic
Type
• Primary (essential) – no obvious medical cause
• Secondary - caused by other conditions that affect the kidneys, arteries, heart or endocrine system
• Isolated systolic - caused by other underlying conditions, such as a leaky heart valve, or hyperthyroidism)
• Refractory - resistant high blood pressure despite treatment regimen
• Malignant - a sudden and rapid development of extremely high blood pressure with diastolic typically
above 130
Pathophysiology of Hypertension
• Primary (essential) hypertension
– persistently elevated vascular resistance
• Secondary hypertension
– Renal and adrenal gland diseases
– Medications and foods
– Acute stress
Assessment
• More common in African-American
• Increases with age
• More common in men in early age
• Women after menopause
• Pregnancy
• Sometimes no symptoms until pt. comes in with stroke, MI, or seizures.
Manifestations
• Early stages—none
• Progressive stages
➢ Headache
➢ Fatigue and dizziness
2
, NUR 242 Exam 4 Study Guidelines
➢ Palpitations
➢ Flushing
➢ Blurred vision
➢ Epistaxis
Syncope
• Syncope
• Postural hypotension
• Normal response when standing
• Syncopal response when standing
• Syncope management
Complications of Hypertension
➢ MI
➢ Stroke
➢ Atherosclerosis
➢ *Nephropathy
➢ PVD (PAD)
➢ Aortic aneurysms
➢ Heart Failure
➢ Hypertensive crisis
Hypertensive Crisis/Malignant Hypertension
• Severe increase in B/P (diastolic > 130)
• May lead to stroke
• Organ damage
• May develop to left ventricular failure
Signs and Symptoms- that are life threatening.
• Restlessness
• LOC changes
• Seizures
• Blurred vision/Visual changes.
• Dizziness
• Severe Headache
• Agitation
• N/V
• Renal insufficiency
• Hemolytic anemia
• Left ventricular failure (LVF)
• Pulmonary Edema (PE)
• Pt can come in comatose
Note Usually these are the patients that end up in ICU and need POTENT anti-hypertensive medications IV.
Medical Management/Treatment
• Revolves around 3 drug regimen:
➢ Diuretics – decreases volume load—Need to monitor potassium levels hyper/hypokalemia
monitoring is essential.
3
PREPARATION FOR PROFESSIONAL
NURSING EXAM 4 STUDY GUIDE
COMPLETE AND VERIFIED A PRAIRIE
STATE COLLEGE.
, NUR 242 Exam 4 Study Guidelines
Recap Notes
Cholesterol Values
LDL/HDL/Total Cholesterol
HDL = greater than 40
LDL = less than 100
Total Cholesterol = less than 200
Lipids less than 150 males and less than 135 females
Heart Placements
2nd intercostal right sternum = aorta valve
2nd intercostal left sternum = pulmonic valve
Erb’s point best s1 s2nsound is 3rd intercostal to left of sternum – Not required to identify in cpe
Tricuspid valve 4th intercostal space left of sternum
Mitral 5th intercostal space mid clavicular, apical under breast tissue.
Healthy heart Diet/Exercise = low fat low cholesterol low sodium diet, moderate regular exercise needs program
regimen and increase omega 3, manage stress, and smoking cessation class or quitting
Cardiac
Topics: HTN, PAD, Amputation, DVT, CAD, HF, Ventricular Tachycardia, Ventricular Fibrillation, Sinus rhythm,
Sinus bradycardia, Sinus Tachycardia. Don’t forget to review cardiac meds: ACE inhibitors, beta blockers, calcium
channel blockers, cardiotonic (digoxin), diuretics (potassium sparing and non-sparing). Review labs such as
cholesterol and lipid levels, aPTT, PTT and PT normal range and therapeutic levels, BNP, troponin level for CAD
(to rule out MI). Review heart sounds/placement.
HTN – Persistent BP of 140/90 and above
• Pre-hypertension – what is it? What does it look like
• Hypertension
o What are the risk factors? – modifiable vs non-modifiable
o What does it look like?
o How is it treated?
▪ Include addressing medication teaching, safety, such as, monitoring parameters and what
to do.
• Malignant hypertension – What is it? What does it look like? How is it treated?
Hypertension – Normal Blood Pressure is 120/80
Prehypertension
1
, NUR 242 Exam 4 Study Guidelines
• 121-139 (systolic)
• 81-89 (diastolic)
• Gets worse over time
Hypertension
• Persistent elevation of systolic or diastolic – NEEDS MORE THAN ONE READING TO DIAGNOSE
needs a trend.
• What is the current standard???
• 140 systolic
• 90 diastolic
Type
• Primary (essential) – no obvious medical cause
• Secondary - caused by other conditions that affect the kidneys, arteries, heart or endocrine system
• Isolated systolic - caused by other underlying conditions, such as a leaky heart valve, or hyperthyroidism)
• Refractory - resistant high blood pressure despite treatment regimen
• Malignant - a sudden and rapid development of extremely high blood pressure with diastolic typically
above 130
Pathophysiology of Hypertension
• Primary (essential) hypertension
– persistently elevated vascular resistance
• Secondary hypertension
– Renal and adrenal gland diseases
– Medications and foods
– Acute stress
Assessment
• More common in African-American
• Increases with age
• More common in men in early age
• Women after menopause
• Pregnancy
• Sometimes no symptoms until pt. comes in with stroke, MI, or seizures.
Manifestations
• Early stages—none
• Progressive stages
➢ Headache
➢ Fatigue and dizziness
2
, NUR 242 Exam 4 Study Guidelines
➢ Palpitations
➢ Flushing
➢ Blurred vision
➢ Epistaxis
Syncope
• Syncope
• Postural hypotension
• Normal response when standing
• Syncopal response when standing
• Syncope management
Complications of Hypertension
➢ MI
➢ Stroke
➢ Atherosclerosis
➢ *Nephropathy
➢ PVD (PAD)
➢ Aortic aneurysms
➢ Heart Failure
➢ Hypertensive crisis
Hypertensive Crisis/Malignant Hypertension
• Severe increase in B/P (diastolic > 130)
• May lead to stroke
• Organ damage
• May develop to left ventricular failure
Signs and Symptoms- that are life threatening.
• Restlessness
• LOC changes
• Seizures
• Blurred vision/Visual changes.
• Dizziness
• Severe Headache
• Agitation
• N/V
• Renal insufficiency
• Hemolytic anemia
• Left ventricular failure (LVF)
• Pulmonary Edema (PE)
• Pt can come in comatose
Note Usually these are the patients that end up in ICU and need POTENT anti-hypertensive medications IV.
Medical Management/Treatment
• Revolves around 3 drug regimen:
➢ Diuretics – decreases volume load—Need to monitor potassium levels hyper/hypokalemia
monitoring is essential.
3
