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Chamberlain College of Nursing NR 509 Final Exam Study Guide (Version 1) / NR509 Final Exam Study Guide (New 2020): Advanced Physical Assessment

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Chamberlain College of Nursing NR 509 Final Exam Study Guide (Version 1) / NR509 Final Exam Study Guide (New 2020): Advanced Physical Assessment

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  • January 31, 2021
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  • chamberlain college of nursing nr 509 final exam study guide version 1 nr509 final exam study guide new 2020 advanced physical assessment

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NR 509 Final Exam Study Guide



 Articular structures include joint capsule and articular cartilage, the synovium and

synovial fluid, intra-articular ligaments and juxta-articular bone

o Articular disease involves:

 Swelling

 Tenderness of the joint

 Crepitus

 Instability “locking”

 Deformity

 Limits active and passive range of motion due to stiffness or pain

 Extra-articular structures include periarticular ligaments, tendons, bursae, muscle,

fascia, bone, nerve and overlying skin

o Extra-articular disease involves:

 “point of focal tenderness in regions adjacent to articular structures

 Limits active range of motion

 RARELY causes swelling, instability, joint deformity



Know the sources of joint pain (pg. 627 algorithm)

 Nonarticular conditions: trauma/fracture, fibromyalgia, polymyalgia rheumatica,

bursitis, tendinitis

 Intra-articular (acute, < 6 weeks): acute arthritis

, o infectious arthritis

o gout

o pseudogout

o Reiter syndrome

 Intra-articular (chronic, > 6 weeks): chronic inflammatory arthritis vs chronic

noninflammatory arthritis

o Chronic inflammatory arthritis with 1-3 joints involved:

 Indolent infection

 Psoriatic arthritis

 Reiter syndrome

 Periarticular JA

o Chronic inflammatory arthritis with >3 joints involved:

 Psoriatic arthritis or Reiter syndrome (no symmetry)

 rheumatoid arthritis if not RA then  systemic lupus, scleroderma,

polymyositis



*Know what causes saddle numbness and urinary retention (pg. 678?)

 CES (cauda equina syndrome) most commonly results from a massive herniated disc in

the lumbar region.

 A single excessive strain or injury may cause a herniated disc.

 However, disc material degenerates naturally as a person ages, and the ligaments that

hold it in place begin to weaken. As this degeneration progresses, a relatively minor

strain or twisting movement can cause a disc to rupture.

, The following are other potential causes of CES:


 Spinal lesions and tumors

 Spinal infections or inflammation

 Lumbar spinal stenosis

 Violent injuries to the lower back (gunshots, falls, auto accidents)

 Birth abnormalities

 Spinal arteriovenous malformations (AVMs)

 Spinal hemorrhages (subarachnoid, subdural, epidural)

 Postoperative lumbar spine surgery complications

 Spinal anesthesia




Know how retinal detachment presents (p.217)

 Sudden, painless vision loss that is unilateral



Know what the word obtunded means (p. 769)

 The obtunded patient opens eyes and looks at you but responds slowly and is somewhat

confused. Alertness and interest in the environment are decreased.



Know what cranial nerve you’re assessing when checking lateral gaze (p. 237)

 Cranial nerve VI: abducens

, Know what should be listed under adult illnesses in health history (pg. 10)

 Medical illnesses: such as diabetes, hypertension, hepatitis, asthma, and HIV. Also

hospitalizations, number and gender of sexual partners, and risk-taking sexual practices

 Surgical: dates, indications, and types of operations

 Obstetric/Gynecologic: obstetric history, menstrual history, methods of contraception,

and sexual function

 Psychiatric: illness and timeframe, diagnoses, hospitalizations, and treatments



Know what conditions do not have red reflexes (p. 239)

 Absence of red reflex suggests an opacity of the lens (cataract), or possibly the vitreous

(or even an artificial eye).

 Less commonly, a detached retina, or in children a retinoblastoma may obscure this

reflex.

Know the signs of seasonal allergies (p. 27)

 itching, watery eyes, sneezing, ear congestion, postnasal drainage



Know how optic neuritis presents (p. 217)

 Sudden visual loss that is unilateral and can be painful, associated with multiple sclerosis



Know how pityriasis rosacea presents (p. 912)

 Oval lesions on trunk, in older children often in a Christmas tree pattern, sometimes a

Harold patch (a large patch that appears first)

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