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NUR 265 EXAM 4/QUESTIONS AND ANSWERS/2025-2026/Graded A+, Exams of Nursing

University of Rochester (UR)Nursing

NUR 265 EXAM 4/QUESTIONS AND ANSWERS/2025-2026/Graded A+

Typology: Exams

2024/2025

Available from 06/05/2025

vivian-mungai 🇺🇸

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NUR 265 EXAM 4/QUESTIONS AND ANSWERS/2025-

2026/Graded A+

Lupus: Hallmark sign

butterfly rash on face

Lupus: Indication of flare

Fever and fatigue

*also assess BUN function

*c reactive protein remains normal

Lupus: Interventions

-Falls precautions

-treat pain with tylenol and NSAIDS (monitor kidney function)

-AVOID SUNLIGHT

-REPORT FLARE IMMEDIATELY

-clean skin with mild soap and pat dry and apply lotion

Lupus: medical management

-hydroxychloroquine(anti-malarial) decreases absorption of UV light

Scleroderma

inflammatory, autoimmune connective tissue disease

Scleroderma: Hallmark Sign

Hard, leather-like edematous skin

Late: esophageal dysmotility

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NUR 265 EXAM 4/QUESTIONS AND ANSWERS/ 2025 -

2026/Graded A+

Lupus: Hallmark sign butterfly rash on face Lupus: Indication of flare Fever and fatigue *also assess BUN function *c reactive protein remains normal Lupus: Interventions

Falls precautions
treat pain with tylenol and NSAIDS (monitor kidney function)
AVOID SUNLIGHT
REPORT FLARE IMMEDIATELY
clean skin with mild soap and pat dry and apply lotion Lupus: medical management
hydroxychloroquine(anti-malarial) decreases absorption of UV light Scleroderma inflammatory, autoimmune connective tissue disease Scleroderma: Hallmark Sign Hard, leather-like edematous skin Late: esophageal dysmotility

Scleroderma: Assess Swallow safety--esophageal dysmotility (ASPIRATION) O circulation skin Scleroderma: Interventions aspiration precautions (keep HOB at 60 degrees during meals and after) skin protection measures small frequent meals--avoid caffeine and alcohol

avoid spices, caffeine and pepper fibromyalgia: S/sx extreme fatigure GI symptoms dysuria blurred vision forgetfulness fibromyalgia: Assess pain level extreme fatigue GI symptoms Fibromyalgia: Interventions NSAIDS Nuerontin (gabapentin) Lyrica (pregabalin) SNRI and tricyclic antidepressants (amitriptyline)

healthcare workers
allergy to avocados, bananas, and some nuts Anaphylactic shock AIRWAY--give epi IV or IM STAT and intubate if needed BREATHING--apply O2; mechanically ventilate CIRCULATION--monitor for distributive shock; give fluids Epinephrine Auto-injector teaching always carry 2 devices inject by "stabbing" into top of thigh with pants on (AVOID pockets) call 911 immediately--patient still needs to be monitored keep epi in cool dark place. Immunocompromised Patient
Do not drink anything that has been sitting out
take temp at least once per day
clean toothbrush once weekly in diswasher or bleach solution
do not eat raw foods; salad, cottage cheese
do not scoop litter boxes
no plants or soil exposure
antibacterial soap
AVOID reptiles HIV: Assess CD4 count ELISA test once per year for at risk patients

HIV: Interventions PREVENTION:

condoms
PreP (truvada) must take 4 consecutive days in a row before protected; cant miss more than one dose in a row
needle safety
post exposure prophylaxis-start cART within 24-36 hours of exposure HIV: Nutrition high calorie high protein low fat small frequent meals thrush--treat with anitfungal HIV tx: HAART/cART DOES NOT CURE Does not prevent secondary/opportunistic infections MUST TAKE 90% of the time --otherwise resistance will occur HIV: complications --- AIDS CD4 count less than 200mmhg most likely to experience opportunistic infections --I.e Pneumocystic jiroveci pneumonia (ASSESS AIRWAY!!) consult pallative care/hospice candida albicans
Hallmark sign-- white patches in the mouth
"food doesnt taste right"

breast ultrasound if have dense breast tissue; if cant get good mammography image*** Breast Cancer: interventions pre and post lumpectomy/mastectomy **prophylactic mastectomy is patient with BRCA 1 and 2 gene
then external radiation
chemo
symptom management Lung Cancer: Risks
environmental exposure
radon, environmental tobacco smoke, asbestos
genetic
inhalant exposure Lung Cancer: Warning signs
hoarse voice**
persistant cough**
blood-tinged sputum**
chest pain Lung Cancer: Assess
respiratory
smoking history

screening history (chest CT)--typically only for high risk patients; (smoking for 20 years; may get routine CT) Lung cancer: Interventions VAT with wedge resection chemo external radiation Colorectal cancer: risks
over the age of 50
genetic
history of IBD
smoking
alcohol consumption
high fat diet of red meat Colorectal Cancer: screening
fecal occult blood test yearly***
sigmoidoscopy OR double contrast barium enem OR colonoscopy every 5 YEARS** Colorectal: s/sx
rectal bleeding
anemia
changes in tool consistency
mahogany (dark) colored or bright red stools

nocturia Prostate cancer: Interventions
TURP (if obstruction occurs)
chemo (metastasis)
external radiation Testicular cancer: Risks
men age 20- 35
white men
genetic
cryptorchidism (nondescended testicle)
HIV Testicular cancer: Screening self exam Testicular cancer: Hallmark sign painless, hard, swelling/enlargement of testicle (unilateral) Testicular cancer: Interventions surgical removal chemo radiation

cervical cancer: risks

HPV virus
smoking
multiple partners Cervical cancer: hallmark sign painless vaginal bleeding Cervical cancer: screening pap test every 3 years for women of childbearing age**** Cervical cancer: assess
vaginal discharge (painless vaginal bleeding)
sexual hx
vaccine
screening hx cervical cancer: Interventions
vaccinate boys and girls for HPV; 3 vaccines; puberty age
screen for it
removal of cancerous/pre-cancerous cells (cervical scraping, hysterectomy with vaginal resection)
brachytherapy (internal radiation)

skin
hx of tanning, outdoor work, SPF use
screening hx
family hx of melanoma skin cancer: Interventions PREVENTION: SPF 30 or higher (fair skin needs higher SPF)
surgical
chemo
external radiation
avoid sun exposure from 11am-3pm Bladder Cancer "urothelial cancer": risks
smoking*****
chemical exposure bladder cancer: screening none; only cystoscopy after symptoms present bladder cancer: assess
urine output
hemturia
pain with urination

Bladder cancer: interventions

surgical removal of cancerous tissue
scraping bladder lining to radical cystectomy with urinary diversion (ileal conduit placement)
chemo chemotherapy
can be intrathecal, IV, PO, intrvesical
must be chemo certified; must have 2 RNs double check (high risk meds) chemo side effects
nausea
vomiting
pancytopenia
immunosuppression chemo precautions
double flush toilet
chem-safe PPE
spill clean up per agency protocal External Radiation "teletherapy"
external source (client will not emit radiation) External radiation side effects

early intervention with IV antibiotics at the first sign of infection (low grade fever) saves LIVES Complication: spinal chord compression tumor presses on and compresses the spinal chord, or vertebrae collapse due to bone loss associated with bone cancer Complication: spinal chord compression hallmark sign back pain*

will progress to neuromuscular weakness
loss of sensation
burning pain
paralysis Complication: spinal chord compression TX high dose corticosteroids, radiation, and spinal stabilization surgery (if caused by bone cancer) Complication: Hypercalcemia certain cancers release PTH stimulating bones to release calcium, elevating serum calcium levels Complication: hypercalcemia Early symptoms
skeletal pain
kidney stones

altered cognition Complication: hypercalcemia late symptoms
ECG changes
Dehydration
severe muscle weakness
loss of deep tendon reflexes Complication: Hypercalcemia Tx
treat with Normal saline IV
then......treat with furosemide to pull off the excess calcium Complication: superior vena cava syndrome tumor or clot compresses SVC and limits blood flow into right atrium; can be acute or slow onset Complication: superior vena cava syndrome--- EARLY SIGN
periorbital edema upon waking
edema/tightness of the collar Complication: superior vena cava syndrome--- LATE SIGN
redness to upper chest, neck, and face
engorged blood vessels above the blockage (EXTREME JVD)
edema in arms and hands******
dyspnea

Cardiac tamponade tumor direct pressure in or around pericardial sac resulting in decreased venous return and sudden drop in cardiac output cardiac tamponade: assess

JVD (fluid overload with clear lungs)
decreased HR and CO
dyspnea
hypotension
heart sounds are distant and muffled End of life: decision making the only right decision is the one that the client/family makes.
DNR does not matter in EMS or OR exemption Stroke Emergent* mass causality --emergent chest pain Emergent positive influenza not respiratory distress--non urgent

respiratory distress--urgent respiratory failure--emergent urgent/nonurgent and flu postive give mask and have them wait in waiting room meningitis (nuchal rigidity) stick in room DROPLET PRECAUTIONS Knife sticking out of head GO TO OR/SURGERY suspecting violence in death leave lines in place*** call coroner dont let people alone with body hypothermia warm fluids** warm from inside out--starting at trunk*** mild--mental slowness, shivers, slurred speech** moderate--confusion, slower** ABCDE A-airway; jaw thrust maneuver