Medical-Surgical Nursing Concepts (NUR 242): Exams 1-4 Study
Guides (in 1 pdf)| Latest Summer 2026-2027 | A+ Guide- Galen.
Med Surg Exam 1
Unit 1 Patient Safety 5 Questions
Fall prevention
Fall Risk Assessment includes:
Fall history – if the patient has fallen in the past year and what cause the fall?
a) Lack of coordination
b) Patient weakness
c) Related to an injury
Advanced age (greater than 80 years are at a higher risk)
Multiple illnesses
a) Diabetes - lost sensation
b) Decrease coordination
c) Cardiovascular diseases – decrease endurance
Generalized weakness (osteoporosis or bed ridden long periods at a time)
Gait and postural stability
Drug assessment (polypharmacy)
Urinary incontinence (huge safety issue is the elderly falling during the night going the
restroom)
Communication/visual impairment
Alcohol/substance abuse
Change of shift/mealtime in hospital/nursing home (Falls usually happen during shift
change or at night).
There is hourly rounding to addresses the 3P’s:
a) Positioning
b) Pain
c) Potty
Home at nighttime fall risk increase
a) Clutter in pathway to the bathroom
b) Proper lighting (hard to see) be carefully of the light changes, light to bright or
bright to light. (momentary blindness)
c) No area rugs (wall to wall carpet okay)
d) No waxed floors
e) Assistance devices
f) Check for steps, or stairs they must navigate, that there are banisters
g) Bathroom safety bars
Room close to the nursing station and equipment works (good lighting, canes, walkers
and especially the call light and it can be reached)
Takes two people to get a patient up from bed, have them sit and dangle legs before
getting up
Have patient lead with strong leg and arm, never weak side.
Gait belt for ambulation
Have patient assume a wide base of support when standing or with walker for balance
and posture.
If patient getting out of be properly position the chair
, If using a cane need proper height, have patient dangle arms on side and cane should
come up to the patient’s wrist level, hold cane with the strong hand, will move the cane
with the weaker leg forward at the same time with the cane, and one step at a time
With a walker, both hands on the walker, wide base of support, lift the walker
approximately two feet forward, and take small steps forward toward the walker
Patient Immobility
Age related risk factors and skin integrity
The limitation in independent, purposeful physical movement of the body or of one or
more extremities
Immobility in the elderly, which leads to pressure, shear, and friction, is the factor most
likely to put an individual at risk for altered skin integrity.
Elderly patients skin integrity increases due to:
a) Dry skin
b) Skin becomes thins
c) Fragile
d) Lose elasticity
e) Loses padding
f) Loses hydration
g) Becomes flaky
h) Under nourished and dehydrated
i) Weakness
j) Decrease endurement
k) Dementia
l) Diminished sensation
Nursing Actions:
a) Repositioning a patient at least every two hours
b) If patient is in a chair or wheelchair they need to be reposition very hour
c) No rubber donuts while sitting, use gel pads
d) Always support bony prominent with pillows, heal protectors and make sure that
those prominent areas are supported. (elbows, back cervical spine and shoulders)
e) Never massage any bony prominent or while moving a patient do not drag the
heals
f) Foot-drop - is a peripheral nerve injury that affects a patient's ability to lift the
foot at the ankle. (to prevent wear high top tennis shoes and frequent skin
assessments)
g) Meticulous skin care, skin is clean, dry, soft soaps, tempered warm water, and
never rub skin dry with a towel, need to pat the skin dry use skin barriers in areas
that tend to be moist like folds, and peri areas.
h) Use moisturizer on heals
i) No powder or talc’s ever used
j) ROM helps with circulation and helps prevent contractures
Common Complication and Preventions:
a) Contractures or muscle wasting, do ROM or if patient can get up, get them up
(increase patients’ activity)
, b) Use devices to align the joints to prevent contractures and support the joints
c) DVT’s, wear compression stockings (ted hose), ROM, increase ambulation, or
activities, and check if patient is on an anticoagulant like Heparin
d) Constipation - increase activity keep, well hydrated, ROM and high fiber diet
e) Disorientation, mimic day and night, like lighting or by opening the blinds and let
the sun in.
f) Respiratory problems (atelectasis is the collapse or closure of a lung and
pneumonia) need to have patient cough, deep breath, increase activity, incentive
spirometer
g) Pressure ulcers (repositioning patient), adequate skin care, adequate nutrition,
frequent skin assessments (on admission skin assessment and each shift or some
places, approximately every 8 hours) if pressure ulcer not caught on admission,
then found later, that facility owns the pressure for lifetime
Health and Wellness
Process of:
a) Fostering awareness, influencing attitudes, and identifying alternatives
b) Individuals can make informed choices, change behaviors
c) Achieve an optimal level of physical and mental health and improve physical and social
environment
Levels of Prevention
a) Primary – prevent occurrence of specific diseases (ex: chicken pox vaccination)
b) Secondary – behavior that promotes early detection or screening of disease as well as
treatment of and prevention of disability (ex: mammogram with family history, there are
risk factors)
c) Tertiary – direct towards rehabilitation from disease (ex: the disease has already
occurred) (ex: stroke, treatment and rehabilitation)
Genetic Concepts
To test for genetic disorders
Autosomal Dominant Pattern of Inheritance
In an autosomal dominant disease, if you get the abnormal gene from only one parent,
you can get the disease. Every generation carrier the gene, does not skip a generation,
each pregnancy has a 50% chance of getting the gene, and equal in both sexes
Autosomal Recessive Pattern of Inheritance
In an autosomal recessive disorder means two copies of an abnormal gene must be
present for the disease or trait to develop. May skip generations, family has a 25% chance
of being affected, and equal in both sexes
Nurses action:
a) Assist and identify parents that are at risk
b) Assist with teaching for the ones that or at risk
c) Assist how to prevent like screenings or reduce symptoms
, d) Make such they are educated before, during and after testing
Unit 2 Pain 6 Questions
Whatever person experiencing it says it is; exists whenever person says it does!!!
Pain Assessment
a) Location
Localized – restricted to a specific place
Projected - pain that has been localized incorrectly due to the ascending pain
pathway.
Radiating – spreads to surrounding area
Referred - when there is visceral pain which is sensed as superficial pain.
b) What is the intensity?
c) What does it feel like?
d) What makes it better or worse?
e) When does it occurs?
Always assess before and after interventions
Cutaneous Pain – sharp, bright, burning; can have a fast or slow onset
Somatic Pain – stems from tendons, muscles, joints, periosteum, vessels
Visceral Pain – originates from internal organs; Poorly localized, diffuse, deep cramping or
pressure, sharp, stabbing (i.e. appendicitis)
Psychogenic Pain – individual feels pain but cause is emotional rather than physical
Mild pain 1-3
Moderate 4-6
Severe pain 7-10
Opioids vs Non-Opioids
Usually can identify the injury causing the acute pain
Opioids very effective for noxious pain, will not work on Neurogenic or Neuropathic
pain
(Non-Opioids NSAID’s) causes gastric gases or gastric ulcer, take with food
Complications that can occur with Opioids:
a) Depressed respirations (less than 12 reps) check LOC
b) Diminished LOC
c) Constipation (hydrate, fiber diet and stool softeners)
d) Urinary retention
Acute Pain – Surgical
Early ambulation (has a lot of benefits)
Abdominal pain, distention, and gas (include ambulation)
Frequent use of PCA pump:
a) Patient education
Guides (in 1 pdf)| Latest Summer 2026-2027 | A+ Guide- Galen.
Med Surg Exam 1
Unit 1 Patient Safety 5 Questions
Fall prevention
Fall Risk Assessment includes:
Fall history – if the patient has fallen in the past year and what cause the fall?
a) Lack of coordination
b) Patient weakness
c) Related to an injury
Advanced age (greater than 80 years are at a higher risk)
Multiple illnesses
a) Diabetes - lost sensation
b) Decrease coordination
c) Cardiovascular diseases – decrease endurance
Generalized weakness (osteoporosis or bed ridden long periods at a time)
Gait and postural stability
Drug assessment (polypharmacy)
Urinary incontinence (huge safety issue is the elderly falling during the night going the
restroom)
Communication/visual impairment
Alcohol/substance abuse
Change of shift/mealtime in hospital/nursing home (Falls usually happen during shift
change or at night).
There is hourly rounding to addresses the 3P’s:
a) Positioning
b) Pain
c) Potty
Home at nighttime fall risk increase
a) Clutter in pathway to the bathroom
b) Proper lighting (hard to see) be carefully of the light changes, light to bright or
bright to light. (momentary blindness)
c) No area rugs (wall to wall carpet okay)
d) No waxed floors
e) Assistance devices
f) Check for steps, or stairs they must navigate, that there are banisters
g) Bathroom safety bars
Room close to the nursing station and equipment works (good lighting, canes, walkers
and especially the call light and it can be reached)
Takes two people to get a patient up from bed, have them sit and dangle legs before
getting up
Have patient lead with strong leg and arm, never weak side.
Gait belt for ambulation
Have patient assume a wide base of support when standing or with walker for balance
and posture.
If patient getting out of be properly position the chair
, If using a cane need proper height, have patient dangle arms on side and cane should
come up to the patient’s wrist level, hold cane with the strong hand, will move the cane
with the weaker leg forward at the same time with the cane, and one step at a time
With a walker, both hands on the walker, wide base of support, lift the walker
approximately two feet forward, and take small steps forward toward the walker
Patient Immobility
Age related risk factors and skin integrity
The limitation in independent, purposeful physical movement of the body or of one or
more extremities
Immobility in the elderly, which leads to pressure, shear, and friction, is the factor most
likely to put an individual at risk for altered skin integrity.
Elderly patients skin integrity increases due to:
a) Dry skin
b) Skin becomes thins
c) Fragile
d) Lose elasticity
e) Loses padding
f) Loses hydration
g) Becomes flaky
h) Under nourished and dehydrated
i) Weakness
j) Decrease endurement
k) Dementia
l) Diminished sensation
Nursing Actions:
a) Repositioning a patient at least every two hours
b) If patient is in a chair or wheelchair they need to be reposition very hour
c) No rubber donuts while sitting, use gel pads
d) Always support bony prominent with pillows, heal protectors and make sure that
those prominent areas are supported. (elbows, back cervical spine and shoulders)
e) Never massage any bony prominent or while moving a patient do not drag the
heals
f) Foot-drop - is a peripheral nerve injury that affects a patient's ability to lift the
foot at the ankle. (to prevent wear high top tennis shoes and frequent skin
assessments)
g) Meticulous skin care, skin is clean, dry, soft soaps, tempered warm water, and
never rub skin dry with a towel, need to pat the skin dry use skin barriers in areas
that tend to be moist like folds, and peri areas.
h) Use moisturizer on heals
i) No powder or talc’s ever used
j) ROM helps with circulation and helps prevent contractures
Common Complication and Preventions:
a) Contractures or muscle wasting, do ROM or if patient can get up, get them up
(increase patients’ activity)
, b) Use devices to align the joints to prevent contractures and support the joints
c) DVT’s, wear compression stockings (ted hose), ROM, increase ambulation, or
activities, and check if patient is on an anticoagulant like Heparin
d) Constipation - increase activity keep, well hydrated, ROM and high fiber diet
e) Disorientation, mimic day and night, like lighting or by opening the blinds and let
the sun in.
f) Respiratory problems (atelectasis is the collapse or closure of a lung and
pneumonia) need to have patient cough, deep breath, increase activity, incentive
spirometer
g) Pressure ulcers (repositioning patient), adequate skin care, adequate nutrition,
frequent skin assessments (on admission skin assessment and each shift or some
places, approximately every 8 hours) if pressure ulcer not caught on admission,
then found later, that facility owns the pressure for lifetime
Health and Wellness
Process of:
a) Fostering awareness, influencing attitudes, and identifying alternatives
b) Individuals can make informed choices, change behaviors
c) Achieve an optimal level of physical and mental health and improve physical and social
environment
Levels of Prevention
a) Primary – prevent occurrence of specific diseases (ex: chicken pox vaccination)
b) Secondary – behavior that promotes early detection or screening of disease as well as
treatment of and prevention of disability (ex: mammogram with family history, there are
risk factors)
c) Tertiary – direct towards rehabilitation from disease (ex: the disease has already
occurred) (ex: stroke, treatment and rehabilitation)
Genetic Concepts
To test for genetic disorders
Autosomal Dominant Pattern of Inheritance
In an autosomal dominant disease, if you get the abnormal gene from only one parent,
you can get the disease. Every generation carrier the gene, does not skip a generation,
each pregnancy has a 50% chance of getting the gene, and equal in both sexes
Autosomal Recessive Pattern of Inheritance
In an autosomal recessive disorder means two copies of an abnormal gene must be
present for the disease or trait to develop. May skip generations, family has a 25% chance
of being affected, and equal in both sexes
Nurses action:
a) Assist and identify parents that are at risk
b) Assist with teaching for the ones that or at risk
c) Assist how to prevent like screenings or reduce symptoms
, d) Make such they are educated before, during and after testing
Unit 2 Pain 6 Questions
Whatever person experiencing it says it is; exists whenever person says it does!!!
Pain Assessment
a) Location
Localized – restricted to a specific place
Projected - pain that has been localized incorrectly due to the ascending pain
pathway.
Radiating – spreads to surrounding area
Referred - when there is visceral pain which is sensed as superficial pain.
b) What is the intensity?
c) What does it feel like?
d) What makes it better or worse?
e) When does it occurs?
Always assess before and after interventions
Cutaneous Pain – sharp, bright, burning; can have a fast or slow onset
Somatic Pain – stems from tendons, muscles, joints, periosteum, vessels
Visceral Pain – originates from internal organs; Poorly localized, diffuse, deep cramping or
pressure, sharp, stabbing (i.e. appendicitis)
Psychogenic Pain – individual feels pain but cause is emotional rather than physical
Mild pain 1-3
Moderate 4-6
Severe pain 7-10
Opioids vs Non-Opioids
Usually can identify the injury causing the acute pain
Opioids very effective for noxious pain, will not work on Neurogenic or Neuropathic
pain
(Non-Opioids NSAID’s) causes gastric gases or gastric ulcer, take with food
Complications that can occur with Opioids:
a) Depressed respirations (less than 12 reps) check LOC
b) Diminished LOC
c) Constipation (hydrate, fiber diet and stool softeners)
d) Urinary retention
Acute Pain – Surgical
Early ambulation (has a lot of benefits)
Abdominal pain, distention, and gas (include ambulation)
Frequent use of PCA pump:
a) Patient education
