FINAL EXAM BLUEPRINT FOR NUR 390 NURSING CARE OF THE ADULT I | COMPREHENSIVE
STUDY GUIDE, NCLEX-STYLE PRACTICE QUESTIONS AND ANSWERS 2026/2027
Module 13: Arthritis and Connective Tissue Disorders
Key Assessment Findings for Orthopedic Clients
Compartment Syndrome: A serious condition characterized by the 6 Ps: pain, pressure,
paresthesia, pallor, paralysis, and pulselessness. Immediate recognition is crucial to
prevent permanent damage.
Venous Thromboembolism (VTE): A condition where blood clots form in the veins,
potentially leading to serious complications. Symptoms may include swelling and pain in
the affected limb.
Fat Embolism Syndrome: Typically occurs 24-48 hours post-injury, especially with long
bone fractures. Symptoms include chest pain, tachypnea, and confusion due to fat
globules entering the bloodstream.
Rhabdomyolysis: Muscle breakdown that releases myoglobin into the bloodstream,
leading to acute kidney injury (AKI). Symptoms include dark reddish-brown urine.
Complications of Orthopedic Trauma
Compartment Syndrome: Caused by increased pressure within a muscle compartment,
leading to decreased blood flow and potential nerve damage. It can result from
restrictive dressings or increased compartment contents due to bleeding or swelling.
Fat Embolism Syndrome: Fat globules can travel to the lungs and brain, causing
respiratory distress and neurological symptoms. Early recognition is key to management.
Deep Vein Thrombosis (DVT): Characterized by leg pain and swelling, DVT can lead to
pulmonary embolism if not treated promptly.
Monitoring Parameters for Orthopedic Clients
Neurovascular Status: Essential to monitor peripheral pulses, capillary refill, sensation,
and movement to detect complications early.
Pain Levels: Regular assessment of pain can indicate complications such as compartment
syndrome or infection.
Nursing Actions for Post-Operative Care
, Pain Management: Administer prescribed analgesics and monitor the patient's response
to ensure effective pain control.
Elevation of Affected Limb: Helps reduce swelling and improve circulation, which is
critical in the post-operative phase.
Module 14: Sexuality
Interventions for Clients with STIs
Antibiotic or Antiviral Administration: Depending on the STI, timely administration of
medication is crucial for effective treatment.
Education on Safe Sex Practices: Providing information on safe sex can help prevent
reinfection and transmission to partners.
Risk Factors for Infertility Related to STIs
Pelvic Inflammatory Disease (PID): Often a consequence of untreated STIs, PID can lead
to infertility due to scarring and damage to reproductive organs.
Epididymitis: Inflammation of the epididymis can also result from STIs and may affect
fertility if not treated.
Important Teaching for Polycystic Ovary Syndrome (PCOS)
Healthy Lifestyle: Emphasizing the importance of diet and exercise to manage weight
and reduce symptoms associated with PCOS.
Medication Adherence: Patients may need to take insulin-sensitizing drugs like
metformin to manage symptoms effectively.
Client Education for HPV and HIV Prevention
HPV Vaccination: Educating clients on the importance of receiving the HPV vaccine to
prevent certain types of HPV-related cancers.
HIV Prevention Strategies: Discussing safe sex practices and the use of pre-exposure
prophylaxis (PrEP) for high-risk individuals.
Additional Clinical Considerations
Signs and Symptoms of Breast Changes
Fibrocystic Changes: Patients may experience lumpy or rope-like breast tissue, often
accompanied by tenderness, especially before menstruation.
Assessment for Gynecomastia
, Hormonal Evaluation: Assessing hormone levels, including estrogen and testosterone, is
crucial in diagnosing gynecomastia.
Medication Review: Some medications can cause gynecomastia as a side effect,
necessitating a thorough medication history.
Lab Monitoring for Menorrhagia
Complete Blood Count (CBC): To check for anemia, which may result from excessive
menstrual bleeding.
Coagulation Studies: Important to assess for any underlying bleeding disorders that may
contribute to menorrhagia.
Interventions for Amenorrhea
Hormonal Therapy: Depending on the underlying cause, hormonal therapy may be
necessary to restore menstrual function.
Nutritional Support: If amenorrhea is related to weight issues or eating disorders,
nutritional counseling is essential.
Findings in Clients with AIDS
Opportunistic Infections: Patients may present with infections such as Pneumocystis
pneumonia or Kaposi’s sarcoma, which are indicative of advanced disease.
Persistent Symptoms: Symptoms like fever and weight loss can signal disease
progression and require immediate medical attention.
Module 1: Fluid, Electrolyte and Acid-Base Imbalances
Hyperkalemia Interventions
Stop Potassium Administration: Cease any potassium supplements or infusions to
prevent further elevation of serum potassium levels.
Administer IV Fluids and Diuretics: Use isotonic fluids to help dilute serum potassium
and diuretics like furosemide to promote renal excretion of potassium.
Cardiac Monitoring: Continuous ECG monitoring is essential to detect any arrhythmias
that may arise due to hyperkalemia.
Monitor for Hypoglycemia: Insulin administration can drive potassium back into cells,
potentially causing hypoglycemia; monitor blood glucose levels closely.
STUDY GUIDE, NCLEX-STYLE PRACTICE QUESTIONS AND ANSWERS 2026/2027
Module 13: Arthritis and Connective Tissue Disorders
Key Assessment Findings for Orthopedic Clients
Compartment Syndrome: A serious condition characterized by the 6 Ps: pain, pressure,
paresthesia, pallor, paralysis, and pulselessness. Immediate recognition is crucial to
prevent permanent damage.
Venous Thromboembolism (VTE): A condition where blood clots form in the veins,
potentially leading to serious complications. Symptoms may include swelling and pain in
the affected limb.
Fat Embolism Syndrome: Typically occurs 24-48 hours post-injury, especially with long
bone fractures. Symptoms include chest pain, tachypnea, and confusion due to fat
globules entering the bloodstream.
Rhabdomyolysis: Muscle breakdown that releases myoglobin into the bloodstream,
leading to acute kidney injury (AKI). Symptoms include dark reddish-brown urine.
Complications of Orthopedic Trauma
Compartment Syndrome: Caused by increased pressure within a muscle compartment,
leading to decreased blood flow and potential nerve damage. It can result from
restrictive dressings or increased compartment contents due to bleeding or swelling.
Fat Embolism Syndrome: Fat globules can travel to the lungs and brain, causing
respiratory distress and neurological symptoms. Early recognition is key to management.
Deep Vein Thrombosis (DVT): Characterized by leg pain and swelling, DVT can lead to
pulmonary embolism if not treated promptly.
Monitoring Parameters for Orthopedic Clients
Neurovascular Status: Essential to monitor peripheral pulses, capillary refill, sensation,
and movement to detect complications early.
Pain Levels: Regular assessment of pain can indicate complications such as compartment
syndrome or infection.
Nursing Actions for Post-Operative Care
, Pain Management: Administer prescribed analgesics and monitor the patient's response
to ensure effective pain control.
Elevation of Affected Limb: Helps reduce swelling and improve circulation, which is
critical in the post-operative phase.
Module 14: Sexuality
Interventions for Clients with STIs
Antibiotic or Antiviral Administration: Depending on the STI, timely administration of
medication is crucial for effective treatment.
Education on Safe Sex Practices: Providing information on safe sex can help prevent
reinfection and transmission to partners.
Risk Factors for Infertility Related to STIs
Pelvic Inflammatory Disease (PID): Often a consequence of untreated STIs, PID can lead
to infertility due to scarring and damage to reproductive organs.
Epididymitis: Inflammation of the epididymis can also result from STIs and may affect
fertility if not treated.
Important Teaching for Polycystic Ovary Syndrome (PCOS)
Healthy Lifestyle: Emphasizing the importance of diet and exercise to manage weight
and reduce symptoms associated with PCOS.
Medication Adherence: Patients may need to take insulin-sensitizing drugs like
metformin to manage symptoms effectively.
Client Education for HPV and HIV Prevention
HPV Vaccination: Educating clients on the importance of receiving the HPV vaccine to
prevent certain types of HPV-related cancers.
HIV Prevention Strategies: Discussing safe sex practices and the use of pre-exposure
prophylaxis (PrEP) for high-risk individuals.
Additional Clinical Considerations
Signs and Symptoms of Breast Changes
Fibrocystic Changes: Patients may experience lumpy or rope-like breast tissue, often
accompanied by tenderness, especially before menstruation.
Assessment for Gynecomastia
, Hormonal Evaluation: Assessing hormone levels, including estrogen and testosterone, is
crucial in diagnosing gynecomastia.
Medication Review: Some medications can cause gynecomastia as a side effect,
necessitating a thorough medication history.
Lab Monitoring for Menorrhagia
Complete Blood Count (CBC): To check for anemia, which may result from excessive
menstrual bleeding.
Coagulation Studies: Important to assess for any underlying bleeding disorders that may
contribute to menorrhagia.
Interventions for Amenorrhea
Hormonal Therapy: Depending on the underlying cause, hormonal therapy may be
necessary to restore menstrual function.
Nutritional Support: If amenorrhea is related to weight issues or eating disorders,
nutritional counseling is essential.
Findings in Clients with AIDS
Opportunistic Infections: Patients may present with infections such as Pneumocystis
pneumonia or Kaposi’s sarcoma, which are indicative of advanced disease.
Persistent Symptoms: Symptoms like fever and weight loss can signal disease
progression and require immediate medical attention.
Module 1: Fluid, Electrolyte and Acid-Base Imbalances
Hyperkalemia Interventions
Stop Potassium Administration: Cease any potassium supplements or infusions to
prevent further elevation of serum potassium levels.
Administer IV Fluids and Diuretics: Use isotonic fluids to help dilute serum potassium
and diuretics like furosemide to promote renal excretion of potassium.
Cardiac Monitoring: Continuous ECG monitoring is essential to detect any arrhythmias
that may arise due to hyperkalemia.
Monitor for Hypoglycemia: Insulin administration can drive potassium back into cells,
potentially causing hypoglycemia; monitor blood glucose levels closely.
