CuraRN

NSG210 Exam 1 Study Guide

Exam 1: Monday, September 14, 2026, 1400-1520. Content cutoff is the September 9 lecture (see exam_conflicts for why September 9 rather than the later date some raw scheduling notes suggest).

This is the condensed, exam-focused version - read this first, and drop into the full weekly summaries when a topic needs more depth.

High-Yield: What Is Most Likely to Be Tested

Med-Surg: Chronic Illness and Older Adult

A chronic condition lasts 3+ months, does not resolve spontaneously, and is rarely curable - management targets acceptance and realistic use of remaining strengths, not cure. Social determinants of health (neighborhood, healthcare access, social/community context, education, economic stability) drive health disparities.

Age-related changes span every system, but the cardiovascular and respiratory ones matter most for this exam: myocardial hypertrophy and decreased cardiac output, arterial stiffening (widened pulse pressure), reduced beta-adrenergic responsiveness, and on the respiratory side, reduced inspiratory/expiratory force and diminished efficiency. SPICES catches the geriatric triad (cognitive changes, falls, incontinence) plus sleep and eating/feeding problems and skin breakdown - use it as a 24-hour-admission screen, not a full assessment replacement. DIAPPERS covers reversible causes of acute incontinence (Delirium, Infection, Atrophic vaginitis, Pharmaceuticals, Psychological, Excess urine output, Restricted mobility, Stool impaction). Polypharmacy management follows “start low, go slow.” See the full nsg210-week-02-summary for the incontinence-type table and the complete system-by-system list of aging changes.

Med-Surg: Oxygenation (Asthma and COPD)

Asthma is reversible airway hyperresponsiveness driven by sensitized mast cells; status asthmaticus is severe, treatment-refractory asthma. A dangerous sign is reduced wheezing with inaudible breath sounds - it can mean too little airflow to wheeze, not improvement. The acute treatment bundle: Adrenergics (albuterol), Steroids, Theophylline (fallback), Hydration, Mask oxygen, Anticholinergics (ipratropium).

COPD is largely irreversible airflow obstruction (low FEV1/FVC that does not fully reverse with bronchodilators), driven 80-90 percent of the time by smoking. Chronic bronchitis is a clinical diagnosis (productive cough, 3+ months/year for 2+ years); emphysema is a structural diagnosis (alveolar wall destruction) - most patients have both patterns. Alpha-1 antitrypsin deficiency causes early-onset emphysema even in non-smokers and can also cause liver disease. Cor pulmonale is right heart failure specifically from lung disease (chronic hypoxia leads to pulmonary vasoconstriction leads to pulmonary hypertension leads to RV strain) - correcting hypoxia with long-term oxygen therapy is one of the few interventions proven to reduce mortality here. BiPAP (two pressures, gives ventilatory assistance) is preferred over CPAP (one constant pressure, airway support only) for an acute COPD exacerbation with respiratory failure.

Med-Surg: Cardiac Assessment and Heart Failure

Age-related cardiac change plus the atypical-presentation pearl above are the assessment foundation. Auscultation sequence is Aortic, Pulmonic, Erb’s point, Tricuspid, Mitral (“APE To Man”); only valve closures make sound (S1 = mitral/tricuspid close, S2 = aortic/pulmonic close), so a murmur elsewhere in the cycle means stenosis or regurgitation.

Heart failure is a clinical syndrome where the heart cannot meet metabolic demand. RAAS activation (renin leads to angiotensin I leads to angiotensin II leads to vasoconstriction and aldosterone-driven fluid retention) is compensatory short-term and maladaptive long-term - this is the physiologic reason every major HFrEF drug class targets some point in that cascade. Left-sided HF gives pulmonary symptoms (dyspnea, crackles, orthopnea); right-sided HF gives systemic symptoms (JVD, edema, hepatomegaly, ascites, weight gain) and often follows chronic left-sided HF. See nsg210-week-02-summary for the full four-pillars medication breakdown (SGLT2 inhibitors, diuretics, RAAS blockers, beta-blockers), the preload/afterload framework, and the worked Henry Winston case study applying all of this to one patient with a real medication list and a real clinical-priority question.

OB: Genetics, Fetal Development, and Antepartal Testing

Inheritance patterns: autosomal recessive needs both parents carrying the gene (sickle cell, CF, Tay-Sachs, PKU); autosomal dominant needs only one affected parent (Huntington’s, often 50 percent risk); X-linked recessive primarily affects males with the mother as carrier (hemophilia, Duchenne). The embryonic period (weeks 3-8) is the critical window for teratogen-related defects; teratogens include alcohol, ACE inhibitors, anticonvulsants, cocaine, warfarin, and the TORCH-type infections (CMV, varicella, rubella, syphilis, toxoplasmosis, Zika).

Naegele’s rule for EDD: LMP + 7 days - 3 months + 1 year (“add 7, subtract 3, add 1”). Fundal height in cm approximates gestational age in weeks after 20 weeks. Signs of pregnancy run presumptive (reported, not diagnostic) to probable (observed, still not proof) to positive (fetal heart rate, fetal movement felt by examiner, ultrasound - the only tier that is actual proof).

Antepartal testing: BPP scores 5 components (NST, breathing, movement, tone, amniotic fluid) 0 or 2 each, max 10. NST reassuring pattern is 15-15-2 (see above). Diagnostic tests (CVS, amniocentesis, PUBS) confirm; screening tests (cell-free DNA, AFP, multiple-marker) only flag risk. See nsg210-week-03b-summary for full detail on all of this, including physiologic adaptations to pregnancy by body system.

Cost containment shortens hospital stays (48 hours vaginal, 96 hours cesarean), making discharge teaching and home follow-up essential since a mother may have no support at home. Nonmaleficence is the duty to do no harm; moral distress is knowing the right action but being unable to take it (a distinct concept from an ethical dilemma, which is a conflict between two legitimate goods, like maternal autonomy versus fetal well-being). Maternity is the most litigious nursing area, and “failure to communicate” is the leading cause of related malpractice suits. Leading cause of infant mortality: congenital malformations. Leading causes of maternal mortality: hemorrhage, hypertensive disorders, infection/sepsis. See nsg210-week-03-summary for the full context and the noted content gap for genetics/antepartal-testing material not yet available in the raw source.

Pharmacology Quick Reference for This Exam

Pulled from nsg210-week-01-summary and woven through the med-surg and OB content above - these are the medication safety points most likely to be tested as a standalone question:

Open Items Before September 14

  1. Genetics/conception/fetal development, antepartal nursing care, and antepartal testing have no raw source material yet. Resolved - see nsg210-week-03b-summary. Health promotion during pregnancy specifically (discomforts, immunizations, childbirth/breastfeeding prep) is still not covered in raw source material.
  2. SPICES now has full notes here and in the Week 02 summary - previously an open gap, now resolved.
  3. Heart failure medications now have full notes (mechanism, examples, nursing considerations for all four pillars) - previously an open gap, now resolved.
  4. OB medications now have full notes - previously an open gap, now resolved.
  5. GTPAL terminology now has full notes at nsg210-ob-terminology, plus a practice quiz at raw/nsg210_GTPAL_Pregnancy_Classification_Quiz.md - previously an open gap, now resolved.