NUR 283 Comprehensive 2 Study Guide | 2026 Latest
Update with Complete Solution - Galen College of Nursing
You learned about stomach disorders, including peptic ulcer disease (PUD), in
the first med/surg course. H.pylori infection is a common cause of ulcers but
NSAIDs, stress, having type O blood (universal donor), and hypersecretion of
acid are other causes.
See IGGY 10th edition page 1102, managing upper GI bleeding. Hemorrhage
is the most serious complication of peptic ulcer disease. This is a life-
threatening emergency. Gastrointestinal bleeding in the form of
hematemesis or melena can cause manifestations of shock (hypotension,
tachycardia, dizziness, confusion), and decreased hemoglobin.
Interventions for patients experiencing upper GI bleed due to PUD include:
• Report findings, prepare the client for endoscopic or surgical
intervention, replace fluid and blood losses to maintain blood pressure,
insert nasogastric tube, and provide saline lavages. The NG tube
provides a way to monitor the rate of bleeding and for possible lavage.
• You should know best practices related to caring for patients with an
NG tube. Basic NG tube care is noted on page 176 in IGGY 10 th
• Care of NG tubes for intestinal obstruction is noted on pages 1113 -
1114. See critical rescue box on page 1114.
• With gastric surgery or esophageal surgery, the NG tube is not to be
irrigated or repositioned due to possible disruption of suture site.
• Supportive therapy to prevent hypovolemic shock and death.
Blood and fluids replacement are priorities.9%NS will likely be
prescribed along with packed RBCs. Type and cross required prior
to blood transfusions. Start two large-bore IVs.
• Support oxygen needs. Monitor vital signs, H&H, and coagulation
studies.
• Endoscopic therapy (EGD) is used to stop bleeding. Remember to
check gag reflex after an EGD before the patient receives any
food or liquids. If this procedure doesn’t stop the bleeding an
endovascular procedure can be performed.
• After bleeding is stopped, aggressive acid suppression will help
prevent rebleeding.
Good points on safety teaching include placing baby on back for sleeping.
Make sure parents understand to avoid placing anything in the bed with the
infant. No blankets.
Newborn infants should be placed in a federally approved car seat at a 45-
degree angle to prevent slumping and airway obstruction. The car seat is
placed rear facing in the rear seat of the vehicle and secured using the
,safety belt. The shoulder harnesses are placed in the slots at or below the
level of the infant’s shoulders. The harness should be snug, and the retainer
clip placed at the level of the infant’s armpits.
Infants should remain in a rear facing car seat at least until age 2. All infants
and toddlers should ride in a rear-facing seat until they reach the highest
weight or height allowed by their car seat manufacturer. Most convertible
seats have limits that will allow children to ride rear facing for at least 2
years.
After outgrowing the rear-facing car seat, use a forward-facing car seat
until at least age 5.
• When children outgrow their rear-facing car seats, they should be
buckled in a forward-facing car seat, in the back seat (middle preferred
unless seat doesn’t fit), until they reach the upper weight or height
limit of their car seat.
• After outgrowing the forward-facing car seat, use a booster seat until
seat belts fit properly.
• Once children outgrow their forward-facing car seat, they should
be buckled in a belt-positioning booster seat, in the back seat,
until seat belts fit properly. Seat belts fit properly when the lap
belt lays across the upper thighs (not the stomach) and the
shoulder belt lays across the chest (not the neck).
Children who have outgrown the rear-facing weight or height limit for their
convertible seat should use a forward-facing car seat with a harness for as
long as possible, up to the highest weight or height allowed by their car seat
manufacturer. Forward facing seats can accommodate children up to 65
pounds or more.
All children whose weight or height exceeds the forward-facing limit for their
car safety seat should use a belt-positioning booster seat with shoulder strap
until the vehicle seat belt fits properly, typically when they have reached 4
feet 9 inches in height and are 8 through 12 years of age. All children
younger than 13 years should ride in the back seat.
When children are old enough and large enough for the vehicle seat belt to
fit them correctly, they should always use lap and shoulder seat belts for the
best protection. As noted above, in the back seat is appropriate for all
children younger than 13.
Mechanical ventilation is used to maintain a patent airway and improve gas
exchange.
, See IGGY 10th edition page 603 Table 29-5 Nursing Interventions for Various
Causes of Ventilator Alarms.
The low-pressure alarm indicates a leak, or the tube has been disconnected.
The high-pressure alarm may be due to secretions/mucus plug or the patient
may be fighting the vent. Always check to see if the patient needs suctioned
if the high-pressure alarm sounds.
See critical rescue box IGGY 10th edition page 602 bottom of first column. If a
patient develops respiratory distress while on vent remove the ventilator and
ventilate patient manually while determining if the problem is related to the
vent or patient.
Under the Reduction of Risk Potential part of the NCLEX test plan there is a
section titled Potential for Complications of Diagnostic
Tests/Treatments/Procedures. Insertion, maintaining, and removing an NG
tube is included in this part of the test plan.
You learned about NG tubes in fundamentals and med/surg. Nasogastric
tubes are indicated for patients with intestinal obstruction and can also be
used to provide nutritional support. They are most common in post-op
surgical patients and when gastric decompression or nutritional support is
necessary. NG tubes are also used for lavage - wash out the stomach to treat
active bleeding, ingestion of poison, or for gastric dilation
You should know best practices related to caring for patients with an NG
tube. See IGGY 10th edition page 1102, which notes NG tube is needed for
upper GI bleeding or obstruction. Care of patients with NG tube is noted on
page 1113-1114. Make note of the action alert box in the left column page
1114 as well as the text on that page.
Use at least two of the following bedside methods to assess tube location
during the insertion procedure: assess for respiratory distress, use
capnography if available, test pH aspirate from the tube, and observe the
appearance of aspirate from the tube. Do not use the auscultatory (air bolus)
or water bubbling method to determine tube location.
The NG tube may become dislocated during use. NG tubes can migrate
proximal to the initial placement site with coughing, suctioning, vomiting,
repositioning the patient, ambulation, and failure of the securement method
or device. Consequently, tube position must be reconfirmed frequently for as
long as the tube is in place.
For monitoring placement of NG have available pH test strip or meter to
measure gastric secretions for acidity. Check placement. Aspirate gently to
collect gastric contents, testing pH (4 or less is expected), and assess odor,
Update with Complete Solution - Galen College of Nursing
You learned about stomach disorders, including peptic ulcer disease (PUD), in
the first med/surg course. H.pylori infection is a common cause of ulcers but
NSAIDs, stress, having type O blood (universal donor), and hypersecretion of
acid are other causes.
See IGGY 10th edition page 1102, managing upper GI bleeding. Hemorrhage
is the most serious complication of peptic ulcer disease. This is a life-
threatening emergency. Gastrointestinal bleeding in the form of
hematemesis or melena can cause manifestations of shock (hypotension,
tachycardia, dizziness, confusion), and decreased hemoglobin.
Interventions for patients experiencing upper GI bleed due to PUD include:
• Report findings, prepare the client for endoscopic or surgical
intervention, replace fluid and blood losses to maintain blood pressure,
insert nasogastric tube, and provide saline lavages. The NG tube
provides a way to monitor the rate of bleeding and for possible lavage.
• You should know best practices related to caring for patients with an
NG tube. Basic NG tube care is noted on page 176 in IGGY 10 th
• Care of NG tubes for intestinal obstruction is noted on pages 1113 -
1114. See critical rescue box on page 1114.
• With gastric surgery or esophageal surgery, the NG tube is not to be
irrigated or repositioned due to possible disruption of suture site.
• Supportive therapy to prevent hypovolemic shock and death.
Blood and fluids replacement are priorities.9%NS will likely be
prescribed along with packed RBCs. Type and cross required prior
to blood transfusions. Start two large-bore IVs.
• Support oxygen needs. Monitor vital signs, H&H, and coagulation
studies.
• Endoscopic therapy (EGD) is used to stop bleeding. Remember to
check gag reflex after an EGD before the patient receives any
food or liquids. If this procedure doesn’t stop the bleeding an
endovascular procedure can be performed.
• After bleeding is stopped, aggressive acid suppression will help
prevent rebleeding.
Good points on safety teaching include placing baby on back for sleeping.
Make sure parents understand to avoid placing anything in the bed with the
infant. No blankets.
Newborn infants should be placed in a federally approved car seat at a 45-
degree angle to prevent slumping and airway obstruction. The car seat is
placed rear facing in the rear seat of the vehicle and secured using the
,safety belt. The shoulder harnesses are placed in the slots at or below the
level of the infant’s shoulders. The harness should be snug, and the retainer
clip placed at the level of the infant’s armpits.
Infants should remain in a rear facing car seat at least until age 2. All infants
and toddlers should ride in a rear-facing seat until they reach the highest
weight or height allowed by their car seat manufacturer. Most convertible
seats have limits that will allow children to ride rear facing for at least 2
years.
After outgrowing the rear-facing car seat, use a forward-facing car seat
until at least age 5.
• When children outgrow their rear-facing car seats, they should be
buckled in a forward-facing car seat, in the back seat (middle preferred
unless seat doesn’t fit), until they reach the upper weight or height
limit of their car seat.
• After outgrowing the forward-facing car seat, use a booster seat until
seat belts fit properly.
• Once children outgrow their forward-facing car seat, they should
be buckled in a belt-positioning booster seat, in the back seat,
until seat belts fit properly. Seat belts fit properly when the lap
belt lays across the upper thighs (not the stomach) and the
shoulder belt lays across the chest (not the neck).
Children who have outgrown the rear-facing weight or height limit for their
convertible seat should use a forward-facing car seat with a harness for as
long as possible, up to the highest weight or height allowed by their car seat
manufacturer. Forward facing seats can accommodate children up to 65
pounds or more.
All children whose weight or height exceeds the forward-facing limit for their
car safety seat should use a belt-positioning booster seat with shoulder strap
until the vehicle seat belt fits properly, typically when they have reached 4
feet 9 inches in height and are 8 through 12 years of age. All children
younger than 13 years should ride in the back seat.
When children are old enough and large enough for the vehicle seat belt to
fit them correctly, they should always use lap and shoulder seat belts for the
best protection. As noted above, in the back seat is appropriate for all
children younger than 13.
Mechanical ventilation is used to maintain a patent airway and improve gas
exchange.
, See IGGY 10th edition page 603 Table 29-5 Nursing Interventions for Various
Causes of Ventilator Alarms.
The low-pressure alarm indicates a leak, or the tube has been disconnected.
The high-pressure alarm may be due to secretions/mucus plug or the patient
may be fighting the vent. Always check to see if the patient needs suctioned
if the high-pressure alarm sounds.
See critical rescue box IGGY 10th edition page 602 bottom of first column. If a
patient develops respiratory distress while on vent remove the ventilator and
ventilate patient manually while determining if the problem is related to the
vent or patient.
Under the Reduction of Risk Potential part of the NCLEX test plan there is a
section titled Potential for Complications of Diagnostic
Tests/Treatments/Procedures. Insertion, maintaining, and removing an NG
tube is included in this part of the test plan.
You learned about NG tubes in fundamentals and med/surg. Nasogastric
tubes are indicated for patients with intestinal obstruction and can also be
used to provide nutritional support. They are most common in post-op
surgical patients and when gastric decompression or nutritional support is
necessary. NG tubes are also used for lavage - wash out the stomach to treat
active bleeding, ingestion of poison, or for gastric dilation
You should know best practices related to caring for patients with an NG
tube. See IGGY 10th edition page 1102, which notes NG tube is needed for
upper GI bleeding or obstruction. Care of patients with NG tube is noted on
page 1113-1114. Make note of the action alert box in the left column page
1114 as well as the text on that page.
Use at least two of the following bedside methods to assess tube location
during the insertion procedure: assess for respiratory distress, use
capnography if available, test pH aspirate from the tube, and observe the
appearance of aspirate from the tube. Do not use the auscultatory (air bolus)
or water bubbling method to determine tube location.
The NG tube may become dislocated during use. NG tubes can migrate
proximal to the initial placement site with coughing, suctioning, vomiting,
repositioning the patient, ambulation, and failure of the securement method
or device. Consequently, tube position must be reconfirmed frequently for as
long as the tube is in place.
For monitoring placement of NG have available pH test strip or meter to
measure gastric secretions for acidity. Check placement. Aspirate gently to
collect gastric contents, testing pH (4 or less is expected), and assess odor,
