NSG 4800 Comprehensive Exam 3 Review 2026 | Class Notes, Key Concepts &
Study Guide | Galen College of Nursing PDF
Care of lumbar spinal surgery patient (1055)
● Postoperative interventions
○ Monitor sensation and circulatory status in lower extremities
○ Encourage breathing exercises
○ Keep pt in a flat position as prescribed
○ Provide cast care if in full body cast
○ Turn and reposition frequently by logrolling side to back to side, using turning sheets & pillows between legs to
maintain alignment
○ Maintain NPO until the pt is passing flatus
○ Use a fracture bedpan
Monitor for AD, autonomic dysreflexia in a spinal cord injury pt (1056)
Raise hob, notify pcp
Loosen tight clothing
Check for bladder distention or other noxious stimulus
Document
PE treatment and labs (200, 669-70)
● Assessment
○ Sudden dyspnea
○ Sudden sharp chest or upper abdominal pain
○ Cyanosis
○ Tachycardia
○ A drop in blood pressure
● Interventions
○ Notify surgeon immediately
○ Monitor VS
○ Administer oxygen, medications, and treatments as prescribed
● A client, experiencing a sudden onset of chest pain and dyspnea, is diagnosed with a pulmonary embolus. The nurse
immediately implements which expected prescription for this client? Select all that apply.
○ 1. Supplemental oxygen
○ 2. High Fowler’s position
○ 3. Semi-Fowler’s position
○ 4. Morphine sulfate intravenously
○ 5. Two tablets of acetaminophen with codeine
○ 6. Meperidine hydrochloride intravenously
○ Rationale: Standard therapeutic intervention for the client with pulmonary embolus includes proper positioning,
oxygen, and intravenous analgesics. The head of the bed is placed in semi-Fowler’s position. Fowler’s is avoided
because extreme hip flexure slows venous return from the legs and increases the risk of new thrombi. The usual
analgesic of choice is morphine sulfate administered intravenously. This medication reduces pain, alleviates
anxiety, and can diminish congestion of blood in the pulmonary vessels because it causes peripheral venous
dilation. Priority Nursing Tip: Clients prone to pulmonary embolism are those at risk for deep vein thrombosis
● The nurse has conducted teaching, with a client who experienced pulmonary embolism, about methods to prevent
recurrence after discharge. Which client statement demonstrates understanding of the teaching?
○ 1. “I will limit the intake of fluids.”
○ 2. “I will sit down whenever possible.”
○ 3. “I am planning to continue to wear supportive hose.”
○ 4. “I will cross my legs only at the ankle and not at the knees.”
○ Rationale: The recurrence of pulmonary embolism can be minimized with the wearing of elastic or supportive
hose because these hoses enhance venous return. The client should take in sufficient fluids to prevent
, hemoconcentration and hypercoagulability. The client also enhances venous return by interspersing periods of
sitting with walking, avoiding crossing the legs at the knees or ankles and doing active foot and ankle exercises.
Priority Nursing Tip: Pulmonary embolism occurs when a thrombus forms (most commonly in a deep vein),
detaches, travels to the right side of the heart, and then lodges in a branch of the pulmonary artery.
● The nurse is caring for a postpartum client with thromboembolytic disease. Which intervention is most important to
include when planning care to prevent the complication of pulmonary embolism?
○ 1. Enforce bed rest.
○ 2. Monitor the vital signs frequently.
○ 3. Assess the breath sounds frequently.
○ 4. Administer prescribed anticoagulant therapy.
○ Rationale: The purposes of anticoagulant therapy for the treatment of thromboembolytic disease are to prevent the
formation of a clot and to prevent a clot from moving to another area, thus preventing pulmonary embolism.
Although the remaining options may be implemented for a client with thromboembolytic disease, the correct
option will specifically assist in the prevention of pulmonary embolism. Priority Nursing Tip: Medications
containing aspirin should not be given to clients receiving anticoagulant therapy, because aspirin prolongs the
clotting time and increases the risk of bleeding.
● The nurse is preparing to implement emergency care measures for the client who has just demonstrated signs and
symptoms of a pulmonary embolism. Which primary health care provider prescription should the nurse implement first?
○ 1. Apply oxygen.
○ 2. Administer morphine sulfate.
○ 3. Start an intravenous (IV) line.
○ 4. Obtain an electrocardiogram (ECG).
○ Rationale: The client needs oxygen immediately because of hypoxemia, which is most often accompanied by
respiratory distress and cyanosis. The client should also have an IV line for the administration of emergency
medications such as morphine sulfate. An ECG is useful in determining the presence of possible right ventricular
hypertrophy. All of the interventions listed are appropriate, but the client needs the oxygen first. Priority Nursing
Tip: If pulmonary embolism is suspected, notify the rapid response team immediately.
Colostomy and proper stoma care (546)
● Postoperative colostomy
○ a. If a pouch system is not in place, apply a petroleum jelly gauze over the stoma to keep it moist,
covered with a dry sterile dressing; place a pouch system on the stoma as soon as possible.
○ b. Monitor the pouch system for proper fit and signs of leakage; empty the pouch when one-third full.
○ c. Monitor the stoma for size, unusual bleeding, color changes, or necrotic tissue.
○ d. Note that the normal stoma color is red or pink, indicating high vascularity.
○ e. Note that a pale pink stoma indicates low hemoglobin and hematocrit levels.
○ f. Assess the functioning of the colostomy.
○ g. Expect that stool will be liquid postoperatively but will become more solid, depending on the area of
the colostomy.
○ h. Expect liquid stool from an ascending colon colostomy, loose to semiformed stool from a transverse
colon colostomy, or close to normal stool from a descending colon colostomy.
○ i. Fecal matter should not be allowed to remain on the skin.
○ j. Administer analgesics and antibiotics as prescribed.
○ k. Irrigate perineal wound if present and if prescribed, and monitor for signs of infection; provide
comfort measures for perineal itching and pain.
○ l. Instruct the client to avoid foods that cause excessive gas formation and odor.
○ m. Instruct the client in stoma care and irrigations as prescribed.
○ n. Instruct the client on when to resume normal activities, including work, travel, and sexual intercourse,
as prescribed; provide psychosocial support.
● The nurse is demonstrating colostomy care to a client with a newly created colostomy. The nurse demonstrates
the correct cutting of the appliance by making the circle how much larger than the client’s stoma?
○ 1. 1/8 inch
, ○ 2. 1/4 inch
○ 3. 1/2 inch
○ 4. 1 inch
○ Rationale: The size of the opening for the appliance is generally cut 1/8 inch larger than the size of the
client’s stoma. This minimizes the amount of exposed skin but does not put pressure on the stoma. The
larger sizes leave too much skin area exposed for irritation by gastrointestinal contents. Priority Nursing
Tip: A pale pink colostomy stoma most likely indicates that the client has a low hemoglobin and
hematocrit level.
○ For the client with a colostomy, the nurse should monitor stoma color. A dark blue, purple, or black
stoma indicates compromised circulation, requiring primary health care provider notification
MS patient education (843-44, meds 855-56)
● Description
○ A chronic, progressive, non contagious, degenerative disease of the CNS characterized by demyelinization of the
neurons.
○ It usually occurs between the ages of 20 and 40 years and consists of periods of remissions and exacerbations.
○ The causes are unknown, but the disease is thought to be the result of an autoimmune response or viral infection.
○ Precipitating factors include pregnancy, fatigue, stress, infection, and trauma.
○ Electroencephalographic findings are abnormal.
○ Assessment of a lumbar puncture indicates an increased gamma globulin level, but the serum globulin level is
normal.
● Assessment
○ Fatigue and weakness
○ Ataxia and vertigo
○ Tremors and spasticity of the lower extremities
○ Paresthesias
○ Blurred vision, diplopia, and transient blindness
○ Nystagmus (involuntary eye movement)
○ Dysphasia (language disorder marked by deficiency in the generation of speech)
○ Decreased perception to pain, touch, and temperature
○ Bladder and bowel disturbances, including urgency, frequency, retention, and incontinence
○ Abnormal reflexes, including hyperreflexia, absent reflexes, and a positive Babinski’s reflex
○ Emotional changes such as apathy, euphoria, irritability, and depression
○ Memory changes and confusion
● Interventions
○ Provide energy conservation measures during exacerbation.
○ Protect the client from injury by providing safety measures.
○ Place an eye patch on the eye for diplopia.
○ Monitor for potential complications such as urinary tract infections, calculi, pressure ulcers, respiratory
tract infections, and contractures.
○ Promote regular elimination by bladder and bowel training.
○ Encourage independence.
○ Assist the client to establish a regular exercise and rest program and to balance moderate activity with rest
periods.
○ Assess the need for and provide assistive devices.
○ Initiate physical and speech therapy.
○ Instruct the client to avoid fatigue, stress, infection, overheating, and chilling.
○ Instruct the client to increase fluid intake and eat a balanced diet, including low-fat, high-fiber foods and
foods high in potassium.
○ Instruct the client in safety measures related to sensory loss, such as regulating the temperature of bath
water and avoiding heating pads.
○ Instruct the client in safety measures related to motor loss, such as avoiding the use of scatter rugs and
Study Guide | Galen College of Nursing PDF
Care of lumbar spinal surgery patient (1055)
● Postoperative interventions
○ Monitor sensation and circulatory status in lower extremities
○ Encourage breathing exercises
○ Keep pt in a flat position as prescribed
○ Provide cast care if in full body cast
○ Turn and reposition frequently by logrolling side to back to side, using turning sheets & pillows between legs to
maintain alignment
○ Maintain NPO until the pt is passing flatus
○ Use a fracture bedpan
Monitor for AD, autonomic dysreflexia in a spinal cord injury pt (1056)
Raise hob, notify pcp
Loosen tight clothing
Check for bladder distention or other noxious stimulus
Document
PE treatment and labs (200, 669-70)
● Assessment
○ Sudden dyspnea
○ Sudden sharp chest or upper abdominal pain
○ Cyanosis
○ Tachycardia
○ A drop in blood pressure
● Interventions
○ Notify surgeon immediately
○ Monitor VS
○ Administer oxygen, medications, and treatments as prescribed
● A client, experiencing a sudden onset of chest pain and dyspnea, is diagnosed with a pulmonary embolus. The nurse
immediately implements which expected prescription for this client? Select all that apply.
○ 1. Supplemental oxygen
○ 2. High Fowler’s position
○ 3. Semi-Fowler’s position
○ 4. Morphine sulfate intravenously
○ 5. Two tablets of acetaminophen with codeine
○ 6. Meperidine hydrochloride intravenously
○ Rationale: Standard therapeutic intervention for the client with pulmonary embolus includes proper positioning,
oxygen, and intravenous analgesics. The head of the bed is placed in semi-Fowler’s position. Fowler’s is avoided
because extreme hip flexure slows venous return from the legs and increases the risk of new thrombi. The usual
analgesic of choice is morphine sulfate administered intravenously. This medication reduces pain, alleviates
anxiety, and can diminish congestion of blood in the pulmonary vessels because it causes peripheral venous
dilation. Priority Nursing Tip: Clients prone to pulmonary embolism are those at risk for deep vein thrombosis
● The nurse has conducted teaching, with a client who experienced pulmonary embolism, about methods to prevent
recurrence after discharge. Which client statement demonstrates understanding of the teaching?
○ 1. “I will limit the intake of fluids.”
○ 2. “I will sit down whenever possible.”
○ 3. “I am planning to continue to wear supportive hose.”
○ 4. “I will cross my legs only at the ankle and not at the knees.”
○ Rationale: The recurrence of pulmonary embolism can be minimized with the wearing of elastic or supportive
hose because these hoses enhance venous return. The client should take in sufficient fluids to prevent
, hemoconcentration and hypercoagulability. The client also enhances venous return by interspersing periods of
sitting with walking, avoiding crossing the legs at the knees or ankles and doing active foot and ankle exercises.
Priority Nursing Tip: Pulmonary embolism occurs when a thrombus forms (most commonly in a deep vein),
detaches, travels to the right side of the heart, and then lodges in a branch of the pulmonary artery.
● The nurse is caring for a postpartum client with thromboembolytic disease. Which intervention is most important to
include when planning care to prevent the complication of pulmonary embolism?
○ 1. Enforce bed rest.
○ 2. Monitor the vital signs frequently.
○ 3. Assess the breath sounds frequently.
○ 4. Administer prescribed anticoagulant therapy.
○ Rationale: The purposes of anticoagulant therapy for the treatment of thromboembolytic disease are to prevent the
formation of a clot and to prevent a clot from moving to another area, thus preventing pulmonary embolism.
Although the remaining options may be implemented for a client with thromboembolytic disease, the correct
option will specifically assist in the prevention of pulmonary embolism. Priority Nursing Tip: Medications
containing aspirin should not be given to clients receiving anticoagulant therapy, because aspirin prolongs the
clotting time and increases the risk of bleeding.
● The nurse is preparing to implement emergency care measures for the client who has just demonstrated signs and
symptoms of a pulmonary embolism. Which primary health care provider prescription should the nurse implement first?
○ 1. Apply oxygen.
○ 2. Administer morphine sulfate.
○ 3. Start an intravenous (IV) line.
○ 4. Obtain an electrocardiogram (ECG).
○ Rationale: The client needs oxygen immediately because of hypoxemia, which is most often accompanied by
respiratory distress and cyanosis. The client should also have an IV line for the administration of emergency
medications such as morphine sulfate. An ECG is useful in determining the presence of possible right ventricular
hypertrophy. All of the interventions listed are appropriate, but the client needs the oxygen first. Priority Nursing
Tip: If pulmonary embolism is suspected, notify the rapid response team immediately.
Colostomy and proper stoma care (546)
● Postoperative colostomy
○ a. If a pouch system is not in place, apply a petroleum jelly gauze over the stoma to keep it moist,
covered with a dry sterile dressing; place a pouch system on the stoma as soon as possible.
○ b. Monitor the pouch system for proper fit and signs of leakage; empty the pouch when one-third full.
○ c. Monitor the stoma for size, unusual bleeding, color changes, or necrotic tissue.
○ d. Note that the normal stoma color is red or pink, indicating high vascularity.
○ e. Note that a pale pink stoma indicates low hemoglobin and hematocrit levels.
○ f. Assess the functioning of the colostomy.
○ g. Expect that stool will be liquid postoperatively but will become more solid, depending on the area of
the colostomy.
○ h. Expect liquid stool from an ascending colon colostomy, loose to semiformed stool from a transverse
colon colostomy, or close to normal stool from a descending colon colostomy.
○ i. Fecal matter should not be allowed to remain on the skin.
○ j. Administer analgesics and antibiotics as prescribed.
○ k. Irrigate perineal wound if present and if prescribed, and monitor for signs of infection; provide
comfort measures for perineal itching and pain.
○ l. Instruct the client to avoid foods that cause excessive gas formation and odor.
○ m. Instruct the client in stoma care and irrigations as prescribed.
○ n. Instruct the client on when to resume normal activities, including work, travel, and sexual intercourse,
as prescribed; provide psychosocial support.
● The nurse is demonstrating colostomy care to a client with a newly created colostomy. The nurse demonstrates
the correct cutting of the appliance by making the circle how much larger than the client’s stoma?
○ 1. 1/8 inch
, ○ 2. 1/4 inch
○ 3. 1/2 inch
○ 4. 1 inch
○ Rationale: The size of the opening for the appliance is generally cut 1/8 inch larger than the size of the
client’s stoma. This minimizes the amount of exposed skin but does not put pressure on the stoma. The
larger sizes leave too much skin area exposed for irritation by gastrointestinal contents. Priority Nursing
Tip: A pale pink colostomy stoma most likely indicates that the client has a low hemoglobin and
hematocrit level.
○ For the client with a colostomy, the nurse should monitor stoma color. A dark blue, purple, or black
stoma indicates compromised circulation, requiring primary health care provider notification
MS patient education (843-44, meds 855-56)
● Description
○ A chronic, progressive, non contagious, degenerative disease of the CNS characterized by demyelinization of the
neurons.
○ It usually occurs between the ages of 20 and 40 years and consists of periods of remissions and exacerbations.
○ The causes are unknown, but the disease is thought to be the result of an autoimmune response or viral infection.
○ Precipitating factors include pregnancy, fatigue, stress, infection, and trauma.
○ Electroencephalographic findings are abnormal.
○ Assessment of a lumbar puncture indicates an increased gamma globulin level, but the serum globulin level is
normal.
● Assessment
○ Fatigue and weakness
○ Ataxia and vertigo
○ Tremors and spasticity of the lower extremities
○ Paresthesias
○ Blurred vision, diplopia, and transient blindness
○ Nystagmus (involuntary eye movement)
○ Dysphasia (language disorder marked by deficiency in the generation of speech)
○ Decreased perception to pain, touch, and temperature
○ Bladder and bowel disturbances, including urgency, frequency, retention, and incontinence
○ Abnormal reflexes, including hyperreflexia, absent reflexes, and a positive Babinski’s reflex
○ Emotional changes such as apathy, euphoria, irritability, and depression
○ Memory changes and confusion
● Interventions
○ Provide energy conservation measures during exacerbation.
○ Protect the client from injury by providing safety measures.
○ Place an eye patch on the eye for diplopia.
○ Monitor for potential complications such as urinary tract infections, calculi, pressure ulcers, respiratory
tract infections, and contractures.
○ Promote regular elimination by bladder and bowel training.
○ Encourage independence.
○ Assist the client to establish a regular exercise and rest program and to balance moderate activity with rest
periods.
○ Assess the need for and provide assistive devices.
○ Initiate physical and speech therapy.
○ Instruct the client to avoid fatigue, stress, infection, overheating, and chilling.
○ Instruct the client to increase fluid intake and eat a balanced diet, including low-fat, high-fiber foods and
foods high in potassium.
○ Instruct the client in safety measures related to sensory loss, such as regulating the temperature of bath
water and avoiding heating pads.
○ Instruct the client in safety measures related to motor loss, such as avoiding the use of scatter rugs and
