NSG 4800 Comprehensive Exam Study Guide - Summer 2026
SECTION 1: FUNDAMENTALS (Questions 1–26)
1. Vital Signs – Significant Blood Pressure Drop
A drop of 20 mmHg systolic or 10 mmHg diastolic from baseline is clinically significant. This
is the hallmark of orthostatic (postural) hypotension — measure BP lying, sitting, and
standing with 1–3 minutes between position changes.
Key nursing actions: Ensure safety (fall risk), hold antihypertensives, encourage slow position
changes, adequate hydration. Report a sustained drop ≥ 20/10 to the provider.
2. Infection Control Precautions
Precaution Type Details & Examples
Standard Precautions Used for ALL patients regardless of diagnosis. Hand
hygiene, gloves for body fluids, gown/mask/eye
protection when splash risk exists.
Contact Precautions Gown + gloves upon entry. Private room or cohort.
Examples: MRSA, VRE, C. diff, scabies, wound
infections with heavy drainage.
Droplet Precautions Surgical mask within 3–6 feet. Private room (door
can remain open). Examples: Influenza, pertussis,
meningococcal meningitis, mumps, rubella, strep
pharyngitis.
Airborne Precautions N95 respirator (fit-tested). Negative-pressure room,
door closed. Examples: TB, measles, varicella
(chickenpox), disseminated herpes zoster.
Memory tip: "My Chicken Has TB" = Measles, Chickenpox, Herpes zoster (disseminated), TB
are airborne.
3. Fire Safety – RACE & PASS
RACE (what to do when fire is discovered):
• R – Rescue: Remove patients from immediate danger first.
• A – Alarm: Pull the nearest fire alarm and call the operator.
• C – Confine: Close all doors and windows to contain fire/smoke.
• E – Extinguish/Evacuate: Use extinguisher if small fire, evacuate if not.
PASS (how to use a fire extinguisher):
• P – Pull: Pull the pin.
• A – Aim: Aim at the base of the fire.
• S – Squeeze: Squeeze the handle.
• S – Sweep: Sweep side to side.
,Moving patients: Ambulatory patients walk out first. Wheelchair patients next. Bedbound
patients: use a draw/lift sheet to drag or carry. Move horizontally away from the fire first (same
floor), then vertically down if needed.
4. Restraints
The magic number: Check circulation, sensation, and movement (neurovascular checks +
CMS) every 2 hours. Release restraints and perform ROM every 2 hours. Offer food, fluids,
and toileting every 2 hours. Document every 2 hours.
Assessment priority: Circulation distal to the restraint (pulse, color, temperature, sensation,
capillary refill). Two fingers should fit between the restraint and the skin.
Orders: Non-violent restraints: renewed every 24 hours. Violent/self-destructive: renewed every
4 hours (adults), 2 hours (ages 9–17), 1 hour (under 9). Always use the least restrictive device.
5. Bed-to-Wheelchair Transfer
Position wheelchair on the patient’s stronger side, lock brakes, remove footrests. Lower the
bed to the lowest position. Have the patient sit on the edge of the bed (dangle) and assess for
dizziness. Use a gait belt around the waist. Patient places hands on your shoulders (never the
neck); you grip the gait belt. On the count of three, assist to standing, pivot toward the
wheelchair, and lower slowly. Replace footrests, position safely.
6. Crutch Walking – Gaits & Stairs
Gait Pattern Description & Use
Two-point gait Move right crutch + left foot together, then left crutch
+ right foot. Requires partial weight-bearing on both
legs. Faster, more natural pattern.
Three-point gait Both crutches + affected leg advance together, then
the unaffected leg follows. Used when one leg is
non-weight-bearing.
Four-point gait Right crutch → left foot → left crutch → right foot.
Slow but very stable. Requires partial weight-bearing
on both legs.
Stairs: Going UP – "Good goes up": strong leg first, then crutches + weak leg. Going DOWN –
"Bad goes down": crutches + weak leg first, then strong leg.
7. Therapeutic Communication (Non-Psych)
Use open-ended questions ("Tell me more about your pain"), active listening, reflection ("It
sounds like you’re worried about surgery"), and silence to allow processing. Offer empathy,
not sympathy. Avoid: giving advice, false reassurance ("Everything will be fine"), "why"
questions (feels judgmental), changing the subject, approving/disapproving. Use SBAR for
nurse-to-provider communication.
8. Compression Stockings (TEDs/SCDs)
,Apply in the morning before the patient gets out of bed (legs are least swollen). Measure calf
circumference and leg length for proper fit. Smooth out wrinkles (prevent skin breakdown).
Remove at least once per shift to assess skin integrity, circulation, and sensation. Toe area
should be checked for color and warmth. Avoid rolling down (creates tourniquet effect).
9. Hearing Aids & Dentures Care
Hearing aids: Remove before bathing/showering. Clean with a dry cloth (no water/alcohol).
Store in a case when not in use. Check battery regularly. When talking to a patient, face them,
speak clearly at a normal pace, reduce background noise.
Dentures: Remove and clean after meals and at bedtime. Use a soft brush, cool/lukewarm
water (hot water warps them). Store in water or denture solution when not in the mouth. Handle
over a towel or basin of water to prevent breakage if dropped. Label the denture cup with the
patient’s name.
10. Clean-Catch Urine Specimen
Instruct the patient to: (1) Wash hands. (2) Clean the urethral meatus front-to-back (females) or
in a circular motion from tip (males) with provided antiseptic wipes — use each wipe only once.
(3) Begin voiding into the toilet. (4) Midstream, catch the urine in the sterile cup without
stopping the flow. (5) Finish voiding into the toilet. Cap the container without touching the inside.
Label and send to lab promptly (within 15–30 minutes, or refrigerate).
11. Dysphagia Precautions
Key precautions: Elevate HOB to 90 degrees (high Fowler’s) during and 30–60 minutes after
meals. Provide thickened liquids as ordered (thin liquids highest aspiration risk). Small bites,
thorough chewing. Tuck chin down ("chin tuck") when swallowing. Assess for coughing,
wet/gurgling voice, pocketing food in cheeks. Keep suction at bedside. Speech therapy consult
for swallow evaluation.
12. Enema Administration
Position patient in left Sims’ position (left lateral with right knee flexed). Lubricate the tip. Insert
3–4 inches for adults. Hold the enema bag 12–18 inches above the rectum (higher = more
pressure). Lower the bag if the patient reports cramping. Stop the enema if: severe cramping
unrelieved by lowering the bag, rectal bleeding, or inability to retain fluid. Instruct patient to hold
the solution as long as possible (5–15 min). Document the type, amount administered, results,
and patient tolerance.
13. Delegation – LPN vs. UAP Scope
Role What They Can Do
RN (never delegate) Assessment, nursing diagnosis, care planning,
evaluation, patient teaching, triage, unstable
patients, IV push meds, blood administration
initiation, any task requiring nursing judgment.
LPN/LVN Reinforce (not initiate) teaching, collect data (not
assess), wound care, suctioning, administer
, oral/IM/SQ meds and some IV meds (state-
dependent), catheter insertion, dressing changes,
monitor stable patients.
UAP/CNA Vital signs (stable patients), I&O, daily weights,
bathing/hygiene, feeding (non-dysphagia),
ambulation (stable), specimen collection (non-
sterile), CPR in emergencies. NEVER: assessment,
meds, sterile procedures, teaching, unstable
patients.
Memory tip: The 5 Rights of Delegation – Right Task, Right Circumstance, Right Person, Right
Direction/Communication, Right Supervision.
14. Ethical Principles
Principle Definition & Example
Autonomy The patient’s right to make informed decisions about
their own care, even if the nurse disagrees.
Example: A patient refusing a blood transfusion for
religious reasons.
Beneficence The duty to do good and act in the patient’s best
interest. Example: Administering pain medication to
relieve suffering.
Non-maleficence "First, do no harm." Avoid actions that cause harm.
Example: Checking allergies before administering
medications.
Justice Fair and equal treatment of all patients regardless of
status, background, or ability to pay. Example:
Triage based on acuity, not social status.
Veracity The obligation to tell the truth. Example: Informing a
patient about the risks and benefits of a procedure.
Fidelity Keeping promises and being faithful to
commitments. Example: If you tell a patient you’ll
return with pain medication in 10 minutes, follow
through.
15. Legal Principles
Term Definition
Negligence Failure to act as a reasonable, prudent nurse would
in a similar situation. An unintentional tort. Must
prove: duty, breach, causation, damages.
SECTION 1: FUNDAMENTALS (Questions 1–26)
1. Vital Signs – Significant Blood Pressure Drop
A drop of 20 mmHg systolic or 10 mmHg diastolic from baseline is clinically significant. This
is the hallmark of orthostatic (postural) hypotension — measure BP lying, sitting, and
standing with 1–3 minutes between position changes.
Key nursing actions: Ensure safety (fall risk), hold antihypertensives, encourage slow position
changes, adequate hydration. Report a sustained drop ≥ 20/10 to the provider.
2. Infection Control Precautions
Precaution Type Details & Examples
Standard Precautions Used for ALL patients regardless of diagnosis. Hand
hygiene, gloves for body fluids, gown/mask/eye
protection when splash risk exists.
Contact Precautions Gown + gloves upon entry. Private room or cohort.
Examples: MRSA, VRE, C. diff, scabies, wound
infections with heavy drainage.
Droplet Precautions Surgical mask within 3–6 feet. Private room (door
can remain open). Examples: Influenza, pertussis,
meningococcal meningitis, mumps, rubella, strep
pharyngitis.
Airborne Precautions N95 respirator (fit-tested). Negative-pressure room,
door closed. Examples: TB, measles, varicella
(chickenpox), disseminated herpes zoster.
Memory tip: "My Chicken Has TB" = Measles, Chickenpox, Herpes zoster (disseminated), TB
are airborne.
3. Fire Safety – RACE & PASS
RACE (what to do when fire is discovered):
• R – Rescue: Remove patients from immediate danger first.
• A – Alarm: Pull the nearest fire alarm and call the operator.
• C – Confine: Close all doors and windows to contain fire/smoke.
• E – Extinguish/Evacuate: Use extinguisher if small fire, evacuate if not.
PASS (how to use a fire extinguisher):
• P – Pull: Pull the pin.
• A – Aim: Aim at the base of the fire.
• S – Squeeze: Squeeze the handle.
• S – Sweep: Sweep side to side.
,Moving patients: Ambulatory patients walk out first. Wheelchair patients next. Bedbound
patients: use a draw/lift sheet to drag or carry. Move horizontally away from the fire first (same
floor), then vertically down if needed.
4. Restraints
The magic number: Check circulation, sensation, and movement (neurovascular checks +
CMS) every 2 hours. Release restraints and perform ROM every 2 hours. Offer food, fluids,
and toileting every 2 hours. Document every 2 hours.
Assessment priority: Circulation distal to the restraint (pulse, color, temperature, sensation,
capillary refill). Two fingers should fit between the restraint and the skin.
Orders: Non-violent restraints: renewed every 24 hours. Violent/self-destructive: renewed every
4 hours (adults), 2 hours (ages 9–17), 1 hour (under 9). Always use the least restrictive device.
5. Bed-to-Wheelchair Transfer
Position wheelchair on the patient’s stronger side, lock brakes, remove footrests. Lower the
bed to the lowest position. Have the patient sit on the edge of the bed (dangle) and assess for
dizziness. Use a gait belt around the waist. Patient places hands on your shoulders (never the
neck); you grip the gait belt. On the count of three, assist to standing, pivot toward the
wheelchair, and lower slowly. Replace footrests, position safely.
6. Crutch Walking – Gaits & Stairs
Gait Pattern Description & Use
Two-point gait Move right crutch + left foot together, then left crutch
+ right foot. Requires partial weight-bearing on both
legs. Faster, more natural pattern.
Three-point gait Both crutches + affected leg advance together, then
the unaffected leg follows. Used when one leg is
non-weight-bearing.
Four-point gait Right crutch → left foot → left crutch → right foot.
Slow but very stable. Requires partial weight-bearing
on both legs.
Stairs: Going UP – "Good goes up": strong leg first, then crutches + weak leg. Going DOWN –
"Bad goes down": crutches + weak leg first, then strong leg.
7. Therapeutic Communication (Non-Psych)
Use open-ended questions ("Tell me more about your pain"), active listening, reflection ("It
sounds like you’re worried about surgery"), and silence to allow processing. Offer empathy,
not sympathy. Avoid: giving advice, false reassurance ("Everything will be fine"), "why"
questions (feels judgmental), changing the subject, approving/disapproving. Use SBAR for
nurse-to-provider communication.
8. Compression Stockings (TEDs/SCDs)
,Apply in the morning before the patient gets out of bed (legs are least swollen). Measure calf
circumference and leg length for proper fit. Smooth out wrinkles (prevent skin breakdown).
Remove at least once per shift to assess skin integrity, circulation, and sensation. Toe area
should be checked for color and warmth. Avoid rolling down (creates tourniquet effect).
9. Hearing Aids & Dentures Care
Hearing aids: Remove before bathing/showering. Clean with a dry cloth (no water/alcohol).
Store in a case when not in use. Check battery regularly. When talking to a patient, face them,
speak clearly at a normal pace, reduce background noise.
Dentures: Remove and clean after meals and at bedtime. Use a soft brush, cool/lukewarm
water (hot water warps them). Store in water or denture solution when not in the mouth. Handle
over a towel or basin of water to prevent breakage if dropped. Label the denture cup with the
patient’s name.
10. Clean-Catch Urine Specimen
Instruct the patient to: (1) Wash hands. (2) Clean the urethral meatus front-to-back (females) or
in a circular motion from tip (males) with provided antiseptic wipes — use each wipe only once.
(3) Begin voiding into the toilet. (4) Midstream, catch the urine in the sterile cup without
stopping the flow. (5) Finish voiding into the toilet. Cap the container without touching the inside.
Label and send to lab promptly (within 15–30 minutes, or refrigerate).
11. Dysphagia Precautions
Key precautions: Elevate HOB to 90 degrees (high Fowler’s) during and 30–60 minutes after
meals. Provide thickened liquids as ordered (thin liquids highest aspiration risk). Small bites,
thorough chewing. Tuck chin down ("chin tuck") when swallowing. Assess for coughing,
wet/gurgling voice, pocketing food in cheeks. Keep suction at bedside. Speech therapy consult
for swallow evaluation.
12. Enema Administration
Position patient in left Sims’ position (left lateral with right knee flexed). Lubricate the tip. Insert
3–4 inches for adults. Hold the enema bag 12–18 inches above the rectum (higher = more
pressure). Lower the bag if the patient reports cramping. Stop the enema if: severe cramping
unrelieved by lowering the bag, rectal bleeding, or inability to retain fluid. Instruct patient to hold
the solution as long as possible (5–15 min). Document the type, amount administered, results,
and patient tolerance.
13. Delegation – LPN vs. UAP Scope
Role What They Can Do
RN (never delegate) Assessment, nursing diagnosis, care planning,
evaluation, patient teaching, triage, unstable
patients, IV push meds, blood administration
initiation, any task requiring nursing judgment.
LPN/LVN Reinforce (not initiate) teaching, collect data (not
assess), wound care, suctioning, administer
, oral/IM/SQ meds and some IV meds (state-
dependent), catheter insertion, dressing changes,
monitor stable patients.
UAP/CNA Vital signs (stable patients), I&O, daily weights,
bathing/hygiene, feeding (non-dysphagia),
ambulation (stable), specimen collection (non-
sterile), CPR in emergencies. NEVER: assessment,
meds, sterile procedures, teaching, unstable
patients.
Memory tip: The 5 Rights of Delegation – Right Task, Right Circumstance, Right Person, Right
Direction/Communication, Right Supervision.
14. Ethical Principles
Principle Definition & Example
Autonomy The patient’s right to make informed decisions about
their own care, even if the nurse disagrees.
Example: A patient refusing a blood transfusion for
religious reasons.
Beneficence The duty to do good and act in the patient’s best
interest. Example: Administering pain medication to
relieve suffering.
Non-maleficence "First, do no harm." Avoid actions that cause harm.
Example: Checking allergies before administering
medications.
Justice Fair and equal treatment of all patients regardless of
status, background, or ability to pay. Example:
Triage based on acuity, not social status.
Veracity The obligation to tell the truth. Example: Informing a
patient about the risks and benefits of a procedure.
Fidelity Keeping promises and being faithful to
commitments. Example: If you tell a patient you’ll
return with pain medication in 10 minutes, follow
through.
15. Legal Principles
Term Definition
Negligence Failure to act as a reasonable, prudent nurse would
in a similar situation. An unintentional tort. Must
prove: duty, breach, causation, damages.
