NSG 4800 Comprehensive Exam Review 2 | Exam 2 Class Notes & Study Guide |
Galen College of Nursing | 2026 PDF
• Assault: occurs when a person puts another person in fear of a harmful or offensive contact
(threatening). Something you say, that is offensive.
o Example:
▪ A patient refuses a vaccine IM, but the nurse administers the injection. (Battery)
▪ A patient refuses a vaccine IM, but the nurse threatens to give it anyway. (Assault)
▪ The nurse forgets to check the patients' O2 stats after giving Morphine and the
patient dies (Negligence)
▪ The nurse locks an alert and oriented calm patient in his hospital room (false
imprisonment)
▪ Saying that you’re going to hit the patient, or threatening is assault.
▪ Actually, hitting the patient is battery. The physical doing is assault.
• Defamation of character: false communication that causes damage to someone’s reputation, either
in writing (libel) or verbally (slander)
o Examples:
▪ Charting the physician is stupid for not ordering the medication
▪ A RN telling the patient that the UAP is on drugs.
• Restraints: Restraints are devices that limit a patient's movement. Restraints can help keep a
person from getting hurt or doing harm to others, including their caregivers. They are used as a last
resort. Belts, vests, jackets, and mitts for the patient's hands. Devices that prevent people from
being able to move their elbows, knees, wrists, and ankles
o Examples:
▪ Placing mitts on a patient who is trying to pull out her IV is a restraint. Could cause
harm to themself or others)
▪ Taping a patient to the chair is an example of malpractice!
▪ 4 side rails up is a restraint
• Informed consent:
o This is a patient’s permission for treatment, surgery, or procedure
o Patient must be informed of the risks & benefits. (The surgeon is the one who speaks to the
patient about the risks and benefits, not the nurse)
o The patient’s questions must be answered by the doctor or the surgeon. The nurse must
call them if the patient still has questions.
o Patients who have been medicated can’t sign
o Patients must be mentally & emotionally competent
o Patient must be 18yrs. Old unless she has been emancipated or a minor mother.
o The nurse is there to witness the signature. The nurse can witness the consent signature
but not the advance directives, they can’t witness that.
o The nurse cannot answer questions about procedures, she must call the doctor or surgeon
if there’s questions.
o Informed consent can be waived in an urgent situation
o Patient has the right to refuse signing consent
o Patient may withdraw consent at anytime
• Domestic violence:
o Characteristics of abusers:
▪ Aggressive
, ▪ Controlling (of money and speaking for the patient)
▪ Overprotective.
▪ Pacing
▪ Clenched fist
▪ Low self-esteem/insecure.
▪ Strong dependency needs
▪ Narcissistic & suspicious
▪ History of abuse during childhood
▪ Perceive victims as their property & believe that they are entitled to abuse them
• Domestic Violence:
o Characteristics of victims:
▪ Low self-esteem/insecure
▪ Bruises
▪ Timid/quiet
▪ Denial.
▪ Anxious
▪ Scare.
▪ WITHDRAWN
▪ No eye contact
▪ some may have a dependent personality disorder
▪ Feel trapped, helpless, & powerless
▪ May become depressed as they are trapped in the abusers’ power and control cycle
• Neglect or abuse of elderly:
o Patient in bed with multiple wounds on body and son discussing European vacation. This
could indicate that the elderly person is being neglected or abused with wounds on the
body and discussing a vacation could indicate acts of interest in money.
• Suicide:
o Risk factors:
▪ Feeling there is no hope (hopelessness)
▪ Giving away meaningful items.
▪ Telling others, they can’t be helped
• ERCP: Endoscopic retrograde cholangiopancreatography: Complications:
o Abdomen bleeding: an abdominal assessment would begin with looking then listening first.
Auscultate for bowel sounds and then feel for a board like abdomen. It will be hard as a
board.
o Aspirations: after any procedure that is endoscopic you must do a gag reflex first. Before
you give ice chips or anything, always assess for a gag!
o Not right shoulder pain or headache.
• Delegation:
o We do not give away what we EAT: evaluate, assess, teach. Or Unstable patients!
o LPN’s can perform dressing change or wound care on a day 2 post-op patient (the surgeon
usually does the first wound care). They can pass morning meds and they can collect V/S.
They can also reinforce teaching to a patient being discharged, they just can’t give the initial
, teaching to a patient. The LPN cannot do admission data collection and VS because this
would be considered assessment.
o Remember can a UAP ambulate patient? The nurse must ambulate first (this is assessing)
o UAP: VAPER: Vitals, ambulation, position changes, eating, recording I&O’s
• Collection of a midstream urine sample:
o Teachings on how to collect a midstream:
▪ Lable a sterile container with name
▪ Wash hands
▪ Clean around urethra using wipe, never wipe from back to front
▪ Start to pee for several seconds
▪ Stop flow of urine and position cup
▪ Begin catching the “mid-stream” urine
▪ Avoid touching body related to contamination risk
▪ Wash hands
• Glomerulonephritis
o Signs and symptoms:
▪ JVD
▪ Crackles
▪ HTN
▪ Peaked T waves
▪ Hyperkalemia (metabolic acidosis)
▪ Neuro symptoms
▪ High BUN
▪ Dark color urine
▪ Decrease urine output
▪ Low calcium (tetany, numbness around the mouth)
▪ High phosphate
o Remember these patients are going to be in fluid overload.
o What is the diet for these patients:
▪ Low sodium diet. (They have kidney issues)
▪ Limit protein intake
• Hemophilia:
o Expected findings:
▪ Prolonged bleeding after placing an IV: These patients are going to bleed.
▪ Bring gauze with you for any type of invasive procedures.
▪ A lot of bleeding in their joints.
▪ If they bump their head, they can bleed or hemorrhage
▪ These patients are unable to clot properly
• Sickle cell crisis:
o Expected findings:
▪ pain/extreme pain (joint pain). Give opioids!
▪ SOB with exertion due to anemia and their RBCs don’t work they have low oxygen.
▪ A risk factor is frequent infections: can cause crisis.
, ▪ Dehydration can cause a crisis so try to avoid a lot of sweating, which could lead to
dehydration. Stay hydrated!
▪ Avoid extreme cold.
o What are the complications:
▪ confusion (clot to their brain). Change in LOC or VS could mean shock
▪ Extreme SOB or can’t breathe (clot in their lungs)
▪ Severe chest pains (S&S of clot in their coronary arteries).
▪ Looking for MI, stroke, PE. These are complications
o Treatment for sickle cell crisis:
▪ Hydration and morphine PCA pump.
▪ Remember HOP: hydration, oxygen, pain management
• Celiac disease:
o Expected findings:
▪ Fat in their stool (steatorrhea)
▪ They can’t eat gluten (pasta, rye, barley, wheat. They can eat beans, corn, rice,
potatoes)
▪ Abdominal pain
▪ Malnutrition (they can’t absorb their nutrition), so we’re concerned that they
don’t have the B vitamins which can cause depression and mental health issues
▪ Monitor hypokalemia due to malnutrition.
• Kidney transplant:
o Complications:
▪ Rejection is a big one (fever, oliguria, hematuria. Pain over the kidney, decrease
U/O, blood in the urine, weight gain, edema, HTN)
▪ Infection
▪ Blood clots
▪ Immunosuppression (due to medications related to corticosteroids, this weakens
our immune response. Remember to monitor hyperglycemia r/t steroids).
• ADPIE:
o What is the first thing done when the nurse is planning care:
▪ Assessment! Assess their knowledge about what they know about their disease.
▪ Always start planning discharge.
▪ Setting realistic goals, long-term and short-term goals with the patient. Involve the
patient and see what the patient can do now.
▪ SMART goals: specific, manageable, achievable, realistic, and time.
• AWIPE:
o Announce yourself
o wash your hands
o Identify the patient
o Provide privacy
o Explain the procedure.
• Documentation:
o “Patient walked down the hall this morning.” This would be incorrect. Need more
information and more specifics
Galen College of Nursing | 2026 PDF
• Assault: occurs when a person puts another person in fear of a harmful or offensive contact
(threatening). Something you say, that is offensive.
o Example:
▪ A patient refuses a vaccine IM, but the nurse administers the injection. (Battery)
▪ A patient refuses a vaccine IM, but the nurse threatens to give it anyway. (Assault)
▪ The nurse forgets to check the patients' O2 stats after giving Morphine and the
patient dies (Negligence)
▪ The nurse locks an alert and oriented calm patient in his hospital room (false
imprisonment)
▪ Saying that you’re going to hit the patient, or threatening is assault.
▪ Actually, hitting the patient is battery. The physical doing is assault.
• Defamation of character: false communication that causes damage to someone’s reputation, either
in writing (libel) or verbally (slander)
o Examples:
▪ Charting the physician is stupid for not ordering the medication
▪ A RN telling the patient that the UAP is on drugs.
• Restraints: Restraints are devices that limit a patient's movement. Restraints can help keep a
person from getting hurt or doing harm to others, including their caregivers. They are used as a last
resort. Belts, vests, jackets, and mitts for the patient's hands. Devices that prevent people from
being able to move their elbows, knees, wrists, and ankles
o Examples:
▪ Placing mitts on a patient who is trying to pull out her IV is a restraint. Could cause
harm to themself or others)
▪ Taping a patient to the chair is an example of malpractice!
▪ 4 side rails up is a restraint
• Informed consent:
o This is a patient’s permission for treatment, surgery, or procedure
o Patient must be informed of the risks & benefits. (The surgeon is the one who speaks to the
patient about the risks and benefits, not the nurse)
o The patient’s questions must be answered by the doctor or the surgeon. The nurse must
call them if the patient still has questions.
o Patients who have been medicated can’t sign
o Patients must be mentally & emotionally competent
o Patient must be 18yrs. Old unless she has been emancipated or a minor mother.
o The nurse is there to witness the signature. The nurse can witness the consent signature
but not the advance directives, they can’t witness that.
o The nurse cannot answer questions about procedures, she must call the doctor or surgeon
if there’s questions.
o Informed consent can be waived in an urgent situation
o Patient has the right to refuse signing consent
o Patient may withdraw consent at anytime
• Domestic violence:
o Characteristics of abusers:
▪ Aggressive
, ▪ Controlling (of money and speaking for the patient)
▪ Overprotective.
▪ Pacing
▪ Clenched fist
▪ Low self-esteem/insecure.
▪ Strong dependency needs
▪ Narcissistic & suspicious
▪ History of abuse during childhood
▪ Perceive victims as their property & believe that they are entitled to abuse them
• Domestic Violence:
o Characteristics of victims:
▪ Low self-esteem/insecure
▪ Bruises
▪ Timid/quiet
▪ Denial.
▪ Anxious
▪ Scare.
▪ WITHDRAWN
▪ No eye contact
▪ some may have a dependent personality disorder
▪ Feel trapped, helpless, & powerless
▪ May become depressed as they are trapped in the abusers’ power and control cycle
• Neglect or abuse of elderly:
o Patient in bed with multiple wounds on body and son discussing European vacation. This
could indicate that the elderly person is being neglected or abused with wounds on the
body and discussing a vacation could indicate acts of interest in money.
• Suicide:
o Risk factors:
▪ Feeling there is no hope (hopelessness)
▪ Giving away meaningful items.
▪ Telling others, they can’t be helped
• ERCP: Endoscopic retrograde cholangiopancreatography: Complications:
o Abdomen bleeding: an abdominal assessment would begin with looking then listening first.
Auscultate for bowel sounds and then feel for a board like abdomen. It will be hard as a
board.
o Aspirations: after any procedure that is endoscopic you must do a gag reflex first. Before
you give ice chips or anything, always assess for a gag!
o Not right shoulder pain or headache.
• Delegation:
o We do not give away what we EAT: evaluate, assess, teach. Or Unstable patients!
o LPN’s can perform dressing change or wound care on a day 2 post-op patient (the surgeon
usually does the first wound care). They can pass morning meds and they can collect V/S.
They can also reinforce teaching to a patient being discharged, they just can’t give the initial
, teaching to a patient. The LPN cannot do admission data collection and VS because this
would be considered assessment.
o Remember can a UAP ambulate patient? The nurse must ambulate first (this is assessing)
o UAP: VAPER: Vitals, ambulation, position changes, eating, recording I&O’s
• Collection of a midstream urine sample:
o Teachings on how to collect a midstream:
▪ Lable a sterile container with name
▪ Wash hands
▪ Clean around urethra using wipe, never wipe from back to front
▪ Start to pee for several seconds
▪ Stop flow of urine and position cup
▪ Begin catching the “mid-stream” urine
▪ Avoid touching body related to contamination risk
▪ Wash hands
• Glomerulonephritis
o Signs and symptoms:
▪ JVD
▪ Crackles
▪ HTN
▪ Peaked T waves
▪ Hyperkalemia (metabolic acidosis)
▪ Neuro symptoms
▪ High BUN
▪ Dark color urine
▪ Decrease urine output
▪ Low calcium (tetany, numbness around the mouth)
▪ High phosphate
o Remember these patients are going to be in fluid overload.
o What is the diet for these patients:
▪ Low sodium diet. (They have kidney issues)
▪ Limit protein intake
• Hemophilia:
o Expected findings:
▪ Prolonged bleeding after placing an IV: These patients are going to bleed.
▪ Bring gauze with you for any type of invasive procedures.
▪ A lot of bleeding in their joints.
▪ If they bump their head, they can bleed or hemorrhage
▪ These patients are unable to clot properly
• Sickle cell crisis:
o Expected findings:
▪ pain/extreme pain (joint pain). Give opioids!
▪ SOB with exertion due to anemia and their RBCs don’t work they have low oxygen.
▪ A risk factor is frequent infections: can cause crisis.
, ▪ Dehydration can cause a crisis so try to avoid a lot of sweating, which could lead to
dehydration. Stay hydrated!
▪ Avoid extreme cold.
o What are the complications:
▪ confusion (clot to their brain). Change in LOC or VS could mean shock
▪ Extreme SOB or can’t breathe (clot in their lungs)
▪ Severe chest pains (S&S of clot in their coronary arteries).
▪ Looking for MI, stroke, PE. These are complications
o Treatment for sickle cell crisis:
▪ Hydration and morphine PCA pump.
▪ Remember HOP: hydration, oxygen, pain management
• Celiac disease:
o Expected findings:
▪ Fat in their stool (steatorrhea)
▪ They can’t eat gluten (pasta, rye, barley, wheat. They can eat beans, corn, rice,
potatoes)
▪ Abdominal pain
▪ Malnutrition (they can’t absorb their nutrition), so we’re concerned that they
don’t have the B vitamins which can cause depression and mental health issues
▪ Monitor hypokalemia due to malnutrition.
• Kidney transplant:
o Complications:
▪ Rejection is a big one (fever, oliguria, hematuria. Pain over the kidney, decrease
U/O, blood in the urine, weight gain, edema, HTN)
▪ Infection
▪ Blood clots
▪ Immunosuppression (due to medications related to corticosteroids, this weakens
our immune response. Remember to monitor hyperglycemia r/t steroids).
• ADPIE:
o What is the first thing done when the nurse is planning care:
▪ Assessment! Assess their knowledge about what they know about their disease.
▪ Always start planning discharge.
▪ Setting realistic goals, long-term and short-term goals with the patient. Involve the
patient and see what the patient can do now.
▪ SMART goals: specific, manageable, achievable, realistic, and time.
• AWIPE:
o Announce yourself
o wash your hands
o Identify the patient
o Provide privacy
o Explain the procedure.
• Documentation:
o “Patient walked down the hall this morning.” This would be incorrect. Need more
information and more specifics
