NUR280 Exam 3 Comprehensive Review | Transition
to RN Practice | Galen College | 2026/2027 Latest |
Complete Guide with Verified Answers | 100%
Correct
Integrated Clinical Judgment & Complex Patient Management | Exam 3 Focus |
2026/2027 Standards
Galen College of Nursing | NUR 280 Transition to RN Practice | Exam 3 Review
PART 1 – EXAM 3 FOCUSED CONTENT SYNTHESIS (2026-2027)
A. Managing the Patient with Multiple Chronic Conditions & Acute Decompensation
• CHF + COPD + CKD + DM: “Cardio-renal-pulmonary-metabolic” axis
– O2 strategy: target SpO₂ 90–92% (COPD) but ≥ 88% (CKD ignores hypercapnia)
– Diuretics: loop + MRA (watch K⁺ > 5.5, creatinine ↑ > 0.3 mg/dL from baseline)
– Steroids for COPD flare: ↑ glucose → insulin adjustment; avoid high-dose if active
infection
– Pain control: multimodal; avoid NSAIDs (renal), use acetaminophen ≤ 3 g/day, opioid if
severe
– Daily wt, I&O, BNP, ABG, glucose q6 h, mental status (delirium screen CAM-ICU q8 h)
,• Sepsis in multi-morbid adult: 2026 SSC bundle
– 30 mL/kg crystalloid even if CKD (coordinate with nephrology for urgent HD if needed)
– Blood cultures → broad-spectrum within 1 h; reassess abx daily (DOPA stewardship)
– Lactate trend < 2 mmol/L = resuscitation success; if > 4 → escalate (pressor,
echocardiogram)
B. Integration of Mental Health Principles in the Medical-Surgical Setting
• Delirium vs. Dementia vs. Depression (3-D’s)
– Delirium: acute, fluctuating, inattention; CAM-ICU positive; treat underlying (hypoxia,
infection, meds)
– Dementia: chronic, progressive, sundowning; provide familiar objects, clock, calendar
– Depression: persistent low mood, anhedonia; screen PHQ-2/9; involve psychiatry &
social work
• Alcohol withdrawal (CIWA-Ar ≥ 10)
– Benzodiazepines: lorazepam 1–2 mg PO/IV q1 h PRN until CIWA < 10; escalate to
phenobarbital or propofol if refractory
– High-dose thiamine 300 mg daily × 3 days, MgSO₄ if low, multivitamin
– Seizure precautions, Q15 min vitals, fall-risk bracelet
• Opioid Use Disorder on medical floor
– Continue MOUD (buprenorphine or methadone) unless NPO for surgery > 24 h
, – Pain: multimodal (acetaminophen, NSAID if renal okay, regional blocks, ketamine gtt
low-dose)
– Naloxone at bedside if on PCA; monitor RR, sedation Q2 h
• Suicidality on med-surg unit
– Screen PHQ-9 item #9; if positive → 1:1 sitter, remove harmful objects, psychiatry
consult within 1 h, safety plan
– Document Q15 min checks, hand-off communication tool includes suicide risk flag
C. Advanced Leadership & Delegation for Complex Assignment
• Acuity tool + scope grid (2026 update):
– RN: unstable VS, titration of vasoactive drips, blood administration, conscious
sedation, acute mental health crisis, discharge teaching
– LPN: stable chronic meds (PO, SC, IM), wound care (non-complex), Foley insertion,
feeding tubes, glucose monitoring
– UAP: ADLs, stable VS, transport, stocking, basic hygiene; cannot perform any
assessment or medication activity
• Managing behavioral outburst in shared room
– Call for help (security/charge), clear area, de-escalate (talk-down, offer PRN meds),
move other patients if needed
– If physical aggression imminent: apply least-restrictive hold per policy, obtain STAT
psychiatry, document incident
to RN Practice | Galen College | 2026/2027 Latest |
Complete Guide with Verified Answers | 100%
Correct
Integrated Clinical Judgment & Complex Patient Management | Exam 3 Focus |
2026/2027 Standards
Galen College of Nursing | NUR 280 Transition to RN Practice | Exam 3 Review
PART 1 – EXAM 3 FOCUSED CONTENT SYNTHESIS (2026-2027)
A. Managing the Patient with Multiple Chronic Conditions & Acute Decompensation
• CHF + COPD + CKD + DM: “Cardio-renal-pulmonary-metabolic” axis
– O2 strategy: target SpO₂ 90–92% (COPD) but ≥ 88% (CKD ignores hypercapnia)
– Diuretics: loop + MRA (watch K⁺ > 5.5, creatinine ↑ > 0.3 mg/dL from baseline)
– Steroids for COPD flare: ↑ glucose → insulin adjustment; avoid high-dose if active
infection
– Pain control: multimodal; avoid NSAIDs (renal), use acetaminophen ≤ 3 g/day, opioid if
severe
– Daily wt, I&O, BNP, ABG, glucose q6 h, mental status (delirium screen CAM-ICU q8 h)
,• Sepsis in multi-morbid adult: 2026 SSC bundle
– 30 mL/kg crystalloid even if CKD (coordinate with nephrology for urgent HD if needed)
– Blood cultures → broad-spectrum within 1 h; reassess abx daily (DOPA stewardship)
– Lactate trend < 2 mmol/L = resuscitation success; if > 4 → escalate (pressor,
echocardiogram)
B. Integration of Mental Health Principles in the Medical-Surgical Setting
• Delirium vs. Dementia vs. Depression (3-D’s)
– Delirium: acute, fluctuating, inattention; CAM-ICU positive; treat underlying (hypoxia,
infection, meds)
– Dementia: chronic, progressive, sundowning; provide familiar objects, clock, calendar
– Depression: persistent low mood, anhedonia; screen PHQ-2/9; involve psychiatry &
social work
• Alcohol withdrawal (CIWA-Ar ≥ 10)
– Benzodiazepines: lorazepam 1–2 mg PO/IV q1 h PRN until CIWA < 10; escalate to
phenobarbital or propofol if refractory
– High-dose thiamine 300 mg daily × 3 days, MgSO₄ if low, multivitamin
– Seizure precautions, Q15 min vitals, fall-risk bracelet
• Opioid Use Disorder on medical floor
– Continue MOUD (buprenorphine or methadone) unless NPO for surgery > 24 h
, – Pain: multimodal (acetaminophen, NSAID if renal okay, regional blocks, ketamine gtt
low-dose)
– Naloxone at bedside if on PCA; monitor RR, sedation Q2 h
• Suicidality on med-surg unit
– Screen PHQ-9 item #9; if positive → 1:1 sitter, remove harmful objects, psychiatry
consult within 1 h, safety plan
– Document Q15 min checks, hand-off communication tool includes suicide risk flag
C. Advanced Leadership & Delegation for Complex Assignment
• Acuity tool + scope grid (2026 update):
– RN: unstable VS, titration of vasoactive drips, blood administration, conscious
sedation, acute mental health crisis, discharge teaching
– LPN: stable chronic meds (PO, SC, IM), wound care (non-complex), Foley insertion,
feeding tubes, glucose monitoring
– UAP: ADLs, stable VS, transport, stocking, basic hygiene; cannot perform any
assessment or medication activity
• Managing behavioral outburst in shared room
– Call for help (security/charge), clear area, de-escalate (talk-down, offer PRN meds),
move other patients if needed
– If physical aggression imminent: apply least-restrictive hold per policy, obtain STAT
psychiatry, document incident
