NUR 283 COMPREHENSIVE 1 STUDY GUIDE 2025
For patients prescribed digoxin monitor apical pulse rate for one full minute. Recognize and
report changes (irregular rate with early or extra beats). Teach to withhold dose and notify
health care professional if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in
an infant.
GI effects include anorexia (usually the first manifestation of toxicity), nausea, vomiting, and
abdominal pain. CNS effects include fatigue, weakness, vision changes (blurred vision, yellow-
green or white halos around objects). Teach the patient to monitor for these effects and report
to the provider if they occur.
One of the scenarios this week is about IV infiltration. When caring for a patient that develops
IV phlebitis manifestations, what are appropriate nursing actions?
For any peripheral IV, if the site is red and swollen upon assessment the next action is to remove
the IV. Phlebitis/infiltration from the IV requires the nurse to document in the medical record as
well as complete an incident report.
Document objectively a description of the facts and your actions. Do not document in the
medical record that an incident report was completed. The incident report is for the risk
management department in the organization. Again, only document the facts and nursing
actions taken. Do not state in the medical record that you completed an incident report.
For older adults a 19 or 20g is indicated due to fragile skin. Protect the skin of older adults with
IV insertion by using a soft cloth between the tourniquet and skin or a blood pressure cuff
inflated 10 to 15 cm (4 to 6 in) above the insertion site to compress only venous blood flow.
Interventions for patients with digoxin toxicity:
• Monitor VS
• Stop digoxin and potassium-wasting diuretics immediately.
• Monitor K+ levels. For levels less than 3.5 mEq/L, administer potassium IV or by mouth.
Do not give any further K+ if the level is greater than 5.0 mEq/L or AV block is present.
• Treat dysrhythmias with phenytoin or lidocaine.
• Treat bradycardia with atropine.
• For excessive toxicity, activated charcoal, cholestyramine, or digoxin immune Fab can be
used to bind digoxin and prevent absorption.
mailto:https://www.stuvia.com/user/techgrades
, You previously learned about Total Enteral Nutrition (TEN) and tube feedings. Enteral feedings
are instituted for a client who has a functioning GI tract but is unable to swallow or take in
adequate calories and protein orally. It can be in addition to an oral diet, or it can be the only
source of nutrition.
What are best practices for tube-feeding care and maintenance for these patients?
See best practice boxes on page 1206 in IGGY 10th edition med/surg book, Tube Feeding Care
and Maintenance and Maintaining a Patent Feeding Tube.
• For g tube or j tube rotate tube 360 degrees each day and notify provider if tube cannot
be moved.
• Check residual every 6 hrs or per agency policy for clients receiving enteral feedings to
decrease the risk of aspiration. Do not discard the residual. Follow facility policy as most
or all of the residual should be replaced into the patient’s stomach to prevent fluid,
electrolyte, and nutrient loss.
• For continuous feedings add only 4 hours of product to the bag at a time to prevent
bacterial growth. Discard unused open cans after 24 hours.
• Change feeding bag and tubing every 24-48 hours. Replace irrigation set at least every
24 hours.
• Do not use any food dye color in formula.
• Keep HOB elevated at least 30 degrees during the feeding and for at least 1 hour after
the feeding (if bolus feedings) to prevent aspiration. For cyclic or continual feedings
maintain semi-Fowler’s position.
• A clogged tube is the most common problem. Flush tube with water:
o Every 4 hours during continuous tube feedings
o Before and after intermittent tube feeding o
Before and after drug administration o After
checking residual volume
The NCLEX category Pharmacological and Parenteral Therapies has a section titled
Parenteral/Intravenous Therapies (page 32 of test plan). Monitor intravenous infusion and
maintain site is an activity statement noted for this part of the test plan. Registered nurses have
a duty to ensure the infusion rate is correct and monitor the site for clinical indications the IV
should be removed and rotated to a different site. Manifestations of phlebitis include
redness/erythema, inflammation, and tenderness at IV site.
Failure to detect an error with an IV could result in infiltration or extravasation. Monitor the rate
and site closely. Intervene if needed to prevent pain, swelling, compartment syndrome or, in
extreme cases, an amputation of the affected limb.
mailto:https://www.stuvia.com/user/techgrades
, Try this practice question from the NCLEX® Connection: Reduction of Risk Potential, Therapeutic
Procedures and provide a rationale for your response.
A nurse is planning care for a client who has a platelet count of 10,000/mm3. Which of the
following interventions should the nurse include in the plan of care?
1. Apply prolonged pressure to puncture site after blood sampling.
2. Administer epoetin alfa as prescribed.
3. Place the client in a private room.
4. Have the client use an oral topical anesthetic before meals.
Answer: 1
1. CORRECT: The nurse should implement bleeding precautions for the client who has
thrombocytopenia (abnormally low platelet count).
2. Epoetin alfa is administered to the client who has anemia. This medication will increase red
blood cells, which will increase Hemoglobin levels.
3. The client who has neutropenia is placed in a private room. If private room not available,
roommate should also need protection from infection.
4. A topical oral anesthetic is used for the client who has mucositis.
Clients can receive transfusions of whole blood or components of whole blood for replacement
due to blood loss or blood disease. Blood components include packed RBCs, washed red blood
cells (WBC- poor RBCs), white blood cells (WBCs), fresh frozen plasma, albumin, clotting factors,
cryoprecipitate, and platelets.
Blood is usually administered over 3 hours via an 18 - 20g needle. Make sure the patient has an
appropriately sized IV catheter beforeyou obtain the blood for infusion then check the blood for
discoloration or bubbles. Contaminated blood may appear unusually dark or contain gas
bubbles.
Always check blood with another nurse at the bedside then prime the tubing with 0.9NaCl
before priming the tubing with blood. Remember we only administer blood with 0.9NS solution
to prevent hemolysis. Never hang a dextrose or lactated ringer solution with blood.
The nurse should remain with the patient for the first 15 minutes of the transfusion and monitor
VS during this time. Once the first 15 minutes is complete without any s/s of a reaction, an LPN
can monitor patient.
If there is any indication of a reaction such as chills or hives the priority action is to stop the
transfusion and change the tubing at the hub to avoid infusing any more of the blood in the IV
mailto:https://www.stuvia.com/user/techgrades
, tubing. Then notify the provider and send the blood bag and administration set (tubing) to the
lab for testing.
Respiratory and cardiac assessment is important for all patients. Students sometimes have
trouble remembering correct assessment technique for auscultating heart and lung sounds as
well as correct descriptions of lung sounds. Where would you place the stethoscope to
auscultate the pulmonic valve and what are considered normal breath sounds?
Place the stethoscope on the second intercostal space, LEFT of the sternal notch, to auscultate
opening and closing sounds of the pulmonic valve. This is the opposite side of the sternal notch
for auscultating the aorta opening and closing, which would be second intercostal space, right
sternal notch.
You should know where to place the stethoscope to listen to lung and heart sounds. This is
fundamental nursing knowledge. Normal breath sounds include bronchial, bronchovesicular,
and vesicular depending on the areas auscultated. See IGGY med/surg book for details on
normal vs abnormal breath sounds. Characteristics of Normal Breath sounds are in table 24.4 in
IGGY 10th edition book.
Auscultation is the process of listening to sounds the body produces to identify unexpected
findings. Some sounds are loud enough to hear unaided (speech and coughing), but most
sounds require a stethoscope or a Doppler technique (heart sounds, air moving through the
respiratory tract, blood moving through blood vessels). Learn to isolate the various sounds to
collect data accurately.
• Evaluate sounds for amplitude or intensity (loud or soft), pitch or frequency (high or
low), duration (time the sound lasts), and quality (what it sounds like).
• Use the diaphragm of the stethoscope to listen to high-pitched sounds (heart sounds,
bowel sounds, lung sounds). Place the diaphragm firmly on the body part.
• Use the bell of the stethoscope to listen to low-pitched sounds (unexpected heart
sounds, bruits). Place the bell lightly on the body part.
Blood is a medium for bacterial growth, any bacteria contaminating the unit will begin to grow if
left outside of a controlled refrigerated temperature for longer than four hours, placing the
client at risk for septicemia.
Try this practice question and provide a rationale for your response:
You are caring for a client who is 34 weeks gestation, has a hematocrit of 28 mg/dL. The
provider prescribes iron supplementation. Which teaching should the nurse provide? Select all
that apply.
1. "Take the iron pill in the morning with eggs."
2. "Take the iron pill every other day for best benefit”
mailto:https://www.stuvia.com/user/techgrades
For patients prescribed digoxin monitor apical pulse rate for one full minute. Recognize and
report changes (irregular rate with early or extra beats). Teach to withhold dose and notify
health care professional if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in
an infant.
GI effects include anorexia (usually the first manifestation of toxicity), nausea, vomiting, and
abdominal pain. CNS effects include fatigue, weakness, vision changes (blurred vision, yellow-
green or white halos around objects). Teach the patient to monitor for these effects and report
to the provider if they occur.
One of the scenarios this week is about IV infiltration. When caring for a patient that develops
IV phlebitis manifestations, what are appropriate nursing actions?
For any peripheral IV, if the site is red and swollen upon assessment the next action is to remove
the IV. Phlebitis/infiltration from the IV requires the nurse to document in the medical record as
well as complete an incident report.
Document objectively a description of the facts and your actions. Do not document in the
medical record that an incident report was completed. The incident report is for the risk
management department in the organization. Again, only document the facts and nursing
actions taken. Do not state in the medical record that you completed an incident report.
For older adults a 19 or 20g is indicated due to fragile skin. Protect the skin of older adults with
IV insertion by using a soft cloth between the tourniquet and skin or a blood pressure cuff
inflated 10 to 15 cm (4 to 6 in) above the insertion site to compress only venous blood flow.
Interventions for patients with digoxin toxicity:
• Monitor VS
• Stop digoxin and potassium-wasting diuretics immediately.
• Monitor K+ levels. For levels less than 3.5 mEq/L, administer potassium IV or by mouth.
Do not give any further K+ if the level is greater than 5.0 mEq/L or AV block is present.
• Treat dysrhythmias with phenytoin or lidocaine.
• Treat bradycardia with atropine.
• For excessive toxicity, activated charcoal, cholestyramine, or digoxin immune Fab can be
used to bind digoxin and prevent absorption.
mailto:https://www.stuvia.com/user/techgrades
, You previously learned about Total Enteral Nutrition (TEN) and tube feedings. Enteral feedings
are instituted for a client who has a functioning GI tract but is unable to swallow or take in
adequate calories and protein orally. It can be in addition to an oral diet, or it can be the only
source of nutrition.
What are best practices for tube-feeding care and maintenance for these patients?
See best practice boxes on page 1206 in IGGY 10th edition med/surg book, Tube Feeding Care
and Maintenance and Maintaining a Patent Feeding Tube.
• For g tube or j tube rotate tube 360 degrees each day and notify provider if tube cannot
be moved.
• Check residual every 6 hrs or per agency policy for clients receiving enteral feedings to
decrease the risk of aspiration. Do not discard the residual. Follow facility policy as most
or all of the residual should be replaced into the patient’s stomach to prevent fluid,
electrolyte, and nutrient loss.
• For continuous feedings add only 4 hours of product to the bag at a time to prevent
bacterial growth. Discard unused open cans after 24 hours.
• Change feeding bag and tubing every 24-48 hours. Replace irrigation set at least every
24 hours.
• Do not use any food dye color in formula.
• Keep HOB elevated at least 30 degrees during the feeding and for at least 1 hour after
the feeding (if bolus feedings) to prevent aspiration. For cyclic or continual feedings
maintain semi-Fowler’s position.
• A clogged tube is the most common problem. Flush tube with water:
o Every 4 hours during continuous tube feedings
o Before and after intermittent tube feeding o
Before and after drug administration o After
checking residual volume
The NCLEX category Pharmacological and Parenteral Therapies has a section titled
Parenteral/Intravenous Therapies (page 32 of test plan). Monitor intravenous infusion and
maintain site is an activity statement noted for this part of the test plan. Registered nurses have
a duty to ensure the infusion rate is correct and monitor the site for clinical indications the IV
should be removed and rotated to a different site. Manifestations of phlebitis include
redness/erythema, inflammation, and tenderness at IV site.
Failure to detect an error with an IV could result in infiltration or extravasation. Monitor the rate
and site closely. Intervene if needed to prevent pain, swelling, compartment syndrome or, in
extreme cases, an amputation of the affected limb.
mailto:https://www.stuvia.com/user/techgrades
, Try this practice question from the NCLEX® Connection: Reduction of Risk Potential, Therapeutic
Procedures and provide a rationale for your response.
A nurse is planning care for a client who has a platelet count of 10,000/mm3. Which of the
following interventions should the nurse include in the plan of care?
1. Apply prolonged pressure to puncture site after blood sampling.
2. Administer epoetin alfa as prescribed.
3. Place the client in a private room.
4. Have the client use an oral topical anesthetic before meals.
Answer: 1
1. CORRECT: The nurse should implement bleeding precautions for the client who has
thrombocytopenia (abnormally low platelet count).
2. Epoetin alfa is administered to the client who has anemia. This medication will increase red
blood cells, which will increase Hemoglobin levels.
3. The client who has neutropenia is placed in a private room. If private room not available,
roommate should also need protection from infection.
4. A topical oral anesthetic is used for the client who has mucositis.
Clients can receive transfusions of whole blood or components of whole blood for replacement
due to blood loss or blood disease. Blood components include packed RBCs, washed red blood
cells (WBC- poor RBCs), white blood cells (WBCs), fresh frozen plasma, albumin, clotting factors,
cryoprecipitate, and platelets.
Blood is usually administered over 3 hours via an 18 - 20g needle. Make sure the patient has an
appropriately sized IV catheter beforeyou obtain the blood for infusion then check the blood for
discoloration or bubbles. Contaminated blood may appear unusually dark or contain gas
bubbles.
Always check blood with another nurse at the bedside then prime the tubing with 0.9NaCl
before priming the tubing with blood. Remember we only administer blood with 0.9NS solution
to prevent hemolysis. Never hang a dextrose or lactated ringer solution with blood.
The nurse should remain with the patient for the first 15 minutes of the transfusion and monitor
VS during this time. Once the first 15 minutes is complete without any s/s of a reaction, an LPN
can monitor patient.
If there is any indication of a reaction such as chills or hives the priority action is to stop the
transfusion and change the tubing at the hub to avoid infusing any more of the blood in the IV
mailto:https://www.stuvia.com/user/techgrades
, tubing. Then notify the provider and send the blood bag and administration set (tubing) to the
lab for testing.
Respiratory and cardiac assessment is important for all patients. Students sometimes have
trouble remembering correct assessment technique for auscultating heart and lung sounds as
well as correct descriptions of lung sounds. Where would you place the stethoscope to
auscultate the pulmonic valve and what are considered normal breath sounds?
Place the stethoscope on the second intercostal space, LEFT of the sternal notch, to auscultate
opening and closing sounds of the pulmonic valve. This is the opposite side of the sternal notch
for auscultating the aorta opening and closing, which would be second intercostal space, right
sternal notch.
You should know where to place the stethoscope to listen to lung and heart sounds. This is
fundamental nursing knowledge. Normal breath sounds include bronchial, bronchovesicular,
and vesicular depending on the areas auscultated. See IGGY med/surg book for details on
normal vs abnormal breath sounds. Characteristics of Normal Breath sounds are in table 24.4 in
IGGY 10th edition book.
Auscultation is the process of listening to sounds the body produces to identify unexpected
findings. Some sounds are loud enough to hear unaided (speech and coughing), but most
sounds require a stethoscope or a Doppler technique (heart sounds, air moving through the
respiratory tract, blood moving through blood vessels). Learn to isolate the various sounds to
collect data accurately.
• Evaluate sounds for amplitude or intensity (loud or soft), pitch or frequency (high or
low), duration (time the sound lasts), and quality (what it sounds like).
• Use the diaphragm of the stethoscope to listen to high-pitched sounds (heart sounds,
bowel sounds, lung sounds). Place the diaphragm firmly on the body part.
• Use the bell of the stethoscope to listen to low-pitched sounds (unexpected heart
sounds, bruits). Place the bell lightly on the body part.
Blood is a medium for bacterial growth, any bacteria contaminating the unit will begin to grow if
left outside of a controlled refrigerated temperature for longer than four hours, placing the
client at risk for septicemia.
Try this practice question and provide a rationale for your response:
You are caring for a client who is 34 weeks gestation, has a hematocrit of 28 mg/dL. The
provider prescribes iron supplementation. Which teaching should the nurse provide? Select all
that apply.
1. "Take the iron pill in the morning with eggs."
2. "Take the iron pill every other day for best benefit”
mailto:https://www.stuvia.com/user/techgrades
