DHA Nursing Exam cheat sheet

Normal adult resting vital signs: temperature 36.5-37.5 C (97.7-99.5 F), pulse 60-100/min, respirations 12-20/min, blood pressure below 120/80 mmHg, SpO2 95% or higher on room air.

Nursing process order is Assessment, Diagnosis, Planning, Implementation, Evaluation; the diagnosis is a nursing judgment and is never written as a medical diagnosis.

Braden Scale: lower total score means higher pressure-injury risk; 9 or below is very high risk and 19-23 indicates no risk.

Pressure injury staging: stage 1 intact skin with non-blanchable erythema, stage 2 partial-thickness loss, stage 3 full-thickness loss, stage 4 exposed bone, tendon, or muscle, and unstageable when eschar obscures depth.

Urine output benchmark is 0.5 mL/kg/hour in adults; less than 30 mL/hour for two consecutive hours prompts assessment for hypovolemia or retention.

Morse Fall Scale: 45 or higher indicates high fall risk, requiring bed low, brakes locked, call light in reach, and non-skid footwear.

Gastric tube placement is supported by aspirate pH of 5.5 or lower; auscultating injected air is not a reliable confirmation method.

Hand hygiene duration: alcohol-based rub 20-30 seconds, soap and water 40-60 seconds; soap and water is required when hands are visibly soiled or after caring for a patient with C. difficile.

Troponin rises 3-6 hours after myocardial injury, peaks at 12-24 hours, and stays elevated 7-10 days; myoglobin rises earliest but is nonspecific.

BNP below 100 pg/mL makes acute heart failure unlikely; levels rise with ventricular stretch and are higher in older adults and in renal impairment.

Cushing triad is hypertension with widened pulse pressure, bradycardia, and irregular respirations; it is a late sign of rising intracranial pressure.

Thrombolysis for ischemic stroke is considered up to 4.5 hours from last known well, with blood pressure below 185/110 mmHg and CT excluding hemorrhage.

DKA criteria: glucose above 250 mg/dL, arterial pH below 7.30, bicarbonate below 18 mEq/L, and ketonemia; isotonic fluid comes first, then insulin, and potassium is replaced once the level is below 5.2 mEq/L.

Hyperkalemia sequence: IV calcium gluconate to stabilize myocardium, insulin with glucose and a beta-2 agonist to shift potassium intracellularly, then removal by diuretic, binder, or dialysis.

In chronic CO2 retention from COPD, titrate oxygen to SpO2 88-92% to preserve hypoxic respiratory drive.

Hepatic encephalopathy: rising ammonia with confusion is treated with lactulose titrated to two to three soft stools per day to reduce ammonia absorption.

Naegele's rule: estimated delivery date equals the first day of the last menstrual period minus 3 months plus 7 days.

Normal fetal heart rate baseline is 110-160 beats per minute; accelerations of 15 beats for 15 seconds indicate a reactive tracing after 32 weeks.

Labor progress: latent phase to about 6 cm with slow change, active phase 6-10 cm; dilation slower than about 1 cm/hour in active phase prompts evaluation for arrest.

Apgar components are heart rate, respiratory effort, muscle tone, reflex irritability, and color, each scored 0-2 at 1 and 5 minutes; 7-10 is normal.

Preeclampsia is blood pressure 140/90 or higher after 20 weeks with proteinuria or organ dysfunction; magnesium sulfate prevents seizures and calcium gluconate is the antidote.

During magnesium sulfate infusion monitor respiratory rate at least 12/min, present deep tendon reflexes, and urine output at least 30 mL/hour.

Postpartum hemorrhage is over 500 mL after vaginal birth or over 1000 mL after cesarean; uterine atony is the most common cause, treated by fundal massage and uterotonics.

Lochia progression: rubra days 1-3, serosa days 4-10, alba after day 10; a saturated pad within 1 hour or return to rubra suggests hemorrhage.

Pediatric maintenance fluids (4-2-1 rule): 4 mL/kg/hour for the first 10 kg, plus 2 mL/kg/hour for the next 10 kg, plus 1 mL/kg/hour for each kilogram above 20.

Adult CPR: rate 100-120/min, depth 5-6 cm, ratio 30:2 before an advanced airway, full chest recoil, interruptions under 10 seconds, and defibrillation as soon as available.

Two-rescuer pediatric CPR uses a 15:2 ratio with depth of about one-third the chest diameter (approximately 4 cm in infants, 5 cm in children).

Shock categories are hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), and obstructive (tension pneumothorax, tamponade, pulmonary embolism).

Sepsis bundle: measure lactate, culture before antibiotics, give broad-spectrum antibiotics and 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L or higher, targeting MAP of 65 mmHg or higher.

Anaphylaxis: IM epinephrine 0.3-0.5 mg of 1:1000 solution in adults (0.01 mg/kg in children) into the anterolateral thigh, repeated every 5-15 minutes as needed.

Parkland formula: 4 mL x body weight in kg x percent total body surface area of lactated Ringer's over 24 hours, half in the first 8 hours from the time of injury; adult urine target 0.5 mL/kg/hour.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6, total 3-15; a score of 8 or less generally requires intubation.

High peak airway pressure with normal plateau indicates increased airway resistance; high plateau pressure indicates decreased lung compliance such as ARDS or pneumothorax.

Triage categories: red immediate, yellow delayed, green minor or walking, black deceased or expectant.

Five rights are right patient, right drug, right dose, right route, and right time; documentation and reason for the drug are added as best practice checks.

Dosage calculation: desired dose divided by available dose, multiplied by quantity; IV drip rate equals (mL/hour x drop factor) divided by 60.

Steady state is reached after about four to five half-lives; a loading dose shortens the time to therapeutic effect.

Antidote pairs: warfarin and vitamin K, heparin and protamine sulfate, opioids and naloxone, benzodiazepines and flumazenil, acetaminophen and N-acetylcysteine, digoxin and digoxin immune Fab.

Regular insulin is the only insulin given intravenously; lispro and aspart act within 10-15 minutes, NPH peaks at 4-12 hours, and glargine has no pronounced peak.

Vancomycin: monitor trough 10-20 mcg/mL (15-20 for severe infection) and infuse over at least 60 minutes to limit infusion reactions.

Aminoglycosides are nephrotoxic and ototoxic, so serum creatinine and peak and trough levels are monitored.

Levothyroxine is taken on an empty stomach 30-60 minutes before breakfast and separated from calcium and iron by at least 4 hours.

IV potassium is never given by push; peripheral concentration generally does not exceed 10 mEq per 100 mL and rates above 10 mEq/hour require cardiac monitoring.

Chain of infection links are infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host; hand hygiene interrupts the transmission link.

Donning order is gown, mask or respirator, eye protection, then gloves; doffing reverses this with gloves removed first and mask last, with hand hygiene between steps.

Airborne precautions for tuberculosis, measles, and varicella require an N95 or higher respirator and a negative-pressure room with the door closed.

Droplet precautions for influenza, pertussis, mumps, rubella, and meningococcal disease require a surgical mask and about 3 feet of spatial separation.

Contact precautions for MRSA, VRE, C. difficile, scabies, and RSV use gown and gloves with dedicated equipment; C. difficile requires soap-and-water hand washing because alcohol does not kill spores.

Sterile field rules: a 1-inch border is unsterile, items below waist level or out of view are contaminated, and sterile items never contact non-sterile surfaces.

Needlestick injury: wash with soap and water without scrubbing, report immediately, and start HIV post-exposure prophylaxis within hours, ideally under 2 hours and no later than 72 hours.

Neutropenic precautions exclude fresh flowers, standing water, raw meat and eggs, and ill visitors.

Live vaccines such as MMR, varicella, and intranasal influenza are contraindicated in pregnancy and severe immunocompromise.

Ethical principles: autonomy (self-determination), beneficence (doing good), nonmaleficence (avoiding harm), justice (fairness), veracity (truthfulness), and fidelity (keeping promises).

Valid informed consent requires competence, voluntariness, full disclosure, and understanding; the provider performing the procedure obtains consent and the nurse may witness it.

A living will states desired treatment if terminally ill, while a durable power of attorney for health care names a surrogate decision maker.

Delegation: the RN keeps accountability and may not delegate assessment, nursing diagnosis, care planning, teaching, or evaluation; unlicensed assistive personnel may perform ADLs and vital signs on stable patients.

Documentation must be objective, factual, and timed; incident reports are not referenced in the patient record, and late entries are labeled as late rather than altered.

Restraints are used only after less restrictive measures fail; violent or self-destructive restraint requires a face-to-face evaluation within 1 hour and an order limited to 4 hours in adults.

Mandatory reporting includes suspected abuse or neglect of children, older adults, or dependent adults, specified communicable diseases, and gunshot or certain knife wounds.

SBAR handoff stands for Situation, Background, Assessment, Recommendation.

When a colleague appears impaired, the nurse's duty is to protect patients by removing the colleague from patient care and reporting through the chain of command.

Primary prevention acts before disease occurs (immunization, seat belts, sanitation), secondary prevention is screening and early detection, and tertiary prevention is rehabilitation and limiting disability.

Incidence is new cases divided by the population at risk over a period; prevalence is all existing cases divided by the total population at a point in time.

The epidemiologic triangle consists of agent, host, and environment, and intervention can target any of the three.

Herd immunity thresholds are high for measles at about 95% and lower for many other vaccine-preventable diseases; reportable diseases are tracked by public health authorities.

Therapeutic communication uses open-ended questions, reflection, restating, and silence while avoiding false reassurance, advice-giving, and repeated why questions.

Suicide assessment asks directly about ideation, plan, means, and intent; a no-harm contract is not a substitute for observation and safety planning.

Alcohol withdrawal is scored with CIWA-Ar and treated with benzodiazepines; thiamine is given before or with glucose to prevent Wernicke encephalopathy.

Lithium therapeutic range is 0.6-1.2 mEq/L; dehydration, low sodium intake, and NSAIDs raise levels, and toxicity causes tremor, vomiting, ataxia, and seizures.

Serotonin syndrome shows clonus, hyperreflexia, dilated pupils, and rapid onset; neuroleptic malignant syndrome shows lead-pipe rigidity, hyperthermia, and autonomic instability days after antipsychotic exposure.