DHCA Nursing Exam cheat sheet

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; breaking any link prevents transmission.

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, gloves, gown, mask, eye protection based on anticipated exposure to blood or body fluids.

Transmission-based precautions: contact (MRSA, C. difficile, scabies), droplet (influenza, pertussis, meningococcus; mask within 3–6 feet), airborne (TB, measles, varicella; N95 plus negative-pressure room).

C. difficile requires soap-and-water handwashing because alcohol-based sanitizers do not reliably kill spores.

Surgical hand antisepsis and sterile field: sterile items contact sterile items only; any item below waist level or outside the field is considered contaminated.

Fall risk factors include age over 65, sedatives, orthostatic hypotension, and prior falls; bed in lowest position, call light within reach, non-skid footwear.

Restraints require a provider order with time limits (adults: 4 hours for violent/self-destructive behavior), face-to-face evaluation, and frequent monitoring.

Needlestick exposure: wash site with soap and water, report immediately, and initiate post-exposure prophylaxis evaluation; time to HIV PEP is best within hours.

Normal adult vital sign ranges: temperature 36.5–37.5°C, pulse 60–100/min, respirations 12–20/min, BP under 120/80 mmHg.

The six rights: right patient, drug, dose, route, time, and documentation; two patient identifiers are required before administration.

Parenteral routes differ in onset: IV fastest, then IM, then subcutaneous; IM absorption is faster in deltoid than gluteus.

First-pass metabolism reduces oral bioavailability because drug absorbed in the gut passes through the liver before systemic circulation.

Therapeutic index = toxic dose / therapeutic dose; a narrow index (digoxin, warfarin, lithium) requires serum level monitoring.

Heparin: monitor aPTT; antidote protamine sulfate. Warfarin: monitor INR; antidote vitamin K.

Opioid overdose: decreased respiratory rate and pinpoint pupils; antidote naloxone. Benzodiazepine overdose: antidote flumazenil.

Acetaminophen overdose: antidote N-acetylcysteine; hepatotoxicity risk rises above 4 g/day in adults.

Insulin onset: rapid-acting (lispro, aspart) 10–15 min, short-acting (regular) 30 min, intermediate (NPH) 1–2 h, long-acting (glargine) 1–2 h with no peak.

High-alert medications (insulin, heparin, opioids, potassium chloride concentrate) require independent double-check before administration.

Postoperative priority assessment is airway, breathing, circulation, then neurologic status and surgical site; hypoxemia and hemorrhage are early complications.

Signs of hypovolemic shock: tachycardia, hypotension, narrowed pulse pressure, cool clammy skin, decreased urine output below 0.5 mL/kg/h.

Deep vein thrombosis prevention: early ambulation, sequential compression devices, and anticoagulation; assess for unilateral calf pain and swelling.

Heart failure: left-sided causes pulmonary edema (dyspnea, crackles, orthopnea); right-sided causes peripheral edema, JVD, and hepatomegaly.

COPD oxygen therapy targets SpO2 of 88–92% because high-flow oxygen can suppress hypoxic drive in chronic CO2 retainers.

Diabetes: HbA1c reflects average glucose over about 3 months; hypoglycemia is glucose below 70 mg/dL with sweating, tremor, and confusion.

Pressure injury staging: stage 1 non-blanchable erythema; stage 2 partial-thickness loss; stage 3 full-thickness loss; stage 4 extends to muscle or bone.

Bowel obstruction: distention, vomiting, absent or high-pitched bowel sounds, and inability to pass flatus; NG decompression is a common intervention.

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

Normal fetal heart rate is 110–160 beats/min; late decelerations indicate uteroplacental insufficiency and require repositioning and oxygen.

Variable decelerations suggest umbilical cord compression; reposition the mother and consider amnioinfusion.

Preeclampsia: hypertension after 20 weeks plus proteinuria or end-organ symptoms; magnesium sulfate prevents seizures, and toxicity is monitored by reflexes and respiratory rate.

Postpartum hemorrhage is most often caused by uterine atony; fundal massage and oxytocin are first-line interventions.

Lochia sequence: rubra (days 1–3), serosa (days 4–10), alba (after day 10); saturated pads in under an hour warrant evaluation.

APGAR scores at 1 and 5 minutes assess heart rate, respiratory effort, muscle tone, reflex irritability, and color; each scored 0–2.

Newborn physiologic jaundice appears after 24 hours and peaks at 3–5 days; jaundice within 24 hours is pathologic.

Breast milk is the preferred infant nutrition; colostrum provides immunoglobulin A and is produced in the first days postpartum.

Pediatric vital signs vary by age: newborns have heart rates of 100–160/min and respiratory rates of 30–60/min; rates decline with age.

Infant weight doubles by 5–6 months and triples by 12 months; birth weight is regained by about 2 weeks.

Dehydration in children: sunken fontanelle, decreased tears, dry mucous membranes, and capillary refill over 2 seconds.

Pediatric maintenance fluid (Holliday-Segar): 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, 20 mL/kg for each kg above 20.

Epiglottitis presents with drooling, tripod positioning, and muffled voice; avoid inspecting the throat because of airway spasm risk.

Kawasaki disease: fever over 5 days, conjunctivitis, strawberry tongue, rash, and extremity changes; IVIG and aspirin reduce coronary aneurysm risk.

Croup produces a barking cough and inspiratory stridor; racemic epinephrine and cool mist are common treatments.

Immunization schedule: hepatitis B at birth, DTaP and IPV starting at 2 months, MMR and varicella at 12–15 months.

Child abuse indicators include injuries inconsistent with developmental stage, patterned bruises, and delayed care-seeking; reporting to authorities is mandatory.

Therapeutic communication uses open-ended questions, reflection, and clarification; avoid false reassurance, advice-giving, and changing the subject.

Suicide risk assessment: ask directly about ideation, plan, means, and intent; high-risk patients require line-of-sight observation and removal of means.

Serotonin syndrome: agitation, hyperthermia, clonus, and hyperreflexia after serotonergic drugs; stop the drug and seek emergency care.

Neuroleptic malignant syndrome: rigidity, fever, altered mental status, and elevated creatine kinase after antipsychotics; stop the drug and treat supportively.

Alcohol withdrawal: tremors, tachycardia, and seizures; benzodiazepines are first-line, and thiamine is given to prevent Wernicke encephalopathy.

Anorexia nervosa signs include low body mass index, lanugo, bradycardia, and electrolyte disturbances; refeeding syndrome is a risk during nutrition restoration.

Lithium therapeutic range is 0.6–1.2 mEq/L; toxicity causes tremor, vomiting, and ataxia and is worsened by dehydration.

Anxiety disorders are treated with SSRIs and cognitive behavioral therapy; benzodiazepines are for short-term use due to dependence risk.

ABCDE primary survey: airway, breathing, circulation, disability, exposure; reversible causes of arrest are the Hs and Ts.

Cardiopulmonary resuscitation for adults: compressions at 100–120/min, depth 5–6 cm, ratio 30:2, and minimize interruptions to under 10 seconds.

Defibrillation for ventricular fibrillation is delivered as soon as available; each minute of delay reduces survival by about 7–10%.

Sepsis bundle: measure lactate, obtain cultures, give broad-spectrum antibiotics, and administer 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or higher.

Mean arterial pressure equals (systolic + 2 × diastolic) / 3; a target of 65 mmHg or higher is typical for organ perfusion.

Anaphylaxis: epinephrine intramuscularly in the anterolateral thigh, 0.3–0.5 mg of 1:1000 for adults; antihistamines are adjuncts only.

Stroke: IV thrombolysis window is typically up to 4.5 hours from symptom onset; time of onset and last known well time guide eligibility.

Mechanical ventilation: high peak pressures suggest airway resistance or compliance problems; monitor for barotrauma and ventilator-associated pneumonia.

Informed consent requires capacity, disclosure of risks and benefits, comprehension, and voluntariness; the provider obtains consent and the nurse witnesses.

Informed consent is not valid from a patient who is intoxicated, confused, or under duress; emergency exceptions exist when no surrogate is available.

Mandatory reporting includes suspected child abuse, elder abuse, certain communicable diseases, and gunshot wounds in many jurisdictions.

A living will and durable power of attorney for health care are advance directives; the surrogate decides if the patient lacks capacity.

Ethical principles: autonomy (self-determination), beneficence (do good), nonmaleficence (avoid harm), justice (fairness), and fidelity (keep promises).

Nurse practice acts define scope of practice; delegation requires the task be within the delegatee's training and the nurse retains accountability.

Documentation should be objective, timely, and factual; late entries are labeled as such, and errors are corrected with a single line and initials.

Patient confidentiality is protected by HIPAA; disclosure without consent is permitted only for treatment, payment, operations, or legal requirements.

A sentinel event is an unexpected occurrence causing death or serious harm; root cause analysis is conducted, and disclosure to the patient is expected.