Afghanistan Nursing Exit Exam cheat sheet

Normal adult vital signs: oral temperature 36.5–37.5 °C, pulse 60–100 bpm, respirations 12–20/min, blood pressure <120/80 mmHg, oxygen saturation ≥95% on room air.

Body mass index (BMI) = weight (kg) / height (m)^2; underweight <18.5, normal 18.5–24.9, overweight 25–29.9, obese ≥30.

Stages of pressure injury: Stage 1 = intact skin with non-blanchable erythema; Stage 2 = partial-thickness loss (shallow open ulcer or blister); Stage 3 = full-thickness loss with visible subcutaneous fat; Stage 4 = full-thickness loss exposing muscle, tendon, or bone.

Standard precautions apply to all patients: hand hygiene before and after contact, gloves for body fluid contact, gown/mask/eye protection when splash risk exists; hand hygiene is the single most effective infection-control measure.

The nursing process sequence is Assessment, Diagnosis, Planning, Implementation, Evaluation (ADPIE); reassessment and revision occur continuously.

Maslow's hierarchy (physiologic, safety, love/belonging, esteem, self-actualization) is used to prioritize needs; physiologic needs generally precede psychosocial needs.

Intake and output: 1 mL of urine ≈ 1 g; normal adult urine output is 0.5–1 mL/kg/hr; output <30 mL/hr in an adult suggests hypovolemia or renal impairment.

Safe medication rights: right patient, right drug, right dose, right route, right time, right documentation, right reason, and right to refuse.

Sterile field rules: sterile items contact only sterile items; any item touching a non-sterile surface is contaminated; never turn away from or reach over a sterile field.

Signs of hypoglycemia (blood glucose <70 mg/dL): tremor, diaphoresis, palpitations, confusion, hunger; immediate treatment is 15–20 g fast-acting oral carbohydrate if conscious, IV dextrose or glucagon if unconscious.

Diabetic ketoacidosis (DKA) triad: hyperglycemia (>250 mg/dL), ketosis, and metabolic acidosis (pH <7.3, bicarbonate <18 mEq/L); treatment includes IV fluids, insulin infusion, and potassium replacement.

Heart failure manifestations: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles, dependent edema, jugular venous distension, S3 gallop; daily weight gain >2–3 lb/day or >5 lb/week signals fluid retention.

Acute coronary syndrome: MONA mnemonic (morphine, oxygen if hypoxemic, nitroglycerin, aspirin); nitroglycerin is contraindicated with systolic BP <90 mmHg or recent phosphodiesterase-5 inhibitor use.

Chronic obstructive pulmonary disease (COPD): oxygen therapy target SpO2 88–92% to avoid hypercarbia; pursed-lip breathing and tripod position reduce dyspnea.

Postoperative care priorities: airway patency, vital signs, pain control, early ambulation, incentive spirometry, and wound assessment; fever >38 °C after 24–48 hours suggests infection.

Stroke: thrombolytic (alteplase) window is up to 4.5 hours from symptom onset; blood pressure must be <185/110 mmHg before administration; assess using the NIH Stroke Scale.

Cirrhosis complications include ascites, esophageal varices, hepatic encephalopathy, and coagulopathy; lactulose titrated to 2–3 soft stools/day reduces ammonia in encephalopathy.

Estimated date of delivery (EDD) by Naegele's rule: first day of last menstrual period + 7 days − 3 months + 1 year.

Normal fetal heart rate is 110–160 bpm; baseline variability 6–25 bpm is moderate and reassuring; late decelerations indicate uteroplacental insufficiency and require repositioning and oxygen.

Stages of labor: first stage (latent 0–6 cm, active 6–10 cm), second stage (full dilation to birth), third stage (birth to placental delivery), fourth stage (first 1–2 hours postpartum).

Postpartum hemorrhage is blood loss >500 mL after vaginal birth or >1000 mL after cesarean; uterine atony is the most common cause - massage the fundus and administer uterotonics.

APGAR scores at 1 and 5 minutes assess Appearance, Pulse, Grimace, Activity, Respiration; each 0–2, total 0–10; score ≥7 is generally reassuring.

Normal newborn findings: weight 2.5–4.0 kg, respiratory rate 30–60/min, heart rate 110–160 bpm, temperature 36.5–37.5 °C; physiologic jaundice appears after 24 hours.

Preeclampsia: blood pressure ≥140/90 mmHg after 20 weeks plus proteinuria or end-organ dysfunction; severe features include BP ≥160/110, platelets <100,000, elevated liver enzymes, and pulmonary edema.

Breastfeeding: colostrum is produced first, feed on demand (8–12 times/24 hr), and adequate intake is indicated by 6+ wet diapers/day and weight gain after initial loss of up to 7–10%.

Pediatric vital sign ranges vary by age: infants respiratory rate 30–60/min and heart rate 100–160 bpm; school-age children respiratory rate 18–25/min and heart rate 70–110 bpm.

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

Developmental milestones: head control by 3–4 months, sits unsupported by 6–8 months, walks by 12–15 months, uses 2-word phrases by 2 years.

Dehydration in children: mild <5% weight loss, moderate 5–10%, severe >10%; signs include sunken fontanel, decreased tears, dry mucous membranes, and capillary refill >2 seconds.

Pediatric medication dosing is weight-based (mg/kg); always verify weight in kilograms and use an oral syringe for liquid medications.

Kawasaki disease diagnostic criteria: fever ≥5 days plus 4 of 5 (conjunctivitis, oral mucous membrane changes, rash, extremity changes, cervical lymphadenopathy); risk of coronary artery aneurysm.

Epiglottitis presents with drooling, dysphagia, distress, and high fever; do not inspect the throat or place the child supine - keep the child upright and prepare for airway management.

Normal pediatric urine output is 1–2 mL/kg/hr for infants and 0.5–1 mL/kg/hr for children; output <0.5 mL/kg/hr suggests dehydration or renal compromise.

Levels of prevention: primary (immunization, health education), secondary (screening, early detection), tertiary (rehabilitation, chronic disease management).

Incidence = new cases / population at risk over a time period; prevalence = all existing cases / total population at a point or period.

Attack rate = number of new cases / number of persons at risk × 100; used in outbreak investigations.

Herd immunity threshold depends on basic reproduction number R0: threshold = 1 − 1/R0; for measles (R0 ≈ 12–18) this is approximately 92–95%.

Notifiable disease reporting is mandated by national law; in Afghanistan, suspected cases of polio, measles, cholera, and other epidemic-prone diseases must be reported immediately to the provincial surveillance system.

Cold chain for vaccines: most vaccines require 2–8 °C; avoid freezing; monitor with a vaccine vial monitor and temperature log.

Community assessment components: demographic, epidemiologic, environmental, health services, and sociocultural data; triangulate data sources.

Screening test validity: sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Therapeutic communication techniques include active listening, open-ended questions, reflection, clarification, and summarizing; avoid false reassurance, advice-giving, and why-questions.

Suicide risk assessment: ask directly about suicidal ideation, plan, intent, and access to means; highest risk often follows initiation of antidepressant therapy or recent discharge.

Serotonin syndrome triad: mental status changes (agitation, confusion), autonomic instability (hyperthermia, tachycardia), and neuromuscular abnormalities (clonus, hyperreflexia); stop serotonergic drugs and provide supportive care.

Neuroleptic malignant syndrome: rigidity, high fever, altered mental status, autonomic instability, elevated creatine kinase; stop antipsychotic, provide cooling, and consider dantrolene or bromocriptine.

Alcohol withdrawal: monitor with CIWA-Ar; benzodiazepines are first-line; risk of seizures and delirium tremens peaks 48–96 hours after last drink.

Mental status examination components: appearance, behavior, speech, mood, affect, thought process, thought content, perception, cognition, insight, and judgment.

Eating disorders: anorexia nervosa features low body weight, fear of weight gain, and body image disturbance; refeeding syndrome risk requires gradual caloric increase and electrolyte monitoring.

Involuntary commitment criteria generally require danger to self or others or grave disability; document rationale and follow legal jurisdiction requirements.

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

Digoxin: therapeutic range 0.5–2.0 ng/mL; signs of toxicity include nausea, visual changes (yellow-green halos), bradycardia, and arrhythmias; check apical pulse for 1 full minute before administration and hold if <60 bpm in adults.

Warfarin: monitor INR; target INR 2–3 for most indications (2.5–3.5 for mechanical mitral valves); antidote is vitamin K; heparin antidote is protamine sulfate.

Opioid overdose triad: pinpoint pupils, respiratory depression, and coma; antidote is naloxone, titrated to restore adequate respiration.

Acetaminophen overdose: toxic dose >150 mg/kg or >7.5 g in adults; antidote is N-acetylcysteine; monitor liver enzymes and INR.

Aminoglycosides (gentamicin, amikacin) are nephrotoxic and ototoxic; monitor peak and trough levels and renal function.

Insulin types by onset: rapid-acting (lispro, aspart) 15 min; short-acting (regular) 30 min; intermediate (NPH) 1–2 hr; long-acting (glargine, detemir) 1–2 hr with no peak.

IV push rate for most adult medications is ≤1 mL/min for small volumes; verify compatibility and use a filter when required; never administer IV push medications from an unlabeled syringe.

Primary survey: Airway, Breathing, Circulation, Disability, Exposure (ABCDE); correct life-threatening problems before proceeding.

Adult cardiopulmonary resuscitation: compression rate 100–120/min, depth 5–6 cm, full recoil, minimize interruptions to <10 seconds, compression-to-ventilation ratio 30:2 for one or two rescuers without advanced airway.

Defibrillation for shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia) is unsynchronized; synchronized cardioversion is used for unstable tachyarrhythmias with a pulse.

Sepsis bundle: measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics within 1 hour, and give 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Acute respiratory distress syndrome (ARDS) Berlin criteria: onset within 1 week, bilateral opacities, not fully explained by heart failure, PaO2/FiO2 ≤300 mmHg with PEEP ≥5 cmH2O; lung-protective ventilation uses tidal volume 6 mL/kg predicted body weight.

Increased intracranial pressure (ICP) normal is 5–15 mmHg; maintain cerebral perfusion pressure (CPP) = mean arterial pressure − ICP, target 60–70 mmHg; elevate head of bed 30°, avoid hip flexion, and maintain normocapnia.

Glasgow Coma Scale: eye 1–4, verbal 1–5, motor 1–6; total 3–15; score ≤8 indicates severe impairment and need for airway protection.

Massive transfusion: 1:1:1 ratio of red blood cells, plasma, and platelets is commonly used; monitor for hypocalcemia, hypothermia, and dilutional coagulopathy.

Four ethical principles: autonomy (respect patient choice), beneficence (do good), nonmaleficence (do no harm), and justice (fair distribution of resources).

Informed consent requires capacity, disclosure of risks/benefits/alternatives, understanding, and voluntariness; nurses may witness consent but the provider performing the procedure obtains it.

Confidentiality: disclose patient information only on a need-to-know basis or when legally required (e.g., reportable diseases, court order, imminent harm).

Negligence elements: duty, breach of duty, causation, and damages; malpractice is professional negligence.

Advance directives (living will, durable power of attorney for health care) communicate patient wishes when the patient lacks decision-making capacity.

Delegation: the nurse retains accountability; delegate tasks based on patient stability, complexity, and the delegate's competence; never delegate assessment, teaching, or evaluation to unlicensed assistive personnel.

Incident reporting: complete an incident report for errors and near misses; document objective facts in the medical record and do not mention the incident report in the chart.

Leadership styles: autocratic (rapid decisions in emergencies), democratic (shared decision-making), laissez-faire (minimal direction); situational leadership adapts style to team competence and commitment.

Scope of practice is defined by law and regulation; nurses must practice within their licensure and institutional policy.