Medical-Surgical Nursing
Core concepts
Medical-surgical questions reward pattern recognition across systems: cardiovascular (angina, MI, heart failure, hypertension), respiratory (asthma, COPD, pneumonia, PE), endocrine (diabetes, thyroid, adrenal), renal (AKI, CKD, electrolytes), GI and hepatic, neurologic (stroke, seizures, increased intracranial pressure), musculoskeletal, and hematologic disorders. For each, know the hallmark manifestations, the priority complication, and the key monitoring parameter. Fluid and electrolyte balance, acid-base interpretation, perioperative care, and wound healing recur throughout.
Traps candidates fall for
- Missing the complication behind a symptom: e.g., sudden dyspnea and tachycardia after surgery suggests pulmonary embolism, not anxiety.
- Confusing left- and right-sided heart failure signs (left: pulmonary congestion, orthopnea; right: peripheral edema, JVD, hepatomegaly).
- Reversing hyper- and hypoglycemia symptoms, or forgetting that a diabetic patient with sweating, tremor, and confusion needs glucose first.
- Misreading ABGs: check pH first (acidemia vs alkalemia), then whether PaCO2 or HCO3 explains it, then compensation.
- Forgetting that potassium and sodium abnormalities can cause lethal dysrhythmias and neurologic changes.
Rule of thumb
For any new symptom, ask three questions in order: Is this life-threatening right now? What body system explains it? What monitoring or intervention will confirm or correct it?
Worked example
A patient with COPD has an ABG of pH 7.28, PaCO2 60 mmHg, HCO3 26 mEq/L. pH is low (acidemia); PaCO2 is high, which explains the acidosis; bicarbonate is near normal, so there is little metabolic compensation. This is acute respiratory acidosis, and the priority is improving ventilation and watching for somnolence, which signals CO2 narcosis.