BNMC Licensing Exam cheat sheet

Normal adult vital signs: oral temperature 36.5-37.5 C, pulse 60-100/min, respirations 12-20/min, blood pressure under 120/80 mmHg, SpO2 95-100% on room air.

Stages of pressure injury: 1 = non-blanchable erythema of intact skin; 2 = partial-thickness loss with dermis exposed; 3 = full-thickness loss with subcutaneous fat visible; 4 = full-thickness loss exposing fascia, muscle, or bone.

Maslow priority order for care decisions: physiologic needs first, then safety, love/belonging, esteem, self-actualization; ABC (airway, breathing, circulation) overrides all.

Intake-output balance: 1 kg body weight change equals approximately 1 L of fluid; normal adult urine output is at least 0.5 mL/kg/hour or 30 mL/hour.

Isolation precautions: contact for MRSA, C. difficile, and scabies; droplet for influenza and pertussis; airborne for tuberculosis, measles, and varicella with N95 respirator.

Hand hygiene is the single most effective infection-control measure; use alcohol-based rub for 20-30 seconds when hands are not visibly soiled.

Wound healing phases: hemostasis (minutes to hours), inflammatory (1-5 days), proliferative (5 days to 3 weeks), maturation/remodeling (3 weeks to 1 year or more).

Body mechanics: keep the load close to the body, widen the base of support, bend at the knees, and avoid twisting the spine while lifting.

Acute coronary syndrome: ST-elevation myocardial infarction requires reperfusion within 90 minutes of first medical contact; give aspirin 162-325 mg chewed unless contraindicated.

Heart failure: report weight gain of 2-3 lb in 24 hours or 5 lb in a week; administer loop diuretics and monitor potassium and renal function.

Chronic obstructive pulmonary disease: use the Venturi mask for controlled low-flow oxygen; target SpO2 88-92% in patients at risk of carbon dioxide retention.

Diabetic ketoacidosis: give isotonic saline first, then insulin infusion; monitor potassium because insulin drives potassium into cells and hypokalemia can result.

Acute kidney injury: oliguric phase shows rising creatinine, hyperkalemia, and metabolic acidosis; treat hyperkalemia with calcium, insulin-dextrose, and dialysis if refractory.

Stroke: thrombolytic window is up to 4.5 hours from symptom onset; blood pressure must be below 185/110 mmHg before alteplase administration.

Postoperative care: early ambulation reduces deep vein thrombosis and atelectasis; incentive spirometry 10 breaths per hour while awake is standard.

Cirrhosis: monitor for hepatic encephalopathy (asterixis, confusion) and give lactulose to reduce ammonia; restrict sodium with ascites.

Estimated date of delivery by Naegele rule: first day of last menstrual period plus 7 days minus 3 months plus 1 year.

Stages of labor: first stage from onset to full cervical dilation (10 cm), second stage from full dilation to birth, third stage from birth to placental delivery, fourth stage first 1-2 hours postpartum.

Fetal heart rate baseline is 110-160 beats/min; late decelerations indicate uteroplacental insufficiency and require repositioning to the left side and oxygen.

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

Preeclampsia is blood pressure of 140/90 mmHg or higher after 20 weeks with proteinuria or end-organ dysfunction; magnesium sulfate prevents seizures.

APGAR scoring at 1 and 5 minutes assesses appearance, pulse, grimace, activity, and respiration; each 0-2 points, total 0-10.

Newborn thermoregulation: keep the infant dry, skin-to-skin, and under a radiant warmer; cold stress increases oxygen consumption and risks hypoglycemia.

Breastfeeding: colostrum is produced first, mature milk by 2-3 weeks; feed 8-12 times in 24 hours to establish supply.

Pediatric vital sign trends: heart rate and respiratory rate are highest in newborns and decline with age; blood pressure rises with age.

Weight-based dosing: verify pediatric doses in mg/kg per dose and confirm the maximum adult dose is not exceeded.

Dehydration in children: assess fontanelle, mucous membranes, tears, skin turgor, and urine output; use oral rehydration solution for mild to moderate dehydration.

Infant milestones: social smile at 6 weeks, sits without support at 6-8 months, walks alone at 12-15 months, two-word phrases at 18-24 months.

Fever in infants under 3 months is a red flag requiring full sepsis evaluation and immediate medical evaluation.

Kawasaki disease: treat with intravenous immunoglobulin and aspirin; monitor for coronary artery aneurysms.

Epiglottitis versus croup: epiglottitis presents with drooling, tripod posture, and muffled voice; never inspect the throat without airway readiness.

Immunization schedule principle: live vaccines are generally deferred in severely immunocompromised children; inactivated vaccines are preferred.

Levels of prevention: primary prevents disease before onset, secondary screens and detects early, tertiary limits disability and rehabilitates.

Epidemiology measures: incidence counts new cases over a period; prevalence counts all existing cases at a point in time.

Attack rate equals number of new cases divided by population at risk, multiplied by 100, expressed as a percentage.

Herd immunity threshold depends on basic reproduction number: threshold equals 1 minus 1/R0.

Screening test properties: sensitivity detects true positives; specificity detects true negatives; positive predictive value depends on prevalence.

Community assessment models include windshield survey, key informant interviews, and secondary data review of census and health department reports.

Reportable disease surveillance requires nurses to notify local public health authorities for conditions such as tuberculosis, measles, and foodborne illness.

Home visit safety: schedule during daylight, verify address, carry a charged phone, and document the visit immediately after leaving.

Therapeutic communication techniques: use open-ended questions, reflection, silence, and clarification; avoid false reassurance, advice, and why-questions.

Suicide risk assessment: ask directly about ideation, plan, intent, and access to means; implement safety precautions and continuous observation for high risk.

Serotonin syndrome: triad of mental status change, autonomic instability, and neuromuscular hyperactivity; stop serotonergic drugs and give supportive care.

Neuroleptic malignant syndrome: rigidity, high fever, altered consciousness, and autonomic instability; stop antipsychotic and give dantrolene or bromocriptine.

Alcohol withdrawal: monitor with CIWA scale; treat with benzodiazepines and give thiamine before glucose to prevent Wernicke encephalopathy.

Lithium therapeutic range is 0.6-1.2 mEq/L; toxicity signs include tremor, vomiting, ataxia, and confusion; maintain sodium and fluid intake.

Defense mechanisms: denial, projection, rationalization, displacement, and sublimation are unconscious coping strategies; identify rather than confront early.

Restraint use requires a physician order, time limits, frequent monitoring, and documentation of least restrictive alternatives first.

Six rights of medication administration: right patient, drug, dose, route, time, and documentation; verify with two identifiers.

Narrow therapeutic index drugs requiring serum monitoring include digoxin, lithium, warfarin, phenytoin, and vancomycin.

Digoxin: check apical pulse for one full minute; hold and notify prescriber if heart rate is below 60/min in adults.

Warfarin: monitor INR, target 2-3 for most indications; antidote is vitamin K; heparin antidote is protamine sulfate.

Opioid overdose: give naloxone; monitor respiratory rate and level of consciousness; effects may wear off before opioid, so observe.

Acetaminophen maximum adult dose is 4 g per day; overdose antidote is acetylcysteine; monitor liver function.

Insulin types by onset: rapid (lispro, aspart) 10-15 min, short (regular) 30-60 min, intermediate (NPH) 1-2 hours, long (glargine) steady without peak.

Intravenous push rates and dilution must follow facility policy; never administer intravenous potassium as a bolus; maximum usual rate 10-20 mEq/hour with pump.

Scope of practice is defined by state nurse practice acts, board of nursing rules, and institutional policy; the nurse is accountable for personal competence.

Informed consent requires capacity, voluntariness, disclosure of risks and benefits, and alternatives; the physician obtains consent, the nurse witnesses and advocates.

Mandatory reporting includes suspected child abuse, elder abuse, and certain communicable diseases; failure to report is a legal violation.

Negligence elements: duty, breach of duty, causation, and damages; all four must be proven.

Confidentiality is protected by HIPAA; disclose only minimum necessary information to those involved in care.

Ethical principles: autonomy respects self-determination, beneficence promotes good, nonmaleficence avoids harm, justice ensures fairness, veracity requires truthfulness.

Advance directives include living wills and durable power of attorney for health care; the nurse confirms and follows documented wishes.

Delegation to unlicensed assistive personnel requires stable patients, predictable outcomes, and retained nurse accountability for assessment and evaluation.

Evidence hierarchy from strongest to weakest: systematic reviews and meta-analyses, randomized controlled trials, cohort studies, case-control studies, case reports, expert opinion.

PICO format frames clinical questions: population, intervention, comparison, and outcome.

Levels of measurement: nominal (categories), ordinal (ranked), interval (equal intervals without true zero), ratio (true zero).

Sensitivity equals true positives divided by true positives plus false negatives; specificity equals true negatives divided by true negatives plus false positives.

Validity is accuracy of measurement; reliability is consistency or repeatability; a test can be reliable without being valid.

Quality improvement models include PDSA (plan-do-study-act) and root cause analysis for sentinel events.

Informed consent in research requires institutional review board approval, voluntary participation, and the right to withdraw without penalty.

Statistical significance is a p value below the alpha level (commonly 0.05); clinical significance is whether the effect matters to patients.