Egypt Nursing Licensure Exam cheat sheet

Vital sign reference ranges for adults: oral temperature 36.5-37.5 °C, pulse 60-100/min, respirations 12-20/min, blood pressure under 120/80 mmHg, oxygen saturation 95-100% on room air.

Body mass index = weight in kilograms divided by height in meters squared (kg/m²); BMI 18.5-24.9 is normal, 25-29.9 overweight, 30 and above obese.

Mean arterial pressure = (systolic + 2 x diastolic) / 3; a value below 60 mmHg indicates inadequate organ perfusion.

Intake and output: 1 mL of urine output per kg per hour is the minimum adequate adult rate; report output under 30 mL/h for two consecutive hours.

Pressure injury staging: stage 1 is intact skin with non-blanchable erythema; stage 2 is partial-thickness loss; stage 3 is full-thickness loss with visible fat; stage 4 exposes fascia, muscle, or bone.

Normal adult urine specific gravity is 1.010-1.025; a value above 1.025 suggests dehydration, and below 1.010 suggests overhydration or impaired concentrating ability.

Wound healing by intention: primary intention is a clean approximated surgical wound; secondary intention heals by granulation from the base; tertiary intention is delayed closure of a contaminated wound.

The nursing process order is assessment, diagnosis, planning, implementation, and evaluation; evaluation findings feed back into reassessment.

Acute coronary syndrome: ST-elevation myocardial infarction requires reperfusion, preferably percutaneous coronary intervention within 90 minutes of first medical contact when available.

Heart failure: daily weight gain of more than 2 kg in 3 days, or 1 kg overnight, signals fluid retention before overt edema appears.

Diabetic ketoacidosis presents with blood glucose usually above 250 mg/dL, arterial pH below 7.30, bicarbonate below 18 mEq/L, and ketones in blood or urine; treatment begins with isotonic saline then intravenous insulin.

Hypoglycemia is blood glucose below 70 mg/dL; below 54 mg/dL it is clinically significant, and an unconscious patient who cannot swallow receives intravenous glucose or intramuscular glucagon, never oral fluids.

Chronic kidney disease stages use glomerular filtration rate: stage 1 at 90 or above, stage 2 at 60-89, stage 3 at 30-59, stage 4 at 15-29, and stage 5 below 15 mL/min/1.73 m².

Hyperkalemia with ECG changes such as peaked T waves is treated first with intravenous calcium to stabilize the myocardium, then insulin with glucose and a beta-2 agonist to shift potassium intracellularly.

Stroke: thrombolysis with alteplase may be given within 4.5 hours of symptom onset after computed tomography excludes hemorrhage; blood pressure must be below 185/110 mmHg before treatment.

Cirrhosis complications: ascites is managed with sodium restriction and spironolactone plus furosemide; hepatic encephalopathy is treated with lactulose titrated to two to three soft stools daily.

Estimated date of delivery by Naegele's rule: add 7 days to the first day of the last menstrual period, subtract 3 months, and add 1 year.

Normal labor progress: the cervix dilates about 1 cm per hour in active first-stage labor; the second stage begins at full dilation and ends with birth of the baby.

Fetal heart rate baseline is 110-160 beats per minute; late decelerations mirror contractions and indicate uteroplacental insufficiency, requiring repositioning to the left side, oxygen, and stopping oxytocin.

Variable decelerations are abrupt drops caused by cord compression; management is position change, and if unresolved, amnioinfusion or further evaluation.

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

Preeclampsia with severe features includes blood pressure of 160/110 mmHg or higher, platelets below 100,000/µL, transaminases twice normal, creatinine above 1.1 mg/dL, or symptoms such as headache and visual disturbance; magnesium sulfate prevents seizures.

Magnesium sulfate toxicity monitoring: respirations at least 12/min, deep tendon reflexes present, and urine output at least 30 mL/h; calcium gluconate is the antidote.

Newborn Apgar score assesses heart rate, respiratory effort, muscle tone, reflex irritability, and color at 1 and 5 minutes; each component scores 0-2, for a maximum of 10.

Normal pediatric heart rates at rest: newborn 100-160/min, infant 100-150/min, toddler 90-140/min, preschool 80-120/min, school age 70-110/min, adolescent 60-90/min.

Normal pediatric respiratory rates: newborn 30-60/min, infant 30-53/min, toddler 22-37/min, preschool 20-28/min, school age 18-25/min, adolescent 12-20/min.

Pediatric maintenance fluid by the Holliday-Segar method: 100 mL/kg/day for the first 10 kg, 50 mL/kg/day for the next 10 kg, and 20 mL/kg/day for each kilogram above 20 kg.

Dehydration classification: mild under 5% weight loss, moderate 5-10%, severe over 10%; severe dehydration with shock is treated with a 20 mL/kg isotonic saline bolus.

Infant immunization schedule anchors: hepatitis B at birth, DTaP and polio and pneumococcal and rotavirus at 2 months, measles-mumps-rubella and varicella at 12-15 months.

Croup presents with a barking cough and inspiratory stridor; a single dose of dexamethasone is given, and nebulized epinephrine is added for moderate to severe stridor at rest.

Bronchiolitis in infants under 2 years is usually caused by respiratory syncytial virus; treatment is supportive with oxygen and hydration, and routine bronchodilators are not recommended.

Kawasaki disease diagnostic criteria include fever for 5 days plus 4 of 5 features: conjunctivitis, oral mucosal changes, cervical lymphadenopathy, rash, and extremity changes; intravenous immunoglobulin plus aspirin prevents coronary aneurysms.

Cardiopulmonary resuscitation for adults: compress at 100-120/min, depth 5-6 cm, with full recoil and a compression-to-ventilation ratio of 30:2; defibrillate shockable rhythms as soon as the device is available.

Shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia; non-shockable rhythms are asystole and pulseless electrical activity.

Triage in mass casualty incidents uses color tags: red for immediate, yellow for delayed, green for minor, and black for deceased or expectant.

The ABCDE primary survey order is airway, breathing, circulation, disability, and exposure; catastrophic hemorrhage control precedes airway in the current trauma sequence.

Sepsis is suspected with suspected infection plus a Sequential Organ Failure Assessment score of 2 or more; septic shock is sepsis with vasopressor need to keep mean arterial pressure at 65 mmHg or higher and lactate above 2 mmol/L.

Anaphylaxis is treated with intramuscular epinephrine 0.3-0.5 mg of 1:1000 solution in the adult anterolateral thigh, repeated every 5-15 minutes as needed.

Glasgow Coma Scale sums eye opening (1-4), verbal response (1-5), and motor response (1-6); a score of 8 or below indicates need for airway protection.

Central venous pressure and lactate guide resuscitation: a lactate above 2 mmol/L with hypotension defines septic shock, and lactate clearance is used to judge response.

Levels of prevention: primary prevents disease before onset through immunization and sanitation; secondary detects disease early through screening; tertiary limits disability from established disease.

Incidence counts new cases in a population over a period; prevalence counts all existing cases at a point in time; prevalence approximates incidence multiplied by disease duration.

Attack rate = new cases divided by population at risk, multiplied by 100; it is used for outbreaks of a single exposure.

Crude mortality rate = number of deaths in a year divided by mid-year population, multiplied by 1000.

Infant mortality rate = deaths of infants under 1 year per 1000 live births in the same year; it is a sensitive indicator of population health.

Herd immunity thresholds depend on transmissibility: measles requires about 95% coverage, while seasonal influenza requires roughly 50-60%.

Cold chain storage: most vaccines are kept at 2-8 °C; varicella vaccine and oral polio are frozen or specific, and freeze-sensitive vaccines such as hepatitis B and DTaP must never be frozen.

Screening test properties: sensitivity is true positives divided by all with disease; specificity is true negatives divided by all without disease; positive predictive value depends on prevalence.

Therapeutic communication techniques include open-ended questions, reflection, restatement, and silence; non-therapeutic techniques include false reassurance, advice-giving, and changing the subject.

Suicide risk is highest in the period after discharge and after a recent attempt; direct questioning about suicidal ideation does not increase risk and is required for assessment.

Serotonin syndrome presents with agitation, hyperthermia, tremor, clonus, and hyperreflexia after serotonergic drugs; treatment is stopping the agent and supportive care, with cyproheptadine for severe cases.

Neuroleptic malignant syndrome presents with rigidity, hyperthermia, altered mental status, and elevated creatine kinase after antipsychotics; treatment is stopping the drug, cooling, and dantrolene or bromocriptine.

Extrapyramidal symptoms from antipsychotics include acute dystonia, akathisia, parkinsonism, and tardive dyskinesia; acute dystonia responds to anticholinergics such as benztropine.

Lithium therapeutic serum level is 0.6-1.2 mEq/L in maintenance; toxicity signs include coarse tremor, vomiting, diarrhea, ataxia, and confusion, and dehydration raises lithium levels.

Alcohol withdrawal: benzodiazepines are first-line for withdrawal seizures and delirium tremens; thiamine is given before or with glucose to prevent Wernicke encephalopathy.

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

The six rights of medication administration are right patient, right drug, right dose, right route, right time, and right documentation; some frameworks add right reason and right response.

The parenteral routes differ in onset: intravenous is fastest, then intramuscular, then subcutaneous; intraosseous is used when intravenous access fails in emergencies.

Intramuscular injection sites for adults are the ventrogluteal, deltoid, and vastus lateralis; the deltoid accepts volumes up to 1 mL and the ventrogluteal up to 3 mL.

Digoxin has a narrow therapeutic range of 0.5-2 ng/mL; the apical pulse is counted for one full minute before each dose, and a rate below 60/min in adults warrants holding the dose.

Warfarin is monitored with the international normalized ratio, target 2-3 for most indications; vitamin K is the antidote and fresh frozen plasma is used for major bleeding.

Heparin is monitored with activated partial thromboplastin time, and protamine sulfate reverses it; low-molecular-weight heparin usually needs no routine monitoring.

Aminoglycosides such as gentamicin are nephrotoxic and ototoxic; peak and trough levels are drawn and troughs are kept low to limit toxicity.

Paracetamol (acetaminophen) overdose is treated with N-acetylcysteine, and the antidote is most effective when started within 8-10 hours of ingestion.

Standard precautions apply to all patients regardless of diagnosis and include hand hygiene, gloves, gown, mask, eye protection, and safe sharps handling.

Transmission-based precautions: contact for multidrug-resistant organisms and Clostridioides difficile, droplet for influenza and pertussis, airborne for tuberculosis, measles, and varicella.

Airborne precautions require a fit-tested N95 or higher respirator and a negative-pressure room with 6-12 air exchanges per hour.

Hand hygiene moments are before patient contact, before an aseptic task, after body fluid exposure risk, after patient contact, and after touching patient surroundings.

Alcohol-based hand rub is preferred for routine hand hygiene when hands are not visibly soiled; soap and water are required for C. difficile and norovirus because alcohol does not kill spores.

Surgical site infection prevention: give prophylactic antibiotics within 60 minutes before incision, keep perioperative glucose controlled, and maintain normothermia.

Needlestick exposure to bloodborne pathogens: wash the site with soap and water, do not squeeze or scrub, report immediately, and start post-exposure prophylaxis for HIV within hours when indicated.

Sterilization destroys all microorganisms including spores; high-level disinfection kills all microorganisms except high numbers of bacterial spores.

Informed consent requires capacity, disclosure of risks and benefits and alternatives, comprehension, and voluntariness; the treating clinician obtains consent, and the nurse witnesses or verifies it.

Autonomy respects the patient's choices; beneficence acts for the patient's good; nonmaleficence avoids harm; justice distributes care fairly.

A competent adult may refuse treatment, including life-sustaining treatment; a signed do-not-resuscitate order is honored and documented in the record.

Confidentiality may be breached only where law requires, such as reportable communicable diseases, suspected child or elder abuse, and court orders.

Negligence requires duty, breach of duty, causation, and damages; professional misconduct is judged against what a reasonably prudent nurse with similar training would do.

Mandatory reporting in most jurisdictions covers suspected child abuse, elder abuse, and certain communicable diseases; the nurse reports to the designated authority, not necessarily to the family first.

Delegation to unlicensed assistive personnel requires that the task be within their training, the patient stable, and the nurse retains accountability for assessment and evaluation.

The nurse's scope of practice is set by the licensing law of the jurisdiction and the regulatory board; a license is required before practice, and renewal requires continuing education.