Medical-Surgical Nursing
Medical-Surgical Nursing tests recognition and management of adult health problems across cardiac, respiratory, neurologic, renal, endocrine, gastrointestinal, and perioperative care. The exam favors deterioration, prioritization, and interpretation of data over memorized disease lists.
Core rules and concepts
- Prioritization. Use ABCDE: airway, breathing, circulation, disability, exposure. Treat life threats before chronic issues. A patient with new confusion after surgery may be hypoxic or hypotensive, not simply anxious.
- Fluid and electrolytes. Isotonic fluids expand extracellular volume; hypotonic fluids shift water into cells; hypertonic fluids pull water out. Potassium is never given IV push; verify renal function and use a pump. Hypokalemia causes dysrhythmias and weakness; hyperkalemia causes peaked T waves and cardiac arrest.
- Acid-base. Interpret pH first, then PaCO2 and HCO3. pH below 7.35 is acidemia; above 7.45 is alkalemia. Respiratory disorders change PaCO2; metabolic disorders change HCO3. Compensation moves the other system in the same direction as the primary change but does not fully correct pH.
- Cardiac. For suspected acute coronary syndrome, obtain ECG and troponin, give aspirin if not contraindicated, and monitor. STEMI needs reperfusion. Heart failure with fluid overload needs positioning, oxygen, diuretics, and monitoring.
- Respiratory. In COPD, target SpO2 88–92% to avoid worsening hypercapnia. In asthma, give bronchodilators and steroids early. Sudden dyspnea with chest pain after surgery suggests pulmonary embolism.
- Perioperative. Verify consent, allergies, NPO status, and site marking. In PACU, assess airway and breathing before pain.
Worked example
ABG: pH 7.28, PaCO2 30 mmHg, HCO3 14 mEq/L. The pH is acidemic. PaCO2 is low, which would raise pH; HCO3 is low, which lowers pH. The primary disorder is metabolic acidosis with respiratory compensation. The nurse should assess for causes such as sepsis, ketoacidosis, or diarrhea, monitor potassium and breathing, and treat the underlying cause.
Traps that cost marks
- Giving potassium IV push or ignoring urine output.
- Assuming all confusion is delirium rather than hypoxia, hypoglycemia, or stroke.
- Giving high-flow oxygen to a COPD patient without target-range monitoring.
- Treating chest pain with morphine before ECG and aspirin in suspected ACS.