Fiji Nursing Registration Exam cheat sheet

Fiji nursing practice is governed by the Nurses Act (as amended) and the Nursing Council of Fiji; registration, enrolment and annual practising certificates are legal prerequisites to practise.

Four core ethical principles: autonomy (respect patient choice), beneficence (act in patient's interest), non-maleficence (do no harm), justice (fair allocation of care).

Informed consent requires capacity, adequate disclosure of risks/benefits/alternatives, comprehension, and voluntariness; document who consented and when.

Confidentiality is a legal and ethical duty; disclosure without consent is justified only where statute requires (e.g., notifiable diseases) or where there is serious risk to others.

Negligence requires four elements: a duty of care, breach of the standard of a reasonably competent nurse, causation, and actual harm/damages.

Scope of practice: an enrolled nurse works under delegation and supervision of a registered nurse; a registered nurse assesses, plans, implements and evaluates care independently within the scope.

Mandatory reporting obligations include suspected child abuse, notifiable infectious diseases, and unsafe practice by a colleague through the proper channels.

Documentation is a legal record: contemporaneous, factual, signed, timed, and never altered retrospectively; corrections are made with a single line, initialled and dated.

Advocacy: the nurse's first duty is to the patient; when a doctor's order appears unsafe, the nurse seeks clarification and escalates rather than simply complying.

Vital sign reference (adult): temperature 36.5-37.5 °C, pulse 60-100/min, respirations 12-20/min, BP ~120/80 mmHg, SpO2 ≥95% on room air.

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

Pressure injury risk is reduced by repositioning at least every 2 hours, keeping skin clean and dry, and using pressure-redistributing surfaces; stage by depth of tissue damage.

Standard adult IV flow rate: drops per minute = (volume in mL × drop factor) / time in minutes; macrodrop 20 drops/mL, microdrip 60 drops/mL.

Pain is the fifth vital sign: use a 0-10 numeric rating scale for adults, Wong-Baker FACES for children, and PAINAD/ behavioural scales for non-verbal patients.

Hand hygiene moments (WHO): before patient contact, before aseptic procedure, after body fluid exposure, after patient contact, after touching patient surroundings.

Intake-output balance: record all oral, IV, enteral intake and urine, vomitus, drain and stool output; report urine output <0.5 mL/kg/h as oliguria.

Aseptic technique for wound dressing: clean to dirty, one swab per stroke, sterile gloves for sterile fields, and document wound appearance and size.

Falls prevention: assess risk on admission and each shift, keep bed low and brakes on, call bell in reach, and orient confused patients to the environment.

Hypoglycaemia is blood glucose <4 mmol/L: give 15-20 g fast-acting oral carbohydrate if conscious, or IV 50% dextrose/IM glucagon if unconscious, then recheck in 15 minutes.

Acute coronary syndrome: MONA approach (morphine, oxygen if SpO2 <94%, nitrates, aspirin 300 mg chewed) plus 12-lead ECG within 10 minutes of arrival.

Heart failure: assess for orthopnoea, bibasal crackles, raised JVP, peripheral oedema; nurse upright, restrict fluid/salt, monitor daily weight and strict intake-output.

COPD: controlled low-flow oxygen (target SpO2 88-92%) in patients at risk of CO2 retention; pursed-lip breathing and smoking cessation education.

Stroke: use FAST (Face, Arms, Speech, Time); thrombolysis window is typically within 4.5 hours of symptom onset, so rapid assessment and CT are critical.

Diabetic ketoacidosis: monitor blood glucose, ketones, potassium and fluid balance; insulin infusion and potassium replacement are core, as potassium falls with insulin.

Post-operative care: assess airway, breathing, circulation, wound, drains, pain and urine output; early mobilisation and DVT prophylaxis reduce complications.

Acute kidney injury: monitor urine output, creatinine and potassium; restrict potassium and fluid as ordered and avoid nephrotoxic drugs such as NSAIDs and aminoglycosides.

Gastrointestinal bleeding: monitor for melaena, haematemesis, tachycardia and falling BP; keep patient nil by mouth and prepare for IV access and transfusion.

Normal labour stages: first stage from onset of regular contractions to full cervical dilatation (10 cm); second stage to birth of baby; third stage to delivery of placenta (usually within 30 minutes).

Partograph: plot cervical dilatation, descent, contractions, fetal heart rate, and maternal observations; alert line deviation indicates slow progress and the need for review.

Fetal heart rate normal range is 110-160 beats/min; decelerations with contractions may indicate head compression, while late decelerations suggest uteroplacental insufficiency.

Postpartum haemorrhage is blood loss >500 mL after vaginal birth or >1000 mL after caesarean; manage with uterine massage, uterotonics, IV fluids, and escalation.

Preeclampsia: BP ≥140/90 mmHg with proteinuria after 20 weeks; severe features include headache, visual disturbance, epigastric pain; magnesium sulphate prevents seizures.

APGAR is scored at 1 and 5 minutes on Appearance, Pulse, Grimace, Activity, Respiration, each 0-2; score 7-10 is normal.

Newborn thermoregulation: dry the baby immediately, skin-to-skin contact, cap and warm blankets; hypothermia is a major contributor to neonatal death.

Exclusive breastfeeding is recommended for the first 6 months; support early initiation within the first hour and correct attachment and positioning.

Antenatal care: at least four focused visits; screen for anaemia, hypertension, syphilis, HIV and blood group, and give tetanus toxoid and iron-folate supplements.

Paediatric vital sign ranges vary with age: infants have higher respiratory and pulse rates; always compare with age-specific reference ranges.

Paediatric weight-based dosing: verify dose in mg/kg against a current formulary and never exceed the adult dose; double-check calculations with a second nurse.

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

Integrated Management of Childhood Illness (IMCI): assess for danger signs (lethargy, convulsions, inability to feed, vomiting everything) and refer urgently.

Immunisation schedule in Fiji follows the national Expanded Programme on Immunisation; check the child's health record and document each vaccine given.

Respiratory distress signs in children: nasal flaring, grunting, intercostal/subcostal recession, tachypnoea, and cyanosis; these require urgent review.

Fever in children: use paracetamol 15 mg/kg per dose (max 4 doses/24 h); avoid aspirin due to Reye's syndrome risk.

Growth monitoring: plot weight and height on growth charts each visit; crossing centiles downward signals faltering growth and needs assessment.

Child safety: use car seats, prevent burns and drowning, and educate caregivers on home safety and danger signs requiring return to clinic.

Therapeutic communication: use open questions, active listening, reflection and clarification; avoid false reassurance, advice-giving and judgemental responses.

Mental status examination covers appearance, behaviour, speech, mood, affect, thought form and content, perception, cognition, insight and judgement.

Suicide risk assessment: ask directly about thoughts, plans, means and intent; a high-risk patient requires continuous observation and removal of means.

Psychosis: hallucinations are false sensory perceptions (commonly auditory); delusions are fixed false beliefs; respond to the underlying feeling rather than arguing with the content.

Depression: core symptoms are low mood and loss of interest for at least two weeks, with sleep, appetite, energy and concentration changes.

Anxiety: use calm environment, breathing techniques, grounding, and gradual exposure; benzodiazepines are short-term only due to dependence risk.

Mental Health Act provisions in Fiji allow involuntary assessment and treatment where a person has a mental disorder and is a risk to self or others; follow legal safeguards.

De-escalation is first-line for aggression: maintain distance, speak calmly, offer choices, and use physical restraint only as a last resort with monitoring and documentation.

Electroconvulsive therapy and psychotropic medicines require informed consent, monitoring for side effects such as extrapyramidal symptoms and metabolic changes.

Primary prevention targets risk factors before disease (immunisation, health education); secondary prevention is early detection (screening); tertiary prevention is rehabilitation.

Notifiable disease surveillance requires prompt reporting to the Ministry of Health so that outbreak investigation and contact tracing can occur.

Cold chain: vaccines are stored at 2-8 °C; monitor fridge temperature twice daily and discard vaccines exposed to freezing or heat.

Epidemiology measures: incidence = new cases/population at risk/time; prevalence = all existing cases/total population at a point in time.

Contact tracing: identify, notify, test and follow up contacts of a case; quarantine or isolation periods depend on the disease's incubation and infectious periods.

Vector control for dengue: eliminate standing water, use larvicides and repellents, and promote community clean-up campaigns.

Health education principles: identify the learner's needs, use simple language, involve the community, and evaluate understanding.

Non-communicable disease prevention focuses on tobacco, alcohol, unhealthy diet and physical inactivity; screen for hypertension, diabetes and obesity in adults.

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

High-alert medicines include insulin, heparin, opioids, potassium chloride and chemotherapy; use independent double-checking and clear labelling.

Calculate doses using the formula: dose required = (desired dose / stock strength) × stock volume; check units carefully (mg vs mcg, units vs mL).

Never give potassium chloride by IV push; it must be diluted and infused with rate and cardiac monitoring.

Adverse drug reactions: distinguish predictable (Type A, dose-related) from unpredictable (Type B, idiosyncratic); report all suspected reactions through the pharmacovigilance system.

Antibiotic stewardship: prescribe only when indicated, take cultures before starting, and complete the prescribed course to reduce resistance.

Warfarin monitoring uses INR; heparin monitoring uses APTT; check platelet counts for heparin-induced thrombocytopenia.

Digoxin has a narrow therapeutic index: monitor pulse before administration and withhold if bradycardic or if signs of toxicity appear.

Medication errors: report immediately, assess the patient, inform the prescriber, and complete an incident report without blame or concealment.

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; break a link to prevent transmission.

Standard precautions apply to all patients: hand hygiene, gloves, gown, mask, eye protection, safe sharps handling and safe waste disposal.

Transmission-based precautions: contact (gown and gloves), droplet (surgical mask, distance >1 m), airborne (N95/P2 respirator, negative-pressure room).

Hand hygiene with alcohol-based rub for visibly clean hands; use soap and water when hands are visibly soiled or after caring for patients with C. difficile.

Sharps safety: never recap needles, use sharps containers to the fill line, and report needlestick injuries immediately for post-exposure prophylaxis assessment.

Sterilisation kills all microorganisms including spores; disinfection reduces but does not eliminate all organisms; cleaning removes organic matter first.

Healthcare-associated infection prevention includes catheter care bundles, surgical site care, ventilator bundles and antimicrobial stewardship.

Personal protective equipment must be removed in the correct sequence: gloves, goggles, gown, then mask, with hand hygiene after removal.

Basic life support sequence: check responsiveness and breathing, call for help, start chest compressions at 100-120/min, depth 5-6 cm, ratio 30:2 with ventilations.

Use an AED as soon as available; shock for shockable rhythms (VF, pulseless VT) and resume compressions immediately after the shock.

ABCDE assessment: Airway, Breathing, Circulation, Disability, Exposure; treat the most life-threatening problem first and reassess after each intervention.

Anaphylaxis: give IM adrenaline 0.5 mg (1:1000) into the anterolateral thigh, remove the trigger, give oxygen and IV fluids, and call for help.

Shock: recognise tachycardia, hypotension, cool peripheries, altered consciousness and oliguria; give oxygen, IV access and fluid resuscitation as ordered.

Perioperative safety: complete the WHO surgical safety checklist (sign in, time out, sign out), verify consent, site marking and allergies.

Post-anaesthesia recovery: monitor airway, breathing, circulation, temperature, pain, nausea and wound; use Aldrete-type criteria before discharge from recovery.

Triage uses a colour or number system to prioritise care; life-threatening conditions are treated first regardless of arrival order.

Crash cart and emergency equipment checks should be done each shift and after use, with seals intact and expiry dates verified.

Management functions: planning, organising, staffing, directing and controlling; leadership is about influencing and motivating others toward goals.

Delegation requires matching the task to the delegate's competence and scope of practice, with clear instructions and accountability retained by the delegator.

Nursing handover should use a structured format such as ISBAR (Identify, Situation, Background, Assessment, Recommendation) for safe transfer of care.

Quality improvement models include PDSA (Plan-Do-Study-Act) and root cause analysis for adverse events; the aim is system improvement, not blame.

Clinical audit compares practice against agreed standards, identifies gaps, implements change and re-audits to close the loop.

Incident reporting systems are for learning and prevention; a just culture distinguishes human error from reckless behaviour.

Staffing and rostering should match patient acuity and skill mix; workload and fatigue contribute to errors.

Conflict resolution: address issues early, use 'I' statements, focus on behaviour not personality, and escalate through the chain of command when needed.

Fiji's health system is delivered through divisional health services (Central, Western, Northern) with subdivisional hospitals, health centres and nursing stations.

Primary health care is delivered through health centres and nursing stations, with referral to divisional and tertiary hospitals such as the Colonial War Memorial Hospital.

The Ministry of Health and Medical Services sets national policy; the Nursing Council of Fiji regulates registration, standards and discipline.

Fiji's health financing includes government funding and out-of-pocket payments; the Fiji National Provident Fund and private insurance cover some services.

Primary health care principles (Alma-Ata/ Astana): equity, community participation, intersectoral collaboration, appropriate technology and affordability.

Nursing registration requires an approved qualification, current practising certificate and compliance with continuing professional development requirements.

Referral pathways: nursing station to health centre to subdivisional hospital to divisional hospital, based on the level of care required.

Health promotion in Fiji addresses non-communicable diseases, maternal and child health, immunisation, and communicable disease control such as dengue and typhoid.

The Nursing Council may investigate complaints, suspend or cancel registration, and require remediation; nurses must know their scope of practice and professional obligations.