NCHK RN(G) LE cheat sheet

Autonomy: respecting the patient's right to make informed decisions, even when the choice conflicts with the nurse's personal values.

Beneficence: acting to promote the patient's good; nonmaleficence: avoiding harm. Both are foundational bioethical principles.

Justice: equitable allocation of nursing time and resources regardless of patient status, diagnosis, or ability to pay.

Veracity: truthfulness with patients; deception about a diagnosis or procedure violates this duty.

Fidelity: keeping promises and maintaining loyalty to the patient; includes following through on commitments.

Advocacy: the nurse speaks for the patient's rights and preferences when the patient cannot do so.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, comprehension, and voluntariness.

Ethical decision-making frameworks: identify the dilemma, gather facts, identify stakeholders, weigh principles, choose and evaluate.

Accountability: the nurse remains responsible for delegated tasks and for personal competence within scope of practice.

Vital sign ranges (adult): oral temperature 36.5–37.5 °C; pulse 60–100/min; respirations 12–20/min; BP <120/80 mmHg; SpO2 ≥95%.

Hand hygiene: wash with soap and water when hands are visibly soiled or after C. difficile; alcohol-based rub for routine decontamination.

Pressure injury staging: Stage 1 = intact skin with non-blanchable erythema; Stage 2 = partial-thickness loss; Stage 3 = full-thickness loss; Stage 4 = exposed bone/tendon/muscle.

Aseptic technique: sterile field edges are contaminated; anything below waist or outside the field is unsterile.

Intake/output: 1 mL = 1 g; 240 mL = 1 cup; normal adult urine output ≈0.5–1 mL/kg/hr.

Falls prevention: bed low, brakes locked, call light within reach, non-skid footwear, hourly rounding.

Body mechanics: wide base of support, bend knees, keep load close, avoid twisting; push rather than pull.

Oxygen delivery: nasal cannula 1–6 L/min (24–44%); simple mask 5–8 L/min (35–50%); non-rebreather 10–15 L/min (80–95%).

Wound healing: inflammatory (0–3 days), proliferative (3–21 days), maturation (21 days–1 year).

Heart failure: report weight gain >1 kg in 24 hr or >2.5 kg in a week; monitor K+ with diuretics; assess for orthopnea and crackles.

COPD: low-flow O2 (1–2 L/min) titrated to SpO2 88–92%; assess for pursed-lip breathing and barrel chest.

Myocardial infarction: MONA (morphine, oxygen if hypoxemic, nitroglycerin, aspirin); assess for crushing chest pain radiating to left arm/jaw.

Stroke: use FAST (Face, Arms, Speech, Time); thrombolytic window typically 3–4.5 hr from onset; keep BP per protocol before lysis.

Diabetic ketoacidosis: pH <7.30, bicarbonate <18, ketones, Kussmaul breathing; treat with IV fluids, insulin, and potassium replacement.

Hypoglycemia: glucose <3.9 mmol/L (70 mg/dL); give 15–20 g fast-acting carbohydrate if conscious, glucagon or IV dextrose if unconscious.

Acute kidney injury: monitor urine output <0.5 mL/kg/hr, rising creatinine, hyperkalemia; restrict potassium and phosphate.

Post-operative care: early ambulation, incentive spirometry, assess for DVT (calf pain, unilateral swelling) and atelectasis.

Cirrhosis: monitor for ascites, hepatic encephalopathy (asterixis, confusion), and esophageal varices; restrict sodium and protein per provider.

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

Stages of labour: first (latent 0–3 cm, active 4–7 cm, transition 8–10 cm), second (full dilation to birth), third (birth to placenta), fourth (first 1–2 hr postpartum).

Fetal heart rate normal range 110–160 bpm; late decelerations indicate uteroplacental insufficiency; variable decelerations indicate cord compression.

Postpartum haemorrhage: blood loss >500 mL after vaginal birth or >1000 mL after caesarean; uterine atony is the most common cause.

APGAR: Appearance, Pulse, Grimace, Activity, Respiration; scored 0–2 each at 1 and 5 minutes; score ≥7 is generally reassuring.

Newborn vital signs: heart rate 120–160/min; respirations 30–60/min; temperature 36.5–37.5 °C axillary.

Paediatric weight-based dosing: always verify mg/kg and maximum dose; use a calibrated measuring device, not household spoons.

Breastfeeding: feed on demand, 8–12 times per 24 hr; adequate output ≥6 wet diapers/day after day 5.

Pregnancy warning signs: vaginal bleeding, severe headache, visual changes, epigastric pain, decreased fetal movement - report immediately.

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

Suicide risk assessment: ask directly about ideation, plan, means, and intent; do not leave a high-risk patient alone; remove means.

Depression: assess for anhedonia, sleep change, appetite change, hopelessness, and psychomotor retardation; monitor for suicidal ideation as energy returns.

Mania: set firm limits, reduce stimulation, provide high-calorie finger foods, monitor for exhaustion and dehydration.

Schizophrenia: assess for auditory hallucinations and delusions; respond to the feeling, not the content; do not argue with delusions.

Anxiety: use calm presence, breathing techniques, and grounding; panic attacks peak within 10 minutes and resolve.

Neuroleptic malignant syndrome: fever, rigidity, altered mental status, autonomic instability; stop antipsychotic and notify provider.

Serotonin syndrome: agitation, hyperthermia, clonus, hyperreflexia; often triggered by combining serotonergic agents.

Chemical restraint: only for imminent danger, requires a provider order, time limit, and frequent monitoring per policy and law.

Levels of prevention: primary (immunisation, health education), secondary (screening, early detection), tertiary (rehabilitation, chronic disease management).

Incidence = new cases in a period ÷ population at risk; prevalence = all existing cases ÷ total population.

Attack rate = number of new cases ÷ population at risk during an outbreak, expressed as a percentage.

Herd immunity threshold depends on R0; for measles R0 ≈12–18, requiring very high vaccination coverage (≈92–95%).

Notifiable disease reporting: report to local public health authority within the timeframe set by regulation; do not wait for lab confirmation if suspected.

Community assessment: windshield survey, key informant interviews, demographic and morbidity data, and asset mapping.

Home visit safety: plan route, carry phone, assess environment, and document findings; maintain professional boundaries.

Screening criteria: condition must be important, have a detectable early stage, acceptable test, and effective early treatment.

Age-related changes: decreased renal clearance, decreased hepatic metabolism, decreased lean body mass, and increased body fat alter drug action.

Delirium vs dementia: delirium has acute onset, fluctuating course, and altered attention; dementia is chronic and progressive.

Fall risk tools (e.g., Morse, Hendrich) guide interventions: bed alarm, non-skid footwear, toileting schedule, and review of sedatives.

Polypharmacy: review medications regularly; Beers criteria list potentially inappropriate drugs for older adults.

Pressure injury prevention: reposition every 2 hours, use pressure-redistributing surfaces, keep skin clean and dry, and optimise nutrition.

Rehabilitation: promote independence in ADLs, use assistive devices, and set realistic, patient-centred goals.

Urinary incontinence: rule out infection, constipation, and medications; timed voiding and pelvic floor exercises are first-line.

Osteoporosis: weight-bearing exercise, calcium and vitamin D, fall prevention, and bone density screening.

Five rights: right patient, right drug, right dose, right route, right time; add right documentation and right reason per policy.

High-alert medications (insulin, heparin, opioids, potassium chloride) require independent double-check and standard concentrations.

Digoxin: therapeutic range 0.5–2 ng/mL; monitor for bradycardia, nausea, visual changes (yellow-green halos); hold if apical pulse <60/min.

Warfarin: monitor INR, target usually 2–3; antidote vitamin K; heparin antidote protamine sulfate.

Opioid adverse effects: respiratory depression, constipation, sedation; naloxone reverses opioid toxicity.

Aminoglycosides (gentamicin): monitor peak and trough levels, renal function, and hearing; nephrotoxic and ototoxic.

Vancomycin: monitor trough levels and renal function; infuse over at least 60 minutes to avoid red man syndrome.

Medication errors: report via incident system, assess patient, notify provider, and document objectively; do not alter records.

Scope of practice: the nurse performs only tasks authorised by law, regulation, and employer policy; delegation requires competence and supervision.

Negligence elements: duty, breach, causation, and damages; documentation is the primary legal record.

Confidentiality: disclose patient information only on a need-to-know basis or as required by law; breach may lead to disciplinary action.

Informed consent: the provider obtains consent; the nurse verifies understanding and witnesses the signature.

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

Standard precautions apply to all patients: hand hygiene, gloves, gown, mask, eye protection based on anticipated exposure.

Transmission-based precautions: contact (MRSA, C. difficile), droplet (influenza, pertussis), airborne (TB, measles, varicella) with N95 and negative-pressure room.

Needlestick injury: wash with soap and water, report immediately, and follow post-exposure prophylaxis protocol.

Notifiable diseases and outbreak reporting are legal duties; failure to report may result in penalties.