OSCE Profesi Ners cheat sheet

Autonomy requires informed consent: disclosure of risks, benefits, alternatives, and the right to refuse; consent from a minor or unconscious adult without proxy is invalid.

Beneficence = act in the patient's best interest; nonmaleficence = avoid harm (primum non nocere); these can conflict when a beneficial treatment carries high risk.

Veracity obliges truthful disclosure; therapeutic privilege to withhold information is narrowly justified and must be documented and discussed with the team.

Confidentiality exceptions: statutory reporting (communicable disease, gunshot wounds, child/elder abuse), court order, and imminent serious harm to self or others.

Negligence elements that must all be proven: duty of care, breach of standard, causation, and actual damages; res ipsa loquitur shifts the burden when the injury could not occur without negligence.

Nursing documentation standard: record in real time, objectively, chronologically; late entries labeled as such; never alter or destroy a record - spoliation supports liability.

Scope of practice is set by nurse practice act (statute), board regulations, institutional policy, and individual competence; delegation to unlicensed assistive personnel requires predictable outcome and no ongoing assessment need.

Advocacy triggers: unsafe staffing, impaired colleague, medication error, patient refusal of care - escalate through chain of command and document the escalation.

ABCDE primary survey order: Airway, Breathing, Circulation, Disability (GCS/pupils/glucose), Exposure; reassess after every intervention.

GCS = eye (1-4) + verbal (1-5) + motor (1-6); range 3-15; score ≤8 indicates need to assess airway protection.

qSOFA (1 point each): respiratory rate ≥22/min, systolic BP ≤100 mmHg, altered mentation; ≥2 points flags high risk in suspected sepsis.

Vital sign red flags: RR >30 or <8, SpO2 <90% on room air, SBP <90 or MAP <65, HR >130, temperature >39 °C or <36 °C, urine output <0.5 mL/kg/h.

Nursing process is cyclic: assessment → diagnosis (NANDA-I) → planning (SMART outcomes) → implementation → evaluation; reassessment restarts the cycle.

Pain assessment tool by population: numeric rating scale for adults, Wong-Baker FACES or FLACC for children, PAINAD or Abbey for advanced dementia.

Focused cardiovascular assessment: inspect JVP at 45°, auscultate S1/S2 at aortic, pulmonic, tricuspid, mitral sites; murmur timing (systolic vs diastolic) guides urgency.

Cranial nerve quick screen: II visual acuity, III/IV/VI eye movements, VII facial symmetry, IX/X swallow and gag, XII tongue midline.

WHO 5 Moments for hand hygiene: before patient contact, before aseptic task, after body fluid exposure risk, after patient contact, after contact with patient surroundings.

Alcohol-based rub is first choice for non-soiled hands; soap and water is required for visible soiling and for spore-forming organisms such as Clostridioides difficile.

Donning order: gown → mask/respirator → goggles/face shield → gloves; doffing order: gloves → goggles → gown → mask; hand hygiene after glove removal.

N95/FFP2 respirator is required for airborne precautions (tuberculosis, measles, varicella); surgical mask for droplet (influenza, pertussis, meningococcus).

Contact precautions for MRSA, VRE, ESBL/CRE, C. difficile, scabies; dedicate equipment and cohort patients when single rooms are limited.

Sterile field rule: anything below waist level, out of direct view, or touched by a non-sterile object is contaminated; 2.5 cm (1 inch) border of a sterile drape is non-sterile.

Needlestick management: wash with soap and water, do not squeeze or scrub, report immediately; HIV PEP is most effective when started within hours (ideally <2 h, up to 72 h).

Surgical site infection prevention: chlorhexidine-alcohol skin prep, maintain normothermia and normoglycemia, avoid shaving (clip if needed), timely prophylactic antibiotic within 60 min of incision.

Standard precautions apply to all patients regardless of diagnosis; PPE selection is based on anticipated exposure, not on known infection status.

Fall risk bundles: bed low and locked, call bell in reach, non-skid footwear, hourly rounding, delirium screening; Morse or Hendrich II score triggers the bundle.

Pressure injury staging: stage 1 non-blanchable erythema; stage 2 partial-thickness dermis loss; stage 3 full-thickness to subcutaneous fat; stage 4 to fascia/bone; unstageable when eschar or slough obscures the bed.

Braden subscales: sensory perception, moisture, activity, mobility, nutrition, friction/shear; lower score = higher risk; ≤9 is very high risk.

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

Look-alike/sound-alike pairs (e.g., hydrOXYzine/hydrALAZINE, glipiZIDE/glyBURIDE) require tall-man lettering and read-back verification.

Speak-up tool: identify patient, state the concern, state the action needed, obtain agreement; escalate to supervisor if unresolved.

Restraint standards: used only for immediate safety after less restrictive measures fail, time-limited orders, face-to-face evaluation, monitoring of circulation, skin, and breathing, and documentation of alternatives tried.

Root cause analysis focuses on system factors (latent conditions) rather than individual blame; just culture distinguishes human error, at-risk behavior, and reckless behavior.

Surgical safety checklist phases: sign-in (before induction), time-out (before incision, with patient identity, site, procedure, consent), sign-out (before patient leaves the room).

Body mechanics: feet shoulder-width, bend knees not waist, load close to body, pivot rather than twist; keep the head of bed at or below 30° when turning a patient unless contraindicated.

Pressure redistribution: reposition at least every 2 hours, use a 30° lateral tilt, keep heels off the surface, and limit head-of-bed elevation to reduce shear.

Range of motion: active = patient performs; passive = nurse performs without patient effort; stop at the point of resistance or pain.

Urinary catheter care: secure tubing, keep bag below bladder and off the floor, maintain a closed system, and remove as soon as no longer indicated.

Bowel elimination aids: increase fiber and fluids, encourage mobility, and use a bedside commode or toilet rather than bedpan when the patient can sit up.

Oxygen delivery estimates: nasal cannula 1-6 L/min (24-44%), simple mask 5-10 L/min (35-55%), Venturi mask delivers a precise FiO2, non-rebreather 10-15 L/min (up to 90%).

Suctioning: pre-oxygenate, limit each pass to ≤10-15 seconds, use sterile technique for artificial airways, and allow recovery between passes.

Enteral feeding: confirm tube placement per policy (pH of aspirate, not auscultation alone), elevate head of bed 30-45°, and check residual per protocol.

Wound dressing principles: cleanse from clean to dirty, use moist wound healing for granulating wounds, and document size, depth, exudate, and periwound skin.

Rights of administration: right patient (two identifiers), drug, dose, route, time, documentation, reason, and right to refuse; verify at the bedside.

Never administer a drug prepared by someone else, and never leave medications at the bedside for later administration.

IV push rate example: undiluted push rate is determined by drug, concentration, and patient; rapid push of many drugs causes hypotension or arrhythmia.

High-alert double-check: two licensed clinicians independently verify drug, dose, concentration, pump settings, and patient identity.

Heparin-induced thrombocytopenia: platelet drop >50% or thrombosis 5-14 days after heparin; stop heparin and avoid platelet transfusions.

Digoxin: narrow therapeutic index, therapeutic level roughly 0.5-0.9 ng/mL in heart failure; toxicity signs include nausea, visual halos, and bradycardia.

Vancomycin: monitor trough (target typically 10-20 mcg/mL depending on indication) and watch for infusion reaction (red man syndrome) - slow the infusion.

Insulin: rapid-acting (lispro, aspart) peaks in 1-2 h; regular insulin peaks 2-4 h; NPH peaks 4-12 h; glargine is peakless basal insulin.

Anaphylaxis management: stop the drug, call for help, give IM epinephrine 0.3-0.5 mg (1:1000) into the anterolateral thigh, support airway, and give oxygen and fluids.

Opioid adverse effects: respiratory depression (monitor RR and sedation), constipation (prophylactic bowel regimen), and naloxone reversal.

Acute coronary syndrome: MONA is outdated; priority is aspirin, ECG within 10 minutes, troponin, and reperfusion (PCI within 90 minutes of first medical contact for STEMI).

Heart failure: assess daily weight, dyspnea, edema, and JVD; a gain of >2 kg in 3 days or >2.5 kg in a week warrants provider notification.

COPD: use controlled low-flow oxygen targeting SpO2 88-92% in patients at risk of CO2 retention; pursed-lip breathing and tripod position reduce dyspnea.

Diabetic ketoacidosis: give isotonic fluids first, then insulin infusion, and replace potassium before insulin if K+ <3.3 mmol/L.

Acute kidney injury: monitor urine output and creatinine; hyperkalemia with ECG changes (peaked T waves, widened QRS) requires calcium gluconate first.

Cirrhosis and ascites: restrict sodium, monitor for hepatic encephalopathy (asterixis, confusion), and avoid sedatives and NSAIDs.

Stroke: thrombolysis window generally ≤4.5 h from symptom onset; do not give aspirin within 24 h of thrombolytic therapy.

Postoperative care: early ambulation, incentive spirometry, and adequate analgesia prevent atelectasis and venous thromboembolism.

Fetal heart rate baseline 110-160 bpm; early decelerations mirror contractions (head compression) and are benign; late decelerations follow contractions and signal uteroplacental insufficiency.

Variable decelerations indicate cord compression: reposition to left lateral, give oxygen, stop oxytocin, and consider amnioinfusion.

Postpartum hemorrhage: cumulative blood loss ≥1000 mL or bleeding with hemodynamic instability; uterine atony is the most common cause - massage the fundus first.

Magnesium sulfate for preeclampsia: monitor respiratory rate ≥12, deep tendon reflexes, and urine output ≥30 mL/h; antidote is calcium gluconate.

HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets; right upper quadrant pain and headache are warning signs.

Newborn APGAR at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration; score 0-10; ≥7 is generally reassuring.

Newborn thermoregulation: dry and cover immediately, skin-to-skin contact, and hat; cold stress leads to hypoglycemia and respiratory distress.

Lochia progression: rubra (days 1-4), serosa (days 4-10), alba (after day 10); return to bright red bleeding suggests hemorrhage or retained tissue.

Breastfeeding: colostrum in the first days, feed on demand at least 8-12 times per day, and assess latch and audible swallowing.

Pediatric vital sign trends: respiratory rate falls with age (newborn 30-60, infant 30-53, school age 18-25); heart rate falls similarly.

Weight-based dosing: always verify the weight in kilograms; the safe dose range must be checked against a pediatric reference before administration.

Dehydration assessment: sunken fontanel, decreased skin turgor, dry mucous membranes, decreased urine output, and lethargy; ORS is first-line for mild-moderate dehydration.

Signs of respiratory distress in children: nasal flaring, grunting, retractions, head bobbing, and tripod positioning; grunting indicates severe distress.

Kawasaki disease: fever ≥5 days plus conjunctivitis, rash, strawberry tongue, cervical lymphadenopathy, and extremity changes; risk of coronary aneurysm - give IVIG and aspirin.

Intussusception: colicky pain, vomiting, and currant-jelly stools; an enema is both diagnostic and therapeutic.

Epiglottitis: drooling, tripod posture, muffled voice; do not inspect the throat or use a tongue blade without airway readiness.

Immunization schedule: live vaccines are contraindicated in severe immunocompromise; MMR and varicella are given at 12-15 months and 4-6 years in many schedules.

Therapeutic communication: use open-ended questions, reflection, clarification, and silence; avoid false reassurance, giving advice, and changing the subject.

Suicide risk assessment: ask directly about ideation, plan, intent, access to means, and prior attempts; direct questions do not increase risk.

Serotonin syndrome: agitation, hyperreflexia, clonus, hyperthermia, and tremor after serotonergic drugs; stop the offending agents and seek urgent care.

Neuroleptic malignant syndrome: rigidity, high fever, autonomic instability, and elevated CK after antipsychotics; stop the drug and treat emergently.

Lithium: narrow therapeutic index (roughly 0.6-1.2 mmol/L); monitor levels, renal function, and thyroid; dehydration and NSAIDs increase toxicity.

Clozapine requires monitoring for agranulocytosis (regular CBC) and myocarditis; report fever or sore throat immediately.

Alcohol withdrawal: use a CIWA-Ar score, give benzodiazepines, and monitor for seizures and delirium tremens; thiamine before glucose in at-risk patients.

Restraint and seclusion in psychiatry: use only for imminent danger, obtain an order, monitor closely, and debrief the patient afterward.

CPR quality: compress at 100-120/min, depth 5-6 cm, allow full recoil, minimize interruptions to <10 seconds, and change compressor every 2 minutes.

Defibrillation is indicated for VF and pulseless VT; asystole and PEA are non-shockable and treated with epinephrine and high-quality CPR.

Shock types: hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), and obstructive (tension pneumothorax, tamponade, PE).

Sepsis bundle: measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Tension pneumothorax: tracheal deviation, absent breath sounds, and hypotension - needle decompression before imaging.

Mass casualty triage (START): immediate (red), delayed (yellow), minor (green), expectant/deceased (black); prioritize by physiologic compromise, not by injury type.

Disaster phases: mitigation, preparedness, response, recovery; surge capacity and incident command structure guide resource allocation.

ICU delirium prevention: reorient, maintain day-night lighting, minimize restraints, promote sleep, and involve family.

SBAR: Situation, Background, Assessment, Recommendation; use it for handoffs and escalation calls.

Closed-loop communication: sender gives an instruction, receiver repeats it back, sender confirms; used in emergencies and high-risk procedures.

Handoff standard: use I-PASS or SBAR, include allergies, code status, and pending results, and allow the receiver to ask questions.

Read-back is required for verbal or telephone orders and critical lab values; the receiver writes the order and reads it back for confirmation.

Conflict resolution: address behavior, not personality; use 'I' statements, focus on patient safety, and escalate to a supervisor when unresolved.

Interpreter use: use a trained medical interpreter, not a family member, for consent, bad news, and complex teaching; document the interpreter's identifier.

Health literacy: use teach-back, plain language, and limit to 3-5 key points per session; confirm understanding by asking the patient to explain in their own words.

Documentation of communication: record who was notified, when, what was communicated, and the response.