Israel RN Licensure Exam cheat sheet

Heart failure exacerbation: assess orthopnea, JVD, lung crackles, weight gain >2 kg in 3 days; sit upright, oxygen, loop diuretic, daily weights.

Acute COPD exacerbation: controlled low-flow oxygen targeting SpO2 88-92% in known CO2 retainers; monitor drowsiness as hypercapnia sign.

Diabetic ketoacidosis: pH <7.30, bicarbonate <18, ketones positive, anion gap >12; isotonic saline first, then insulin infusion, potassium replacement when K <5.5.

Hypoglycemia in a conscious patient: 15-20 g fast carbohydrate, recheck glucose in 15 minutes; if unconscious, IV glucose or IM glucagon.

Acute ischemic stroke: last-known-well time drives eligibility; IV thrombolysis window generally up to 4.5 hours; keep glucose 140-180 mg/dL and treat fever.

Upper GI bleed: two large-bore IVs, crystalloid, type and crossmatch, PPI infusion; watch for hematemesis, melena, and orthostatic hypotension.

Cirrhosis with ascites: paracentesis >5 L requires albumin replacement to prevent circulatory dysfunction; restrict sodium, monitor daily weight and abdominal girth.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia; monitor for infection and thromboembolism.

Preoperative fasting: clear fluids typically 2 hours, breast milk 4 hours, light meal 6 hours before anesthesia; document actual intake times.

Malignant hyperthermia: rising end-tidal CO2, masseter rigidity, tachycardia, hyperthermia; stop triggering agents, give dantrolene 2.5 mg/kg IV, cool actively.

Postoperative hypoxemia and atelectasis: incentive spirometry, early ambulation, head-of-bed elevation; watch for tachypnea, falling SpO2, and fever.

Anastomotic leak signs: tachycardia, fever, abdominal pain, peritonitis, rising CRP or WBC; escalate urgently rather than attributing to normal postoperative pain.

Wound dehiscence or evisceration: cover with sterile saline-soaked gauze, position supine with knees flexed, keep NPO, prepare for return to theater.

Postoperative hemorrhage: tachycardia and narrowing pulse pressure precede hypotension; check drains, dressings, and serial hemoglobin.

Venous thromboembolism prophylaxis: early mobilization, graduated compression, and pharmacologic prophylaxis per risk; assess bleeding risk before anticoagulation.

Surgical site infection prevention: chlorhexidine-alcohol skin prep, appropriate antibiotic timing within 60 minutes of incision, normothermia, and glucose control.

Postpartum hemorrhage: cumulative blood loss >1000 mL or signs of hypovolemia within 24 hours; uterine massage, oxytocin, tranexamic acid, and escalate to balloon or surgery.

Preeclampsia with severe features: BP >=160/110, platelets <100,000, liver enzymes elevated, creatinine rising, pulmonary edema, or neurologic symptoms; magnesium sulfate for seizure prophylaxis.

Magnesium sulfate toxicity: loss of deep tendon reflexes, respiratory depression, oliguria; stop infusion, give calcium gluconate 1 g IV, monitor reflexes and urine output.

Fetal heart rate category III: absent variability with recurrent late or variable decelerations, or bradycardia; intrauterine resuscitation and urgent obstetric review.

Active third stage: prophylactic oxytocin reduces hemorrhage; assess uterine tone, lochia, and bladder distension every 15 minutes in the first hour.

Neonatal jaundice: bilirubin plotted against age in hours; phototherapy thresholds vary by gestational age, weight, and risk factors; assess feeding and hydration.

Neonatal resuscitation: warm, dry, stimulate, clear airway if needed; positive pressure ventilation if apnea or heart rate <100 after initial steps.

Breastfeeding support: skin-to-skin contact, frequent feeding 8-12 times per day, correct latch assessed by wide mouth and pain-free suckling.

Pediatric vital signs change with age: infant respiratory rate 30-53, toddler 22-37, school age 18-25; hypotension is a late sign of shock in children.

Dehydration classification: mild <5% weight loss, moderate 5-10%, severe >10%; use oral rehydration solution for mild-moderate, IV isotonic fluid for severe.

Maintenance fluid: Holliday-Segar 4-2-1 rule - 4 mL/kg/h first 10 kg, 2 mL/kg/h next 10 kg, 1 mL/kg/h thereafter.

Croup: barking cough, inspiratory stridor; dexamethasone and nebulized epinephrine for moderate-severe; keep child calm and upright.

Epiglottitis: drooling, tripod posture, muffled voice, high fever; do not inspect the throat, keep child calm, prepare for controlled airway.

Kawasaki disease: fever >=5 days plus conjunctivitis, rash, mucosal changes, extremity changes, cervical lymphadenopathy; IVIG and aspirin to prevent coronary aneurysm.

Pyloric stenosis: projectile nonbilious vomiting at 3-6 weeks, visible peristalsis, hypochloremic hypokalemic metabolic alkalosis; correct electrolytes before surgery.

Pediatric pain assessment: use FLACC for young or nonverbal children, Wong-Baker FACES for school age, numeric scale for older children.

Serotonin syndrome: clonus, hyperreflexia, agitation, hyperthermia after serotonergic drugs; stop offending agents and give supportive care or cyproheptadine.

Neuroleptic malignant syndrome: rigidity, high fever, altered consciousness, autonomic instability, elevated creatine kinase; stop antipsychotic and give dantrolene or bromocriptine.

Delirium tremens: tremor, hallucinations, seizures, autonomic hyperactivity 48-96 hours after alcohol cessation; benzodiazepines and thiamine before glucose.

Acute dystonia: sustained muscle spasm, often neck or eyes, after dopamine-blocking drugs; treat with anticholinergic such as benztropine or diphenhydramine.

Suicide risk assessment: direct questioning about ideation, plan, means, and intent; means restriction and safety planning reduce risk.

Lithium toxicity: tremor, ataxia, vomiting, confusion; levels >1.5 mEq/L are concerning; monitor renal function, sodium, and hydration.

Anorexia nervosa: refeeding syndrome risk with hypophosphatemia, hypokalemia, hypomagnesemia; start low-calorie and monitor electrolytes.

Therapeutic communication: use open questions and reflection; avoid false reassurance, advice-giving, and why-questions that imply judgment.

Delirium versus dementia: delirium has acute onset, fluctuating attention, and altered consciousness; dementia is chronic and progressive with preserved consciousness until late.

Fall risk: orthostatic hypotension, polypharmacy, vision, footwear, and environment; assess blood pressure lying and standing and review sedatives.

Beers criteria: avoid benzodiazepines, anticholinergics, and long-acting sulfonylureas in older adults when safer alternatives exist.

Pressure injury staging: stage 1 nonblanchable erythema, stage 2 partial-thickness loss, stage 3 full-thickness loss, stage 4 exposed bone, tendon, or muscle.

Urinary incontinence: distinguish stress, urge, overflow, and functional types; rule out infection, constipation, and medication effects before labeling.

Elder abuse screening: ask directly about safety, finances, and being hurt; report per mandatory reporting rules and document findings objectively.

Home care medication safety: use pill organizers, reconcile at each transition, and assess vision, dexterity, and caregiver support.

Nutrition in older adults: unintentional weight loss >5% in 1 month warrants assessment for dysphagia, depression, dental problems, and malignancy.

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

Anaphylaxis: IM epinephrine 0.3-0.5 mg (1 mg/mL) into the anterolateral thigh, repeat every 5-15 minutes; fluids and adjuncts follow epinephrine.

Acute coronary syndrome: aspirin 300 mg chewed, ECG within 10 minutes, troponin, and reperfusion within 90 minutes for STEMI at a PCI center.

Acute respiratory distress syndrome: low tidal volume 6 mL/kg predicted body weight, plateau pressure <=30 cmH2O, prone positioning for severe hypoxemia.

Ventilator alarm: high-pressure alarm suggests obstruction, secretions, or bronchospasm; low-pressure alarm suggests disconnection or leak.

Vasopressor choice: norepinephrine first-line for septic shock; add vasopressin or epinephrine for refractory shock; ensure adequate volume first.

Traumatic brain injury: maintain systolic BP >=110 mmHg, avoid hypoxia, keep head neutral, and monitor for pupillary changes and decreased consciousness.

Cardiac arrest: high-quality compressions 100-120 per minute, depth 5-6 cm, minimize interruptions, and defibrillate shockable rhythms promptly.

High-alert medications include insulin, heparin, opioids, and concentrated electrolytes; use independent double checks and standardized concentrations.

Warfarin: monitor INR, target usually 2-3; vitamin K reverses effect; major bleeding requires prothrombin complex concentrate plus vitamin K.

Heparin-induced thrombocytopenia: platelet drop >50% or thrombosis 5-10 days after exposure; stop heparin and use a non-heparin anticoagulant.

Digoxin toxicity: nausea, visual changes, bradycardia, arrhythmias; risk rises with hypokalemia, renal impairment, and drug interactions.

Aminoglycosides: nephrotoxicity and ototoxicity; monitor trough levels, creatinine, and duration; adjust dose in renal impairment.

Opioid safety: assess sedation and respiratory rate before and after dose; naloxone reverses respiratory depression; co-prescribe laxatives.

Antibiotic stewardship: match culture and sensitivity, avoid unnecessary broad-spectrum agents, and document indication and planned duration.

Medication reconciliation at every transition: compare preadmission list, discharge prescriptions, and patient understanding to prevent discrepancies.

The Israeli Nurses' Union and the Ministry of Health set scope of practice and licensure requirements; the license must be renewed periodically per ministry rules.

Informed consent requires capacity, disclosure of material risks and alternatives, and voluntariness; document the discussion and the patient's decision.

Confidentiality is a legal duty; disclosure without consent is permitted only where statute requires, such as mandatory reporting of certain infectious diseases or abuse.

Patient autonomy: a competent adult may refuse treatment, including life-sustaining treatment; document refusal and ensure the patient understands consequences.

Advance directives and a durable power of attorney allow a patient to designate a decision-maker and record treatment preferences in advance.

Mandatory reporting in Israel includes suspected child abuse, elder abuse, and certain notifiable infectious diseases; follow ministry and hospital protocol.

Nursing documentation is a legal record: record objectively, contemporaneously, sign, and never alter a record after the fact without proper correction procedure.

Delegation and supervision: a nurse remains accountable for tasks delegated to unlicensed staff; verify competence and follow scope-of-practice rules.

Hand hygiene: five moments - before patient contact, before aseptic task, after body fluid exposure, after patient contact, and after touching patient surroundings.

Standard precautions apply to all patients: gloves, gown, mask, eye protection based on exposure risk, and safe sharps handling.

Contact precautions for MRSA, VRE, C. difficile, and scabies; use gown and gloves, dedicate equipment, and clean environment.

Airborne precautions for tuberculosis, measles, and varicella: fit-tested N95 or equivalent, negative-pressure room, and door closed.

Droplet precautions for influenza, pertussis, and meningococcal disease: surgical mask and spatial separation; patient mask during transport.

Central line-associated bloodstream infection prevention: hand hygiene, maximal sterile barrier, chlorhexidine skin antisepsis, and daily review of line necessity.

Catheter-associated urinary tract infection prevention: avoid unnecessary catheters, maintain closed drainage, and remove as soon as possible.

Needlestick injury: wash with soap and water, report immediately, and follow post-exposure prophylaxis protocol for HIV, hepatitis B, and hepatitis C.

Root cause analysis is a structured retrospective review of a serious safety event; it identifies system failures rather than individual blame.

Failure mode and effects analysis is proactive: identify steps, score severity, occurrence, and detection, and prioritize high-risk processes.

SBAR handoff: situation, background, assessment, recommendation; include allergies, code status, and pending results.

Speak-up and just culture: staff are encouraged to report errors and near misses without fear; reckless behavior is still addressed.

Fall prevention bundle: risk assessment on admission and after change, bed brakes, low bed, call bell in reach, and hourly rounding.

Pressure injury prevention: repositioning, support surfaces, moisture management, nutrition, and skin inspection at each shift.

Medication error reporting: report all errors and near misses through the incident system, disclose to the patient, and analyze for system causes.

Quality indicators include falls with injury, hospital-acquired pressure injuries, central line infections, catheter-associated infections, and medication errors.