Medical-Surgical Nursing
This section examines adult medical and surgical nursing: cardiovascular, respiratory, endocrine, renal, neurological and perioperative care. Items typically test priority assessment, drug safety and recognition of complications.
Core rules
- Acute coronary syndrome: 12-lead ECG within 10 minutes; aspirin 300 mg chewed unless contraindicated; nitroglycerin for ongoing pain; oxygen only if SpO₂ <90% or breathless.
- COPD: target SpO₂ 88–92% in patients at risk of CO₂ retention; teach pursed-lip breathing and controlled oxygen.
- Diabetes: hypoglycaemia (glucose <70 mg/dL) causes sweating, tremor and confusion; treat with 15 g fast carbohydrate if conscious. DKA causes polyuria, vomiting, Kussmaul breathing and ketones.
- Post-operative: airway, breathing, circulation, wound, drains and urine output; early ambulation and compression for DVT prophylaxis.
Worked example
A man has central chest pain and ST elevation on ECG. The nurse gives aspirin 300 mg chewed, applies oxygen only because SpO₂ is 88%, administers sublingual nitrate, and prepares for primary PCI. Reasoning: reperfusion is time-critical; aspirin reduces mortality; routine oxygen in normoxaemic patients is not recommended.
Traps
Giving high-flow oxygen routinely in COPD; mixing DKA with hyperosmolar hyperglycaemic state; ignoring a falling urine output; stopping aspirin because of minor bruising.