Iran Nursing Competency Exam cheat sheet

Vital sign reference ranges for adults: oral temperature 36.5–37.5 °C, pulse 60–100/min, respirations 12–20/min, blood pressure <120/80 mmHg, SpO2 ≥95% on room air.

Normal adult urine output is 0.5–1 mL/kg/h (about 30 mL/h); output below 0.5 mL/kg/h for 2 consecutive hours signals oliguria and possible hypovolemia or renal injury.

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

Intramuscular injection sites and maximum volumes: ventrogluteal is preferred for adults (up to 3 mL); deltoid is limited to 1 mL; dorsogluteal is avoided because of sciatic nerve risk.

Pressure injury staging: Stage 1 intact skin with non-blanchable erythema; Stage 2 partial-thickness loss with exposed dermis; Stage 3 full-thickness loss with visible fat; Stage 4 full-thickness loss exposing fascia, muscle, tendon, or bone.

Nasogastric tube placement verification: aspirate gastric pH ≤5.5 supports gastric placement; auscultating injected air is unreliable and is not a recommended confirmation method.

Fowler position is 45–60° head-of-bed elevation; semi-Fowler is 30–45°; Trendelenburg places the head lower than the feet and is used for hypotension and central line placement.

Wound healing phases: hemostasis (minutes to hours), inflammatory (days 1–4), proliferative (days 4–21), and maturation/remodeling (3 weeks to 1 year or more).

Intake-output documentation rule: record all oral, enteral, parenteral, and irrigant intake against urine, emesis, drainage, and insensible losses; report a net negative balance with weight loss or tachycardia.

Acute myocardial infarction: ST-elevation MI requires reperfusion - primary PCI within 90 minutes of first medical contact when available; aspirin 300 mg chewed is given unless contraindicated.

Heart failure with reduced ejection fraction (HFrEF) is EF ≤40%; guideline-directed therapy includes ACE inhibitors or ARBs/ARNI, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors.

Diabetic ketoacidosis: pH <7.30, bicarbonate <18 mEq/L, glucose >250 mg/dL, and positive ketones; treatment is IV isotonic saline, insulin infusion, and potassium replacement once K+ <5.5 mEq/L.

Hyperkalemia ECG progression: peaked T waves, prolonged PR interval, widened QRS, sine wave; IV calcium gluconate stabilizes the myocardium, insulin with glucose and beta-2 agonists shift potassium intracellularly.

Chronic kidney disease stages by GFR (mL/min/1.73 m²): G1 ≥90, G2 60–89, G3a 45–59, G3b 30–44, G4 15–29, G5 <15 (kidney failure).

Stroke: alteplase window is up to 4.5 hours from last known well; blood pressure must be <185/110 mmHg before thrombolysis and kept <180/105 mmHg for 24 hours after.

Postoperative care: early ambulation and incentive spirometry reduce atelectasis and venous thromboembolism; opioid-induced respiratory depression presents with sedation and respiratory rate <10/min.

Cirrhosis complications: ascites, spontaneous bacterial peritonitis (ascitic fluid neutrophils >250/mm³), esophageal varices, hepatic encephalopathy (lactulose titrated to 2–3 soft stools/day), and hepatorenal syndrome.

Asthma severity control: short-acting beta-2 agonist use more than twice weekly, nighttime symptoms, or frequent exacerbations indicate poor control; inhaled corticosteroid is the cornerstone controller therapy.

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

Normal labor stages: first stage from onset of regular contractions to full cervical dilation (10 cm); second stage from full dilation to birth; third stage from birth to placental delivery (usually ≤30 minutes); fourth stage is the first 1–2 hours postpartum.

Fetal heart rate baseline is 110–160 beats/min; late decelerations indicate uteroplacental insufficiency and require repositioning, oxygen, IV fluid bolus, and stopping oxytocin.

Postpartum hemorrhage is blood loss ≥500 mL after vaginal birth or ≥1000 mL after cesarean birth, or any loss causing hemodynamic instability; uterine atony is the most common cause.

Preeclampsia is new hypertension ≥140/90 mmHg after 20 weeks with proteinuria or end-organ dysfunction; magnesium sulfate is given for seizure prophylaxis with monitoring of reflexes, respirations, and urine output.

Normal newborn parameters: birth weight 2500–4000 g, length 45–55 cm, head circumference 33–35 cm, heart rate 120–160/min, respirations 30–60/min, axillary temperature 36.5–37.5 °C.

Apgar score is assessed at 1 and 5 minutes across five components (heart rate, respiratory effort, muscle tone, reflex irritability, color), each scored 0–2 for a maximum of 10.

Breastfeeding: colostrum is produced in the first 2–3 days; exclusive breastfeeding is recommended for the first 6 months, with on-demand feeding 8–12 times per 24 hours in the newborn period.

Lochia progression: rubra (red, days 1–3), serosa (pink-brown, days 4–10), alba (white-yellow, days 10–14 or longer); return to bright red bleeding with clots suggests secondary hemorrhage.

Pediatric vital signs vary by age: newborn heart rate 100–160/min and respirations 30–60/min; by school age heart rate 70–110/min and respirations 18–25/min; systolic BP rises with age.

Pediatric weight estimation for emergency dosing: 1–12 months = (age in months + 9)/2 kg; 1–5 years = 2 × (age in years + 5) kg.

Maintenance IV fluid by Holliday-Segar method: 100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day for each kg above 20.

Dehydration classification in children: mild <5% weight loss, moderate 5–10%, severe >10% with lethargy, sunken eyes, and delayed capillary refill; isotonic saline 20 mL/kg bolus is initial therapy for shock.

Bronchiolitis in infants under 2 years is most often caused by respiratory syncytial virus; treatment is supportive - hydration, oxygenation, and nasal suctioning; routine bronchodilators and corticosteroids are not recommended.

Kawasaki disease: fever ≥5 days plus conjunctivitis, oral changes, rash, extremity changes, and cervical lymphadenopathy; IV immunoglobulin and aspirin prevent coronary artery aneurysms.

Intussusception presents at 3 months to 3 years with colicky pain, vomiting, and red currant jelly stool; air or contrast enema is both diagnostic and therapeutic.

Infant immunization schedule: BCG and hepatitis B at birth; DTaP, IPV, Hib, and pneumococcal series begin at 2 months; MMR and varicella at 12–15 months.

Pediatric pain and medication safety: weight-based dosing in mg/kg is mandatory; codeine and tramadol are contraindicated in children under 12 years due to respiratory depression risk.

Therapeutic communication techniques include open-ended questions, reflection, restating, clarification, and silence; non-therapeutic techniques include giving advice, false reassurance, and changing the subject.

Serotonin syndrome triad: mental status change, autonomic hyperactivity, and neuromuscular abnormalities (clonus, hyperreflexia); it occurs with serotonergic drug combinations.

Neuroleptic malignant syndrome: rigidity, hyperthermia >38 °C, autonomic instability, and elevated creatine kinase; treatment is stopping the antipsychotic, dantrolene or bromocriptine, and supportive care.

Lithium therapeutic range is 0.6–1.2 mEq/L; toxicity signs include tremor, vomiting, diarrhea, ataxia, and confusion; dehydration and NSAIDs increase lithium levels.

Alcohol withdrawal: symptoms begin 6–24 hours after the last drink; benzodiazepines are first-line; monitor for delirium tremens (24–72 hours) with tachycardia, fever, and hallucinations.

Suicide risk assessment: highest risk is associated with a specific plan, prior attempt, access to lethal means, hopelessness, and recent loss; ask directly about suicidal ideation.

Anorexia nervosa medical complications: bradycardia, hypotension, hypothermia, lanugo, amenorrhea, electrolyte disturbances, and refeeding syndrome risk with rapid caloric increase.

Mental status examination domains: appearance, behavior, speech, mood and affect, thought process and content, perception, cognition, insight, and judgment.

Basic life support sequence for adults: check responsiveness and breathing, activate emergency response, start chest compressions at 100–120/min with depth 5–6 cm, compression-to-ventilation ratio 30:2, and use an AED as soon as available.

Sepsis-3 definition: suspected infection with organ dysfunction reflected by a SOFA score increase of ≥2; septic shock is sepsis with vasopressor need to keep MAP ≥65 mmHg and lactate >2 mmol/L despite fluid resuscitation.

Sepsis bundle first hour: measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics, begin 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, and apply vasopressors for MAP <65 mmHg.

Anaphylaxis: intramuscular epinephrine 0.3–0.5 mg (1:1000) into the anterolateral thigh, repeated every 5–15 minutes; adjuncts are oxygen, IV fluids, and adjunct antihistamines or steroids.

Tension pneumothorax: unilateral absent breath sounds, distended neck veins, tracheal deviation, and hypotension; immediate needle decompression is required before imaging.

Mechanical ventilation basics: tidal volume 6–8 mL/kg of predicted body weight; plateau pressure goal <30 cmH2O; permissive hypercapnia is accepted in acute respiratory distress syndrome.

Vasoactive infusions: norepinephrine is first-line for septic shock; dopamine and dobutamine are inotropes; central administration is preferred and extravasation requires prompt phentolamine or local infiltration per protocol.

Glasgow Coma Scale: eye opening 1–4, verbal response 1–5, motor response 1–6; total 3–15; score ≤8 indicates severe brain injury and need to assess airway protection.

Mass casualty triage: red (immediate, life-threatening but salvageable), yellow (delayed, serious but stable), green (minor, walking wounded), black (deceased or expectant).

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

Incidence is new cases over a period divided by the population at risk; prevalence is all existing cases at a point in time divided by the total population.

Relative risk = incidence in exposed / incidence in unexposed; attributable risk = incidence in exposed minus incidence in unexposed.

Herd immunity threshold depends on basic reproduction number: threshold = 1 − 1/R0; measles with R0 of 12–18 requires roughly 92–95% coverage.

Screening test properties: sensitivity = true positives / all diseased; specificity = true negatives / all non-diseased; positive predictive value depends on prevalence.

Notifiable disease reporting requires timely notification to public health authorities; contact tracing and isolation or quarantine are core containment measures.

Home visit priorities: assess safety, medication adherence, family support, environmental hazards, and caregiver burden; document a care plan with measurable goals.

Community health needs assessment steps: define the population, collect data, analyze and prioritize, plan interventions, implement, and evaluate with measurable indicators.

Core ethical principles: autonomy (respect for the patient's choices), beneficence (act for the patient's good), nonmaleficence (do no harm), justice (fair distribution), and veracity (truthfulness).

Informed consent requires capacity, disclosure of risks and benefits and alternatives, understanding, and voluntariness; the nurse's role is to verify and witness, not to obtain consent for a procedure the provider must explain.

The nurse's duty to advocate requires reporting unsafe practice, medication errors, and suspected abuse to the appropriate authority; whistleblower protections exist for good-faith reports.

Confidentiality is limited by legal exceptions: mandatory reporting of communicable disease, suspected child or elder abuse, and imminent risk of serious harm to self or others.

Negligence requires four elements: duty, breach of duty, causation, and damages; documentation made contemporaneously is the strongest evidence of care delivered.

Do-not-resuscitate orders require physician authorization and patient or surrogate consent; a DNR order does not limit comfort care, nutrition, or other treatments.

Scope of practice: tasks outside the nurse's authorized scope require delegation to a qualified provider; the nurse remains accountable for assessments, teaching, and evaluation.

Ethical decision frameworks: identify the dilemma, gather facts, identify stakeholders, apply principles, consider alternatives, decide, act, and evaluate the outcome.

Five stages of the nursing process as a management framework: assessment, diagnosis, planning, implementation, and evaluation; delegation follows the same cycle with supervision.

Delegation rules: the delegator retains accountability; delegate tasks that are stable and predictable to the right person with clear instructions, and evaluate outcomes.

Leadership styles: autocratic (crisis, rapid decisions), democratic (shared decision-making), laissez-faire (mature autonomous teams), and transformational (vision and empowerment).

Nursing workload metrics include nurse-to-patient ratio, patient acuity, and nursing hours per patient day; unsafe staffing is linked to adverse events and burnout.

Quality tools: PDSA (plan-do-study-act) cycles, root cause analysis for sentinel events, failure mode and effects analysis for prospective risk, and control charts for monitoring variation.

Health policy levels: national legislation and regulation, ministry of health standards, professional council licensure, and institutional policies; nurses influence policy through professional associations and evidence-based advocacy.

Conflict resolution modes: avoiding, accommodating, competing, compromising, and collaborating; collaboration is preferred for patient safety and team outcomes.

Budget concepts for nurse managers: fixed versus variable costs, staffing cost per unit of service, variance analysis, and cost-effectiveness of interventions.

WHO five moments for hand hygiene: before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings.

Standard precautions apply to all patients: hand hygiene, gloves, gown, mask and eye protection according to exposure risk, safe sharps handling, and safe injection practices.

Transmission-based precautions: contact for MRSA, C. difficile, and scabies; droplet for influenza, pertussis, and meningococcal disease; airborne for tuberculosis, measles, and varicella (negative-pressure room, N95 or higher respirator).

Surgical site infection prevention: administer prophylactic antibiotic within 60 minutes before incision, maintain normothermia and normoglycemia, use chlorhexidine-alcohol skin antisepsis, and remove drains and catheters as early as possible.

Catheter-associated urinary tract infection prevention: avoid unnecessary catheters, use closed drainage, keep the bag below the bladder, and review daily for removal.

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

Patient safety goals include correct patient identification with two identifiers, safe medication administration, fall prevention, pressure injury prevention, and effective handoff communication (SBAR).

Medication error reporting is non-punitive and system-focused; high-alert medications such as insulin, heparin, and concentrated electrolytes require independent double-check and standardized labeling.

Quality improvement indicators: structure, process, and outcome measures; benchmark against evidence-based standards and monitor with run charts or control charts.

Pulse oximetry reading is unreliable with poor perfusion, motion, nail polish, or dark skin pigmentation; confirm with arterial blood gas when the value is inconsistent with the patient.

Blood pressure measurement technique: patient seated with arm at heart level, cuff width about 40% of arm circumference, and two readings averaged when elevated.

Aseptic technique for wound care: clean from least to most contaminated area; sterile field must remain above waist level and out of direct sight is considered contaminated.

Enteral feeding safety: verify tube placement, elevate head of bed 30–45°, check residual per policy, and flush with water before and after medications.

Urinary catheterization: use sterile technique, lubricate, insert 7–10 cm in females and 20–25 cm in males, and secure the catheter to prevent traction.

Oxygen delivery devices: nasal cannula 1–6 L/min (24–44%), simple mask 5–8 L/min (40–60%), venturi mask precise FiO2, non-rebreather 10–15 L/min (up to 90–100%).

Specimen collection: draw blood cultures before antibiotics, use aseptic technique, and label specimens at the bedside with patient identifiers and time.

Diabetes diagnostic criteria: fasting plasma glucose ≥126 mg/dL, 2-hour OGTT ≥200 mg/dL, HbA1c ≥6.5%, or random glucose ≥200 mg/dL with symptoms; repeat testing confirms diagnosis in asymptomatic patients.

Hypoglycemia management: glucose <70 mg/dL; give 15–20 g fast-acting carbohydrate if conscious, recheck in 15 minutes, and use IV dextrose or intramuscular glucagon if unconscious.

Thyroid storm: fever, tachycardia, agitation, and altered mental status; treatment includes beta-blockade, thionamide, iodine after thionamide, and supportive care.

Acute pancreatitis: severe epigastric pain radiating to the back, elevated lipase >3 times normal; treatment is IV fluids, analgesia, early enteral nutrition, and monitoring for hypocalcemia.

Deep vein thrombosis: unilateral leg swelling and pain; anticoagulation with heparin or direct oral anticoagulant; monitor for pulmonary embolism with dyspnea, tachycardia, and hypoxemia.

Peptic ulcer bleeding: melena or hematemesis; resuscitate, give proton pump inhibitor infusion, and plan endoscopy within 24 hours for high-risk features.

Oncology emergencies: febrile neutropenia (fever with absolute neutrophil count <500/µL) needs empiric antibiotics within 1 hour; tumor lysis syndrome shows hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia.

Antepartum danger signs requiring urgent evaluation: vaginal bleeding, severe headache with visual changes, epigastric pain, decreased fetal movement, rupture of membranes, and fever.

Fetal monitoring categories: Category I is normal (baseline 110–160/min, moderate variability, no late or variable decelerations); Category III includes absent variability with recurrent late or variable decelerations or bradycardia and needs immediate action.

Gestational diabetes screening: 50-g glucose challenge at 24–28 weeks; diagnostic 75-g or 100-g OGTT with thresholds per protocol; target fasting glucose <95 mg/dL.

Group B streptococcus prophylaxis: intrapartum penicillin for colonization, previous infant with GBS disease, or unknown status with risk factors such as preterm labor or prolonged rupture of membranes ≥18 hours.

Magnesium sulfate toxicity: loss of deep tendon reflexes, respiratory depression, oliguria; antidote is IV calcium gluconate 1 g; monitor serum magnesium and urine output.

Newborn resuscitation: dry and stimulate, clear airway, and provide positive pressure ventilation if heart rate <100/min or apnea; chest compressions if heart rate <60/min after effective ventilation.

Newborn jaundice: physiologic jaundice appears after 24 hours; jaundice within 24 hours is pathologic and requires urgent bilirubin measurement and phototherapy evaluation.

Pediatric airway differences: larger head, smaller airway diameter, larger tongue relative to the mouth, and funnel-shaped larynx; head-tilt chin-lift with attention to neutral position in infants.

Pediatric cardiopulmonary arrest is usually respiratory in origin; start rescue breathing and high-quality compressions at 100–120/min with depth one-third of chest diameter.

Febrile seizures: most occur at 6 months to 5 years with temperature >38 °C; simple febrile seizure lasts <15 minutes and does not recur within 24 hours; antipyretics do not prevent recurrence.

Croup (laryngotracheobronchitis): barking cough, hoarseness, inspiratory stridor; treat with dexamethasone and nebulized epinephrine for moderate to severe symptoms.

Epiglottitis: drooling, dysphagia, distress, and high fever; do not inspect the throat or place the child supine; prepare for emergency airway management.

Failure to thrive: weight below the 3rd to 5th percentile or crossing two major percentile lines; assess feeding, growth chart trend, and family and social factors.

Child developmental milestones: sits unsupported at 6–8 months, walks at 12–15 months, uses two-word phrases at 18–24 months, and rides a tricycle at 3 years.

Major depressive disorder requires ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia; assess suicide risk at every encounter.

Antidepressant response takes 2–4 weeks; SSRIs are first-line; monitor for increased suicidality in the first weeks of treatment, especially in young people.

Schizophrenia positive symptoms: hallucinations, delusions, disorganized speech; negative symptoms: flat affect, avolition, alogia; first-line treatment is an antipsychotic with metabolic monitoring.

Bipolar mania: elevated or irritable mood, decreased need for sleep, grandiosity, pressured speech, and risky behavior; treatment includes mood stabilizers and antipsychotics.

Opioid use disorder: withdrawal symptoms include yawning, rhinorrhea, piloerection, diarrhea, and mydriasis; medication treatment with buprenorphine or methadone reduces mortality.

Restraint and seclusion: use only for imminent danger, obtain a provider order, monitor vital signs and circulation, and reassess at intervals per policy; document alternatives attempted.

Therapeutic milieu elements: safety, structure, reality orientation, limit setting, and a therapeutic relationship that maintains professional boundaries.

Advanced cardiac life support rhythms: shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia - defibrillate immediately and resume compressions; non-shockable are asystole and pulseless electrical activity - give epinephrine 1 mg every 3–5 minutes.

Post-cardiac arrest care: target temperature management, avoid hyperthermia, maintain normoglycemia, treat hypotension with fluids and vasopressors, and obtain 12-lead ECG.

Acute respiratory distress syndrome Berlin criteria: onset within 1 week, bilateral opacities, not fully explained by heart failure, and PaO2/FiO2 ≤300 mmHg with positive end-expiratory pressure ≥5 cmH2O.

Hemodynamic monitoring: central venous pressure estimates right heart filling; mean arterial pressure = (systolic + 2 × diastolic)/3; MAP ≥65 mmHg is the usual resuscitation target.

Trauma primary survey: airway with cervical spine protection, breathing, circulation with hemorrhage control, disability (neurological), and exposure with environmental control.

Burns: estimate total body surface area with the rule of nines (head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%); use Parkland formula 4 mL/kg/%TBSA of crystalloid in the first 24 hours, half in the first 8 hours.

Increased intracranial pressure: head of bed 30°, midline head position, avoid hypoxia and hypercapnia, maintain normothermia, and monitor for Cushing triad (hypertension, bradycardia, irregular respirations).

Epidemiologic study designs: cross-sectional measures prevalence; cohort measures incidence and relative risk; case-control measures odds ratio; randomized controlled trial provides the strongest causal evidence.

Outbreak investigation steps: verify the diagnosis, confirm the outbreak, define and identify cases, describe by person, place, and time, generate hypotheses, and implement control measures.

Cold chain for vaccines: most vaccines are stored at 2–8 °C; avoid freezing; monitor temperature and discard vaccines exposed to temperature excursions per protocol.

Primary health care principles: accessibility, community participation, intersectoral collaboration, appropriate technology, and equity.

Vulnerable population assessment: consider housing, income, education, food security, social support, and access to transport and insurance.

Environmental health nursing: assess water and sanitation, air quality, vector control, and occupational exposures; report clusters of illness to public health authorities.

Health education planning: assess readiness and literacy, set behavioral objectives, use teach-back, and evaluate with measurable outcomes.

Advance directives: a living will states treatment preferences; a durable power of attorney for health care designates a surrogate decision-maker; both guide care when the patient lacks capacity.

Mandatory reporting obligations typically include suspected child abuse, elder abuse, gunshot wounds, and specified communicable diseases; failure to report may carry legal and professional consequences.

Documentation standards: objective, timely, accurate, complete, and legible entries with date, time, and signature; late entries are labeled as such and never altered retrospectively.

Informed refusal: a competent patient may refuse treatment after being informed of consequences; document the discussion and ensure the patient understands the risks.

Professional licensure: practicing without a valid license or outside the authorized scope is a legal violation; continuing education and competency requirements must be met for renewal.

Patient rights include privacy, informed consent, access to records, respectful care, and the right to refuse treatment; restraints require specific justification and monitoring.

Ethical distress arises when the nurse knows the right action but institutional constraints prevent it; report through ethics committees and incident reporting systems.

Change management: unfreeze, change, refreeze (Lewin); assess readiness, identify champions, communicate the rationale, and evaluate adoption.

Performance improvement: use SMART goals (specific, measurable, achievable, relevant, time-bound) and audit against standards with feedback to staff.

Staffing and acuity: calculate nursing hours per patient day from direct and indirect care time; adjust staffing to acuity and monitor adverse events and overtime.

Incident reporting: report near misses and adverse events through a non-punitive system; analyze system causes rather than blaming individuals.

Recruitment and retention: orientation, preceptorship, shared governance, and career development reduce turnover and improve patient outcomes.

Policy advocacy: use evidence, coalitions, and professional associations; understand the legislative process and timing of public comment periods.

Nursing-sensitive indicators: falls with injury, pressure injuries, catheter-associated infections, medication errors, and patient satisfaction are linked to nursing care quality.

Isolation precautions: standard plus contact for MRSA and C. difficile (soap and water hand hygiene for C. difficile because alcohol does not kill spores); droplet for influenza; airborne for tuberculosis and measles.

Personal protective equipment sequence: don gown, mask or respirator, goggles or face shield, then gloves; remove gloves first, then goggles, gown, and mask with hand hygiene after removal.

Needlestick injury: wash with soap and water, report immediately, and follow post-exposure prophylaxis protocol; HIV PEP is most effective when started within hours.

Multidrug-resistant organism prevention: antimicrobial stewardship, hand hygiene, contact precautions, environmental cleaning, and device bundles.

Patient identification: use two identifiers (name and date of birth or medical record number) before medication administration, procedures, and blood transfusion.

Handoff communication: use SBAR (situation, background, assessment, recommendation) and read-back for verbal orders and critical results.

Root cause analysis: a structured retrospective review after a sentinel event that identifies system failures and produces an action plan with measurable follow-up.

Pain assessment tools: numeric rating scale for adults, Wong-Baker FACES for children, and PAINAD or behavioral scales for patients unable to self-report; reassess after intervention within the expected onset time.

Positioning and mobility: turn and reposition every 2 hours for immobile patients; assess skin at each turn; use mechanical lifts and gait belts to prevent staff injury.

Medication administration rights: right patient, drug, dose, route, time, documentation, reason, and response; verify allergies before administration.

Oxygen safety: post no-smoking signs, avoid petroleum products near the face, and ensure functioning equipment; humidify high-flow oxygen to prevent mucosal drying.

Bowel and bladder care: assess bowel sounds and last bowel movement; encourage fluids, fiber, and ambulation; report no bowel movement with abdominal distension and vomiting.

Vital sign changes in shock: early tachycardia and narrow pulse pressure; late hypotension, cool extremities, and decreased urine output.

Specimen labeling and transport: label at the bedside, use appropriate container and preservative, and transport within the required time and temperature.

Chronic obstructive pulmonary disease: pursed-lip breathing and controlled breathing reduce dyspnea; avoid high-flow oxygen in patients with chronic hypercapnia - target SpO2 88–92%.

Heart failure exacerbation: assess weight gain, dyspnea, orthopnea, crackles, and edema; treat with diuretics, vasodilators, and oxygen; monitor potassium and renal function.

Acute kidney injury: prerenal (hypovolemia), intrinsic (acute tubular necrosis), and postrenal (obstruction); monitor urine output, creatinine, and potassium; avoid nephrotoxins.

Liver failure: monitor for bleeding (elevated INR, low platelets), ascites, encephalopathy, and hypoglycemia; restrict protein only in severe encephalopathy per provider order.

Sepsis screening: use qSOFA (respiratory rate ≥22/min, altered mentation, systolic BP ≤100 mmHg) as a prompt for further assessment, not as a stand-alone diagnosis.

Anticoagulation safety: monitor aPTT for unfractionated heparin and INR for warfarin; know reversal agents - protamine for heparin and vitamin K plus prothrombin complex for warfarin.

Postoperative respiratory complications: incentive spirometry every 1–2 hours while awake, early ambulation, and adequate analgesia to enable deep breathing and coughing.

Labor assessment: cervical dilation, effacement, station, fetal position, and contraction frequency, duration, and intensity; rupture of membranes requires assessment of color, odor, and time.

Induction with oxytocin: monitor contraction frequency and fetal heart rate; stop the infusion for tachysystole (more than 5 contractions in 10 minutes averaged over 30 minutes) and for non-reassuring fetal status.

Cesarean birth postoperative care: monitor incision, lochia, uterine tone, vital signs, and early ambulation; assess for thrombophlebitis and infection.

Postpartum infection: endometritis presents with fever, uterine tenderness, and foul lochia; mastitis presents with a painful red breast and fever.

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

Newborn feeding cues: rooting, hand-to-mouth movements, and sucking; feed on demand and monitor weight loss - more than 10% of birth weight requires evaluation.

Postpartum depression screening: use the Edinburgh Postnatal Depression Scale; symptoms lasting more than 2 weeks with functional impairment require referral.

Pediatric medication safety: verify weight in kilograms, calculate dose in mg/kg, and use an oral syringe for liquids; never use household spoons for measuring.

Dehydration signs in children: decreased tears, dry mucous membranes, sunken fontanelle in infants, decreased urine output, and prolonged capillary refill.

Pediatric pain assessment: use age-appropriate self-report scales when possible and behavioral scales for preverbal children; involve parents in assessment.

Child abuse recognition: inconsistent history, injuries in patterns, delayed care, and fear of caregivers; report to the appropriate authority per legal mandate.

Pediatric respiratory distress signs: nasal flaring, grunting, retractions, head bobbing, and accessory muscle use; position for comfort and provide oxygen as needed.

Immunization documentation: record vaccine name, lot number, date, site, and route; provide the immunization record to the family and follow catch-up schedules.

Adolescent health: confidentiality and consent laws vary; screen for mental health, substance use, sexual health, and safety, and provide nonjudgmental counseling.

Mental health assessment includes risk of harm to self or others, substance use, medical causes of psychiatric symptoms, and social supports.

Delirium versus dementia: delirium has acute onset, fluctuating course, and impaired attention; dementia has gradual decline with relatively preserved attention in early stages.

Agitation management: use verbal de-escalation first, ensure safety of the patient and staff, and use medication and restraint only when less restrictive measures fail.

Eating disorder monitoring: assess electrolytes, vital signs, weight, and purging behaviors; refeeding syndrome risk requires gradual caloric advancement and electrolyte monitoring.

Post-traumatic stress disorder: re-experiencing, avoidance, negative cognitions and mood, and hyperarousal lasting more than 1 month; trauma-informed care avoids re-traumatization.

Substance withdrawal monitoring: alcohol and benzodiazepine withdrawal can be life-threatening; opioid withdrawal is very uncomfortable but rarely fatal.

Psychotropic medication adherence: assess side effects, health literacy, and stigma; use motivational interviewing and family involvement to improve adherence.

Airway management: predict difficult airway, prepare suction and bag-mask ventilation, and confirm endotracheal tube placement with waveform capnography and bilateral breath sounds.

Mechanical ventilation alarms: high peak pressure suggests obstruction, secretions, or decreased compliance; low pressure suggests leak or disconnection; treat the patient first, then the alarm.

Arterial blood gas interpretation: pH <7.35 is acidemia; pH >7.45 is alkalemia; check PaCO2 for respiratory cause and bicarbonate for metabolic cause; calculate compensation.

Fluid resuscitation: crystalloids are first-line; monitor for volume overload with crackles, jugular venous distension, and worsening oxygenation.

Emergency drug administration: epinephrine 1 mg IV every 3–5 minutes in cardiac arrest; amiodarone for refractory ventricular fibrillation; atropine for symptomatic bradycardia per protocol.

Rapid sequence intubation: preoxygenate, prepare suction and backup airway, administer induction and paralytic agents, and anticipate hypotension after sedation.

Crisis resource management: closed-loop communication, role clarity, and debriefing improve team performance during emergencies.

Epidemiologic measures: attack rate = new cases / population at risk during an outbreak; case fatality rate = deaths / diagnosed cases.

Screening program criteria: the condition must be important, have a detectable preclinical phase, an acceptable test, and effective early treatment.

Immunization program quality: maintain the cold chain, track coverage, follow up defaulters, and address vaccine hesitancy with clear, evidence-based communication.

Home safety assessment: falls, medication storage, fire and electrical hazards, sanitation, and access to emergency services.

Chronic disease self-management support: teach symptom monitoring, medication adherence, lifestyle modification, and when to seek care.

Maternal and child community programs: antenatal care, skilled birth attendance, postpartum visits, growth monitoring, and immunization.

Disaster preparedness: know the community emergency plan, triage principles, shelter needs, and communication channels; participate in drills.

Professional boundaries: avoid dual relationships, financial exploitation, and social media disclosure of patient information; maintain a therapeutic relationship.

Consent for minors: parental or guardian consent is usually required, with exceptions for emancipated minors and specific services such as emergency care or reproductive health per local law.

Restraint use: requires a provider order and periodic reassessment, monitoring of circulation, nutrition, hydration, and elimination; the least restrictive intervention is preferred.

Incident documentation: document facts objectively in the medical record and complete a separate incident report; do not reference the incident report in the clinical record.

Patient confidentiality and electronic records: use secure systems, log out, avoid sharing passwords, and disclose only the minimum necessary information.

Professional competence: maintain current knowledge, follow evidence-based guidelines, and participate in continuing education and peer review.

Ethical resource use: avoid unnecessary tests and treatments, consider cost and benefit, and advocate for equitable access to care.

Quality improvement models: Plan-Do-Study-Act, Six Sigma, and Lean; choose the model based on the problem and available data.

Team building: define roles, set clear goals, build trust, and give constructive feedback; psychological safety improves error reporting and learning.

Nursing informatics: use data to monitor outcomes, protect patient privacy, and support clinical decision-making with validated tools.

Health policy analysis: define the problem, identify stakeholders, assess evidence, consider political feasibility, and evaluate implementation and outcomes.

Workforce planning: project demand from population needs, retirement, and turnover; plan education, recruitment, and retention strategies.

Accreditation and standards: prepare staff for accreditation surveys by maintaining documentation, competency records, and continuous readiness.

Delegation and supervision: provide clear expectations, monitor performance, and give feedback; the nurse retains accountability for delegated care.

Surgical hand antisepsis: use an approved antiseptic for the required contact time; keep hands above elbows during the scrub and dry with a sterile towel.

Sterile field rules: sterile touches sterile; consider the field contaminated if it contacts non-sterile items, is below waist level, or is out of view.

Isolation room cleaning: use an EPA-approved disinfectant for the required contact time; C. difficile requires sporicidal agents.

Blood transfusion safety: verify patient identity and blood product with two staff, monitor vital signs before and after initiation, and stop the transfusion for a reaction.

Fall prevention: assess risk on admission and after changes, use bed alarms and low beds, keep call lights and personal items within reach, and involve the family.

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

Quality measurement: define numerator and denominator, collect data consistently, and use statistical process control to distinguish common and special cause variation.

Aseptic technique for urinary catheter insertion: use sterile gloves and equipment, clean the meatus with antiseptic, and maintain a closed drainage system.

Wound assessment: describe location, size, depth, tissue type, drainage, odor, and surrounding skin; measure with a consistent method and document.

Oxygen therapy monitoring: assess respiratory rate, effort, and SpO2; titrate to target; document the device and flow rate.

Medication administration: use two identifiers, verify allergies, check the label three times, and document immediately after administration.

Patient education: use plain language, teach-back, and written materials; assess understanding and barriers to adherence.

Restraint monitoring: check circulation, skin integrity, and vital signs at required intervals; provide range-of-motion exercises and toileting.

End-of-life care: provide comfort, manage symptoms, support the family, and respect cultural and religious preferences.

Acute coronary syndrome: obtain a 12-lead ECG within 10 minutes of arrival, give aspirin unless contraindicated, and monitor for arrhythmias and heart failure.

Hypertension emergency: severe elevation with end-organ damage requires controlled reduction of blood pressure, usually by no more than 25% in the first hour.

Pneumonia: assess oxygenation, sputum, and vital signs; start antibiotics promptly and encourage coughing and deep breathing.

Gastrointestinal bleeding: monitor vital signs, hemoglobin, and stool; resuscitate with fluids and blood products as indicated.

Thyroid surgery: monitor for hypocalcemia (tingling, positive Chvostek or Trousseau sign) and hematoma causing airway obstruction.

Total joint replacement: prevent dislocation with positioning per protocol, encourage early ambulation, and monitor for infection and venous thromboembolism.

Pain management: use multimodal analgesia, assess response, and monitor for opioid side effects such as sedation and respiratory depression.

Antepartum care schedule: monthly until 28 weeks, every 2 weeks until 36 weeks, then weekly until birth; assess blood pressure, weight, fundal height, and fetal heart rate.

Fetal movement counting: report decreased movement; use kick counts per protocol and follow up with fetal assessment.

Labor pain management: nonpharmacologic methods include breathing, position changes, and support; epidural anesthesia requires monitoring for hypotension and urinary retention.

Postpartum hemorrhage management: massage the uterus, give oxytocin, empty the bladder, and escalate to additional uterotonics and surgical intervention as needed.

Newborn screening: perform heel stick after feeding and within the recommended timeframe; document and follow up abnormal results.

Newborn infection prevention: hand hygiene, skin care, and early breastfeeding support reduce infection risk.

Postpartum family planning counseling: discuss options, effectiveness, and timing; respect patient preferences.

Pediatric resuscitation: provide effective ventilation with a bag-mask device and 100% oxygen, and use appropriate-sized equipment.

Pediatric fluid bolus: 20 mL/kg isotonic crystalloid for shock, reassess after each bolus, and monitor for hepatomegaly and pulmonary edema.

Pediatric medication administration: use the least invasive route, comfort measures, and distraction; document the dose and response.

Childhood asthma: assess severity, use a spacer with a metered-dose inhaler, and provide an asthma action plan.

Pediatric nutrition: support breastfeeding, introduce complementary foods at about 6 months, and monitor growth.

Pediatric safety: use car seats, prevent falls, and store medications and poisons out of reach.

Adolescent mental health: screen for depression and suicide risk, provide confidential support, and involve family as appropriate.

Therapeutic relationship phases: orientation, working, and termination; establish trust and boundaries and evaluate progress.

Crisis intervention: assess safety, provide support, explore coping, and plan follow-up; short-term and goal-directed.

Grief and loss: assess stage and cultural context; provide presence, listening, and referral to support services.

Anxiety management: teach relaxation and grounding techniques, and use gradual exposure with support.

Psychiatric emergency: assess for danger to self or others, provide a safe environment, and follow legal procedures for involuntary assessment.

Medication education: explain purpose, side effects, and adherence; monitor for adverse effects and drug interactions.

Community mental health: coordinate with outpatient services, support housing and employment, and reduce stigma.

Emergency assessment: primary survey (ABCDE) and secondary survey; treat life threats as they are found.

Shock management: identify type, restore perfusion, and monitor response with vital signs, urine output, and lactate.

Ventilator-associated pneumonia prevention: elevate head of bed 30–45°, oral care, and daily sedation interruption.

Sepsis: recognize early, obtain cultures, give antibiotics within 1 hour, and provide fluid resuscitation.

Trauma: control hemorrhage, immobilize the spine, and prevent hypothermia.

Cardiac arrest: high-quality compressions, early defibrillation, and post-arrest care.

Emergency preparedness: know the disaster plan, triage, and communication.

Community assessment: use data sources, key informants, and observation to identify needs and assets.

Health promotion: use the Ottawa Charter strategies - build healthy public policy, create supportive environments, strengthen community action, develop personal skills, and reorient health services.

Communicable disease control: identify, report, isolate, treat, and trace contacts.

Vaccination: follow the national schedule, maintain records, and address contraindications.

Maternal and child health: promote antenatal care, skilled birth attendance, and postnatal care.

Environmental health: assess water, sanitation, and air quality; report hazards.

Program evaluation: use process, impact, and outcome indicators.

Informed consent: ensure the patient understands the procedure, risks, benefits, and alternatives; document the discussion.

Confidentiality: protect patient information and disclose only as permitted by law.

Advocacy: speak up for patient safety and rights, and report unsafe practice.

Professional boundaries: maintain a therapeutic relationship and avoid conflicts of interest.

Legal documentation: record facts accurately and timely; do not alter records.

Mandatory reporting: report suspected abuse, neglect, and specified diseases.

Ethical decision-making: use a structured framework and consult ethics committees.

Leadership: set a vision, build trust, and empower staff; use transformational and situational styles.

Delegation: assess the task, the person, and the situation; provide clear instructions and follow up.

Quality improvement: use data to identify problems and test changes with PDSA cycles.

Staffing: match staffing to acuity and monitor outcomes.

Conflict management: address issues early, listen actively, and seek collaborative solutions.

Health policy: understand the legislative process and advocate for nursing and patient interests.

Budget: monitor costs, variance, and productivity.

Hand hygiene: use the five moments and perform hand hygiene before and after patient contact.

Standard precautions: apply to all patients; use PPE based on risk.

Transmission-based precautions: contact, droplet, and airborne; use appropriate room and PPE.

Device bundles: prevent catheter-associated infections with insertion and maintenance bundles.

Patient identification: use two identifiers before care.

Medication safety: use the rights of administration and double-check high-alert medications.

Incident reporting: report adverse events and near misses to improve systems.

Vital signs: measure and document temperature, pulse, respirations, blood pressure, and SpO2; report abnormal values.

Hygiene: provide oral care, bathing, and skin care; assess skin integrity.

Mobility: assist with ambulation, transfers, and range-of-motion exercises; use safety equipment.

Nutrition: assess intake, assist with feeding, and monitor for aspiration.

Elimination: monitor bowel and bladder function and provide appropriate care.

Rest and sleep: promote a quiet environment and manage pain.

Documentation: record assessments and interventions accurately.

Cardiac: monitor chest pain, ECG changes, and hemodynamics; administer medications per protocol.

Respiratory: assess breath sounds, oxygenation, and sputum; provide breathing exercises.

Neurological: assess level of consciousness, pupils, and motor function.

Renal: monitor urine output, creatinine, and electrolytes.

Endocrine: monitor glucose and thyroid function; manage complications.

Gastrointestinal: assess abdomen, bowel sounds, and nutrition.

Musculoskeletal: assess mobility, pain, and risk of falls.

Antenatal: assess maternal health, fetal growth, and risk factors.

Labor: monitor contractions, fetal heart rate, and progress.

Postpartum: assess uterine tone, lochia, and vital signs.

Newborn: assess breathing, temperature, feeding, and jaundice.

Breastfeeding: support latch and frequency.

Complications: recognize hemorrhage, infection, and preeclampsia.

Education: provide postpartum and newborn care teaching.

Growth and development: assess milestones and growth charts.

Vital signs: use age-appropriate ranges and equipment.

Medication: calculate weight-based doses and use safe administration.

Respiratory: assess distress and provide oxygen.

Fluids: calculate maintenance and replace deficits.

Safety: prevent injury and report abuse.

Family-centered care: involve parents and provide education.

Assessment: assess mood, thought, perception, cognition, and risk.

Therapeutic communication: use active listening and open questions.

Medication: monitor adherence and side effects.

Crisis: assess safety and provide intervention.

Milieu: maintain safety and structure.

Legal: follow involuntary admission and restraint rules.

Community: coordinate care and support recovery.

ABCDE: assess airway, breathing, circulation, disability, and exposure.

Monitoring: use vital signs, ECG, and hemodynamics.

Resuscitation: follow ACLS and BLS protocols.

Ventilation: monitor settings and complications.

Sepsis: recognize and treat early.

Trauma: control bleeding and prevent complications.

Communication: use SBAR and document.

Assessment: collect community data and identify needs.

Planning: set priorities and objectives.

Implementation: deliver programs and services.

Evaluation: measure outcomes.

Epidemiology: use rates and study designs.

Prevention: apply primary, secondary, and tertiary prevention.

Partnerships: collaborate with stakeholders.

Ethics: apply autonomy, beneficence, nonmaleficence, and justice.

Consent: ensure informed consent and document.

Confidentiality: protect privacy and disclose only as permitted.

Advocacy: report unsafe practice.

Legal: follow licensure and scope of practice.

Documentation: record accurately and timely.

Reporting: report abuse and notifiable diseases.

Planning: set goals and allocate resources.

Organizing: define roles and responsibilities.

Staffing: match staff to workload.

Directing: lead and motivate staff.

Controlling: monitor performance and quality.

Policy: advocate for health policy.

Budget: manage resources efficiently.

Hand hygiene: perform at the five moments.

PPE: use based on risk.

Isolation: apply transmission-based precautions.

Bundles: prevent device-related infections.

Safety: identify patients and prevent falls.

Medication: follow the rights and double-check high-alert drugs.

Quality: use data and PDSA to improve.