NCK Licensure Exam cheat sheet

Normal adult vital sign ranges: oral temperature 36.5-37.5 C, pulse 60-100/min, respirations 12-20/min, blood pressure under 120/80 mmHg, SpO2 95-100% on room air.

Body mass index formula: weight in kg divided by height in meters squared; BMI 18.5-24.9 is normal, 25-29.9 overweight, 30 or above obese.

Maslow hierarchy guides priority setting: physiological needs (airway, breathing, circulation) precede safety, love, esteem, and self-actualization.

Inspection, palpation, percussion, and auscultation order applies except the abdomen, where auscultation follows inspection and precedes palpation and percussion.

Pulse deficit equals apical rate minus radial rate; it is measured by counting apical and radial pulses simultaneously for one full minute.

Braden Scale scores 6-23; lower scores indicate higher pressure injury risk, and scores of 18 or below trigger preventive interventions.

Morse Fall Scale items include history of falling, secondary diagnosis, ambulatory aid, IV line, gait, and mental status; higher totals mean higher risk.

Pupil assessment uses PERRLA: pupils equal, round, reactive to light, and accommodating; a fixed dilated pupil may signal increased intracranial pressure.

Acute coronary syndrome: ST-elevation myocardial infarction requires reperfusion within 90 minutes of first medical contact when percutaneous coronary intervention is available.

Heart failure exacerbation signs: weight gain over 1 kg per day or 2.3 kg per week, dyspnea, orthopnea, jugular venous distention, and bibasilar crackles.

Chronic obstructive pulmonary disease: target oxygen saturation 88-92% in patients at risk of carbon dioxide retention; place in semi-Fowler or high-Fowler position.

Diabetic ketoacidosis management priorities are IV isotonic fluids, insulin infusion, and potassium replacement once potassium is below 5.2 mEq/L and urine output is adequate.

Stroke: fibrinolytic therapy window is up to 4.5 hours from symptom onset; glucose and noncontrast head CT must be checked before administration.

Chronic kidney disease: normal glomerular filtration rate is about 125 mL/min; stage 5 is below 15 mL/min, and hyperkalemia is the most dangerous electrolyte imbalance.

Postoperative care: early ambulation, incentive spirometry every 1-2 hours while awake, and sequential compression devices reduce atelectasis and venous thromboembolism.

Cirrhosis complications include ascites, esophageal varices, hepatic encephalopathy, and spontaneous bacterial peritonitis; lactulose titrates to 2-3 soft stools daily.

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

Normal fetal heart rate is 110-160 beats per minute; late decelerations indicate uteroplacental insufficiency and require repositioning to left lateral and oxygen.

First stage of labor ends at full cervical dilation of 10 cm; second stage ends with birth, and third stage ends with delivery of the placenta.

Postpartum hemorrhage is blood loss over 500 mL after vaginal birth or over 1000 mL after cesarean; uterine atony is the most common cause.

Apgar score assesses heart rate, respiratory effort, muscle tone, reflex irritability, and color at 1 and 5 minutes; each component scores 0-2.

Magnesium sulfate for preeclampsia toxicity signs: loss of deep tendon reflexes, respiratory rate below 12/min, and oliguria; antidote is calcium gluconate.

Newborn transitional findings: weight loss up to 10% in the first week, physiologic jaundice after 24 hours, and milia and Mongolian spots that resolve without treatment.

Lochia progresses from rubra (days 1-3) to serosa (days 4-10) to alba (after day 10); saturated pad in one hour warrants evaluation.

Pediatric vital signs vary by age: infant pulse 100-160/min and respirations 30-60/min, decreasing progressively toward adult ranges by adolescence.

Weight-based dosing uses 15-20 mL/kg isotonic fluid bolus for pediatric shock and 0.01 mg/kg IV epinephrine (maximum 0.5 mg) for anaphylaxis.

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

Infant pain is assessed with the FLACC scale (face, legs, activity, cry, consolability), scored 0-10; children over age 4 may use the Wong-Baker FACES scale.

Developmental milestones: head control by 4 months, sitting unsupported by 8 months, walking by 15 months, and two-word phrases by 24 months.

Kawasaki disease criteria include fever over 5 days plus conjunctivitis, mucosal changes, rash, extremity changes, and cervical lymphadenopathy; IV immunoglobulin prevents coronary aneurysm.

Intussusception presents with colicky pain, currant-jelly stools, and a sausage-shaped abdominal mass; air enema is diagnostic and therapeutic.

Epiglottitis presents with drooling, tripod positioning, and muffled voice; avoid throat inspection and keep the child calm until the airway is secured.

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

Serotonin syndrome triad: mental status change, autonomic instability, and neuromuscular hyperactivity; it can occur within hours of starting or increasing serotonergic drugs.

Neuroleptic malignant syndrome: rigidity, high fever, altered mental status, and elevated creatine kinase; stop the antipsychotic and give dantrolene or bromocriptine.

Alcohol withdrawal timeline: tremor and anxiety at 6-12 hours, seizures at 12-24 hours, and delirium tremens at 48-96 hours; treat with benzodiazepines and thiamine.

Lithium therapeutic range is 0.6-1.2 mEq/L; toxicity signs include tremor, vomiting, ataxia, and confusion, and levels rise with dehydration or NSAID use.

Suicide risk assessment screens for ideation, plan, intent, means, and prior attempts; a patient with a plan and access to means requires continuous observation.

Anorexia nervosa medical complications include bradycardia, hypotension, hypothermia, lanugo, and electrolyte disturbance; refeeding syndrome risk rises with rapid calorie increase.

Anticholinergic side effects of typical antipsychotics include dry mouth, constipation, urinary retention, blurred vision, and tachycardia; tardive dyskinesia may be irreversible.

Levels of prevention: primary acts before disease (immunization), secondary detects early disease (screening), and tertiary limits disability (rehabilitation).

Incidence counts new cases in a period divided by the population at risk; prevalence counts all existing cases at a point or period.

Crude mortality rate equals number of deaths in a year divided by midyear population, multiplied by 1000.

Herd immunity threshold depends on basic reproduction number: for measles (R0 about 12-18) roughly 92-95% coverage is needed.

Reportable disease surveillance and notifiable condition lists are set by state or national health authorities; nurses report to the local health department.

Community assessment models include the windshield survey, key informant interviews, and demographic and epidemiological data review.

Outbreak investigation steps: verify diagnosis, define and find cases, describe by person, place, and time, form a hypothesis, and implement control measures.

Screening test properties: sensitivity detects true positives, specificity detects true negatives, and positive predictive value rises as disease prevalence rises.

Ethical principles: autonomy respects choice, beneficence promotes good, nonmaleficence avoids harm, justice distributes fairly, and veracity requires truthfulness.

Informed consent requires capacity, disclosure of risks and alternatives, voluntariness, and comprehension; the provider obtains consent and the nurse witnesses or clarifies.

Nurse Practice Act in each jurisdiction defines scope of practice, delegation, and licensure; delegation of nursing judgment to unlicensed assistive personnel is not permitted.

Five rights of delegation: right task, right circumstance, right person, right direction and communication, and right supervision and evaluation.

Conflict management modes: avoiding, accommodating, competing, compromising, and collaborating; collaborating aims for a win-win outcome and suits patient safety issues.

Just culture distinguishes human error (console), at-risk behavior (coach), and reckless behavior (sanction); it supports nonpunitive error reporting.

Transformational leadership components are idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration.

Triage classification in mass casualty incidents uses color tags: red immediate, yellow delayed, green minor, and black expectant or deceased.

Six rights of medication administration: right patient, drug, dose, route, time, and documentation; use two patient identifiers and a second nurse for high-alert drugs.

Digoxin: therapeutic level 0.5-2 ng/mL; hold for apical pulse below 60/min in adults and monitor for nausea, visual halos, and bradycardia.

Warfarin: monitor INR, target 2-3 for most indications; antidote is vitamin K, and fresh frozen plasma is used for severe bleeding.

Heparin: monitor activated partial thromboplastin time, typically 1.5-2.5 times control; antidote is protamine sulfate.

Vancomycin: monitor trough levels and infuse over at least 60 minutes to prevent infusion reaction (flushing, hypotension); nephrotoxicity and ototoxicity are risks.

Aminoglycosides (gentamicin, tobramycin) are nephrotoxic and ototoxic; monitor peak and trough levels and creatinine.

Opioid overdose triad: pinpoint pupils, respiratory depression, and unconsciousness; naloxone reverses it and may require repeat dosing.

Insulin onset: rapid-acting lispro and aspart 10-15 minutes, short-acting regular 30-60 minutes, intermediate NPH 1-2 hours, long-acting glargine 1-2 hours with no peak.

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

Hand hygiene moments: before patient contact, before aseptic procedure, after body fluid exposure risk, after patient contact, and after touching patient surroundings.

Alcohol-based hand rub is preferred for routine decontamination but is ineffective against Clostridioides difficile spores; use soap and water for C. difficile and norovirus.

Transmission-based precautions: contact for MRSA, VRE, C. difficile, and scabies; droplet for influenza, pertussis, and meningococcal disease; airborne for tuberculosis, measles, and varicella.

Airborne precautions require a negative-pressure room with at least 6-12 air exchanges per hour and an N95 or higher respirator for staff.

Needlestick injury: wash with soap and water, report immediately, and start postexposure prophylaxis within hours; HIV PEP is most effective when begun within 2 hours.

Surgical aseptic technique: sterile field is contaminated by contact with unsterile objects, by prolonged exposure to air, and by moisture striking through.

Restraints require a provider order within the time frame set by facility policy, usually 1 hour for violent behavior and 4 hours for nonviolent, plus frequent monitoring.

Normal adult oral temperature is 36.5-37.5 C; pulse 60-100/min; respirations 12-20/min; blood pressure below 120/80 mmHg; SpO2 95-100% on room air.

BMI equals weight in kilograms divided by height in meters squared; 18.5-24.9 is normal, 25-29.9 overweight, and 30 or above obese.

Auscultation precedes palpation and percussion in the abdomen because palpation can alter bowel sounds; for other systems the order is inspection, palpation, percussion, auscultation.

Pulse deficit is apical rate minus radial rate, counted simultaneously for one full minute; it is common in atrial fibrillation.

Braden Scale ranges 6-23; lower scores mean higher pressure injury risk, and 18 or below triggers prevention measures.

Morse Fall Scale totals six items including fall history, secondary diagnosis, ambulatory aid, IV line, gait, and mental status; higher scores mean higher risk.

PERRLA documents pupils equal, round, reactive to light, and accommodating; a fixed dilated pupil may indicate increased intracranial pressure.

ST-elevation myocardial infarction requires reperfusion within 90 minutes of first medical contact when percutaneous coronary intervention is available.

Heart failure worsening is signaled by weight gain over 1 kg per day or 2.3 kg per week, dyspnea, orthopnea, jugular venous distention, and bibasilar crackles.

In chronic obstructive pulmonary disease with carbon dioxide retention risk, target oxygen saturation is 88-92% and semi-Fowler or high-Fowler positioning aids breathing.

Diabetic ketoacidosis: give IV isotonic fluids and insulin infusion, and add potassium once the level is below 5.2 mEq/L and urine output is adequate.

Fibrinolytic therapy for ischemic stroke is given within 4.5 hours of symptom onset only after glucose and noncontrast head CT exclude hemorrhage.

Chronic kidney disease stage 5 is glomerular filtration rate below 15 mL/min; hyperkalemia is the most immediately dangerous electrolyte imbalance.

Postoperative prevention includes early ambulation, incentive spirometry every 1-2 hours while awake, and sequential compression devices to prevent atelectasis and thromboembolism.

Cirrhosis complications include ascites, esophageal varices, hepatic encephalopathy, and spontaneous bacterial peritonitis; lactulose is titrated to 2-3 soft stools daily.

Naegele rule estimates delivery date: first day of last menstrual period plus 7 days minus 3 months plus 1 year.

Normal fetal heart rate is 110-160 beats per minute; late decelerations suggest uteroplacental insufficiency and call for left lateral positioning and oxygen.

Labor stages: first ends at 10 cm dilation, second ends at birth, and third ends with placental delivery.

Postpartum hemorrhage is over 500 mL after vaginal birth or over 1000 mL after cesarean; uterine atony is the most common cause.

Apgar score rates heart rate, respiratory effort, muscle tone, reflex irritability, and color at 1 and 5 minutes, each 0-2 points.

Magnesium sulfate toxicity shows loss of deep tendon reflexes, respiratory rate below 12/min, and oliguria; calcium gluconate is the antidote.

Lochia changes from rubra (days 1-3) to serosa (days 4-10) to alba (after day 10); a saturated pad in one hour needs evaluation.

Newborn norms include weight loss up to 10% in the first week and physiologic jaundice appearing after 24 hours; milia and Mongolian spots need no treatment.

Infant pulse is 100-160/min and respirations 30-60/min; both decline with age toward adult ranges by adolescence.

Pediatric shock fluid bolus is 15-20 mL/kg isotonic crystalloid; anaphylaxis epinephrine dose is 0.01 mg/kg IV (maximum 0.5 mg).

Holliday-Segar maintenance fluid: 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, and 20 mL/kg for each kilogram above 20.

FLACC (face, legs, activity, cry, consolability) scores infant and toddler pain 0-10; children over 4 years may use the Wong-Baker FACES scale.

Milestones: head control by 4 months, sitting unsupported by 8 months, walking by 15 months, and two-word phrases by 24 months.

Kawasaki disease is fever over 5 days plus conjunctivitis, mucosal changes, rash, extremity changes, and cervical lymphadenopathy; IV immunoglobulin prevents coronary aneurysm.

Intussusception causes colicky pain, currant-jelly stools, and a sausage-shaped mass; air enema is both diagnostic and therapeutic.

Epiglottitis causes drooling, tripod positioning, and muffled voice; avoid throat inspection and keep the child calm until the airway is secured.

Therapeutic techniques include open-ended questions, reflection, restating, and silence; false reassurance, advice giving, and changing the subject are nontherapeutic.

Serotonin syndrome shows mental status change, autonomic instability, and neuromuscular hyperactivity, often within hours of a new or increased serotonergic drug.

Neuroleptic malignant syndrome shows rigidity, high fever, altered mental status, and elevated creatine kinase; stop the antipsychotic and give dantrolene or bromocriptine.

Alcohol withdrawal progresses from tremor at 6-12 hours to seizures at 12-24 hours and delirium tremens at 48-96 hours; treat with benzodiazepines and thiamine.

Lithium therapeutic range is 0.6-1.2 mEq/L; toxicity causes tremor, vomiting, ataxia, and confusion, and levels rise with dehydration or NSAIDs.

Suicide risk assessment covers ideation, plan, intent, means, and prior attempts; a plan with access to means requires continuous observation.

Anorexia nervosa causes bradycardia, hypotension, hypothermia, lanugo, and electrolyte disturbance; rapid refeeding risks refeeding syndrome.

Typical antipsychotics cause anticholinergic effects such as dry mouth, constipation, urinary retention, blurred vision, and tachycardia; tardive dyskinesia may be irreversible.

Primary prevention acts before disease (immunization), secondary detects early disease (screening), and tertiary limits disability (rehabilitation).

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

Crude mortality rate is deaths in a year divided by midyear population, multiplied by 1000.

Herd immunity threshold rises with the basic reproduction number; measles (R0 about 12-18) requires roughly 92-95% coverage.

Notifiable disease lists are set by state or national health authorities, and nurses report cases to the local health department.

Community assessment uses windshield surveys, key informant interviews, and demographic and epidemiological data review.

Outbreak investigation: verify diagnosis, define and find cases, describe by person, place, and time, form a hypothesis, then apply control measures.

Sensitivity detects true positives, specificity detects true negatives, and positive predictive value rises as disease prevalence rises.

Autonomy respects choice, beneficence promotes good, nonmaleficence avoids harm, justice distributes fairly, and veracity requires truthfulness.

Informed consent needs capacity, disclosure of risks and alternatives, voluntariness, and comprehension; the provider obtains consent and the nurse witnesses or clarifies.

Each jurisdiction's Nurse Practice Act defines scope of practice, delegation, and licensure; nursing judgment cannot be delegated to unlicensed assistive personnel.

Five rights of delegation are right task, right circumstance, right person, right direction and communication, and right supervision and evaluation.

Conflict modes are avoiding, accommodating, competing, compromising, and collaborating; collaborating seeks a win-win outcome for patient safety issues.

Just culture consoles human error, coaches at-risk behavior, and sanctions reckless behavior, which supports nonpunitive error reporting.

Transformational leadership comprises idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration.

Mass casualty triage tags: red immediate, yellow delayed, green minor, and black expectant or deceased.

Six rights are right patient, drug, dose, route, time, and documentation; use two patient identifiers and a second nurse check for high-alert drugs.

Digoxin therapeutic level is 0.5-2 ng/mL; hold for adult apical pulse below 60/min and watch for nausea, visual halos, and bradycardia.

Warfarin is monitored by INR with a target of 2-3 for most indications; vitamin K reverses it and fresh frozen plasma treats severe bleeding.

Heparin is monitored by activated partial thromboplastin time, usually 1.5-2.5 times control; protamine sulfate is the antidote.

Vancomycin requires trough monitoring and infusion over at least 60 minutes to prevent flushing and hypotension; it is nephrotoxic and ototoxic.

Aminoglycosides such as gentamicin and tobramycin are nephrotoxic and ototoxic; monitor peak and trough levels and creatinine.

Opioid overdose triad is pinpoint pupils, respiratory depression, and unconsciousness; naloxone reverses it and may need repeat doses.

Insulin onset: lispro and aspart 10-15 minutes, regular 30-60 minutes, NPH 1-2 hours, and glargine 1-2 hours with no peak.

Standard precautions apply to every patient: hand hygiene, gloves, gown, mask and eye protection per exposure risk, and safe sharps handling.

Five hand hygiene moments: before patient contact, before aseptic procedure, after body fluid exposure risk, after patient contact, and after touching surroundings.

Alcohol rub is ineffective against Clostridioides difficile spores; use soap and water for C. difficile and norovirus.

Contact precautions for MRSA, VRE, C. difficile, and scabies; droplet for influenza, pertussis, and meningococcal disease; airborne for tuberculosis, measles, and varicella.

Airborne precautions need a negative-pressure room with at least 6-12 air exchanges per hour and an N95 or higher respirator for staff.

After a needlestick, wash with soap and water, report immediately, and start HIV postexposure prophylaxis within hours; it is most effective within 2 hours.

A sterile field is contaminated by contact with unsterile objects, prolonged exposure to air, and moisture striking through the drape.

Restraints need a provider order within the policy time frame, usually 1 hour for violent and 4 hours for nonviolent behavior, with frequent monitoring.

Normal adult oral temperature is 36.5-37.5 C; pulse 60-100/min; respirations 12-20/min; blood pressure below 120/80 mmHg; SpO2 95-100% on room air.

BMI equals weight in kilograms divided by height in meters squared; 18.5-24.9 is normal, 25-29.9 overweight, and 30 or above obese.

Auscultation precedes palpation and percussion in the abdomen because palpation can alter bowel sounds; for other systems the order is inspection, palpation, percussion, auscultation.

Pulse deficit is apical rate minus radial rate, counted simultaneously for one full minute; it is common in atrial fibrillation.

Braden Scale ranges 6-23; lower scores mean higher pressure injury risk, and 18 or below triggers prevention measures.

Morse Fall Scale totals six items including fall history, secondary diagnosis, ambulatory aid, IV line, gait, and mental status; higher scores mean higher risk.

PERRLA documents pupils equal, round, reactive to light, and accommodating; a fixed dilated pupil may indicate increased intracranial pressure.

ST-elevation myocardial infarction requires reperfusion within 90 minutes of first medical contact when percutaneous coronary intervention is available.

Heart failure worsening is signaled by weight gain over 1 kg per day or 2.3 kg per week, dyspnea, orthopnea, jugular venous distention, and bibasilar crackles.

In chronic obstructive pulmonary disease with carbon dioxide retention risk, target oxygen saturation is 88-92% and semi-Fowler or high-Fowler positioning aids breathing.

Diabetic ketoacidosis: give IV isotonic fluids and insulin infusion, and add potassium once the level is below 5.2 mEq/L and urine output is adequate.

Fibrinolytic therapy for ischemic stroke is given within 4.5 hours of symptom onset only after glucose and noncontrast head CT exclude hemorrhage.

Chronic kidney disease stage 5 is glomerular filtration rate below 15 mL/min; hyperkalemia is the most immediately dangerous electrolyte imbalance.

Postoperative prevention includes early ambulation, incentive spirometry every 1-2 hours while awake, and sequential compression devices to prevent atelectasis and thromboembolism.

Cirrhosis complications include ascites, esophageal varices, hepatic encephalopathy, and spontaneous bacterial peritonitis; lactulose is titrated to 2-3 soft stools daily.

Naegele rule estimates delivery date: first day of last menstrual period plus 7 days minus 3 months plus 1 year.

Normal fetal heart rate is 110-160 beats per minute; late decelerations suggest uteroplacental insufficiency and call for left lateral positioning and oxygen.

Labor stages: first ends at 10 cm dilation, second ends at birth, and third ends with placental delivery.

Postpartum hemorrhage is over 500 mL after vaginal birth or over 1000 mL after cesarean; uterine atony is the most common cause.

Apgar score rates heart rate, respiratory effort, muscle tone, reflex irritability, and color at 1 and 5 minutes, each 0-2 points.

Magnesium sulfate toxicity shows loss of deep tendon reflexes, respiratory rate below 12/min, and oliguria; calcium gluconate is the antidote.

Lochia changes from rubra (days 1-3) to serosa (days 4-10) to alba (after day 10); a saturated pad in one hour needs evaluation.

Newborn norms include weight loss up to 10% in the first week and physiologic jaundice appearing after 24 hours; milia and Mongolian spots need no treatment.

Infant pulse is 100-160/min and respirations 30-60/min; both decline with age toward adult ranges by adolescence.

Pediatric shock fluid bolus is 15-20 mL/kg isotonic crystalloid; anaphylaxis epinephrine dose is 0.01 mg/kg IV (maximum 0.5 mg).

Holliday-Segar maintenance fluid: 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, and 20 mL/kg for each kilogram above 20.

FLACC (face, legs, activity, cry, consolability) scores infant and toddler pain 0-10; children over 4 years may use the Wong-Baker FACES scale.

Milestones: head control by 4 months, sitting unsupported by 8 months, walking by 15 months, and two-word phrases by 24 months.

Kawasaki disease is fever over 5 days plus conjunctivitis, mucosal changes, rash, extremity changes, and cervical lymphadenopathy; IV immunoglobulin prevents coronary aneurysm.

Intussusception causes colicky pain, currant-jelly stools, and a sausage-shaped mass; air enema is both diagnostic and therapeutic.

Epiglottitis causes drooling, tripod positioning, and muffled voice; avoid throat inspection and keep the child calm until the airway is secured.

Therapeutic techniques include open-ended questions, reflection, restating, and silence; false reassurance, advice giving, and changing the subject are nontherapeutic.

Serotonin syndrome shows mental status change, autonomic instability, and neuromuscular hyperactivity, often within hours of a new or increased serotonergic drug.

Neuroleptic malignant syndrome shows rigidity, high fever, altered mental status, and elevated creatine kinase; stop the antipsychotic and give dantrolene or bromocriptine.

Alcohol withdrawal progresses from tremor at 6-12 hours to seizures at 12-24 hours and delirium tremens at 48-96 hours; treat with benzodiazepines and thiamine.

Lithium therapeutic range is 0.6-1.2 mEq/L; toxicity causes tremor, vomiting, ataxia, and confusion, and levels rise with dehydration or NSAIDs.

Suicide risk assessment covers ideation, plan, intent, means, and prior attempts; a plan with access to means requires continuous observation.

Anorexia nervosa causes bradycardia, hypotension, hypothermia, lanugo, and electrolyte disturbance; rapid refeeding risks refeeding syndrome.

Typical antipsychotics cause anticholinergic effects such as dry mouth, constipation, urinary retention, blurred vision, and tachycardia; tardive dyskinesia may be irreversible.

Primary prevention acts before disease (immunization), secondary detects early disease (screening), and tertiary limits disability (rehabilitation).

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

Crude mortality rate is deaths in a year divided by midyear population, multiplied by 1000.

Herd immunity threshold rises with the basic reproduction number; measles (R0 about 12-18) requires roughly 92-95% coverage.

Notifiable disease lists are set by state or national health authorities, and nurses report cases to the local health department.

Community assessment uses windshield surveys, key informant interviews, and demographic and epidemiological data review.

Outbreak investigation: verify diagnosis, define and find cases, describe by person, place, and time, form a hypothesis, then apply control measures.

Sensitivity detects true positives, specificity detects true negatives, and positive predictive value rises as disease prevalence rises.

Autonomy respects choice, beneficence promotes good, nonmaleficence avoids harm, justice distributes fairly, and veracity requires truthfulness.

Informed consent needs capacity, disclosure of risks and alternatives, voluntariness, and comprehension; the provider obtains consent and the nurse witnesses or clarifies.

Each jurisdiction's Nurse Practice Act defines scope of practice, delegation, and licensure; nursing judgment cannot be delegated to unlicensed assistive personnel.

Five rights of delegation are right task, right circumstance, right person, right direction and communication, and right supervision and evaluation.

Conflict modes are avoiding, accommodating, competing, compromising, and collaborating; collaborating seeks a win-win outcome for patient safety issues.

Just culture consoles human error, coaches at-risk behavior, and sanctions reckless behavior, which supports nonpunitive error reporting.

Transformational leadership comprises idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration.

Mass casualty triage tags: red immediate, yellow delayed, green minor, and black expectant or deceased.

Six rights are right patient, drug, dose, route, time, and documentation; use two patient identifiers and a second nurse check for high-alert drugs.

Digoxin therapeutic level is 0.5-2 ng/mL; hold for adult apical pulse below 60/min and watch for nausea, visual halos, and bradycardia.

Warfarin is monitored by INR with a target of 2-3 for most indications; vitamin K reverses it and fresh frozen plasma treats severe bleeding.

Heparin is monitored by activated partial thromboplastin time, usually 1.5-2.5 times control; protamine sulfate is the antidote.

Vancomycin requires trough monitoring and infusion over at least 60 minutes to prevent flushing and hypotension; it is nephrotoxic and ototoxic.

Aminoglycosides such as gentamicin and tobramycin are nephrotoxic and ototoxic; monitor peak and trough levels and creatinine.

Opioid overdose triad is pinpoint pupils, respiratory depression, and unconsciousness; naloxone reverses it and may need repeat doses.

Insulin onset: lispro and aspart 10-15 minutes, regular 30-60 minutes, NPH 1-2 hours, and glargine 1-2 hours with no peak.

Standard precautions apply to every patient: hand hygiene, gloves, gown, mask and eye protection per exposure risk, and safe sharps handling.

Five hand hygiene moments: before patient contact, before aseptic procedure, after body fluid exposure risk, after patient contact, and after touching surroundings.

Alcohol rub is ineffective against Clostridioides difficile spores; use soap and water for C. difficile and norovirus.

Contact precautions for MRSA, VRE, C. difficile, and scabies; droplet for influenza, pertussis, and meningococcal disease; airborne for tuberculosis, measles, and varicella.

Airborne precautions need a negative-pressure room with at least 6-12 air exchanges per hour and an N95 or higher respirator for staff.

After a needlestick, wash with soap and water, report immediately, and start HIV postexposure prophylaxis within hours; it is most effective within 2 hours.

A sterile field is contaminated by contact with unsterile objects, prolonged exposure to air, and moisture striking through the drape.

Restraints need a provider order within the policy time frame, usually 1 hour for violent and 4 hours for nonviolent behavior, with frequent monitoring.

Normal adult oral temperature is 36.5-37.5 C; pulse 60-100/min; respirations 12-20/min; blood pressure below 120/80 mmHg; SpO2 95-100% on room air.

BMI equals weight in kilograms divided by height in meters squared; 18.5-24.9 is normal, 25-29.9 overweight, and 30 or above obese.

Auscultation precedes palpation and percussion in the abdomen because palpation can alter bowel sounds; for other systems the order is inspection, palpation, percussion, auscultation.

Pulse deficit is apical rate minus radial rate, counted simultaneously for one full minute; it is common in atrial fibrillation.

Braden Scale ranges 6-23; lower scores mean higher pressure injury risk, and 18 or below triggers prevention measures.

Morse Fall Scale totals six items including fall history, secondary diagnosis, ambulatory aid, IV line, gait, and mental status; higher scores mean higher risk.

PERRLA documents pupils equal, round, reactive to light, and accommodating; a fixed dilated pupil may indicate increased intracranial pressure.

ST-elevation myocardial infarction requires reperfusion within 90 minutes of first medical contact when percutaneous coronary intervention is available.

Heart failure worsening is signaled by weight gain over 1 kg per day or 2.3 kg per week, dyspnea, orthopnea, jugular venous distention, and bibasilar crackles.

In chronic obstructive pulmonary disease with carbon dioxide retention risk, target oxygen saturation is 88-92% and semi-Fowler or high-Fowler positioning aids breathing.

Diabetic ketoacidosis: give IV isotonic fluids and insulin infusion, and add potassium once the level is below 5.2 mEq/L and urine output is adequate.

Fibrinolytic therapy for ischemic stroke is given within 4.5 hours of symptom onset only after glucose and noncontrast head CT exclude hemorrhage.

Chronic kidney disease stage 5 is glomerular filtration rate below 15 mL/min; hyperkalemia is the most immediately dangerous electrolyte imbalance.

Postoperative prevention includes early ambulation, incentive spirometry every 1-2 hours while awake, and sequential compression devices to prevent atelectasis and thromboembolism.

Cirrhosis complications include ascites, esophageal varices, hepatic encephalopathy, and spontaneous bacterial peritonitis; lactulose is titrated to 2-3 soft stools daily.

Naegele rule estimates delivery date: first day of last menstrual period plus 7 days minus 3 months plus 1 year.

Normal fetal heart rate is 110-160 beats per minute; late decelerations suggest uteroplacental insufficiency and call for left lateral positioning and oxygen.

Labor stages: first ends at 10 cm dilation, second ends at birth, and third ends with placental delivery.

Postpartum hemorrhage is over 500 mL after vaginal birth or over 1000 mL after cesarean; uterine atony is the most common cause.

Apgar score rates heart rate, respiratory effort, muscle tone, reflex irritability, and color at 1 and 5 minutes, each 0-2 points.

Magnesium sulfate toxicity shows loss of deep tendon reflexes, respiratory rate below 12/min, and oliguria; calcium gluconate is the antidote.

Lochia changes from rubra (days 1-3) to serosa (days 4-10) to alba (after day 10); a saturated pad in one hour needs evaluation.

Newborn norms include weight loss up to 10% in the first week and physiologic jaundice appearing after 24 hours; milia and Mongolian spots need no treatment.

Infant pulse is 100-160/min and respirations 30-60/min; both decline with age toward adult ranges by adolescence.

Pediatric shock fluid bolus is 15-20 mL/kg isotonic crystalloid; anaphylaxis epinephrine dose is 0.01 mg/kg IV (maximum 0.5 mg).

Holliday-Segar maintenance fluid: 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, and 20 mL/kg for each kilogram above 20.

FLACC (face, legs, activity, cry, consolability) scores infant and toddler pain 0-10; children over 4 years may use the Wong-Baker FACES scale.

Milestones: head control by 4 months, sitting unsupported by 8 months, walking by 15 months, and two-word phrases by 24 months.

Kawasaki disease is fever over 5 days plus conjunctivitis, mucosal changes, rash, extremity changes, and cervical lymphadenopathy; IV immunoglobulin prevents coronary aneurysm.

Intussusception causes colicky pain, currant-jelly stools, and a sausage-shaped mass; air enema is both diagnostic and therapeutic.

Epiglottitis causes drooling, tripod positioning, and muffled voice; avoid throat inspection and keep the child calm until the airway is secured.

Therapeutic techniques include open-ended questions, reflection, restating, and silence; false reassurance, advice giving, and changing the subject are nontherapeutic.

Serotonin syndrome shows mental status change, autonomic instability, and neuromuscular hyperactivity, often within hours of a new or increased serotonergic drug.

Neuroleptic malignant syndrome shows rigidity, high fever, altered mental status, and elevated creatine kinase; stop the antipsychotic and give dantrolene or bromocriptine.

Alcohol withdrawal progresses from tremor at 6-12 hours to seizures at 12-24 hours and delirium tremens at 48-96 hours; treat with benzodiazepines and thiamine.

Lithium therapeutic range is 0.6-1.2 mEq/L; toxicity causes tremor, vomiting, ataxia, and confusion, and levels rise with dehydration or NSAIDs.

Suicide risk assessment covers ideation, plan, intent, means, and prior attempts; a plan with access to means requires continuous observation.

Anorexia nervosa causes bradycardia, hypotension, hypothermia, lanugo, and electrolyte disturbance; rapid refeeding risks refeeding syndrome.

Typical antipsychotics cause anticholinergic effects such as dry mouth, constipation, urinary retention, blurred vision, and tachycardia; tardive dyskinesia may be irreversible.

Primary prevention acts before disease (immunization), secondary detects early disease (screening), and tertiary limits disability (rehabilitation).

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

Crude mortality rate is deaths in a year divided by midyear population, multiplied by 1000.

Herd immunity threshold rises with the basic reproduction number; measles (R0 about 12-18) requires roughly 92-95% coverage.

Notifiable disease lists are set by state or national health authorities, and nurses report cases to the local health department.

Community assessment uses windshield surveys, key informant interviews, and demographic and epidemiological data review.

Outbreak investigation: verify diagnosis, define and find cases, describe by person, place, and time, form a hypothesis, then apply control measures.

Sensitivity detects true positives, specificity detects true negatives, and positive predictive value rises as disease prevalence rises.

Autonomy respects choice, beneficence promotes good, nonmaleficence avoids harm, justice distributes fairly, and veracity requires truthfulness.

Informed consent needs capacity, disclosure of risks and alternatives, voluntariness, and comprehension; the provider obtains consent and the nurse witnesses or clarifies.

Each jurisdiction's Nurse Practice Act defines scope of practice, delegation, and licensure; nursing judgment cannot be delegated to unlicensed assistive personnel.

Five rights of delegation are right task, right circumstance, right person, right direction and communication, and right supervision and evaluation.

Conflict modes are avoiding, accommodating, competing, compromising, and collaborating; collaborating seeks a win-win outcome for patient safety issues.

Just culture consoles human error, coaches at-risk behavior, and sanctions reckless behavior, which supports nonpunitive error reporting.

Transformational leadership comprises idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration.

Mass casualty triage tags: red immediate, yellow delayed, green minor, and black expectant or deceased.

Six rights are right patient, drug, dose, route, time, and documentation; use two patient identifiers and a second nurse check for high-alert drugs.

Digoxin therapeutic level is 0.5-2 ng/mL; hold for adult apical pulse below 60/min and watch for nausea, visual halos, and bradycardia.

Warfarin is monitored by INR with a target of 2-3 for most indications; vitamin K reverses it and fresh frozen plasma treats severe bleeding.

Heparin is monitored by activated partial thromboplastin time, usually 1.5-2.5 times control; protamine sulfate is the antidote.

Vancomycin requires trough monitoring and infusion over at least 60 minutes to prevent flushing and hypotension; it is nephrotoxic and ototoxic.

Aminoglycosides such as gentamicin and tobramycin are nephrotoxic and ototoxic; monitor peak and trough levels and creatinine.

Opioid overdose triad is pinpoint pupils, respiratory depression, and unconsciousness; naloxone reverses it and may need repeat doses.

Insulin onset: lispro and aspart 10-15 minutes, regular 30-60 minutes, NPH 1-2 hours, and glargine 1-2 hours with no peak.

Standard precautions apply to every patient: hand hygiene, gloves, gown, mask and eye protection per exposure risk, and safe sharps handling.

Five hand hygiene moments: before patient contact, before aseptic procedure, after body fluid exposure risk, after patient contact, and after touching surroundings.

Alcohol rub is ineffective against Clostridioides difficile spores; use soap and water for C. difficile and norovirus.

Contact precautions for MRSA, VRE, C. difficile, and scabies; droplet for influenza, pertussis, and meningococcal disease; airborne for tuberculosis, measles, and varicella.

Airborne precautions need a negative-pressure room with at least 6-12 air exchanges per hour and an N95 or higher respirator for staff.

After a needlestick, wash with soap and water, report immediately, and start HIV postexposure prophylaxis within hours; it is most effective within 2 hours.

A sterile field is contaminated by contact with unsterile objects, prolonged exposure to air, and moisture striking through the drape.

Restraints need a provider order within the policy time frame, usually 1 hour for violent and 4 hours for nonviolent behavior, with frequent monitoring.