Cambodia Nursing Exit Exam cheat sheet

Normal adult vital signs: temperature 36.5-37.5 C, pulse 60-100/min, respirations 12-20/min, BP below 120/80 mmHg, SpO2 95-100% on room air.

Left-sided heart failure: pulmonary congestion, dyspnea, orthopnea, crackles, pink frothy sputum. Right-sided: jugular venous distension, hepatomegaly, dependent edema, weight gain.

Acute myocardial infarction triad: crushing chest pain over 20 minutes unrelieved by rest or nitrates, diaphoresis, nausea; ST elevation on ECG; troponin rises within 3-6 hours.

Hypoglycemia is below 70 mg/dL: tremors, sweating, tachycardia, confusion; give 15 g fast carbohydrate and recheck in 15 minutes. Hyperglycemia above 250 mg/dL with ketones suggests DKA.

Stroke: sudden facial droop, arm weakness, speech difficulty. Thrombolysis window is up to 4.5 hours from onset; check blood glucose first because hypoglycemia mimics stroke.

Chronic kidney disease stages are by glomerular filtration rate: stage 3 is 30-59, stage 4 is 15-29, stage 5 below 15 mL/min/1.73 m2. Monitor potassium, phosphate, and fluid balance.

COPD: oxygen target saturation 88-92% to avoid hypercapnia; pursed-lip breathing prolongs expiration; barrel chest and prolonged expiratory phase are typical.

Postoperative care priorities: airway and breathing first, then circulation, pain control, early ambulation, and wound assessment for dehiscence or infection.

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

Normal labor progress: latent phase to 4-6 cm, active phase 6-10 cm with cervical change of at least 1 cm per hour in first labors; second stage up to 2-3 hours.

Fetal heart rate baseline is 110-160/min. Late decelerations indicate uteroplacental insufficiency; variable decelerations indicate cord compression; both need repositioning and oxygen.

Postpartum hemorrhage is blood loss over 500 mL after vaginal birth or over 1000 mL after cesarean. Uterine atony is the most common cause; massage the fundus and give oxytocin.

Preeclampsia: BP at least 140/90 mmHg after 20 weeks plus proteinuria or end-organ signs. Magnesium sulfate prevents seizures; monitor respirations, reflexes, and urine output.

Lochia sequence: rubra (red, days 1-3), serosa (pink-brown, days 4-10), alba (white-yellow, after day 10). Foul odor suggests infection.

Newborn Apgar is scored at 1 and 5 minutes on five items: heart rate, respiratory effort, muscle tone, reflex irritability, and color; each scored 0-2, total 10.

Newborn thermoregulation: heat loss by evaporation, conduction, convection, and radiation. Skin-to-skin contact and drying immediately after birth prevent hypothermia.

Weight doubles by 5 months and triples by 12 months; birth weight averages 3-3.5 kg. Height increases about 25 cm in the first year.

Infant milestones: head control at 3-4 months, sitting unsupported at 6-8 months, pincer grasp at 9 months, walking at 12-15 months.

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

Dehydration signs in children: sunken fontanel, decreased tears, dry mucous membranes, poor skin turgor, decreased urine output below 1 mL/kg/hour.

Respiratory distress signs: nasal flaring, intercostal retractions, grunting, tachypnea, and head bobbing. Grunting indicates severe distress.

Kawasaki disease: fever over 5 days, conjunctivitis, rash, cervical lymphadenopathy, cracked lips, and peeling extremities; risk is coronary aneurysm, treated with IV immunoglobulin and aspirin.

Immunization schedule anchors: BCG and hepatitis B at birth; DPT-HepB-Hib and oral polio at 6, 10, and 14 weeks; measles-rubella at 9 and 18 months.

Epiglottitis and severe croup: never inspect the throat with a tongue blade when epiglottitis is suspected because of laryngospasm risk; keep the child calm and upright.

Primary health care principles from Alma-Ata: equitable access, community participation, intersectoral collaboration, appropriate technology, and health promotion.

Levels of prevention: primary (immunization, sanitation), secondary (screening, early diagnosis), tertiary (rehabilitation, disability limitation).

Incidence counts new cases in a period; prevalence counts all existing cases at a point in time. Incidence measures risk; prevalence measures burden.

Attack rate equals new cases divided by population at risk, multiplied by 100, used in outbreak investigation.

Cold chain: BCG and measles vaccines need 2-8 C; OPV is stored frozen; avoid freezing DPT, hepatitis B, and tetanus toxoid.

Community diagnosis steps: collect data, identify problems, prioritize by magnitude, severity, and feasibility, then plan, implement, and evaluate.

Epidemiological triad is host, agent, and environment. Breaking any link prevents disease transmission.

Home visiting priority: maternal and newborn danger signs, immunization status, water and sanitation, and nutrition screening.

Vital signs order: temperature, pulse, respiration, blood pressure. Count respirations without telling the patient to avoid altering the rate.

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

Pressure injury stages: stage 1 non-blanchable redness, stage 2 partial-thickness loss, stage 3 full-thickness to fascia, stage 4 to bone or tendon; unstageable has slough or eschar.

Intake and output: average adult intake 2000-2500 mL/day; minimum urine output 0.5 mL/kg/hour; 1 kg weight change equals about 1 liter of fluid.

Body mechanics: widen base of support, bend at knees, keep load close, and avoid twisting the spine.

Sterile field rule: any object below waist level or out of sight is contaminated; never turn your back on a sterile field.

Normal bowel and bladder patterns: constipation prevention needs fiber, fluids, and mobility; urinary retention is assessed by bladder scan and palpation.

Documentation must be objective, timely, accurate, complete, and signed; record facts, not opinions or blame.

Rights of medication administration: right patient, drug, dose, route, time, and documentation, plus right reason and right to refuse.

Six rights plus two identifiers: verify name and date of birth or hospital number before giving any drug.

Intramuscular injection sites: ventrogluteal is preferred for adults; vastus lateralis for infants; deltoid for small volumes up to 1 mL.

Digoxin: check apical pulse for one full minute; withhold if below 60/min in adults; therapeutic range 0.5-2 ng/mL; toxicity causes nausea, visual changes, bradycardia.

Aminoglycosides (gentamicin): monitor peak and trough levels, renal function, and hearing; trough drawn before the next dose.

Warfarin: monitor INR, target 2-3 for most indications; antidote is vitamin K. Heparin: monitor aPTT; antidote is protamine sulfate.

Paracetamol maximum adult dose is 4 g/day; overdose causes hepatic injury; antidote is N-acetylcysteine.

IV flow rate in drops per minute equals volume in mL times drop factor divided by time in minutes.

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

Transmission-based precautions: contact for MRSA and Clostridioides difficile, droplet for influenza and pertussis, airborne for tuberculosis, measles, and varicella.

Airborne precautions need a negative-pressure room, N95 respirator, and door kept closed.

Needlestick injury: wash with soap and water, do not squeeze, report immediately, and assess HIV and hepatitis B and C post-exposure prophylaxis.

Sterilization destroys all microorganisms including spores; disinfection reduces pathogens on inanimate objects. Autoclave uses moist heat under pressure.

Clostridioides difficile requires soap and water handwashing because alcohol does not kill spores.

Surgical asepsis keeps sterile items separate from unsterile items; sterile gloves must stay above waist level.

Isolation waste and sharps go into color-coded, puncture-resistant containers per local policy.

Adult basic life support: check responsiveness and breathing, call for help, start chest compressions 30:2 at 100-120/min, depth 5-6 cm, allow full recoil.

Choking adult: encourage coughing; if ineffective, give back blows and abdominal thrusts; for infants use back blows and chest thrusts, not abdominal thrusts.

Anaphylaxis: adrenaline intramuscularly into the anterolateral thigh, 0.5 mg of 1:1000 for adults, repeat in 5-15 minutes; then airway, oxygen, and IV fluids.

Shock signs: tachycardia, hypotension, cool clammy skin, altered mental status, decreased urine output. Treat with oxygen, positioning, and IV fluids.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; total 3-15; score 8 or below indicates need for airway protection.

Burns: rule of nines in adults: head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%.

Triage color coding: red immediate, yellow delayed, green minor, black deceased or expectant.

Poisoning: identify substance, time, and amount; do not induce vomiting after caustic ingestion; contact poison control.

Therapeutic communication: use open-ended questions, reflection, silence, and clarification; avoid false reassurance, advice, and why questions.

Suicide risk assessment: ask directly about intent, plan, means, and previous attempts; remove means and maintain close observation.

Depression core symptoms: low mood and loss of interest for at least 2 weeks plus sleep, appetite, energy, and concentration changes.

Serotonin syndrome: agitation, hyperthermia, tremor, clonus, and diarrhea after serotonergic drugs; stop the drug and seek urgent care.

Neuroleptic malignant syndrome: rigidity, high fever, altered consciousness, autonomic instability after antipsychotics; stop the drug and give supportive care.

Mania: elevated mood, decreased sleep, pressured speech, grandiosity, and risky behavior; provide a low-stimulus environment and set limits.

Alcohol withdrawal: tremor, agitation, seizures, and delirium tremens; use a benzodiazepine taper and monitor vital signs.

Restraint use requires a physician order, time limits, frequent monitoring of circulation and safety, and documentation.

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

Confidentiality: share patient information only on a need-to-know basis; exceptions include legal reporting and imminent harm.

Negligence elements: duty, breach, causation, and damages. Malpractice is professional negligence.

Advocacy: the nurse protects patient rights, reports unsafe practice, and follows the chain of command.

Scope of practice is defined by the nursing council license and law; delegating nursing judgment to unlicensed staff is not permitted.

Documentation is a legal record: record objectively, never alter a record, and correct errors with a single line, date, and initials.

Ethical principles: autonomy, beneficence, nonmaleficence, justice, veracity, and confidentiality.

Mandatory reporting includes communicable disease, suspected abuse, and unsafe practitioner behavior according to law.

Normal adult vital signs: temperature 36.5-37.5 C, pulse 60-100/min, respirations 12-20/min, BP below 120/80 mmHg, SpO2 95-100% on room air.

Left-sided heart failure: pulmonary congestion, dyspnea, orthopnea, crackles, pink frothy sputum. Right-sided: jugular venous distension, hepatomegaly, dependent edema, weight gain.

Acute myocardial infarction triad: crushing chest pain over 20 minutes unrelieved by rest or nitrates, diaphoresis, nausea; ST elevation on ECG; troponin rises within 3-6 hours.

Hypoglycemia is below 70 mg/dL: tremors, sweating, tachycardia, confusion; give 15 g fast carbohydrate and recheck in 15 minutes. Hyperglycemia above 250 mg/dL with ketones suggests DKA.

Stroke: sudden facial droop, arm weakness, speech difficulty. Thrombolysis window is up to 4.5 hours from onset; check blood glucose first because hypoglycemia mimics stroke.

Chronic kidney disease stages are by glomerular filtration rate: stage 3 is 30-59, stage 4 is 15-29, stage 5 below 15 mL/min/1.73 m2. Monitor potassium, phosphate, and fluid balance.

COPD: oxygen target saturation 88-92% to avoid hypercapnia; pursed-lip breathing prolongs expiration; barrel chest and prolonged expiratory phase are typical.

Postoperative care priorities: airway and breathing first, then circulation, pain control, early ambulation, and wound assessment for dehiscence or infection.

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

Normal labor progress: latent phase to 4-6 cm, active phase 6-10 cm with cervical change of at least 1 cm per hour in first labors; second stage up to 2-3 hours.

Fetal heart rate baseline is 110-160/min. Late decelerations indicate uteroplacental insufficiency; variable decelerations indicate cord compression; both need repositioning and oxygen.

Postpartum hemorrhage is blood loss over 500 mL after vaginal birth or over 1000 mL after cesarean. Uterine atony is the most common cause; massage the fundus and give oxytocin.

Preeclampsia: BP at least 140/90 mmHg after 20 weeks plus proteinuria or end-organ signs. Magnesium sulfate prevents seizures; monitor respirations, reflexes, and urine output.

Lochia sequence: rubra (red, days 1-3), serosa (pink-brown, days 4-10), alba (white-yellow, after day 10). Foul odor suggests infection.

Newborn Apgar is scored at 1 and 5 minutes on five items: heart rate, respiratory effort, muscle tone, reflex irritability, and color; each scored 0-2, total 10.

Newborn thermoregulation: heat loss by evaporation, conduction, convection, and radiation. Skin-to-skin contact and drying immediately after birth prevent hypothermia.

Weight doubles by 5 months and triples by 12 months; birth weight averages 3-3.5 kg. Height increases about 25 cm in the first year.

Infant milestones: head control at 3-4 months, sitting unsupported at 6-8 months, pincer grasp at 9 months, walking at 12-15 months.

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

Dehydration signs in children: sunken fontanel, decreased tears, dry mucous membranes, poor skin turgor, decreased urine output below 1 mL/kg/hour.

Respiratory distress signs: nasal flaring, intercostal retractions, grunting, tachypnea, and head bobbing. Grunting indicates severe distress.

Kawasaki disease: fever over 5 days, conjunctivitis, rash, cervical lymphadenopathy, cracked lips, and peeling extremities; risk is coronary aneurysm, treated with IV immunoglobulin and aspirin.

Immunization schedule anchors: BCG and hepatitis B at birth; DPT-HepB-Hib and oral polio at 6, 10, and 14 weeks; measles-rubella at 9 and 18 months.

Epiglottitis and severe croup: never inspect the throat with a tongue blade when epiglottitis is suspected because of laryngospasm risk; keep the child calm and upright.

Primary health care principles from Alma-Ata: equitable access, community participation, intersectoral collaboration, appropriate technology, and health promotion.

Levels of prevention: primary (immunization, sanitation), secondary (screening, early diagnosis), tertiary (rehabilitation, disability limitation).

Incidence counts new cases in a period; prevalence counts all existing cases at a point in time. Incidence measures risk; prevalence measures burden.

Attack rate equals new cases divided by population at risk, multiplied by 100, used in outbreak investigation.

Cold chain: BCG and measles vaccines need 2-8 C; OPV is stored frozen; avoid freezing DPT, hepatitis B, and tetanus toxoid.

Community diagnosis steps: collect data, identify problems, prioritize by magnitude, severity, and feasibility, then plan, implement, and evaluate.

Epidemiological triad is host, agent, and environment. Breaking any link prevents disease transmission.

Home visiting priority: maternal and newborn danger signs, immunization status, water and sanitation, and nutrition screening.

Vital signs order: temperature, pulse, respiration, blood pressure. Count respirations without telling the patient to avoid altering the rate.

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

Pressure injury stages: stage 1 non-blanchable redness, stage 2 partial-thickness loss, stage 3 full-thickness to fascia, stage 4 to bone or tendon; unstageable has slough or eschar.

Intake and output: average adult intake 2000-2500 mL/day; minimum urine output 0.5 mL/kg/hour; 1 kg weight change equals about 1 liter of fluid.

Body mechanics: widen base of support, bend at knees, keep load close, and avoid twisting the spine.

Sterile field rule: any object below waist level or out of sight is contaminated; never turn your back on a sterile field.

Normal bowel and bladder patterns: constipation prevention needs fiber, fluids, and mobility; urinary retention is assessed by bladder scan and palpation.

Documentation must be objective, timely, accurate, complete, and signed; record facts, not opinions or blame.

Rights of medication administration: right patient, drug, dose, route, time, and documentation, plus right reason and right to refuse.

Six rights plus two identifiers: verify name and date of birth or hospital number before giving any drug.

Intramuscular injection sites: ventrogluteal is preferred for adults; vastus lateralis for infants; deltoid for small volumes up to 1 mL.

Digoxin: check apical pulse for one full minute; withhold if below 60/min in adults; therapeutic range 0.5-2 ng/mL; toxicity causes nausea, visual changes, bradycardia.

Aminoglycosides (gentamicin): monitor peak and trough levels, renal function, and hearing; trough drawn before the next dose.

Warfarin: monitor INR, target 2-3 for most indications; antidote is vitamin K. Heparin: monitor aPTT; antidote is protamine sulfate.

Paracetamol maximum adult dose is 4 g/day; overdose causes hepatic injury; antidote is N-acetylcysteine.

IV flow rate in drops per minute equals volume in mL times drop factor divided by time in minutes.

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

Transmission-based precautions: contact for MRSA and Clostridioides difficile, droplet for influenza and pertussis, airborne for tuberculosis, measles, and varicella.

Airborne precautions need a negative-pressure room, N95 respirator, and door kept closed.

Needlestick injury: wash with soap and water, do not squeeze, report immediately, and assess HIV and hepatitis B and C post-exposure prophylaxis.

Sterilization destroys all microorganisms including spores; disinfection reduces pathogens on inanimate objects. Autoclave uses moist heat under pressure.

Clostridioides difficile requires soap and water handwashing because alcohol does not kill spores.

Surgical asepsis keeps sterile items separate from unsterile items; sterile gloves must stay above waist level.

Isolation waste and sharps go into color-coded, puncture-resistant containers per local policy.

Adult basic life support: check responsiveness and breathing, call for help, start chest compressions 30:2 at 100-120/min, depth 5-6 cm, allow full recoil.

Choking adult: encourage coughing; if ineffective, give back blows and abdominal thrusts; for infants use back blows and chest thrusts, not abdominal thrusts.

Anaphylaxis: adrenaline intramuscularly into the anterolateral thigh, 0.5 mg of 1:1000 for adults, repeat in 5-15 minutes; then airway, oxygen, and IV fluids.

Shock signs: tachycardia, hypotension, cool clammy skin, altered mental status, decreased urine output. Treat with oxygen, positioning, and IV fluids.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; total 3-15; score 8 or below indicates need for airway protection.

Burns: rule of nines in adults: head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%.

Triage color coding: red immediate, yellow delayed, green minor, black deceased or expectant.

Poisoning: identify substance, time, and amount; do not induce vomiting after caustic ingestion; contact poison control.

Therapeutic communication: use open-ended questions, reflection, silence, and clarification; avoid false reassurance, advice, and why questions.

Suicide risk assessment: ask directly about intent, plan, means, and previous attempts; remove means and maintain close observation.

Depression core symptoms: low mood and loss of interest for at least 2 weeks plus sleep, appetite, energy, and concentration changes.

Serotonin syndrome: agitation, hyperthermia, tremor, clonus, and diarrhea after serotonergic drugs; stop the drug and seek urgent care.

Neuroleptic malignant syndrome: rigidity, high fever, altered consciousness, autonomic instability after antipsychotics; stop the drug and give supportive care.

Mania: elevated mood, decreased sleep, pressured speech, grandiosity, and risky behavior; provide a low-stimulus environment and set limits.

Alcohol withdrawal: tremor, agitation, seizures, and delirium tremens; use a benzodiazepine taper and monitor vital signs.

Restraint use requires a physician order, time limits, frequent monitoring of circulation and safety, and documentation.

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

Confidentiality: share patient information only on a need-to-know basis; exceptions include legal reporting and imminent harm.

Negligence elements: duty, breach, causation, and damages. Malpractice is professional negligence.

Advocacy: the nurse protects patient rights, reports unsafe practice, and follows the chain of command.

Scope of practice is defined by the nursing council license and law; delegating nursing judgment to unlicensed staff is not permitted.

Documentation is a legal record: record objectively, never alter a record, and correct errors with a single line, date, and initials.

Ethical principles: autonomy, beneficence, nonmaleficence, justice, veracity, and confidentiality.

Mandatory reporting includes communicable disease, suspected abuse, and unsafe practitioner behavior according to law.