Kuwait MOH Nurse Exam cheat sheet

Normal adult vital signs: 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.

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

Stages of pressure injury: 1 = non-blanchable erythema of intact skin; 2 = partial-thickness loss with dermis exposed; 3 = full-thickness loss with subcutaneous fat visible; 4 = full-thickness loss with fascia, muscle, tendon, or bone exposed.

Reposition an immobile patient at least every 2 hours; use the Braden Scale (≤18 indicates risk) to guide prevention.

Intake and output: 1 mL of urine weighs approximately 1 g; minimum adequate adult urine output is 0.5 mL/kg/h (about 30 mL/h).

Maslow's hierarchy order: physiological, safety, love/belonging, esteem, self-actualization; physiological needs are met first.

The nursing process sequence is Assessment, Diagnosis, Planning, Implementation, Evaluation (ADPIE); evaluation is continuous, not only terminal.

Fowler position is 45–60° head elevation; semi-Fowler 30°; Trendelenburg places the head lower than the feet.

Hand hygiene is indicated before and after every patient contact and after body-fluid exposure; alcohol rub is ineffective against spores such as Clostridioides difficile.

Hypoglycemia is blood glucose <70 mg/dL; give 15–20 g fast-acting oral carbohydrate if conscious, or IV dextrose/IM glucagon if unresponsive, then recheck in 15 minutes.

Diabetic ketoacidosis: glucose >250 mg/dL, pH <7.30, bicarbonate <18 mEq/L, ketonemia; treat with isotonic fluids, insulin infusion, and potassium replacement.

Acute coronary syndrome: aspirin 162–325 mg chewed plus nitroglycerin; withhold nitrates if systolic BP <90 mmHg or a phosphodiesterase inhibitor was used within 24–48 h.

Heart failure exacerbation signs: dyspnea, orthopnea, bibasilar crackles, S3 gallop, jugular venous distension, and weight gain >2 kg in 2–3 days.

Chronic obstructive pulmonary disease: give controlled low-flow oxygen targeting SpO2 88–92% in patients at risk of CO2 retention.

Peptic ulcer bleeding presents with hematemesis or melena; a nasogastric aspirate that is coffee-ground supports upper GI bleeding.

Deep vein thrombosis prevention includes early ambulation, graduated compression stockings, and prescribed pharmacologic prophylaxis; unilateral calf pain and swelling are warning signs.

Acute kidney injury is staged by serum creatinine rise and urine output; oliguria is <400 mL/24 h and anuria <100 mL/24 h.

Hyperkalemia ECG changes progress from peaked T waves to widened QRS and sine wave; calcium gluconate stabilizes the myocardium first.

Naegele's rule: estimated date of delivery = first day of last menstrual period + 7 days − 3 months (+1 year).

Normal first-stage labor progress: latent phase to about 6 cm dilation, active phase 6–10 cm with cervical change of at least 1 cm/h in active labor.

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

Variable decelerations indicate umbilical cord compression; respond with position change and amnioinfusion if ordered.

Preeclampsia is BP ≥140/90 mmHg after 20 weeks with proteinuria or end-organ dysfunction; severe features include BP ≥160/110, platelets <100,000, or elevated liver enzymes.

Magnesium sulfate toxicity signs: loss of deep tendon reflexes, respiratory depression, oliguria; antidote is calcium gluconate 10%.

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

Lochia progression: rubra (days 1–3), serosa (days 4–10), alba (after day 10); foul odor suggests infection.

Newborn APGAR is scored at 1 and 5 minutes on appearance, pulse, grimace, activity, and respiration, each 0–2 (total 0–10).

Pediatric vital sign trends: heart rate and respiratory rate are highest in newborns and decline with age; systolic BP rises with age.

Infant weight typically doubles by 5–6 months and triples by 12 months; birth weight is regained by about 2 weeks.

Normal newborn weight loss is up to 10% of birth weight in the first week, regained by 10–14 days.

Dehydration in children: 5% weight loss = mild, 10% = moderate, 15% = severe; assess fontanel, mucous membranes, tears, and capillary refill.

Maintenance IV fluid for children uses the 4-2-1 rule: 4 mL/kg/h for first 10 kg, 2 mL/kg/h for next 10 kg, 1 mL/kg/h for each kg thereafter.

Croup (laryngotracheobronchitis) produces a barking cough and inspiratory stridor; epiglottitis produces drooling, tripod posture, and muffled voice - do not inspect the throat.

Kawasaki disease: fever ≥5 days plus conjunctivitis, rash, mucosal changes, extremity changes, and cervical lymphadenopathy; risk is coronary artery aneurysm.

Intussusception presents with colicky pain, vomiting, and red currant jelly stools; a sausage-shaped abdominal mass may be palpable.

Immunization schedule principles: live vaccines are generally deferred in severe immunodeficiency; fever alone is not a contraindication to routine vaccination.

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

Suicide risk factors: prior attempt, male sex, older age, substance use, access to lethal means, hopelessness; a direct question about suicidal intent does not increase risk.

Serotonin syndrome: agitation, hyperthermia, clonus, hyperreflexia, diarrhea; stop serotonergic agents and give supportive care.

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

Extrapyramidal symptoms include acute dystonia, akathisia, parkinsonism, and tardive dyskinesia; anticholinergics treat dystonia and parkinsonism but not tardive dyskinesia.

Alcohol withdrawal timeline: tremor and anxiety at 6–12 h, seizures at 12–48 h, delirium tremens at 48–96 h; benzodiazepines are first-line.

Lithium therapeutic range is 0.6–1.2 mEq/L; toxicity signs include coarse tremor, vomiting, ataxia, and confusion.

Anorexia nervosa hallmarks: low body weight, fear of weight gain, amenorrhea; refeeding syndrome risk includes hypophosphatemia and hypokalemia.

Mania features: elevated or irritable mood, decreased need for sleep, grandiosity, pressured speech, and impulsive behavior for at least 1 week.

Primary prevention acts before disease (immunization, sanitation); secondary prevention is early detection (screening); tertiary prevention limits disability (rehabilitation).

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

Attack rate = (number of new cases among exposed / total exposed) × 100.

Infant mortality rate = (deaths under 1 year / live births in the same year) × 1000.

Herd immunity threshold depends on basic reproduction number: for measles (R0 high) it exceeds 90%, for influenza it is lower.

Notifiable disease reporting enables surveillance and outbreak control; reporting is a legal duty of the diagnosing clinician.

Case definition for an outbreak includes person, place, and time criteria to identify cases consistently.

Cold chain: routine vaccines are kept at 2–8 °C; frozen vaccines must not be refrozen after thawing.

Screening test validity: sensitivity detects true positives; specificity detects true negatives; a highly sensitive test is preferred when missing disease is dangerous.

Adult basic life support: compressions at 100–120/min, depth 5–6 cm, full recoil, compression-to-ventilation ratio 30:2, minimize interruptions to <10 s.

Defibrillation for ventricular fibrillation or pulseless ventricular tachycardia is delivered as soon as available; resume compressions immediately after a shock.

Shockable rhythms are VF and pulseless VT; non-shockable rhythms are asystole and pulseless electrical activity.

Sepsis-3: suspected infection plus SOFA score increase ≥2; septic shock requires vasopressors to keep MAP ≥65 mmHg and lactate >2 mmol/L despite fluids.

Anaphylaxis: intramuscular epinephrine 0.3–0.5 mg (1:1000) into the anterolateral thigh; repeat every 5–15 minutes as needed.

Glasgow Coma Scale ranges 3–15; score ≤8 generally indicates need for airway protection.

Opioid overdose: give naloxone, support ventilation, and monitor for re-sedation because naloxone's duration is shorter than many opioids.

Central venous pressure and mean arterial pressure guide hemodynamic assessment; MAP = (systolic + 2 × diastolic) / 3.

Mass casualty triage prioritizes immediate life-saving intervention over first-come order; expectant category is reserved for unsurvivable injuries when resources are overwhelmed.

The rights of medication administration: right patient, drug, dose, route, time, documentation, reason, and response.

Digoxin: therapeutic level 0.5–2 ng/mL; check apical pulse for 1 full minute and withhold if <60/min in adults; hypokalemia increases toxicity risk.

Warfarin: monitor INR, target usually 2–3 (2.5–3.5 for mechanical valves); antidote is vitamin K.

Heparin: monitor aPTT or anti-Xa; antidote is protamine sulfate.

Aminoglycosides (gentamicin) are nephrotoxic and ototoxic; monitor peak and trough levels and renal function.

Vancomycin requires monitoring of trough levels and renal function; rapid infusion causes flushing ('red man syndrome').

Acetaminophen maximum adult dose is 4 g/day (lower in liver disease); overdose antidote is N-acetylcysteine.

Insulin onset: rapid-acting 10–30 min, short-acting (regular) 30–60 min, intermediate (NPH) 1–2 h, long-acting (glargine) 1–2 h with no peak; only regular insulin is given IV.

Potassium chloride must be diluted and infused at a controlled rate; never give undiluted IV push.

High-alert medications (insulin, heparin, opioids, concentrated electrolytes) require independent double-check.

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

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

Airborne precautions require a negative-pressure room and N95 or higher respirator; a surgical mask on the patient during transport.

C. difficile spores resist alcohol; use soap and water handwashing and bleach-based environmental cleaning.

Sterile technique is required for invasive procedures such as urinary catheter insertion, central line insertion, and wound care into sterile body cavities.

Surgical scrub and sterile gowning: sterile gloves are put on last and must not touch non-sterile surfaces.

Needlestick injury: wash with soap and water, report immediately, and start post-exposure prophylaxis evaluation within hours; HIV PEP is most effective when begun within 72 h.

Chain of infection links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; interrupting any link prevents transmission.

Antimicrobial stewardship: culture before antibiotics when feasible, match therapy to susceptibilities, and review de-escalation at 48–72 h.

Kuwait's Ministry of Health (MOH) licenses nurses and regulates practice through the Nursing Licensure and Registration framework; practicing without a valid license is prohibited.

Kuwait MOH requires reporting of communicable diseases and adverse events through official channels; documentation must be timely and factual.

Informed consent requires capacity, adequate information including risks and alternatives, and voluntariness; consent may be withdrawn at any time.

Confidentiality is a professional duty; disclosure is permitted only with patient consent, legal requirement, or serious public health risk.

The four ethical principles are autonomy, beneficence, nonmaleficence, and justice; veracity and fidelity are supporting duties.

Advocacy obliges the nurse to protect patient rights even when the request conflicts with institutional convenience.

Nursing documentation standards: record objectively, in chronological order, with date, time, and signature; never alter records retrospectively.

Delegation: the registered nurse retains accountability for tasks delegated to assistants; assessment, planning, and evaluation are not delegated.

Mandatory reporting of suspected abuse or neglect of vulnerable persons overrides confidentiality in most jurisdictions, including Kuwait's child protection framework.