Medical-Surgical Nursing
What you must understand
Expect questions on fluid and electrolyte balance, diabetes, cardiac conditions, respiratory disorders, renal and gastrointestinal problems, and perioperative care. Know the classic signs: hypokalaemia (weakness, arrhythmia, ileus), hyperkalaemia (peaked T waves), hypoglycaemia (sweating, tremor, confusion), and dehydration (tachycardia, low urine output, poor skin turgor).
Traps in questions
- Priority of airway over circulation. In a deteriorating surgical client, bleeding and airway compete; airway and breathing come first, then circulation.
- Post-operative complications - atelectasis and hypoxaemia present early with low-grade fever and falling saturation; wound infection presents later.
- Insulin vs oral agents - only insulin is used in type 1 diabetes and in DKA; metformin is held before contrast studies.
- Diet and fluid restrictions in heart failure and chronic kidney disease; questions often hide the restriction in the stem.
Worked rule of thumb
For any acute deterioration, run ABC then cause: Airway, Breathing, Circulation, then look for the likely cause (hypoglycaemia, bleeding, sepsis, opioid oversedation). Reversible causes such as hypoglycaemia should be corrected immediately rather than investigated first.
Monitoring principle
Trends matter more than single values. A falling urine output over three hours or a rising respiratory rate is a warning even when each individual number looks acceptable.