Lesotho Nursing Council Licensure Examination cheat sheet

Nursing process: Assessment (data collection) → Diagnosis (NANDA-I) → Planning (outcomes/goals) → Implementation → Evaluation; it is cyclic and dynamic, not strictly linear.

Subjective data = what the patient reports (symptoms, feelings); objective data = measurable/observable findings (vital signs, lab values, physical exam).

Maslow's hierarchy guides priority setting: physiological needs (airway, breathing, circulation) before safety, love/belonging, esteem, self-actualization.

Normal adult vital signs: temperature 36.1–37.2 °C oral; pulse 60–100/min; respirations 12–20/min; BP <120/80 mmHg; SpO2 ≥95% on room air.

Stages of infection: incubation → prodromal → illness → decline → convalescence; the prodromal stage is the most infectious period for many communicable diseases.

Medical asepsis reduces organisms (hand hygiene, clean gloves); surgical asepsis eliminates all microorganisms (sterile field, sterile gloves, sterile technique).

Stages of pressure injury (NPIAP): 1 = intact skin with non-blanchable erythema; 2 = partial-thickness loss; 3 = full-thickness loss; 4 = full-thickness with exposed fascia/bone; unstageable = eschar/slough.

Wound healing: primary intention (clean surgical edges approximated), secondary intention (granulation, larger defect), tertiary intention (delayed closure after contamination cleared).

Intake/output balance: 1 kg body weight change ≈ 1 L fluid; minimum adult urine output 0.5 mL/kg/h (≈30 mL/h).

Acute coronary syndrome: MONA-B - Morphine, Oxygen (if hypoxemic), Nitroglycerin, Aspirin; ECG within 10 minutes of presentation.

Heart failure: left-sided → pulmonary congestion (dyspnea, orthopnea, crackles, pink frothy sputum); right-sided → systemic congestion (JVD, peripheral edema, hepatomegaly).

COPD: oxygen target SpO2 88–92% in those at risk of CO2 retention; pursed-lip breathing prolongs expiration and reduces air trapping.

Diabetic ketoacidosis: glucose >13.9 mmol/L, pH <7.30, bicarbonate <18 mmol/L, ketones present, anion gap elevated; treat with IV fluids, insulin infusion, potassium replacement.

Hypoglycemia: glucose <3.9 mmol/L; if conscious give 15–20 g fast-acting oral carbohydrate and recheck in 15 minutes; if unconscious give IV dextrose or IM glucagon.

Stroke: thrombolysis window typically up to 4.5 hours from symptom onset; use FAST (Face, Arms, Speech, Time) for recognition.

Post-operative care: early ambulation prevents DVT and atelectasis; incentive spirometry and coughing every 1–2 hours reduce pulmonary complications.

Burns: Parkland formula = 4 mL × body weight (kg) × %TBSA burned of crystalloid in first 24 hours; half in first 8 hours from time of burn.

Hyperkalemia ECG changes: peaked T waves → widened QRS → sine wave; treat with calcium gluconate, insulin/dextrose, and salbutamol.

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

Stages of labour: 1st = onset to full cervical dilatation (10 cm); 2nd = full dilatation to birth; 3rd = birth to placental delivery; 4th = first 1–2 hours postpartum.

Normal fetal heart rate 110–160 beats/min; decelerations: early (head compression, benign), variable (cord compression), late (uteroplacental insufficiency - concerning).

Postpartum haemorrhage: >500 mL after vaginal birth or >1000 mL after caesarean; uterine atony is the commonest cause - massage the fundus and give uterotonics.

Lochia: rubra (days 1–3, red), serosa (days 4–10, pink/brown), alba (day 10 onward, white/yellow).

APGAR scored at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration; each 0–2, total 0–10; ≥7 is generally reassuring.

Newborn thermoregulation: large surface area to weight ratio, little subcutaneous fat, and inability to shiver - risk of hypothermia; use skin-to-skin and warm chains.

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

Exclusive breastfeeding is recommended for the first 6 months; colostrum provides immunoglobulin A and is produced in the first days postpartum.

Paediatric vital sign ranges vary with age: infants have higher pulse (100–160/min) and respiratory rates (30–60/min) than older children and adults.

Weight-based dosing: verify dose per kilogram against a paediatric reference; never extrapolate adult doses to children.

Dehydration in children: mild <5% weight loss, moderate 5–10%, severe >10%; WHO ORS is first-line for mild-moderate dehydration.

Signs of severe dehydration: sunken eyes, skin pinch returns slowly (>2 seconds), lethargy/unconsciousness, inability to drink - give IV fluids urgently.

Immunisation schedule (WHO/EPI): BCG and OPV-0 at birth; then pentavalent, OPV, and pneumococcal at 6, 10, and 14 weeks; measles at 9 and 18 months.

Respiratory distress signs in children: nasal flaring, intercostal/subcostal recession, grunting, head bobbing, and tracheal tug - count as danger signs.

Kangaroo mother care: continuous skin-to-skin contact, exclusive breastfeeding, and early discharge - reduces mortality in low-birth-weight infants.

Integrated Management of Childhood Illness (IMCI) danger signs: inability to drink or breastfeed, vomiting everything, convulsions, lethargy/unconsciousness, and convulsions now.

Primary health care principles (Alma-Ata 1978): equity, community participation, intersectoral collaboration, appropriate technology, and health promotion.

Levels of prevention: primary (immunisation, health education), secondary (screening, early diagnosis), tertiary (rehabilitation, disability limitation).

Incidence = new cases in a period ÷ population at risk; prevalence = all existing cases ÷ total population at a point or period.

Crude birth rate = live births in a year ÷ mid-year population × 1000; crude death rate uses deaths in the same formula.

Infant mortality rate = deaths under 1 year ÷ live births in the same year × 1000; the commonest causes in low-resource settings are neonatal conditions, pneumonia, and diarrhoea.

Herd immunity threshold depends on R0: for measles (R0 ≈ 12–18) it is approximately 92–95%; for polio it is approximately 80–85%.

Cold chain: vaccines must be kept at 2–8 °C at health facility level; OPV is most heat-sensitive and is monitored with vaccine vial monitors.

Notifiable disease reporting enables outbreak detection; a case definition standardises what counts as a case in surveillance.

Therapeutic communication: use open-ended questions, reflection, clarification, and silence; avoid false reassurance, giving advice, changing the subject, or judging.

Defence mechanisms: denial (refusing reality), projection (attributing own feelings to others), displacement (redirecting emotion to a safer target), rationalisation (logical excuse), sublimation (channeling into acceptable activity).

Depression core symptoms (ICD-11/DSM-5): depressed mood and/or anhedonia for ≥2 weeks plus sleep, appetite, energy, concentration, psychomotor, guilt, or suicidal changes.

Suicide risk assessment: direct, non-judgemental questioning does not increase risk; assess plan, means, intent, and prior attempts; remove means and maintain observation.

Serotonin syndrome: agitation, hyperthermia, tremor, clonus, hyperreflexia - a medical emergency related to serotonergic drugs.

Neuroleptic malignant syndrome: rigidity, high fever, autonomic instability, raised creatine kinase - stop antipsychotic and give supportive care/dantrolene or bromocriptine.

Mental Health Act principles: least restrictive option, voluntary treatment preferred, and detention only when there is risk to self or others.

Psychosis: hallucinations (perception without stimulus) and delusions (fixed false beliefs); do not argue with or reinforce delusions - focus on feelings and reality-testing gently.

The rights of medication administration: right patient, drug, dose, route, time, documentation, and reason - plus right to refuse and right assessment.

Six rights checkpoints: verify at least three times - when removing from storage, when preparing, and at the bedside before administration.

Oral route is contraindicated in unconscious patients, those with vomiting, or those unable to swallow due to aspiration risk.

Intramuscular injection sites: ventrogluteal (safest for adults and children over 7 months), vastus lateralis (infants), deltoid (small volumes ≤1 mL).

Peak and trough levels: trough is drawn just before the next dose; peak is drawn after absorption - timing depends on the drug (e.g., vancomycin trough before 4th dose).

Narrow therapeutic index drugs (digoxin, lithium, warfarin, phenytoin, aminoglycosides) require serum monitoring and careful dose adjustment.

Antidotes: paracetamol → N-acetylcysteine; warfarin → vitamin K; heparin → protamine sulfate; opioid → naloxone; benzodiazepine → flumazenil; organophosphate → atropine plus pralidoxime.

High-alert medications (insulin, heparin, concentrated electrolytes, chemotherapy) require independent double-check and standardised concentrations.

Adverse drug reaction reporting: report suspected reactions to the national pharmacovigilance system even if the reaction is already known.

Four ethical principles: autonomy (respect patient choice), beneficence (do good), non-maleficence (do no harm), justice (fair distribution of care).

Informed consent requires capacity, adequate information, understanding, and voluntariness; it can be withdrawn at any time.

Confidentiality: disclose only on a need-to-know basis; exceptions include statutory reporting, serious risk to others, and court order.

Negligence elements: duty of care, breach of duty, causation, and damage - all four must be proven.

Scope of practice: a nurse must perform only tasks for which they are trained, competent, and authorised; delegating to unqualified staff is unsafe.

Documentation is a legal record: record factually, contemporaneously, in ink, without alterations; late entries must be clearly marked.

Advocacy: the nurse's duty is to protect the patient's rights and interests, including reporting unsafe practice through the proper channels.

Professional boundaries: dual relationships and accepting gifts that could influence care are inappropriate; maintain a therapeutic, not personal, relationship.