Mongolia Nurse Licensing Exam cheat sheet

Nursing process: Assessment (collect subjective/objective data), Diagnosis (NANDA-I), Planning (SMART goals), Implementation, Evaluation (reassess and revise).

Maslow hierarchy guides prioritization: physiological > safety > love/belonging > esteem > self-actualization; ABC (Airway, Breathing, Circulation) overrides for immediate threats.

Vital sign norms (adult): oral temp 36.5–37.5°C; pulse 60–100/min; respirations 12–20/min; BP <120/80 mmHg; SpO2 ≥95% on room air.

Hand hygiene: soap and water 40–60 seconds; alcohol-based rub 20–30 seconds; before and after every patient contact and after body-fluid exposure.

Sterile field: 2.5 cm border is non-sterile; never turn back on sterile field; any item touching non-sterile surface is contaminated.

Pressure injury staging: Stage 1 non-blanchable erythema; Stage 2 partial-thickness loss (dermis); Stage 3 full-thickness to fascia; Stage 4 to muscle/bone; unstageable if eschar/slough.

Intake/output: 1 mL = 1 g; normal adult urine output ≥0.5 mL/kg/h; 24-hour output <400 mL = oliguria, <100 mL = anuria.

Documentation: objective, timely, accurate, complete; use quotes for subjective data; never document before intervention is performed.

Cardiac output = heart rate × stroke volume; normal 4–8 L/min; stroke volume determined by preload, afterload, contractility.

Renin-angiotensin-aldosterone system: low BP → renin → angiotensin I → angiotensin II (vasoconstriction) → aldosterone (Na+/water retention) → BP rises.

Acid-base: pH 7.35–7.45; PaCO2 35–45 mmHg; HCO3− 22–26 mEq/L; respiratory opposite (CO2), metabolic equal (HCO3−).

Nephron: glomerulus filters plasma; proximal tubule reabsorbs ~65% Na+/water; loop of Henle concentrates urine; distal tubule/collecting duct respond to aldosterone and ADH.

Oxygen–hemoglobin dissociation curve shifts right (↓affinity, ↑O2 delivery) with ↑CO2, ↑H+, ↑temperature, ↑2,3-BPG; shifts left with hypothermia, alkalosis, low 2,3-BPG.

Inflammation: vasodilation → redness/heat; ↑capillary permeability → swelling; prostaglandins/bradykinin → pain; cytokines → fever.

Cell injury: hypoxia most common cause; reversible until mitochondrial ATP depletion; irreversible when membrane integrity lost (enzyme leakage, Ca2+ influx).

Liver: produces albumin and clotting factors, detoxifies, stores glycogen; jaundice from ↑unconjugated (prehepatic) or ↑conjugated (hepatic/posthepatic) bilirubin.

Heart failure: left-sided → dyspnea, orthopnea, crackles, frothy sputum; right-sided → JVD, peripheral edema, hepatomegaly, ascites.

Myocardial infarction: MONA (Morphine, Oxygen if SpO2<90%, Nitroglycerin, Aspirin 160–325 mg chewed); troponin rises 3–6 h, peaks 12–24 h.

COPD: oxygen target SpO2 88–92% to avoid hypercarbia; pursed-lip breathing and tripod position reduce dyspnea.

Diabetes: hypoglycemia <3.9 mmol/L → 15 g fast carbohydrate, recheck in 15 min; DKA → K+ may be normal/low despite total-body depletion; give insulin then replace K+.

Renal failure: CKD stage by GFR (stage 5 <15 mL/min); hyperkalemia and hyperphosphatemia common; restrict potassium, phosphorus, sodium, protein as indicated.

Stroke: thrombolytic (alteplase) window up to 4.5 h from onset; check glucose, CT to rule out hemorrhage; keep BP <185/110 before thrombolysis.

Postoperative: early ambulation prevents DVT and atelectasis; incentive spirometry 10 breaths/hour; assess bowel sounds before advancing diet.

Cirrhosis: ascites managed with sodium restriction, spironolactone/furosemide; monitor for hepatic encephalopathy (asterixis, ↑ammonia).

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

Stages of labor: 1st (latent 0–6 cm, active 6–10 cm), 2nd (full dilation to birth), 3rd (birth to placenta), 4th (first 1–2 h postpartum).

Fetal heart rate baseline 110–160/min; early decelerations = head compression (benign); late = uteroplacental insufficiency (reposition, O2, stop oxytocin); variable = cord compression.

Postpartum hemorrhage: >500 mL vaginal or >1000 mL cesarean; uterine atony most common cause → fundal massage, oxytocin, empty bladder.

Preeclampsia: BP ≥140/90 after 20 weeks + proteinuria or organ dysfunction; severe features ≥160/110, platelets <100,000, liver enzymes ↑, pulmonary edema; magnesium sulfate for seizure prophylaxis.

Newborn APGAR at 1 and 5 min: Appearance, Pulse, Grimace, Activity, Respiration; score 0–10; <7 at 5 min requires continued resuscitation.

Breastfeeding: colostrum first 2–3 days; feed 8–12 times/24 h; adequate intake = 6+ wet diapers/day and weight gain after initial 7–10% loss.

Contraception effectiveness: implant/IUD >99%; combined oral pill ~91% typical use; condoms also reduce STI transmission.

Pediatric vital signs vary by age: infant HR 100–160, RR 30–60; school-age HR 70–110, RR 18–25; adolescent HR 60–100, RR 12–20.

Weight-based dosing: verify mg/kg and maximum dose; pediatric maintenance fluids 4-2-1 rule (4 mL/kg/h first 10 kg, 2 mL/kg next 10 kg, 1 mL/kg thereafter).

Dehydration: mild <5% weight loss, moderate 5–10%, severe >10%; assess fontanel, mucous membranes, skin turgor, urine output.

Kawasaki disease: fever ≥5 days + ≥4 of conjunctivitis, rash, cervical lymphadenopathy, oral changes, extremity changes; risk of coronary aneurysms; treat with IVIG + aspirin.

Croup: barking cough, inspiratory stridor; treat with dexamethasone and nebulized epinephrine for moderate/severe.

Epiglottitis: drooling, tripod positioning, muffled voice; do not inspect throat; prepare for emergency airway.

Adolescent development (Erikson): identity vs role confusion; provide privacy and confidentiality within legal limits.

Immunization schedule principles: live vaccines contraindicated in immunocompromised; minimum intervals must be respected; catch-up schedules per national guidance.

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

Suicide risk: ask directly about ideation, plan, means, intent; highest risk with plan and access to means; implement safety precautions and no-suicide contract is not evidence-based alone.

Depression: SIGECAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal ideation) ≥5 for ≥2 weeks.

Serotonin syndrome: agitation, hyperthermia, clonus, hyperreflexia; triggered by SSRIs + MAOIs, tramadol, triptans; stop serotonergic drugs.

Neuroleptic malignant syndrome: rigidity, fever, autonomic instability, ↑CK; stop antipsychotic, supportive care, dantrolene or bromocriptine.

Alcohol withdrawal: tremor, anxiety, seizures, delirium tremens; CIWA-Ar guides treatment; benzodiazepines first-line; thiamine before glucose.

Anorexia nervosa: low BMI, fear of weight gain, amenorrhea; refeeding syndrome risk (↓phosphate, ↓K+, ↓Mg2+) - start low, monitor electrolytes.

Mental health law: involuntary admission requires imminent danger to self/others or grave disability; least restrictive alternative; document capacity assessment.

Levels of prevention: primary (immunization, health education), secondary (screening, early treatment), tertiary (rehabilitation, chronic disease management).

Incidence = new cases / population at risk over time; prevalence = all existing cases / total population at a point or period.

Attack rate = (new cases during outbreak / population at risk) × 100; used in outbreak investigation.

Herd immunity threshold depends on R0: threshold = 1 − 1/R0; e.g., R0=5 → 80%.

Screening test properties: sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); positive predictive value depends on prevalence.

Epidemiologic triad: host, agent, environment; chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host.

Mongolia community priorities: air pollution (winter PM2.5), road traffic injuries, alcohol-related harm, hepatitis B/C, tuberculosis, and noncommunicable diseases.

Home visit sequence: previsit planning, introduction, assessment, intervention, evaluation, documentation, and follow-up scheduling.

Adult CPR: compressions 100–120/min, depth 5–6 cm, full recoil, 30:2 ratio; minimize interruptions <10 s; defibrillate VF/pVT as soon as available.

Choking adult: abdominal thrusts (Heimlich); infant: 5 back blows then 5 chest thrusts; unconscious → start CPR.

Anaphylaxis: IM epinephrine 0.3–0.5 mg (1:1000) into vastus lateralis, repeat every 5–15 min; adjuncts antihistamine and corticosteroid do not replace epinephrine.

Sepsis: infection + SOFA ≥2; septic shock = sepsis + vasopressor need to maintain MAP ≥65 + lactate >2 mmol/L despite fluids; antibiotics within 1 hour.

Shock types: hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), obstructive (tension pneumothorax, tamponade, PE).

Isolation precautions: contact (MRSA, C. difficile - soap and water), droplet (influenza, pertussis - surgical mask), airborne (TB, measles - N95, negative pressure).

Needlestick: wash with soap and water, report immediately, assess source, PEP for HIV within 72 h (ideally <2 h), hepatitis B vaccine/immunoglobulin as indicated.

Triage: ABCs first; mass casualty use color tags - red immediate, yellow delayed, green minor, black deceased/expectant.

Rights of medication administration: right patient, drug, dose, route, time, documentation, reason, and patient education/refusal.

High-alert medications: insulin, heparin, opioids, chemotherapy, potassium chloride concentrate; independent double-check and standardized concentrations.

Narrow therapeutic index drugs: digoxin (0.5–2 ng/mL), warfarin (INR 2–3), lithium (0.6–1.2 mEq/L), phenytoin (10–20 mcg/mL), vancomycin (trough 10–20 mcg/mL).

Heparin: monitor aPTT (therapeutic 1.5–2.5× control); antidote protamine sulfate; HIT → stop heparin, use alternative anticoagulant.

Warfarin: monitor INR; antidote vitamin K (phytonadione); many drug/food interactions (vitamin K–rich foods, antibiotics).

Opioid overdose: pinpoint pupils, respiratory depression, sedation; antidote naloxone; monitor for re-sedation.

Pediatric/weight-based calculations: dose (mg) = ordered mg/kg × weight (kg); verify safe range; use oral syringe for small volumes.

Pharmacokinetics: absorption, distribution (albumin binding), metabolism (liver CYP450), excretion (kidney); adjust doses in renal/hepatic impairment.

Mongolian nursing practice is regulated under the Law on Health (2003, amended) and Ministry of Health orders; the nursing license is issued and renewed through the health professional licensing system.

Scope of practice: nurses act within competencies defined by their education and license; delegated tasks require supervision and documented competence.

Informed consent: patient must receive diagnosis, proposed treatment, risks, alternatives, and right to refuse; emergency exception applies when immediate life-saving care is needed.

Confidentiality: patient information may be disclosed only with consent or when required by law (reportable diseases, court order, child/elder protection).

Mandatory reporting: suspected child abuse, infectious disease outbreaks, and certain injuries per Mongolian law; document objectively.

Ethical principles: autonomy, beneficence, nonmaleficence, justice; veracity and fidelity support trust; apply in dilemmas such as resource allocation.

Negligence elements: duty, breach, causation, damages; documentation is the primary legal record; late entries must be labeled as such.

Professional boundaries: no personal relationships, gifts that influence care, or social media disclosure of patient information; report impaired colleagues to the appropriate authority.