MNB/LJM Nursing Examination cheat sheet

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

Maslow hierarchy orders priorities: physiological (airway, breathing, circulation) before safety, love/belonging, esteem, self-actualization.

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

Wound drainage: serous = clear plasma-like; sanguineous = bloody; serosanguineous = pink mixed; purulent = thick, opaque, infected.

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

Fowler position is 45-60 degrees; semi-Fowler 30-45 degrees; Trendelenburg places head lower than feet.

Braden Scale scores 6-23; lower scores indicate higher pressure injury risk (≤9 = very high risk).

Pulse deficit = apical rate minus radial rate, counted simultaneously for one full minute; indicates atrial fibrillation or weak peripheral perfusion.

Left-sided heart failure: pulmonary congestion, crackles, orthopnea, dyspnea; right-sided: jugular venous distension, hepatomegaly, peripheral edema, ascites.

Hyperkalemia ECG progression: peaked T waves, prolonged PR, widened QRS, sine wave; treat with calcium gluconate first to stabilize myocardium, then insulin/glucose and albuterol.

Diabetic ketoacidosis: glucose >250 mg/dL, pH <7.30, bicarbonate <18 mEq/L, anion gap >10, ketonemia; treat with isotonic fluids, IV insulin, potassium replacement.

Acute pancreatitis hallmark: severe epigastric pain radiating to the back, elevated lipase (≥3x upper limit), nausea; keep NPO initially and manage pain.

Stroke: alteplase window up to 4.5 h from last known well; exclude hemorrhage by CT before thrombolysis; blood pressure <185/110 mmHg required.

Cushing triad (increased intracranial pressure): hypertension with widened pulse pressure, bradycardia, irregular respirations.

COPD expected ABG: chronic hypoxemia with compensated respiratory acidosis (elevated PaCO2 with near-normal pH and elevated bicarbonate).

Postoperative atelectasis prevention: incentive spirometry 10 breaths/hour, early ambulation, splinting incisions, deep breathing and coughing.

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

Fetal heart rate baseline 110-160/min; early decelerations mirror head compression (benign); variable decelerations reflect cord compression; late decelerations reflect uteroplacental insufficiency and require repositioning, oxygen, and stopping oxytocin.

Four stages of labor: 1 = dilation 0-10 cm, 2 = full dilation to birth, 3 = delivery of placenta, 4 = first 1-2 h postpartum.

Postpartum hemorrhage: blood loss >1000 mL after cesarean or >500 mL after vaginal birth; uterine atony is the most common cause, treated with fundal massage and oxytocin.

Magnesium sulfate toxicity signs: loss of deep tendon reflexes, respiratory depression <12/min, oliguria; antidote is calcium gluconate.

APGAR scored at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration, each 0-2; score ≥7 is normal.

Newborn transitional weight loss up to 10% of birth weight in the first week; regain by 2 weeks.

Breastfeeding: colostrum in the first days is high in immunoglobulin A; feed 8-12 times per 24 h on demand.

Pediatric vital sign trend: heart rate and respiratory rate decrease with age; infant heart rate 100-160/min, respirations 30-60/min; school-age 70-110/min and 18-25/min.

Infant weight doubles by 5-6 months and triples by 12 months; birth weight averages 3-3.5 kg.

Dehydration assessment in children: sunken fontanel, decreased tears, dry mucous membranes, capillary refill >2 s, weight loss percentage.

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

Epiglottitis: drooling, tripod positioning, muffled voice, high fever; do not inspect the throat or use a tongue blade; keep child calm.

Kawasaki disease criteria: fever ≥5 days plus 4 of 5 (conjunctivitis, oral changes, rash, extremity changes, cervical lymphadenopathy); risk of coronary aneurysms; treat with IV immunoglobulin and aspirin.

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

Child abuse red flags: injuries inconsistent with developmental stage, delay in seeking care, patterned bruises, and inconsistent caregiver explanations.

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

Serotonin syndrome triad: mental status change, autonomic instability, neuromuscular hyperactivity (clonus, hyperreflexia); triggered by SSRIs combined with MAOIs or other serotonergic drugs.

Neuroleptic malignant syndrome: fever, muscle rigidity, altered consciousness, elevated creatine kinase; stop antipsychotic, give dantrolene or bromocriptine.

Lithium therapeutic range 0.6-1.2 mEq/L; toxicity signs include tremor, vomiting, ataxia, confusion; maintain sodium and fluid intake.

Alcohol withdrawal timeline: tremor and anxiety 6-12 h, seizures 12-48 h, delirium tremens 48-96 h; treat with benzodiazepines and thiamine.

Suicide risk factors: prior attempt, plan with lethal means, male sex, older age, substance use, access to firearms; direct questioning does not increase risk.

Anorexia nervosa: low body weight, fear of weight gain, amenorrhea; refeeding syndrome risk requires slow caloric advancement and electrolyte monitoring.

Involuntary commitment requires imminent danger to self or others or grave disability, determined by statute; nurses must know their jurisdiction's criteria.

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

Incidence = new cases in a period divided by population at risk; prevalence = all existing cases divided by total population.

Herd immunity threshold depends on basic reproduction number R0: threshold = 1 - 1/R0 (e.g., R0 = 5 gives 80%).

Reportable disease surveillance: notifiable conditions are reported to local health authorities within statutory timeframes; some require immediate notification.

Sensitivity = true positives divided by (true positives + false negatives); specificity = true negatives divided by (true negatives + false positives).

Community assessment models include windshield survey, key informant interviews, and secondary data review from vital statistics.

Case management and outreach target vulnerable populations: homebound older adults, homeless individuals, and uninsured families.

Outbreak investigation steps: confirm diagnosis, define cases, identify source, implement control measures, communicate findings.

Six rights: right patient, drug, dose, route, time, and documentation; verify with two identifiers.

Digoxin: therapeutic 0.5-2 ng/mL; hold and notify for apical pulse <60/min in adults; hypokalemia increases toxicity risk.

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

Aminoglycosides (gentamicin, tobramycin): nephrotoxic and ototoxic; monitor peak and trough levels and creatinine.

Vancomycin: monitor trough (target 10-20 mcg/mL depending on indication); infuse over at least 60 minutes to prevent red man syndrome.

Acetaminophen maximum adult dose 4 g/day (3 g/day in chronic alcohol use or hepatic impairment); overdose antidote N-acetylcysteine.

Insulin onset: rapid-acting lispro/aspart 10-15 min, short-acting regular 30 min, intermediate NPH 1-2 h, long-acting glargine 1-2 h with no peak.

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

Cardiac output = heart rate × stroke volume; normal adult 4-8 L/min.

Blood flow through the heart: vena cava → right atrium → tricuspid valve → right ventricle → pulmonary valve → lungs → left atrium → mitral valve → left ventricle → aortic valve → aorta.

Nephron order: glomerulus → proximal tubule → loop of Henle → distal tubule → collecting duct; most reabsorption occurs in the proximal tubule.

Acid-base compensation: respiratory disorders compensated by renal bicarbonate changes (slow, 24-48 h); metabolic disorders compensated by respiratory rate changes (fast).

Normal ABG: pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3 22-26 mEq/L, PaO2 80-100 mmHg.

Insulin lowers blood glucose by promoting cellular uptake; glucagon raises it via hepatic glycogenolysis and gluconeogenesis.

Renin-angiotensin-aldosterone system: renin release → angiotensin I → angiotensin II (vasoconstriction) → aldosterone (sodium and water retention).

Oxygen-hemoglobin dissociation shifts right (decreased affinity, more oxygen delivery) with increased temperature, CO2, acidosis, and 2,3-DPG.

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

Transmission-based precautions: contact (MRSA, C. difficile, scabies), droplet (influenza, pertussis, meningococcus), airborne (tuberculosis, measles, varicella).

Airborne precautions require a negative-pressure room with ≥12 air changes per hour and N95 or higher respirator.

C. difficile requires soap-and-water handwashing because alcohol-based rub does not kill spores.

Five moments of hand hygiene: before patient contact, before aseptic task, after body fluid exposure, after patient contact, after contact with patient surroundings.

Sterile field rules: 2.5 cm (1 inch) border is contaminated; never turn away from the field; any moisture strike-through renders the field unsterile.

Needlestick protocol: wash with soap and water, report immediately, initiate post-exposure prophylaxis evaluation within hours.

Surgical site infection prevention: chlorhexidine-alcohol skin prep, appropriate prophylactic antibiotic within 60 minutes of incision, normothermia and normoglycemia.

National Patient Safety Goals address patient identification, communication, medication safety, clinical alarms, health care-associated infections, and falls.

Two patient identifiers (name and date of birth or medical record number) before medication administration, transfusion, and procedures.

Fall risk tools (Morse, Hendrich) guide interventions: bed low and locked, call light within reach, nonskid footwear, hourly rounding.

Speak-up and chain-of-command: any team member can escalate a safety concern; SBAR is the standard handoff structure.

RCA (root cause analysis) is retrospective for sentinel events; FMEA (failure mode and effects analysis) is prospective for process risk.

PDSA cycle: Plan, Do, Study, Act; used for iterative quality improvement testing.

Six aims of quality (IOM/NAM): safe, effective, patient-centered, timely, efficient, equitable.

Restraint use requires a time-limited order, ongoing monitoring, and the least restrictive alternative; never used for convenience or discipline.

Informed consent elements: competence, voluntariness, disclosure of risks, benefits, and alternatives; the provider performing the procedure obtains consent, nurse witnesses.

Nurse Practice Acts define scope of practice and are enforced by state boards of nursing.

Mandatory reporting includes suspected child abuse, elder abuse, and certain communicable diseases; nurses are mandatory reporters in most jurisdictions.

Good Samaritan laws protect off-duty emergency assistance that is within the nurse's training and not grossly negligent.

Four ethical principles: autonomy, beneficence, nonmaleficence, justice; veracity and fidelity are additional core obligations.

HIPAA permits disclosure for treatment, payment, and operations; minimum necessary standard applies.

Negligence elements: duty, breach, causation, and damages; all four must be proven.

Advance directives: living will specifies treatments; durable power of attorney for health care names a surrogate decision-maker.

Five rights of delegation: right task, right circumstance, right person, right direction/communication, right supervision/evaluation.

RNs may delegate tasks to LPNs and unlicensed assistive personnel but retain accountability for assessment, teaching, and evaluation.

Never delegate: initial assessment, care planning, evaluation of outcomes, or administration of IV push medications to unlicensed staff.

Leadership styles: autocratic (crisis), democratic (shared decision-making), laissez-faire (experienced self-directed teams), transformational (vision and motivation).

Conflict resolution steps: identify the problem, gather facts, discuss privately, agree on a solution, follow up.

Prioritization frameworks: ABC (airway, breathing, circulation), Maslow, and the nursing process (assess, diagnose, plan, implement, evaluate).

SBAR: Situation, Background, Assessment, Recommendation; used for structured handoffs and escalation.

Staffing and acuity: patient assignment should reflect skill mix and acuity, not just nurse-to-patient ratios.