Medical-Surgical Nursing
Medical-surgical nursing is the largest OMSB nurse exam domain. It tests whether you can assess adults with common medical and surgical conditions, recognize deterioration early, prioritize care, and apply medication and monitoring safeguards across cardiac, respiratory, endocrine, renal, gastrointestinal, neurological, and perioperative presentations.
Core rules
- Use ABC plus level of consciousness first; a stable blood pressure does not exclude compensated shock.
- Interpret labs with the clinical picture: potassium, creatinine, glucose, and arterial blood gases rarely change management alone.
- In heart failure, assess perfusion and congestion before adjusting diuretics; daily weight is more useful than a single edema grade.
- After surgery, monitor airway, bleeding, urine output, pain, and temperature; oliguria below 0.5 mL/kg/h warrants review.
- For diabetes, match insulin type to onset and meal timing; never give rapid-acting insulin without confirming the meal is available.
Worked example
A 24-year-old with type 1 diabetes has glucose 28 mmol/L, pH 7.18, bicarbonate 12 mmol/L, ketones 4+, and K+ 5.6 mmol/L. He is drowsy and has deep respirations. The priority is not a sliding-scale insulin bolus alone: treat DKA with isotonic fluid, IV insulin infusion, and potassium replacement once K+ is below 5.5 mmol/L and urine output is adequate. Reasoning: insulin shifts potassium intracellularly; giving it before volume and potassium assessment can precipitate arrhythmia. Recheck glucose hourly, potassium every 2–4 hours, and add dextrose when glucose falls to about 11–14 mmol/L.
Traps
Do not label all hyperglycemia as DKA; HHS has higher osmolality and less ketosis. Do not withhold insulin in DKA because potassium is high-treat the cause and monitor. Avoid NSAIDs in CKD and metformin around contrast if renal function is uncertain. In COPD, do not give high-flow oxygen without a target range; aim for 88–92% if at risk of CO2 retention.