PNLE cheat sheet

Nursing process order: assessment, diagnosis, planning, implementation, evaluation; the diagnostic statement often uses the PES format: problem, etiology, signs and symptoms.

Maslow priority order: physiologic needs, safety, love and belonging, esteem, self-actualization; unmet lower-level needs generally take priority.

Delegation rule: the registered nurse retains accountability; delegated tasks must be within the delegatee's legal scope, predictable, stable, and clearly directed.

Leadership styles: autocratic suits crises, democratic involves the group in decisions, laissez-faire suits mature self-directed teams; situational leadership matches style to follower readiness.

Ethical principles: autonomy respects informed choice, beneficence promotes good, nonmaleficence avoids harm, justice ensures fairness, veracity requires truthfulness, fidelity requires keeping promises.

Informed consent elements: competence, voluntariness, disclosure, understanding, and consent; the nurse witnesses consent but the provider obtains it.

Incident report rule: record objective facts about an unusual event in an internal report; do not place it in the medical record and do not assign blame.

Research formula: sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

PICO structure: population, intervention, comparison, outcome; it frames a focused clinical question and guides search terms and study selection.

GTPAL: gravida counts all pregnancies including the current one; term births are after 37 weeks, preterm births are 20 to before 37 weeks, abortions are before 20 weeks, and living children are currently alive.

Naegele's rule: estimate due date by subtracting 3 months from the first day of the last menstrual period, adding 7 days, and adding 1 year.

Fetal heart rate baseline is 110 to 160 beats per minute; moderate variability is 6 to 25 beats per minute and is reassuring.

Deceleration rule: early decelerations reflect head compression and are benign; variable decelerations reflect cord compression; late decelerations reflect uteroplacental insufficiency and require immediate action.

Labor stages: first stage from 0 to 10 cm dilation, second stage from full dilation to birth, third stage from birth to placenta delivery, fourth stage the first 1 to 2 hours postpartum.

Postpartum hemorrhage is blood loss greater than 500 mL after vaginal birth or greater than 1000 mL after cesarean birth; uterine atony is the most common cause.

APGAR: appearance, pulse, grimace, activity, respiration; each scored 0 to 2 at 1 and 5 minutes, with a maximum total of 10.

Physiologic newborn jaundice appears after 24 hours; jaundice within the first 24 hours is pathologic and requires prompt evaluation.

Magnesium sulfate toxicity signs include loss of deep tendon reflexes, respiratory depression, and oliguria; calcium gluconate is the antidote.

ABG rule: pH below 7.35 is acidosis and above 7.45 is alkalosis; PaCO2 35 to 45 mm Hg reflects respiratory status; HCO3 22 to 26 mEq/L reflects metabolic status.

Potassium normal range is 3.5 to 5.0 mEq/L; hyperkalemia causes peaked T waves and arrhythmias; hypokalemia causes U waves, weakness, and ileus.

Sodium normal range is 135 to 145 mEq/L; hyponatremia causes neurologic changes and seizures; correction must be slow to avoid osmotic demyelination.

STEMI with ST elevation requires reperfusion; chewable aspirin is given unless contraindicated; troponin rises 3 to 6 hours after myocardial injury and peaks around 12 to 24 hours.

DKA triad: hyperglycemia, acidosis with low bicarbonate, and ketones; treatment includes fluid replacement, insulin infusion, and potassium monitoring.

Heart failure rule: left-sided failure causes pulmonary congestion with dyspnea, orthopnea, crackles, and frothy sputum; right-sided failure causes jugular venous distention, edema, and hepatomegaly.

Cirrhosis complications include ascites, esophageal varices, and hepatic encephalopathy; lactulose lowers ammonia by trapping it in the gut.

Postoperative atelectasis is the most common pulmonary complication; incentive spirometry, deep breathing, coughing, and early ambulation help prevent it.

Parkland formula: 4 mL/kg/% total body surface area burned of lactated Ringer solution in 24 hours; half is given in the first 8 hours from the burn time.

Therapeutic communication techniques include open-ended questions, reflection, clarification, and silence; avoid false reassurance, judgment, and repeated why questions.

Nurse-patient relationship phases: orientation establishes trust, working addresses goals and interventions, termination reviews progress and manages separation.

Anxiety levels: mild, moderate, severe, panic; at panic level the patient cannot problem-solve or follow complex instructions and needs short simple directions and safety.

Suicide risk is higher with a specific plan, access to lethal means, hopelessness, recent loss, and previous attempts; asking directly about suicidal thoughts does not increase risk.

Depression features include depressed mood and anhedonia; SSRIs are first-line pharmacotherapy; serotonin syndrome causes agitation, clonus, hyperreflexia, fever, and autonomic instability.

Lithium therapeutic range is usually 0.6 to 1.2 mEq/L; toxicity causes coarse tremor, ataxia, vomiting, diarrhea, confusion, and seizures.

Neuroleptic malignant syndrome: fever, muscle rigidity, autonomic instability, altered mental status, and elevated creatine kinase; stop the antipsychotic and use dantrolene or bromocriptine.

Alcohol withdrawal timeline: tremor and anxiety within 6 to 24 hours, seizures within 12 to 48 hours, delirium tremens within 48 to 96 hours; benzodiazepines are first-line treatment.

Eating disorder cues: anorexia nervosa shows low body mass index, lanugo, and bradycardia; bulimia nervosa often shows normal weight and dental erosion from recurrent vomiting.

Nursing process order: assessment, diagnosis, planning, implementation, evaluation; the diagnostic statement often uses PES format: problem, etiology, signs and symptoms.

Maslow priority order: physiologic needs, safety, love and belonging, esteem, self-actualization; unmet lower needs generally take priority.

Delegation rule: the registered nurse retains accountability; delegated tasks must be within scope, predictable, stable, and clearly directed.

Leadership styles: autocratic suits crises, democratic involves the group in decisions, laissez-faire suits mature self-directed teams; situational leadership matches style to follower readiness.

Ethical principles: autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity guide nursing decisions.

Informed consent elements: competence, voluntariness, disclosure, understanding, and consent; the nurse witnesses consent, not obtains it.

Incident report rule: document objective facts internally, not in the medical record, and do not assign blame.

Research formula: sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

PICO structure: population, intervention, comparison, outcome; it frames a focused clinical question and guides search terms.

GTPAL: gravida counts all pregnancies including current; term is after 37 weeks, preterm is 20 to before 37 weeks, abortion is before 20 weeks, living children are alive.

Naegele's rule: first day of last menstrual period minus 3 months plus 7 days plus 1 year estimates the due date.

Fetal heart rate baseline is 110 to 160 beats per minute; moderate variability is 6 to 25 beats per minute and is reassuring.

Early decelerations reflect head compression and are benign; variable decelerations reflect cord compression; late decelerations reflect uteroplacental insufficiency and require immediate action.

Labor stages: first is 0 to 10 cm dilation, second is full dilation to birth, third is birth to placenta, fourth is the first 1 to 2 hours postpartum.

Postpartum hemorrhage is greater than 500 mL after vaginal birth or greater than 1000 mL after cesarean birth; uterine atony is the most common cause.

APGAR assesses appearance, pulse, grimace, activity, and respiration at 1 and 5 minutes; each item scores 0 to 2, maximum total 10.

Physiologic newborn jaundice appears after 24 hours; jaundice within the first 24 hours is pathologic and requires prompt evaluation.

Magnesium sulfate toxicity causes loss of deep tendon reflexes, respiratory depression, and oliguria; calcium gluconate is the antidote.

ABG rule: pH below 7.35 is acidosis and above 7.45 is alkalosis; PaCO2 35 to 45 mm Hg reflects respiratory status; HCO3 22 to 26 mEq/L reflects metabolic status.

Potassium normal range is 3.5 to 5.0 mEq/L; hyperkalemia causes peaked T waves and arrhythmias; hypokalemia causes U waves, weakness, and ileus.

Sodium normal range is 135 to 145 mEq/L; hyponatremia causes neurologic changes and seizures; correction must be slow.

STEMI with ST elevation requires reperfusion; chewable aspirin is given unless contraindicated; troponin rises 3 to 6 hours after injury and peaks around 12 to 24 hours.

DKA triad: hyperglycemia, acidosis with low bicarbonate, and ketones; treatment includes fluids, insulin infusion, and potassium monitoring.

Left-sided heart failure causes pulmonary congestion with dyspnea, orthopnea, crackles, and frothy sputum; right-sided failure causes jugular venous distention, edema, and hepatomegaly.

Cirrhosis complications include ascites, esophageal varices, and hepatic encephalopathy; lactulose lowers ammonia by trapping it in the gut.

Postoperative atelectasis is the most common pulmonary complication; incentive spirometry, deep breathing, coughing, and early ambulation help prevent it.

Parkland formula: 4 mL/kg/% total body surface area burned of lactated Ringer solution in 24 hours; half is given in the first 8 hours from burn time.

Therapeutic communication uses open-ended questions, reflection, clarification, and silence; avoid false reassurance, judgment, and repeated why questions.

Nurse-patient relationship phases: orientation establishes trust, working addresses goals, termination reviews progress and manages separation.

Anxiety levels are mild, moderate, severe, and panic; at panic level the patient cannot problem-solve and needs short simple directions and safety.

Suicide risk is higher with a specific plan, access to lethal means, hopelessness, recent loss, and previous attempts; ask directly about suicidal thoughts.

Depression includes depressed mood and anhedonia; SSRIs are first-line pharmacotherapy; serotonin syndrome causes agitation, clonus, hyperreflexia, fever, and autonomic instability.

Lithium therapeutic range is usually 0.6 to 1.2 mEq/L; toxicity causes coarse tremor, ataxia, vomiting, diarrhea, confusion, and seizures.

Neuroleptic malignant syndrome: fever, rigidity, autonomic instability, altered mental status, and elevated creatine kinase; stop the antipsychotic and use dantrolene or bromocriptine.

Alcohol withdrawal timeline: tremor and anxiety within 6 to 24 hours, seizures within 12 to 48 hours, delirium tremens within 48 to 96 hours; benzodiazepines are first-line.

Eating disorder cues: anorexia nervosa shows low body mass index, lanugo, and bradycardia; bulimia nervosa often shows normal weight and dental erosion from vomiting.

Nursing process order: assessment, diagnosis, planning, implementation, evaluation; the diagnostic statement often uses PES format.

Maslow priority order: physiologic needs, safety, love and belonging, esteem, self-actualization; unmet lower needs generally take priority.

Delegation rule: the registered nurse retains accountability; delegated tasks must be within scope, predictable, stable, and clearly directed.

Leadership styles: autocratic suits crises, democratic involves the group, laissez-faire suits mature self-directed teams; situational leadership matches style to readiness.

Ethical principles: autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity guide nursing decisions.

Informed consent elements: competence, voluntariness, disclosure, understanding, and consent; the nurse witnesses consent, not obtains it.

Incident report rule: document objective facts internally, not in the medical record, and do not assign blame.

Research formula: sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

PICO structure: population, intervention, comparison, outcome; it frames a focused clinical question and guides search terms.

GTPAL: gravida counts all pregnancies; term is after 37 weeks, preterm is 20 to before 37 weeks, abortion is before 20 weeks, living children are alive.

Naegele's rule: first day of last menstrual period minus 3 months plus 7 days plus 1 year estimates the due date.

Fetal heart rate baseline is 110 to 160 beats per minute; moderate variability is 6 to 25 beats per minute and is reassuring.

Early decelerations reflect head compression and are benign; variable decelerations reflect cord compression; late decelerations reflect uteroplacental insufficiency and require immediate action.

Labor stages: first is 0 to 10 cm dilation, second is full dilation to birth, third is birth to placenta, fourth is the first 1 to 2 hours postpartum.

Postpartum hemorrhage is greater than 500 mL after vaginal birth or greater than 1000 mL after cesarean birth; uterine atony is the most common cause.

APGAR assesses appearance, pulse, grimace, activity, and respiration at 1 and 5 minutes; each item scores 0 to 2, maximum total 10.

Physiologic newborn jaundice appears after 24 hours; jaundice within the first 24 hours is pathologic and requires prompt evaluation.

Magnesium sulfate toxicity causes loss of deep tendon reflexes, respiratory depression, and oliguria; calcium gluconate is the antidote.

ABG rule: pH below 7.35 is acidosis and above 7.45 is alkalosis; PaCO2 35 to 45 mm Hg reflects respiratory status; HCO3 22 to 26 mEq/L reflects metabolic status.

Potassium normal range is 3.5 to 5.0 mEq/L; hyperkalemia causes peaked T waves and arrhythmias; hypokalemia causes U waves, weakness, and ileus.

Sodium normal range is 135 to 145 mEq/L; hyponatremia causes neurologic changes and seizures; correction must be slow.

STEMI with ST elevation requires reperfusion; chewable aspirin is given unless contraindicated; troponin rises 3 to 6 hours after injury and peaks around 12 to 24 hours.

DKA triad: hyperglycemia, acidosis with low bicarbonate, and ketones; treatment includes fluids, insulin infusion, and potassium monitoring.

Left-sided heart failure causes pulmonary congestion with dyspnea, orthopnea, crackles, and frothy sputum; right-sided failure causes jugular venous distention, edema, and hepatomegaly.

Cirrhosis complications include ascites, esophageal varices, and hepatic encephalopathy; lactulose lowers ammonia by trapping it in the gut.

Postoperative atelectasis is the most common pulmonary complication; incentive spirometry, deep breathing, coughing, and early ambulation help prevent it.

Parkland formula: 4 mL/kg/% total body surface area burned of lactated Ringer solution in 24 hours; half is given in the first 8 hours from burn time.

Therapeutic communication uses open-ended questions, reflection, clarification, and silence; avoid false reassurance, judgment, and repeated why questions.

Nurse-patient relationship phases: orientation establishes trust, working addresses goals, termination reviews progress and manages separation.

Anxiety levels are mild, moderate, severe, and panic; at panic level the patient cannot problem-solve and needs short simple directions and safety.

Suicide risk is higher with a specific plan, access to lethal means, hopelessness, recent loss, and previous attempts; ask directly about suicidal thoughts.

Depression includes depressed mood and anhedonia; SSRIs are first-line pharmacotherapy; serotonin syndrome causes agitation, clonus, hyperreflexia, fever, and autonomic instability.

Lithium therapeutic range is usually 0.6 to 1.2 mEq/L; toxicity causes coarse tremor, ataxia, vomiting, diarrhea, confusion, and seizures.

Neuroleptic malignant syndrome: fever, rigidity, autonomic instability, altered mental status, and elevated creatine kinase; stop the antipsychotic and use dantrolene or bromocriptine.

Alcohol withdrawal timeline: tremor and anxiety within 6 to 24 hours, seizures within 12 to 48 hours, delirium tremens within 48 to 96 hours; benzodiazepines are first-line.

Eating disorder cues: anorexia nervosa shows low body mass index, lanugo, and bradycardia; bulimia nervosa often shows normal weight and dental erosion from vomiting.