QCHP/DHP Nurse Exam cheat sheet

Normal ABG values: pH 7.35–7.45, PaCO2 35–45 mm Hg, HCO3 22–26 mEq/L, PaO2 80–100 mm Hg.

Uncompensated respiratory acidosis: pH below 7.35 with PaCO2 above 45 mm Hg; renal HCO3 compensation takes 24–48 hours to develop.

Left-sided heart failure causes pulmonary congestion (crackles, orthopnea, dyspnea); right-sided failure causes JVD, peripheral edema and hepatomegaly.

Troponin I/T rise within 3–6 hours of myocardial injury, peak at 12–24 hours, and stay elevated 7–10 days.

STEMI reperfusion targets: door-to-balloon 90 minutes or less for PCI, or fibrinolysis within 30 minutes of arrival when PCI is unavailable.

Ischemic stroke thrombolysis window is up to 4.5 hours from last known well; blood pressure must be below 185/110 mm Hg before alteplase.

In DKA total body potassium is depleted even when serum K+ is normal or high; insulin drives K+ intracellularly, so replace K+ when the level is below 5.2 mEq/L.

Water-seal chamber tidaling with respiration is normal; continuous bubbling means an air leak, while bubbling in the suction-control chamber reflects the ordered suction level.

Hepatic encephalopathy: lactulose titrated to 2–3 soft stools per day; avoid sedatives and monitor serum ammonia.

Normal adult vital signs: temperature 36.5–37.5 °C, pulse 60–100/min, respirations 12–20/min, BP below 120/80 mm Hg, SpO2 95% or higher on room air.

Alcohol-based hand rub: 20–30 seconds; soap and water: 40–60 seconds, and always soap and water for C. difficile or visible soiling.

Nasogastric tube placement is verified by gastric aspirate pH of 5.5 or less or by chest X-ray; auscultating an injected air bolus is unreliable.

Braden score of 18 or less indicates pressure-injury risk; reposition immobile patients at least every 2 hours.

A 1 kg change in body weight equals roughly 1 L of fluid; daily weights are more reliable than intake-and-output records.

Restraint orders require face-to-face evaluation within 1 hour, reassessment every 15 minutes for violent patients, and a maximum of 4 hours for adults.

A sterile field is contaminated by contact with the outer 2.5 cm (1-inch) border, by moisture strike-through, or if the nurse turns away from it.

Airborne precautions (negative-pressure room, N95) for TB, measles, varicella; droplet for influenza, pertussis, meningococcus; contact for MRSA and C. difficile.

Naegele's rule: estimated due date = first day of last menstrual period minus 3 months, plus 7 days.

GTPAL: gravida, term births, preterm births, abortions (spontaneous or induced), living children.

Normal fetal heart rate is 110–160/min; accelerations of at least 15/min lasting at least 15 seconds are reassuring after 32 weeks.

Postpartum hemorrhage: more than 500 mL after vaginal birth or more than 1000 mL after cesarean; first action is fundal massage with oxytocin.

Lochia rubra lasts 1–3 days, serosa 4–10 days, alba beyond 10 days; return to rubra or a foul odor suggests infection or retained placenta.

Preeclampsia is BP of 140/90 mm Hg or higher after 20 weeks plus proteinuria or end-organ damage; magnesium sulfate prevents seizures and calcium gluconate is the antidote.

Magnesium toxicity signs: loss of deep tendon reflexes, respiratory rate below 12/min, oliguria - stop the infusion and notify the provider.

APGAR components (0–2 each): appearance, pulse, grimace, activity, respiration; scored at 1 and 5 minutes for a total of 0–10.

Newborn norms: heart rate 120–160/min, respirations 30–60/min; give vitamin K IM and erythromycin ophthalmic ointment after birth.

Anterior fontanelle closes at 12–18 months, posterior at 6–8 weeks; a sunken fontanelle suggests dehydration, a bulging one suggests increased ICP.

Gross motor milestones: head control at 3–4 months, sitting unsupported at 6–8 months, walking independently by 12–15 months.

Croup: barking cough, hoarseness, inspiratory stridor - treat with dexamethasone and nebulized epinephrine. Epiglottitis: drooling and tripod posture - never inspect the throat.

Bronchiolitis (RSV): suction secretions, humidified oxygen and hydration; bronchodilators and corticosteroids are not routinely effective.

Tetralogy of Fallot hypercyanotic spell: knee-chest position, 100% oxygen, morphine and IV fluids; avoid crying and feeding.

Intussusception causes colicky pain, currant-jelly stools and a sausage-shaped mass; an air or barium enema is both diagnostic and therapeutic.

Pyloric stenosis: projectile nonbilious vomiting at 3–6 weeks with a visible peristaltic wave and hypochloremic, hypokalemic metabolic alkalosis.

Never give aspirin to a child with a viral illness because of Reye syndrome risk; use acetaminophen or ibuprofen.

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

Six rights: right patient, drug, dose, route, time and documentation, verified against two patient identifiers.

Digoxin: count the apical pulse for 1 minute, hold if below 60/min in adults; therapeutic level 0.5–2 ng/mL; antidote is digoxin immune Fab.

Heparin is monitored by aPTT (therapeutic about 1.5–2.5 times control) and reversed by protamine sulfate; warfarin is monitored by INR 2–3 and reversed by vitamin K.

Insulin: lispro/aspart onset about 15 minutes (give with meals), regular onset 30–60 minutes, NPH peaks 4–12 hours, glargine is peakless basal insulin.

Aminoglycosides such as gentamicin are nephrotoxic and ototoxic; monitor peak and trough levels plus serum creatinine.

Vancomycin infusion reaction (red man syndrome) is rate-related; infuse over at least 60 minutes and monitor trough levels.

Acetaminophen maximum is 4 g/day in adults (2–3 g with liver disease); overdose antidote is N-acetylcysteine.

Opioid-induced respiratory depression: stop the opioid, stimulate the patient, give naloxone, and monitor respiratory rate with a sedation scale.

Phenytoin therapeutic level 10–20 mcg/mL; toxicity causes nystagmus, ataxia and gingival hyperplasia; dilute in normal saline, never dextrose.

Ethical principles: autonomy (self-determination), beneficence (do good), nonmaleficence (do no harm), justice (fairness), fidelity (keep promises), veracity (truthfulness).

Informed consent: the provider explains risks, benefits and alternatives; the nurse witnesses the signature and verifies the patient's understanding.

The RN cannot delegate assessment, teaching, evaluation or clinical judgment; UAP may perform ADLs and vital signs on stable patients.

SBAR - Situation, Background, Assessment, Recommendation - is the standard structure for handoffs and escalation.

Incident reports record facts and are not copied into the medical record; they support quality improvement and are not punitive.

A sentinel event is unexpected death or serious harm; it requires containment, disclosure to the patient, and root cause analysis.

Advance directives and DNR orders must be verified and documented; the nurse advocates for the patient's stated wishes.

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

Use the chain of command when an order is unsafe or unclear; the nurse remains accountable for accepting and acting on orders.

Primary prevention: immunization, seat belts, health education. Secondary: screening (Pap, mammogram, BP). Tertiary: rehabilitation and chronic disease management.

Epidemiologic triad: host, agent and environment interact to produce disease.

Incidence counts new cases over a period; prevalence counts all existing cases at a point or over a period.

Sensitivity is the probability a test correctly identifies people with disease; specificity is the probability it correctly identifies those without; PPV depends on prevalence.

Herd immunity protects unvaccinated people when a sufficient proportion of the population is immune.

Airborne transmission requires a negative-pressure room and N95 respirator; TB contact investigation covers household and close contacts.

Reportable communicable diseases (TB, hepatitis, STIs, measles) are reported to the local health authority under state law.

Disaster triage colors: red immediate, yellow delayed, green minor, black deceased or expectant.

Home visit safety: visit in daylight, carry a phone, assess environmental hazards, and use bag technique to keep supplies clean.

Therapeutic communication: open-ended questions, reflection, restating, offering self, silence; avoid 'why' questions, false reassurance and advice-giving.

Nurse-client relationship phases: orientation, working, termination; recognize transference and countertransference.

Anxiety levels: mild (increased alertness), moderate (narrowed perception), severe (impaired learning), panic (loss of control, unable to function).

Serotonin syndrome: hyperthermia, clonus, hyperreflexia, agitation (SSRIs/MAOIs). Neuroleptic malignant syndrome: rigidity, high fever, autonomic instability (antipsychotics).

Lithium therapeutic level 0.6–1.2 mEq/L; toxicity causes tremor, ataxia, vomiting and confusion; maintain sodium and fluid intake.

Alcohol withdrawal: use the CIWA scale, give benzodiazepines, and give thiamine before glucose to prevent Wernicke encephalopathy.

Delirium is acute, fluctuating and reversible with inattention; dementia is insidious, progressive memory loss with consciousness intact.

Suicide risk assessment covers ideation, plan, intent, means and prior attempts; a no-suicide contract is insufficient - provide direct observation and a safe environment.

Refeeding syndrome in anorexia: monitor phosphate, potassium and magnesium and advance nutrition slowly.