Adult Health and Medical-Surgical Nursing
Priority framework
Adult health items are usually prioritization items in disguise. Anchor every scenario in the ABCs, then in the direction of travel: a patient whose vital signs look acceptable but who is becoming restless, confused, or oliguric is deteriorating and needs the nurse first. Learn the classic patterns - early shock (restlessness, tachycardia, narrowing pulse pressure, falling urine output) versus late shock (hypotension, bradycardia); sepsis (fever or hypothermia plus confusion, tachypnea, hypotension); and hypoxia (agitation before desaturation).
High-yield conditions
Heart failure: daily weights, orthopnea, jugular venous distension, crackles, fluid and sodium limits, holding digoxin for bradycardia. COPD: pursed-lip breathing and low-flow oxygen targeting SpO2 88–92% in known CO2 retainers. Post-operative care: atelectasis is the most common early pulmonary complication, so incentive spirometry and early ambulation matter; also DVT prophylaxis, and dehiscence (support the wound, low-Fowler, notify). Stroke: thrombolytic window and a swallow screen before any oral intake. Thyroidectomy: tracheostomy tray and calcium gluconate at the bedside.
Traps
Questions ask for the FIRST action, not the best eventual action; an intervention that needs a prescription is rarely first when a nursing action exists; and 'which finding requires follow-up' means a deviation from expected, not necessarily a complication.
Worked rule
Ask: is this patient safe right now? If not, the answer is a hands-on airway or circulation action plus summoning help - not documentation, not the provider call alone, not a lab draw. Example: stridor and neck swelling after thyroidectomy - position, stay with the patient, call for help; checking calcium comes later.