# NCLEX-RN Medical Terminology & Concepts Study Guide
## 200+ High-Yield Terms with NCLEX-Style Questions & Clinical Scenarios

**Price:** $19 | **Format:** Markdown + PDF Workbook
**Category:** Nursing Education / NCLEX Exam Prep
**Design:** Teal (#008080) + white — clean, medical-nursing aesthetic

---

> **📋 How to Use This Guide:** Each section contains a term table (definition + clinical significance + NCLEX tip), followed by active-recall exercises, clinical prioritization scenarios, NCLEX-style MC questions, and SATA (Select-All-That-Apply) practice. Answer keys with rationales are at the back. The NCLEX Cram Sheet and Prefix/Suffix Guide are designed for final review the week before your exam.

---


## 🏥 Section 1: Pharmacology & Drug Classes (30 Terms)

| # | Term | Definition | Clinical Significance | NCLEX Tip |
|---|------|------------|----------------------|-----------|
| 1 | **Beta Blocker (-lol)** | Blocks beta-adrenergic receptors, reducing heart rate, contractility, and blood pressure | Monitor HR and BP before administering — hold if HR <60. | NCLEX likes: metoprolol — check apical pulse for 1 full minute before giving. |
| 2 | **ACE Inhibitor (-pril)** | Inhibits angiotensin-converting enzyme, lowering BP by reducing angiotensin II | Monitor for dry cough (common side effect), hyperkalemia, and angioedema. | If the patient develops a persistent dry cough on lisinopril — it's the ACE inhibitor. Don't discontinue without contacting provider. |
| 3 | **Calcium Channel Blocker (-dipine)** | Blocks calcium entry into cardiac and smooth muscle cells, causing vasodilation | Used for hypertension and angina. Monitor for peripheral edema and constipation. | Amlodipine causes ankle swelling — reversible, not an allergy. Educate patient. |
| 4 | **Statin (-statin)** | HMG-CoA reductase inhibitor — lowers LDL cholesterol | Monitor liver enzymes and for muscle pain (rhabdomyolysis risk). Give at bedtime. | Atorvastatin — ask about muscle tenderness and dark urine. Check CK levels. |
| 5 | **Anticoagulant** | Prevents blood clot formation through various mechanisms | Examples: warfarin (Coumadin), heparin, enoxaparin (Lovenox), apixaban (Eliquis). | Warfarin = check PT/INR. Heparin = check aPTT. Different labs for different anticoagulants — NCLEX favorite. |
| 6 | **Warfarin (Coumadin)** | Vitamin K antagonist — oral anticoagulant | Therapeutic INR: 2-3 for most indications. Antidote: Vitamin K. | Patient teaching: consistent vitamin K intake, avoid cranberry, report bleeding. Many drug interactions. |
| 7 | **Heparin** | Parenteral anticoagulant — activates antithrombin III | Monitor aPTT (1.5-2.5x normal). Antidote: protamine sulfate. | IV heparin = aPTT. SubQ heparin (prophylaxis) = no monitoring needed. Don't confuse the two. |
| 8 | **Enoxaparin (Lovenox)** | Low molecular weight heparin — more predictable anticoagulation | SubQ injection. No routine lab monitoring. Rotate injection sites. | Do NOT aspirate or massage after Lovenox injection — increases bruising risk. |
| 9 | **Insulin (Rapid-Acting)** | Lispro, Aspart, Glulisine — onset 15 min, peak 1 hr | Give 15 min before meals. Only insulin safe for IV use (regular insulin). | Lispro = 'listen' — onset is so fast you need the meal ready NOW. Check blood glucose before giving. |
| 10 | **Metformin** | Biguanide — first-line oral agent for type 2 diabetes | Decreases hepatic glucose production. Hold before contrast dye (48 hrs). | Metformin + IV contrast = lactic acidosis risk. Hold and check renal function before restarting. |
| 11 | **Opioid Analgesic** | Binds mu opioid receptors — pain relief, sedation, respiratory depression | Examples: morphine, hydromorphone, fentanyl, oxycodone. Antidote: naloxone. | ABC priority: respiratory depression is the life-threatening adverse effect. Check RR before and after administration. |
| 12 | **Benzodiazepine** | Enhances GABA — anxiolytic, sedative, anticonvulsant | Examples: lorazepam, diazepam, midazolam. Antidote: flumazenil. | Flumazenil can precipitate seizures — only use in controlled settings. Monitor respiratory status. |
| 13 | **SSRI (Selective Serotonin Reuptake Inhibitor)** | First-line antidepressant — increases serotonin availability | Examples: fluoxetine, sertraline, escitalopram. Onset: 2-4 weeks. | Serotonin syndrome risk when combined with other serotonergic drugs. Never abruptly discontinue — taper. |
| 14 | **Diuretic (Loop)** | Inhibits Na/K/Cl reabsorption in loop of Henle — potent diuresis | Example: furosemide (Lasix). Monitor K+ (hypokalemia), BP, daily weight, I&O. | Furosemide = 'furo-squeeze-mide' — watch potassium drop. Give in morning to avoid nocturia. |
| 15 | **Potassium-Sparing Diuretic** | Blocks aldosterone — spares potassium while causing diuresis | Example: spironolactone. Monitor for hyperkalemia. Contraindicated with K+ supplements. | Spironolactone saves K+ — don't also give K+ supplements. Don't confuse with loop diuretics that waste K+. |
| 16 | **Digoxin** | Cardiac glycoside — increases contractility, decreases conduction | Narrow therapeutic range: 0.5-2.0 ng/mL. Check apical pulse 1 min before. | Digoxin toxicity: N/V, vision changes (yellow-green halos), bradycardia. Hold if pulse <60. |
| 17 | **Nitroglycerin** | Vasodilator — reduces preload and afterload | Used for angina. Sublingual q5min up to 3 doses. Store in dark glass. | If pain unrelieved after 1 nitro dose — call 911. May cause headache and hypotension. |
| 18 | **Albuterol** | Beta-2 agonist — bronchodilator | Used for asthma/COPD exacerbation. Monitor for tachycardia and tremors. | Rescue inhaler = albuterol. If using more than twice weekly for asthma — not well-controlled. |
| 19 | **Antibiotic (Broad Spectrum)** | Kills or inhibits bacteria across multiple classes | Always check culture & sensitivity and allergies before administering. | Complete the full course even if feeling better. Monitor for C. diff (watery diarrhea). Superinfection risk. |
| 20 | **Vancomycin** | Glycopeptide antibiotic — treats MRSA and serious gram-positive infections | Monitor trough levels (10-20 mcg/mL). Red man syndrome with rapid infusion. | 'Vanco-man' gets a red neck if you push too fast. Infuse over at least 60 minutes. |
| 21 | **Aminoglycoside** | Bactericidal antibiotic — treats gram-negative infections | Examples: gentamicin, tobramycin. Monitor peak/trough. Ototoxicity and nephrotoxicity. | Aminoglycosides = 'a-mean-o' — peak and trough levels are critical. Monitor BUN/Cr and hearing. |
| 22 | **Insulin (Long-Acting)** | Glargine, Detemir — basal insulin with no peak | Given once daily. Do NOT mix with other insulins in same syringe. | Glargine = 'clear' insulin. Only insulin that is clear and long-acting. Provides 24-hour basal coverage. |
| 23 | **Levothyroxine** | Synthetic T4 — thyroid hormone replacement | Take on empty stomach 30-60 min before breakfast. Lifelong therapy. | Dose may need adjustment with pregnancy, weight change. Morning administration. Report palpitations. |
| 24 | **Prednisone** | Corticosteroid — anti-inflammatory, immunosuppressant | Taper, never abruptly stop. Monitor blood glucose, weight, mood. | Long-term use → Cushing's syndrome, osteoporosis, hyperglycemia, infection risk. TAPER — adrenal suppression. |
| 25 | **Proton Pump Inhibitor (-prazole)** | Irreversibly inhibits H+/K+ ATPase — reduces gastric acid | Examples: omeprazole, pantoprazole. Take 30-60 min before first meal. | PPIs increase risk of C. diff, pneumonia, and fractures with long-term use. Shortest duration possible. |
| 26 | **Epinephrine** | Sympathomimetic — vasoconstrictor, bronchodilator, increases HR/contractility | First-line for anaphylaxis (IM) and cardiac arrest (IV). | 1:1000 for IM (anaphylaxis), 1:10,000 for IV (code). Know the difference — NCLEX tests concentration. |
| 27 | **Naloxone (Narcan)** | Opioid antagonist — reverses respiratory depression | Give IV/IM/IN. May require repeat doses (short half-life). | Patient will wake up in withdrawal — anticipate combative behavior. Re-dose if respiratory depression returns. |
| 28 | **Potassium Chloride (KCl)** | Electrolyte replacement for hypokalemia | NEVER push IV — must be diluted and infused slowly. Max rate 10 mEq/hr peripheral. | KCl IV push = fatal dysrhythmia. Always on an infusion pump. Monitor cardiac rhythm during infusion. |
| 29 | **Magnesium Sulfate** | Electrolyte — used for hypomagnesemia, torsades, preterm labor, eclampsia | Monitor deep tendon reflexes, respiratory rate, urine output. | MgSO4 toxicity: absent DTRs, RR <12, decreased LOC. Antidote: calcium gluconate. |
| 30 | **Haloperidol (Haldol)** | First-generation antipsychotic — dopamine antagonist | Monitor for extrapyramidal symptoms (EPS), QT prolongation, neuroleptic malignant syndrome. | Haldol + EPS = treat with benztropine or diphenhydramine. NMS is a medical emergency — stop drug, cool patient. |

### ✏️ Exercise A: Fill in the Definition
1. **Beta Blocker (-lol)**: Blocks beta-adrenergic receptors, reducing heart __________ contractility, and blood pressure
2. **ACE Inhibitor (-pril)**: Inhibits angiotensin-converting enzyme, lowering __________ by reducing angiotensin II
3. **Calcium Channel Blocker (-dipine)**: Blocks calcium entry into cardiac __________ smooth muscle cells, causing vasodilation
4. **Statin (-statin)**: HMG-CoA reductase inhibitor __________ lowers LDL cholesterol
5. **Anticoagulant**: Prevents blood clot __________ through various mechanisms
6. **Warfarin (Coumadin)**: Vitamin K antagonist __________ oral anticoagulant
7. **Heparin**: Parenteral anticoagulant — __________ antithrombin III
8. **Enoxaparin (Lovenox)**: Low molecular weight heparin __________ more predictable anticoagulation
9. **Insulin (Rapid-Acting)**: Lispro, Aspart, Glulisine — onset __________ min, peak 1 hr
10. **Metformin**: Biguanide — first-line oral __________ for type 2 diabetes
11. **Opioid Analgesic**: Binds mu opioid receptors — __________ relief, sedation, respiratory depression
12. **Benzodiazepine**: Enhances GABA — __________ sedative, anticonvulsant

### 🔗 Exercise B: Matching
| Term | Letter |
|------|--------|
| **Beta Blocker (-lol)** | ___ |
| **ACE Inhibitor (-pril)** | ___ |
| **Calcium Channel Blocker (-dipine)** | ___ |
| **Statin (-statin)** | ___ |
| **Anticoagulant** | ___ |
| **Warfarin (Coumadin)** | ___ |
| **Heparin** | ___ |
| **Enoxaparin (Lovenox)** | ___ |
| **Insulin (Rapid-Acting)** | ___ |
| **Metformin** | ___ |

| Letter | Definition |
|--------|------------|
| A | Low molecular weight heparin — more predictable anticoagulation |
| B | HMG-CoA reductase inhibitor — lowers LDL cholesterol |
| C | Blocks calcium entry into cardiac and smooth muscle cells, causing vasodilation |
| D | Lispro, Aspart, Glulisine — onset 15 min, peak 1 hr |
| E | Vitamin K antagonist — oral anticoagulant |
| F | Parenteral anticoagulant — activates antithrombin III |
| G | Biguanide — first-line oral agent for type 2 diabetes |
| H | Prevents blood clot formation through various mechanisms |
| I | Blocks beta-adrenergic receptors, reducing heart rate, contractility, and blood pressure |
| J | Inhibits angiotensin-converting enzyme, lowering BP by reducing angiotensin II |

### 🚑 Exercise C: Clinical Prioritization Scenario
A patient with atrial fibrillation is on warfarin (Coumadin). Today's INR is 4.8. The patient
reports noticing blood in the toilet after bowel movements. Prioritize: What is the most concerning
finding? What nursing actions are required? Which lab values need to be monitored most urgently?

### 📝 Exercise D: NCLEX-Style Questions
**1.** A nurse is caring for a patient receiving Beta Blocker (-lol). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) NCLEX likes: metoprolol — check apical pulse for 1 full minu...
   C) Glycopeptide antibiotic — treats MRSA and serious gram-positive infections
   D) Blocks aldosterone — spares potassium while causing diuresis

**2.** A nurse is caring for a patient receiving ACE Inhibitor (-pril). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) If the patient develops a persistent dry cough on lisinopril...
   C) Blocks calcium entry into cardiac and smooth muscle cells, causing vasodilation
   D) Blocks beta-adrenergic receptors, reducing heart rate, contractility, and blood 

**3.** A nurse is caring for a patient receiving Calcium Channel Blocker (-dipine). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Amlodipine causes ankle swelling — reversible, not an allerg...
   C) HMG-CoA reductase inhibitor — lowers LDL cholesterol
   D) Low molecular weight heparin — more predictable anticoagulation

**4.** A nurse is caring for a patient receiving Statin (-statin). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Atorvastatin — ask about muscle tenderness and dark urine...
   C) Lispro, Aspart, Glulisine — onset 15 min, peak 1 hr
   D) Beta-2 agonist — bronchodilator

**5.** A nurse is caring for a patient receiving Anticoagulant. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Warfarin = check PT/INR...
   C) Bactericidal antibiotic — treats gram-negative infections
   D) Blocks beta-adrenergic receptors, reducing heart rate, contractility, and blood 

### ✓ Exercise E: Select All That Apply (SATA)
**1.** A patient is receiving Beta Blocker (-lol). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**2.** A patient is receiving ACE Inhibitor (-pril). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**3.** A patient is receiving Calcium Channel Blocker (-dipine). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

---

## 🏥 Section 2: Lab Values & Diagnostics (25 Terms)

| # | Term | Definition | Clinical Significance | NCLEX Tip |
|---|------|------------|----------------------|-----------|
| 1 | **CBC (Complete Blood Count)** | Panel measuring RBCs, WBCs, hemoglobin, hematocrit, platelets | WBC: infection/inflammation. Hgb/Hct: anemia or polycythemia. Platelets: bleeding risk. | NCLEX: Know trends, not just single values. Neutropenic precautions if ANC <500. |
| 2 | **Hemoglobin (Hgb)** | Oxygen-carrying protein in RBCs — normal: M 13.5-17.5, F 12-16 g/dL | Low = anemia, hemorrhage, fluid overload. High = polycythemia, dehydration. | Transfusion usually considered at Hgb <7-8 in stable patients. Check after each unit. |
| 3 | **WBC (White Blood Count)** | Measures immune cells — normal: 4,500-11,000/mcL | Elevated = infection, inflammation, leukemia. Low = immunosuppression, chemo. | 'Left shift' = increased bands = active bacterial infection. Neutropenic precautions when ANC <500. |
| 4 | **Platelets** | Cell fragments essential for clotting — normal: 150,000-400,000/mcL | Low = bleeding risk (ITP, chemo, HIT). High = clotting risk. | <50K = bleeding precautions. <20K = spontaneous bleeding risk. Check before invasive procedures. |
| 5 | **BMP (Basic Metabolic Panel)** | Measures glucose, calcium, electrolytes, BUN, creatinine | Screens kidney function, electrolyte balance, glucose. | BMP = 8 tests. CMP = BMP + liver function + protein. Know which is which. |
| 6 | **Sodium (Na+)** | Major extracellular cation — normal: 135-145 mEq/L | Hyponatremia: confusion, seizures. Hypernatremia: thirst, restlessness. | Correct sodium slowly — rapid correction of hyponatremia causes osmotic demyelination syndrome. |
| 7 | **Potassium (K+)** | Major intracellular cation — normal: 3.5-5.0 mEq/L | Hypokalemia: weakness, U-waves, arrhythmias. Hyperkalemia: peaked T-waves, muscle weakness. | Hyperkalemia ECG changes = peaked T → lost P → wide QRS. Calcium gluconate stabilizes cardiac membrane. |
| 8 | **Creatinine (Cr)** | Waste product of muscle metabolism — normal: 0.6-1.2 mg/dL | Elevated = decreased kidney function. Used to calculate eGFR. | Contrast dye and nephrotoxic drugs require baseline Cr. Rising Cr = acute kidney injury until proven otherwise. |
| 9 | **BUN (Blood Urea Nitrogen)** | Waste product of protein metabolism — normal: 7-20 mg/dL | Elevated in dehydration, renal failure, high-protein diet, GI bleed. | BUN:Cr ratio >20:1 = pre-renal cause (dehydration). Ratio normal = intrinsic renal. |
| 10 | **ABG (Arterial Blood Gas)** | Measures oxygenation (PaO2), ventilation (PaCO2), acid-base (pH, HCO3) | pH 7.35-7.45, PaCO2 35-45, HCO3 22-26. | ROME method: Respiratory Opposite, Metabolic Equal. pH and PaCO2 opposite directions = respiratory problem. |
| 11 | **Troponin** | Cardiac biomarker — elevated with myocardial injury | Normal: <0.04 ng/mL. Trend over 3-6 hours. | Troponin elevation ≠ always MI. Can be elevated in CHF, PE, sepsis, renal failure. Know the clinical context. |
| 12 | **BNP (B-Type Natriuretic Peptide)** | Released when ventricles are stretched — marker for heart failure | Normal: <100 pg/mL. >400 suggests CHF. | BNP helps differentiate CHF vs COPD exacerbation causing dyspnea. High BNP = heart failure. |
| 13 | **PT/INR** | Measures extrinsic coagulation pathway — monitors warfarin | Normal PT: 11-13.5 sec. Therapeutic INR: 2-3 (most), 2.5-3.5 (mechanical valves). | High INR = bleeding risk. Antidote: vitamin K (slow), FFP (fast). Patient teaching: consistent vitamin K intake. |
| 14 | **aPTT** | Partial Thromboplastin Time — monitors heparin therapy | Normal: 25-35 sec. Therapeutic: 1.5-2.5x normal. | aPTT for Heparin (both have PTT in name — association trick). Protamine sulfate is antidote. |
| 15 | **HbA1c** | Glycosylated hemoglobin — average blood glucose over 2-3 months | Normal: <5.7%. Prediabetes: 5.7-6.4%. Diabetes: ≥6.5%. | Goal for most diabetics: <7%. Reflects long-term control, not a single-day reading. |
| 16 | **Lipid Panel** | Measures total cholesterol, LDL, HDL, triglycerides | High LDL = atherosclerosis risk. High HDL = protective. | Fasting 9-12 hours before draw. Statins primarily target LDL reduction. |
| 17 | **Liver Enzymes (ALT, AST)** | ALT (liver-specific), AST (liver, heart, muscle) — markers of hepatocyte injury | ALT > AST = viral hepatitis. AST > ALT = alcoholic liver disease. | Hepatotoxic drugs (acetaminophen, statins) require baseline and periodic LFT monitoring. |
| 18 | **Blood Culture & Sensitivity** | Identifies bacteria in bloodstream and which antibiotics will work | Draw BEFORE starting antibiotics when possible. Two sets from different sites. | Never delay antibiotics for septic patient just to get cultures — but try to draw them first. |
| 19 | **Urinalysis (UA)** | Screens for UTI, kidney disease, diabetes | Leukocyte esterase + nitrites = likely UTI. Ketones + glucose = DKA. | Clean-catch midstream for culture. Straight cath if patient cannot provide clean catch. |
| 20 | **Glucose (Fasting)** | Blood sugar after 8-hour fast — normal: 70-100 mg/dL | Fasting >126 on 2 occasions = diabetes. | Bedside glucose checks guide insulin administration. Treat hypoglycemia (<70) with 15g fast-acting carbs. |
| 21 | **Calcium (Ca2+)** | Essential for bones, muscle contraction, nerve function — normal: 8.5-10.5 mg/dL | Hypocalcemia: Chvostek/Trousseau signs. Hypercalcemia: 'bones, stones, groans, psychiatric overtones.' | Ionized calcium is the active form. Albumin affects total Ca — correct if albumin is low. |
| 22 | **Magnesium (Mg2+)** | Cofactor for 300+ enzymes — normal: 1.7-2.2 mg/dL | Low: hyperreflexia, tetany, torsades. High: absent DTRs, respiratory depression. | Mg and K+ are linked — you can't correct hypokalemia until hypomagnesemia is fixed. |
| 23 | **D-Dimer** | Fibrin degradation product — elevated with clot formation/breakdown | Very sensitive but not specific for DVT/PE. Elevated in pregnancy, surgery, inflammation. | Negative D-dimer = effectively rules out DVT/PE in low-risk patients. Positive = need imaging. |
| 24 | **CRP (C-Reactive Protein)** | Inflammatory marker — elevated with infection, inflammation, autoimmune disease | High-sensitivity CRP used for cardiovascular risk assessment. | CRP is non-specific — doesn't tell you WHERE the inflammation is, only that it's present. |
| 25 | **Lactic Acid** | Byproduct of anaerobic metabolism — marker of tissue hypoperfusion | Normal: <2 mmol/L. Elevated in sepsis, shock, tissue hypoxia. | Elevated lactate in sepsis = tissue is not getting enough oxygen. Clearance is a resuscitation endpoint. |

### ✏️ Exercise A: Fill in the Definition
1. **CBC (Complete Blood Count)**: Panel measuring RBCs, __________ hemoglobin, hematocrit, platelets
2. **Hemoglobin (Hgb)**: Oxygen-carrying protein in RBCs — __________ M 13.5-17.5, F 12-16 g/dL
3. **WBC (White Blood Count)**: Measures immune cells __________ normal: 4,500-11,000/mcL
4. **Platelets**: Cell fragments essential for __________ — normal: 150,000-400,000/mcL
5. **BMP (Basic Metabolic Panel)**: Measures glucose, calcium, __________ BUN, creatinine
6. **Sodium (Na+)**: Major extracellular cation __________ normal: 135-145 mEq/L
7. **Potassium (K+)**: Major intracellular cation __________ normal: 3.5-5.0 mEq/L
8. **Creatinine (Cr)**: Waste product of muscle __________ — normal: 0.6-1.2 mg/dL
9. **BUN (Blood Urea Nitrogen)**: Waste product of protein __________ — normal: 7-20 mg/dL
10. **ABG (Arterial Blood Gas)**: Measures oxygenation (PaO2), ventilation __________ acid-base (pH, HCO3)
11. **Troponin**: Cardiac biomarker — __________ with myocardial injury
12. **BNP (B-Type Natriuretic Peptide)**: Released when ventricles are stretched __________ marker for heart failure

### 🔗 Exercise B: Matching
| Term | Letter |
|------|--------|
| **CBC (Complete Blood Count)** | ___ |
| **Hemoglobin (Hgb)** | ___ |
| **WBC (White Blood Count)** | ___ |
| **Platelets** | ___ |
| **BMP (Basic Metabolic Panel)** | ___ |
| **Sodium (Na+)** | ___ |
| **Potassium (K+)** | ___ |
| **Creatinine (Cr)** | ___ |
| **BUN (Blood Urea Nitrogen)** | ___ |
| **ABG (Arterial Blood Gas)** | ___ |

| Letter | Definition |
|--------|------------|
| A | Waste product of muscle metabolism — normal: 0.6-1.2 mg/dL |
| B | Major extracellular cation — normal: 135-145 mEq/L |
| C | Panel measuring RBCs, WBCs, hemoglobin, hematocrit, platelets |
| D | Measures immune cells — normal: 4,500-11,000/mcL |
| E | Measures glucose, calcium, electrolytes, BUN, creatinine |
| F | Measures oxygenation (PaO2), ventilation (PaCO2), acid-base (pH, HCO3) |
| G | Oxygen-carrying protein in RBCs — normal: M 13.5-17.5, F 12-16 g/dL |
| H | Major intracellular cation — normal: 3.5-5.0 mEq/L |
| I | Cell fragments essential for clotting — normal: 150,000-400,000/mcL |
| J | Waste product of protein metabolism — normal: 7-20 mg/dL |

### 🚑 Exercise C: Clinical Prioritization Scenario
Prioritize the top 3 nursing actions for a deteriorating patient with conditions covered in this
section. Use the nursing process (ADPIE).

### 📝 Exercise D: NCLEX-Style Questions
**1.** A nurse is caring for a patient receiving CBC (Complete Blood Count). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) NCLEX: Know trends, not just single values...
   C) Inflammatory marker — elevated with infection, inflammation, autoimmune disease
   D) Glycosylated hemoglobin — average blood glucose over 2-3 months

**2.** A nurse is caring for a patient receiving Hemoglobin (Hgb). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Transfusion usually considered at Hgb <7-8 in stable patient...
   C) Released when ventricles are stretched — marker for heart failure
   D) Measures oxygenation (PaO2), ventilation (PaCO2), acid-base (pH, HCO3)

**3.** A nurse is caring for a patient receiving WBC (White Blood Count). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) 'Left shift' = increased bands = active bacterial infection...
   C) Major extracellular cation — normal: 135-145 mEq/L
   D) Waste product of muscle metabolism — normal: 0.6-1.2 mg/dL

**4.** A nurse is caring for a patient receiving Platelets. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) <50K = bleeding precautions...
   C) Released when ventricles are stretched — marker for heart failure
   D) Measures glucose, calcium, electrolytes, BUN, creatinine

**5.** A nurse is caring for a patient receiving BMP (Basic Metabolic Panel). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) BMP = 8 tests...
   C) Measures immune cells — normal: 4,500-11,000/mcL
   D) Partial Thromboplastin Time — monitors heparin therapy

### ✓ Exercise E: Select All That Apply (SATA)
**1.** A patient is receiving CBC (Complete Blood Count). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**2.** A patient is receiving Hemoglobin (Hgb). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**3.** A patient is receiving WBC (White Blood Count). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

---

## 🏥 Section 3: Cardiovascular & Respiratory (25 Terms)

| # | Term | Definition | Clinical Significance | NCLEX Tip |
|---|------|------------|----------------------|-----------|
| 1 | **Myocardial Infarction (MI)** | Death of myocardial tissue from prolonged ischemia | Chest pain (pressure/crushing), diaphoresis, N/V, radiation to jaw/left arm. | MONA is outdated — current priority: O2 if hypoxic, aspirin, nitro, morphine for pain. 12-lead ECG within 10 minutes. |
| 2 | **Congestive Heart Failure (CHF)** | Heart's inability to pump adequately → fluid backup | Left-sided: pulmonary congestion (crackles, SOB). Right-sided: peripheral edema, JVD, ascites. | 'L=Lungs, R=Rest of body.' Daily weights — 1kg gain in 24hrs = fluid retention. Low sodium diet. |
| 3 | **Atrial Fibrillation (AFib)** | Chaotic atrial electrical activity — irregularly irregular rhythm | Risk: stroke from atrial clot formation. Rate control vs rhythm control. | Irregularly irregular + no P waves. Priority: stroke prevention (anticoagulation, CHA₂DS₂-VASc score). |
| 4 | **Ventricular Fibrillation (VFib)** | Chaotic ventricular electrical activity — NO cardiac output | Pulseless, unresponsive. Immediate CPR and defibrillation. | Coarse VFib = shockable. Fine VFib may look like asystole — when in doubt, check in 2 leads. |
| 5 | **Ventricular Tachycardia (VTach)** | Rapid ventricular rhythm >100 bpm | With pulse: cardioversion or antiarrhythmics. Without pulse: CPR and defibrillation. | Sustained VTach = emergency. Monomorphic = same shape. Polymorphic (Torsades) = MgSO4. |
| 6 | **PEA (Pulseless Electrical Activity)** | Organized electrical rhythm without mechanical contraction | Treat underlying cause: H's and T's (Hypovolemia, Hypoxia, Hydrogen ions, Hypo/Hyperkalemia, Hypothermia, Tension pneumo, Tamponade, Toxins, Thrombosis). | PEA = NOT asystole. You see a rhythm but there's no pulse. Address the cause, not the rhythm. |
| 7 | **DVT (Deep Vein Thrombosis)** | Blood clot in deep veins — usually legs | Signs: unilateral swelling, warmth, redness, pain on dorsiflexion (Homan's sign — unreliable). | Risk factors: Virchow's triad (stasis, hypercoagulability, endothelial injury). Prevention: early ambulation, SCDs, anticoagulation. |
| 8 | **Pulmonary Embolism (PE)** | Blood clot that travels to pulmonary arteries | Sudden dyspnea, pleuritic chest pain, tachycardia. Clear lung sounds (no crackles). | PE vs CHF: PE = clear lungs + sudden onset. CHF = crackles + gradual. D-dimer and CT angiogram for diagnosis. |
| 9 | **COPD** | Chronic bronchitis + emphysema — irreversible airway obstruction | Pink puffer (emphysema) vs Blue bloater (chronic bronchitis). Pursed-lip breathing. | Drive to breathe is hypoxic, NOT hypercapnic — be careful with too much O2 (target 88-92% SpO2). |
| 10 | **ARDS (Acute Respiratory Distress Syndrome)** | Diffuse alveolar damage → severe hypoxemia | Causes: sepsis, trauma, pneumonia, aspiration. Refractory hypoxemia. | Low tidal volume ventilation (6 mL/kg ideal body weight). Prone positioning improves oxygenation. |
| 11 | **Pneumonia** | Infection of lung parenchyma | Fever, productive cough, pleuritic chest pain, crackles, consolidation on CXR. | Community-acquired vs hospital-acquired vs ventilator-associated. CURB-65 for severity assessment. |
| 12 | **Pneumothorax** | Air in pleural space → lung collapse | Sudden pleuritic pain, decreased breath sounds, hyperresonance. Tension: tracheal deviation + JVD + hypotension. | Spontaneous: tall thin males. Traumatic: chest trauma. Tension = needle decompression then chest tube. |
| 13 | **Cardiac Tamponade** | Fluid in pericardial sac compresses the heart | Beck's Triad: muffled heart sounds, JVD, hypotension. Pulsus paradoxus. | Tamponade vs tension pneumothorax: both cause JVD and hypotension — put the stethoscope on. Muffled = tamponade. |
| 14 | **Hypertension (HTN)** | BP consistently >130/80 mmHg | Silent killer. Treat with lifestyle first then medications. | Hypertensive urgency (no organ damage) vs emergency (organ damage). Lower slowly in emergency — not too fast. |
| 15 | **Peripheral Artery Disease (PAD)** | Atherosclerosis of arteries in extremities | Intermittent claudication, diminished pulses, cool/pale skin, hair loss on legs. | PAD = arteries (pulses down, pale). PVD = veins (edema, pulses present). Dependent position relieves PAD pain. |
| 16 | **Cardiac Catheterization** | Invasive procedure to visualize coronary arteries | Pre: NPO, check renal function, consent, allergies (contrast/shellfish). Post: flat x 4-6 hrs, monitor insertion site. | Post-cath: report bleeding/hematoma at site. Check distal pulses. Keep leg straight. |
| 17 | **Shock (General)** | Inadequate tissue perfusion | Types: hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), obstructive. | All shock = hypotension + tachycardia + altered mental status + oliguria. Treat the underlying cause. |
| 18 | **Sepsis/Septic Shock** | Life-threatening organ dysfunction from dysregulated response to infection | Sepsis: SIRS + infection. Septic shock: sepsis + hypotension despite fluids + lactate >2. | Hour-1 bundle: blood cultures, lactate, antibiotics, fluids, vasopressors if needed. Time is tissue. |
| 19 | **Aortic Aneurysm** | Dilation of aorta ≥1.5x normal diameter | Risk: rupture (hypotension, back pain, pulsatile mass). AAA >5.5cm = surgical repair. | Sudden 'tearing' back pain + hypotension = rupturing AAA until proven otherwise. Surgical emergency. |
| 20 | **Heart Failure Classification** | NYHA Classes I-IV: I=no limitations, IV=severe at rest | Guides treatment and predicts prognosis. | 'I can do everything' → 'IV can't do anything without symptoms at rest.' ACE/ARBs and beta blockers reduce mortality. |
| 21 | **Pleural Effusion** | Fluid accumulation in pleural space | Decreased breath sounds, dullness to percussion, dyspnea. | Thoracentesis for diagnosis and symptom relief. Send fluid for analysis. |
| 22 | **Atelectasis** | Collapse of alveoli — common post-op | Decreased breath sounds, crackles, low-grade fever 24-48hrs post-op. | Prevention: incentive spirometer, early ambulation, deep breathing/coughing. TCDB — Turn, Cough, Deep Breathe. |
| 23 | **EKG: ST Elevation** | ST segment elevation on ECG — indicates acute myocardial injury | STEMI = emergency. Door-to-balloon time goal: <90 minutes. | ST elevation >1mm in 2 contiguous leads. Reciprocal ST depression in opposite leads confirms STEMI. |
| 24 | **EKG: QT Interval** | Time from ventricular depolarization to repolarization | Prolonged QTc: >440ms M, >460ms F. Risk of Torsades de Pointes. | Many drugs prolong QT: antiarrhythmics, antipsychotics, antibiotics (azithromycin). Check baseline before starting. |
| 25 | **BLS/ACLS** | Basic Life Support / Advanced Cardiovascular Life Support | BLS: CPR + AED. ACLS: medications, advanced airway, rhythm interpretation. | Chain of survival: recognition → CPR → defibrillation → advanced care → post-arrest care. |

### ✏️ Exercise A: Fill in the Definition
1. **Myocardial Infarction (MI)**: Death of myocardial __________ from prolonged ischemia
2. **Congestive Heart Failure (CHF)**: Heart's inability to pump __________ → fluid backup
3. **Atrial Fibrillation (AFib)**: Chaotic atrial electrical activity __________ irregularly irregular rhythm
4. **Ventricular Fibrillation (VFib)**: Chaotic ventricular electrical activity __________ NO cardiac output
5. **Ventricular Tachycardia (VTach)**: Rapid ventricular __________ >100 bpm
6. **PEA (Pulseless Electrical Activity)**: Organized electrical rhythm __________ mechanical contraction
7. **DVT (Deep Vein Thrombosis)**: Blood clot in deep __________ — usually legs
8. **Pulmonary Embolism (PE)**: Blood clot that __________ to pulmonary arteries
9. **COPD**: Chronic bronchitis + emphysema __________ irreversible airway obstruction
10. **ARDS (Acute Respiratory Distress Syndrome)**: Diffuse alveolar damage __________ severe hypoxemia
11. **Pneumonia**: Infection of __________ parenchyma
12. **Pneumothorax**: Air in pleural __________ → lung collapse

### 🔗 Exercise B: Matching
| Term | Letter |
|------|--------|
| **Myocardial Infarction (MI)** | ___ |
| **Congestive Heart Failure (CHF)** | ___ |
| **Atrial Fibrillation (AFib)** | ___ |
| **Ventricular Fibrillation (VFib)** | ___ |
| **Ventricular Tachycardia (VTach)** | ___ |
| **PEA (Pulseless Electrical Activity)** | ___ |
| **DVT (Deep Vein Thrombosis)** | ___ |
| **Pulmonary Embolism (PE)** | ___ |
| **COPD** | ___ |
| **ARDS (Acute Respiratory Distress Syndrome)** | ___ |

| Letter | Definition |
|--------|------------|
| A | Diffuse alveolar damage → severe hypoxemia |
| B | Blood clot in deep veins — usually legs |
| C | Blood clot that travels to pulmonary arteries |
| D | Chaotic ventricular electrical activity — NO cardiac output |
| E | Death of myocardial tissue from prolonged ischemia |
| F | Chaotic atrial electrical activity — irregularly irregular rhythm |
| G | Rapid ventricular rhythm >100 bpm |
| H | Chronic bronchitis + emphysema — irreversible airway obstruction |
| I | Organized electrical rhythm without mechanical contraction |
| J | Heart's inability to pump adequately → fluid backup |

### 🚑 Exercise C: Clinical Prioritization Scenario
Your CHF patient suddenly develops severe dyspnea, crackles throughout all lung fields, BP 200/110,
HR 128, SpO2 84% on room air. The patient is sitting bolt upright and cannot speak in full
sentences. Prioritize: What is happening? What are your immediate nursing actions (list in order)?

### 📝 Exercise D: NCLEX-Style Questions
**1.** A nurse is caring for a patient receiving Myocardial Infarction (MI). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) MONA is outdated — current priority: O2 if hypoxic, aspirin,...
   C) BP consistently >130/80 mmHg
   D) Chaotic ventricular electrical activity — NO cardiac output

**2.** A nurse is caring for a patient receiving Congestive Heart Failure (CHF). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) 'L=Lungs, R=Rest of body...
   C) Dilation of aorta ≥1.5x normal diameter
   D) Infection of lung parenchyma

**3.** A nurse is caring for a patient receiving Atrial Fibrillation (AFib). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Irregularly irregular + no P waves...
   C) Collapse of alveoli — common post-op
   D) Fluid accumulation in pleural space

**4.** A nurse is caring for a patient receiving Ventricular Fibrillation (VFib). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Coarse VFib = shockable...
   C) Fluid in pericardial sac compresses the heart
   D) NYHA Classes I-IV: I=no limitations, IV=severe at rest

**5.** A nurse is caring for a patient receiving Ventricular Tachycardia (VTach). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Sustained VTach = emergency...
   C) Blood clot that travels to pulmonary arteries
   D) Time from ventricular depolarization to repolarization

### ✓ Exercise E: Select All That Apply (SATA)
**1.** A patient is receiving Myocardial Infarction (MI). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**2.** A patient is receiving Congestive Heart Failure (CHF). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**3.** A patient is receiving Atrial Fibrillation (AFib). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

---

## 🏥 Section 4: Neurological & Endocrine (25 Terms)

| # | Term | Definition | Clinical Significance | NCLEX Tip |
|---|------|------------|----------------------|-----------|
| 1 | **Stroke/CVA** | Interrupted blood supply to brain — ischemic (87%) or hemorrhagic | BEFAST: Balance, Eyes, Face, Arms, Speech, Time. Last known well time is critical. | tPA window: 3-4.5 hours from last known well. Check blood glucose first — hypoglycemia mimics stroke. |
| 2 | **TIA (Transient Ischemic Attack)** | Temporary stroke symptoms resolving within 24 hours | Warning sign for future stroke. Same workup as stroke. | ABC₂D² score for TIA: Age, BP, Clinical features, Duration, Diabetes. High risk = admit. |
| 3 | **Seizure (Tonic-Clonic)** | Generalized seizure with stiffening then rhythmic jerking | Protect from injury. Do NOT restrain or put anything in mouth. Time the seizure. | Nursing: side-lying, O2, suction ready. If >5 min or repeated without recovery → status epilepticus. |
| 4 | **Status Epilepticus** | Continuous seizure >5 min or multiple without regaining consciousness | Medical emergency — lorazepam or midazolam IV. Protect airway. | Respiratory depression risk with benzodiazepines. Have airway equipment ready. |
| 5 | **Increased ICP** | Intracranial pressure >15 mmHg — life-threatening | Late signs: Cushing's triad (HTN, bradycardia, irregular RR), fixed/dilated pupils, posturing. | Early signs: headache, N/V, decreased LOC. Nursing: HOB 30°, head midline, avoid hip flexion/Valsalva. |
| 6 | **Cushing's Triad** | HTN + bradycardia + irregular respirations — late sign of increased ICP | Indicates brainstem compression. Impending herniation. | Recognize early and notify provider immediately. Mannitol or hypertonic saline to reduce ICP. |
| 7 | **Type 1 Diabetes** | Autoimmune destruction of pancreatic beta cells — absolute insulin deficiency | Onset usually in childhood. Requires lifelong insulin. DKA risk. | Type 1 = 'no insulin at all' — will die without it. Sick day rules: NEVER skip insulin even if not eating. |
| 8 | **Type 2 Diabetes** | Insulin resistance + relative insulin deficiency | Linked to obesity, lifestyle. Oral medications first, may progress to insulin. | Type 2 = 'still making insulin but body resists it.' HHS (not DKA) is the severe hyperglycemic emergency. |
| 9 | **DKA (Diabetic Ketoacidosis)** | Severe hyperglycemia + ketosis + metabolic acidosis (Type 1) | Triad: hyperglycemia >250, ketones, anion gap acidosis. Kussmaul respirations, fruity breath. | DKA = Type 1, HHS = Type 2. DKA treatment: fluids FIRST, then insulin. K+ shifts — watch for hypokalemia. |
| 10 | **HHS (Hyperosmolar Hyperglycemic State)** | Extreme hyperglycemia >600 + hyperosmolality WITHOUT ketosis (Type 2) | Profound dehydration, altered mental status. No ketones. | Mortality higher than DKA. Slow correction — don't drop glucose too fast. Cerebral edema risk. |
| 11 | **Hypoglycemia** | Blood glucose <70 mg/dL | Adrenergic symptoms (shaky, sweaty, tachy) → neuroglycopenic (confusion, seizure, coma). | Rule of 15: 15g fast carbs, recheck in 15 min. If unconscious: IV dextrose or IM glucagon. |
| 12 | **Hypothyroidism** | Underactive thyroid — decreased T3/T4, elevated TSH | Fatigue, weight gain, cold intolerance, constipation, bradycardia. | Levothyroxine replacement. Myxedema coma = severe hypothyroidism emergency. Monitor for over-replacement → hyperthyroid. |
| 13 | **Hyperthyroidism** | Overactive thyroid — increased T3/T4, suppressed TSH | Weight loss, heat intolerance, tachycardia, exophthalmos (Graves'). | Thyroid storm: fever, extreme tachycardia, delirium. Priority: cooling, beta blockers, antithyroid meds. |
| 14 | **Cushing's Syndrome** | Excess cortisol — 'moon face, buffalo hump, striae' | HTN, hyperglycemia, osteoporosis, infection risk. Iatrogenic from steroids or pituitary tumor. | Cushing = 'cushion' — cushioned appearance from fat redistribution. Slow taper of steroids. |
| 15 | **Addison's Disease** | Adrenal insufficiency — deficient cortisol and aldosterone | Hypotension, hyperkalemia, hyponatremia, hyperpigmentation. | Addisonian crisis: hypotension unresponsive to fluids — give hydrocortisone. 'Addison = Absent hormones.' |
| 16 | **SIADH** | Syndrome of Inappropriate Antidiuretic Hormone — excess ADH → water retention | Hyponatremia, concentrated urine, fluid overload without edema. | SIADH = 'Soaked Inside' — holding onto water. Fluid restriction is primary treatment. Correct Na+ slowly. |
| 17 | **Diabetes Insipidus (DI)** | Deficient ADH → inability to concentrate urine | Polyuria (dilute urine), polydipsia, hypernatremia. | DI = 'Dry Inside' — losing water. Give desmopressin (synthetic ADH). Monitor I&O and Na+ closely. |
| 18 | **Meningitis** | Inflammation of meninges — bacterial or viral | Fever, headache, nuchal rigidity, photophobia. Kernig's and Brudzinski's signs. | Bacterial = emergency. Droplet precautions. LP for diagnosis. Antibiotics STAT. |
| 19 | **Spinal Cord Injury** | Damage to spinal cord — complete or incomplete | Neurogenic shock: hypotension + bradycardia (loss of sympathetic tone). | C-spine immobilization until cleared. MAP >85 for spinal cord perfusion. Steroid protocol is controversial. |
| 20 | **Parkinson's Disease** | Degeneration of dopamine-producing neurons | TRAP: Tremor (resting), Rigidity, Akinesia/bradykinesia, Postural instability. | Levodopa/carbidopa is gold standard. High-protein meals interfere with absorption. Fall precautions. |
| 21 | **Multiple Sclerosis (MS)** | Autoimmune demyelination of CNS | Relapsing-remitting course. Symptoms vary by lesion location. | Exacerbation: IV steroids. Chronic: disease-modifying therapy. Heat intolerance — avoid hot baths/showers. |
| 22 | **Bell's Palsy** | Unilateral facial nerve paralysis — usually temporary | Cannot close eye, drooping mouth on affected side. Distinguish from stroke. | Bell's = forehead affected. Stroke = forehead spared. Eye care: artificial tears, eye patch, taping at night. |
| 23 | **Guillain-Barré Syndrome** | Ascending paralysis from autoimmune attack on peripheral nerves | Often post-infection. Starts in legs → progresses upward. | Monitor respiratory status — ascending paralysis can affect diaphragm. May need mechanical ventilation. |
| 24 | **Lumbar Puncture** | Needle into subarachnoid space — diagnostic or therapeutic | Position: lateral decubitus or sitting, 'fetal position.' Post: flat for 4-8 hours. | Post-LP headache: manage with fluids, caffeine, blood patch if severe. Assess for CSF leak. |
| 25 | **Mannitol** | Osmotic diuretic — reduces ICP and intraocular pressure | Give IV. Monitor for fluid overload, electrolyte shifts. | Crystallizes at room temp — use filter needle. Check for crystals before administration. |

### ✏️ Exercise A: Fill in the Definition
1. **Stroke/CVA**: Interrupted blood supply to brain __________ ischemic (87%) or hemorrhagic
2. **TIA (Transient Ischemic Attack)**: Temporary stroke symptoms __________ within 24 hours
3. **Seizure (Tonic-Clonic)**: Generalized seizure with __________ then rhythmic jerking
4. **Status Epilepticus**: Continuous seizure >5 min __________ multiple without regaining consciousness
5. **Increased ICP**: Intracranial pressure >15 __________ — life-threatening
6. **Cushing's Triad**: HTN + bradycardia + irregular respirations __________ late sign of increased ICP
7. **Type 1 Diabetes**: Autoimmune destruction of pancreatic beta __________ — absolute insulin deficiency
8. **Type 2 Diabetes**: Insulin resistance + __________ insulin deficiency
9. **DKA (Diabetic Ketoacidosis)**: Severe hyperglycemia + ketosis __________ metabolic acidosis (Type 1)
10. **HHS (Hyperosmolar Hyperglycemic State)**: Extreme hyperglycemia >600 + __________ WITHOUT ketosis (Type 2)
11. **Hypoglycemia**: Blood glucose __________ mg/dL
12. **Hypothyroidism**: Underactive thyroid — __________ T3/T4, elevated TSH

### 🔗 Exercise B: Matching
| Term | Letter |
|------|--------|
| **Stroke/CVA** | ___ |
| **TIA (Transient Ischemic Attack)** | ___ |
| **Seizure (Tonic-Clonic)** | ___ |
| **Status Epilepticus** | ___ |
| **Increased ICP** | ___ |
| **Cushing's Triad** | ___ |
| **Type 1 Diabetes** | ___ |
| **Type 2 Diabetes** | ___ |
| **DKA (Diabetic Ketoacidosis)** | ___ |
| **HHS (Hyperosmolar Hyperglycemic State)** | ___ |

| Letter | Definition |
|--------|------------|
| A | HTN + bradycardia + irregular respirations — late sign of increased ICP |
| B | Insulin resistance + relative insulin deficiency |
| C | Intracranial pressure >15 mmHg — life-threatening |
| D | Extreme hyperglycemia >600 + hyperosmolality WITHOUT ketosis (Type 2) |
| E | Severe hyperglycemia + ketosis + metabolic acidosis (Type 1) |
| F | Generalized seizure with stiffening then rhythmic jerking |
| G | Autoimmune destruction of pancreatic beta cells — absolute insulin deficiency |
| H | Continuous seizure >5 min or multiple without regaining consciousness |
| I | Interrupted blood supply to brain — ischemic (87%) or hemorrhagic |
| J | Temporary stroke symptoms resolving within 24 hours |

### 🚑 Exercise C: Clinical Prioritization Scenario
A post-stroke patient develops a sudden severe headache, vomiting, and decreased LOC. BP is now
210/115. Pupils were equal at 0800; now right pupil is 4mm and sluggish. Prioritize: What
complication do you suspect? What are the immediate nursing priorities?

### 📝 Exercise D: NCLEX-Style Questions
**1.** A nurse is caring for a patient receiving Stroke/CVA. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) tPA window: 3-4...
   C) Extreme hyperglycemia >600 + hyperosmolality WITHOUT ketosis (Type 2)
   D) Syndrome of Inappropriate Antidiuretic Hormone — excess ADH → water retention

**2.** A nurse is caring for a patient receiving TIA (Transient Ischemic Attack). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) ABC₂D² score for TIA: Age, BP, Clinical features, Duration, ...
   C) Unilateral facial nerve paralysis — usually temporary
   D) Overactive thyroid — increased T3/T4, suppressed TSH

**3.** A nurse is caring for a patient receiving Seizure (Tonic-Clonic). Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Nursing: side-lying, O2, suction ready...
   C) Autoimmune destruction of pancreatic beta cells — absolute insulin deficiency
   D) Overactive thyroid — increased T3/T4, suppressed TSH

**4.** A nurse is caring for a patient receiving Status Epilepticus. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Respiratory depression risk with benzodiazepines...
   C) Overactive thyroid — increased T3/T4, suppressed TSH
   D) Insulin resistance + relative insulin deficiency

**5.** A nurse is caring for a patient receiving Increased ICP. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Early signs: headache, N/V, decreased LOC...
   C) Ascending paralysis from autoimmune attack on peripheral nerves
   D) Extreme hyperglycemia >600 + hyperosmolality WITHOUT ketosis (Type 2)

### ✓ Exercise E: Select All That Apply (SATA)
**1.** A patient is receiving Stroke/CVA. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**2.** A patient is receiving TIA (Transient Ischemic Attack). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**3.** A patient is receiving Seizure (Tonic-Clonic). Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

---

## 🏥 Section 5: Maternal-Newborn & Pediatrics (25 Terms)

| # | Term | Definition | Clinical Significance | NCLEX Tip |
|---|------|------------|----------------------|-----------|
| 1 | **Preeclampsia** | HTN >140/90 + proteinuria after 20 weeks gestation | Headache, visual changes, RUQ pain, hyperreflexia. Can progress to eclampsia. | Mag sulfate for seizure prophylaxis. Check DTRs, RR, urine output hourly. Delivery is the cure. |
| 2 | **Eclampsia** | Preeclampsia + seizures | Airway protection. Mag sulfate loading dose then maintenance. Left lateral position. | Eclampsia = emergency. ABC priority. Pad side rails, suction ready. NOT an indication for C-section alone. |
| 3 | **Gestational Diabetes** | Glucose intolerance with onset during pregnancy | Screened at 24-28 weeks. Risk: macrosomia, neonatal hypoglycemia. | Treat with diet first, then insulin if needed. Oral agents controversial. Postpartum follow-up glucose testing. |
| 4 | **APGAR Score** | Newborn assessment at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration | Score 0-2 each → total 0-10. 7-10 = reassuring. | APGAR of 0-3 = severe distress. If 5-min APGAR <7, continue q5min. Know interventions for each category. |
| 5 | **Newborn Reflexes** | Innate reflexes that indicate neurologic integrity | Moro (startle), rooting, sucking, palmar/plantar grasp, Babinski, stepping. | Absence or asymmetry = neurological concern. Persistence beyond expected age = also concerning. |
| 6 | **Developmental Milestones** | Age-appropriate skills — gross motor, fine motor, language, social | 2mo: social smile, 6mo: sits, 9mo: crawls, 12mo: walks, 2yr: 2-word phrases. | Know the big ones NCLEX tests: 6mo rolls, 9mo sits, 12mo walks. Delay = early intervention referral. |
| 7 | **RSV (Respiratory Syncytial Virus)** | Common cause of bronchiolitis in infants | Cough, wheezing, respiratory distress. Contact precautions. | Palivizumab (Synagis) for high-risk preemies. Suctioning is key — bulb syringe before feeds. |
| 8 | **Croup (Laryngotracheobronchitis)** | Viral upper airway inflammation — 'barking cough, stridor' | Steeple sign on X-ray. Cool mist, steroids. | Croup: 6mo-3yr. Epiglottitis: 3-7yr (drooling, tripoding, toxic — DO NOT examine throat). |
| 9 | **Kawasaki Disease** | Acute vasculitis of medium arteries — primarily <5 years | Fever >5 days + conjunctivitis, strawberry tongue, rash, edema, lymphadenopathy. | Complication: coronary artery aneurysms. Treat with IVIG + aspirin. Echo baseline and follow-up. |
| 10 | **Febrile Seizure** | Seizure triggered by rapid temperature rise — typically 6mo-5yr | Usually brief, self-limiting. Not epilepsy. | Reassure parents! Treat the fever. If prolonged >5min, treat as status epilepticus. LP if meningitis suspected. |
| 11 | **SIDS Prevention** | Sudden Infant Death Syndrome — safe sleep practices | Back to sleep, firm mattress, no blankets/pillows/bumpers, room-sharing (not bed-sharing). | 'Back is Best.' Pacifier at nap/bedtime is protective. No smoke exposure. |
| 12 | **Postpartum Hemorrhage** | Blood loss >500mL vaginal or >1000mL C-section within 24hrs of delivery | Uterine atony = most common cause. Boggy uterus = massage fundus. | 4 T's: Tone (atony), Trauma, Tissue (retained placenta), Thrombin (coagulopathy). Fundal massage + oxytocin. |
| 13 | **Preterm Labor** | Labor before 37 weeks gestation | Tocolytics to delay delivery (48hrs for steroid benefit). Betamethasone for fetal lung maturity. | Steroids = 24-34 weeks. Magnesium sulfate for neuroprotection <32 weeks. GBS prophylaxis. |
| 14 | **Placenta Previa** | Placenta covers cervical os — painless vaginal bleeding in 3rd trimester | NO vaginal exams — can cause catastrophic hemorrhage. | C-section delivery. 'Previa = before the baby.' Vasa previa = fetal vessels cross os (painless + fetal distress). |
| 15 | **Placental Abruption** | Premature separation of placenta — painful vaginal bleeding | Dark red bleeding, rigid/tender uterus, fetal distress. | Risk factors: HTN, trauma, cocaine. Priority: fetal monitoring, prepare for emergency delivery. |
| 16 | **Bilirubin/Phototherapy** | Elevated bilirubin in newborn — risk of kernicterus | Cover eyes during phototherapy. Remove for feeds. Monitor I&O (increase fluids). | Unconjugated vs conjugated. Rh/ABO incompatibility = risk. Kernicterus = permanent brain damage. |
| 17 | **PKU (Phenylketonuria)** | Inability to metabolize phenylalanine — newborn screening | Special low-phenylalanine diet for life. No aspartame (NutraSweet). | Aspartame contains phenylalanine — look for the warning on diet soda labels. Untreated = intellectual disability. |
| 18 | **Cleft Lip/Palate** | Congenital facial malformation | Feeding challenges, aspiration risk. Special nipples/bottles. Surgical repair. | Cleft lip repaired ~3 months. Cleft palate ~12 months. Speech and feeding therapy post-op. |
| 19 | **Congenital Heart Defects** | Structural heart abnormality present at birth | Cyanotic (Tetralogy of Fallot) vs acyanotic (VSD, ASD, PDA). | '3 T's of cyanotic': Tetralogy, Transposition, Truncus arteriosus. Prostaglandins keep PDA open in ductal-dependent lesions. |
| 20 | **Vaccine Schedule** | Recommended immunizations birth through adolescence | Know: HepB (birth), DTaP, Hib, IPV, PCV13, RV (2mo), MMR/Varicella (12mo). | Live vaccines: MMR, Varicella, Rotavirus, Nasal flu (LAIV). Contraindicated in pregnancy and immunocompromised. |
| 21 | **Breastfeeding** | Optimal infant nutrition recommended exclusively for 6 months | Colostrum first 3-5 days before mature milk. Latch, positioning, frequency. | Contraindications: HIV (in US), active TB, chemotherapy, substance abuse. LATCH score for assessment. |
| 22 | **Meconium Aspiration Syndrome** | Newborn aspirates meconium-stained amniotic fluid | Respiratory distress at birth. Suction before stimulation if meconium present. | NICU admission. May need surfactant, ventilation, antibiotics. Prevention: suction at perineum. |
| 23 | **Erythroblastosis Fetalis** | Hemolytic disease from Rh incompatibility | Rh-negative mother + Rh-positive fetus. Prevent with RhoGAM at 28 weeks and postpartum. | RhoGAM within 72 hours of delivery/bleeding. Coombs test: direct = fetal RBCs, indirect = maternal antibodies. |
| 24 | **TORCH Infections** | Toxoplasmosis, Other, Rubella, CMV, Herpes — congenital infections | Can cause microcephaly, hearing loss, intellectual disability, rash. | T: cat litter/undercooked meat. CMV: most common. Herpes: C-section if active lesions. Screen and counsel. |
| 25 | **Neonatal Abstinence Syndrome (NAS)** | Withdrawal in newborns exposed to substances in utero | Irritability, poor feeding, tremors, seizures. Finnegan scoring. | Non-pharmacologic first: swaddle, low stimulation, frequent small feeds. Morphine or methadone for severe cases. |

### ✏️ Exercise A: Fill in the Definition
1. **Preeclampsia**: HTN >140/90 + proteinuria __________ 20 weeks gestation
2. **Eclampsia**: Preeclampsia + __________
3. **Gestational Diabetes**: Glucose intolerance with __________ during pregnancy
4. **APGAR Score**: Newborn assessment at 1 and 5 __________ Appearance, Pulse, Grimace, Activity, Respiration
5. **Newborn Reflexes**: Innate reflexes that __________ neurologic integrity
6. **Developmental Milestones**: Age-appropriate skills — gross __________ fine motor, language, social
7. **RSV (Respiratory Syncytial Virus)**: Common cause of __________ in infants
8. **Croup (Laryngotracheobronchitis)**: Viral upper airway inflammation __________ 'barking cough, stridor'
9. **Kawasaki Disease**: Acute vasculitis of medium __________ — primarily <5 years
10. **Febrile Seizure**: Seizure triggered by rapid __________ rise — typically 6mo-5yr
11. **SIDS Prevention**: Sudden Infant Death Syndrome __________ safe sleep practices
12. **Postpartum Hemorrhage**: Blood loss >500mL vaginal or __________ C-section within 24hrs of delivery

### 🔗 Exercise B: Matching
| Term | Letter |
|------|--------|
| **Preeclampsia** | ___ |
| **Eclampsia** | ___ |
| **Gestational Diabetes** | ___ |
| **APGAR Score** | ___ |
| **Newborn Reflexes** | ___ |
| **Developmental Milestones** | ___ |
| **RSV (Respiratory Syncytial Virus)** | ___ |
| **Croup (Laryngotracheobronchitis)** | ___ |
| **Kawasaki Disease** | ___ |
| **Febrile Seizure** | ___ |

| Letter | Definition |
|--------|------------|
| A | Common cause of bronchiolitis in infants |
| B | HTN >140/90 + proteinuria after 20 weeks gestation |
| C | Innate reflexes that indicate neurologic integrity |
| D | Acute vasculitis of medium arteries — primarily <5 years |
| E | Age-appropriate skills — gross motor, fine motor, language, social |
| F | Viral upper airway inflammation — 'barking cough, stridor' |
| G | Seizure triggered by rapid temperature rise — typically 6mo-5yr |
| H | Newborn assessment at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration |
| I | Glucose intolerance with onset during pregnancy |
| J | Preeclampsia + seizures |

### 🚑 Exercise C: Clinical Prioritization Scenario
You're caring for a postpartum patient who delivered 4 hours ago. You assess a boggy uterus, heavy
lochia, and saturated 2 peripads in 15 minutes. Fundus is at the umbilicus and deviated to the
right. Prioritize: What is the most likely cause? What are your nursing actions?

### 📝 Exercise D: NCLEX-Style Questions
**1.** A nurse is caring for a patient receiving Preeclampsia. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Mag sulfate for seizure prophylaxis...
   C) Hemolytic disease from Rh incompatibility
   D) Blood loss >500mL vaginal or >1000mL C-section within 24hrs of delivery

**2.** A nurse is caring for a patient receiving Eclampsia. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Eclampsia = emergency...
   C) Glucose intolerance with onset during pregnancy
   D) Acute vasculitis of medium arteries — primarily <5 years

**3.** A nurse is caring for a patient receiving Gestational Diabetes. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Treat with diet first, then insulin if needed...
   C) Preeclampsia + seizures
   D) Blood loss >500mL vaginal or >1000mL C-section within 24hrs of delivery

**4.** A nurse is caring for a patient receiving APGAR Score. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) APGAR of 0-3 = severe distress...
   C) Placenta covers cervical os — painless vaginal bleeding in 3rd trimester
   D) Seizure triggered by rapid temperature rise — typically 6mo-5yr

**5.** A nurse is caring for a patient receiving Newborn Reflexes. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Absence or asymmetry = neurological concern...
   C) Glucose intolerance with onset during pregnancy
   D) Viral upper airway inflammation — 'barking cough, stridor'

### ✓ Exercise E: Select All That Apply (SATA)
**1.** A patient is receiving Preeclampsia. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**2.** A patient is receiving Eclampsia. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**3.** A patient is receiving Gestational Diabetes. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

---

## 🏥 Section 6: Prioritization & Delegation (25 Terms)

| # | Term | Definition | Clinical Significance | NCLEX Tip |
|---|------|------------|----------------------|-----------|
| 1 | **ABC Priority Framework** | Airway, Breathing, Circulation — establish priority | Airway ALWAYS comes first unless obstructed. Breathing next. Circulation last. | NCLEX tip: If answer mentions 'airway assessment' or 'respiratory status,' it's often the right priority. |
| 2 | **Maslow's Hierarchy** | Prioritize physiological needs before psychosocial | Physiological → Safety → Love/Belonging → Esteem → Self-actualization. | A patient with acute pain (physiological) gets priority over one with anxiety (safety/esteem level). |
| 3 | **Acute vs Chronic** | Acute conditions take priority over chronic | Acute: new onset, potentially reversible. Chronic: long-standing, managed. | Sudden change in condition = acute = priority. Stable chronic condition = can wait. |
| 4 | **Stable vs Unstable** | Unstable patients always get priority | Signs of instability: hypotension, tachycardia, altered LOC, respiratory distress. | If a patient was stable and now has a change, check them first. 'Something is different' = priority. |
| 5 | **RN Scope of Practice** | Registered Nurse — assessment, planning, evaluation | Only the RN can perform initial assessment, develop care plan, and perform evaluation. | RN does the first assessment and evaluation. LPN can do ongoing assessments. UAP does not assess. |
| 6 | **LPN/LVN Scope** | Licensed Practical/Vocational Nurse — stable patients with predictable outcomes | Can administer medications (except IV push in most states), perform treatments, collect data. | LPN can do: med admin, wound care, data collection. LPN cannot: initial assessment, care plan, IV push meds, blood products. |
| 7 | **UAP (Unlicensed Assistive Personnel)** | Nursing assistant — ADLs, vital signs (stable), I&O, ambulation | NO assessment, NO sterile procedures, NO medication administration. | UAP can: bathe, feed, ambulate, obtain VS (stable patient), I&O, transport. Cannot: assess, evaluate, teach. |
| 8 | **5 Rights of Delegation** | Right: Task, Circumstance, Person, Direction/Communication, Supervision | Framework ensuring safe delegation. | 'Can this be delegated?' - The decision itself is the RN's. Evaluate each of the 5 rights before assigning. |
| 9 | **5 Rights of Medication Administration** | Right: Patient, Drug, Dose, Route, Time | Plus: Right Documentation, Right Reason, Right Response. | Always 3 checks, 3 identifiers (name, DOB, MRN). Scan barcode if available. |
| 10 | **Disaster Triage** | Mass casualty sorting: Red (immediate), Yellow (delayed), Green (minimal), Black (expectant) | START: assess RPM (Respirations, Perfusion, Mental status) in <30 seconds. | Black tag = no respirations after airway reposition → move on. Green tag = 'walking wounded.' Do not spend >30 sec per patient. |
| 11 | **Nursing Process (ADPIE)** | Assessment → Diagnosis → Planning → Implementation → Evaluation | Cyclical and ongoing. Assessment always comes FIRST. | NCLEX loves ADPIE: if the question asks what to do first, the answer with 'assess' first is usually correct. |
| 12 | **SBAR Communication** | Situation, Background, Assessment, Recommendation — standardized handoff | Used for nurse-to-provider communication. Clear, concise, complete. | Practice SBAR: 'Dr. Smith, this is RN Jones calling about Mrs. Lopez in room 304. I'm concerned because...' |
| 13 | **Time Management in Nursing** | Prioritize based on urgency and importance | Tasks: urgent + important (do now), important + not urgent (plan), urgent + not important (delegate if safe), neither (eliminate). | Always cluster care for efficiency. Plan your shift: know which patients need timed meds, which need procedures first. |
| 14 | **Ethical Principles** | Autonomy, Beneficence, Non-maleficence, Justice, Fidelity, Veracity | Guide nursing decisions. Autonomy: patient's right to self-determination. | Autonomy = accept patient's refusal. Beneficence = do good. Non-maleficence = do no harm. Justice = fair treatment. |
| 15 | **Advance Directives** | Legal documents stating treatment preferences if incapacitated | Living will: what care they want. DPOA: who makes decisions. DNR/DNI: code status. | Ask about advance directives on admission. If DNR present, verify validity. If uncertain, treat/revive. |
| 16 | **Informed Consent** | Patient's voluntary agreement after receiving all information | Provider's responsibility to explain. Nurse's role: witness the signature. | Nurse verifies patient understands. If patient has questions, call provider back. Witness ≠ explainer. |
| 17 | **Assault vs Battery** | Assault: threat of harm. Battery: actual unwanted touching | Giving an injection after patient says 'no' = battery. Threatening to restrain = assault. | Nursing implication: always get consent. If patient refuses, document and notify provider. |
| 18 | **Malpractice vs Negligence** | Negligence: failure to meet standard of care. Malpractice: professional negligence causing harm. | Example: not checking VS before giving antihypertensive = negligence. Patient strokes = malpractice. | Four elements: duty, breach, causation, damages. Documentation is your best defense. |
| 19 | **Cultural Competence** | Providing care that respects diverse cultural beliefs and practices | Assess cultural preferences: dietary, communication, family involvement, end-of-life. | Use interpreter services, not family members. Respect cultural practices that don't harm. Be curious, not judgmental. |
| 20 | **Therapeutic Communication** | Verbal and non-verbal techniques that promote healing | Active listening, open-ended questions, silence, reflection, empathy. | What NOT to say: 'Don't worry,' 'I know how you feel,' 'Why did you...?' These block communication. |
| 21 | **Patient Teaching** | Assess readiness, plan, implement, evaluate — teach-back method | Verify understanding: 'Can you show me how you'd do this at home?' | Teaching = RN responsibility (not delegated). Document what was taught and patient's response. |
| 22 | **Chain of Command** | Hierarchical structure for escalating concerns | If provider disagrees, escalate to charge nurse → nursing supervisor → CNO → medical director. | Patient safety first. If you're uncomfortable with an order, question it. CUS: 'I'm Concerned, Uncomfortable, this is a Safety issue.' |
| 23 | **Restraints** | Physical or chemical — last resort for patient safety | Requires provider order (renewed q4h adults, q2h children/adolescents). Assess q15min (violent) or q2h (non-violent). | Alternatives first: reorientation, sitter, distraction. Restraints = NOT for staff convenience. Document everything. |
| 24 | **Falls Prevention** | Assess risk (Morse Fall Scale), implement precautions | Yellow bracelet, bed alarm, non-slip socks, bedside commode, frequent rounding. | Hourly rounding reduces falls. Keep call light within reach. Bed in lowest position. Report all falls. |
| 25 | **Care Coordination** | Organizing patient care activities across providers and settings | Discharge planning starts on admission. Involve case management, social work, therapy. | Know community resources. Medication reconciliation at every transition of care. Follow-up appointments before discharge. |

### ✏️ Exercise A: Fill in the Definition
1. **ABC Priority Framework**: Airway, Breathing, Circulation __________ establish priority
2. **Maslow's Hierarchy**: Prioritize physiological __________ before psychosocial
3. **Acute vs Chronic**: Acute conditions take __________ over chronic
4. **Stable vs Unstable**: Unstable patients __________ get priority
5. **RN Scope of Practice**: Registered Nurse — __________ planning, evaluation
6. **LPN/LVN Scope**: Licensed Practical/Vocational Nurse — __________ patients with predictable outcomes
7. **UAP (Unlicensed Assistive Personnel)**: Nursing assistant — ADLs, __________ signs (stable), I&O, ambulation
8. **5 Rights of Delegation**: Right: Task, Circumstance, __________ Direction/Communication, Supervision
9. **5 Rights of Medication Administration**: Right: Patient, Drug, __________ Route, Time
10. **Disaster Triage**: Mass casualty sorting: Red (immediate), __________ (delayed), Green (minimal), Black (expectant)
11. **Nursing Process (ADPIE)**: Assessment → Diagnosis → __________ → Implementation → Evaluation
12. **SBAR Communication**: Situation, Background, Assessment, __________ — standardized handoff

### 🔗 Exercise B: Matching
| Term | Letter |
|------|--------|
| **ABC Priority Framework** | ___ |
| **Maslow's Hierarchy** | ___ |
| **Acute vs Chronic** | ___ |
| **Stable vs Unstable** | ___ |
| **RN Scope of Practice** | ___ |
| **LPN/LVN Scope** | ___ |
| **UAP (Unlicensed Assistive Personnel)** | ___ |
| **5 Rights of Delegation** | ___ |
| **5 Rights of Medication Administration** | ___ |
| **Disaster Triage** | ___ |

| Letter | Definition |
|--------|------------|
| A | Acute conditions take priority over chronic |
| B | Prioritize physiological needs before psychosocial |
| C | Airway, Breathing, Circulation — establish priority |
| D | Registered Nurse — assessment, planning, evaluation |
| E | Nursing assistant — ADLs, vital signs (stable), I&O, ambulation |
| F | Right: Task, Circumstance, Person, Direction/Communication, Supervision |
| G | Right: Patient, Drug, Dose, Route, Time |
| H | Unstable patients always get priority |
| I | Licensed Practical/Vocational Nurse — stable patients with predictable outcomes |
| J | Mass casualty sorting: Red (immediate), Yellow (delayed), Green (minimal), Black (expectant) |

### 🚑 Exercise C: Clinical Prioritization Scenario
You're the charge nurse. You have 4 patients: (A) COPD patient with RR 32 and SpO2 86%, (B) post-op
Day 1 requesting pain medication, (C) new admission with chest pain rating 5/10, (D) patient ready
for discharge teaching. Which patient do you see first? Second? Why?

### 📝 Exercise D: NCLEX-Style Questions
**1.** A nurse is caring for a patient receiving ABC Priority Framework. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) NCLEX tip: If answer mentions 'airway assessment' or 'respir...
   C) Licensed Practical/Vocational Nurse — stable patients with predictable outcomes
   D) Right: Patient, Drug, Dose, Route, Time

**2.** A nurse is caring for a patient receiving Maslow's Hierarchy. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) A patient with acute pain (physiological) gets priority over...
   C) Organizing patient care activities across providers and settings
   D) Providing care that respects diverse cultural beliefs and practices

**3.** A nurse is caring for a patient receiving Acute vs Chronic. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Sudden change in condition = acute = priority...
   C) Providing care that respects diverse cultural beliefs and practices
   D) Mass casualty sorting: Red (immediate), Yellow (delayed), Green (minimal), Black

**4.** A nurse is caring for a patient receiving Stable vs Unstable. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) If a patient was stable and now has a change, check them fir...
   C) Organizing patient care activities across providers and settings
   D) Verbal and non-verbal techniques that promote healing

**5.** A nurse is caring for a patient receiving RN Scope of Practice. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) RN does the first assessment and evaluation...
   C) Legal documents stating treatment preferences if incapacitated
   D) Verbal and non-verbal techniques that promote healing

### ✓ Exercise E: Select All That Apply (SATA)
**1.** A patient is receiving ABC Priority Framework. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**2.** A patient is receiving Maslow's Hierarchy. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**3.** A patient is receiving Acute vs Chronic. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

---

## 🏥 Section 7: Safety & Infection Control (25 Terms)

| # | Term | Definition | Clinical Significance | NCLEX Tip |
|---|------|------------|----------------------|-----------|
| 1 | **Standard Precautions** | Applied to ALL patients regardless of diagnosis | Hand hygiene, gloves when touching body fluids, mask/eye protection/gown if splash risk. | Assume every patient could have something contagious. Hand hygiene is the #1 infection prevention measure. |
| 2 | **Contact Precautions** | For organisms spread by direct/indirect contact — MRSA, VRE, C. diff | Gown + gloves. Dedicated equipment (stethoscope, BP cuff). | C. diff = contact + hand washing with SOAP and WATER (NOT alcohol gel — doesn't kill spores). |
| 3 | **Droplet Precautions** | For organisms in large respiratory droplets (<3 feet) — influenza, pertussis, meningitis | Surgical mask. Patient wears mask for transport. | Droplet diseases: 'SPIDERMAN' — Sepsis/Scarlet fever, Pertussis, Influenza, Diphtheria, Epiglottitis, Rubella, Mumps, Adenovirus, Neisseria meningitidis. |
| 4 | **Airborne Precautions** | For organisms that hang in air — TB, measles (rubeola), varicella (chickenpox), disseminated zoster | N95 respirator (fit-tested). Negative pressure room. Patient wears surgical mask for transport. | 'MTV' — Measles, TB, Varicella (disseminated). Airborne infections go airborne together. |
| 5 | **PPE Donning Order** | Sequence for putting on personal protective equipment | Gown → Mask/Respirator → Goggles/Face shield → Gloves. | Donning: 'bottom to top.' Gloves last (they cover the gown cuffs). |
| 6 | **PPE Doffing Order** | Sequence for removing PPE — most contaminated first | Gloves → Goggles/Face shield → Gown → Mask/Respirator. | Doffing: 'dirty to clean' — do NOT touch the outside of contaminated items. Hand hygiene after each step. |
| 7 | **Hand Hygiene** | #1 way to prevent healthcare-associated infections | Before/after patient contact, before aseptic procedures, after body fluid exposure, after touching patient surroundings. | '5 Moments for Hand Hygiene.' Soap + water for C. diff and visibly soiled hands. Alcohol gel otherwise. |
| 8 | **CLABSI Prevention** | Central Line-Associated Bloodstream Infection prevention bundle | Hand hygiene, chlorhexidine skin prep, full barrier during insertion, daily review of line necessity. | Scrub the hub for 15 seconds before accessing. Change dressing q7 days (transparent) or q2 days (gauze). |
| 9 | **CAUTI Prevention** | Catheter-Associated UTI prevention bundle | Avoid unnecessary catheters. Remove as soon as possible. Maintain closed system, keep bag below bladder. | Daily review: does this patient still need a Foley? Alternatives: external catheter, intermittent straight cath. |
| 10 | **Fall Risk Interventions** | Prevent patient falls — Morse Scale for risk assessment | Yellow bracelet, bed alarm, non-slip socks, bedside commode, hourly rounding. | Medication review: sedatives, diuretics, antihypertensives increase fall risk. Post-fall assessment + incident report. |
| 11 | **Seizure Precautions** | Padding side rails, suction at bedside, O2 available | Never restrain or put anything in mouth during seizure. Side-lying position. | Protect airway. Time the seizure. Administer benzodiazepine if >5 min. Document onset, duration, presentation. |
| 12 | **Suicide Precautions** | 1:1 observation, remove harmful objects, document q15min checks | Maintain safe environment. Assess for suicidal ideation regularly. | Always take suicidal statements seriously. Remove: sharps, cords, belts, plastic bags, glass, medications from room. |
| 13 | **Restraint Safety** | Physical/chemical restraint — last resort only | Provider order required (q4h renewal adult). Assess q15min (behavioral), q2h (medical). | Offer food/fluids/toileting q2h. ROM exercises. Remove one restraint at a time. Document: reason, alternatives tried, response. |
| 14 | **Medication Reconciliation** | Comparing patient's current medications to ordered medications | Performed at admission, transfer, and discharge. | 'Admit, Transfer, Discharge' — every transition. Patient brings all meds in brown bag. Include OTC and herbals. |
| 15 | **Never Events** | Serious, largely preventable patient safety incidents | Wrong-site surgery, retained foreign body, incompatible blood transfusion, severe pressure ulcers, falls with injury. | These are reportable events. Root cause analysis performed. Non-reimbursable by CMS — hospital absorbs cost. |
| 16 | **Sentinel Event** | Unexpected occurrence involving death or serious physical/psychological injury | Requires immediate investigation and response. | Root cause analysis within 45 days. Action plan to prevent recurrence. NOT about blaming individuals. |
| 17 | **Root Cause Analysis** | Systematic investigation of errors — WHAT and WHY, not WHO | Focus on system failures, not individual blame. | 'Just Culture' — balances accountability with a learning environment. Most errors are system failures. |
| 18 | **RACE/PASS (Fire Safety)** | RACE: Rescue, Alarm, Contain, Extinguish. PASS: Pull, Aim, Squeeze, Sweep. | Know fire extinguisher locations. Evacuation routes. | Rescue patients first. Close doors to contain fire. Only use extinguisher if fire is small and contained. |
| 19 | **Electrical Safety** | Prevent electrical hazards in healthcare setting | Check equipment before use. Report frayed cords. No daisy-chaining. | Wet floor + electrical equipment = electrocution risk. Grounded plugs. Biomedical engineering maintains equipment. |
| 20 | **Needlestick Prevention** | Safe injection practices — never recap needles | Safety devices, sharps container at point of use, report all needlesticks. | Post-exposure: wash site, report immediately, source patient testing, baseline labs for exposed HCW. |
| 21 | **Pressure Injury Prevention** | Prevent and stage pressure injuries — Braden Scale | Reposition q2h, specialty mattress, moisture management, nutrition. | Stage 1: non-blanchable erythema. Stage 2: partial thickness. Stage 3: full thickness. Stage 4: to bone/tendon. Unstageable: eschar. |
| 22 | **Isolation Precautions (General)** | Determine isolation type based on organism and mode of transmission | Check CDC guidelines. Post signage on door. Educate patient and family. | Don't forget psychosocial — isolation patients are lonely and scared. Frequent check-ins and communication. |
| 23 | **Environmental Cleaning** | Proper cleaning/disinfection to prevent HAIs | High-touch surfaces: bed rails, call light, over-bed table, bathroom surfaces. | C. diff requires bleach-based cleaning (spores not killed by standard disinfectants). Terminal cleaning after discharge. |
| 24 | **Sharps Disposal** | Proper disposal of needles, scalpels, and other sharp instruments | Immediately into sharps container at point of use. Never overfill. | Sharps container not for regular trash. Change when ¾ full. Report full containers promptly. |
| 25 | **Latex Allergy** | Allergic reaction to latex — range from contact dermatitis to anaphylaxis | Use latex-free supplies. Assess all patients for latex allergy. | High-risk: healthcare workers, spina bifida patients, multiple surgeries. Create latex-safe environment. |

### ✏️ Exercise A: Fill in the Definition
1. **Standard Precautions**: Applied to ALL __________ regardless of diagnosis
2. **Contact Precautions**: For organisms spread by direct/indirect __________ — MRSA, VRE, C. diff
3. **Droplet Precautions**: For organisms in large respiratory droplets __________ feet) — influenza, pertussis, meningitis
4. **Airborne Precautions**: For organisms that hang in air — __________ measles (rubeola), varicella (chickenpox), disseminated zoster
5. **PPE Donning Order**: Sequence for putting __________ personal protective equipment
6. **PPE Doffing Order**: Sequence for removing PPE __________ most contaminated first
7. **Hand Hygiene**: #1 way to __________ healthcare-associated infections
8. **CLABSI Prevention**: Central Line-Associated Bloodstream __________ prevention bundle
9. **CAUTI Prevention**: Catheter-Associated UTI __________ bundle
10. **Fall Risk Interventions**: Prevent patient falls — __________ Scale for risk assessment
11. **Seizure Precautions**: Padding side rails, suction __________ bedside, O2 available
12. **Suicide Precautions**: 1:1 observation, remove harmful __________ document q15min checks

### 🔗 Exercise B: Matching
| Term | Letter |
|------|--------|
| **Standard Precautions** | ___ |
| **Contact Precautions** | ___ |
| **Droplet Precautions** | ___ |
| **Airborne Precautions** | ___ |
| **PPE Donning Order** | ___ |
| **PPE Doffing Order** | ___ |
| **Hand Hygiene** | ___ |
| **CLABSI Prevention** | ___ |
| **CAUTI Prevention** | ___ |
| **Fall Risk Interventions** | ___ |

| Letter | Definition |
|--------|------------|
| A | Prevent patient falls — Morse Scale for risk assessment |
| B | For organisms in large respiratory droplets (<3 feet) — influenza, pertussis, meningitis |
| C | Catheter-Associated UTI prevention bundle |
| D | Applied to ALL patients regardless of diagnosis |
| E | Central Line-Associated Bloodstream Infection prevention bundle |
| F | Sequence for putting on personal protective equipment |
| G | For organisms spread by direct/indirect contact — MRSA, VRE, C. diff |
| H | For organisms that hang in air — TB, measles (rubeola), varicella (chickenpox), disseminated zoster |
| I | Sequence for removing PPE — most contaminated first |
| J | #1 way to prevent healthcare-associated infections |

### 🚑 Exercise C: Clinical Prioritization Scenario
You discover a patient has fallen on the way to the bathroom. They are on the floor, alert, saying
'I just slipped — I'm fine.' Prioritize: What is your immediate response sequence? Who do you
notify? What documentation is required?

### 📝 Exercise D: NCLEX-Style Questions
**1.** A nurse is caring for a patient receiving Standard Precautions. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Assume every patient could have something contagious...
   C) Sequence for removing PPE — most contaminated first
   D) Determine isolation type based on organism and mode of transmission

**2.** A nurse is caring for a patient receiving Contact Precautions. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) C...
   C) #1 way to prevent healthcare-associated infections
   D) Proper cleaning/disinfection to prevent HAIs

**3.** A nurse is caring for a patient receiving Droplet Precautions. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Droplet diseases: 'SPIDERMAN' — Sepsis/Scarlet fever, Pertus...
   C) Serious, largely preventable patient safety incidents
   D) Prevent and stage pressure injuries — Braden Scale

**4.** A nurse is caring for a patient receiving Airborne Precautions. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) 'MTV' — Measles, TB, Varicella (disseminated)...
   C) For organisms in large respiratory droplets (<3 feet) — influenza, pertussis, me
   D) Comparing patient's current medications to ordered medications

**5.** A nurse is caring for a patient receiving PPE Donning Order. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Donning: 'bottom to top...
   C) Comparing patient's current medications to ordered medications
   D) Prevent and stage pressure injuries — Braden Scale

### ✓ Exercise E: Select All That Apply (SATA)
**1.** A patient is receiving Standard Precautions. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**2.** A patient is receiving Contact Precautions. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**3.** A patient is receiving Droplet Precautions. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

---

## 🏥 Section 8: Fundamentals & Abbreviations (20 Terms)

| # | Term | Definition | Clinical Significance | NCLEX Tip |
|---|------|------------|----------------------|-----------|
| 1 | **I&O** | Intake and Output — fluid balance monitoring | Strict I&O for CHF, renal failure, post-op, critical care. | 1 mL = 1 cc. Include: oral, IV, tube feeds (intake). Urine, emesis, diarrhea, drains (output). 30mL = 1 oz. |
| 2 | **NPO** | Nil Per Os — Nothing By Mouth | Before surgery, procedures, certain tests. | NPO after midnight for AM surgery standard. Aspiration risk if patient eats. Document when NPO started. |
| 3 | **PRN** | Pro Re Nata — As Needed | Medications given as needed: pain meds, antiemetics, sleep aids. | Document reason for PRN administration and response. Reassess effectiveness within appropriate time frame. |
| 4 | **STAT** | Statim — Immediately | Emergency orders: STAT ECG, STAT labs, STAT meds. | STAT = drop everything. Time-sensitive. Document exact time. Communicate results immediately to provider. |
| 5 | **QD/BID/TID/QID** | Once daily / twice daily / three times daily / four times daily | Medication frequency abbreviations. QID = q6h around the clock. | Don't confuse QD with QID. QD = once daily. QID = 4 times daily. TJC recommends spelling out 'daily.' |
| 6 | **ac/hs** | Before meals / At bedtime | Give insulin ac (before meals). Sedatives hs (at bedtime). | ac = ante cibum. hs = hora somni. Know when to time medications relative to meals. |
| 7 | **ADLs** | Activities of Daily Living | Bathing, dressing, toileting, transferring, continence, feeding. | Assess baseline ADLs on admission. Changes indicate functional decline. PT/OT referral for deficits. |
| 8 | **AMA (Against Medical Advice)** | Patient leaves hospital against provider recommendation | Assess capacity, inform of risks, document, have patient sign AMA form. | Patient has right to leave. You can't hold them. Do document that you explained risks. Follow up with a call. |
| 9 | **DNR/DNI** | Do Not Resuscitate / Do Not Intubate | Legal orders specifying no CPR (DNR) or no intubation (DNI). | Verify validity: is it signed, dated, matching patient? If in doubt, resuscitate. Discuss code status on admission. |
| 10 | **Advance Directive** | Legal document specifying healthcare wishes | Living will + Durable Power of Attorney for Healthcare. | Ask on admission. Copy to chart. Review periodically. Surrogate decision-maker if capacity is lost. |
| 11 | **HIPAA** | Health Insurance Portability and Accountability Act | Protects patient privacy and health information. | No discussing patients in public areas. No social media posts about patients. Minimum necessary standard. |
| 12 | **SBAR** | Situation, Background, Assessment, Recommendation | Structured communication tool for nurse-provider reports. | Write it out before calling. Be specific: 'I'm calling about Mrs. X in room Y. The situation is...' Know vitals and recent labs. |
| 13 | **Informed Refusal** | Patient's right to refuse treatment after being informed of risks | Document: what was offered, risks/benefits explained, patient's stated reason, that they understood. | Refusal is a patient right. Notify provider. Document thoroughly. Offer alternatives if available. |
| 14 | **q2h/q4h/q6h/q8h** | Every 2/4/6/8 hours | Medication and assessment frequencies. | q2h turns for immobile patients. q4h vitals for stable patients. q8h antibiotics. Set alarms to stay on schedule. |
| 15 | **Vital Signs** | Temperature, pulse, respiration, blood pressure, O2 saturation, pain | Normal adult: T 97.8-99.1°F, HR 60-100, RR 12-20, BP <120/80, SpO2 >94%. | Pain = '5th vital sign.' Trends matter more than single readings. Always correlate with patient presentation. |
| 16 | **Code Blue** | Cardiac or respiratory arrest — immediate resuscitation | Call for help, start CPR, bring crash cart/AED. | Know your role on the code team. Compressions, airway, medications, documentation. Resuscitation status should already be known. |
| 17 | **Rapid Response Team** | Team that responds to deteriorating patients BEFORE cardiac arrest | Call when: acute change in VS, decreased LOC, respiratory distress, staff concerned. | Early intervention prevents codes. 'I'm worried about this patient' is justification enough. Know your hospital's number. |
| 18 | **Admission Assessment** | Comprehensive evaluation when patient enters care | History, physical assessment, VS, allergies, medications, advance directives, fall risk, skin assessment. | Complete within 24 hours of admission. Baseline for all future comparisons. Document head-to-toe findings. |
| 19 | **Discharge Planning** | Preparation for patient to leave healthcare setting | Starts ON ADMISSION. Includes: medications, follow-ups, equipment, home care, education. | Teach-back: 'Tell me/show me what you'll do at home.' Med reconciliation at discharge. Follow-up within 7 days. |
| 20 | **Documentation** | Legal record of patient care — 'If it wasn't documented, it wasn't done' | Objective, timely, complete, accurate. No blank spaces. Late entry: mark as 'late entry.' | Defensive charting. No opinions ('patient is difficult') — use objective descriptions. Draw through error with single line, initial. |

### ✏️ Exercise A: Fill in the Definition
1. **I&O**: Intake and Output __________ fluid balance monitoring
2. **NPO**: Nil Per Os __________ Nothing By Mouth
3. **PRN**: Pro Re Nata __________ As Needed
4. **STAT**: Statim — __________
5. **QD/BID/TID/QID**: Once daily / twice daily / __________ times daily / four times daily
6. **ac/hs**: Before meals __________ At bedtime
7. **ADLs**: Activities of __________ Living
8. **AMA (Against Medical Advice)**: Patient leaves hospital __________ provider recommendation
9. **DNR/DNI**: Do Not Resuscitate __________ Do Not Intubate
10. **Advance Directive**: Legal document __________ healthcare wishes
11. **HIPAA**: Health Insurance Portability __________ Accountability Act
12. **SBAR**: Situation, Background, __________ Recommendation

### 🔗 Exercise B: Matching
| Term | Letter |
|------|--------|
| **I&O** | ___ |
| **NPO** | ___ |
| **PRN** | ___ |
| **STAT** | ___ |
| **QD/BID/TID/QID** | ___ |
| **ac/hs** | ___ |
| **ADLs** | ___ |
| **AMA (Against Medical Advice)** | ___ |
| **DNR/DNI** | ___ |
| **Advance Directive** | ___ |

| Letter | Definition |
|--------|------------|
| A | Activities of Daily Living |
| B | Nil Per Os — Nothing By Mouth |
| C | Statim — Immediately |
| D | Pro Re Nata — As Needed |
| E | Before meals / At bedtime |
| F | Intake and Output — fluid balance monitoring |
| G | Legal document specifying healthcare wishes |
| H | Once daily / twice daily / three times daily / four times daily |
| I | Do Not Resuscitate / Do Not Intubate |
| J | Patient leaves hospital against provider recommendation |

### 🚑 Exercise C: Clinical Prioritization Scenario
A patient scheduled for surgery at 0800 is found eating breakfast at 0630. The order says NPO after
midnight. Prioritize: What do you do? What communication is needed? What is the patient safety
concern?

### 📝 Exercise D: NCLEX-Style Questions
**1.** A nurse is caring for a patient receiving I&O. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) 1 mL = 1 cc...
   C) Once daily / twice daily / three times daily / four times daily
   D) Health Insurance Portability and Accountability Act

**2.** A nurse is caring for a patient receiving NPO. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) NPO after midnight for AM surgery standard...
   C) Temperature, pulse, respiration, blood pressure, O2 saturation, pain
   D) Activities of Daily Living

**3.** A nurse is caring for a patient receiving PRN. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Document reason for PRN administration and response...
   C) Cardiac or respiratory arrest — immediate resuscitation
   D) Intake and Output — fluid balance monitoring

**4.** A nurse is caring for a patient receiving STAT. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) STAT = drop everything...
   C) Legal document specifying healthcare wishes
   D) Comprehensive evaluation when patient enters care

**5.** A nurse is caring for a patient receiving QD/BID/TID/QID. Which finding requires immediate intervention?
   A) Expected patient outcome
   B) Don't confuse QD with QID...
   C) Activities of Daily Living
   D) Comprehensive evaluation when patient enters care

### ✓ Exercise E: Select All That Apply (SATA)
**1.** A patient is receiving I&O. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**2.** A patient is receiving NPO. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

**3.** A patient is receiving PRN. Which nursing interventions are appropriate? (Select all that apply.)
   ☐ Assess vital signs before administration
   ☐ Monitor for expected side effects
   ☐ Educate patient about purpose and adverse effects
   ☐ Document effectiveness after administration
   ☐ Delegate medication administration to UAP

---

## 📋 Answer Keys (with Rationales)

### Section 1: Pharmacology & Drug Classes

**Exercise A:**
1. **Beta Blocker (-lol)**: Blocks beta-adrenergic receptors, reducing heart rate, contractility, and blood pressure
2. **ACE Inhibitor (-pril)**: Inhibits angiotensin-converting enzyme, lowering BP by reducing angiotensin II
3. **Calcium Channel Blocker (-dipine)**: Blocks calcium entry into cardiac and smooth muscle cells, causing vasodilation
4. **Statin (-statin)**: HMG-CoA reductase inhibitor — lowers LDL cholesterol
5. **Anticoagulant**: Prevents blood clot formation through various mechanisms
6. **Warfarin (Coumadin)**: Vitamin K antagonist — oral anticoagulant
7. **Heparin**: Parenteral anticoagulant — activates antithrombin III
8. **Enoxaparin (Lovenox)**: Low molecular weight heparin — more predictable anticoagulation
9. **Insulin (Rapid-Acting)**: Lispro, Aspart, Glulisine — onset 15 min, peak 1 hr
10. **Metformin**: Biguanide — first-line oral agent for type 2 diabetes
11. **Opioid Analgesic**: Binds mu opioid receptors — pain relief, sedation, respiratory depression
12. **Benzodiazepine**: Enhances GABA — anxiolytic, sedative, anticonvulsant

**Exercise B:**
- Beta Blocker (-lol) → D
- ACE Inhibitor (-pril) → J
- Calcium Channel Blocker (-dipine) → F
- Statin (-statin) → H
- Anticoagulant → I
- Warfarin (Coumadin) → C
- Heparin → E
- Enoxaparin (Lovenox) → A
- Insulin (Rapid-Acting) → B
- Metformin → G

**Exercise D (NCLEX MC):** All answers are B — each describes a finding requiring immediate intervention based on the NCLEX tip.

**Exercise E (SATA):** Correct answers for each: ☐ Assess, ☐ Monitor, ☐ Educate, ☐ Document. ☐ Delegate to UAP is INCORRECT — medication administration and assessment cannot be delegated to UAP.

---

### Section 2: Lab Values & Diagnostics

**Exercise A:**
1. **CBC (Complete Blood Count)**: Panel measuring RBCs, WBCs, hemoglobin, hematocrit, platelets
2. **Hemoglobin (Hgb)**: Oxygen-carrying protein in RBCs — normal: M 13.5-17.5, F 12-16 g/dL
3. **WBC (White Blood Count)**: Measures immune cells — normal: 4,500-11,000/mcL
4. **Platelets**: Cell fragments essential for clotting — normal: 150,000-400,000/mcL
5. **BMP (Basic Metabolic Panel)**: Measures glucose, calcium, electrolytes, BUN, creatinine
6. **Sodium (Na+)**: Major extracellular cation — normal: 135-145 mEq/L
7. **Potassium (K+)**: Major intracellular cation — normal: 3.5-5.0 mEq/L
8. **Creatinine (Cr)**: Waste product of muscle metabolism — normal: 0.6-1.2 mg/dL
9. **BUN (Blood Urea Nitrogen)**: Waste product of protein metabolism — normal: 7-20 mg/dL
10. **ABG (Arterial Blood Gas)**: Measures oxygenation (PaO2), ventilation (PaCO2), acid-base (pH, HCO3)
11. **Troponin**: Cardiac biomarker — elevated with myocardial injury
12. **BNP (B-Type Natriuretic Peptide)**: Released when ventricles are stretched — marker for heart failure

**Exercise B:**
- CBC (Complete Blood Count) → I
- Hemoglobin (Hgb) → H
- WBC (White Blood Count) → G
- Platelets → C
- BMP (Basic Metabolic Panel) → A
- Sodium (Na+) → B
- Potassium (K+) → F
- Creatinine (Cr) → J
- BUN (Blood Urea Nitrogen) → D
- ABG (Arterial Blood Gas) → E

**Exercise D (NCLEX MC):** All answers are B — each describes a finding requiring immediate intervention based on the NCLEX tip.

**Exercise E (SATA):** Correct answers for each: ☐ Assess, ☐ Monitor, ☐ Educate, ☐ Document. ☐ Delegate to UAP is INCORRECT — medication administration and assessment cannot be delegated to UAP.

---

### Section 3: Cardiovascular & Respiratory

**Exercise A:**
1. **Myocardial Infarction (MI)**: Death of myocardial tissue from prolonged ischemia
2. **Congestive Heart Failure (CHF)**: Heart's inability to pump adequately → fluid backup
3. **Atrial Fibrillation (AFib)**: Chaotic atrial electrical activity — irregularly irregular rhythm
4. **Ventricular Fibrillation (VFib)**: Chaotic ventricular electrical activity — NO cardiac output
5. **Ventricular Tachycardia (VTach)**: Rapid ventricular rhythm >100 bpm
6. **PEA (Pulseless Electrical Activity)**: Organized electrical rhythm without mechanical contraction
7. **DVT (Deep Vein Thrombosis)**: Blood clot in deep veins — usually legs
8. **Pulmonary Embolism (PE)**: Blood clot that travels to pulmonary arteries
9. **COPD**: Chronic bronchitis + emphysema — irreversible airway obstruction
10. **ARDS (Acute Respiratory Distress Syndrome)**: Diffuse alveolar damage → severe hypoxemia
11. **Pneumonia**: Infection of lung parenchyma
12. **Pneumothorax**: Air in pleural space → lung collapse

**Exercise B:**
- Myocardial Infarction (MI) → A
- Congestive Heart Failure (CHF) → J
- Atrial Fibrillation (AFib) → C
- Ventricular Fibrillation (VFib) → B
- Ventricular Tachycardia (VTach) → F
- PEA (Pulseless Electrical Activity) → D
- DVT (Deep Vein Thrombosis) → G
- Pulmonary Embolism (PE) → I
- COPD → E
- ARDS (Acute Respiratory Distress Syndrome) → H

**Exercise D (NCLEX MC):** All answers are B — each describes a finding requiring immediate intervention based on the NCLEX tip.

**Exercise E (SATA):** Correct answers for each: ☐ Assess, ☐ Monitor, ☐ Educate, ☐ Document. ☐ Delegate to UAP is INCORRECT — medication administration and assessment cannot be delegated to UAP.

---

### Section 4: Neurological & Endocrine

**Exercise A:**
1. **Stroke/CVA**: Interrupted blood supply to brain — ischemic (87%) or hemorrhagic
2. **TIA (Transient Ischemic Attack)**: Temporary stroke symptoms resolving within 24 hours
3. **Seizure (Tonic-Clonic)**: Generalized seizure with stiffening then rhythmic jerking
4. **Status Epilepticus**: Continuous seizure >5 min or multiple without regaining consciousness
5. **Increased ICP**: Intracranial pressure >15 mmHg — life-threatening
6. **Cushing's Triad**: HTN + bradycardia + irregular respirations — late sign of increased ICP
7. **Type 1 Diabetes**: Autoimmune destruction of pancreatic beta cells — absolute insulin deficiency
8. **Type 2 Diabetes**: Insulin resistance + relative insulin deficiency
9. **DKA (Diabetic Ketoacidosis)**: Severe hyperglycemia + ketosis + metabolic acidosis (Type 1)
10. **HHS (Hyperosmolar Hyperglycemic State)**: Extreme hyperglycemia >600 + hyperosmolality WITHOUT ketosis (Type 2)
11. **Hypoglycemia**: Blood glucose <70 mg/dL
12. **Hypothyroidism**: Underactive thyroid — decreased T3/T4, elevated TSH

**Exercise B:**
- Stroke/CVA → B
- TIA (Transient Ischemic Attack) → D
- Seizure (Tonic-Clonic) → I
- Status Epilepticus → E
- Increased ICP → H
- Cushing's Triad → A
- Type 1 Diabetes → F
- Type 2 Diabetes → G
- DKA (Diabetic Ketoacidosis) → J
- HHS (Hyperosmolar Hyperglycemic State) → C

**Exercise D (NCLEX MC):** All answers are B — each describes a finding requiring immediate intervention based on the NCLEX tip.

**Exercise E (SATA):** Correct answers for each: ☐ Assess, ☐ Monitor, ☐ Educate, ☐ Document. ☐ Delegate to UAP is INCORRECT — medication administration and assessment cannot be delegated to UAP.

---

### Section 5: Maternal-Newborn & Pediatrics

**Exercise A:**
1. **Preeclampsia**: HTN >140/90 + proteinuria after 20 weeks gestation
2. **Eclampsia**: Preeclampsia + seizures
3. **Gestational Diabetes**: Glucose intolerance with onset during pregnancy
4. **APGAR Score**: Newborn assessment at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration
5. **Newborn Reflexes**: Innate reflexes that indicate neurologic integrity
6. **Developmental Milestones**: Age-appropriate skills — gross motor, fine motor, language, social
7. **RSV (Respiratory Syncytial Virus)**: Common cause of bronchiolitis in infants
8. **Croup (Laryngotracheobronchitis)**: Viral upper airway inflammation — 'barking cough, stridor'
9. **Kawasaki Disease**: Acute vasculitis of medium arteries — primarily <5 years
10. **Febrile Seizure**: Seizure triggered by rapid temperature rise — typically 6mo-5yr
11. **SIDS Prevention**: Sudden Infant Death Syndrome — safe sleep practices
12. **Postpartum Hemorrhage**: Blood loss >500mL vaginal or >1000mL C-section within 24hrs of delivery

**Exercise B:**
- Preeclampsia → D
- Eclampsia → A
- Gestational Diabetes → B
- APGAR Score → G
- Newborn Reflexes → J
- Developmental Milestones → H
- RSV (Respiratory Syncytial Virus) → I
- Croup (Laryngotracheobronchitis) → C
- Kawasaki Disease → E
- Febrile Seizure → F

**Exercise D (NCLEX MC):** All answers are B — each describes a finding requiring immediate intervention based on the NCLEX tip.

**Exercise E (SATA):** Correct answers for each: ☐ Assess, ☐ Monitor, ☐ Educate, ☐ Document. ☐ Delegate to UAP is INCORRECT — medication administration and assessment cannot be delegated to UAP.

---

### Section 6: Prioritization & Delegation

**Exercise A:**
1. **ABC Priority Framework**: Airway, Breathing, Circulation — establish priority
2. **Maslow's Hierarchy**: Prioritize physiological needs before psychosocial
3. **Acute vs Chronic**: Acute conditions take priority over chronic
4. **Stable vs Unstable**: Unstable patients always get priority
5. **RN Scope of Practice**: Registered Nurse — assessment, planning, evaluation
6. **LPN/LVN Scope**: Licensed Practical/Vocational Nurse — stable patients with predictable outcomes
7. **UAP (Unlicensed Assistive Personnel)**: Nursing assistant — ADLs, vital signs (stable), I&O, ambulation
8. **5 Rights of Delegation**: Right: Task, Circumstance, Person, Direction/Communication, Supervision
9. **5 Rights of Medication Administration**: Right: Patient, Drug, Dose, Route, Time
10. **Disaster Triage**: Mass casualty sorting: Red (immediate), Yellow (delayed), Green (minimal), Black (expectant)
11. **Nursing Process (ADPIE)**: Assessment → Diagnosis → Planning → Implementation → Evaluation
12. **SBAR Communication**: Situation, Background, Assessment, Recommendation — standardized handoff

**Exercise B:**
- ABC Priority Framework → H
- Maslow's Hierarchy → J
- Acute vs Chronic → B
- Stable vs Unstable → A
- RN Scope of Practice → G
- LPN/LVN Scope → I
- UAP (Unlicensed Assistive Personnel) → F
- 5 Rights of Delegation → C
- 5 Rights of Medication Administration → D
- Disaster Triage → E

**Exercise D (NCLEX MC):** All answers are B — each describes a finding requiring immediate intervention based on the NCLEX tip.

**Exercise E (SATA):** Correct answers for each: ☐ Assess, ☐ Monitor, ☐ Educate, ☐ Document. ☐ Delegate to UAP is INCORRECT — medication administration and assessment cannot be delegated to UAP.

---

### Section 7: Safety & Infection Control

**Exercise A:**
1. **Standard Precautions**: Applied to ALL patients regardless of diagnosis
2. **Contact Precautions**: For organisms spread by direct/indirect contact — MRSA, VRE, C. diff
3. **Droplet Precautions**: For organisms in large respiratory droplets (<3 feet) — influenza, pertussis, meningitis
4. **Airborne Precautions**: For organisms that hang in air — TB, measles (rubeola), varicella (chickenpox), disseminated zoster
5. **PPE Donning Order**: Sequence for putting on personal protective equipment
6. **PPE Doffing Order**: Sequence for removing PPE — most contaminated first
7. **Hand Hygiene**: #1 way to prevent healthcare-associated infections
8. **CLABSI Prevention**: Central Line-Associated Bloodstream Infection prevention bundle
9. **CAUTI Prevention**: Catheter-Associated UTI prevention bundle
10. **Fall Risk Interventions**: Prevent patient falls — Morse Scale for risk assessment
11. **Seizure Precautions**: Padding side rails, suction at bedside, O2 available
12. **Suicide Precautions**: 1:1 observation, remove harmful objects, document q15min checks

**Exercise B:**
- Standard Precautions → J
- Contact Precautions → H
- Droplet Precautions → F
- Airborne Precautions → I
- PPE Donning Order → A
- PPE Doffing Order → B
- Hand Hygiene → E
- CLABSI Prevention → D
- CAUTI Prevention → C
- Fall Risk Interventions → G

**Exercise D (NCLEX MC):** All answers are B — each describes a finding requiring immediate intervention based on the NCLEX tip.

**Exercise E (SATA):** Correct answers for each: ☐ Assess, ☐ Monitor, ☐ Educate, ☐ Document. ☐ Delegate to UAP is INCORRECT — medication administration and assessment cannot be delegated to UAP.

---

### Section 8: Fundamentals & Abbreviations

**Exercise A:**
1. **I&O**: Intake and Output — fluid balance monitoring
2. **NPO**: Nil Per Os — Nothing By Mouth
3. **PRN**: Pro Re Nata — As Needed
4. **STAT**: Statim — Immediately
5. **QD/BID/TID/QID**: Once daily / twice daily / three times daily / four times daily
6. **ac/hs**: Before meals / At bedtime
7. **ADLs**: Activities of Daily Living
8. **AMA (Against Medical Advice)**: Patient leaves hospital against provider recommendation
9. **DNR/DNI**: Do Not Resuscitate / Do Not Intubate
10. **Advance Directive**: Legal document specifying healthcare wishes
11. **HIPAA**: Health Insurance Portability and Accountability Act
12. **SBAR**: Situation, Background, Assessment, Recommendation

**Exercise B:**
- I&O → C
- NPO → B
- PRN → H
- STAT → J
- QD/BID/TID/QID → F
- ac/hs → G
- ADLs → E
- AMA (Against Medical Advice) → A
- DNR/DNI → I
- Advance Directive → D

**Exercise D (NCLEX MC):** All answers are B — each describes a finding requiring immediate intervention based on the NCLEX tip.

**Exercise E (SATA):** Correct answers for each: ☐ Assess, ☐ Monitor, ☐ Educate, ☐ Document. ☐ Delegate to UAP is INCORRECT — medication administration and assessment cannot be delegated to UAP.

---

## 🎯 BONUS: NCLEX Cram Sheet (50 High-Yield Terms)

| **Beta Blockers** | -lol, check HR, hold if <60 |
| **ACE Inhibitors** | -pril, dry cough, check K+ |
| **Statins** | -statin, muscle pain, check CK |
| **Warfarin** | PT/INR 2-3, Vitamin K antidote |
| **Heparin** | aPTT, protamine antidote |
| **Insulin Lispro** | Give 15min before meal, only reg IV |
| **Metformin** | Hold 48hrs before/after contrast |
| **Furosemide** | Lasix, watch K+, daily weights |
| **Digoxin** | Check apical pulse, 0.5-2.0 range |
| **Naloxone** | Opioid reversal, short half-life |
| **ABGs** | ROME: pH/PaCO2 opposite=respiratory |
| **Troponin** | MI marker, trend over 3-6hrs |
| **BNP** | CHF marker, >400 = likely HF |
| **CBC** | WBC infection, Hgb anemia, Plt bleeding |
| **Potassium** | K+ 3.5-5.0, ECG changes |
| **Sodium** | Na+ 135-145, correct SLOWLY |
| **Creatinine** | Kidney function, contrast risk |
| **AFib** | Irregularly irregular, stroke risk |
| **VFib/VTach** | Shockable rhythms, CPR+defib |
| **CHF** | Left=lungs, Right=rest of body |
| **DVT/PE** | Virchow's triad, unilateral swelling |
| **Stroke** | BEFAST, tPA within 3-4.5hrs |
| **Seizure** | Side-lying, time it, protect airway |
| **DKA vs HHS** | DKA=Type1+ketones, HHS=Type2+no ketones |
| **Hypoglycemia** | <70, Rule of 15 |
| **APGAR** | 1+5min, 7-10 reassuring |
| **Preeclampsia** | HTN+proteinuria, mag sulfate |
| **SIDS** | Back to sleep, firm mattress |
| **PPH** | Boggy uterus, massage fundus |
| **ABC Priority** | Airway → Breathing → Circulation |
| **Maslow** | Physiologic before psychosocial |
| **ADPIE** | Assessment ALWAYS comes first |
| **Delegation** | RN=assess/eval, LPN=stable pts, UAP=ADLs |
| **Standard Precautions** | ALL patients, hand hygiene #1 |
| **Contact** | C. diff = soap+water, not gel |
| **Droplet** | Surgical mask, 'SPIDERMAN' mnemoic |
| **Airborne** | N95, negative pressure, 'MTV' |
| **CLABSI/CAUTI** | Prevention bundles, daily review |
| **Seizure Precautions** | Pad rails, suction at bedside |
| **Suicide Precautions** | 1:1, remove harmful objects |
| **Restraints** | Provider order, q15min/q2h checks |
| **Never Events** | Wrong-site, retained object, falls |
| **Sentinel Event** | RCA within 45 days |
| **Fire Safety** | RACE+PASS |
| **NPO** | Nothing by mouth, aspiration risk |
| **PRN** | As needed, document response |
| **STAT** | Immediately |
| **HIPAA** | Patient privacy |
| **SBAR** | Structured communication |
| **Documentation** | If not documented, not done |

## 🧩 BONUS: Nursing Prefix/Suffix Guide

| **hypo-** | low | hypotension |
| **hyper-** | high | hypertension |
| **brady-** | slow | bradycardia |
| **tachy-** | fast | tachycardia |
| **-itis** | inflammation | bronchitis |
| **-ectomy** | removal | appendectomy |
| **-ostomy** | opening | colostomy |
| **-otomy** | cut into | tracheotomy |
| **-ology** | study of | cardiology |
| **-pathy** | disease | cardiomyopathy |
| **-emia** | blood | anemia |
| **-uria** | urine | hematuria |
| **-plegia** | paralysis | quadriplegia |
| **dys-** | difficult | dyspnea |
| **poly-** | many | polyuria |
| **oligo-** | few | oliguria |
| **a-/an-** | without | apnea |
| **intra-** | within | intravenous |
| **sub-** | under | sublingual |
| **pre-** | before | prenatal |
| **post-** | after | postpartum |
| **neo-** | new | neonatal |
| **hemo-** | blood | hemorrhage |
| **cardio-** | heart | cardiomegaly |
| **neuro-** | nerve | neurological |
| **pulmo-** | lung | pulmonary |
| **gastro-** | stomach | gastritis |
| **hepato-** | liver | hepatitis |
| **osteo-** | bone | osteoporosis |
| **nephro-** | kidney | nephrology |

---
**© TemplateForge** | Part of the Nursing & Healthcare Education Collection