Adult Nursing
40%of exam
Maternal-Child Nursing
30%of exam
Nursing Fundamentals
20%of exam
Management + Leadership
10%of exam
PrioritizationDelegationEthicsPatient SafetyScope
Quick Facts
- Exam
- SNLE
- Credential
- Saudi nursing license
- Items
- 200 MCQ
- Time
- 120 min x 2
- Pass
- Scaled 500/800
- Format
- Prometric CBT
- Body
- SCFHS
- Parts
- 100 + 100
MI Initial Meds
Morphine O2 Nitro Aspirin
Morphine: pain anxietyO2: if hypoxicNitro: coronary dilationAspirin: antiplatelet chew
Left vs Right HF
Left HF
- Pulmonary congestion
- Crackles dyspnea
- Orthopnea
Right HF
- Systemic congestion
- JVD edema
- Hepatomegaly
Lungs vs periphery
Cardiac
- MI pain
- Nitro first if BP OK
- Left HF
- Crackles pulmonary edema
- Right HF
- JVD peripheral edema
- A-fib
- Irregular no P waves
- V-fib
- Defibrillate immediately
- Cardiogenic shock
- Low CO high PAWP
- MONA
- Morphine O2 Nitro Aspirin
- Troponin
- MI biomarker rises
DKA vs HHS
DKA
- Type 1 common
- Ketones present
- Moderate glucose
HHS
- Type 2 common
- No ketones
- Very high glucose
Ketones vs extreme sugar
Respiratory
- COPD
- Low O2 retain CO2
- Asthma
- Bronchospasm wheezing
- PE
- Sudden dyspnea pain
- Pneumonia
- Fever crackles infiltrate
- ARDS
- Bilateral infiltrates hypoxia
- ABG resp acid
- High CO2 low pH
- Peak flow
- Asthma severity tool
- Incentive spirometer
- Prevent atelectasis
Endocrine + Shock
- DKA
- High glucose ketones
- HHS
- Very high glucose
- Hypoglycemia
- Give fast glucose
- Hypovolemic shock
- Low preload high SVR
- Septic shock
- Low SVR warm skin
- Anaphylaxis
- Epinephrine IM first
- Insulin
- Only hormone lowers glucose
- Glucagon
- Severe hypoglycemia rescue
Apgar Score
Appearance Pulse Grimace Activity Respiration
A: skin colorP: heart rateG: reflex irritabilityA: muscle toneR: resp effort
Previa vs Abruptio
Placenta previa
- Painless bleeding
- Soft uterus
- Placenta low
Abruptio
- Painful bleeding
- Rigid uterus
- Placenta separates
Painless vs painful
Antepartum
- FHR baseline
- 110-160 bpm normal
- Late decel
- Uteroplacental insufficiency
- Variable decel
- Cord compression
- Preeclampsia
- HTN proteinuria 20wk+
- Eclampsia
- Seizures with preeclampsia
- Placenta previa
- Painless bleeding
- Abruptio
- Painful rigid uterus
- GDM screen
- 24-28 week glucose
Late vs Variable Decel
Late decel
- After contraction
- Uteroplacental
- O2 left side
Variable decel
- Abrupt V shape
- Cord compression
- Reposition mom
Placenta vs cord
Labor + Postpartum
- Active labor
- 6 cm dilation
- Effacement
- Cervix thinning percent
- PP hemorrhage
- Over 500 mL loss
- Uterine atony
- Soft boggy uterus
- Oxytocin
- Firm uterus postpartum
- Mastitis
- Breast redness fever
- Lochia rubra
- Red days 1-3
- Rh negative
- RhoGAM if baby Rh+
Pediatric + Neonatal
- Apgar
- 1 and 5 min score
- Croup
- Barking seal cough
- Epiglottitis
- Drooling tripod position
- RSV
- Wheezing in infant
- Dehydration
- Sunken fontanelle
- Febrile seizure
- Brief with fever
- Hirschsprung
- No meconium 48hr
- PKU screen
- Newborn heel stick
Isolation Types
Standard Contact Droplet Airborne
Standard: all patientsContact: gown glovesDroplet: surgical maskAirborne: N95 room
Contact vs Airborne
Contact
- Gown gloves
- MRSA C diff
- Touch spread
Airborne
- N95 mask
- TB measles
- Negative pressure
Touch vs inhalation
Med Picker
- Ischemic chest pain→Nitroglycerin SL(If BP OK)
- Heparin bleeding→Protamine sulfate(Antidote)
- Warfarin bleeding→Vitamin K(Slow reversal)
- Opioid respiratory→Naloxone(Rapid reversal)
- Anaphylaxis→Epinephrine IM(First line)
- Hypoglycemia awake→Oral glucose(Fast sugar)
- DKA acidosis→IV insulin fluids(Close K+)
- Digoxin toxicity→Digibind(Fab antidote)
Pharmacology
- Heparin antidote
- Protamine sulfate
- Warfarin antidote
- Vitamin K
- Digoxin toxicity
- Digibind antidote
- Opioid overdose
- Naloxone reversal
- Five rights
- Right drug dose route
- Peak/trough
- Therapeutic drug level
- Enteric coated
- Do not crush
- Sublingual
- Under tongue fast
Infection + Safety
- Standard precautions
- All patients all times
- Contact isolation
- Gown gloves room
- Droplet isolation
- Mask within 3ft
- Airborne isolation
- N95 negative pressure
- Hand hygiene
- Before after patient
- Sterile field
- 1 inch border rule
- Fall risk
- Bed low call bell
- Restraints
- Least restrictive option
Primary Survey
Airway Breathing Circulation Disability Exposure
A: patent airwayB: ventilate oxygenateC: perfusion bleedingD: neuro statusE: full exam
Delegate vs Assign
Delegate
- UAP stable tasks
- RN retains accountability
- Within scope
Assign
- RN to RN tasks
- Shared responsibility
- Complex care
UAP vs RN work
Priority Picker
- Airway blocked→Open airway(ABCs)
- Chest pain MI→Nitro O2 ECG(Cardiac)
- Active bleeding→Direct pressure(Circulation)
- Anaphylaxis→Epinephrine IM(Immediate)
- Altered glucose→Check BS first(Neuro sign)
- Post-op fever→Assess wound(Infection)
- FHR late decel→Left side O2(Fetal distress)
- Multiple stable→Delegate UAP(Leadership)
Leadership + Priority
- ABCs first
- Airway breathing circulation
- Maslow acute
- Physiologic before psychosocial
- Unstable first
- Assess before stable
- Delegate UAP
- Routine stable tasks
- RN only
- Assessment teaching IV
- Informed consent
- Competent voluntary info
- Advocacy
- Speak for patient
- Incident report
- Document facts not blame
Common Traps
Left vs right HF
Left = lungs crackles ≠ Right = JVD edema
DKA vs HHS
DKA has ketones ≠ HHS extreme glucose
Heparin vs warfarin
Protamine reverses heparin ≠ Vitamin K warfarin
Previa vs abruptio
Previa painless ≠ Abruptio painful rigid
Delegate vs teach
UAP routine care ≠ RN assessment teaching
Late vs variable
Late = placenta ≠ Variable = cord
Last Minute
- 1.Weights: 40 / 30 / 20 / 10
- 2.Adult = largest domain
- 3.Pass = scaled 500/800
- 4.200 Q two 100-part sessions
- 5.ABCs before psychosocial
- 6.Left HF = crackles
- 7.DKA = ketones insulin
- 8.Heparin OD = protamine
- 9.Late decel = left side O2
- 10.Anaphylaxis = epi IM first
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